Term
|
Definition
| NT located @ ganglions and the parasympathetic terminal nerve endings |
|
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Term
|
Definition
| Parasympathomimetics; mimic acetylcholine. a.k.a. cholinomimetics, cholinergic stimulants, cholinergic agonists |
|
|
Term
| What are the 2 types of cholinergic receptors? |
|
Definition
Muscarinic and nicotinic
Muscarinic-stimilate smooth MMMMuscle & slow the heart rate
Nicotinic (NNNNeuromscular)- affect the skeletal muscle |
|
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Term
| Direct-acting versus indirect acting cholinergic agonists |
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Definition
| act on receptors to activate a tissue response, but indirect inhibit the action of the enzyme cholinesterase (CHe)by forming a complex thus permitting ACh to persist and attach to the receptor |
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Term
|
Definition
Drugs that inhibit cholinesterase. Can be reversible or irreversible
a.k.a. Cholinesterase inhibitors, ACHe inhibitors |
|
|
Term
| Parasympathetic responses |
|
Definition
| pupil constriction (miosis), constriction of bronchioles/increase lung secretions, decreased HR, blood vessel dilation, increased peristalsis and GI secretions, contraction of bladder, increased salivation |
|
|
Term
| Major actions of cholinergic agonists |
|
Definition
| stimulate bladder and GI tone, constrict pupils, increase neuromuscular transmission |
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Term
| The nurse is reviewing the history of a client who has been prescribed tolterodine tartrate (Detrol, Detrol LA) for treatment of incontinence. The nurse plans to contact the health care provider if the client has: |
|
Definition
narrow-angle glaucoma.
Tolterodine tartrate is an antimuscarinic and anticholinergic agent. It is contraindicated in clients with narrow-angle glaucoma. |
|
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Term
| A client is receiving bethanechol chloride (Urecholine) as part of his treatment regimen. He is experiencing swallowing difficulties. The highest priority action on the part of the nurse is to contact the physician to administer the drug by _____ injection. |
|
Definition
subcutaneous
Bethanechol may be given orally or subcutaneously. |
|
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Term
| The client that would be a poor candidate for treatment with bethanechol chloride (Urecholine) is the client who is experiencing: |
|
Definition
severe bradycardia and hypotension.
Side effects of this medication are decreasing the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension. |
|
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Term
| Reversible cholinesterase inhibitors can be an effective treatment for glaucoma because of which action of the drug? |
|
Definition
It produces pupillary constriction.
With constriction, the outflow of aqueous humor is facilitated, decreasing intraocular pressure. |
|
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Term
| The client has myasthenia gravis. The highest priority client teaching is: |
|
Definition
nstructing the client to take the drug on a strict schedule to avoid respiratory
muscle weakness.
Even small gaps in time may cause respiratory muscle weakness; therefore the time schedule is strict. |
|
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Term
| The client has been diagnosed with early-stage Alzheimer’s dementia. What cholinesterase inhibitor is most likely to be ordered for this client? |
|
Definition
Donepezil (Aricept)
This is the medication commonly given for Alzheimer’s dementia and is thought to improve memory. |
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Term
| A nurse is teaching a client about bethanechol hydrochloride (Urecholine). The nurse informs the client that this drug warrants which precaution? |
|
Definition
Rising slowly from lying positions
This medication may lead to orthostatic hypotension and warrants careful position changes. Although bradycardia is a risk, it is not important to count pulse rate frequently. |
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|
Term
| The client who is being treated with an anticholinergic medication should receive which instruction? |
|
Definition
Suggest hard candy, chewing gum, and oral hygiene for dry mouth.
Dry mouth is a common side effect of the anticholinergics. |
|
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Term
| The client that would be a poor candidate for treatment with an atropine-like drug is the client who has: |
|
Definition
glaucoma.
Atropine may cause pupillary dilation, which increases intraocular pressure. |
|
|
Term
| Which response can the nurse expect to see in the client who has parkinsonism and is being treated with anticholinergics? |
|
Definition
Decreased tremors and rigidity
This is the use for parkinsonism, a disease whose symptoms include tremors, bradykinesia, rigidity, and drooling. |
|
|
Term
|
Definition
Direct-acting cholinergic used to treat urinary retention, abdominal distention. Stimulates muscarinic receptor. Adverse rxns- hypotension, bradycardia .
Poorly absorbed from GI tract; excreted in urine.
Client will void 30 min-1.5 hours after taking orally; 15 minutes after taking subQ |
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|
Term
| Muscarinic agonists should be used cautiously in ____ and are contraindicated in pts with _____ |
|
Definition
Cautious- Low BP and low HR
Contraindicated- intestinal or urinary tract obstruction, severe bradycardia, active asthma (can cause attacks) |
|
|
Term
| What lab values increase when a patient is on cholinergic agonists? |
|
Definition
| Serum amylase, lipase, aspartate aminotransferase, bilirubin |
|
|
Term
| What is the primary use of cholinesterase inhibitors? What are some other uses? |
|
Definition
Primary- myasthenia gravis (bc increases force of muscular contraction)
Other- glaucoma, Alzheimers, muscarinic antagonist poisoning |
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|
Term
| The nurse teaches the client receiving atropine to expect which side effect? |
|
Definition
|
|
Term
| A client is receiving bethanecol (Urecholine). The nurse realizes that the action of this drug is to treat |
|
Definition
|
|
Term
| When benzetropine (Cogentin) is ordered for a client, the nurse acknowledges that this drug is an effective treatment for which condition? |
|
Definition
|
|
Term
| Dicyclomine (Bentyl) is an anticholinergic, which the nurse realizes is given to treat which condition? |
|
Definition
| IBS (irritable bowel syndrome) |
|
|
Term
| The nurse realizes that cholinergic agonists mimic which parasympathetic NT? |
|
Definition
|
|
Term
| When the client has a cholinergic overdose, the nurse anticipates administration of which drug as the antidote? |
|
Definition
|
|
Term
| What are cautions and contraindications for REVERSIBLE cholinesterase INHIBITORS? |
|
Definition
Caution- bradycardia, asthma, peptic ulcers, hyperthyroidism
Contra- intestinal and urinary obstruction
p 275 |
|
|
Term
| Uses of reversible cholinesterase inhibitors |
|
Definition
-pupillary constriction for glaucoma pts
-increase muscle strength in pts with myasthenia gravis |
|
|
Term
| Uses of IRreversible cholinesterase inhibitors |
|
Definition
potent agents bc of long-lasting effect.
