Hurst Review RN Resource Materials PDF

A Critical Thinking and Application
NCLEX-RN Review
®
HURST
®
R E S O U R C E M AT E R I A L S REVIEW SERVICES
CHAPTER 1 - PHARMACOLOGY
Introduction
Herbal Supplements, Possible Side Effects, and Drug Interactions
Transfusing Blood and Blood Products
Medications by Body System
Analgesic Medications
Antibiotics - Antiinfectives Medications
Antineoplastic Medications
Cardiac Medications
Central Nervous System Medications
Dermatologic Medications
Endocrine Medications
Gastrointestinal Medications
Hematology Medications
Immune System Medications
Men’s and Women’s Health Medications
Renal Medications
Respiratory Medications
Vitamins, Minerals and Electrolytes
CHAPTER 2 - INFECTION CONTROL

Infection Control Chart
Infection Control Precautions
Isolation Precautions Exercise
CHAPTER 3 - MANAGEMENT OF CARE

Five Rights of Delegation and Prioritization/Assignment Principles
Emergency Department Triage Review
Emergency Department Triage Review Answer Key
Disaster Triage Review
CHAPTER 4 - PEDIATRICS
Asthma Handout
Immunizations
Specific Pediatric Heart Defects
Understanding Growth and Development: Infants
Understanding Growth and Development: Toddlers
Understanding Growth and Development: Preschoolers
Understanding Growth and Development: School - Age
Understanding Growth and Development: Adolescents
CHAPTER 5 - MISCELLANEOUS
ABG Interpretation Practice Problems - RN
ABG Interpretation Practice Problems with Answers - RN
12 Cranial Nerves
Critical Thinking Exercises with Answers
ECG Handout
Hurst Lab Values
Maslow’s Hierarchy of Needs
NCLEX® Strategy Questions with Answers - RN
Orthopedic Tips: Crutches, Canes and Walkers
Specific Types of Cancer: An Overview
Signs and Symptoms of Abuse
Types of Shock

Introduction to Pharmacology
Dear New Graduate,
Many of you have requested more pharmacology and we always listen to

your requests…so here it is!!! We want to caution you that there is no way that we
could include all medications nor could you learn all the medications that are on the
market. We want you to base your study on the core content and then incorporate
the medications into that thinking process: i.e. as you study cardiac, go to the cardiac
system medications. Remember, this is all about critical thinking, not memorization.
We have included medications outside the core content for your reference.
You need to determine how prepared you are in pharmacology from your nursing
school education and decide how much time you need to spend in these other areas.
You will note that Women’s Health covers some of the medications covered in
Maternity and Men’s Health covers some concepts in Oncology. Again, don’t spend
too much time in the pharmacology category because there are seven more areas
of the NCLEX® Exam you need to study.
I always get the question about “rounding off” math problems. Well, worry no
more because all the instructions that you need will be on each question. They will
tell you how they want the problem rounded and will even provide you with the
measurements at the end (mg, kg, and mL). You do have to remember to not round
off until the end and then provide the numbers and the decimal point that they
instruct you to use. If you try to write more than numbers in the box, they will stop
you with an error statement. Don’t stress about rounding off, you will be
given all the instructions you need.
Now, here is a MUST…before you take the test, go to www.vue.com/nclex/

and do the Online Tutorial and the online virtual tour of the Pearson Center. This is
going to help you relieve a lot of that anxiety about the computer and what is
going to happen the day of the test.
Go Pass that NCLEX® the first time!!

Herbal Supplements, Possible Side Effects, and Drug Interactions
*It is important to inform your primary healthcare provider about any herbal
supplement you are using. This helps to ensure safe and coordinated care.
Herbal Supplement Possible Side Effect(s) Drug Interactions

Chondroitin Sulfate Diarrhea, constipation, Daily ASA, blood thinners
stomach pain (Coumadin®)
Echinacea Upset stomach, diarrhea, Steroids, other medications
constipation, rash, dizziness that will suppress the
immune system
Ginkgo Upset stomach, diarrhea, ASA, NSAIDS, blood thinners,
HA, bleeding, seizures, clot-busting medications
muscle cramping, dizziness (Ticlid® and Plavix®),
diuretics
Glucosamine Upset stomach, heartburn, Diuretics, insulin
gas, bloating, and diarrhea
Melatonin Fatigue, headache, upset NSAIDS, steroids, anti-anxiety
stomach, depression medications, blood pressure
medication (especially beta
blockers)
Saw Palmetto Upset stomach Asthma medications(inhalers,
and bronchodilators),
hormonal medications
St John’s Wort Upset stomach, dry mouth, Antidepressants, MAOIs, blood
fatigue, dizziness, rash thinners, Digoxin®, birth control
confused/anxious, pills, anticonvulsants and
headache, sunburn easily antiviral drugs, migraine
headache medications, any
medication that will depress the
immune system

Transfusing Blood and Blood Products
Points to Remember
• Blood and Blood products are to be administered by the RN
• Only NS may be used in conjunction with administering blood and blood

products
• Product instructions will be on the packet stating the maximum number of

units that can be administered through a single filte .
• Do not infuse any medication into the client via the blood IV tubing.
• All blood products require a filte .
• Most of the time, blood will be given via a pump.
• Be sure to complete all vital signs and transfusion records. You will need a
set of baseline vital signs before administering the blood.
• You may have a separate flo sheet for administering blood

products. See your facilities policy and procedure manual.
• Each client must have a type and screen and crossmatch in the lab prior to
obtaining a blood product. Each type and screen is only good for 72 hours.
• Verificatio occurs in the blood bank and on the floo . A designated person
in the blood bank verifie with the RN, and the RN verifie with another RN
at the bedside. See your hospital’s policy and procedure manual for specifi
details; however, the following verification must be made: the client’s name,
date of birth, blood bank number, unit number, expiration date of unit of
blood or blood product, blood type and group, primary healthcare provider’s
order.

• Check blood product for any signs of abnormalities.
• You will need a primary healthcare provider’s order to administer

blood or blood products.
• Signed consent form from the client (or the next of kin if the client is
unable to sign the form). It is the primary healthcare provider’s
responsibility to have the consent form signed and to explain to the
client and/or family the need and possible side effects.
• Initially begin infusion slowly and observe client closely especially for
the firs 15 minutes of the infusion. If no reaction is observed,
infusion rate may be increased. The rate will depend on the condition
of the client. You will not want to infuse the blood quickly if you have
a client that is elderly, has any type of heart or kidney condition or
someone very young.
• Infusion of the blood should be started within 30 minutes of receiving

the blood from the blood bank.
• All blood from each unit must be completed within a 4 hour time
frame. If the unit of blood is not completed in a 4 hour time frame
the blood must be discarded.
• Dispose of blood tubing and blood or blood product bag according

to hospital policy.
• Be sure to flus lines after transfusing blood or blood product with

0.9% normal saline.
• Document administration of blood transfusion according to hospital

policy.
Signs of Transfusion Reaction
• Chest pain
• Hives or skin rash
• Hypotension/Hypertension

• Fever
• Chills
• Anxiety
• Wheezing
• Headache or muscle pain with fever
• Flushing
• Back pain
• Dizziness
• Itching
• Urticaria
• Tachycardia

• Tachypnea
• Dyspnea
• GI symptoms: nausea and vomiting

If an adverse reaction occurs you should:
• Discontinue the transfusion IMMEDIATELY.
• Remove blood and blood tubing set.
• Check your facility’s policies and procedure manual. You may

have to return the blood and tubing to the blood bank.
• Start normal saline with new primed tubing at keep vein open
rate.
• Check and document vital signs. Stay with client.
• Notify primary healthcare provider and monitor client closely

for anaphylaxis.
• Notify lab/ blood bank of transfusion reaction.
Potter and Perry, Clinical Nursing Skills and Techniques, 2010

Infusion Nursing Standards of Practice, 2011.
Class: Analgesics/Non-Opioid; Antipyretic
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Acetaminophen Anti-fever drug of choice Liver disease or PO PO: ½ to 1 hr Increased hepatoxicity with
(Tylenol) (DOC) for children and alcohol consumption alcohol
adolescents. Mild to Hypothrombinemia if taken
Warfarin Rectal Rectal: ½ to 1 hr with warfarin
moderate pain, or fever.
Primary alternative to Caution in pregnancy and
NSAIDs breastfeeding
Decreases the effects of
barbiturates
Mechanism of Action
May block pain impulses peripherally and increasing the pain threshold. This causes the body to require a higher degree of pain before the
client feels it. Antipyretic action results from inhibition of prostaglandins in the CNS (Hypothalamic heat regulating center).
Advantages/Disadvantages
Side Effects Adverse Effects
Easy to administer and obtain under many Drowsiness or stimulation, rash Hepatotoxicity (nausea, upper stomach pain,
brand names. Few side effects. or urticaria itching, loss of appetite, dark urine, clay
colored stools or jaundice), GI bleeding,
leukopenia, neutropenia, thrombocytopenia
Nursing Interventions Client Education
Hepatotoxic in large doses. Do not exceed recommended dosage to prevent toxicity.

Monitor renal function: BUN, urine creatinine, occult blood Do not use with alcohol or herbal medication without
Acetaminophen inhibits warfarin metabolism, which can cause warfarin to physician approval.
accumulate to toxic levels. Notify physician if pain and fever last more than 3 days.
Monitor hepatic function tests, ALT, AST, and bilirubin Teach signs and symptoms of Hepatotoxicity (nausea,
Treat overdose with IV or oral N-acetylcysteine (Acetadote), or inhaled or upper stomach pain, itching, loss of appetite, dark urine,
oral acetylcysteine (Mucomyst) clay colored stools or jaundice)
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: NSAID
Ketorolac (Toradol) MIld to Pregnancy Intranasal Increase toxicity with
Ibuprofen (Advil, moderate pain Hypersensitivity PO 30-60 minutes methotrexate, lithium.
Motrin), Naproxen Asthma IM 30 minutes Increase bleeding risk with
anticoagulants, salicylates,
sodium (Anaprox, Hepatic disease IV 10 minutes
thrombolytics, SSRIs.
Aleve), Meloxicam Peptic ulcer disease Increase renal impairment with
(Mobic) ACE inhibitors.
Mechanism of Action
Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis. Anti-inflammator , antipyretic effects.
Dizziness Drowsiness Seizures

Tremors Headache MI
Tinnitus Blurred vision Stroke
Nausea/vomiting Anorexia GI bleeding
Diarrhea Constipation Hepatic failure
Flatulence Cramps Nephrotoxicity
Dry mouth Hematuria
Angioedema
IM injection deeply and slowly in large muscle mass. Report blurred vision, tinnitus as toxicity may occurring
Monitor for signs of bleeding. Avoid driving, other hazardous activities if dizziness/drowsiness occurs
Monitor for hepatic dysfunction Avoid alcohol, salicylates, other NSAIDS
Discard nasal bottle within 24 hours of opening.
Class: Opioids
Hydromorphone Moderate to severe GI obstruction PO Varies Increases effect with
(Dilaudid), Morphine pain. May mask IM 15-30 min alcohol, tranquilizers,
Cancer pain antidepressants, kava
sulfate, Oxycodone, Gallbladder pain. IV Rapid
Morphine: DOC - MI
Hydrocodone, Fentanyl kava, St. John’s wort.
(Duragesic), Tramadol
(Ultram)
Mechanism of Action
Binds with the opiate receptor in the central nervous system. Suppresses pain impulses as well as respiration and coughing by
acting on the respiratory and cough centers of the medulla of the brainstem.
Gold standard for cancer pain. Constipation Respiratory depression

There is no ceiling on the dose of an opioid Sleepiness Orthostatic hypotension
for a cancer client. It is client dependent. Nausea/Vomiting Increased intracranial pressure
May need larger doses to relieve increasing Itching
pain to overcome drug tolerance. But the Confusion
medication is not withheld with cancer pain. Anorexia
Administer before pain reaches its peak to maximize effectiveness. Do not crush extended release tablets.
Monitor vital signs for signs of hypotension and respiratory depression. Drink 8-10 (8 ounce) glasses of fluid each da .
I&O Eat foods high in fiber or oughage.
Check bowel sounds for decreased peristalsis.
Have naloxone (Narcan) available for overdose.
Class: Salicylate - Mild Analgesic
Acetylsalicylic Acid Platelet aggregation Sensitivity PO 30 minutes Do not take with
(Aspirin) to reduce risk of MI, GI Bleeding other NSAIDS as it will
strokes. decrease blood level and
Vitamin K deficienc Rectal Rectal - erratic
Mild to moderate effectiveness of NSAID.
pain relief, especially Cerebral hemorrhage
Coumadin taken with ASA
associated with will increase anticoagulant
inflamma ion. levels.
Mechanism of Action
Keeps the blood flowing because he platelets don’t stick together, so more blood flow and oxygen get to he heart muscle. This
leads to less pain. Inhibits prostaglandins to decrease inflamma ion and pain.
Inexpensive, readily available. GI distress GI bleeding

Indicated in initial treatment for clients Ulcer
suffering from acute ischemic stroke who
are not candidates for fibrinoly ic therapy
Administer chewable tablet 160-325 mg orally at onset of chest pain Take with food, milk or water to decrease GI upset.
for quick absorption. Enteric coated can decrease gastric distress.
Observe for signs of bleeding Do not crush enteric coated tablets.
Do not give to children with the flu or virus
Do not take with alcohol.
Class: Aminoglycosides
Tobramycin (Nebcin), Serious gram (-) Renal disease Neomycin – Increased risk of
Gentamycin (Garamycin), infections Hearing impairment PO, topical ototoxicity with loop
Given parenterally for diuretics.
Neomycin, Amikacin Pregnancy
systemic use. Increased risk of
(Amikin),
*Generally restricted PO nephrotoxicity with
Streptomycin* to TB treatment. IM, IV Rapid furosemide.
Mechanism of Action
Interferes with protein synthesis in bacterial cells.

Confusion Depression, Seizures

Numbness Vertigo Ototoxicity
Nausea/Vomiting Nephrotoxicity
Can cause irreversible ototoxicity and Renal failure
nephrotoxicity. Anaphylaxis
Poorly absorbed from the GI tract.
Baseline hearing test recommended
Monitor peak and trough levels. Teach to report headache or dizziness.

Monitor BUN and Creatinine levels. Drink adequate fluids
Increase fluids to 1500-2000 mL per da .
I&O
Daily weight
Reference: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Class: Antibacterial/Antiprotozoal
Metronidazole (Flagyl) H-pylori/GI tract Hypersensitivity PO 2 hours Avoid alcohol and alcohol
disorders Pregnancy IV Rapid containing medications
UTI for at least 48 hours after
Hepatic disease Topical
Septicemia treatment complete.
Meningitis
Mechanism of Action
Impairs DNA function of susceptible bacteria

Dual action on bacteria and protozoa Dark/reddish brown urine Thrombophlebitis

(parasites). Nausea/vomiting Bone marrow suppression
Metallic or bitter taste Neurotoxicity
Headache Dizziness
Depression Irritability
Insomnia
Monitor urine output and color changes DO NOT use alcohol or medications with alcohol for 48
Assess ECG and neuro changes during medication administration hours after treatment complete.
Proper handwashing and hygiene after bowel cleansing. Teach that urine may turn dark/reddish brown in color
May have metallic or bitter taste in mouth
Use proper hygiene with bowel movements and cleansing
Class: Antibiotics: Vancomycin
Vancomycin (Vancocin) DOC for MRSA Hypersensitivity PO Interacts with some
Cellulitis Pregnancy IV Rapid vitamins and herbal
Bone infections products. Avoid use
Renal disease
Colitis when on Amikacin,
Meningitis gentamicin or
streptomycin.
Mechanism of Action
It works by killing bacteria or preventing bacterial growth. Best for severe Gram + infections
Dry mouth Muscles cramps Blloody urine - Nephrotoxicity

Diarrhea Nausea/vomiting Loss of hearing - Ototoxicity
Abdominal cramping Anaphylaxis
Headache Flushing
Hypotension Tachycardia
Monitor peak and trough levels. Teach to report headache or dizziness.

Infuse over at least 60 minutes on an infusion pump. Drink adequate fluids
Monitor BUN and Creatinine levels. Report bloody urine or dizziness, ringing in the ears or loss
Increase fluids to 1500-2000 mL per da . of hearing.
I&O, Daily weight
Baseline hearing test recommended
Class: Antihelminthics
Mebendazole (Vermox) Parasites: pinworms, Pregnancy PO <24 hours Effectiveness
Ivermectin (Stromectol) tapeworms, Children < 2 years decreased by some
Pyrantel pamoate (Pin-X) hookworms, anticonvulsants.
roundworms Increased absorption
Trichinosis with high fat meal.
Mechanism of Action
Inhibits glucose uptake and degeneration of microtubules in the cell: parasite dies and is excreted.
Treament is easy and usually well tolerated Diarrhea Abdominal pain Seizures (rare)
by all requiring medication. Nausea/vomiting Intestinal blockage as parasited die
Dizziness Headache
Entire family and close contacts must be treated to prevent reinfestation Teach proper hygiene and cleansing of clothes and
Proper handwashing and hygiene with bowel movements linens to prevent reinfestation.
Monitor stools for presence of worms/parasites Infected person should sleep alone until treatment
Monitor CBC, BUN, Creatinie and liver enzymes during treatment complete.
Teach to wear shoes when out doors
Teach proper cleansing of fresh fruits and vegetables
Class: Antivirals: HIV
Zidovudine or AZT HIV/AIDS Hypersensitivity PO 30-60 minutes Bone marrow
(Retrovir) Pregnancy IV Rapid depression with
Unlabeled uses: antineoplastics.
Epstein-Barr virus Decreased platelets
Hepatitis B and granulocytes
Mechanism of Action
Inhibit viral replication and prevents synthesis of DNA of the HIV virus
Nausea/vomiting Diarrhea Seizures

Anorexia Flatulence Hepatomegaly
Rash Flushing Anemia/Granulocytopenia
Does not cure AIDS but will control Headache Dizziness Anaphylaxis
symptoms: compliance with treatment Dyspepsia Insomnia
required.
Monitor Vital signs and signs of bleeding problems Teach that GI complaints and insomnia resolve after 3-4
Monitor CBC, BUN and creatinine closely weeks of treatment.
Report symptoms of suprainfections
Teach to not take with OTC products like Tylenol or aspirin.
Class: Broad Spectrum Antibiotics: Clindamycin
Clindamycin (Cleocin) Oral/Skin Infections Hypersensitivity PO Blocked by
Pregnancy IM erythromycin,
chloramphenicol.
Breast feeding IV
Decreases absorption
Hepatic Disease Topical of kaolin.
Mechanism of Action
Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth.
Can be used to treat MRSA Dry mouth Muscles cramps Pseudomembranous colitis
Diarrhea Nausea/vomiting Stevens-Johson syndrome
Abdominal cramping Exfoliative dermatitis
Headache Flushing Suprainfections
Anorexia Rash
Culture before medication started for accurate results Take with food to reduce GI upset
Monitor Vital signs, urine output and stools Complete entire course of medication
Monitor AST, ALT if on long term therapy Take with full glass of water
Assess for skin reactions frequently Report any symptoms of suprainfections and extreme
diarrhea
Class: Cephalosporins: 4 Generations
1st: cefazolin sodium Septicemia Hypersensitivity PO 24-48 hours Some interact with
(Ancef); cephalexin UTI’s IM Rapid alcohol. Uricosurics
Respiratory infections increase the excretion
(Keflex IV
Skin/bone infections rate of uric acid
2nd: cefaclor (Ceclor)
and can decrease
3rd: cefixime (Suprax); the excretion of
ceftriaxone (Rocephin) cephalosporins
4th: cefepime causing serum level
(Maxipime) increase.
Mechanism of Action
Inhibit bacterial cell-wall synthesis and produce a bactericidal action.

Usually well tolerated when other Nausea/vomiting Diarrhea Increased bleeding

antibiotics cannot be administered Anorexia Flatulence Nephrotoxicity
Rash Flushing Seizures
Frequent cross hypersensitivity to penicillins Headache Dizziness Anaphylaxis
Dyspepsia Leukopenia/Neutropenia
Culture the infected area before medications are started. Keep drugs out of reach of children
Monitor for adverse reactions and/or super infections Report sign of superinfections like mouth ulcers or
anal discharge
Advise use of probiotics when taking medications.
Take medications with food if GI upset occurs.
Class: Fluoroquinolones
Ciprofloxacin Broad spectrum Hypersensitivity PO Rapid Antacids, minerals and multivitamins
(Cipro,Septra) antibiotic Pregnancy IV interfere with absorption.
Anthrax Concurrent use with amiodarone,
Gatifloxacin ( equin, Infants and young Topical disopyramide. Erythromycin,
Respiratory infections
Zymar)
Cystic Fibrosis children some antipsychotics and tricyclic
Levofloxacin (Levaquin antidepressants increases risk of
Moxifloxacin ( velox) torsade de pointes in susceptible
individuals. Concurrent use with
corticosteroids may increase risk of
tendon rupture.
Mechanism of Action
Prevention of bacterial DNA from duplication.

