NURS 2474 Exam 2 NCLEX Study Guide 2023 A+ Success Guaranteed, Exams of Nursing

Download NURS 2474 Exam 2 NCLEX Study Guide 2023 A+ Success Guaranteed and more Exams Nursing in PDF only on Docsity! NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED General tips for studying: 1. Memorize names of medication categories from the presentation 2. Memorize key drugs from categories above (there are many questions with specific drug names) 3. Use generic names 4. When reviewing particular drugs note category, indications, common side effects, toxicity signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or antagonizing which receptors) 5. Read question instructions (there will be ‘select all that apply’ questions) Topics to review: 1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.). a. For any patient prescribed an inhaler, the RN should ensure the client can self administer the medication. i. Teach back needed b. The patient should wait 1-2 minutes between puffs c. The patient should wait 5 minutes between 2 different inhalers d. The patient should take a bronchodilator before a corticosteroid medication (B before C) e. The patient must keep track of doses on their inhaler f. If opening a new inhaler, the patient should shake it and test before use. g. If dexterity is limited, a spacer can be used to get more medication in the airway. h. If the patient uses a steroid, they must wash their mouth out after use. i. If not, fungal infection may occur i. The patient should hold breath 10 seconds after receiving a puff. 2. Know the difference between short and long term treatments for asthma and COPD a. Short term asthma treatment: i. Bronchodilator: albuterol 1. Acts as a rescue inhaler during asthma attacks. 2. Onset is in 5 minutes and will last longer. ii. Xanthine Derivatives: theophylline 1. Dilates airways 2. Can have high drug interactions in the body iii. IV/ inhaled glucocorticoids. NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED b. Long term asthma treatment: i. Bronchodilator: salmeterol. 1. Used to control symptoms of asthma 2. Never is used alone (often with steroid) ii. Anticholinergics: ipratropium bromide 1. For long term asthma prevention 2. Works very slowly. 3. Fast onset, short duration * Tiotropium has longer duration that Ipratropium iii. Corticosteroids: fluticasone or Budesonide 1. Non bronchodilation 2. Can take several weeks to show c. COPD treatment: i. Bronchodilator- short acting albuterol ii. Steroid iii. Must keep o2 saturation between 88-92% 3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what is for long term management) a. Rescue inhalers: albuterol, epinephrine, metaproterenol, IV steroid b. Long term: salmeterol, ipratropium, theophylline, montelukast ,fluticasone 4. Treatment of acute asthma a. Oxygen use b. Short acting bronchodilator- albuterol c. Corticosteroid- ipratropium bromide IV d. Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction. 5. Administration of bronchodilator (MOA,SE,Considerations) a. MOA: mimics the sympathetic NS and opens up the lungs and stimulates beta receptors b. Fast acting: used for acute asthma relief, Long acting is for chronic asthma management and COPD c. AE: tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia. d. Considerations: ensure patient takes medication as prescribed and does not overuse short acting bronchodilator. Never use it alone with asthma treatment. 6. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt. education) a. MOA: works to stop the inflammatory process in the lungs, preventing bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting substances, increases bronchial smooth muscle beta adrenergic stimulation. b. Inhaled: used for asthma and is the most tolerated and fast acting, but can also be IV for systemic effects on the body. c. AE: throat and mouth irritation, dry mouth, oral fungal infections. d. Must be used with another drug for asthma control. e. Nursing interventions: must teach patients to rinse mouth out after steroid use to prevent oral fungal infections, take bronchodilator 5 mins before steroid. 7. Tiotropium administration, onset, and therapeutic level timeframes NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED a. Opiates work to decrease bowel motility and reduce pain by relief of muscle spasms. They also decrease transit time of stool through the bowel, allowing more time for water and electrolytes to be absorbed. b. Used for patients with frequent diarrhea, to decrease stool in ileostomy and decrease diarrhea from opioid withdrawal. c. If a patient takes too much of an opiate due to its dependent effects, a patient may experience s/s similar to morphine and may cause an increased constipation. The patient will need naloxone to help reverse this cause. 