-pupillary constriciton
-manufacturing of organophosphate insecticides |
|
|
Term
| Anticholinergics/Parasympatholytics |
|
Definition
Inhibit action of ACh by occupying ACh receptors
a.k.a. cholinergic blocking agents; decrease GI motility and salivation, decrease bladder contraction, dilate pupils (MYDRIASIS), increase pulse
Example- Atropine sulfate |
|
|
Term
| A client with nausea and vomiting has been prescribed an antihistamine and an anticholinergic. The nurse anticipates that which expected side effect of these medications will be observed in the client? |
|
Definition
Drowsiness and dry mouth
These are common side effects associated with these medications. |
|
|
Term
| The nurse notes that a client with glaucoma has been ordered an anticholinergic medication. What is the highest priority action on the part of the nurse? |
|
Definition
Call the physician; this is an inappropriate drug for this client.
With pupillary dilation, the outflow of aqueous humor is hampered, increasing the intraocular pressure. |
|
|
Term
| A client is ordered bethanechol chloride (Urecholine) for urinary retention. A nurse is adding up the client’s intake and output for the 8-hour shift. The client’s I = 850 mL, O = 350 mL. What should the nurse do? |
|
Definition
Palpate the client’s bladder.
The client’s output is adequate but does not match the intake. The nurse should assess for bladder distention and retention. |
|
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Term
| client experiences bradycardia as a result of vagal stimulation. What will the nurse expect to administer? |
|
Definition
Atropine sulfate (atropine)
Atropine is given to increase heart rate in patients with vagally stimulated bradycardia. |
|
|
Term
| The client has been started on Detrol LA. She is also being treated with a tricyclic antidepressant. What effect should the nurse anticipate from the interaction of the medications? |
|
Definition
Increased action of the Detrol LA
The combination of Detrol LA and a tricyclic antidepressant can result in an increase in the action of the Detrol LA. |
|
|
Term
|
Definition
Classic anticholinergic used for
-preoperatively to decrease salivary secretion
-antispasmodic to treat peptic ulcers
-increase HR when bradycardia is present
-Effect is increased when taken w/tricyclic AD, antihistimines
-ADRs- hypotension, tachycardia
_longterm use causes dry mouth, decreased urination, constipation
-Should urinate BEFORE taking
-Crosses blood-brain barrier and the placenta
-Excreted through urine |
|
|
Term
| The client has been started on Detrol LA and tells the nurse that he is experiencing constipation. What is the highest priority action on the part of the nurse? |
|
Definition
Notify the physician; this is a side effect of the medication.
A side effect of Detrol LA can be constipation. |
|
|
Term
| The client has been started on Artane. The nurse notes that the client’s bowel sounds are decreasing. What is the highest priority action on the part of the nurse? |
|
Definition
Hold the drug; this is a life-threatening response.
A decrease in bowel sounds could signal the beginning of paralytic ileus. |
|
|
Term
| The nurse notes that Artane has been ordered as a preoperative medication for the client. What is the highest priority action on the part of the nurse? |
|
Definition
Call the physician to question the order; this is not a usual preoperation
medication.
Atropine is typically given as part of a preoperative regimen, but not Artane. |
|
|
Term
| he client is being treated with a large dose of an anticholinergic medication. She complains of feeling disoriented. What should be the nurse’s highest priority action based on the client’s complaint? |
|
Definition
Call the physician; the medication is causing an expected side effect.
n expected side effect of giving large doses of an anticholinergic medication is that of disorientation. |
|
|
Term
| A client’s serum cholesterol level is 268 mg/dl. Lovastatin (Mevacor) is prescribed. A positive outcome of treatment with the medication is ________ of cholesterol. |
|
Definition
inhibition of hepatic synthesis
Lovastatin (Mevacor) should result in inhibition of the hepatic synthesis of cholesterol. |
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|
Term
| The level of risk for coronary artery disease for a client with a serum cholesterol level of 270 mg/dl is _____ risk. |
|
Definition
high
A value of 270 for serum cholesterol puts the client at high risk. |
|
|
Term
The nurse assesses a client for side effects of lovastatin (Mevacor). Which symptom would be least likely to be associated with Mevacor?
a. Headache
b. Tachycardia
c. Gastrointestinal (GI) disturbances
d. Dizziness |
|
Definition
Tachycardia
Tachycardia is not an associated side effect of lovastatin. Headache, GI disturbance, and dizziness are associated with this medication. |
|
|
Term
| Which laboratory test would be highest priority for the nurse to monitor while a client receives treatment with the statin medications? |
|
Definition
Liver enzymes
The statin medications are hepatotoxic. |
|
|
Term
| Which symptom would be highest priority for the nurse to monitor while the client is being treated with peripheral vasodilators? |
|
Definition
Dizziness
Peripheral vasodilators cause a decrease in blood pressure, which can cause dizziness. |
|
|
Term
| A client is receiving atorvastatin (Lipitor) for high blood cholesterol level. Which sign warrants the client’s immediate contacting of the healthcare provider? |
|
Definition
Muscle tenderness
Muscle tenderness may be an early sign of a serious condition known as rhabdomyolysis that affects some users of Lipitor. |
|
|
Term
| A nurse is teaching a client about the treatment of hyperlipidemia and use of statin drugs. What do the instructions include? |
|
Definition
“Annual eye examinations are recommended.”
The use of statins may lead to cataracts; therefore, regular eye examinations are ordered. |
|
|
Term
| A nurse is monitoring a client after the client has received pentoxifylline (Trental) for treatment of intermittent claudication. Which effect indicates a positive response to the medication? |
|
Definition
Decrease in pain
Pentoxifylline is a hemorrheologic agent that improves microcirculation and tissue perfusion. It is has been approved by the U.S. Food and Drug Administration for clients with intermittent claudication. A decrease in pain is a positive response. |
|
|
Term
| A client is to receive simvastatin (Zocor) to reduce serum cholesterol levels. The nurse recommends to the client that the best time to take this medication is: |
|
Definition
in the evening.
