Pharmacology Reviewer
Pharmacology Reviewer
Pharmacology Reviewer
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PHARMACOLOGY a. immediately notify the nursing supervisor, the prescribing physician, and
Pharmacology the
- most simply defined as study of drug. pharmacist.
b. assess the client’s condition and provide any necessary care.
Fundamentals of Pharmacology 9. For postpartum women, advice to take drugs after breastfeeding.
1. Pharmacokinetics Administration of Drugs :
- study of drug’s changes as it enters and passes through the body.
a. absorption Routes and Nursing considerations:
b. distribution 1. Enteral – oral, sublingual, rectal, gastric tubes
c. biotransformation - capsulated pill, sustained release and enteric coated should not be crushed.
d. excretion 2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural.
- vastus lateralis (safest site for IM)
2. Pharmacodynamics 3. Topical – skin, inhalants, mucus membrane.
- mechanism by which drugs produce changes in body tissue.
a. desired effect - intended action of drugs Eye medications :
b. adverse effect - harmful unintended reactions - administer eyedrops first then ointment.
c. side effects – consequence reactions - use a separate bottle for each client.
d. toxicity – the degree which something is poisonous - instruct the client to tilt the head backward, open eyes and look up.
digoxin = 0.5 – 2.0 ng/mL - avoid contact of medication bottle to the eyeball.
lithium = 0.5 – 1.5 mEq/L - place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canthus for 30-60 seconds.
Safety and Efficacy - instruct the client to close the eye gently.
Nursing Principles :
1. Always verify the Five Rights . Ear drops
a. the right medications - in infant and children younger than 3 y.o, pull pinna downward and
b. the right client backward.
c. the right dosage - in older children and adult, upward and backward.
d. the right form, route and technique - direct the solution on the wall of the ear canal, not directly on the ear drum.
e. the right time
2. Chart drug administration only after its been given, never before.
3. Never leave the medication on cart or tray unattended.
4. Chart observed therapeutic and adverse effects accurately and fully.
5. Check history for allergies and potential drug interactions before CLASSIFICATIONS OF DRUGS
administering a
newly ordered drug. DRUGS AFFECTING THE CENTRAL AND AUTONOMIC SYSTEM
6. Inform the prescribing physician of any observed adverse effects; if cannot be
located, inform the nursing supervisor Cholinergic Agents (Parasympathomemitics)
7. Question drug orders that are unclear, that appear to contain errors, or that Prototype :
have - synthetic acetylcholine, pilocarpine, carbachol, bethanecol (Urocholine),
potential to harm. edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine
8. Take the following actions if an error occurs : (Mestinon).
Mechanism of action :
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ANALGESICS Indications :
Prototype : - thrombosis, pulmonary embolism, myocardial infarction
a. Narcotic analgesics Adverse effect :
- codeine, meperidine (Demerol) morphine, butorphanol (Stadol) - bleeding
nalbuphine (Nubain) Nursing considerations :
b. Non – narcotic analgesic 1. HEPARIN sodium
NSAIDs – aspirin (aminosalicylic acid), mefenamic acid (Ponstan), - if given SQ don’t aspirate or rub the injection site (above the scapula - best
ibuprofen (Motrin), naproxen, ketoprofen (Orudis), ketorolac. site).
paracetamol and acetaminophen (Tylenol) - therapeutic level 1.5-2.5 times normal PTT;
Mechanism of actions : normal PTT is 20-35 sec. = 50-85 sec.
a. Narcotic analgesics - antidote : (protamine sulfate)
- alter pain perception by binding to opiod receptors in CNS.
b. Non- narcotic analgesic 2. WARFARIN sodium (coumadin)
- relieves pain and fever by inhibiting the prostaglandin pathway. - warfarin is used for long-term .
Nursing considerations : - onset of action is 4-5 days.
1. Monitor respiratory depression & hypotension in clients taking narcotic - therapeutic level is 1.5-2.5 times normal PT;
analgesic. normal PT = 9.6 -11.8 sec. = 25 - 30 sec.
2. Injury and accident precautions in clients taking narcotic analgesic. INR = 2 - 3
3. Warn clients about possibility of dependency,and do not discontinue - should be taken at the same time of the day to maintain at therapeutic level.
narcotics - reduce intake of green leafy vegetables.