Used in the treatment of infectious Diarrhea Nausea/vomiting, Suprainfection Phototoxicity

diseases in adults. Abdominal pain Cardiotoxicity
Dizziness Drowsiness Tendon/joint toxicity (associated with a small risk of
Sleep problems Headache tendon rupture
Monitor I&O Take with a full glass of water. Do not take on an empty stomach.
Monitor BUN and creatinine levels Notify primary healthcare provider of swelling of the face and
Store medication away from heat, moisture, and direct sunlight throat, swallowing problems, shortness of breath, rapid heartbeat,
tingling of fingers or toes, itching or hives.
Stop taking the medicine immediately if swelling in tendon occurs.
Avoid being in direct sunlight and use a sunscreen; do not use
tanning beds.
Do not take antacids that contain aluminum, calcium or magnesium
Class: Macrolides
Azithromycin (Z-Pak, Broad-spectrum Hepatic disease PO 24 hours Increases the plasma levels of
Zithromax) Antibiotic for Hypersensitivity IM Rapid theophylline, carbamazepine,
Pneumonia, pertussis, and warfarin. Conversely,
Clarithromycin (Biaxin) IV
diphtheria, chlamydia, plasma levels of erythromycin
Erythromycin (Erythrocin)
Group A strep Topical
can be reduced when used
infections. with verapamil, diltiazem,
HIV protease inhibitors
and azole antifungal
drugs. Contraindicated
with astemizole, cisapride,
pimozide or terfenadine.
Mechanism of Action
Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth and replication but do not
cause microbial death.
Good alternative for clients with penicillin Nausea/vomiting Suprainfections Hepatotoxicity

allergies. Diarrhea Dysrhythmias (prolonged Q-T interval)
Abdominal pain Ototoxicity Anaphylaxis
Pseudomembranous colitis
Administer on an empty stomach -destroyed by gastric acids and acidic Notify primary health care provider if prolonged diarrhea
fruit juice. occurs.
For capsule administration, take 1-2 hours before meals.
Direct sunlight (UV) exposure should be minimized during
therapy.
Class: Non-HIV Antivirals
Rimantacine HCL Influenz Hypersensitivity PO Decreases effect of
(Flumadine) Herpes viruses Pregnancy IV Rapid phenytoin. Increases
Cytomegalovirus nephro-neurotoxicity
Oseltamivir phosophate Hepatic disease Topical
(CMV) with aminoglycosides,
(Tamiflu
probenecid and
Acyclovir (Zovirax) interferon.
Mechanism of Action
Inhibit viral replication by interferring with viral cell synthesis

Nausea/vomiting Anorexia Anemia

Diarrhea Headache Crystalluria
Agitation Lethargy Nephrotoxicity
Cannot stop the viral infection but will Rash Pruritis Thrombocytopenia
reduce the severity of symtoms and length Leukopenia
of infection.
Monitor Vital signs and urine output closely Teach proper hydration while taking medications
Monitor CBC, BUN, creatinine and liver enzymes Report changes in urine output or signs of bleeding
Increase fluid intake to 1500-2000 mL per da Report CNS changes and safety related to orthostatic
Assess gums for bleeding hypotension
Class: Penicillin
Ampicillin (Principen), Meningitis Hypersensitivity to PO Rapid Give separately
Amoxicillin (Amoxil, Trimox), Gram (+) infections penicillin IM Rapid from
Respiratory infections aminoglycosides:
Penicillin G (Bicillin), Penicillin V IV Rapid
Endocarditis
(PenVK), Ampicillin/Sulbactam
Septicemia
May inactivate
(Unasyn), Amoxicillin/ Otitis media medication.
Clavulanate (Augmentin), GI infections
Ticarcillin (Ticar), Peperacillin/ GU infections
Tazobactam (Zosyn)
Mechanism of Action
Interferes with cell wall replication of susceptible organisms.

Generally, well tolerated Mild rash Anaphylaxis

Nausea/vomiting Glomerulonephritis
Monitor use in renal clients. Diarrhea Bone marrow depression
5-15% incidence of cross-sensitivity to Stomatitis Leukopenia
Cephalosporins. Vaginitis
Administer with water, not acidic juices. Take medication with plenty of water 1-2 hours before
Administer around the clock on empty stomach for better absorption. meals or 2-3 hours after meals).
I&O Report sore throat, fever, fatigue, diarrhea as they may
Monitor CBC indicate superinfection.
Class: Sulfonamides
Trimethoprim/ UTI’s Hypersensitivity PO 30-60 minutes Risk of
Sulfamethoxazole Ear infections Pregnancy IV Rapid thrombocytopenia
Newborn eye with thiazide diuretics;
(Bactrim, Septra) Topical
prophylaxis hyperkalemia with
Sulfisoxazole (Gantrisin
Respiratory other diuretics
infections
Mechanism of Action
Bacteriostatic - inhibit bacterial synthesis of folic acid which is essential for bacterial growth.
Good for clients with penicillin allergy. Nausea/vomiting Diarrhea Nephrotoxicity

Anorexia Crystalluria Hyperkalemia
Rash Flushing Stevens-Johnson syndrome
Headache Dizziness Anaphylaxis
Dyspepsia Photosensitivity
Increase fluids to 2000-3000 mL per da Drink lots of fluid daily when taking me ications
Assess I&O, BUN and creatinine regularly Take 1 hour before or 2 hours after meals
Monitor Vital signs closely Wear sunglasses and avoid direct sunlight
Assess for early signs of anemia or superinfections Report any excess bruising or bleeding
Class: Tetracyclines
Doxycycline (Vibramycin) Broad spectrum use Hypersensitivity PO 1-2 hours Do not take with antacids
Tetracycline (Sumycin) Respiratory infections Pregnancy IM Rapid or calcium products
Skin infections
Hepatic/Renal disease IV
STD/STI’s
Mechanism of Action
Bacteriostatic and inhibit protein synthesis.

Nausea/vomiting Nephrotoxicity
Diarrhea Hepatotoxicity
Abdominal pain Suprainfections
Stains teeth Anaphylaxis
Color vision changes Severe Photosensitivity
Hyperglycemia
Monitor Vital signs and urine output closely Teach whether medication prescribed should be taken
Monitor liver and renal function lab tests with food or without and time frame for best absorption.
Avoid antacids and calcium products when taking medication Avoid sun and use sunglasses
Do not take with milk products, iron or antacids
Take liquid forms via straw to prevent staining of teeth
Class: Alkylating Agents (Chemotherapy)
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Cyclophosphamide Breast cancer Hypersensitivity PO 7 days Garlic and ginko
(Cytoxan) Leukemia Myelosuppression increase antiplatelet
Lymphoma effect. Echinacea
Pregnancy IV
Hodgkin Disease decreases effects of
Multiple myeloma Liver or kidney disease immunosuppressive drugs.
Ginseng and kava kava
alters bleeding times.
Mechanism of Action
Directly damages DNA (the genetic material in each cell) to keep the cell from reproducing. These drugs work in all phases of the cell cycle.
Especially useful for Hodgins’s disease if Nausea Vomiting Leukemia

resistant to other drug combinations. Diarrhea Weight loss Vesicant: Tissue necrosis
Hematuria Alopecia Hemorrhagic cystitis
Severe vesicant that can cause tissue Impotence Sterility Cardiotoxicity
necrosis if it infi trates into the tissues. Ovarian fib osis Headache Hepatotoxicity
Can cause long term damage to the Dizziness
bone marrow.
Monitor IV site for extravasation: Cold compresses Take medication early in the day to prevent accumulation of
Assess need for IV hydration. The client should be well hydrated drug in the bladder.
(2L/day) to prevent hemorrhagic cystitis. Report signs of infection.
Observe for s/s of hematuria. Do not visit anyone who has a respiratory infection
Monitor BUN and creatinine Emphasize protective precautions.
Avoid direct skin, eye, and mucus membrane contact with drug Rationale for chemotherapy.
Teach importance of birth control while receiving therapy
Class: Anthracyclines (Chemotherapy)
Doxorubicin Breast cancer Pregnancy IV 7-10 days Calcium channel
(Adriamycin) Ovarian cancer Severe cardiac blockers increase risk of
Lung cancer cardiotoxicity.
disease
Bladder cancer Green tea may enhance
Leukemia effects.
Garlic, St John’s wart
may decrease effects of
chemo
Mechanism of Action
These drugs are not like the antibiotics used to treat infections. They work by altering the DNA inside cancer cells to keep them
from growing and multiplying.
anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle.
They are widely used for a variety of cancers.
Stomatitis Anorexia Vesicant

Nausea/Vomiting Esophagitis
Severe cardiotoxic side effects can occur. Diarrhea Thrombocytopenia Anemia
Potent vesicant. Rash Cardiotoxicity CHF
Cannot exceed lifetime dose of 550mg/m2 Alopecia Anaphylaxis
Give through large bore IV needle. Signs/symptoms of cardiac dysfunction

Monitor IV site for extravasation: Apply ice pack. Notify MD. Drug causes urine to turn pink or red
Dexrazoxan IV. Report signs of infection or bleeding
Assess cardiac status. Protective precautions
Do not visit anyone with a respiratory infection
Class: Anti-Estrogens (Hormone Therapy)
Tamoxifen (Nolvadex) Palliative treatment Pregnancy PO Increased risk of
of advanced breast Breastfeeding bleeding with
cancer positive anticoagulants
Hypersensitivity
lymph nodes in
postmenopausal
women
Mechanism of Action
This male hormone (androgen) promotes regression of tumors by competing with estradiol at estrogen receptor sites. Decreases
DNA synthesis. Reduces risk of breast cancer in postmenopausal women.
Prevents tumor recurrence in both Masculine secondary sexual characteristics. Increases risk of developing uterine
pre-menopausal and postmenopausal Hot flashe cancer.
women Irregular menses Stroke
Fatigue Pulmonary embolism
Headaches Thrombocytopenia
Impotence
Decreased interest in sexual activity.
Monitor CBC, platelet count weekly. Avoid use of St. John’s wart, dong qui, black cohosh.
Monitor for allergic reactions. Use nonhormonal contraception during and for 2 months
after discontinuing treatment.
Notify prescriber of signs of stroke.
Increase fluids to 2 iters/day unless contraindicated.
Protect from sun.
Class: Antimetabolites (Chemotherapy)
5-Fluorouracil (5-FU) Leukemias Pregnancy IV 1-9 days Cimetidine increases
(Adrucil), Breast cancer Severe infection effect of F-FU
Ovarian cancer Methotrexate: ASA,
Intestinal tract cancer
Methotrexate IM phenytoin increase
(Rheumatrex) IV toxicity of the drug.
Mechanism of Action
Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells
during the S phase, when the cell’s chromosomes are being copied.
Methotrexate acts as a substitute for folic acid, which is needed for the synthesis of proteins and DNA.
Bone marrow suppression Stomatitis Bone marrow suppression

Nausea/Vomiting Anorexia Thrombocytopenia
Clients receiving methotrexate must
Alopecia Rash Hemorrhage
receive leucovorin calcium to “rescue”
Photosensitivity Erythema Renal failure
normal cells from the adverse effects of
Hematic and renal dysfunction Extravasation
the drug.
Monitor IV site for extravasation: Apply ice pack. Notify MD. Report signs of infection
Avoid direct skin contact with medication. Examine mouth daily/ report signs of stomatitis
Administer antiemetic 30-60 minutes before therapy Do not visit anyone with a respiratory infection
I&O Use sunscreen when outdoors
Monitor blood counts. Encourage mouth rinses every 2 hours with Maintain protective precautions
normal saline Good oral care with soft toothbrush
Encourage small, frequent meals. Encourage cool, bland foods.
Class: Gonadotropin-Releasing Hormone
Leuprolide (Lupron), Advanced Breast Pregnancy IM 1-2 weeks Increased antineoplastic
Goserelin (Zoladex) cancer Breastfeeding SubQ action with megestrol.
Prostate cancer
Black cohosh may interfere
with treatment.
Mechanism of Action
Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Initially an increase in testosterone
levels is seen. However, with continued use the pituitary gland becomes insensitive to this stimulation, leading to a reduction in the production
of androgens and estrogens..
Memory impairment Depression Seizures

Peripheral edema Alopecia MI
Anorexia Diarrhea PE
Hot flashes Impotenc Dysrhythmias
Nausea/vomiting GI bleeding
Assess for increased bone pain. Notify prescriber if menstruation continues – menstruation
Monitor for allergic reaction. should stop.
Bone pain should disappear after 1 week.
Monitor weight. Report weight gain of > 2 lbs (0.9 kg)/day.
How to administer SubQ/IM medication.
Class: Plant Alkaloids - Mitotic Inhibitors (Chemotherapy)
Paclitaxel (Taxol) Breast cancer Pregnancy IV Increased bleeding
Lung cancer Hypersensitivity risk with NSAIDS,
Myelomas anticoagulants
Lymphomas
Leukemias
Mechanism of Action
Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis
in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell
reproduction.
Peripheral neuropathy SVT

Bradycardia Hypotension Neutropenia Leukopenia
Nausea/Vomiting Diarrhea Thrombocytopenia Anemia
These medications can cause nerve Mucositis/stomatitis Tissue necrosis
damage. Alopecia Pulmonary edema
Arthralgia
ECG monitoring. Report signs of infection: fever, sore throat, flu ike
Monitor for hypotension symptoms.
Assess for paresthesias. Report signs of anemia: fatigue, headache, faintness, SOB,
Premedicate with antiemetics. irritability.
VS during first Report bleeding.
Monitor IV site for extravasation: Apply ice pack. Bleeding precautions.
Avoid vaccinations.
Class: Plant Alkaloids - Topoisomerase Inhibitor (Chemotherapy)
Topotecan Leukemia Pregnancy PO Increased bleeding
(Hycamtin), Lung cancer Breastfeeding risk with NSAIDS,
Ovarian cancer anticoagulants,
Irinotecan Bone marrow IV
GI cancer
(Camptosar, CPT-11) depression platelet inhibitors
Mechanism of Action
These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied
during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.)
Alopecia Constipation Leukopenia

Diarrhea Nausea Hypersensitivity
Vomiting Neurotoxicity
Damage peripheral nerve fiber Loss of DTRs
Motor instability Bone marrow suppression
Monitor IV site for extravasation: Apply ice pack. Notify MD. Rinse mouth 3-4 times/day with water; Brush teeth with soft
Assess liver and renal function studies. toothbrush for stomatitis.
Increase fluid intake to 2-3 L/day unless contrain icated. Teach that total alopecia may occur. Hair grows back but is
different in color and texture.
Avoid foods with citric acid or hot and rough texture if
stomatitis is present.
Avoid vaccines, toxoids.
Report signs of anemia: fatigue, headache, faintness, SOB,
irritability.
Class: Platinum Drugs (Chemotherapy)
Cisplatin Advanced bladder Pregnancy IV ASA, NSAIDS, Alcohol
cancer Breastfeeding increase bleeding risk.
Metastatic testicular Bumetanide, furosemide
Preexisting hearing
cancer increase ototoxicity risk.
Metastatic ovarian impairment Loop diuretics increase
cancer Bone marrow suppression nephrotoxicity risk.
Mechanism of Action
Alkylates DNA, RNA; Inhibits enzymes that allow for the synthesis of amino acids in proteins; activity not cell-cycle-phase specific
Less likely to cause leukemia later than Tinnitus Blurred vision Extravasation
alkylating agents. Altered color perception N/V Bone marrow depression
Diarrhea Weight loss Renal toxicity
Extravasation can occur damaging Impotence Amenorrhea Bleeding
tissue Alopecia Ototoxicity Seizures
Monitor IV site for extravasation: Sodium Thiosulfate. Cold Report s/s of infection.
compresses. Report s/s of anemia.
Monitor CBC, platelet count weekly. Hold drug for WBC < 4000 or Report bleeding, bruising, petechiae
platelet <100,000. Bleeding precautions.
Monitor BUN, creatinine. Report decreased urine output/flank pain
Monitor for signs of anaphylaxis. Do not receive vaccinations during treatment
Monitor temperature q4h
Monitor for bleeding.
Increase fluid intake to 2-3 L/d to p event calculi and promote
elimination of medication.
Class: Progestins
Medroxyprogesterone Breast cancer Pregnancy PO
acetate (Depo-Provera), Endometrial Hypersensitivity
Megestrol acetate (Megace) carcinoma
Renal cancer
Stimulate appetite
Mechanism of Action
Act by shrinking the cancer tissues. Thought to bring about cell death
Megace stimulates appetite by unknown action. Mood swings Insomnia Fluid retention
Depression Indigestion Thrombotic disorders
Diarrhea Weight gain
Flatus
Nausea/vomiting
Assess PSA levels in men with prostate cancer. Report vaginal bleeding
Monitor for thrombophlebitis. Teach signs of fluid etention.
Monitor glucose if diabetic.
Class: Selective Estrogen Receptor Modulators (SERMS)
Raloxifen (Evista), Breast cancer Pregnancy PO Decrease action of
Toremifene (Fareston) prophylaxis in Breastfeeding anticoagulants.
postmenopausal
Hypersensitivity
women
Mechanism of Action
Act like antiestrogens to slow tumor growth, but have fewer side effects than tamoxifen.
Fewer side effects than tamoxifen Insomnia Depression Stroke

Hot flashes Peripheral edem Thromboembolism
N/V Diarrhea Pulmonary embolism
Dyspepsia Vaginitis
Weight gain
Bone density test at baseline and throughout treatment. Take calcium supplements, Vitamin D if intake is inadequate.
Increase exercise with weights.
Report fever, acute migraine, emotional distress.
Class: Alpha2-Adrenergic Agonists
Clonidine (Catapres) Hypertension Narrow-angle PO 30 min - 2 hours Do not give with Beta
Methyldopa Management of Glaucoma Blockers – accentuates
opioid withdrawal bradycardia and rebound
(Aldomet) Cardiogenic Shock Transdermal 2-3 days
Dysrhythmias patch hypertension of therapy
(Clonidine) discontinuation.
Mechanism of Action
Decreases the release of norepinephrine from sympathetic nerves and decreases peripheral adrenergic receptor activation.
Produce vasodilation which decreases blood pressure.
Methyldopa can be used in PIH Sedation Orthostatic hypotension

Dizziness Pulmonary edema
Headache Dyspnea
Can cause sodium and water retention. Nausea/Vomiting
Often given with diuretics for this reason. Urinary retention
Dry mouth
Monitor vital signs Do not stop abruptly: rebound hypertension can occur.
Monitor liver enzymes Instruct on how to take BP
I&O
Daily weight
Class: Angiotensin-converting Enzyme (ACE) Inhibitors
Captopril (Capoten), DOC for Heart failure Do not give during PO 1-2 hours Hyperkalemia can result if
Enalapril (Vasotec), Hypertension pregnancy taken in combination with
MI potassium-sparing diuretics
Lisinopril (Zestril, IV 15-30 minutes
Prinivil), or eating salt substitutes.
Moexipril (Univasc),
Ramipril (Altace)
Mechanism of Action
Suppress the Renin Angiotensin System (RAS). Prevents the conversion of Angiotensin I to Angiotensin II. This results in arterial
dilation and increased stroke volume. ACE inhibitors block aldosterone so the client loses sodium and water and retains potassium.
Effective in treating heart failure. Dizziness Angioedema