Most cholesterol is manufactured at night, so taking simvastatin (Zocor) at night is most effective. |
|
|
Term
| A client diagnosed with hyperlipidemia has been prescribed cholestyramine (Questran). Which of the following instructions will the nurse include in the client’s teaching plan? |
|
Definition
Mix powder well with fluid.
Cholestyramine should be mixed well in fluid for proper absorption. Fluids and a high-fiber diet should be encouraged as this drug may cause constipation. Cholestyramine may cause GI upset and can be taken with food. |
|
|
Term
| The client is being treated with Atorvastatin (Lipitor). He tells the nurse that he has been self-medicating at home with antacids. The nurse anticipates that the interaction of the two drugs will produce a(n) _____ effect from the _____. |
|
Definition
decreased; Atorvastatin (Lipitor)
The interaction of Atorvastatin and antacids will produce a decreased effect from the Atorvastatin. |
|
|
Term
| Antiparkinson anticholinergics |
|
Definition
Trihexyphenidyl (Artane) (p. 280).
Benxtropine (Cogentin)
Blocks muscarinic receptors to decrease involuntary movements Developed bc regular antiCh do not improve mobility and muscle weakness. ADR- tachycardia, palpitations, ortho hypotension, urinary retention CAN CAUSE PARALYTIC ILEUS (life-threatening) |
|
|
Term
Detrol (tolterodine tartrate)
p 280 |
|
Definition
Decreases urinary frequency, urgency, and incontinence. Blocks cholinergic/muscarinic receptors selectively in urinary bladder
ADRs-Bronchitis, visual abnormalities, chest pain, HTN
Increased effects with tricyclic AD, H1 blockers
Decreased effect with antifungals and some antibiotics |
|
|
Term
| Scopolamine is an anticholinergic that is also used as a __________ |
|
Definition
| antihistamine for motion sickness . Skin patch placed behind the ear, delivered over 3 days |
|
|
Term
| The client is being treated with ergoloid mesylates (Hydergine). The nurse determines that the medication is producing a positive outcome for the client when the client is noted to be exhibiting a(n): |
|
Definition
improvement in mood.
Treatment with ergoloid mesylates (Hydergine) should improve cognitive skills, self-care, and mood. GI distress and orthostatic hypotension are side effects of the drug. |
|
|
Term
| The client is taking fenofibrate (Tricor). The highest priority nursing intervention with this medication is to monitor serum: |
|
Definition
creatinine.
Treatment with this medication can produce changes in the client’s serum creatinine level. |
|
|
Term
| The client is scheduled to begin treatment with Isoxsuprine. In preparing the teaching plan for the client, the nurse anticipates that the client will be taking the drug _____ daily. |
|
Definition
3 to 4 times
Because of its half-life, Isoxsuprine should be given 3 to 4 times daily. |
|
|
Term
| The client is planning a lengthy trip by automobile. She plans to leave her home at 8:00 AM. When should she plan to take her dimenhydrinate (Dramamine) to prevent motion sickness? |
|
Definition
7:30 AM
Motion sickness medication has its onset in 30 minutes. |
|
|
Term
| The client has been prescribed an antihistamine anticholinergic medication. The nurse anticipates that the client will need a teaching plan regarding management of: |
|
Definition
drowsiness and dry mouth.
Antihistamine anticholinergics typically cause drowsiness and dry mouth. |
|
|
Term
|
Definition
| Large particles that transport fatty acids and cholesterol to the liver; composed mostly of triglycerides |
|
|
Term
|
Definition
HDL=good. Smallest, most dense-more protein, less fat
LDL=bad. contain 50-60% of the cholesterol in the blood. increase risk of atherosclerotic plaque and heart disease
VLDL=Carries mostly triglycerides and less cholesterol |
|
|
Term
| A client has been ordered a phenothiazine medication as part of his treatment regimen for a psychiatric disorder. Because he is taking the medication for this purpose, the nurse will prepare a dosage of medication that is: |
|
Definition
larger than the dose he would take for vomiting.
The client will usually take a dose of the medication that is larger when it is prescribed for treatment of a psychiatric disorder. |
|
|
Term
| A school nurse is preparing to administer syrup of ipecac after an ingestion of a noncaustic substance. The label instructs the nurse that the ipecac should be mixed in a glass of: |
|
Definition
water.
Dilution with water allows for more ready administration of the ipecac. |
|
|
Term
| A nurse is teaching caregivers about syrup of ipecac. Caregiver teaching includes the need to observe for vomiting in response to the ipecac within _____ minutes. |
|
Definition
15 to 30
Onset of emesis after ingestion of Ipecac is 15 to 30 minutes. |
|
|
Term
| Which child would not be a candidate for treatment with syrup of ipecac? |
|
Definition
2-year-old who has swallowed chlorine bleach
Bleach is a caustic substance and should not be reintroduced to the esophagus during emesis. |
|
|
Term
| A client has had diarrhea for 36 hours. The healthcare provider orders diphenoxylate with atropine (Lomotil). The nurse should contact the physician if the client has a history of: |
|
Definition
glaucoma.
The atropine would cause dilation of the pupils, which would further increase the intraocular pressure of glaucoma. |
|
|
Term
| What is the highest priority health teaching for a client who has taken an antidiarrheal medication? |
|
Definition
Instruct the client to avoid taking sedatives or tranquilizers with the antidiarrheal.
Many of the antidiarrheals cause sedation and therefore require monitoring. |
|
|
Term
| Clients who are traveling abroad will ask how to avoid “traveler’s diarrhea.” What suggestion should be offered? |
|
Definition
Pack bottled water and plan to drink only that during the trip.