18. Senna side effects a. Senna is a stimulant of the intestines and works to increase peristalsis via intestinal nerve stimulation. b. A big side effect of Senna use is that the patient may have a yellow/brown or pink color to the urine that is harmless. 19. Stool softeners and surgical patients a. Stool softeners will help the stool pass easier through the hypoactive bowel. It will not stimulate bowel activity. b. Will help with post surgical constipation. 20. Ondansetron side effects a. Ondansteron is a serotonin agonist that blocks receptors located in the vagal nerve, GI tract, and chemoreceptor trigger zones in the CNS. b. Used to treat CINV, prevention of post-op nausea and vomiting. c. Side Effects: HA, diarrhea, dizziness, prolonged QT interval, risk of torsades de pointes. 21. Concurrent use of Digoxin and Furosemide (monitoring, interactions) a. Furosemide, a loop diuretic, causes excretion of both sodium and potassium from the body. b. A patient taking digoxin is at risk for having a life threatening arrhythmia due to low potassium levels. c. Nausea and vomiting may also play into the role of having hypokalemia. d. Because of this interaction, the patient should cease use of furosemide and use a potassium sparing diuretic that will hold onto potassium. e. We must monitor digoxin levels, potassium levels, telemetry, and advise the client to eat foods rich in potassium or a supplement to increase potassium in the body if needed. 22. Potassium wasting vs potassium sparing diuretic use (specific med examples from each) a. Potassium wasting diuretic is Loop Diuretic or Thiazide diuretic. i. These drugs work to block absorption of Na, K ,Cl and water. ii. Causes rapid diuresis. iii. Treats: HF, Hypertension, edema, renal disease, liver failure. iv. AE: hypotension ,dehydration, hyponatremia, hypokalemia, hypochloremia. v. May need K supplements to help maintain normal K levels. b. K sparing diuretic is spironolactone. i. This drug works to block absorption of Na and water, and causes the body to hold onto K. ii. Makes Na and water become excreted from the body, K is held on. iii. Used for hypertension and HF NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED iv. AE:hypotension, hyperkalemia (the person holds onto more potassium), drowsiness, metabolic acidosis, gynecomastia, breast tenderness, irregular menstrual cycle, impotence. v. We must monitor ECG so we can assess for arrhythmia related to high K levels, no salt substitutes should be used. 23. Concurrent use of Furosemide and gentamicin a. Furosemide is a diuretic that is ototoxic b. Gentamicin is an antibiotic that is also ototoxic. c. Must have caution when taking these drugs together. d. Teach patients to recognize tinnitus and report it to HCP if taking these 2 medications. 24. Angioedema (common meds that cause it, interventions) a. Angioedema is an adverse effect with ACE inhibitors and A2RB use. b. S/S: facial and tongue swelling. Can be fatal. c. Can be treated with epinephrine for initial reaction. d. The patient with angioedema must discontinue ACE inhibitors or A2RB drugs and never use them again. 25. ACE inhibitors and coughing (interventions) a. A side effect with ACE inhibitor use includes a dry cough. This is due to bradykinin being at increased levels. b. If a patient does not like coughing, we must notify HCP and switch the patient to another medication. 26. ACE inhibitors side effects and patient education a. SE: 1st dose hypotension, dry cough, angioedema, hyperkalemia, fetal injury. b. Education: i. Change positions slowly due to 1st dose hypotension. ii. Teach about relief methods for dry cough like sucking on hard candy or cough drop. However, if they cannot handle the medication because of a cough, they must notify the provider to switch medication. iii. Teach about s/s of angioedema and what to report to the provider. The patient will not take ACE drugs again if this occurs. iv. Educate patients to avoid foods high in potassium. They also must avoid salt substitutes as they are full of potassium. v. For fetal harm, they should notify HCP if they are pregnant or plan to be pregnant while on the medication. vi. Will interact with K sparing diuretics and cause even more increased levels of potassium, so must educate patients to not take spironolactone. 