Hyperkalemia Orthostatic hypotension
African Americans and older adults do Hypermagnesemia
not respond to ACE inhibitors with the Fatigue
desired reduction in blood pressure Headache
without the addition of a diuretic. Dry, nonproductive cough
Monitor BP and HR. Rise slowly from lying or sitting to standing position.
Monitor potassium and magnesium levels. Safety precautions.
Initiate safety precautions. Can be administered with food (EXCEPT: Moexipril)
Do not use salt substitutes with potassium.
Class: Angiotensin II Receptor Blockers (ARBS)
Losartan (Cozaar), Hypertension Pregnancy PO 2 hours MAOIs, alcohol,
Olmesartan (Benicar), Heart Failure diuretics may increase
Valsartan (Diovan) hypotensive effects.
ACE inhibitors and
ASA may increase
hyperkalemia and renal
dysfunction.
Mechanism of Action
Prevent the release of aldosterone. They act on the renin-angiotensin system (RAS). ARBS block angiotensin II from the
angiotensin I receptors found in tissue. Potent vasodilator. Decreases peripheral resistance. Decrease the workload of the heart by
decreasing afterload. This will increase cardiac output and keep blood moving forward out of the heart.
Do not cause the constant, irritating dry Headache Orthostatic hypotension

cough that ACE inhibitors do. Dizziness Hypoglycemia
Drowsiness Hyperkalemia
Less effective for treating hypertension in GI complaints Renal dysfunction
African-American clients. Fatigue Angioedema
Monitor BP and HR. Rise slowly from lying and sitting position to standing position.
Monitor AST, ALT, BUN, Creatinine. Safety precautions.
Can be taken on empty or full stomach.
Do not use salt substitutes.
Class: Antianginal / Nitrates
Nitroglycerin Angina Pre-existing SL – 1 tab every SL /IV – 1-3 min Enhance hypotensive
(Nitrostat, Nitro-Bid) MI Hypertension 5 min. up to 3 PO – 20-30 min effects: Beta blockers,
Pulmonary Calcium channel blockers,
Isosorbide (Isordil) Head trauma doses. Ointment – 20-60 min
edema Vasodilators, Alcohol,
Increased ICP Tablet Transdermal – 30-60
Erectile dysfunction meds
Pericardial tamponade Spray min May antagonize effects of
Heparin: IV nitroglycerin
Mechanism of Action
Acts directly on the smooth muscle of venous and arterial blood vessels, causing relaxation and dilation. Dilates coronary arteries. Sublingual
administration rapidly absorbs into the internal jugular vein and right atrium. IV nitroglycerin vasodilates the client to decrease afterload which
increases cardiac output, so that more blood can be pumped forward.
Decreases preload, afterload, and Headache Faintness/Syncope Hypotension

workload of the heart Nausea/vomiting Dizziness Reflex achycardia
Increases blood flow to heart muscl Flushing Palpitations Paradoxical Bradycardia
Reduces myocardial oxygen demand
Diaphoresis Tolerance Circulatory Collapse
Contact dermatitis with topical
Monitor Blood pressure. Activate EMS if pain unrelieved after taking 1 tab SL or spray.
Do not leave client until BP stabilizes. Do not swallow SL nitro.
Assess cardiac output. Keep in dark, glass bottle.
Evaluate pain relief. Do not mix medications in bottle with nitroglycerin.
Safety precautions. Do not open bottle frequently.
Maintain adequate hydration. Keep dry and cool.
IV: Use a pump; hold for systolic BP < 100 May or may not burn or fizz in mou h.
Renew every 3-5 months; 2 years of spray.
Class: Antidysrhythmic Class III
Amiodarone Used when V-fib Cardiogenic shock IV Rapid MAOIs-hyperpyretic
(Cordarone) and pulseless V-tach 2nd degree heart block crisis, seizures.
are resistant to a
3rd degree heart block PO
vasopressor and
defibri lation. Iodine allergy
Fast arrhythmias.
Mechanism of Action
Prolongs duration of action potential and refractory period to decrease heart rate. Decreases peripheral vascular resistance and
increases PR and QT intervals. First antiarrhythmic of choice.
Very little negative inotropic activity Photophobia Hypotension Bradycardia

making it advantageous for use in clients Weakness Difficu ty breathing Wheezing
with heart failure. Skin discoloration Chest pain Light-headed
Potentially serious side effects requiring Tremors Vision loss Jaundice
careful monitoring. Impaired thinking/reactions
IV: Continuous ECG monitoring and BP monitoring Do not skip a dose or discontinue abruptly.
PO: Assess BP lying, standing. If systolic BP drops 20 mmHg, hold. Do not take with grapefruit juice.
Monitor Hepatic studies: AST, ALT, bilirubin. Use sunscreen or stay out of sun to prevent burns.
Dark glasses may be needed for photophobia.
Class: Antidysrhythmic Class Ib
Lidocaine Frequent PVCs Adams-Stokes IV 45-90 seconds Lidocaine toxicity
(Xylocaine) Ventricular tachycardia syndrome – cimetidine, beta
Alternative antiarrhythmic agent to blockers.
Heart block
amiodarone in the treatment of cardiac
arrest secondary to VF or pulseless
Decrease
VT resistant to CPR, cardioversion lidocaine effects
(after 2 to 3 shocks) and a vasopressor – barbiturates,
(epinephrine). ciprofloxaci
Mechanism of Action
Decreases irritability of the heart muscle. Increases electrical stimulation threshold of ventricles, which stabilizes cardiac
membrane and decreases automaticity.
Headache Heart block Seizures

Dizziness CNS depression
Drowsiness Respiratory depression
Severe adverse effects from lidocaine toxicity Blurred vision Malignant hyperthermia
Phlebitis Lidocaine toxicity
Administer IVP at a rate of 25-50 mg/minute. Monitor lidocaine blood levels. About the use of lidocaine.
Continuous ECG monitoring. Observe for prolonged PR interval and QRS Report signs of toxicity (hearing impairment,
complex. muscle twitching, confusion)
Have resuscitative equipment readily available.
Watch for malignant hyperthermia: tachypnea, tachycardia, changes in BP,
increased temperature.
Monitor for signs of toxicity (hearing impairment, muscle twitching, confusion,
seizures).
Class: Anti-hypertensive / Beta-Adrenergic Blockers (Beta Blockers)
Atenolol (Tenormin) Hypertension 2nd & 3rd degree - PO PO - 15 minutes Digitalis worsens bradycardia.
Metoprolol Angina Heart block IV IV - Immediate Other antihypertensives and
Dysrhythmias alcohol worsen htn.
(Lopressor) Cardiogenic shock NSAIDS, Licorice, ma-haung,
MI
Propranolol (Inderal)
Unlabeled Use: Hypotension ephedra decrease effect
Carvedilol (Coreg) Migraines; Acute Heart Failure of beta blockers causing
Tachycardia due to Sinus Bradycardia hypertension.
stage fright. Black cohosh, Hawthorn,
Parsley, Goldenseal increase
hypotensive effect.
Mechanism of Action
Blocks beta receptor cells (catecholamines) to decrease vascular resistance, decrease BP, decrease HR, decrease myocardial
contractility, decrease workload of the heart, decrease cardiac output, decrease renin release.
Well tolerated in low doses. Blurred vision Mental changes Bradycardia

Nasal stuffiness Photosensi ivity Hypotension
Sexual dysfunction Fatigue 2nd & 3rd degree Heart block
African Americans do not respond well Weakness Dizziness Thrombocytopenia
to Beta Blockers alone for control of
Lethargy Nausea/ Vomiting Bronchospasm
HTN. Use in conjunction with diuretics
Diarrhea Headache Wheezing
Depression Insomnia
Monitor for increased BUN, Creatinine, AST, LDH, Glucose. Teach how to take radial pulse and BP.
Do not discontinue abruptly: Rebound HTN, angina, dysrhythmias, MI Rise slowly to prevent postural hypotension.
can result. May cause sexual dysfunction.
Monitor BP & pulse. Report constipation: Eat foods high in fibe .
Hold for HR < 60 / min.
Class: Calcium Antagonists / Calcium Channel Blockers
Amlodipine Angina Heart Block PO 10-30 minutes Increased levels of digitalis,
(Norvasc), Diltiazem Hypertension Hypotension IV 3 minutes theophylline.
Dysrhythmias Decreased effects of lithium.
(Cardizem), Severe heart failure
Migraines Increased hypotensive
Ranolazine (Ranexa)
Raynaud’s Disease effects with grapefruit juice.
Mechanism of Action
Blocks the calcium channel in the vascular smooth muscle cells. This causes vasodilation of the arterial system to decrease arterial
resistance and decrease blood pressure. This decreases afterload, which decreases the workload of the heart. These medications
dilate the coronary arteries so more oxygen reaches the heart muscle.
Decreases afterload and increases GI upset Ankle edema Bradycardia

oxygen to the heart muscle. Dermatitis Flushing Reflex achycardia
Decreases BP better in African Headache Dizziness Heart Block
Americans than drugs in other categories Hypotension
Need to reduce dose with known liver Dyspnea
disease Wheezing
Taper dose: Do not discontinue abruptly. Do not stop taking abruptly. Rise slowly.
Monitor BP, HR – Notify PHCP for HR < 50 or Systolic BP < 90. Increase fluids and fiber to counteract con ipation.
Monitor for increased AST, ALT, Alk phosphatase, BUN, Creatinine, Teach how to take pulse and BP.
and cholesterol. Avoid hazardous activities until dizziness is no longer a
problem. Avoid grapefruit products.
Report chest pain, palpitations, irregular heart rate, swelling
of extremities, tremor
Class: Cardiac Glycosides
Digoxin (Lanoxin, Heart failure Ventricular PO 30 min-2 hours. Loop diuretics can cause
Digitek) Atrial fibri lation dysrhythmias. hypokalemia and dig toxicity.
Heart blocks IV 5-30 min. Ginseng may elevate digoxin
levels
St John’s wort decreases
absorption of digoxin.
Decrease dig absorption with
antacids.
Mechanism of Action
Promotes increased force of cardiac contraction, cardiac output, and tissue perfusion. Decreases ventricular rate. So heart
contraction is stronger, heart rate slows down. This allows more blood to be ejected out of the ventricles in a forward
direction.
Headache Dig toxicity: anorexia, n/v, weird arrhythmias,

Dizziness vision changes.
Can cause digoxin toxicity. elderly are
Heart block
more prone to dig toxicity
Monitor Digoxin level (Normal 0.5-2 ng/mL) Teach client how to take pulse.
Monitor potassium (Low K+ can increase risk for dig toxicity) Teach the signs of dig toxicity.
Monitor apical pulse. Hold dig for HR < 60 bpm in adults.
Administer IV dose slowly over 5 minutes.
Monitor for signs of dig toxicity: anorexia, nausea/vomiting, weird
arrhythmias, vision changes.
Antidote: Digoxin immune Fab (Digibind)
Class: Catecholamine
Norepinephrine Shock Hypersensitivity IV 1-2 minutes Increase pressor effect
(Levophed) Acute hypotension Tachy dysrhythmias with tricyclics, MAOIs.
Pheochromocytoma Decreased
Hypovolemia norepinephrine action
with alpha blockers.
Mechanism of Action
Potent vasoconstrictor action (alpha-adrenergic effect). It is used in shock states, often when drugs such as dopamine and
dobutamine have failed to produce adequate blood pressure. Causes increased contractility and heart rate by acting on beta
receptors of the heart.
Headache Anxiety Myocardial ischemia/Dysrhythmias

Dizziness Insomnia Impaired organ perfusion
Has potential to impair cardiac Tremor Palpitations Tissue necrosis with extravasation.
performance and decrease organ and Nausea/vomiting Cerebral hemorrhage
tissue perfusion. Anaphylaxis
Correct hypovolemia prior to use. Reason for drug administration

Continuous cardiac monitoring.
Precise blood pressure monitoring and HR every 2-3 min.
Taper drug slowly as abrupt discontinuation can result in severe
hypotension.
Monitor IV site for extravasation frequently. If extravasation occurs,
inject with phentolamine.
I&O
Class: Direct Acting Vasodilators
Hydralazine Hypertension Systemic Lupus PO 20-30 min Increase antihypertensive
(Apresoline) Hypertensive crisis effects: ACE inhibitors,
Severe heart failure vasodilators, diuretics,
Nitroprusside Severe tachycardia IV Rapid
Acute MI with
(Nipride)
hypertension and with heart failure alcohol, MAOIs, tricyclic
persistent chest pain and antidepressants,
/or left ventricular failure hawthorn.
Mechanism of Action
Relaxes smooth muscles of the blood vessels, mainly arteries, causing vasodilation. Promotes an increase in blood flow to he
brain and kidneys.
Nitroprusside is a potent vasodilator that Headache Reflex tachyca dia

rapidly decreases BP in hypertensive crisis. Dizziness Hypotension
Hyperglycemia Rebound hypertension
Adverse effects eliminate use of these drugs Sodium and water retention
as drug of choice. Peripheral edema
Monitor vital signs, I&O, glucose. Purpose of medication

Daily weight Safety precautions
Nitroprusside: Monitor BP frequently with continuous cardiac Move slowly from lying or sitting to standing position.
monitoring.
Class: Direct Vasodilators
Nesiritide (Natrecor) Acute treatment of heart Valvular stenosis IV 15 minutes
failure in clients with Cardiomyopathy
dyspnea at rest
Pericardial tamponade
and/or minimal activity.
Mechanism of Action
An atrial natriuretic peptide hormone that inhibits antidiuretic hormone by increasing urine sodium loss. Vasodilates veins and
arteries. Has a diuretic effect.
Useful for clients decompensating from Headache Hypotension

acute heart failure Dizziness Irregular HR
Nausea/Vomiting Chest pain
For short term IV use only: up to 48 hrs. Fever
Nephrotoxic Unusual weakness
Monitor creatinine level Purpose of medication

Monitor vital signs, hourly urine output Report s/s of allergic reaction.
ECG monitoring
Daily weight
Monitor for allergic reaction (rash, pruritus, laryngeal edema, wheezing).
Class: Oxygen
Oxygen Hypoxemia Use cautiously in clients NC
Severe anemia who have lost hypoxic Face mask
Carbon monoxide
respiratory drive. Non-rebreather face
poisoning
Shock However, never deny mask
Heart failure oxygen to someone who ET
needs it. CPAP/BiPAP
Mechanism of Action
Inadequate oxygenation produces hypoxemia and significant physiologic changes to a l body systems, therefor oxygen is a
first- ine drug for all emergency situations. Oxygen also acts as a potent pulmonary vasodilator and is beneficial for c ients in
heart failure.
Dry or bloody nose Oxygen toxicity

Skin irritation
An FiO2 above 50% for a prolonged Morning headaches
period can lead to oxygen toxicity and Fatigue
detrimental effects to the pulmonary
system. ET: mucus plugs, tracheal injury, infection, ET
misplacement
Make sure that the client’s airway and breathing are adequate to Purpose of oxygen therapy.
promote optimal oxygenation and ventilation.
Monitor pulse oximetry. Optimal oxygen saturation is at or above Fire risk: Do not smoke or have open flame a ound oxygen
94%. source.
Notify primary healthcare provider for oxygen saturation less than
90%.
Class: Phosphodiesterase Inhibitors
Milrinone (Primacor) Short term Acute MI IV (no longer 2-5 minutes Increased effect with
Inamrinone (Inocor) management of heart Severe pulmonic than 48-72 other antihypertensives
failure and diuretics
valvular disease hours)
Mechanism of Action
Inhibits the enzyme phosphodiesterase, promoting a positive inotropic response and vasodilation. Stroke volume and cardiac
output are increased.
Headache Ventricular arrhythmias

NauseaVomiting Hypotension
Anorexia Chest pain
Do to risk of toxicity these medications Thrombocytopenia
are generally reserved for clients who
do not respond to cardiac glycosides or
ACE inhibitors.
Continuous cardiac monitoring. BP & pulse every 5 minutes Purpose of medication

I&O Report angina immediately.
Daily weight
Monitor electrolytes, liver function
Class: Sympathomimetic with Beta Adrenergic activities
Dobutamine Shock Hypersensitivity IV 1-2 minutes Increased pressor effect
(Dobutrex) Aortic stenosis and dysrhythmias with
tricyclics, MAOIs.
Mechanism of Action
The beta1 effects enhance the force of myocardial contraction (positive inotropic effect) and increasing heart rate (positive
chronotropic effect). The beta 2 effects produce mild vasodilation
Blood pressure is elevated only through Headache Nausea Dose related:

the increase in cardiac output. Tremors Anxiety Myocardial ischemia
Dizziness Fatigue Tachycardia Dysrhythmias
Palpitations Hypotension Hypertension
Hypokalemia
Correct hypovolemia prior to use. Reason for drug administration

Usual IV dose is 2-20 mcg/kg/min. Administer via electronic infusion
pump for precision. Taper gradually to avoid clinical deterioration.
Continuous cardiac and blood pressure monitoring.
I&O
Monitor vital signs
Assess for signs of myocardial ischemia.
Continuous ECG monitoring
Class: Vasopressor/Catecholamine
Epinephrine HCL Cardiac arrest Closed-angle glaucoma IVP in Rapid Do not use with
(Adrenalin) Asystole cardiac MAOIs or tricyclics –
V-fi hypertensive crisis may
arrest
Acute asthmatic
attacks
occur.
Anaphylaxis
Mechanism of Action
Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins)
causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.
Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by
increasing heart rate, heart muscle contractility, and conductivity through the AV node
Used to stimulate the heart muscle. Tremors Palpitations Cerebral hemorrhage

Headache Hypertension bronchospasms
Dizziness Nausea/Vomiting
WARNING: Ensure that the correct concentration, 1:10,000 is Reason for medication during a code.
administered IV (Not 1:1,000)
Elevate extremity for 10-20 seconds to facilitate drug delivery to the

central circulation.
Auscultate lungs
Monitor pulse, BP, respirations.
Continuous cardiac monitoring
Do not administer in same IV site as Sodium Bicarbonate.
Class: Alcohol Deterrent
Acamprosate Alcohol abstinence Hypersensitivity PO Increase glucose,
(Campral) management Creatinine clearance < 30 mL/min bilirubin, uric acid.
Decrease Hgb/Hct,
platelets.
Mechanism of Action
Not completely understood. Thought to lower neuronal excitability, centrally mediated.
Anxiety Depression Suicidal ideation

Dizziness Headache Dyspnea
Insomnia Tremors
Chills Drowsiness
Rhinitis Anorexia
Constipation Diarrhea
N/V
Assess mental status for depression, abnormal thoughts, suicidal thoughts. Notify prescriber of depression, abnormal thoughts,
Obtain vital signs. suicidal thoughts.
Evaluate therapeutic response. Do not engage in hazardous activities.
Do not drink alcohol while taking medication.
Class: Aldehyde Dehydrogenase Inhibitor
Disulfiram (Antabuse Alcoholism Myocardial disease PO 2-12 hours Severe unpleasant side effects when
Psychoses taken with alcohol, or foods/ products
Pregnancy containing alcohol such as mouthwash,
cough medicine, cooking wine, vinegar.
Use with phenytoin can lead to phenytoin
intoxication.
Mechanism of Action
Disulfiram blocks he oxidation of alcohol. Blocks an enzyme that is involved in metabolizing alcohol intake. Disulfiram p oduces very
unpleasant side effects when combined with alcohol in the body.
Flushing Sweating Allergic reaction: hives; difficu t breathing; swelling of your

Increased thirst Swelling face, lips, tongue, or throat.
Rapid weight gain Nausea Severe abdominal pain
Severe vomiting Confusion Sudden vision loss
Blurred vision Weakness Optic neuritis/Peripheral neuritis
Throbbing headache Hepatitis
Monitor liver function studies. Do NOT drink alcohol while taking this medication. Severe unpleasant side
Assess for recent alcohol use. Do not administer for 12 hr effects when taken with alcohol, or foods/ products containing alcohol such
following alcohol ingestion. as mouthwash, cough medicine, cooking wine, vinegar.
If a severe disulfiram eaction occurs administer oxygen, Wear a medical alert tag or carry an ID card.
monitor ECG and serum potassium levels, and provide Used with behavior modifica ion, psychotherapy, and counseling support.
supportive measures. Inform patient of purpose of disulfiram and he consequences of drinking
Monitor CBC and blood chemistry every 6 months during alcohol during therapy.
therapy. Avoid driving and other activities requiring alertness
Class: Anti-Anxiety Agents: Antihistamines
Hydroxyzine (Vistaril) Anxiety disorders 1st trimester PO 15-60 minutes Increased CNS effect with use of
Pre and post-op pregnancy IM barbiturates, opioids, analgesics,
sedation alcohol, sedative/hypnotics.
Hypersensitivity
Nausea/Vomiting
Increased anticholinergic effects
with use of phenothiazines,
antihistamines, antidepressants,
atropine, haloperidol, MAOIs
Mechanism of Action
Depresses subcortical levels of CNS, including the limbic system.
Headache Dry mouth Hypotension

Dizziness Fatigue Hives
Increased appetite Seizures
Nausea Diarrhea
Weight gain
Administer IM deep in large muscle using Z-track method to Avoid OTC medications.
decrease pain, chance of necrosis. Avoid driving, activities that require alertness.
Do NOT give IV or SQ. Avoid alcohol, psychotropic medications.
Monitor for sedative effects. Do not discontinue quickly.
Monitor BP Rise slowly.
Assist with ambulation
Class: Anti-Anxiety Agents: Benzodiazepines
Diazepam (Valium), Anxiety disorders Narrow angle PO 30 min Increase diazepam
Lorazepam (Ativan), Alcohol withdrawal glaucoma IM 15-30 min effect with amiodarone,
Personality disorders cimetidine, verapamil,
Alprazolam (Xanax), Hypersensitivity IV Immediate
Panic attacks valproic acid.
Triazolam (Halcion),
Seizures Myasthenia gravis Rectal
Increase toxicity with
Midazolam (Versed) Pre-op sedation Sleep apnea barbiturates, SSRIs,
cimetidine, CNS
depressants, valproic acid.
Mechanism of Action
Potentiates the actions of GABA, especially in the limbic system.
Does not produce life-threatening Drowsiness Dizziness Retrograde amnesia

respiratory depression or coma if taken in Sedation Hypotension
excessive amounts. Headache Depression Tachycardia
Result is less physical dependence than the Blurred vision Tinnitus Neutropenia
barbiturates. Constipation Diarrhea Respiratory depression
Increased risk of falls with elderly Anorexia Nausea/Vomiting
BP lying, sitting, standing. May take with food.