Bacteria is filtered and removed out of bottled water. |
|
|
Term
| The nurse is concerned about the client’s loss of fluids and electrolytes because of diarrhea. The best dietary recommendation that the nurse can give is for the client’s diet to include which foods or drinks? |
|
Definition
Gatorade or Pedialyte
These drinks provide needed electrolytes along with the needed fluid. |
|
|
Term
| The client has been started on a treatment regimen that includes psyllium. The most important instruction that the nurse can give the client regarding preparation of the dose is to mix the dosage in _____ ounces of water and follow it with _____ ounces of water. |
|
Definition
8; 8
The dosage of psyllium consists of 1 to 2 teaspoons in 8 ounces of water, and it should be followed with 8 ounces of water. |
|
|
Term
| The client has been started on a regimen that includes bisacodyl. The nurse notes that she has developed hypokalemia. The highest priority nursing intervention is to call the physician because this is _____ the medication. |
|
Definition
an adverse reaction to
Hypokalemia is considered an adverse reaction to bisacodyl. |
|
|
Term
| The client has been ordered to be treated with Lomotil. He is also being treated with an MAO inhibitor drug. Because of this combination of medications, the nurse must be vigilant in monitoring: |
|
Definition
blood pressure.
The combination of Lomotil and an MAO inhibitor drug can enhance the possibility of a hypertensive crisis. |
|
|
Term
| The client has been ordered to be treated with Lomotil. She tells the nurse that she takes antihistamines for treatment of seasonal allergies. The best response from the nurse is that the combination of Lomotil and antihistamines can: |
|
Definition
result in CNS depression.
The combination of Lomotil and antihistamines can result CNS depression. |
|
|
Term
| The client has been ordered to be treated with Phenergan. Which aspect of the client’s medical history would cause the nurse to notify the physician? |
|
Definition
Hypertension
Phenergan should be administered with caution to a client who has a history of hypertension. |
|
|
Term
| The client is taking GoLYTELY in preparation for a GI examination. What is the highest priority instruction that the nurse can give the client in preparing to take the medication? |
|
Definition
“Plan to fast for 3 to 4 hours.”
Fasting for 3 to 4 hours is required in preparation for a GI examination and as GoLYTELY is taken. |
|
|
Term
| The client is being treated with FiberCon. The highest priority instruction that the nurse should give the client regarding administration of the medication is to: |
|
Definition
chew the tablet and follow with a full glass of water.
FiberCon should be chewed and followed with a glass of water |
|
|
Term
| The client has been ordered Marinol for chemotherapy-induced nausea. In planning the dosage schedule for the drug, the nurse recognizes that the medication will be administered: |
|
Definition
both before and after the chemotherapeutic agent is given.
In order to prevent nausea caused by chemotherapy, Marinol should be given both before and after the chemotherapeutic agent is given. |
|
|
Term
| The client will be taking scopolamine (Transderm-Scop) in his home setting for prevention of motion sickness. In teaching the client how to properly administer the medication, what is the nurse’s highest priority instruction? |
|
Definition
The patch should be applied behind the ear at least 4 hours before the journey.
The patch should be applied behind the ear at least 4 hours before the expected journey. Only one patch should be worn at a time; hands should be washed after application; and the patch maintains effectiveness for only 3 days. |
|
|
Term
| The client takes Metamucil at 9:00 PM. She should expect the onset of action of the drug at between ________ the next day. |
|
Definition
7 AM and 9 PM
Onset of action for Metamucil is between 10 and 24 hours. |
|
|
Term
| The client asks the nurse if she needs to change her diet now that she is being treated with antacids. The nurse instructs her that because of her treatment regimen she should avoid drinking: |
|
Definition
milk.
Milk or foods high in vitamin D interfere with the absorption of antacids. |
|
|
Term
| A client is ordered to receive Mylanta II. The nurse is aware that the ideal timing for taking this medication is: |
|
Definition
1 to 3 hours after meals.
Antacids are best absorbed when the stomach is empty. |
|
|
Term
| The client has been ordered Marinol for chemotherapy-induced nausea. In planning the dosage schedule for the drug, the nurse recognizes that the medication will be administered: |
|
Definition
both before and after the chemotherapeutic agent is given.
In order to prevent nausea caused by chemotherapy, Marinol should be given both before and after the chemotherapeutic agent is given. |
|
|
Term
| The client has been ordered treatment with Sucralfate. The nurse recognizes that what is the most optimal dosage schedule for the drug? |
|
Definition
7:00 AM, 11:00 AM, 4:00 PM, and 9:00 PM
Sucralfate should be given before meals and at bedtime. |
|
|
Term
| A client took Amphojel (aluminum hydroxide). The nurse will instruct the client to monitor for what type of GI disturbance? |
|
Definition
Constipation
Aluminum causes constipation. |
|
|
Term
| The client has been ordered treatment with lansoprazole. The client is being treated for a duodenal ulcer. Because the drug is being used to treat this condition, the nurse anticipates that the client will be ordered: |
|
Definition
15 mg daily for 4 weeks.
When used to treat duodenal ulcer, 15 mg of lansoprazole should be given for 4 weeks. |
|
|
Term
| The client has been ordered treatment with lansoprazole. He is also being treated with theophylline. The combination of the two drugs will result in a(n) _____ in the level of _____. |
|
Definition
decrease; theophylline
The combination of lansoprazole and theophylline will result in a decrease in the level of theophylline. |
|
|
Term
| When administering Mylanta II and ranitidine (Zantac), when does the most optimal administration of both drugs take place? |
|
Definition
1 to 2 hours apart
This is the classic dosing of these medications, such that the antacids do not interfere with the absorption of the ranitidine. |
|
|
Term
| Ranitidine’s (Zantac’s) half-life is 8 to 12 hours. The most appropriate dosing schedule is _____ day. |
|
Definition
twice a
Dosing twice a day allows the medication to be maintained at therapeutic levels. |
|
|
Term
| A client complains of flatulence, belching, and abdominal distention. What is the most appropriate drug to use to treat these symptoms? |
|
Definition
Simethicone (Mylicon)
Simethicone is used to reduce the gastric symptoms of flatulence, belching, and abdominal distention. |
|
|
Term
| The client has been started on a regimen that includes ranitidine. She complains to the nurse of experiencing depression. The highest priority nursing intervention is to call the physician because this is _______ the medication. |
|
Definition
an expected side effect of
Depression is an expected side effect of ranitidine that should be treated if it occurs. |
|
|
Term
| A client is ordered to receive a magnesium-based antacid. The nurse should monitor most closely for: |
|
Definition
diarrhea.