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CALCIUM-CHANNEL BLOCKERS
Prototype : RESPIRATORY MEDICATIONS
- Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Felodipine (Plendil)
Verapramil (Isoptin) Bronchodilators
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Prototype : - Take inhaled bronchodilators first before taking inhaled steroids, and rinse
Symphatomimetic Xanthines mouth
- albuterol, salbutamol - aminophylline after using.
- isoproterenol, salmeterol - theophylline
- terbutaline
MAST CELL STABILIZERS
Mechanism of actions: Prototype : cromolyn sodium (Intal)
- sympathomimetic (b-receptor agonist) bronchodilators, dilate airways. Mechanism of action :
- xanthine bronchodilators, stimulate CNS for respiration. - stabilize mast cells that release histamine triggering asthmatic attacks.
Indications : Nursing Consideration:
- bronchospasm, asthma, bronchitis, COPD. - Should be given before asthmatic attacks.
Adverse effects : - Administer oral capsule at least 30 mins before meals for better absorption.
- palpitations and tachycardia - Drink a few sips of water before & after inhalation to prevent cough &
- restlessness, nervousness, tremors unpleasant taste
- anorexia, nausea and vomiting, headache, dizziness. - Assess for lactose-intolerance.
Nursing considerations :
- Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled ANTI-HISTAMINES (H-1 BLOCKERS)
seizure Protoytype :
disorder. - Astemizole (Hismanal), Loratidine (Claritin),
- Should be used with caution in patient with HPN and narrow-angle Brompheniramine (Dimetapp),
glaucoma. Diphenhydramine (Benadryl),
Cetirizine (Iterax), Celestamine (Tavist).
Mechanism of action :
- decrease nasopharyngeal secretions and decrease nasal itching by blocking
histamine
in H1-receptor.
GLUCOCORTICOIDS (CORTICOSTEROIDS) Indications :
Prototype : - common colds, rhinitis, nausea and
- dexamethasone, budesonide, fluticasone, prednisone, beclomethasone. vomiting, urticaria, allergies and as sleep aid.
Mechanism of actions : Nursing Considerations :
- act as anti-inflammatory agents and reduce edema of the airways, as well - Administer with food and drink.
as - Given IM via Z-track method or orally.
pulmonary edema. - Precautions in handling machine and driving while taking these drugs.
Adverse effects : - Ice chips or candy for dry mouth
- Cushing’s syndrome, neutropenia. osteoporosis
Nursing considerations : ANTI-TUBERCULOSIS
- Take drugs at meal time or with food. Prototype :
- Eat foods high in potassium, low in sodium. First line Second line
- Instruct client to avoid individuals with RTI. - Isoniazid (INH) - Cycloserine
- Instruct client not to stop medication abruptly, it should be tapered to prevent - Rifampicin (Rifadin) - Kanamycin
adrenal insufficiency - Ethambutol - Ethonamide
- Avoid taking NSAID while taking steroids. - Pyrazinamide - Para-aminosalicylic acid
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- Streptomycin Antacids
Prototype :
- active tuberculosis are treated with drug combination for 6-9 mos. - aluminum/magnesium compounds (Maalox)
- multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years - sodium bicarbonate (Alka-Seltzer)
- given before meals - calcium carbonate (Tums)
- magnesium hydroxide (Milk of Magnesia).
Isoniazid Mechanism of actions :
- should be given 1 hr before or 2 hrs after meals because food may delay - neutralize the stomach acidity.
absorption. Adverse effects :
- should be given at least 1 hr before antacids. - metabolic alkalosis, stone formation
- instruct to notify physician for signs of hepatoxicity (jaundice), and - electrolyte imbalance
neurotoxicity - diarrhea (magnesium), constipation (aluminum).
numbness of extremities. Nursing considerations :
- administer with Vitamin B6 to counteract the neurotoxic side effects. - Give 1 hr after meals.
- avoid alcohol. - Avoid giving medications within 1-2 hrs of antacid administration
(decreases absorption).
Rifampicin - Take fluids to flush after intake of antacid suspensions.
- given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours after - Monitor for changes of bowel patterns.
meals
and avoid taking antacids with medications.
- hepatotoxic thus avoid alcohol.