Monitor CBC, AST, ALT, bilirubin, creatinine, LDH, alkaline phosphate. Do not use for everyday stress or for > 4 months unless
Monitor degree of anxiety, mental status. directed by prescriber.
Avoid OTC medications.
Avoid driving, activities that require alertness. Rise slowly.
Avoid alcohol.
Class: Anticonvulsant
Topiramate Seizures Hypersensitivity PO Increased CNS depression
(Topamax) Unlabeled: bipolar Metabolic acidosis with alcohol, CNS
disorder, alcohol depressants. Decreased
Pregnancy
dependence, mania,
bulimia
level of oral contraceptives,
estrogen, digoxin, lithium.
Mechanism of Action
May prevent seizure spread as opposed to an elevation of seizure threshold.
Dizziness Fatigue Suicidal ideation

Insomnia Anxiety Pancreatitis
Memory loss Tremors Death
Diplopia Anorexia
Nausea Dyspepsia
Weight loss
Assess mental status, mood, behavior. Swallow whole. Do not break, crush, or chew.
Monitor seizures. Carry emergency ID.
Assess renal and hepatic studies. Avoid driving, other activities that require alertness.
Assist with ambulation. Notify prescriber of blurred vision, periorbital pain.
Seizure precautions. Maintain adequate fluid intake to p event kidney stones.
May need to increase amount of food consumed since weight
loss may occur.
Class: Antidepressant Agents: Monamine Oxidase Inhibitors (MAOIs)
Phenelzine (Nardil), Severe depression Concurrent use PO Up to 3 weeks High serotonin levels result
Tranylcypromine Psychosis / PTSD of meperidine, in confusion, high BP, tremor,
Dissociative disorders hyperactivity, coma, and death
(Parnate) barbiturates, tricyclic when taken with paroxetine,
Bulimia
Panic disorders when antidepressants, fluoxe ine, amitriptyline,
other agents are antihistamines, CNS nortriptyline,bupropion; pain
ineffective. depressants, OTC cold medications like methadone,
tramadol, and meperidine;
medications. dextromethorphan, St. John’s Wort,
cyclobenzaprine, and mirtazapine.
Mechanism of Action
Affects chemical messengers (neurotransmitters) used to communicate between brain cells. MAOIs work by effecting changes in the brain
chemistry. An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine
from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available to effect changes in both cells and
circuits that have been impacted by depression.
Prescribed when client does not Dizziness Constipation Orthostatic hypotension

respond to other antidepressants. Diarrhea Tremors Seizures
Diaphoresis Sexual dysfunction Coma
Hypertensive crisis can be triggered by
Weight gain Tachycardia
foods rich in tyramine.
Monitor vital signs, reflexes, a fect, orientation, UOP. Avoid tyramine containing foods and beverages (pickled
Obtain CBC, urinalysis, thyroid function tests, ECG, EEG. foods, aged cheese, fermented alcohol, sour cream, figs,
Monitor for symptoms of hypertensive crisis (elevated BP and severe shrimp, bananas, chocolate or caffeinated drinks).
headache) Do not take any other medications without checking with
primary healthcare provider when taking a MAOI.
Class: Antidepressant Agents: Selective Serotonin Reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac), Depression, Bi-polar disorder Hypersensitivity PO 2-4 weeks Increase effects of
Paroxetine (Paxil), Eating disorders, OCD MI CNS and respiratory
Panic attacks, depression, and
Escitalopram (Lexapro), Taking MAOIs
Anxiety disorder
Citalopram (Celexa),
PTSD / Phobia Dehydration hypotensive effect
Sertraline HCL (Zoloft) Dissociative disorder Breastfeeding with alcohol and CNS
Premenstrual dysphoric depressants.
disorder Increase effect of
hypoglycemic.
Mechanism of Action
Serotonin is increased in nerve cells because of blockage from nerve fibers
Insomnia Seizures
Weight loss Hyponatremia
Sexual dysfunction Dehydration
Palpitations Bleeding
Headache Suicidal ideation
Diaphoresis
GI complaints
Do NOT give with MAOIs. Wait 14 days after stopping MAOIs to administer. Therapeutic effect may take several weeks.
Monitor liver functions. Do not discontinue abruptly.
Withdrawal should be gradual. Use with caution when driving.
Avoid alcohol, other CNS depressants.
Class: Antidepressant Agents: Tricyclic Antidepressants
Amitryptyline (Elavil), Depression Clients with suicidal PO 45 minutes Alcohol, hypnotics, sedatives,
Nortriptyline (Pamelor), Anxiety ideations. barbiturates potentiate central
Panic disorder nervous system depression
Imipramine (Tofranil) History of seizures
OCD when taken with tricyclic
Bulimia Chronic cardiac
antidepressants.
Depression related to disease. Concurrent use of MAOIs
alcohol and cocaine with amitriptyline may lead to
withdrawal. cardiovascular instability and
Chronic pain disorder.
toxic psychosis.
Tofranil – childhood enuresis
Antithyroid medications taken
with amitriptyline may increase
the risk of dysrhythmias.
Mechanism of Action
Blocks the uptake of the neurotransmitters norepinephrine and serotonin in the brain.
Effective and less expensive than SSRIs and other Headache Dry mouth Orthostatic hypotension
drugs. Sedation Impotence Dysrhythmias
Urinary retention
Overdose is generally lethal Photosensitivity
Increase fluids, bu k in diet if constipation, urinary retention occur. Therapeutic effects may take 2-3 weeks.
Administer with food, milk for GI symptoms. Use caution when driving, performing activities that require
Crush is client unable to swallow medication whole. alertness.
Administer at bedtime if over sedation occurs during day. Avoid alcohol, other CNS depressants.
Wear sunscreen or large hat when outdoors.
Class: Antipsychotic Agents: Phenothiazines
Chlorpromazine Psychotic disorders Hypersensitivity PO 2-3 hours Kava kava may increase the
(Thorazine), Schizophrenia Subcortical brain damage IM risk and severity of dystonic
Mania reactions when taken with
Fluphenazine Blood dyscrasias IV
Paranoia phenothiazines.
Tourette’s syndrome Renal or liver damage Rectal
Increase depressive effects
Coma when taken with alcohol or
other CNS depressants.
Mechanism of Action
Blocks norepinephrine, causing sedation and hypotensive effects early in treatment. Also blocks the actions of dopamine.
Anorexia Urinary retention Orthostatic hypotension Hypertension

Dry mouth Sedation Extrapyramidal reactions Seizures
Polyuria Dizziness Leukopenia Agranulocytosis
Headache Nasal congestion Tardive dyskinesia
Neuroleptic malignant syndrome
Assess baseline vital signs. Monitor serum glucose level. Encourage client to take the drug exactly as prescribed.
Assess mental status, cardiac, eye, and respiratory disorders. Medication may take 6 weeks or longer to achieve full
Remain with client while medication is taken and swallowed. clinical effect. Advise to wear an ID bracelet.
Avoid skin contact with liquid concentrations to prevent contact Do not consume alcohol or other CNS depressants, such
dermatitis. as narcotics.
Protect liquid from light. Dilute liquid with fruit juice. Do not abruptly discontinue the drug.
Administer with food or milk to decrease gastric irritation. Teach smoking cessation (Smoking increases metabolism
Administer IM deep into muscle. of some antipsychotics).
Observe for Extra Pyramidal Symptoms. Guide client to maintain good oral hygiene by frequent
brushing and flossing of tee h.
Class: Atypical Antipsychotics (AAP)
Risperidone (Risperdal), Psychotic disorders Hypersensitivity PO Use with other CNS
Quetiapine (Seroquel), Schizophrenia Seizure disorders IM depressants, alcohol will
Bipolar mania increase sedation.
Aripiprazole (Abilify) Suicidal ideation
Paranoia
Personality disorder
Use with other antipsychotics,
lithium increase risk of EPS.
Mechanism of Action
The exact mechanism is unknown. May be mediated through both dopamine and serotonin antagonism.
Less likely to cause extrapyramidal effects, Sedation Drowsiness Orthostatic hypotension

neuroleptic malignant syndrome and Headache Dry mouth Seizures
tardive dyskinesia than the phenothiazines. Agitation Anxiety Stroke
Suicidal ideation
Appetite stimulation with Neuroleptic malignant syndrome
weight gain
IM – give deeply into muscle mass. Rise slowly from lying or sitting position.
Monitor for hoarding / not swallowing medication. Avoid hot tubs, hot showers, hot tub baths as hypotension may
I&O occur.
Check bilirubin, CBC, weight, lipid profile, fas ing glucose monthly. Avoid OTC medications unless approved by prescriber.
BP lying, sitting, standing. Avoid use with alcohol.
Heat stroke may occur in hot weather.
Class: CNS Stimulants: ADHD/ADD Stimulants
Methylphenidate (Ritalin), ADD Heart problems PO 20-30-minutes Taking MAO inhibitors with
Amphetamine (Adderall), ADHD Bipolar disorder this medication may cause a
Lisdexamfetamine (Vyvanse), Glaucoma serious (possibly fatal) drug
Dexmethylphenidate (Focalin) Tourette’s Syndrome interaction.
Mechanism of Action
Blocking the dopamine transporter and norepinephrine transporter, leading to increased concentrations of dopamine and
norepinephrine within the synaptic cleft.
Headache Insomnia Hypertension

Dry mouth Blurred vision Tachycardia
High abuse potential due to stimulant effects.
Sudden death has been reported in children Anxiety Nervousness Suicidal thoughts
taking amphetamine with structural cardiac Weight loss Nausea/Vomiting Sudden death in children with structural Cardiac
abnormalities. Decreased Appetite abnormalities.
Monitor mental status and observe for changes in level of consciousness May be habit forming. Avoid drinking alcohol.
and adverse effects such as persistent drowsiness, psychomotor agitation To prevent sleep problems, take this medicine in the morning.
or anxiety, dizziness, trembling or seizures. Methylphenidate may impair thinking or reactions. Do not drive or do
Monitor vital signs. anything that requires alertness.
Monitor gastrointestinal and nutritional status. Instruct client to report any significant inc ease in motor behavior,
Monitor laboratory tests such as CBC, differential, and platelet count. changes in sensorium, or feelings of dysphoria.
Monitor effectiveness of drug therapy. Monitor growth and development. Take drug with meals to reduce GI upset and counteract anorexia; eat
Monitor sleep–wake cycle frequent, small nutrient-and calorie-dense snacks. Weigh weekly and
report significant losses over 1 b. Report shortness of breath, profound
fatigue, pallor, bleeding or excessive bruising (these are signs of blood
disorder).
Class: CNS Stimulants: Anorexiants
Phentermine Appetite Suppressant Hypersensitivity PO Taking MAO inhibitors
(Ionamin) Obesity Hypertension with this medication may
Glaucoma cause a serious (possibly
Heart disease fatal) drug interaction.
Mechanism of Action
Reduces hunger perception, a cognitive process mediated through nuclei within the hypothalamus. Outside the brain,
phentermine releases norepinephrine and epinephrine causing fat cells to break down stored fat as well.
Indicated for treatment of obesity (BMI Anxiety Dizziness Hypertension

>30) and for those overweight (BMI Insomnia Headache Hallucinations
27-30) who have comorbidities such as Dry mouth Nausea/Vomiting Seizures
hypertension, high cholesterol, diabetes. Diarrhea Constipation Pulmonary hypertension
Chest pain
Assess for tolerance to the anorectic effect of the drug. Withhold Take 1 or 2 hours after breakfast. Do not crush or chew.
drug and report to physician when this occurs. Avoid drinking alcohol with Ionamin. May affect blood sugar
Lab tests: Periodic CBC with differential and blood glucose. of client with diabetes. Do not breast feed while taking this
Monitor periodic cardiovascular status, including BP, exercise drug.
tolerance, peripheral edema. Report immediately any of the following: Shortness of breath,
Monitor weight at least 3 times/wk. chest pains, dizziness or fainting, swelling of the extremities.
Tolerance to the appetite suppression effects of the drug
usually develops in a few weeks. Notify physician, but do not
increase the drug dose. Weigh self at least 3 times/week at
the same time with the same amount of clothing.
Class: CNS Stimulants
Caffeine Migraine headache History of cardiac PO 5-10 minutes Taking caffeine along with ephedrine might
Tension headache disease or peptic Rectal cause heart problems. Caffeine might block
Promotes alertness the effects of adenosine, dipyridamole.
ulcer disease IV Rapid
Alleviates fatigue Ciprofloxacin, cime idine, disulfiram, est ogen
In combination with Pregnancy
decrease how quickly the body breaks down
pain medication. caffeine. Caffeine decreases how quickly the
body breaks down clozapine. Taking caffeine
along with medications that slow clotting
might increase the chances bleeding.
Mechanism of Action
Stimulates the CNS, especially the medullary respiratory center. Has a pronounced diuretic effect and is a myocardial stimulant. It can
worsen peripheral vasoconstriction in those with hypertension and causes cerebral vasodilation, making it an effective treatment for
migraines and headaches.
Nervousness Insomnia Cardiac arrhythmias

Caffeine combined with alcohol Irritability Flushing Hypertension
appears to improve response time Palpitations Headache Tachypnea
but does not reduce the errors in Confusion
judgment caused by alcohol. Dehydration
For IV use: Assess respiratory status frequently. Instruct on correct technique for administration. Measure oral dose accurately
Monitor for signs of necrotizing enterocolitis (abdominal with a 1-mL syringe.
distension, vomiting, bloody stools, lethargy). Advise to consult health care professional immediately if signs of necrotizing
Monitor serum caffeine levels before and during therapy. enterocolitis occur.
Monitor serum glucose levels.
Class: CNS Depressants - Barbiturates
Phenobarbital Anesthesia induction. Pregnancy PO 30 minutes Increased CNS depression with
(Luminal), Secobarbital Short-term anesthesia Hypersensitivity IM alcohol, narcotics, sedative-
Seizures hypnotics.
(Seconal), Pentobarbital Depression IV 5 minutes
Short-term use of Decreased effectiveness of
(Nembutal)
insomnia Suicidal tendency
beta-adrenergic blockers,
Liver disease clozapine, corticosteroids,
Respiratory disease digitoxin, doxycycline,
estrogens, oral contraceptives,
quinidine, theophyllines,
voriconazole, or warfarin.
Mechanism of Action
Acts on GABAA receptors, increasing synaptic inhibition. This has the effect of elevating seizure threshold. Phenobarbital may also
inhibit calcium channels, resulting in a decrease in excitatory transmitter release. The sedative-hypnotic effects of phenobarbital
are likely the result of its effect on the polysynaptic midbrain reticular formation, which controls CNS arousal.
Drowsiness Lethargy Respiratory depression

Loading dose may be required. Cautious Dizziness Headache Mental depression
use in elderly, associated with increased Hangover effect Hepatic toxicity
risk of falls. Interferes with REM sleep Renal toxicity

Monitor vital signs. Ensure patient safety. Perform neuro-checks regularly. Do not drive or perform unsafe tasks.
Keep resuscitative equipment accessible. Do not drink alcohol or use medicines that may cause
Monitor response to and effectiveness of drug therapy. drowsiness
Monitor for signs of hepatic or renal toxicity. Hormonal birth control may not work as well.
Monitor laboratory blood tests and urinalysis: CBC with differential, To prevent pregnancy, use an extra form of birth control.
electrolytes, BUN, PT, PTT, liver enzymes.
Class: Miscellaneous Anti-Seizure
Gabapentin Seizures Hypersensitivity PO 1-3 hours CNS depression with alcohol,
(Neurontin) Peripheral neuropathy sedatives, antihistamines.
Migraine prophylaxis Increase gabapentin levels
Vasomotor symptoms in
women with breast cancer
with morphine.
or postmenopausal Decrease gabapentin levels
women. with antacids, cimetidine.
Mechanism of Action
Acts on the peripheral nerves and CNS by inhibiting spontaneous neuronal firing. May inc ease seizure threshold.
Drowsiness Dizziness Increased frequency of partial seizures

Fatigue Confusion Leukopenia
Anxiety Rhinitis Depression
Should be used cautiously with elderly. Constipation Leukopenia
Thrombocytopenia
Monitor seizure activity. Do not crush or chew caps.

Monitor mental status. Take at least 2 hours from antacids.
Seizure precautions May take without regard to meals.
Increase fluids, bu k in diet for constipation. Carry ID
Avoid driving and other activities requiring alertness.
Class: Miscellaneous Anti-Seizure
Phenytoin (Dilantin) Seizures Pregnancy PO 2-24 hours Increase phenytoin effect with
Status epilepticus Hypersensitivity IV 1-2 hours benzodiazepines, cimetidine,
Unlabeled: migraines, tricyclics, salicylates, alcohol.
Bradycardia
paroxysmal atrial Decrease phenytoin effects
tachycardia, ventricular Heart block
with antacids, barbiturates,
tachycardia Stokes-Adams syndrome rifampin.
Mechanism of Action
Inhibits spread of seizure activity in motor cortex by altering ion transport. Increases AV conduction.
Gingival hyperplasia Dizziness Aplastic anemia Agranulocytosis

Insomnia Paresthesias Pancytopenia Hepatitis
Depression Nystagmus Suicidal tendency Bradycardia
Blurred vision Anorexia Ventricular fibri lation Cardiac arrest
Weight loss Nausea/vomiting Stevens-Johnson Syndrome
Blue-Glove syndrome
IV administration should not exceed 50 mg/min in adults. Administer Take with meals to decrease side effects.
slow IVP. Take antacids two hours before or after phenytoin.
Monitor phenytoin level. Urine may turn pink
Monitor seizure activity. Oral hygiene
Monitor EKG, BP, respiratory function during IV infusion. Avoid hazardous activities.
Carry ID
Class: Miscellaneous Sedative-Hypnotics
Chloral Hydrate Short term Hypersensitivity PO 10-20 minutes Side effects of barbiturates
(Noctec) treatment of Hepatic failure may be increased.
insomnia Renal failure Use with loop diuretics may
Sedation cause tachycardia and blood
Alcohol withdrawal pressure changes.
Anticoagulants side effects
may increase.
Mechanism of Action
The mechanism of action by which the Central Nervous System (CNS) is affected is not known.
Does not interfere with REM sleep Drowsiness Hangover effect Cardiac arrhythmias
Nausea/Vomiting Flatulence Sudden death
Diarrhea Confusion Difficu ty breathing
Chest pain
May dilute syrup in water or other oral liquid (eg, fruit juice or ginger If stomach upset occurs, take with food.
ale) to minimize gastric irritation. Swallow chloral hydrate whole.
Administer capsules after meals (when used as sedative). Take chloral hydrate with a full glass of water or other.
Do not take 2 doses at once.
Chloral hydrate may cause drowsiness or dizziness. Do not
drive, operate machinery, or do anything else that could be
dangerous.
Avoid drinking alcohol or taking other medications that cause
drowsiness while taking chloral hydrate.
Class: Miscellaneous Sedative-Hypnotics
Eszopiclone (Lunesta), Insomnia Hypersensitivity to PO 10 minutes Decrease CNS function with
Zolpidem (Ambien) benzodiazepine. alcohol, CNS depressants,
Respiratory depression anticonvulsants.
Food decreases absorption.
Mechanism of Action
The precise mechanism of action of eszopiclone as a hypnotic is unknown, but its effect is believed to result from its interaction
with GABA-receptor complexes at binding domains located close to benzodiazepine receptors.
Zolpidem interacts with a GABA-BZ receptor complex and shares some of the pharmacological properties of the benzodiazepines.
Headache Nervousness Tachycardia

Anxiety Drowsiness Depression
Hot flashes Irritabi ity Hypotension
Nausea / vomiting Sleep driving (Zolpidem)
Erectile dysfunction
Assess vital signs. Teach nonpharmacologic ways to induce sleep – warm bath,
Check for signs of respiratory depression. listening to music, drinking warm fluids, avoi ing caffeine.
Use bed alarm for older clients. Avoid alcohol, antidepressants, antipsychotics, and narcotic
Observe for side effects. drugs.
Take 15-30 minutes before bedtime.
Class: Miscellaneous
Carbamazepine Acute mania associated Hypersensitivity PO Slow Increase CNS toxicity with
(Tegretol) with bipolar disorder. Pregnancy Lithium.
Alcohol withdrawal Fatal reaction with use of
Seizure disorder MAOIs.
Trigeminal neuralgia Decrease anticonvulsant
Diabetic neuropathy effect with use of St. John’s
wort.
Mechanism of Action
Exact mechanism unknown. Appears to decrease polysynaptic responses and block posttetanic potentiation.
Drowsiness Dizziness A plastic anemia

Confusion Fatigue Agranulocytosis
Headache Hallucinations Respiratory depression
Tinnitus Dry mouth Arrhythmias
Blurred vision Photosensitivity AV block
Constipation Diarrhea Stevens-Johnson Syndrome
Nausea/vomiting
Monitor drug effectiveness. Carry emergency ID regarding medication.