Magnesium may cause diarrhea. |
|
|
Term
| The client has been started on a treatment regimen that includes Amphojel as an antacid. The nurse plans what dosage schedule? |
|
Definition
9:00 AM, 1:00 PM, 6:00 PM, and 9:00 PM
When used as an antacid, Amphojel should be given after each meal and at bedtime. |
|
|
Term
| The client has been started on a treatment regimen that includes Amphojel to treat hyperphosphatemia. The nurse plans a dosage schedule of ________ meals. |
|
Definition
3 to 4 times daily with
When used to treat hyperphosphatemia, Amphojel should be given 3 to 4 times daily with meals. |
|
|
Term
| The nurse is preparing to administer a dose of Tagamet IV. The nurse should plan to prepare the drug by diluting it in _____ mL of solution. |
|
Definition
50
Tagamet should be administered IV by diluting it in 50 mL of solution. |
|
|
Term
| The client has been ordered to be treated with belladonna tincture. Which aspect of the client’s history would cause the nurse to contact the physician? |
|
Definition
Urinary retention
Belladonna tincture is contraindicated when the client has urinary retention. |
|
|
Term
| The client is being treated with a histamine2 blocker medication. In implementing diet planning, the nurse should instruct the client to consume a diet that is rich in vitamin: |
|
Definition
B12.
The client may become deficient in vitamin B12 as a result of treatment with a histamine2 blocker medication. |
|
|
Term
| The client is being treated with cimetidine as well as with Coumadin. The nurse anticipates that the action of the two drugs will produce a(n) _____ in the level of _____. |
|
Definition
increase; Coumadin
The combination of the two drugs can produce an increase in the level of oral anticoagulants. |
|
|
Term
| The client is being treated with cimetidine. The nurse anticipates a change in the client’s laboratory values of increased: |
|
Definition
BUN and creatinine.
Cimetidine can cause an increase in the client’s BUN and creatinine levels. |
|
|
Term
| The client is being treated with growth hormone. During treatment, the nurse monitors the client closely for evidence of: |
|
Definition
diabetes mellitus.
Growth hormone antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. |
|
|
Term
| A client is noted to have Cushing syndrome. The highest priority nursing intervention related to the client’s electrolyte levels is to monitor for evidence of: |
|
Definition
sodium retention.
Sodium and water levels are affected by Cushing syndrome. |
|
|
Term
| The nurse teaches the client the signs and symptoms of hypothyroidism. The client is taught to self-monitor closely for: |
|
Definition
weight gain.
Hypothyroidism can lead to a hypometabolic state. This may be manifested by weight gain. |
|
|
Term
| Client teaching on proper administration of a thyroid replacement drug includes which instruction? |
|
Definition
Instruct the client to take the drug at the same time each day.
The drug works in concert with circadian rhythms and so should be taken at the same time each day and on an empty stomach. |
|
|
Term
| The client is being treated with a glucocorticoid medication. The nurse plans to monitor him closely for evidence of: |
|
Definition
hypertension.
Steroids may lead to fluid overload and hypertension. |
|
|
Term
| The healthcare provider left an order to discontinue prednisone (Deltasone, Meticorten, Orasone, others). The highest priority action for the nurse is to: |
|
Definition
contact the healthcare provider to determine a tapering schedule.
Prednisone must be tapered to avoid adrenal insufficiency. |
|
|
Term
| Health teaching for the client receiving prednisone (Deltasone, Meticorten, Orasone, others) to decrease the inflammatory effects related to arthritis includes which instruction? |
|
Definition
Teach the client the signs and symptoms of excessive use of glucocorticoids.
It is important to teach clients the signs and symptoms of excessive use. |
|
|
Term
| A client is found to be deficient in a mineralocorticoid. The nurse assesses the client for manifestation of this deficiency by noting evidence of: |
|
Definition
hypotension.
A severe decrease in the mineralocorticoid aldosterone leads to hypotension and vascular collapse, such as in Addison’s disease. |
|
|
Term
| A school-aged client with growth hormone (GH) deficiency is recommended for growth hormone injections. What in the client’s history would warrant contacting the primary healthcare provider? |
|
Definition
Obesity
Obesity is a contraindication for GH therapy, such as would be present in a client with Prader-Willi syndrome. |
|
|
Term
| A client sustains a brain injury. The client is being treated with desmopressin acetate. What would indicate a positive outcome from the medication? |
|
Definition
a-calcium
The medication secretes the hormone to retain fluid, causing a reduction in urine output. |
|
|
Term
| The nurse provides medication instructions to a client prescribed liothyronine sodium (Cytomel) for treatment of hypothyroidism. Which symptoms should the client be taught to monitor for that will indicate an overaccumulation of this drug? |
|
Definition
Rapid or racing heat rate
An overaccumulation of Cytomel may increase thyroid stimulation and may cause tachycardia. |
|
|
Term
| The client is being treated with prednisone. Her treatment regimen includes estrogen replacement therapy. The nurse anticipates that the interaction of the two medications will result in: |
|
Definition
increased effects from the prednisone.
The interaction of prednisone and estrogen will result in increased effect from the prednisone. |
|
|
Term
| The client is being treated with prednisone. His treatment regimen includes aspirin. The nurse anticipates that the interaction of the two medications will result in _____ toxicity. |
|
Definition
Gastrointestinal
The interaction of prednisone and aspirin will result in gastrointestinal toxicity. |
|
|
Term
| The client is being treated with calcitriol. Her treatment regimen includes thiazide diuretics. The highest priority nursing intervention based on this drug interaction is to monitor serum _____ level. |
|
Definition
Calcium
The interaction of calcitriol and a thiazide diuretic will tend to increase the client’s calcium level. |
|
|
Term
| The client is being treated with calcitriol. He complains of changes in his vision. The nurse recognizes that this symptom is most likely ________ the medication. |
|
Definition
a side effect of
A side effect of treatment with calcitriol can be dizziness and photophobia. |
|
|
Term
| The client is scheduled to be treated with corticotropin. Which aspect of her client history would cause the nurse to contact the primary healthcare provider? |
|
Definition
Peptic ulcer
Peptic ulcer is a contraindication for treatment with corticotropin. |
|
|
Term
| The client is being treated with potassium iodide. In instructing the client on self-administration of the medication, what is the highest priority nursing instruction? |
|
Definition
Sip the medication through a straw.