- instruct the client that urine, feces, sweat, and tears will be red-orange in HISTAMINE – 2 BLOCKERS
color. Prototype :
- cimetidine (Tagamet), ranitidine (Zantac),
Pyrazinamide famotidine (Pepcid), nizatidine (Axid).
- given for 2 months. Mechanism of action:
- increase serum uric acid and cause photosensitivity. - blocks H2 receptors in the stomach, reducing
acid secretions.
Ethambutol Nursing considerations :
- contraindicated in children under 13 years old. - Given before or with meals
- obtain a baseline visual acuity because it can cause optic neuritis. - Avoid giving other drugs with cimetidine
- Instruct the client to notify the physician immediately if any visual problems - Gynecomastia may developed with chronic use of cimetidine.
occurs.
Streptomycin
- aminoglycoside antibiotic given IM. Proton – Pump Inhibitors (PPI)
- nephrotoxic and ototoxic. Prototype :
- obtain baseline audiometric test and repeat every 1-2 months because the - omeprazole (Losec), Lansoprazole (Lanz), pantoprazole (Pantoloc).
medications impairs the CN VIII. Mechanism of action :
- inhibit the proton H+ to combine with Cl- toform hydrochloric acid.
Nursing considerations :
DRUGS AFFECTING GASTROINTESTINAL SYSTEM - Given before meals preferably at morning.
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Indications :
Mucosal Barriers - ingestion of poisonous or toxic substances.
Prototype : Nursing considerations :
- sucralfate (Carafate), misoprostol (Cytotec). - Consult poison control center before induction of vomiting.
Mechanism of action : - Administer ipecac syrup with large amount of fluid.
- coats the mucosa to prevent ulcerations.
Nursing consideration : DRUGS AFFECTING THE ENDOCRINE SYSTEM
- Given before meals.
- Misoprostol is contraindicated for pregnants. THYROID AGENTS
- Sucralfate cause constipation. Prototype :
- Proloid (thryroglobulin )
- Synthroid (levothyroxine)
Anti-diarrheal Agents - Cytomel ( liothyronine).
Prototype : Mechanism of action :
- diphenoxylate (Lomotil), loperamide (Imodium), kaolin/pectin mixture - function as natural or synthetic hormones.
(Kaopectate). Nursing considerations :
Mechanism of actions : - Taken in the morning.
- decrease stomach motility and peristalsis. - Caution with coronary artery disease.
Nursing considerations : - Monitor for signs of hyperthyroidism and refer for decreasing the dose.
- Monitor for rebound constipation.
- Be cautious taking if with infectious diarrhea. PARATHYROID AGENTS
- Monitor atropine toxicity with diphenoxylate. Prototype :
- Clay, white or pale stool is common with kaopectate. a. calcitonin (Calcimar), etidronate (Didronel),
b. calcitrol (Rocaltrol), calcifediol (Calcedrol)
Laxatives Mechanism of action :
a. lactulose (Cephulac), Na biphosphate (Fleet a. reduce bone resorption
enema) & magnesium salt (Milk of Magnesia) b. promotes calcium absorption
- retain fluid and distend intestine Nursing considerations :
b. ducosate (Dialose) - Monitor signs of calcium imbalance
- emulsify fecal fat and water - Report for bone pains.
c. bisacodyl (Dulcolax) & senna (X-prep) - Remain sitting upright after taking etidronate.
- irritates intestinal mucosa and
stimulate intestinal smooth muscles Oral Hypoglycemic Agents (OHA)
d. bulk-forming laxative (Metamucil) 1. Sulfonylureas
- increase fecal bulk and water content - stimulate insulin secretions and increase tissue sensitivity to insulin.
e. mineral oil First Generation :
- lubricates & prevent colon absorption Chlorpropamide (Diabenese)
- disulfiram precautions
EMETICS Tolbutamide (Orinase)
Prototype : ipecac syrup, apomorphine - congenital defect
Mechanism of actions : Second Generation :
- induce vomiting through stimulation of vomiting center of medulla. Glypizide, Glymepiride
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Nursing considerations :
- Effective only for type II DM. ESTROGENS AND PROGESTINS
- Contraindicated to pregnant & breastfeeding. Prototype :
- Given before meals. - conjugated estrogen (Premarin), estrone (Bestrone), estradiol (Estrace),
- Monitor for signs of hypoglycemia. diethylstilbestrol (DES).