Assess urinalysis, BUN, creatinine q 3 months. Avoid driving and other activities that require alertness.
Provide hard candy, gum, frequent rinses for dry mouth. Report chills, rash, light colored stools, dark urine, jaundice.
Urine may turn pink to brown.
Class: Miscellaneous
Valproic Acid Mania Hypersensitivity PO Increase risk of toxicity with
(Depakote) Schizophrenia erythromycin, salicylates,
Seizure disorder NSAIDs.
Migraine prophylaxis Increase CNS depression
Unlabeled: Febrile with alcohol, opioids,
seizures barbiturates, MAOIs,
tricyclics.
Mechanism of Action
Increases levels of GABA in the brain, which decreases seizure activity.
Drowsiness Dizziness Bone marrow depression

Headache Weakness Pancreatitis
Nausea/Vomiting Diarrhea Hepatotoxicity
Constipation Dyspepsia Stevens-Johnson syndrome
Weight loss Coma/Death with overdose
Monitor mental status, mood activity, sleeping/eating behavior, Physical dependency may result from extended use.
suicidal thoughts. Avoid driving, other activities that require alertness
Monitor CBC, PT/PTT, serum ammonia, platelets. Drink plenty of fluids
Monitor for signs of pancreatitis. Report visual disturbances, rash, abdominal pain, light-
colored stools, jaundice, protracted vomiting.
Class: Mood Stabilizers
Lithium (Lithane, Mania Children < 12 years’ PO Rapid May increase lithium level with
Lithobid) Bipolar disorder old thiazide, methyldopa, haloperidol,
Thyroid disease NSAIDS, calcium channel blockers,
ACE inhibitors.
Liver disease
May increase hyperglycemia with
Renal disease antidiabetics.
Caffeine may decrease lithium levels.
Mechanism of Action
Alteration of ion transport in muscle and nerve cells. Increased receptor sensitivity to serotonin.
Headache Memory impairment Toxic effects: tremor, confusion, seizures, death.

Blurred vision Metallic taste
Dental caries Lethargy Hypotension
Long-term therapy may cause Drowsiness Tremors Hyperglycemia
hypothyroidism Slurred speech Dry mouth Hyponatremia
Anorexia Vomiting Proteinuria
Diarrhea Polyuria Cardiac dysrhythmias
Dehydration
Monitor serum sodium (Normal serum sodium helps to Maintain adequate fluid intake of 1-2 L dail .
maintain therapeutic lithium levels). Importance of lab tests and follow-up visits.
Frequently monitor Lithium level (Therapeutic range – 1-1.5 Do not drive until stable lithium level.
mEq/L for acute mania; Maintenance levels are 0.6-1.2 Take with meals to decrease gastric irritation.
mEq/L. Levels exceeding 1.5-2.5 mEq/L begin to produce Wear ID indicating medication taking.
toxicity. Normal levels and toxicity levels are very close).
Class: Neuromuscular Blocker
Succinylcholine Facilitation of ET Hypersensitivity IM 2-3 minutes Increase dysrhythmias with
Chloride (Anectine) intubation. Malignant IV 1 minute theophylline. Melatonin blocks
Skeletal muscle succinylcholine. Increase
hyperthermia
relaxation. neuromuscular blockade with
Trauma
aminoglycosides, beta blockers,
glycosides, procainamide, lithium,
opioids, thiazides.
Mechanism of Action
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, thus antagonizing action of acetylcholine.
Causes release of histamine.
Bradycardia Tachycardia Sinus arrest Dysrhythmias

Flushing Weakness Myoglobulinemia Rhabdomyolysis
Muscle pain Apnea Bronchospasm
Increased secretions Respiratory depression Anaphylaxis
Angioedema
Monitor for electrolyte imbalances: May lead to increased action Use of medication.
of product. Care during recovery.
Monitor vital signs until fully recovered.
I&O
Check for urinary retention, frequency, hesitancy.
Class: Non-phenothiazines
Haloperidol Acute and chronic psychosis Narrow angle glaucoma PO Erratic Increase sedation with
(Haldol) Schizophrenia resistant to Severe hepatic, renal, IM 15-30 minutes alcohol, CNS depressants.
other medications. Increase toxicity with
cardiovascular disease. IV
Tourette’s syndrome anticholinergics, CNS
Paranoia Parkinson’s disease
depressants, Lithium.
Children with severe behavior Bone marrow depression Decrease effects with
problems who are combative. phenobarbital, caffeine.
Suppress narcotic withdrawal.
Mechanism of Action
Alters the effects of dopamine by blocking dopamine receptors.

Tachycardia Urinary retention Seizures Respiratory depression

Constipation Blurred vision Laryngospasm Dysrhythmias
Headache Dry mouth Neuromalignant syndrome
Nausea/vomiting Weight gain Tardive dyskinesia
Photosensitivity Orthostatic hypotension
Assess CBC Rise slowly from lying or sitting position.

Obtain BP lying, sitting, standing. Avoid hazardous activities until stabilized on medication.
Monitor for dizziness, faintness, tachycardia on rising. Avoid abrupt withdrawal of medication.
Monitor for EPS. Avoid OTC preparations.
Supervise ambulation until client stabilized on medication. About EPS.
Provide sips of water, sugarless candy, gum for dry mouth. Oral care.
Report impaired vision, jaundice, tremors, muscle twitching.
Class: Opioid Antagonist
Naltrexone Opiate addiction Hypersensitivity PO 15-30 minutes Increased lethargy with phenothiazines
(ReVia) Alcoholism Opioid dependence IM Increased hepatotoxicity with disulfiram
Nicotine withdrawal Increased bleeding risk with
anticoagulants.
Mechanism of Action
Competes with opioids at opioid-receptor sites.

Stimulation Drowsiness Seizures

Dizziness Confusion Suicidal ideation
Headache Flushing Pulmonary edema
Nervousness Irritability DVT
Anxiety Tinnitus Hepatotoxicity
Blurred vision Diarrhea
Constipation Impotence
Nausea/vomiting
Give with food, antacid to prevent N/V. Must be drug free to start treatment.
Do not give until opioid free for 7-10 days to prevent opioid Using opioid while taking this medication could be fatal.
withdrawal. Carry emergency ID.
Administer IM deep in gluteal. Alternate injection sites. Use caution while driving or performing hazardous tasks.
Aspirate before injection. Report suicidal thoughts.
Monitor cardiac status and respiratory function.
Class: Serotonin Agonists (SSRAs – Selective Serotonin Receptor Agonists)
Ergot Alkaloids: Migraine headache Pregnant SL Variable seconds Severe hypertension can occur
Ergotamine tartrate Breastfeeding Intranasal with the use of Droxidopa or
(Ergostat), Ergotamine Heart disease IM sympathomimetics. Risk of
increase ergotamine side effects
with caffeine (Cafergot, Hypertension IV
can occur with Azole antifungals,
Ercaf)
beta-blockers, fluconazole,
fluoxe ine, fluvoxamine, HIV
protease inhibitors, sumatriptan,
macrolide antibiotics.
Mechanism of Action
Works by narrowing blood vessels in the brain, which helps to relieve migraine headaches.
Can be used to prevent or treat acute Dizziness Angioedema Chest pain

migraine headache with or without an aura. Nausea/vomiting Arrhythmias Muscle pain
Toxicity may occur. SOB
Assess frequency, location, duration, and characteristics Proper use of inhaler.

headaches. During acute attack, assess type, location, and Take at the first sign of a migraine a tack.
intensity of pain before and 60 min after administration. Do not swallow, crush, or chew sublingual tablets. Do not eat,
Monitor BP and peripheral pulses periodically during therapy. drink, or smoke while tablet is dissolving.
Report any increases in BP. If more than 1 dose needed to treat a migraine, take the second
Assess for nausea and vomiting. dose at least 30 minutes after the first dose. Do not take mo e
Assess for toxicity manifested by severe ergotism (chest pain, than 2 tablets for any migraine attack. Do not take more than 3
abdominal pain, persistent paresthesia in the extremities) and tablets in a 24 hour period. Do not take more than 5 tablets within
gangrene. Vasodilators, dextran, or heparin may be ordered to a 7 day period.
improve circulation. Do not use ergotamine daily on a regular basis.
Class: Serotonin Agonists (SSRAs – Selective Serotonin Receptor Agonists)
Triptans: Sumatriptan Migraine headaches History of coronary artery PO 60 minutes Increase vasospastic
(Imitrex), Almotriptan Cluster headaches disease, uncontrolled SubQ 10 minutes effects with ergot
(Axert) hypertension, Intranasal 15 minutes derivatives.
cerebrovascular disease, Increase serotonin
MI. Obesity, diabetes, syndrome with SSRIs
smoking, hepatic disease.
Mechanism of Action
Causes vasoconstriction of cranial arteries to relieve migraine headaches.
Nausea/vomiting Dizziness Hypertension Hypotension

Numbness Tingling Cardiac arrhythmias MI
Dry mouth Diarrhea Seizures Stroke
Abdominal cramping Coronary artery vasospasms
Assess type of headache, pain, aura, alleviating and aggravating Keeping a journal: Ingestion of tyramine foods, food
factors. additives, preservatives, coloring, artificial sweeteners,
Monitor for serotonin syndrome (delirium, coma, agitation, diaphoresis, chocolate, caffeine, may precipitate a migraine attack.
hypertension, fever, tremors). Report chest pain or tightness, sudden and severe
Monitor BP, ECG abdominal pain, swelling around eyes, face, lips.
Monitor neurologic status Do not use for more than 3-4 headaches per month.
Nasal spray: Use 1 spray in 1 nostril. Repeat if headache
returns, but not if pain continues after 1st dose. Lie in dark,
quiet environment.
Avoid hazardous activities if dizziness, drowsiness occurs.
Avoid alcohol: may increase headache.
Class: Skeletal Muscle Relaxants
Lioresal (Baclofen), Muscle spasms. Hypersensitivity PO 1-3 hours CNS depression with
Cyclobenzaprine (Flexeril), Baclofen and Intrathecal 30 minutes alcohol, tricyclics, opiates,
Dantrium: multiple barbiturates, sedatives.
Dantrolene (Dantrium), IM/IV
sclerosis, Increase hypotension with
Methocarbamol (Robaxin)
cerebral palsy. antihypertensives.
Mechanism of Action
Inhibits synaptic responses in CNS by stimulating GABAb receptors. This decreases neurotransmitter function; decreases
frequency, severity of muscle spasms.
Dizziness Drowsiness Hypotension Bradycardia

Fatigue Lightheadedness Angioedema Anaphylaxis
Dry mouth Muscle weakness Hepatotoxicity CNS depression
Constipation Urinary retention Seizures
Anorexia Nausea/vomiting
Assess spasms, spasticity, ataxia for improvement with medication. Methocarbamol may turn urine green, brown, or black.
Assess BP, weight, glucose, hepatic function studies periodically. Take with meals for GI symptoms.
Monitor ALT, AST with long-term Dantrium use. Do not discontinue abruptly.
I&O Do not take with alcohol, other CNS depressants.
Avoid hazardous activities if drowsiness/dizziness occurs.
Class: Enzymatic Debridement Agents
Collagenase (Santyl) Wound debridement Known local OIntment Skin products containing
or systemic heavy metals may
hypersensitivity to decrease the effect of
collagenase. collagenase.
Mechanism of Action
An enzymatic debriding agent capable of specifica ly hydrolyzing peptide bonds of collagen.

Liquefies nec otic tissue without damaging granulation tissue.
Slight erythema may develop in Bacterial infection.

surrounding tissue
Possible risk of systemic bacterial
infection
Prior to each application, cleanse wound with a gauze pad saturated Do not apply to healthy skin.
with 0.9% sodium chloride solution or a compatible cleansing agent Notify primary healthcare provider of any symptoms of serious
to remove necrotic material and follow with a normal saline solution infection (fever, chills, hyperventilation, tachycardia)
rinse.
Use caution to restrict application to the lesion; avoid applying to

healthy skin.
Do not apply to internal cavities.
Class: Topical Anti-infectives
Silver sulfadiazine Prevention and Hypersensitivity Topical 2-4- hours
(Silvadene) treatment Pregnancy
of wound sepsis in
Mafenide acetate Newborns
patients with second-
(Sulfamylon)
and third-degree
Silver nitrate burns.
Povidone-Iodine (Betadine)
Mechanism of Action
Interferes with bacterial protein synthesis.
Skin discoloration Transient leukopenia

Burning sensation Skin necrosis
Rash Interstitial nephritis.
Check for allergy to sulfa antibiotics. Cover wound completely with ointment.
Check for iodine allergy with use of povidone-iodine.
Class: Alpha-Glucosidase Inhibitors
Acarbose (Precose), Type 2 Diabetes DKA PO Decreases levels of
Miglitol (Glyset) Type 1 Diabetes digoxin, propranolol.
Cirrhosis
Intestinal obstruction
Mechanism of Action
Delays absorption of blucose from the GI tract.
Less likely to cause hypoglycemia Flatulence Hepatotoxicity

Abdominal cramps
Diarrhea
Can be hepatotoxic
Monitor liver functions every 3 months for first year of herapy and Importance of diet and exercise.
periodically thereafter. Signs/Symptoms of hypoglycemia and hyperglycemia
Monitor for hypoglycemia if also taking a sulfonylurea. Take with food at the same time each day.
FSBS Self-monitoring blood glucose
Class: Amylin Analog
Pramlintide (Symlin) Adjunct therapy for Hypersensitivity SubQ 20 minutes Increases effect of
Type 1 & 2 Diabetes Gastroparesis acetaminophen.
who have failed to Increases hypoglycemia
achieve optimal glucose
control with insulin
with ACE inhibitors, alcohol,
alone. corticosteroids, insulin.
Mechanism of Action
Augments the effects of insulin. Decreases post meal glucagon and glucose. Slows stomach emptying. Decreases appetite,
leads to decreased caloric intake and weight loss.
Can assist with weight loss Headache Fatigue Hypoglycemia

Dizziness Blurred vision
Nausea/vomiting Anorexia
Abdominal pain
Administer immediately prior to meals. Medication administration.

Give SubQ in abdomen or thigh. DO NOT administer in arm as Give SubQ in abdomen or thigh. DO NOT administer in arm as
absorption is unpredictable. absorption is unpredictable.
Monitor for hypoglycemia/hyperglycemia Sign/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available. Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
Class: Anterior Pituitary Inhibitor Drugs
Octreotide Acromegaly Hypersensitivity SubQ 30 minutes Decreased absorption of
(Sandostatin) Severe diarrhea IM dietary fat, Vit B12 levels.
Flushing episodes
IV
associated with
metastatic tumors
Variceal bleeding
Mechanism of Action
Inhibits growth hormone. Promotes fluid and elelct olyte reabsorption.
Headache Dysrhythmias
GI complaints Heart failure
Fatigue Hyperglycemia
Dizziness Hypoglycemia
Flatulence Cholelithiasis
Constipation Seizure
UTI
Assess growth hormone antibodies. SubQ self-injection

Monitor thyroid function studies. Blood glucose monitoring
Monitor blood glucose.
Class: Anterior Pituitary Stimulant Drugs
Somatropin Growth Hormone: Growth failure SubQ 15 minutes Increase epiphyseal closure
(Genotropin, Growth Failure due after closure of the IM with androgens, thyroid
to growth hormone hormones.
Serostim, Nutropin) epiphyseal plates.
deficienc , AIDS wasting Decrease growth with
syndrome and short glucocorticosteroids.
bowel syndrome. Decrease insulin, antidiabetic
effect.
Mechanism of Action
Stimulates growth.
Headache Hyperglycemia
Fever Hypothyroidism
Nausea/Vomiting Ketosis
Joint and muscle pain
Inject deeply into a large muscle. Treatment may continue for years.
Aspirate before injection. Maintain a growth record.
Rotate injection sites daily. Report knee/hip pain or limping.
Assess for signs/symptoms of diabetes.
Thyroid function tests.
Class: Anti-hypoglycemic
Glucagon Hypoglycemia Hypersensitivity SubQ 10 minutes Increased bleeding risks
Pheochromocytoma IM with anticoagulants.
IV
Mechanism of Action
Increases blood sugar by stimulating glycogenolysis (glycogen breakdown) in the liver. It protects the body cells, especially in the
brain and retina, by providing the nutrients and energy needed to maintain body function.
Dizziness Hyperglycemia
Headache Hypersensitivity
Hypotension
Nausea/vomiting
Monitor glucose levels. Use other products to control hypoglycemia if How to use product.
client is conscious. Glucose self-monitoring.
Sign/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Class: Anti-Thyroids
Methimazole (Tapazole), Hyperthyroidism Pregnancy PO Rapid Increase response to digoxin.
Propylthiouracil (PTU) Graves Disease Breastfeeding Decrease effectiveness of
Thyrotoxicosis warfarin
Hypersensitivity
Pre-op to stun the
thyroid prior to
Increase PT, AST, ALT, alkaline
thyroidectomy. phosphate.
Mechanism of Action
They stop the thyroid from making thyroid hormones.
Rash Leukopenia
Drowsiness Agranulocytosis
Headache Pancytopenia
Vertigo Hepatitis
Nausea/vomiting
Diarrhea
Monitor CBC with differential and PT time for bone marrow Report unusual bruising or bleeding.
suppression. Avoid shellfish and io ine products.
Monitor TSH levels. Teach client how to monitor pulse daily.
Assess for s/s of hypothyroidism as well as hyperthyroidism. Report redness, swelling, sore throat, fever.
I&O Do not discontinue medication abruptly because thyroid crisis
Daily weight can occur.
Increase fluids to 3-4 L/day unless contrain icated
Class: Anti-Thyroids (Radioactive Iodine)
Radioactive iodine Hyperthyroidism Pregnancy PO
Thyroid cancer
Mechanism of Action
Destroys thyroid cells so that the thyroid stops making thyroid hormones. Hypothyroidism is expected now.
Hypothyroidism Hyperthyroidism – rebound effect post

Headache radioactive iodine.
Confusion
Paresthesia
Metallic taste
Stomatitis
Nausea/Vomiting
Diarrhea
Watch for thyroid storm. Stay away from babies for 1 week
Monitor for fever, rash, metallic taste, mouth sores, sore throat, GI Don’t kiss anybody for 1 week.
distress. Avoid crowds and people who are ill.
Report darkening of urine or jaundice.
Monitor for weight gain.
Class: Biguanides
Metformin Hyperglycemia in Type 2 Ketoacidosis PO Unknown May potentiate hypoglycemia
(Glucophage, diabetes Renal impairment when used with ACE inhibitors,
Glucophage XR) Hepatic dysfunction ARBS, calcium channel blockers,
Cardiopulmonary insufficienc beta-blockers, procainamide,
digoxin, furosemide, alcohol,
Alcoholism
cimetidine
Mechanism of Action
Decreases hepatic production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine.
Does not stimulate the release of Dizziness Fatigue Lactic acidosis

more insulin, so less likely to cause Headache Anorexia
hypoglycemia. Nausea/Vomiting
Clients undergoing surgery or any Diarrhea
radiologic procedure that involves contrast Weight loss
dye should temporarily discontinue
metformin. They can resume 48 hours
after the procedure if kidney function has
returned and the creatinine is normal.
Assess for hypoglycemia/hyperglycemia Glucose self-monitoring.