The client should sip the medication through a straw to avoid discoloration of the teeth. |
|
|
Term
| Dietary instructions for the client who is being treated with glucocorticoids includes eating a diet high in: |
|
Definition
potassium.
Advise the client who is being treated with a glucocorticoid medication to eat foods rich in potassium, such as fresh and dried fruits, vegetables, meats, and nuts, because prednisone promotes potassium loss and hypokalemia. |
|
|
Term
| The client is an older adult who is being treated with a glucocorticoid medication. The highest priority nursing intervention with this client is to monitor for evidence of: |
|
Definition
increased osteoporosis.
Monitor older adults for signs and symptoms of increased osteoporosis because glucocorticoids promote calcium loss from bone. |
|
|
Term
| The client is being treated with thyroid replacement therapy. What is the highest priority nursing instruction regarding dietary requirements? |
|
Definition
Avoid eating shellfish.
Iodine is found in shellfish, and clients being treated with thyroid replacement therapy should avoid excessive iodine. |
|
|
Term
| The nurse is teaching the client the proper procedure for administration of insulin. The nurse should direct the client to use a _____ syringe. |
|
Definition
100-unit insulin
A 100-unit insulin syringe is the only insulin syringe currently used. |
|
|
Term
| A client’s insulin is administered at 7:00 AM daily. The client is to receive regular and NPH (Humulin N) insulins. The nurse is teaching the client how to prepare the syringe before injectio |
|
Definition
draw up regular insulin first.
The nurse or client draws up the regular insulin and then the NPH. |
|
|
Term
| In administering an insulin injection to a client, the nurse anticipates that the injection of NPH (Humulin N) and regular (Humulin R) insulins will be administered via the _____ route. |
|
Definition
subcutaneous
Insulin is injected into the subcutaneous tissue. |
|
|
Term
| The nurse is monitoring a client for evidence of a hypoglycemic reaction. The client received Humulin R insulin at 7 AM. The nurse anticipates that the client will need to be most closely monitored for evidence of a hypoglycemic reaction at which time? |
|
Definition
9:00 AM to 11:00 AM
Regular insulin peaks in 2 to 4 hours. |
|
|
Term
| The nurse assesses a client for evidence of hypoglycemic reaction. The highest priority nursing intervention is to assess for: |
|
Definition
nervousness and tremors.
Signs and symptoms of hypoglycemia include nervousness and tremors. |
|
|
Term
| The nurse notes an order for insulin to be administered intravenously. The nurse recognizes that which insulin is the only type that can safely be administered intravenously? |
|
Definition
Regular (Humulin R)
Only regular insulin can be given intravenously. |
|
|
Term
| The best candidate for treatment with a combination insulin such as Humulin 70/30 is the client who: |
|
Definition
can use the prepared amount of regular and NPH units.
Clients must be able to take the predosed combinations since they may be required to mix a prescribed proportion. |
|
|
Term
| A client is ordered to receive insulin glargine (Lantus) insulin. The nurse plans the client’s care based on the fact that Lantus: |
|
Definition
does not peak.
Lantus is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime. |
|
|
Term
| The client is ordered to be treated with glargine (Lantus) insulin. Because of the type of insulin that the client is receiving, the nurse plans a dosage schedule that administers the medication at which time(s)? |
|
Definition
9:00 PM
Lantus is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime. |
|
|
Term
| The client is scheduled to begin treatment with Metformin. The nurse plans to closely monitor which laboratory values? |
|
Definition
Liver function tests
Metformin tends to create alteration in the client’s liver function tests. |
|
|
Term
| The client is being treated with Humulin N. She also takes an oral contraceptive. The nurse anticipates that the interaction of these two medications will result in which effect? |
|
Definition
Decreased effect from the Humulin N
The combination of Humulin N and an oral contraceptive will result in decreased hypoglycemia effect. |
|
|
Term
| The best candidate for oral antidiabetic therapy is the client who: |
|
Definition
has a fasting glucose level of 180 mg/dl.
Criteria for use of oral antidiabetic drugs include onset of diabetes mellitus at age 40 years or older, diagnosis of diabetes for less than 5 years, normal weight or overweight, fasting blood glucose equal to or less than 200 mg/dl, fewer than 40 units of insulin required per day, and normal renal and hepatic function. |
|
|
Term
| The client has been started on Metformin (Glucophage). What would be a positive outcome for this client as a result of the medication he is taking? |
|
Definition
Reduced absorption of glucose from the small intestine
Metformin is designed to reduce the absorption of glucose from the small intestine. |
|
|
Term
| The best candidate for treatment with Diazoxide (Proglycem) is the client who is experiencing: |
|
Definition
hypoglycemia caused by hyperinsulinism.
Diazoxide (Proglycem) is used to treat hypoglycemia caused by hyperinsulinism. |
|
|
Term
| A client with type 2 diabetes mellitus is admitted to the hospital with an infection. The client was taking oral hypoglycemic agents and is prescribed insulin in the hospital. What is the highest priority instruction that the nurse can give the client regarding insulin administration? |
|
Definition
Infection temporarily increases the need for insulin.
Insulin needs increase in the presence of an infection. |
|
|
Term
| A client is to receive Humalog (Lispro) insulin at breakfast. The nurse plans to administer the insulin _____ breakfast. |
|
Definition
5 mins before
Lispro has an onset of 5 minutes. |
|
|
Term
| A client is found unconscious with a Medic-Alert bracelet indicating type 1 diabetes mellitus. What is the highest priority nursing intervention? |
|
Definition
Administer glucagon.
Glucagon is given to unconscious patients in order to stimulate an increase in blood sugar level. |
|
|
Term
| The client is being treated with Metformin. He is also receiving furosemide. The nurse anticipates that the interaction of the two medications will result in: |
|
Definition
potentiated hypoglycemia.