Indications :
- prostate cancer, contraceptions
- estrogen replacement
Adverse effects :
Insulin estrogen - endometrial CA, gallbladder disease, HPN, migraine, breast
Insulin Onset Peak Duration tenderness
progesterone - altered menstrual flow, risk of thrombo embolism
Immediate-acting 0.15h 0.5–1h 5h Nursing considerations :
(lispro) 1. Mix estrogen or progestins prior to IM administration by rolling vials
Short-acting 0.5-1 h 2-4 h 5-7h between palms.
(regular, semilente) 2. Monitor blood pressure
Intermediate-acting 1-3 h 6-12 h 18-24 h 3. Teach patient how to perform BSE.
(NPH, lente) 4. Regular follow-up examination is required to detect associated risk of
Long-acting 4-6h 10-30 h 24-36 h acquiring CA
(ultralente)
Mixed 0.5 h 4-8 h 25 h
(regular 30%, NPH 70%) DRUGS AFFECTING LABOR and LACTATION
General considerations :
ANTIPARASITIC AGENTS - kills or inhibit the reproduction of neoplasmic cells but as well as normal
Prototype : cells.
a. Antimalarial - it could be cell cycle phase specific or cell cycle non-specific.
- chlroquine, mefloquine, primaquine, - preferably given through IV route.
quinine, pyrimethamine
b. Antiamebiasis
- metronidazole (Flagyl), iodoquinol, Prototype :
furozolidone (Furoxone). 1. Alkylating Agents
Mechanism of actions : - inhibits cell production by causing cross linking of DNA
a. antimalarial – alters protozoal DNA, depleting folates, & reducing nucleic a. Busulfan – hyperuricemia
acid b. Chlorambucil – gonadal suppression
production c. Cisplatin – ototoxicity and nephrotoxicity
b. antiamoeba – block protein synthesis. d. Cyclophosphamide – hemorrhagic cystitis.
Nursing considerations : 2. Antitumor Antibiotic Agents
1. Administer anti-malarial drugs with food. - interfere in DNA and RNA synthesis
2. Take seizure precautions while administering a. Plicamycin – affects bleeding time
antimalarial drugs. b. Doxurubicin – cardiotoxicity
3. Refer cinchonism during quinine treatment: c. Bleomycin – pulmonary toxicity.
- tinnitus, headache, vertigo, fever, and visual changes.
4. Inform clients that iodoquinol falsify thyroid function test for up to 6 months.
3. Antimetabolites
- replace normal proteins required for DNA synthesis by inhibiting the S
ANTIHELMINTIC phase
Prototype : a. Cytarabine – hepatotoxicity
- mebendazole (Vermox), thiabendazole, b. 5-flourouracil – phototoxicity reaction and cerebellar dysfunctions
niclosamide (Niclocide), piperazine (Antepar), c. 6-marcaptopurine – hyperuricemia
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d. Methotrexate – photosensitivity
- given with leucoverin to lessen its toxicity. SITUATION: Mr. Hero Fernando, a 60 year-old bank manager had
4. Mitotic Inhibitors (Vinca Alkaloids) experienced a sensation of chest tightness, chest pain, sweating
- prevent mitosis acting on the M phase causing cell death and a feeling of apprehension. A diagnosis of CAD with angina
a. Vincristine sulfate – neurotoxicity, numbness pectoris was established
5. Hormonal Medications and Enzymes 1. The physician orders for nitroglycerin tablet. The nurse knows that the
- block the normal hormones in hormone sensitive tumors pharmacological action of the drug is:
a. Tamoxifen citrate – visual problems a. To dissolve the atheromatous plaque in the coronary artery
– elevate cholesterol & triglycerides level b. Constrict the venous vessels and capillaries
b. Diethylstilbestrol – impotence and gynecomastia in men. c. Dilate the coronary arteries
d. Decrease the myocardial consumption of oxygen
Side Effects:
stomatitis 2. The nurse gave instructions to the patient on nitroglycerin intake. He
- bland diet, avoid strong mouthwash remarked, “I think I will try not to take too many of these pills.” At this
- soft tooth brush, ice chips instance, the nurse’s BEST reply would be:
diarrhea, nausea and vomiting a. “I agree, nitroglycerin can cause drug addiction, that is why you
- anti-emetic, replace fluids and electrolytes must not take too many of the pills”
alopecia b. “I must inform you that nitroglycerin is non-habituating and
- reassure that it is temporary you should take the pills many times to relieve the pain”
- encourage o wear wigs, hats and head scarf c. “You will be needing only three tablets to ease the pain and if
skin pigmentation unrelieved, you must seek medical attention”
- inform that it is only temporary d. “ There is no problem with continuous daily intake because
tumor lysis syndrome nitroglycerin does not cause a tolerance effect”
- hyperuricemia & hyperkalemia
- force fluids 3. The nurse must emphasize to the patient which ONE of the following
infection side-effects of nitroglycerin:
- notify physician if WBC is <2000/mm3 a. Headache c. Nausea and vomiting
- monitor for signs of infection b. Hypertension d. Visual changes
- reverse isolation
- low bacteria diet 4. What other information must the nurse provide to the patient taking
anemia the nitroglycerin?