27. Nifedipine and metoprolol concurrent use (review why and who needs it) a. Nifedipine works on the blood vessels, causing dilation. However, a response that may occur is reflex tachycardia. This response may cause more pain in those with angina. b. Because of this, one may use a beta blocker like metoprolol to prevent reflex tachycardia. 28. Beta blockers mechanism of action, SE, contraindications a. MOA: beta blockers bind to beta 1 and 2 receptors and block responses. NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED i. This causes decreased HR, decreased contractility, decreased cardiac output, decreased SA to AV node conduction. It also decreases peripheral resistance and decreases renin release. b. Indicated for those with hypertension, angina, PSVT, HF, cardioprotection, migraines, anxiety. c. SE: low HR, AV block slowed conduction, bronchoconstriction and bronchospasm, hypoglycemia, orthostatic hypotension, impotence, depression. d. Do not use it with patients who have heart lock or bradycardia, COPD or asthma. e. May prevent reflex tachycardia with Nifedipine 29. CCB all things a. Calcium channel blockers work in 2 ways. i. On the heart- vascular smooth muscle and heart- verapamil and diltiazem ii. On the vessels- only smooth muscle- nifedipine. b. Calcium channel blockers work to block calcium channels in smooth muscle, causing vasodilation, block calcium channels in myocardium, decrease contraction and HR and conduction, decrease afterload, increasing perfusion. c. Treats: hypertension, angina, SVT, Afib, aflutter. d. AE: hypotension, reflex tachycardia- use metoprolol, dizziness, peripheral edema, gingival hyperplasia e. Must monitor BP and HR and hold the med if apical HR is higher than 100 and SBP is less than 90, change positions slowly, monitor weight, give regular oral care. f. NO GRAPEFRUIT JUICE! 30. Treatment of HTN in diabetes a. In patients who are diabetic and hypertensive, the target BP is the same as the population (less than 120/80). b. Preferred drugs are ACE,A2RB,CCB, low dose diuretics. c. Some of the medications may suppress glycemic index and cause hypo/hyperglycemia. d. Use diuretics with care. 31. Furosemide indications (side effects, toxic effects) a. Indications :HF ,Hypertension, pulmonary edema, edematous states b. SE: hypotension, dehydration, hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia c. Can be ototoxic- s/s of tinnitus, hearing loss. d. Hypokalemia may occur, we must monitor ECG and give K supplements and food. e. Interacts with digoxin- causing lowered potassium levels, lithium will increase, antihypertensives will be additives and cause more hypotension. 32. Digoxin therapeutic levels (specific number!) and potassium, how to give digoxin a. Therapeutic level is 0.5-2.0 b. K level 3.5-5, Digoxin can cause arrhythmias if used with medications that rid potassium. If one has low K levels, arrhythmia may occur. c. To give: assess vitals first and potassium levels, obtain apical heart rate for 60 seconds. Will hold drugs if HR is less than 60 and the BP less than 90/60. d. Digoxin toxicity i. S/S: NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED b. See above 43. Heparin monitoring lab (know levels), VS in bleeding patient, antidote for Heparin a. Heparin works to inhibit action or formation of clotting factors, preventing a clot from forming. They have no direct effect on a blood clot that is already formed. b. Used for procedures where anticoagulation is required, PE, strokes, DVT, open heart surgery, renal dialysis, DIC. c. 2 forms: Unfractionated- IV drips, or Low Molecular Weight d. AE: Hemorrhage, Heparin Induced Thrombocytopenia, Allergic reactions. e. Monitor for bleeding, low platelet or WBC counts, blood levels of drug. f. Administration: IV pump, SUBQ injection. g. Labs: aPTT 60-80. i. Less than 60= increase the dose ii. Greater than 80= decrease the dose h. Antidote: protamine sulfate i. VS Bleeding patient: low BP, high HR, high RR 44. Warfarin therapeutic levels, lab values, antidote (signs of bleeding as well) a. Warfarin is used for inhibiting clotting factors and to prevent DVTs long term. b. Works long term and effect may take 3-4 days to work (long half life). i. Have to hold 5 days prior to surgery c. AE: hemorrhage, teratogenesis during pregnancy, purple toes. d. Administration: PO, in the evening, same time each day, with or without food. e. Monitor: PT/INR: PT= 18-24, INR 2-3, bleeding i. INR less than 2= increase dose, greater than 3= decrease dose. f. Interactions: any drug to increase anticoagulant effects (blood thinners), drugs that promote bleeding, decrease anticoagulant effects, heparin, aspirin, acetaminophen. g. Antidote: Vitamin K h. Foods rich in vitamin K are mayo, canola oil, soybean oil, and green leafy vegetables. 