The interaction of Metformin and furosemide will result in potentiated hypoglycemia. |
|
|
Term
| The client is being treated with Glipizide. She begins to exhibit difficulty breathing. The nurse recognizes that this may be indicative of a(n) ________ the medication. |
|
Definition
life-threatening reaction to
Life-threatening reactions to Glipizide include seizures, coma, and respiratory depression. |
|
|
Term
| The client is being treated with rosiglitazone maleate (Avandia). The highest priority instruction to the client based on treatment with this medication is for the client to: |
|
Definition
use birth control.
The drug can cause increase resumption of ovulation in premenopausal women. |
|
|
Term
Cholinergic agents have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.)
a. Dilate pupils.
b. Decrease heart rate.
c. Stimulate gastric muscle. d. Dilate blood vessels.
e. Dilate bronchioles.
f. Increase salivation.
g. Constrict pupils. |
|
Definition
B, C, D, F, G
These are the actions of the parasympathetic nervous system. |
|
|
Term
A client with high cholesterol is ordered to take atorvastatin (Lipitor). What information should be included in the client teaching? (Select all that apply.)
a. Dietary management is not a priority with this medication.
b. The medication should be taken on an empty stomach.
c. The medicine should be taken with a full glass of water.
d. The client should watch for body aches or GI upset as side effects.
____ 2.
____ 3.
e. The client should have renal function tests frequently.
f. The client should have liver function tests frequently. |
|
Definition
C, D, F
This medication is most effective with careful monitoring of diet and does not affect renal function. |
|
|
Term
A client is diagnosed with hypothyroidism. What is characteristic of this condition? (Select all that apply.)
a. Constipation
b. Vomiting
c. Bradycardia
d. Weight gain
e. Racing heart beats
f. Irregular menses
g. Intolerance to heat |
|
Definition
A, C, D, F
These symptoms are indicative of hypothyroidism. The others indicate a hypermetabolic state. |
|
|
Term
A Client is ordered to receive insulin subQ. What is the order of administration?
1. Draw up the insulin.
2. Clean the skin with alcohol.
3. Insert the needle.
4. Count to five.
5. Pinch the skin.
6. Remove the needle.
7. Inject the medication.
8. Verify the doctor’s ordered dosage. |
|
Definition
8. Verify doc ordered dose
1. Draw up the insulin.
2. Clean the skin with alcohol.
5. Pinch the skin.
3. Insert the needle.
7. Inject the medication.
4. Count to five.
6. Remove the needle.
7, 4, 6 |
|
|
Term
Daily total fat intake
Daily cholesterol |
|
Definition
Total fat should be 30% of caloric intake.
Cholesterol should not exceed 300 mg/day |
|
|
Term
Ideal serum lipid values (HDL, LDL, Cholesterol, Lipoproteins)
p 685 |
|
Definition
Cholesterol 150-200 mg/dL
Triglycerides 40-150 mg/dL
HDL 45-60 mg/dL
LDL Less than 100 mg/dL |
|
|
Term
| Antihistamine anticholinergics |
|
Definition
Dimenhydrinate (Dramamine)
Scopolamine (Transderm Scōp)
Motion sickness treatment
Side effects
• Dry mouth, visual disturbances, constipation, urinary
retention, flushing, muscle weakness, tachycardia, hypotension |
|
|
Term
| What is the highest priority problem to monitor in a patient taking Atropine? |
|
Definition
|
|
Term
|
Definition
typically end in "-OR" or "-OL"
Atorvastatin calcium (Lipitor)
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Pravastatin sodium (Pravachol) Rosuvastatin calcium (Crestor)
Simvastatin (Zocor) |
|
|
Term
| What are two dangerous ADRs of Statins/Vastatins? |
|
Definition
| Liver impairment & rhabdomyolysis |
|
|
Term
| What are things a nurse should report when a patient is on statins? |
|
Definition
-Abnormal liver enzymes
-Malaise
-fever
-muscle tenderness/weakness |
|
|
Term
| ADRs and Side effects of LIPITOR (atorvastatin) |
|
Definition
| Serious adverse reactions of atorvastatin include rhabdomyolysis, myalgia, photosensitivity, and cataracts. Less serious side effects include headache, rash, pruritus, constipation, diarrhea, sinusitis, and pharyngitis. |
|
|
Term
Nicotinic acid/ Niacin / Vit B2
p 686 |
|
Definition
Reduces VLDL and LDL very effectively, but has many side effects.
Use with aspirin reduces side effects
Side effects-GI, flushing of skin, elevated serum liver enzymes, hyperglycemia, hyperuricemia |
|
|
Term
| High level of this is linked to CVD, stroke, Alzheimers |
|
Definition
Homocysteine. Normal=4-17 mmol/L
Damages inner lining of blood vessels, causing thickening and loss of flexibility
Vit B6, B12, and folic acid lower homocysteine levels |
|
|
Term
|
Definition
| High sensitivity C-reactive protein- produced in liver, associated with cardiovascular and peripheral vascular disease. |
|
|
Term
| How long does it atke to see a therapeutic effect of Lipitor/atorvastatin? |
|
Definition
|
|
Term
| What herb has been taken for intermittent claudication (related to PVD)? |
|
Definition
|
|
Term
| Symptoms of Peripheral Arterial/Vascular disease |
|
Definition
-numbness/coolness of extremities
-intermittent claudication (pain and weakness of limb when walking but no signs at rest)
-possible leg ulcers |
|
|
Term
| Clients who have _________ ___________ are 2-4 times more likely to have peripheral vascular disease and are at risk of claudicaiton |
|
Definition
|
|
Term
| What are 2 types of drugs whose levels increase in the presence of Lipitor? |
|
Definition
Digoxin
Oral contraceptives |
|
|
Term
|
Definition
Common peripheral vasodilators
p 689 |
|
|
Term
| A client states, "I don't think this statin is working. I think I will stop taking it". How do you respond? |
|
Definition
DO NOT abruptly stop taking a statin. It could have a serious rebound effect and lead to an AMI and possible death!
p 690 |
|
|
Term
|
Definition
Beta-2-adrenergic agonist used as a peripheral vasodilator. SHORT HALF LIFE. Decrease BP when taken w/antihypertensives.
Desired therapeutic response may take 1.5-3 months.