- iron, B-12, folic acid rich food a. Keep the tablet in a clear container
- provide rest periods b. Take the tablet with meals
bleeding c. Continue to take as many tablets of nitroglycerin until chest
- avoid NSAIDs pain subsides
- minimize invasive procedures d. A burning sensation under the tongue is expected
- use soft toothbrush and electric razor
menstrual changes
- reassure that menstruation will resume.
5. The nurse applies the ordered nitroglycerin ointment on the patient’s
THE END chest wall. Which nursing action is considered inappropriate?
REVIEW QUESTIONS a. The nurse chooses a hairless area
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b. She spreads the ointment with her fingers 10. After administering a blood-pressure lowing agent, the nurse must
c. She removes the ointment on the skin from the previous dose caution the patient:
d. She rotates the sites of ointment application a. To avoid straining during defecation
b. To avoid low-sodium and potassium diet
6. The nurse gives which of the following discharge instructions to this c. To avoid abrupt change of positions
patient with angina regarding nitroglycerin therapy? d. To take warm shower immediately after taking the drug
a. Only take the nitroglycerin as desired
b. The drug should be taken before engaging in exertional 11. The nurse prepares to give a diet appropriate for a hypertensive
activities patient. Which food should the nurse include in the menu?
c. The tablet should be taken only in the morning a. Canned meat loaf
d. If the drug does not relieve the pain, increase the frequency of b. Scallops and shrimps
the dose c. Fresh citrus juice and cake
d. Butter and pork steaks
7. Hero asked the nurse what he could do about his concern about sex
activity. The nurse best suggests: 12. If the physician orders Captopril as the home medication for the high
a. Tell him to avoid sex for several months while his heart is on BP, the nurse must caution that the side-effect of this drug that is
therapy disturbing is:
b. Suggests that his wife assume the top position a. Rashes
c. Tell him to avoid sex on days when he is anxious b. Cough
d. Advise that he should have sex only once a month c. Pruritus
d. Ringing of the ears
8. The nurse understands that her discharge teaching is effective
regarding life style modification when the patient says: 13. If the client is discharged with home medication of Propranolol
a. “I know that I will need to eat less, so I will eat once a day only” hydrochloride, the nurse must include in her medication-teaching plan
b. “I will stay on bed most of the time so I wont experience chest which one?
pain” a. Take the medication on an empty stomach
c. “I will stop what I’m doing whenever I have pain and take the b. Obtain blood pressure readings regularly
pill” c. Perform active exercises to prevent Hypotension
d. “I need to enroll in a gym class to have a vigorous exercise to d. Caution to avoid hazardous activities after taking the drug
condition my heart” 14. The nurse determines that the following drugs are calcium channel
blockers that can be prescribed by the physician to the patient. One is
SITUATION: Manny is admitted to the medical ward with the diagnosis not included:
of essential hypertension. He had hypertensive emergency 2 hours ago a. Nifedipine
and was hospitalized for further observation. b. Verapamil
9. The nurse administers prescribed anti-hypertensive meds. If it can be c. Telmisartan
any of the following, she will check the pulse prior to giving: d. Diltiazem
a. Nifedipine
b. Metoprolol SITUATION: Joseph,, 50 y.o. Businessman awakens in the middle of the
c. Clonidine night with dyspnea, bilateral basilar rales and frothy sputum. He is
d. Captopril brought to the Mulawin hospital. His diagnosis is congestive heart
failure.