Monitor CBC, renal and studies every 3 months Signs/Symptoms of hypoglycemia/hyperglycemia.
Administer with meals Avoid OTC medications, alcohol.
Glucophage XR tab may appear in stool.
Carry emergency ID and glucagon emergency kit.
Class: Corticosteroids
Prednisone, Used to prevent N/V Hypersensitivity PO 1 hour
Methylprednisolone caused by chemotherapy. Fungal infections IM
Used before
(Solu-Medrol), Seizure disorder IV
chemotherapy to prevent
Dexamethasone
severe allergic reaction. Pregnancy
(Decadron)
Mechanism of Action
Corticosteroids are natural hormones and hormone-like drugs that are useful in the treatment of many types of cancer, as
well as other illnesses. When these drugs are used as part of cancer treatment, they are considered chemotherapy drugs.
Corticosteroids are anti-inflammatory agents hat suppress the inflammatory p ocess that is associated with tumor growth.
Although the exact mechanism of action is unknown, these agents may block steroid-specific eceptors on the surface of cells.
This blocking action slows the growth fraction of the tumor, thus retarding its growth.
Provide the client with a sense of well-being Increased appetite Seizures

and varying degrees of euphoria. Fluid retention Circulatory collapse
Hypokalemia Infection
Risk for infection
Hyperglycemia
Increased fat distribution
Muscle weakness
Monitor serum glucose levels, electrolytes. Take PO dose with food or milk to decrease GI symptoms.
Administer with food for PO medication. Notify Primary healthcare provider for fever of 100.40F
Daily weight (380C).
I&O. Do not take Aspirin or aspirin containing products without
approval.
Avoid sun exposure.
Class: Fixed Combination Products
Glucovance Type 2 Diabetes Renal insufficienc PO 15-30 minutes Thiazides and other diuretics, corticosteroids,
(Glyburide and Type 1 Diabetes phenothiazines, estrogens, oral contraceptives,
Metformin) DKA phenytoin, calcium channel blockings, and
isoniazid may cause hyperglycemia.
The hypoglycemic action of sulfonylureas
may be potentiated by NSAIDS, salicylates,
sulfonamides, MAOIs, and beta-adrenergic
blocking agents.
Mechanism of Action
GLUCOVANCE combines glyburide and metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action,
to improve glycemic control in patients with type 2 diabetes. Gluburide directly stimulates the beta cells to secrete insulin, thus decreasing
the blood glucose level. Increases the tissue response to insulin and decreases glucose production by the liver. Metformin decreases hepatic
production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine.
URI Diarrhea Lactic acidosis

Contraindicated for clients Headache Dizziness Hypoglycemia
with renal insufficiency due Nausea/vomiting
to possible risk of developing Abdominal pain
lactic acidosis.
Assess for hypoglycemia/hyperglycemia Glucose self-monitoring.

Monitor CBC, renal and studies every 3 months Signs/Symptoms of hypoglycemia/hyperglycemia.
Administer with meals Avoid OTC medications, alcohol.
Glucophage XR tab may appear in stool.
Carry emergency ID and glucagon emergency kit.
Use sunscreen and wear protective clothing when outside for more than a
short time.
Class: Glucocorticoids
Betamethasone Inflamma ion / Allergies Hypersensitivity PO 4-8 days Increased side effects
(Celestone) Cerebral edema Ulcerative colitis IM 1-2 hours with alcohol, salicylates,
Septic shock digoxin, diuretics, NSAIDs.
Dexamethasone Seizure disorders IV
Meningitis
(Decadron), prednisone
Asthma
(Deltasone), Multiple sclerosis Increased dexamethasone
methylprednisolone Irritable bowel syndrome action with salicylates,
(Solu-Medrol) Autoimmune diseases estrogens, indomethacin,
Prenisolone (Prelone) Organ transplant NSAIDs.
Mechanism of Action
Blocks or reduces the inflammatory esponse.
Depression Flushing Seizures Hypertension

Sweating Headache Circulatory collapse Cardiomyopathy
Mood changes Insomnia Heart failure Thromboembolism
Hypernatremia GI bleeding Hyperglycemia
Hypokalemia Muscle wasting Cushing’s syndrome
Osteoporosis Delayed wound healing
Administer PO medication with food or milk to decrease GI symptoms. Take with food or milk
IM injection deeply in large muscle mass. Avoid deltoid. Avoid OTC products
Daily weight, Monitor vital signs, I&O Avoid exposure to chicken pox, measles, individuals with an
Monitor for signs of infection infection.
Monitor fluid and elect olytes and glucose. DO NOT discontinue abruptly.
Do not stop abruptly; taper off medication.
Class: Iodine Compounds
Potassium iodide Hyperthyroidism Pregnancy PO 24-48 hours Increase: hypothyroidism –
(Lugol’s solution, Pre-op to decrease Pulmonary edema lithium
the chance of Increase: hyperkalemia –
SSKI) TB
bleeding.
Bronchitis ACE inhibitors, potassium-
Hypersensitivity sparing diuretics.
Mechanism of Action
Decreases the size and vascularity of the thyroid gland. Inhibits secretion of thyroid hormone.
Headache Angioneurotic edema

Confusion
Paresthesia
Metallic taste
Stomatitis
Nausea/Vomiting
Diarrhea
Dilute in milk or juice and administer through a straw to prevent teeth Keep of graph of weight, pulse, mood
discoloration. Avoid seafood and other iodine products.
Administer after meals to prevent GI upset. Do not discontinue abruptly as thyroid crisis may occur.
Assess Vital signs
Monitor potassium level
Daily weight
I&O
Monitor thyroid levels
Class: Incretin Mimetic
Exenatide (Byetta) Type 2 Diabetes Type 1 Diabetes SubQ 1 hour Increase hypoglycemia
DKA with ACE inhibitors,
Liraglutide (Victoza) Severe renal sulfonylureas, alcohol.
dysfunction Increase hyperglycemia with
Severe GI disease corticosteroids.
Mechanism of Action
Suppresses glucagon secretion

Stimulates insulin release
Exenatide added to type 2 diabetic Headache Hypoglycemia

therapy when inadequately managed by Dizziness Pancreatitis
Metformin or a Sulfonylurea. Jitteriness Angioedema
Liraglutide not recommended for first Nausea/Vomiting Anaphylaxis
line therapy. Risk of thyroid C-cell tumors Diarrhea
including medullary thyroid cancer.
Administer exenatide SQ within 1 hour of morning and evening SubQ medication administration.
meals. Glucose self-monitoring.
Monitor for hypoglycemia Signs/Symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available. Avoid OTC medications, alcohol.
Monitor for pancreatitis. Always have oral carbohydrate available.
Notify PHCP or severe abdominal pain.
Class: Incretin Modifier
Sitagliptin (Januvia), Type 2 Diabetes Angioedema PO Increase level of digoxin.
Saxagliptin (Onglyza) Type 1 Diabetes Increase risk of
DKA hypoglycemia with beta
blockers, cimetidine.
Decrease antidiabetic
effect with thiazides, ACE
inhibitors.
Mechanism of Action
Increases insulin secretion. Decreases Glucagon secretion.

May be taken with or without food. Headache Hypoglycemia

N/V Pancreatitis
Abdominal pain Acute renal failure
Diarrhea Anaphylaxis
Constipation Angioedema
Peripheral edema
Monitor for hypoglycemia. Do not split, crush, chew. Swallow whole.

Monitor for swelling of face, mouth, lips, dyspnea. Self-monitoring blood glucose.
Monitor blood glucose, BUN, Creatinine, Hgb A1C Signs and symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol, digoxin, insulins.
Notify PHCP of rash, swelling of face, dyspnea).
Class: Combination Insulin (Pre-mixed)
Humulin 70/30, Type 1 Diabetes Hypersensitivity SubQ Onset and Peak Increased hypoglycemic
NovoLog Mix 70/30, Type 2 Diabetes Hypoglycemia dependent on effect with aspirin, oral
Humalog Mix 75/25, whether combined anticoagulant, alcohol, oral
Humalog Mix 50/50 with a rapid acting hypoglycemic, beta blockers
or short acting MAOIs.
insulin. All provide
24 hour duration.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of
glucose by body cells.
Intermediate acting insulin combined Confusion Agitation Tachycardia

with either rapid acting or short Tremors Headache Palpitations
acting (regular) insulin. Flushing Hunger Hypoglycemia
Weakness Lethargy Rebound hyperglycemia
Fatigue Lipodystrophy
Redness at injection site. Shock/Anaphylaxis
Monitor for hypoglycemia, hypokalemia, lipodystrophy. SubQ medication administration.

Always have oral carbohydrate available. Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Class: Intermediate Acting Insulin
Isophane suspension Type 1 Diabetes Hypersensitivity SubQ 1 – 1 ½ hour Increased hypoglycemic
(NPH, Humulin N, Type 2 Diabetes Hypoglycemia Peak: 4-12 hours effect with aspirin, oral
Novolin N) Duration: 16-24 hrs anticoagulant, alcohol,
oral hypoglycemic, beta
blockers MAOIs.
Mechanism of Action
Confusion Agitation Tachycardia

Tremors Headache Palpitations
Flushing Hunger Hypoglycemia
Redness at injection site. Shock
Anaphylaxis
Cloudy suspension. Can mix with Regular or Rapid acting insulin: SubQ medication administration.
Draw up clear (Regular or Rapid acting), then cloudy (NPH), “Clear Glucose self-monitoring.
to cloudy”. Signs/symptoms of hypoglycemia/hyperglycemia.
Monitor for hypoglycemia, hypokalemia, lipodystrophy. Always have oral carbohydrate available.
Always have oral carbohydrate available. Carry a glucose source to treat hypoglycemia
Class: Long Acting Insulin
Glargine (Lantus) Type 1 Diabetes Hypersensitivity SubQ 2-4 hours Increased hypoglycemic
Type 2 Diabetes Hypoglycemia Peak: none effect with aspirin, oral
Duration: 24 hours anticoagulant, alcohol, oral
hypoglycemic, beta blockers
MAOIs.
Mechanism of Action
Once daily SubQ injection provides Confusion Agitation Tachycardia

24-hour coverage. No peak, insulin Tremors Headache Palpitations
delivered at steady level, less risk of Flushing Hunger Hypoglycemia
hypoglycemia. Weakness Lethargy Rebound hyperglycemia
Anaphylaxis
Do NOT mix with any other insulin. SubQ medication administration.

Monitor for hypoglycemia, hypokalemia, lipodystrophy. Glucose self-monitoring.
Always have oral carbohydrate available. Signs/symptoms of hypoglycemia/hyperglycemia.
Class: Rapid Acting Insulin
Aspart (NovoLog), Type 1 Diabetes Hypersensitivity SubQ 5-15 minutes Increased hypoglycemic
Lispro (Humalog), Type 2 Diabetes Hypoglycemia IV Peak: 1-3 hours effect with aspirin, oral
Glulisine (Apidra) Duration: 3-5 hours anticoagulant, alcohol,
blockers MAOIs.
Mechanism of Action
Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of glucose
by body cells.
May be given as a short-term IV therapy Confusion Agitation Tachycardia

with close monitoring. Tremors Headache Palpitations
Flushing Hunger Hypoglycemia
Anaphylaxis
Administer with meals. DO NOT administer unless meal is readily SubQ medication administration.
available. Glucose self-monitoring.
Monitor for hypoglycemia, hypokalemia, lipodystrophy. Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available. Always have oral carbohydrate available.
Class: Short Acting Insulin (Regular)
HUmulin R, Novolin R Type 1 Diabetes Hypersensitivity SubQ 30 min – 1 hour Increased hypoglycemic
Type 2 Diabetes Hypoglycemia IV Peak: 2-4 hours effect with aspirin, oral
Duration: 6-8 hours anticoagulant, alcohol,
blockers MAOIs.
Mechanism of Action
Used for dosing clients with Sliding Confusion Agitation Tachycardia

Scale. Can be administered IVP or Tremors Headache Palpitations
continuous IV infusion. Flushing Hunger Hypoglycemia
Anaphylaxis
Administer with meals. DO NOT administer unless meal is readily SubQ medication administration.
available. Glucose self-monitoring.
Finger Stick Blood Sugars (FSBS) Signs/symptoms of hypoglycemia/hyperglycemia.
Monitor for hypoglycemia, hypokalemia, lipodystrophy. Always have oral carbohydrate available.
Always have oral carbohydrate available. Carry a glucose source to treat hypoglycemia
Class: Meglitinides
Nateglinide (Starlix), Type 2 Diabetes Type 1 Diabetes PO 30 minutes Antidiabetic effect
Repaglinide (Prandin) DKA increased with use of
garlic.
Mechanism of Action
Stimulates the release of insulin from the pancreas.
May be used alone or in combination Headache Weakness Hypoglycemia

with Metformin. Tinnitus Sinusitis Pancreatitis
Should be avoided in clients with liver Nausea/vomiting Diarrhea Hemolytic anemia
dysfunction due to possible decreased Constipation Dyspepsia Leukopenia
liver metabolism. Angina URI
Administer 15-30 minutes before meals. Blood glucose monitoring.

Skip dose if meal skipped. Signs/Symptoms of hypoglycemia/hyperglycemia
Monitor for hypoglycemia. Eat after taking medication to prevent hypoglycemia.
Class: Mineralocorticoid
Fludrocortisone Addison’s disease Children <2 y/o PO Increased BP with sodium-
Adrenal insufficienc Hypersensitivity containing food or medication.
Decreased flud ocortisone action
with barbiturates, phenytoin.
Decrease potassium levels with
thiazides, loop diuretics.
Mechanism of Action
Promotes increased reabsorption of sodium and loss of potassium, water, hydrogen from distal renal tubules. Aldosterone
causes the retention of sodium and water.
Flushing Sweating Seizures

Headache Dizziness Circulatory collapse
Hypertension Tachycardia Embolism
Can cause a negative nitrogen Weight gain Hyperglycemia Anaphylaxis
balance Hypokalemia
Daily weight Notify prescriber of weight gain > 5 pounds.

I&O Notify prescriber of chest pain.
Assess for edema Do not discontinue medication abruptly.
Vital Signs every 4 hours Avoid exposure to disease.
Monitor electrolytes
Administer with food or milk to decrease GI symptoms
Class: Parathyroid Agent (Calcium Regulator)
Calcitonin (Fortical) Hypercalcemia Hypersensitivity to SubQ 15 minutes Decrease lithium effect.
Paget’s disease product, fis IM 15 minutes
Osteoporosis
Mechanism of Action
Calcitonin decreases serum calcium by taking the calcium out of the blood and putting it back into the bone.
Headache Tetany Anaphylaxis

Chills Weakness
Dizziness Hypertension
Nasal congestion Nausea/Vomiting
Assess for anaphylaxis. Have emergency equipment readily available. Teach about method of injection if client will be self-
Monitor nutritional status. medicating.
Monitor calcium levels Report difficu ty swallowing.
Class: Sulfonylureas – 1st Generation
Tolbutamide Type 2 Diabetes Type 1 Diabetes PO 20 minutes Beta-blockers may hide signs of
(Orinase), DKA hypoglycemia. ACE inhibitors, anticoagulants
Chlorpropamide MAOIs, NSAIDs, salicylates may increase risk
(Diabinese) of hypoglycemia.
Calcium channel blockers, corticosteroids,
decongestants, diuretics, hormonal
contraceptives, albuterol, epinephrine, thyroid
supplements may result in hyperglycemia.
Mechanism of Action
Stimulating the release of the body’s natural insulin from the pancreas, which in turn helps to lower blood sugar.
Drowsiness Anaphylaxis
Hypoglycemic reaction may occur Dizziness Hypoglycemia
Blurred vision Jaundice
Lightheadedness Blood dyscrasias
Monitor vital signs as oral antidiabetics increase cardiac Importance of diet and exercise.
function and oxygen consumption, which can lead to Signs/Symptoms of hypoglycemia and hyperglycemia
cardiac dysrhythmias. Take with food at the same time each day.
Administer with food. Continue to take tolbutamide even if feeling well. Do not miss any doses.
FSBS Self-monitoring blood glucose
Prepare teaching plan based on client’s knowledge of Use sunscreen and wear protective clothing when outside for more than a
health problems, diet, exercise, drug therapy. short time.
Class: Sulfonylureas – 2nd Generation
Glipizide (Glucotrol), Type 2 Diabetes Type 1 Diabetes PO 15-30 minutes Beta-blockers may hide signs of
Glyburide (DiaBeta), DKA hypoglycemia. ACE inhibitors,
Glimepiride (Amaryl) Liver or renal anticoagulants MAOIs, NSAIDs,
salicylates may increase risk of
dysfunction
hypoglycemia. Calcium channel
blockers, corticosteroids,
decongestants, diuretics, hormonal
contraceptives, albuterol, epinephrine,
thyroid supplements may result in
hyperglycemia.
Mechanism of Action
Directly stimulates the beta cells to secrete insulin, thus decreasing the blood glucose level. Increases the tissue response to
insulin and decreases glucose production by the liver.
Effective doses are lower than 1st Nausea/Vomiting Hypoglycemia

generation. Longer duration of Diarrhea Blood dyscrasias
action and fewer side effects. Abdominal pain Jaundice
Higher hypoglycemic potency than
1st generation. Hypoglycemia more
likely in the older adult.
Monitor vital signs as oral antidiabetics increase cardiac Importance of diet and exercise.
function and oxygen consumption, which can lead to cardiac Signs/Symptoms of hypoglycemia and hyperglycemia
dysrhythmias. Take with food at the same time each day. Self-monitoring blood
Administer with food. FSBS; Prepare teaching plan based on glucose. Use sunscreen and wear protective clothing when outside for
client’s knowledge of health problems, diet, exercise & meds. more than a short time.
Class: Synthetic Antidiuretic Hormone
Desmopressin Diabetes Insipidus Coronary artery disease Intranasally 1 hour Increased
Acetate (DDAVP) Hemophillia A Hypertension IV 1 minute antidiuretic
Vasopressin (Pitressin) Nocturnal enuresis Severe renal disease effect with SSRIs,
Normalizes urinary
water excretion
Hyponatremia carbamazepine
DI related to renal disease
Mechanism of Action
Promotes reabsorption of water by action on renal tubular epithelium. Causes smooth muscle constriction. Increases factor VIII
levels, which increases platelet aggregation, thereby resulting in vasopressor effect (similar to vasopressin).
Drowsiness Seizures
Lethargy IV – Anaphylaxis
Flushing Water intoxication
Clients at risk for hyponatremia or Nasal irritation
thrombi should not receive these Congestion
medications Hyponatremia
Monitor pulse, BP Proper technique for nasal instillation.

I&O Avoid OTC products with epinephrine.
Daily weight
Observe for signs of water intoxication (lethargy, behavior changes,
disorientation)
Class: Thiazolidinediones “Glitazones”
Rosiglitazone Type 2 Diabetes Symptomatic heart PO Avoid concurrent use
(Avandia), disease with insulin, nitrates.
Pioglitazone (Actos) Class 3 / 4 Heart failure Increased antidiabetic
DKA effect with garlic.
Type 1 diabetes
Mechanism of Action
Improves glucose uptake in the muscles, decreases endogenous glucose production. Decrease insulin resistance and improve
blood glucose control.
Does not induce hypoglycemic reactions Fatigue MI

if taken alone. Lowers triglyceride level. Headache CHF
May raise HDL cholesterol Weight gain Hepatotoxicity
May cause heart failure or MI Diarrhea Anaphylaxis
Can be hepatotoxic UTI
May raise LDL cholesterol
Monitor for hypoglycemia. Monitor blood glucose

Monitor ALT level Signs/Symptoms of hyperglycemia / hypoglycemia
Monitor glucose Daily weight
Report edema
*To use Rosiglitazone the provider and client must be enrolled in the Report SOB, chest pain
Avandia-Rosiglitazone Medicines Access Program. Report symptoms of hepatic dysfunction – Nausea/
Vomiting, abdominal pain, dark urine, jaundice, anorexia.
Class: Thyroid Hormone Replacements
T4 Replacement: Hypothyroidism Adrenal insufficienc PO 24 hours Increase cardiac insufficiency
Levothyroxine (Synthroid), Myxedema Recent MI risk with epinephrine products.
Cretinism Decrease levothyroxine
Thyrotoxicosis IV
T3 Replacement: absorption/effect with ferrous
Liothyronine (Cytomel, sulfate, estrogens, antacids,
Triostat) sucralfate.
Mechanism of Action
Increases metabolic rate; increases cardiac output, renal blood flo , oxygen consumption, body temperature, blood volume,
growth, development at cellular level via action on thyroid hormone receptors.
Insomnia Hypertension
Weight loss Tachycardia
Anxiety Chest pain
Insomnia Cardiovascular collapse
Headache Thyrotoxicosis
Nausea
Anorexia
Monitor Vital Signs Life-long replacement with medication is necessary.