ADRs-hypotension (worse w/alcohol), tachycardia, palpitaitons |
|
|
Term
| Patient is taking Crestor. What skeletal/muscular ADR should the nurse monitor for? |
|
Definition
|
|
Term
What are some prescription and non-prescription anti emetics?
p 697 |
|
Definition
Prescription- antihistamines, dopamine antagonists, serotonin antagonists, glucocorticoids, cannabanoids
Non-prescription-antihistamines, bismuth sub-salicylate, phosphorated carbohydrate solution |
|
|
Term
| Do OTC antiemetics work for motion sickness when vomiting has already occurred? |
|
Definition
|
|
Term
What is the difference in the antiemetic mechanisms of Pepto-bismol and antihistamine antiemetics such as Benadryl and Dramamine?
p 697 |
|
Definition
| Pepto-bismol acts directly on the gastric mucosa to suppress vomiting, but the antihistamines inhibit vestibular stimulation in the inner ear. |
|
|
Term
Can a pregnant woman take OTC anti emetics?
p 697 |
|
Definition
| It is NOT recommended that pregnant women take OTC antiemetics because it can harm the fetus. Non-pharmacologic methods are preferred. |
|
|
Term
| A client with nausea is taking ondanstron (Zofran). What is the action of this drug? |
|
Definition
| Blocks serotonin receptors in the CTZ |
|
|
Term
| How does a bisacodyl suppository work for constipation? |
|
Definition
| Acts on smooth intestinal muscle to increase bulk and peristalsis |
|
|
Term
| What is a common side effect of the scopolamine patch for motion sickness? |
|
Definition
|
|
Term
| When a patient takes metoclopramide (Reglan) for nausea, what is she to avoid? |
|
Definition
|
|
Term
| What type of exam is important for patients who take statins? |
|
Definition
| Eye exam because of increased risk of forming cataracts while on statins |
|
|
Term
How soon after poisoning should a patient be given the emetic Ipecac?
Should patients buy Ipecac syrup or fluid extract? Why?
How does Ipecac work?
How soon will a patient vomit?
What beverage should be taken with Ipecac?
p 702 |
|
Definition
Within an hour of poisoning.
Ipecac syrup should be purchased because the fluid extract is more potent and can cause fatalities.
Induces vomiting by stimulating the CTZ in the medulla and acting directly on gastric mucosa.
Pt will vomit w/i 15-30 minutes
Take with WATER. No milk, no carbonated beverages. |
|
|
Term
a. CNS depression is increased when Phenargan/promethazine is taken with _________
b. Anticholinergic effects of Phenargan/promethazine are enhanced when taken with ________
p 700 |
|
Definition
a. alcohol, narcotics, sedative-hypnotics, general anesthesia.
b. antihistamines, anticholinergics, other phenothiazines |
|
|
Term
What is the benzo of choice for nausea/vomiting in patients undergoing chemotherapy?
p 700 |
|
Definition
Lorazepam (Ativan), a benzodiazepine
Lorazepam effectively provides emesis control, sedation, anxiety reduction, and amnesia when used in combination with glucocorticoid and serotonin 5-HT3 receptor antagonists |
|
|
Term
What is the most effective class of drugs for supressing nausea/vomiting related to cancer chemotherapy?
p 700 |
|
Definition
Serotonin antagonists such as Zofran.
Chemical names end in "-ON" (ondansetron, palonosetron, dolasetron)
Work by blocking serotonin receptors in the CTZ and the afferent vagal nerve terminals in the upper GI |
|
|
Term
| Travellers diarrhea- cause, treatment, duration |
|
Definition
| E. coli, lasts 2 days, treat w fluroquinolones and Imodium |
|
|
Term
Patients with _____ impairment should not take opiate antidiarrheals
p 704 |
|
Definition
|
|
Term
What do somatostatin analogue drugs do?
What is an example?
p 704 |
|
Definition
Inhibit gastric secretions and decrease smooth muscle contrractility
octretide (Sandostatin)
Frequently prescribed for diarrhea from metastatic cancer |
|
|
Term
What does an adsorbent do?
What are some examples?
p 704 |
|
Definition
Adsorbents coat the wall of the GI tract to adsorb bacteria, toxins.
Kaolin, pectin, Pepto bismol |
|
|
Term
| What is a normal number of bowel movements per week? |
|
Definition
| as many as 1-3 a day and as few as 3 a week |
|
|
Term
| Should stool be watery and soft after taking a laxative? |
|
Definition
| It should be soft but NOT watery (unless is is a purgative such as Castor oil, which does cause watery stool) |
|
|
Term
Osmotics/hyperosmolar laxatives
a-what do they contain
b-how do they work
c-examples
d-what to monitor
p 706 |
|
Definition
a. osmotic laxatives contain salts/saline (Mg, Na), lactulose, glycerin
b. they draw water into the colon and increase H2O in the feces to increase bulk, which increases peristalsis
c. GoLYTELY, Lactulose, Glycerin
d. electrolyes; can have imbalances when taking osmotics |
|
|
Term
Stimulant/contact laxatives
a. What do they do?
b. Examples & which is the most common?
c. ADRs
p 707 |
|
Definition
a. irritate sensory nerve endings in intestinal mucosa
b. Senokot, castor oil, most common is bisacodyl (Dulcolax)
c. DEPENDENCE, hypokalemia, tetany (life threatening) |
|
|
Term
| If a patient uses mineral oil long-term, what vitamin deficiencies can occur? |
|
Definition
|
|
Term
Bulk forming laxatives
How do they work?
How much water to mix with them?
p 708-709 |
|
Definition
Example-Metamucil (psyllium)
Works by absorbing water and increasing fecal bulk & peristalsis. Does NOT cause dependence
Mix with 8 oz water, then drink 8 oz water 1-3 times a day. Get abdominal cramps if not taken with enough fluid, and can cause intestinal obstruction |
|
|
Term
Emollients (lubricants/stool softeners)
Mechanism
Example
Contraindications
p 709 |
|
Definition
Decrease straining during defecation by lowering surface tension of water and promoting water accumulation
Docusate sodium (Colace), docusate calcium (Surfak)
Not for children, older adults, clients w/debilitating diseases |
|
|
Term
Contraindications for all laxatives
p 709 |
|
Definition
| inflammatory disorders of GI tract, pregnancy, spastic colon, bowel obstruction |
|
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