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15. The physician gives the patient furosemide and digoxin. The nurse’s d. Flavored gelatin and iced tea
main concern is to:
a. Take the central venous pressure reading 21. The nurse obtains an apical pulse of 78 beats/min. She is bringing the
b. Observe for decrease edema next dose of digoxin and then proceeds to do which one action below?
c. Observe for signs and symptoms of hypokalemia a. Withhold the drug and notify the physician
d. Force fluids b. Start IV infusion of Digibind (digoxin antibody)
c. Instruct patient to consume more meat and nuts
16. The mechanism of action of dioxin that makes it useful in patients with d. Administer the drug
CHF is that it:
a. Produces a negative inotropic effect SITUATION: Armida, an 18-year-old adolescent is seen in the health
b. Increases cardiac conduction center because of easy fatigability and frequent dizziness
c. Enhances cardiac contractility 22. The health center physician determines that she has iron-deficiency
d. Increases the heart rate anemia. The nurse will anticipate the doctor to order for:
a. Bone marrow aspiration
17. The nurse is very vigilant about digoxin overdose. Which one statement b. Hemoglobin level determination
below by the patient may alert the nurse of a possible development of c. Platelet count
toxicity? d. BUN and Creatinine
a. “Nurse, I don’t feel like eating for the past few days” 23. A drug is administered to correct anemia, such as an iron. This drug is
b. “I am having constipation lately” classified as:
c. “I am developing a nagging cough and night terrors” a. Antihelminthic
d. “I am experiencing dryness of the eyes and sandy sensation” b. Anticoagulant
c. Hematinic
18. The nurse evaluates that the drug digoxin is effective when the patient d. Antihistaminic
manifests:
a. Decreased bowel sounds 24. The nurse administers the oral iron tablet. She will give the medication:
b. Increased urine output a. With milk and dairy products
c. Increased drowsiness b. With antacids to minimize gastric upset
d. Decreased sympathetic response of the body c. With fruit juices like calamansi and orange
d. With a full glass of coffee or tea
19. The following manifestations must be assessed by the nurse to detect
beginning digitalis toxicity, with the exception of: 25. The nurse instructs the patient to eat iron-rich foods. She determines
a. Nausea and vomiting that her teaching is effective when the client will choose:
b. Palpitations a. Pomelo juice and hamburger
c. Diplopia and visual yellow-green halos b. Gelatin and marshmallows
d. Hypertension c. Lean meat and buttered corn
d. Liver and eggyolk
20. The nurse instructs the patient on diet modification during digitalis
therapy. She is certain that her teaching is effective when the patient 26. The doctor decides to order Iron dextran one ampoule. The nurse
will choose all the foods items below, except: prepares to administer the drug:
a. Fresh orange juice and potato fries a. Intravenously. Slow IV push
b. Dried mangoes and tomato juice b. Intamuscular, Z-track method
c. Broccoli salad with bean sprouts c. Subcutaneous
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DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM 34. When the nurse is monitoring the patient for heparin overdose, she is
SITUATION: Mrs. Rosalinda Amor, 23 year-old actress is admitted observing for the following signs/symptoms, except?
because of a diagnosis of deep vein thrombosis. a. Ecchymoses
29. The nurse employs which of the following non-pharmacological b. Positive Homan’s sign
measures in caring for Mrs. Amor? c. Dark, cola-colored urine
a. Ice compress over the involved leg TID d. Epistaxis
b. Elevate the legs with a pillow
c. Maintain on strict bed rest with minimal bathroom privileges 35. Which one effect of heparin therapy will cause nursing concern?
d. Massage the involved area a. Thrombocytopenia
b. Constipation
30. The physician orders Heparin sodium for Mrs. Amor. The nurse c. Bone marrow depression
understands the reason for this therapy is that: d. Dizziness
a. Heparin will dissolve the clots in the inflamed veins to prevent
emobolization 36. In the event of an overdose of heparin injection, the nurse prepares
b. There is a need to prevent further clot formation in the which one antidote for toxicity?