Monitor for thyrotoxicosis. Do not switch brands
Daily weight Avoid OTC preparations with iodine.
Monitor thyroid hormone levels Avoid iodine-rich foods (Iodized salt, soybeans, tofu, turnips,
Monitor cardiac status seafood).
Class: Alternative Therapy - Cannaboids
Dronabinol (Marinol) Anti-emetic Pregnancy PO 30 minutes - 1 hour Increased CNS depression
Chemotherapy Breastfeeding with other CNS depression
Psychiatric disorders medications.
Mechanism of Action
The mechanism of action of Marinol is not completely understood. It is thought that cannabinoid receptors in neural tissues
may mediate the effects of dronabinol and other cannabinoids. Animal studies with other cannabinoids suggest that Marinol’s
antiemetic effects may be due to inhibition of the vomiting control mechanism in the medulla oblongata.
Euphoria Orthostatic hypotension

Anxiety Seizures
Drowsiness Paranoia
Visual disturbances
Monitor hydration, nutritional status. Rise slowly from a sitting or lying position.
I&O Do not use alcohol or drive while taking this medication.
Monitor BP and heart rate throughout therapy. Capsules should be refrigerated, not frozen.
Monitor closely for side effects. Call for assistance when ambulating.
Capsules should be refrigerated.
Class: Antacids
Magnesium carbonate Heartburn Renal failure PO Risk of side effects of
(Gaviscon), Magnesium Gastritis anticoagulants.
hydroxide (Milk of Peptic Ulcer disease Blocks absorption of
GERD
Magnesia), Calcium
Indigestion
other medications when
Carbonate (Tums), Prophylaxis with burns given simultaneously
Hypomagnesemia
Mechanism of Action
Antacids work by counteracting or neutralizing the acid in the stomach. The neutralization makes the stomach contents less
corrosive.
Diarrhea Hives
Loss of appetite Itching
Dyspnea
Tightness in chest
Edema of face, mouth, tongue
Give either 30 minutes before or 1 hour after other medications to Take with or without food. Follow with a full glass (240 mL)
prevent decreased absorption and effectiveness of medications. water or other liquid.
Class: Anti-ulcer; GI protectant
Sucralfate Peptic ulcer disease Hypersensitivity PO 30 minutes Cimetidine, ranitidine:

(Carafate) Prevention of drug- Precautions: decrease absorption
induced ulcers
pregnancy,
breastfeeding, renal
failure, hypoglycemia
Mechanism of Action
Acts locally, not systemically, binding directly to the surface of an ulcer and absorbs pepsin.
Nausea
Constipation
Dry mouth
No systemic absorption
Assess for abdominal pain or blood in stools. Do not break, crush or chew tablets
Don’t administer with antacids. Take on empty stomach 1 hour before meals and at bedtime
Watch for constipation. Avoid antacids 30 minutes before or 1 hour after taking this
product
Store at room temperature.
Avoid smoking.
Class: Emollient Laxative
polyethylene glycol Bowel cleansing prior Gastrointestinal PO 30-60 minutes Oral medication administered
(GoLytely, CoLyte) to colonoscopy and obstruction within one hour of the
barium enema X-ray start of administration of
Gastric retention,
examination. GoLYTELY for Oral Solution
Bowel perforation,
may be flushed f om the
Toxic colitis, gastrointestinal tract and not
Megacolon / ileus. absorbed.
Mechanism of Action
GoLYTELY for Oral Solution induces a diarrhea which rapidly cleanses the bowel, usually within four hours. The osmotic activity
of polyethylene glycol 3350 and the electrolyte concentration result in virtually no net absorption or excretion of ions or water.
Accordingly, large volumes may be administered without significant changes in fluid or elec olyte balance.
Cleanses the bowel thoroughly so that Severe bloating, distention or

diagnostic tests can be performed abdominal pain (may have to
efficien ly discontinue if doesn’t resolve)
Observed closely with clients that have impaired swallowing or GERD Prepare the solution per the instructions on the bottle. It is more
during the administration of GoLYTELY for Oral Solution. palatable if chilled. For best results, no solid food should be
consumed during the 3 to 4-hour period before drinking the
solution, but in no case should solid foods be eaten within 2
hours of taking GoLYTELY for Oral Solution.
Class: H2 Antagonists (Histamine 2 Receptor Blockers)
Cimetidine (Tagamet), Peptic ulcer disease Hypersensitivity PO 15 minutes Cimetidine potentiates
Famotidine (Pepcid), GERD Severe renal disease the effects of warfarin,
Esophagitis phenytoin, theophylline,
Ranitidine (Xantac), Severe liver disease IV 10-15 minutes
GI Bleeding and lidocaine. Smoking
Nizatidine (Axid
Prophylaxis with decreases the effectiveness
burns of H2 Antagonists.
Mechanism of Action
Blocks the H2 receptors of the parietal cells in the stomach, thus reducing gastric acid secretion and concentration.
Overall low incidence of adverse effects Headache Confusion Hepatotoxicity

Dizziness Vertigo Cardiac dysrhythmias
Constipation Diarrhea Blood dyscrasias
Pruritis Depression
Decreased libido
Give at least 1 hour before antacids for optimal effect. Take at least 1 hour before antacids for optimal effect.
Administer IV in 20-100 mL of solution. Smoking decreases the effectiveness of H2 Antagonists.
Avoid foods that cause gastric irritation.
Class: Laxative (hyperosmotic/ammonia detoxicant)
lactulose Bowel prep – Clients on a low- PO 24 hours Neomycin, anti-
(Constulose, Enulose, diagnostic/surgical galactose diet. Rectal infective(oral) and antacids
procedures. decrease effects of lactulose
Generiac, Kristalose, (Galactose is a
Duphalac)
Hepatic component of
encephalopathy lactulose)
Mechanism of Action
Creates a hyperosmotic (acidic) environment that draws water into the colon and produces a laxative effect. It also reduces
ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and
cannot be reabsorbed in to the systemic circulation.
Ease of use and works within 24 hours. Nausea/vomiting Hypernatremia,

Diarrhea Abdominal bloating
Flatulence Rectal irritation
Distention/bloating
Administer with a full glass of fruit juice, water or milk to increase Teach client causes of constipation such as lack of fiber in he
palatability of oral form. diet, fluids or exe cise.
Give on an empty stomach to increase effect.
Assess stool for amount, color and consistency.
Monitor glucose levels if diabetic.
Class: Non-Stimulant Anorexiants
Lipase Inhibitor: Obesity Cholestasis PO Increases effects of
Orlistat (Xenical), Malabsorption warfarin
OTC strength (Alli) syndromes Decreases absorption of
fat soluble vitamins.
Mechanism of Action
Inhibits gastric and pancreatic lipases reducing fat absorption by 30%. The fats are excreted in feces.
Drug of choice for weight loss Oily spotting Flatulence Hypoglycemia

Fecal incontinence Steatorrhea Hepatic failure
Headache Insomnia Hepatitis
Anxiety Depression Pancreatitis
Abdominal cramping
Nausea/Vomiting
Assess weight status before therapy. Lessen dietary fat intake to decrease side effects.
Assess thyroid function, BMI, glucose, weight weekly. Take multivitamin containing fat-soluble vitamins 2 hrs before
or after medication.
Psyllium taken with each dose or at bedtime may decrease GI
symptoms.
Class: Proton Pump Inhibitors
Pantoprazole (Protonix), GERD Hypersensitivity PO 2 hours May decrease
Omeprazole (Prilosec), Peptic ulcer Pregnancy theophylline levels.
Esophagitis. Food decreases peak
Esomeprazole (Nexium), Lactation IV 15-30 minutes levels. Can enhance
Prophylaxis with
Lansoprazole (Prevacid)
burns Caution in liver the action of digoxin,
disease oral anticoagulants,
phenytoin.
Mechanism of Action
Suppress gastric acid secretion by inhibiting the hydrogen/potassium adenosine triphosphatase (ATPase) enzyme system located in
the gastric parietal cells. They block the final step of acid p oduction.
Overall low incidence of adverse effects Headache Dizziness Elevated AST, ALT
Blurred vision Fatigue Pancreatitis
Thirst Dry mouth Rhabdomyolysis
Increased appetite Anorexia
Diarrhea
Monitor liver function studies. Report severe diarrhea; black, tarry stools; abdominal pain.
Monitor glucose levels in diabetic clients. Hyperglycemia may occur in diabetic clients.
Continue taking even if feeling better.
Class: Serotonin Blocker Antiemetics
Ondansetron (Zofran), Post-op Nausea and Hypersensitivity PO 30 minutes Use with apomorphine can
Granisetron (Kytril), Vomiting Torsades de IV 10 minutes lead to unconsciousness,
Chemotherapy hypotention. Do NOT use
Dolasetron, pointes
Netupitan/ together.
palonosetron (Akymzeo) Decrease ondansetron effect
with rifampin, phenytoin.
Mechanism of Action
Suppress nausea and vomiting by blocking the serotonin receptors in the afferent vagal nerve terminals in the upper GI tract.
Do not block the dopamine receptors; Headache Transient elevation of AST and ALT.
therefore, they do not cause extrapyramidal Diarrhea Bronchospasm
symptoms as do the phenothiazine Dizziness
antiemetics. Fatigue
Monitor ECG for QT prolongation in clients with cardiac disease or Report diarrhea, constipation, rash, changes in respirations.
receiving other medications that prolong QT.
Class: Anticoagulants
Heparin sodium, DVT Bleeding SubQ 20-60 minutes Increase heparin action with
warfarin (Coumadin), Pulmonary embolisms Hypersensitivity IV 5 minutes oral anticoagulants, salicylates,
Enoxaparin (Lovenox), Thromboembolic NSAIDS, penicillin, SSRIs.
complications Decrease heparin action
dabigatran etexilate
Prevention of clot formation with digoxin, tetracyclines,
(Pradaxa) Dialysis antihistamines, cardiac glycosides,
Open heart surgery nicotine, nitroglycerin. Increase
DIC bleeding risk with garlic, ginger,
Atrial fibri lation with
ginkgo, green tea.
embolization
Mechanism of Action
Prevents conversion of fibrinogen to fibrin and othrombin to thrombin by enhancing inhibitory effects of antithrombin III.
Injection site reactions Hemorrhage

Fever Hypotension
Does not dissolve clots already present Chills Thrombocytopenia
Headache Anaphylaxis
Rash
Monitor aPTT (Activated Partial Thromboplastin Time) Purpose of medication.

Heparin dosage is adjusted to keep the aPTT between 1.5 and 2.5 times Avoid OTC preparations.
the normal control level. Bleeding precautions.
Have antidote Protamine Sulfate readily available. Carry ID identifying product.
Monitor for bleeding.
Do not massage SubQ injection.
Class: Antiplatelets
Acetylsalicylic acid (Aspirin), Decrease platelet Bleeding ulcer PO 1-2 hours Increased bleeding when
Clopidogrel (Plavix), aggregation Active bleeding taken with Dong quai,
Arterial thrombi feverfew, garlic, and
Abciximab (ReoPro IV), IV Rapid
Thrombotic stroke
Dipyridamole (Persantine),
TIA’s
ginkgo biloba.
Eptifiba ide (Integrilin), Post-MI thrombi
Ticlopidine (Ticlid), Prevents re-occlusion
Tirofiban (Aggrastat), post stent
Anagrelide HCL (Agrylin)
Mechanism of Action
Antiplatelets are used to prevent thrombosis in the arteries by suppressing platelet aggregation.
Long-term, low-dose ASA therapy has been GI complaints Serious bleeding episodes
found to be both an effective and inexpensive Tinnitus Thrombocytopenia
treatment for suppressing platelet aggregation. Dizziness Agranulocytosis
Monitor for bleeding Teach bleeding precautions.

Safety precautions Notify health care provider if surgery is scheduled while
Bleeding precautions on antiplatelet medication. It should be discontinued at
least 7 days prior to surgery.
Class: Hematopoietic Agent
Erythropoietin- Anemia associated Uncontrolled hypertension SubQ Anticoagulants: need for
Stimulating Agents with: Chronic renal Hypersensitivity to human IV an increase in heparin
failure, HIV, and during hemodialysis
(ESAs): albumin
Chemotherapy
Epoetin alfa (Procrit),
Reduce need for
Darbepoetin alfa blood transfusions in
(Aranesp) surgical clients.
Mechanism of Action
Erythropoietin is one factor controlling the rate of red blood cell production.
Hypertension Flushing Seizures

Headache Seizures Hypertensive encephalopathy
Fever Bone pain CHF
DVT
Monitor hemoglobin. Target hemoglobin should never exceed 12g/dL Teach patient or family how to take blood pressure.
Monitor Blood Pressure. Teach patient to avoid hazardous activity during
Only use one dose per vial treatment.
Do not shake solution, it can cause the glycoprotein to denature.2g/dl. Teach patients with renal disease to include high iron and
Monitor for seizures low potassium foods in their diet: meat, dark green leafy
vegetables, eggs and enriched breads.
Folic Acid, Vitamin B9 Megaloblastic anemia Hypersensitivity PO Estrogens,
(Folate) Folacin Pregnancy Other types of SubQ glucocorticoids,
Anemias IM Hydantoin increase the
IV need for folic acid.
Mechanism of Action
Folic acid is needed for erythropoiesis to increase RBCs, WBCs and platelet formation needed in megablastic anemia and is
necessary for DNA and RNA synthesis.
Genera Allergic bronchospasm Confusion

Pruritus Depression
Rash Excitability, irritability
General malaise Anaphylaxis
Erythema
Monitor Hgb, Hct and reticulocyte count; and Teach foods high in folic acid: bran, yeast, dried beans, nuts,
folate levels: 6 – 15mcg/mL baseline, throughout treatment fruit, fresh vegetables, asparagus.
Take as prescribed, do not double up
Identify products taking that cause increase folic acid use: alcohol, Advise that urine may become dark
oral contraceptives, estrogens, glucocorticoids.
Vitamin B12 Vitamin B12 Optic nerve atrophy IM Cimetidine, colchicine,
(Cyanocobalamin) Deficienc , pernicious (Leber’s disease) SubQ chloramphenicol,
Anemia, aminoglycosides,
Anacobin, Nascobal, Pregnancy and Nasal
Vitamin B12
Cobex
malabsorption breastfeeding Sublingual anticonvulsants and
Cobalt Allergy PO potassium products cause
a decreased absorption
Mechanism of Action
Ease of use and low cost Fever Cardiac failure

Diarrhea Thrombosis
Pruritus Optic nerve atrophy
Flushing/itching Pulmonary edema
Pain at injection site Hypokalemia
Monitor potassium levels. Life-long treatment is required for pernicious anemia.

Monitor CBC for increase in RBC, Hemoglobin. Teach foods high in B12 such as: egg yolks, fish, o gan meats,
Monitor for CHF or pulmonary edema in cardiac patients. dairy products, clams, and oysters.
Class: Immunotherapy
Interleukin-2 (IL-2), Leukemia Hypersensitivity SubQ
Interferon-alfa Melanoma IM
Non-Hodgkin’s
lymphoma
AIDS related Kaposi
sarcoma
Mechanism of Action
Has antiviral, antiproliferative, and immune-modulatory effects, which means that these drugs inhibit intracellular replication of
DNA, interferes with tumor cell growth, and enhances natural killer cell activity.
Can improve resistance to invading Flulike syndrome Seizures Transient aphasia

microorganisms and reduce cell Nausea/Vomiting Diarrhea Psychoses Suicidal ideation
proliferation. Anorexia Xerostomia Cyanosis
Taste alterations Orthostatic hypotension
Poor concentration Thrombocytopenia
Keep prefi led syringes in the refrigerator. Keep prefi led syringes in the refrigerator.
Do not freeze or shake. Protect from light. Do not freeze or shake. Protect from light.
Obtain baseline CBC and liver function tests. Notify prescriber of adverse effects.
Class: Plasminogen Inactivators/Anti-fib olytic Agents
Aminocaproic acid Excessive Disseminated IV 1 hour Factor IX complex:
(Amicar) bleeding from intravascular PO increased risk of
hyperfibrinolysis thrombosis
coagulation (DIC)
Mechanism of Action
Promotes clot formation by inhibiting plasminogen activators.
Antidote for thrombolytic therapy with Edema Uncommon and generally mild.
excessive bleeding. Headache Rare:
Malaise Thrombophlebitis
Nausea/Vomiting Orthostatic hypotension.
Diarrhea
Abdominal pain
Monitor bleeding episode. Report signs of angina, MI

Continuous cardiac monitoring – Looking for signs of re-occlusion
Monitor for signs of MI
Class: Thrombolytics
Tenecteplase Acute MI Intracranial neoplasm IV 5-10 minutes Increased bleeding when

(TNKase), Reteplase Thrombolic stroke Intracranial bleed taken with oral anticoagulants,
(Retavase), Alteplase Pulmonary embolism NSAIDs, ginkgo, garlic, ginger,
Suspected aortic
DVT green tea. Decreased effects
(tPA), Streptokinase, dissection
when taken with nitroglycerin.
Urokinase Internal bleeding
Mechanism of Action
Promotes the fibrinoly ic mechanism (converting plasminogen to plasmin, which destroys the fibrin in he blood clot). The
thrombus disintegrates when a thrombolytic drug is administered within 4 hours after an acute MI. Necrosis is prevented or
minimized.
Dissolves clot within 4 hours after an acute Bleeding Hemorrhage Anemia

MI. Nausea Bronchospasms Anaphylaxis
Vomiting Reperfusion anemias MI
Risk for hemorrhage Fever Stoke
Check baseline vital signs and baseline CBC, PT, INR. Explain thrombolytic treatment.
Obtain medical and drug history. Bleeding history. Advise to report lightheadedness, dizziness, palpitations,
Have Amicar readily available – Antidote. nausea, pruritus, or urticaria.
Continuous cardiac monitoring. Avoid use of aspirin or NSAIDS for pain or discomfort.
Continuously monitor for hemorrhage for 24 hours.
Initiate bleeding precautions
Avoid venipuncture/arterial sticks
Class: Antiviral Monoclonal Antibody
Palivizumab (Synagis) Prevents RSV in Bleeding or clotting IM
RSV Immune globin premature infants disorders
and infants born with
(RespiGam) Low platelet count
certain lung disorders
or heart disease.
Mechanism of Action
A man-made antibody to respiratory syncytial virus (RSV).
Fever Cyanosis
Crying or fussiness Black tarry stools
Change in appetite or sleeping Bleeding gums
patterns
Dosage is based on weight of infant and must be calculated with Must take it monthly during the RSV season – November
every dose. through April
Local reactions may occur to injection: tenderness, hives and
swelling
May interfere with other live vaccines and may need to
revaccinated if taken with 10 months after completed
Class: Biologic
adalimumab Crohn’s disease, Active infections SubQ Anakinra (Kineret) also used
Humira Psoriatic arthritis Lymphoma/leukemia to treat rheumatoid arthritis,
Rheumatoid arthritis vaccines
Tuberculosis
Mechanism of Action
Biologics work by targeting and blocking the effects of a protein in your body called TNF – alpha. In autoimmune disorders, there
is too much of this protein which can cause the body to attack itself. In rheumatoid arthritis, too much of this protein can cause
pain, stiffness and swelling in the joints. In ulcerative colitis or Crohn’s, adalimumab can decrease the symptoms and put the client
in remission.
Provide very specific ta geting of the Headache Cancers

involved cells. Nausea Sepsis
Sinus infections Fungus and other opportunistic infections
Expensive and not always covered by
Rash at the injection site
insurance. Significant adverse symptoms
Check for injection site reactions. Learn proper administration of med in the thigh, abdomen
Assess for TB prior to therapy and upper arm
Assess for blood dyscrasias: CBC, differential periodically Rotate sites at least one inch from old site.
Advise no vaccines
Report signs of infection immediately.
Class: Immune Globulin
Rho (D) immune/ Suppresses active Immune globulins IM May interfere with the
globulin (RhoGAM) antibody response IgA deficienc IV immune response to
and formation of Rho live MMR and varicella
Hypersensitivity
(D) antibodies
vaccines.
Mechanism of Action
Suppresses the active antibody response and formation of Rho (D) antibodies in Rho (D) negative women who have been
exposed to Rho (D) positive blood as the result of pregnancy or other obstetric condition. Also used to suppress Rh
isoimmunization in Rho (D) negative individuals following transfusion of Rho positive blood. Treatment of ITP in Rho (D) positive
non-splenectomized patients
Fever Headache Intravascular hemolysis