45. Heparin vs Warfarin mechanism of action a. Heparin works to inhibit action or formation of clotting factors, preventing a clot from forming. They have no direct effect on a blood clot that is already formed. b. Warfarin is used for inhibiting clotting factors and to prevent DVTs long term. 46. Iron therapy and side effects, patient education a. Iron Therapy is used when a patient has low iron levels, is not getting enough iron from the diet, pregnancy, or is bleeding someplace. b. Many different forms: Iron Salts, Iron Dextran, SFGC, Iron Sucrose, etc. c. AE :GI effects, staining of the teeth. d. Toxicity: N,V,D,shock, acidosis, gastric necrosis, hepatic failure, Pulmonary edema, vasomotor collapse. e. Interacts with antacids, tetracycline, ascorbic acids. i. Must take antacids and Iron 1 hr apart. f. Administer iron with a filter in a large IV. g. Teach patients to expect the iron solution to be black and thick, teach about the potential to have black stool with iron infusion. NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED 47. Lab values to monitor for bleeding, anemia a. Bleeding: i. VS: low BP, high HR and RR ii. RBCs= lower than 4.7 iii. Hemoglobin is lower than 12 iv. Hematocrit is higher than 52% b. Anemia is based on various causes, but after it is due to having small, pale RBCs. i. May need more of a certain vitamin component. ii. Maybe hemolysis also. 48. Filgrastim side effects a. Fligastrim is a medication used to stimulate WBC production. b. It reduces severe neutropenia and reduces need for infection, hospitalization and IV abx. c. Used often with cancer patients due to immune suppression. d. AE: Bone pain, leukocytosis (due to large stimulation). i. If AE occurs, you may need to give acetaminophen or decrease dosage. 49. Dabigatran administration, side effects and patient education a. Dabigatran is a direct thrombin inhibitor that directly prevents clots from forming. b. Treats :A fib, prevents VTE follow surgery and prevents DVT/PE. c. AE: bleeding, dyspepsia. d. Administration: with or without food, PO. e. Nursing consideration: does not monitor anticoagulation, little risk of adverse events, same dose can be used for all patients regardless of age or weight. f. There is NO ANTIDOTE for bleeding related to medication. 50. Rivaroxaban and bleeding precautions a. Rivaroxaban is an oral anticoagulant that causes inhibition of factor Xa. b. It works fast, has fixed dosage, lower bleeding risk, few drug interactions, and no need for monitoring. c. Intended for prevention of DVT/PE, prevention of stroke and PE in AFib patients d. AE: bleeding is the most common adverse effect and can occur at any site. Increased with any drug that impedes hemostasis. e. There is NO KNOWN ANTIDOTE to reverse the drug- must use activated charcoal. f. S/S bleeding: petechial, ecchymosis, tarry stool, coffee ground emesis, bleeding out of unusual places, hematuria, tachycardia, hypotension. g. Bleeding Precautions needed: use soft toothbrush, electric razor, wear good soled shoes, have safe environment, wear medical alert bracelet, do not strain while on toilet, no contact sports, decrease invasiveness of procedures such as needlesticks, blow nose gently, observe for s/s of bleeding 51. Review common lab values (e.g., potassium level) a. K level: 3.5-5 i. If above 5= give K wasting diuretic ii. If lower than 3.5= give K sparing diuretic NURS 2474 EXAM 2 NCLEX STUDY GUIDE 2023 A+ SUCCESS GUARANTEED iii. Assess telemetry with all patients receiving drugs that can alter K levels due to potential for arrhythmias that can be deadly b. Na level: 135-145 c. Kidney labs: must look to see if kidneys are functioning and can tolerate drug effects. i. BUN:7-20 mg/dl ii. Creatine: 0.8-1.4 mg/dl iii. Specific gravity: 1.005 to 1.030 d. RBC: 4.7-6.1 i. Low RBC levels may mean anemia or bleeding someplace e. WBC: 5000-10000 i. Low WBC count means risk for infection ii. High count means there may be active infection f. Platelet: 150000-450000 i. Low platelet level means risk for bleeding g. H/H: 12-18/37-52% h. TG: less than 150 i. HDL: less than 40 i. Must have good physical activity to bring it up. j. LDL: less than 100 k. Digoxin level: 0.5-2.0 l. aPTT: 60-80 i. Less than 60= increase the dose ii. More than 80= decrease the dose m. PT/INR: 18-24, 2-3 i. Less than 2= increase drug dose ii. More than 3= decease drug dose