involved vessels a. Phytomenadione
c. Heparin will anticoauglate the blood by inhibiting vitamin K b. Atropine Sulfate
metabolism c. Protamine sulfate
d. The clot formed in the vein must be lysed by activating plasmin, d. Deferoxamine chelators
the action of heparin
37. The doctor switched from standard heparin to low molecular weight
31. If the doctor orders for heparin therapy monitoring, the nurse must heparin injection. The advantage of LMWH over the standard heparin
obtain which laboratory tests from the lab unit? is:
a. Prothrombin time a. The LMWH can be administered IM
b. Clotting time b. The LMWH does not need frequent laboratory monitoring
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The nurse reads the drug order sheet and is most concern to 54. The nurse is administering acetylcysteine nebulization to a patient. It is
consult the physician if he orders: very much important to keep which item below at bedside?
e. Paracetamol a. Scissors
f. Gemfibrozil b. Ambu bag
g. Vitamin supplements c. Suction machine
h. Omeprazole d. Tracheostmy set
e. NG tube
50. The nurse is giving Guaifenesin to a patient. She includes in her
teaching which of the following interventions? 55. After giving diphenhydramine to the patient, the nurse must ensure
a. Warn the patient that extreme drowsiness may occur that the patient understands the teachings below, EXCEPT:
b. Offer a full glass of water a. Refrain from manipulating delicate machines
c. Nausea and vomiting are potential problems alleviated by b. Take sugarless candy in the mouth to relieve dryness
small frequent meals c. Avoid taking the drug with alcohol
d. Suggest to buy a nebulizer machine to be used at home d. Check pulse rate before taking the drug
e. Vitamin ADEK supplements because of impaired absorption e. Manage gastric upset by taking it with food
51. To be able to detect the effectiveness of Salbutamol, the nurse should 56. The nurse watches out for a side-effect associated with intake of
check for: codeine sulfate and provides appropriate intervention, this can be:
a. Blood pressure and CVP readings a. Constipation- provide liberal fluids
b. Urinary output per hour b. Excitement- provide less stimulation
c. Breath sounds c. Tachycardia- administer lidocaine
d. Level of consciousness d. Polyuria- give the drug in the morning
e. Pupillary reflexes e. Tachypnea- position on semi-fowler’s
52. The patient is receiving theophylline capsule OD. The nurse cautions
the patient to avoid foods with components similar to theophyline and
they can be: 57. Terbutaline sulfate is administered to a patient with asthma. If the
a. Sugar and cream patient has another disease, the nurse is most vigilant and cautious if
b. Coffee and chocolate this condition exists:
c. Spinach and broccoli a. Hypothyroidism
d. Beans and aged cheese b. Rheumatoid arthritis
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c. Diabetes mellitus 62. The second generation anti-histamines like cetirizine have the
d. Polycystic ovarian disease advantage over the first generation antihistamines like
e. Emphysema diphenhydramine because second generation antihistamines:
a. Have shorter duration of action that can be reversed rapidly
58. The nurse is administering oxymetazoline nasal decongestant. She b. Have less sedation and anticholinergic properties
includes in her care plan all of the following interventions, EXCEPT? c. Posses less drug sensitivity reactions
a. Instruct the patient to clear the nasal passage of mucus before d. Have a greater safety profile
instilling e. Have less abuse potential
b. Remind patient to keep the head tilted for a few seconds after
administration 63. The nurse cautions the patient taking diphenhydramine (Benadryl) to
c. Advise increased fluid intake expect all of the following side effects, except?
d. Encourage the use for one week for better effect a. Dry mouth
e. Caution that tachycardia and urinary retention may occur with b. Blurred vision
systemic absorption c. Urinary frequency
d. Drowsiness
59. The physician asks the nurse for an anticholinergic drug to be used for e. Dizziness
the asthmatic patient. The nurse obtains from the pharmacy which
drug? 64. The nurse must remember to administer theophylline slowly or with an
a. Albuterol infusion pump because this drug, if given rapidly can cause:
b. Terbutaline a. Increased alertness
c. Metaproterenol b. Severe hypotension
d. Ipratropium bromide c. Tachycardia
e. Salbutamol d. Pallor
e. Headache
60. The physician orders dextromethorphan for a patient who is
complaining of very uncomfortable coughing. The nurse understands
that this drug acts to suppress cough by:
a. Increasing the secretions of the bronchial glands
b. Removing the irritation from the respiratory tract
c. Inhibiting the medulla oblongata cough center
d. Inhibiting the stretch receptors in the lungs
e. Triggering the vagal responses