Nausea Dizziness
Rash Malaise
Mild hemolysis (increased bilirubin,
decreased hemoglobin),
Injection-site reaction
Administer within 72 hours after termination of pregnancy, delivery or Teach women the importance of informing clinicians
obstetric complication. if they are or plan to become pregnant or plan to
Closely monitor patients with ITP in a healthcare setting for ≥8 hours breast-feed. Teach patients when using RhoGAM, the
after administration. Perform dipstick urinalysis as baseline and after importance of retaining the patient identifica ion card and
administration at 2 hours, 4 hours, and just prior to the end of monitoring of presenting this card to healthcare providers. Instruct
period.1 25 Monitor for signs and symptoms of intravascular hemolysis. patients receiving Rho(D) IG for the treatment of ITP to
Assess renal function (including BUN and creatinine) before initiating immediately report signs or symptoms of hemolysis (e.g.,
Rho(D) back pain, chills, fever, discolored urine, swelling, SOB).
Class: Immune Serum
Tetanus Immune Exposure to tetanus IM 2 days These vaccines may not work
Globulin (Baytet) as well if received shortly
after a tetanus injection:
Measles, mumps, rubella
(MMR), polio.
Mechanism of Action
Tetanus immune globulin works by giving your body the antibodies it needs to protect it against tetanus infection. This is
called passive protection. This passive protection lasts long enough to protect your body until your body can produce its own
antibodies against tetanus.
Itching Facial edema

Redness at injection site Difficu ty swallowing
Anorexia Tightness of chest
Mild fever Dyspnea
Pain at injection site
Monitor for signs of significant eaction (eg, wheezing; chest Reason for medication
tightness; fever; itching; bad cough; blue skin color; seizures; Educate client about signs of a significant eaction (eg, wheezing;
or swelling of face, lips, tongue, or throat). chest tightness; fever; itching; bad cough; blue skin color; seizures;
or swelling of face, lips, tongue, or throat).
Class: Immune System Agents/ Immunosuppressant/ Anti-rejection
tacrolimus (Prograf) Autoimmune Hypersensitivity PO Aminoglycosides: increased
cyclosporine diseases Use cautiously in: IV toxicity
Prevent organ Antifungals and calcium
(Sandimmune) Diabetes, HTN
transplant rejection
Hyperkalemia channel blockers: increase
Hyperuricemia blood levels
Vaccines decrease effect
Mechanism of Action
Produces immunosuppression by inhibiting lymphocytes

Insomnia Back pain Infection

Fever UTI’s Hypertension
Nausea/vomiting Hepatotoxicity
Muscle spasms Nephrotoxicity
Pulmonary edema
Monitor liver functions test: AST, ALT, amylase, and bilirubin Advise to report if pregnancy is planned
Monitor serum creatinine and BUN and output - 75% of patients will Report fever, rash, severe diarrhea, chills, sore throat,
experience a decrease in urinary output because serious infections can occur.
Watch for anaphylaxis Report clay colored tools or cramping as it may indicate
Monitor blood studies hepatotoxicity.
Avoid crowds or persons who are sick to reduce infections.
Avoid eating raw shellfish
Class: Vaccines - Biologic Response Modifiers (BRMs
Hepatitis B Prevention of Hepatitis Life threatening allergies IM
recombinant viral B which can lead to liver Pregnancy
antigen cancer.
Prevention of cervical, anal,
HPV recombinant
oropharyngeal cancers; Life threatening allergies IM
viral antigen genital warts Pregnancy
Mechanism of Action
Hepatitis B vaccine recombinant is used to prevent infection by the hepatitis B virus. The vaccine works by causing your body
to produce its own protection (antibodies) against the disease. It cannot give you the hepatitis B virus (HBV) or the human
immunodeficiency virus (HIV).
HPV: When a client receives the vaccine, the immune system produces antibodies against these proteins so if the body ever
encounters them again in the form of the actual HPV virus it is well equipped to deal with and destroy the virus.
HPV: Available for both men and women ages Injection site soreness Anaphylactic reaction
9-26 years of age. Fever
Hep B: Does not treat Hep B HPV: fainting, dizziness, nausea, headache,
HPV: Does not treat cervical cancer and skin reactions
Observe client for s/s of adverse reaction to vaccines. Discuss vaccine-preventable diseases
Keep epinephrine readily available for immediate use in case of anaphylactic Answer questions regarding vaccine safety and efficac
reaction. Advise female clients of childbearing age to avoid
Provide client with record of immunizations received. pregnancy for 1 month.
Provide Vaccine Information Statements from CDC
Class: Vaccines and Toxoids
Tetanus Toxoid Prevention of tetanus Hypersensitivity SubQ 2 weeks Increased
Active infection IM immunosuppression
if given with warfarin,
Poliomyelitis outbreak
corticosteroids, or
Immunosuppression cancer chemotherapy
Febrile illness drugs
Mechanism of Action
Vaccines work by causing the body to produce its own protection (antibodies). Tetanus vaccine is usually first given to infants wi h 2 other
vaccines for diphtheria and whooping cough (pertussis) in a series of 3 injections. This medication is usually used as a “booster” vaccine after
this first series. Booster injec ions may be needed at the time of injury in older children and adults if it has been 5-10 years since the last
tetanus vaccine was received. Booster injections should also be given every 10 years even if no injury has occurred.
Mild fever Tingling of hands/feet

Joint pain Hearing problems
Muscle aches Trouble swallowing
Do not use the vaccine on children younger Nausea Muscle weakness
than 7 years if it has the preservative Tiredness Seizures
thimerosal in it, as this may contain mercury Pain/itching/redness at injection site Swelling of face/tongue
Have epinephrine infection (1:1,000) readily available should an acute Make sure the client/parents were fully informed of benefits
anaphylactic reaction occur. and risks of immunization by the PHCP.
Monitor for signs of anaphylactic reaction. Provide a copy of the immunization record with the date, lot
Record the date, lot number and manufacturer of the vaccine on the number and manufacturer of the vaccine listed.
immunization record.
Class: Erectile dysfunction
Vardenafil (Levitra), Erectile Dysfunction Severe cardiac disease PO 30 minutes Do not use with nitrates
Sildenafil ( iagra), Peptic ulcers of any form
Tadalafil (Cia is) GERD
Hepatic disease
Mechanism of Action
Enhances erectile function by increasing blood flow into he corpus cavernosum
Headache Hypotension
Nasal congestion Exfoliative dermatitis
Rash Priapism
Cardiac arrest
Monitor Vital Signs Take before sexual activity; do not use more than once a day.
Watch for indications of changes in cardiac output Teach to report an erection lasting > 4 hours.
Does not protect against STDs
Class: Hormones: Estrogen
Estrogen Primary ovarian failure Thyroid dysfunction PO Increased risk of
Conjugated estrogen Menopause and post- Family history Transdermal cardiovascular
hysterectomy Palliative disease and some
(Premarin), of breast cancer Topical
treatment of breast cancer
Osteoporosis Thrombophlebitis forms of breast
Prevention of post-partum cancer.
lactation and dysmenorrhea.
Mechanism of Action
Affects release of pituitary gonadotropins.
Hypertension MI
Headache Stroke
Weight changes Thromboembolism
Seizure
Monitor Blood pressures, weight, serum calcium, glucose and liver Smoking increases risk of embolism, stroke or MI
enzymes
Smoking cessation if necessary
Class: Hormones: Progesterone
Progesterone Fibroids, uterine Pregnancy, PO Barbiturates and phenytoin
(Endometrin, cancer, endometriosis, Reproductive IM decrease progesterone
amenorrhea, uterine effect.
Prometrium) cancer Vaginal
bleeding, premenstrual CYP3A4 inhibitors
Estrogen/Progesterone
syndrome (PMS). Thromboembolic insert &
(ketoconazole, cimetidine,
Combination (Prempro) Prevention of miscarriage. disorders gel clarithromycin, danazol,
Hormone Replacement STDs diltiazem, erythromycin,
Therapy fluconazole, verapamil,
voriconazole) increase
progesterone effect
Mechanism of Action
Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation, ovulation; stimulates growth of mammary tissue;
antineoplastic action against endometrial cancer.
Weight changes Cholestatic jaundice Stroke

Breast tenderness Insomnia Pulmonary embolus MI
Depression Dizziness Thromboembolism Angioedema
Spontaneous abortion
Assess for abnormal uterine bleeding, daily weights, I & O Teach to report breast lumps, vaginal bleeding, edema,
jaundice, dark urine, clay-colored stools, dyspnea,
headache, blurred vision, abdominal pain, numbness or
stiffness in legs, or chest pain.
Class: Hormones: Testosterone
Testosterone Delayed male puberty PO
(Depo-testosterone, Male hypogonadism Topical
Metastatic breast cancer
AndroGel, IM
Testoderm)
Mechanism of Action
Hormone replacement when natural levels are low.
Hair growth Acne Edema Hyperkalemia

Spermatogenesis Hypercalcemia Anaphylaxis (rare).
Increased libido Priaprism
Gynecomastia
Administration may alter glucose tolerance test, thyroid tests, and serum Report symptoms of electrolyte imbalances immediately
cholesterol. Suppresses clotting factors. Ensure proper administration technique
May decrease insulin requirements. Report priaprism immediately
I&O, monitor for decreased urinary output and weight gain (associated Teach good skin hygiene
with Na and water retention)
Class: Selective Estrogen Receptor Modulators (SERMs)
Toremefene Breast cancer - Pregnancy PO Decrease action of
(Fareston), postmenopausal Breast feeding anticoagulants
women
Raloxifen (Evista) Hypersensitivity
Mechanism of Action
Act like anti-estrogens to slow tumor growth, but have fewer side effects than tamoxifen.
Fewer side effects than tamoxifen Insomnia Stroke

Thromboembolism
Pulmonary embolism
Bone density test at baseline and throughout treatment Take calcium supplements, Vitamin D if intake is inadequate
Weight-bearing exercise
Report fever, acute migraine, emotional distress
Class: Uterine Stimulants
Oxytocin (Pitocin) Labor induction, Serum toxemia, IV 1 minute Hypertension with
Methylergonovine Postpartum uterine Cephalopelvic disproportion IM 3-5 minutes vasopressors, ephedra
atony/hemorrhage Cautious use in clients
(Methergine) Fetal distress Intranasal-
with history of migraines,
Prolapsed umbilical cord (after
diabetes, and renal disease
Active genital herpes delivery)
Mechanism of Action
Acts directly on myofibrils p oducing uterine contraction; stimulates milk ejection by breast; vasoactive antidiuretic effect.
Methergine: administer after delivery of a placenta.
Uterine hyperstimulation Tachycardia PVC’s

Hypertension Seizures Coma
Hypotension
Abruptio placenta
Water intoxication
Fetus: Jaundice, hypoxia, intracranial
hemorrhage
Monitor VS, fetal HR and rhythm, intake and output. Teach to report increased blood loss, abdominal cramps,
fever or foul-smelling lochia
Stop oxytocin for contractions lasting longer than 90 seconds,
contractions < 2 minutes apart and/or with a pattern of fetal late
decelerations.
Class: Loop Diuretics
Furosemide (Lasix) Heart Failure Hypovolemia PO 60 minutes Increase ototoxicity
Bumetanide (Bumex) Renal Failure Anuria with aminoglycosides.
Hepatic disease Increase bleeding
Torsemide (Demadex)
Hypertension Severe electrolyte IV 5 minutes with anticoagulants.
Hypercalcemia (increases imbalances Increase digoxin
renal excretion of calcium) Hepatic coma toxicity with digoxin
FVE and hypokalemia
Mechanism of Action
Causes diuresis, but also will cause vasodilation to trap blood out in the arms and legs which reduces preload and afterload.
Rapidly removes fluid to help c ients in acute Nausea Diarrhea Severe dehydration Gout
heart failure or pulmonary edema. Vertigo Constipation Marked hypotension
Weakness Headache Hyperglycemia
Potassium-wasting Electrolyte imbalances Hearing loss
Should not be used if a thiazide could Abdominal cramping Renal failure
alleviate body fluid excess Constipation Thrombocytopenia
Assess vital signs, UOP, electrolytes. Advise to take in the morning and not in the evening to
Daily weight prevent sleep disturbance and nocturia.
Monitor potassium levels. Observe for signs of hypokalemia. Rise slowly from lying or sitting to standing.
Monitor digoxin levels if taking digoxin. Take with food to avoid nausea.
Administer IV dose over 1-2 minutes to prevent hypotension and ototoxicity. Eat foods high in potassium.
Class: Osmotic Diuretic
Mannitol (Osmitrol) Early stage acute Hypersensitivity IV 1 hour May decrease
renal failure Severe dehydration effectiveness of
Reduction of Lithium
Active intracranial
intracranial pressure
Reduction of bleed
intraocular pressure
seen with glaucoma
Mechanism of Action
Inhibits reabsorption of electrolytes and water by affecting pressure of glomerular fi trate.
Used in emergency, trauma, critical Headache Fluid and electrolyte imbalance

care and neurosurgical settings to treat Dry mouth Dehydration
cerebral edema and decreased increased Hypotension Rebound increased intracranial or
ICP intraocular pressure
Very irritating to veins May crystallize when exposed to low
temperatures.
Administer through a fi ter. Reason for medication

Assess neuro status Rise slowly from lying or sitting position.
Monitor lab values (electrolytes and serum osmolality) Report signs of electrolyte imbalance, confusion, pain at injection
I&O site, hearing loss, blurred vision.
Daily weight
Change IV every 24 hours
Monitor for orthostatic hypotension
Class: Potassium-Sparing Diuretics
Spironolactone Hypertension Severe kidney or hepatic PO Unknown Do not take with
(Aldactone) Hyperaldosteronism disease ACE inhibitors
Triamterene (Dyrenium) Reverse potassium or ARBS as
loss from diuretic
induced hypokalemia
hyperkalemia is
more likely.
Mechanism of Action
Acts in the renal tubules and late distal tubule to promote sodium and water excretion and potassium retention. Aldosterone
antagonist.
Potassium supplements not needed. Mild Photosensitivity Hyperkalemia

diuretic. GI upset
Headache
Can lead to hyperkalemia Dizziness
Monitor UOP (at least 600 mL/day) for adequate renal perfusion. Avoid sodium substitutions, K+ supplements, and foods
Monitor electrolytes high in potassium.
Daily weight Teach signs of hyperkalemia.
Observe for signs of hyperkalemia (N/V, diarrhea, abdominal cramps, leg Avoid exposure to direct sunlight.
cramps, tingling hands and feet, peaked t-wave.
Class: Thiazide Diuretics
Hydrochlorothiazide Hypertension HCTZ: contraindicated PO 2 hours Increase dig toxicity
(HydroDiuril, HCTZ Diabetes Insipidus with known sensitivity to with digoxin if
Edema associated with hypokalemia present.
sulfonamides or thiazides.
steroid use, estrogen Increase renal toxicity
therapy, heart disease Renal failure with anuria with ASA. Decrease
or liver disease. absorption with
NSAIDS
Mechanism of Action
Action is on the renal distal tubules, promoting sodium, potassium and water excretion ad decreasing preload and cardiac output.
Also decreases edema. Acts on arterioles, causing vasodilation, thus decreasing blood pressure.
Dizziness Hyperglycemia Severe dehydration

Vertigo Constipation Hypotension
Weakness Nausea/Vomiting Gout
Not effective for immediate diuresis Diarrhea Abdominal pain Hypokalemia
Should only be given with adequate Photosensitivity Shock
renal perfusion. Aplastic Anemia
Monitor vital signs, UOP, Electrolytes, glucose, uric acid. Teach s/s of hypokalemia
Daily weight Take medication in the morning to avoid sleep disturbance and
Assess peripheral extremities for edema. nocturia.
Observe for s/s of hypokalemia (muscle weakness, leg cramps, How to take BP
cardiac dysrhythmias). Safety precautions
Rise slowly from lying or sitting to standing position.
Use sunblock when in direct sunlight for photosensitivity.
Class: Anti-Tuberculin
Isoniazid (INH), Tuberculosis (TB) Hypersensitivity PO Rapid Acetaminophen,
Rifampin (Rifadin) IV chloramphenicol,
cyclosporine, digoxin,
diltiazem, antacids
Mechanism of Action
Prevents the replication of tubercle bacilli by inhibiting DNA dependent polymerase. Bactericidal against the following organisms:
staphylococcus aureus, Haemophilus influenza, Neisseria meningi is, legionella pneumophila
Headache Vertigo Pseudomembranous colitis

Dyspepsia Hepatotoxicity Pancreatitis
Nausea/vomiting Acute renal failure
Red-brown discoloration to sweat,
urine and sputum.
Monitor liver function test every month This medication is best taken on an empty stomach with a full
Monitor renal status glass of water (8 ounces or 240 milliliters) 1 hour before or 2
Observe for diarrhea, abdominal pain, fever associated with hours after meals
pseudomembranous colitis. Do not take antacids with rifampin since it will lessen the
Culture before treatment started effectiveness of this drug.
Keep MD appointments to prevent relapse.
Class: Bronchodilators – Antileukotriene / Leukotriene Receptor Antagonist
Montelukast Asthma Hypersensitivity PO Barbiturates decrease
(Singulair), montelukast levels; black
Zafirlukast (Accolate and green tea increase
stimulation
Mechanism of Action
Inhibits leukotriene formation which prevents smooth muscle contraction of the bronchial airways, decreased mucus secretion and
reduced vascular permeability (which reduces edema).
Stops asthma symptoms that are caused Headache Dizziness Thrombocytopenia

by the immune system at the cellular GI upset Insomnia Suicide thoughts
level. Drowsiness Seizures
Monitor liver enzymes, can be hepatotoxic. Avoid hazardous activities dizziness may occur
Not indicated for acute episodes, improvement Teach not to be used for acute attacks
usually seen after one week of administration.
Monitor CBC and blood chemistry during treatment.
Assess for suicidal thoughts.
Assess respiratory rate, rhythm, depth and auscultate fields bilatera ly.
Class: Bronchodilators – Beta Adrenergic Agonists
Albuterol (Proventil, Asthma Hypersensitivity PO 30 minutes Adrenergic drugs
Ventolin), Terbutaline Bronchitis Tachy-arrhythmias Aerosol 5-15 minutes increase action of
Emphysema albuterol so don’t use
Sulfate (Brethine), Severe cardiac disease Nebulizer
COPD
Salmeterol (Serevent), or heart block together.
B- adrenergic blockers
Mechanism of Action
These drugs are usually used during the acute phase of an asthma attack to quickly reduce airway constriction and restore airflow
to normal. They are agonist or stimulators of the adrenergic receptors in the sympathetic nervous system. They imitate the effects
of norepinephrine and cause bronchodilation.
Muscle tremor Anxiety Hypertension

Nervousness Insomnia Hallucinations
Tachycardia Dysrhythmias
Assess heart rate and rhythm, assess respiratory function, ABGs, lung Do not use other bronchodilators or OTC medications with
sounds Terbutaline, as they may cause additive cardiovascular effects.
Watch for evidence of allergic reactions. Notify prescriber if Do not break, crush or chew extended release tablets
bronchospasms occur. Give inhaler instructions.
Limit caffeine products such as chocolate, coffee, tea and cola
Class: Mucolytic
Acetylcysteine Acetaminophen Increased ICP PO 5-10 minutes Nitrates: increased
(Mucomyst) toxicity Status asthmaticus IV effects, Iron, copper,
Bronchitis/ COPD nickel or rubber
Nebulizer
Cystic Fibrosis
Atelectasis
– Interacts with
acetylcysteine
Mechanism of Action
Decreases the viscosity of secretions in respiratory tract by breaking disulfide inks of mucoproteins. Inactivates acetaminophen
toxic metabolites in acetaminophen overdose.
Stomatitis Fever Hepatotoxicity

Nausea/vomiting Rhinorrhea Anaphylaxis
Drowsiness Diaphoresis Bronchospasms
Chest tightness
Assess cough type, frequency, character including sputum. Teach patient that unpleasant odor will decrease after
Assess character, rate, rhythm of respirations. repeated use.
Assess liver function test Tell client to avoid alcohol and other CNS depressants as they
May be given in nebulizer or instilled intratracheally will enhance the sedating properties of this product.
If the patient vomits within one hour of administration, repeat the
dose.
Give gum, hard candy, frequent rinsing of mouth for dryness of oral
cavity
Class: Calcium Salts
Calcium gluconate Hypocalcemia Hypercalcemia IV Unknown Increase
Calcium chloride Hypermagnesemia Digoxin toxicity hypercalcemia with
Hypoparathyroidism thiazide diuretics.
Ventricular fibri lation
Cardiac toxicity
caused by Renal calculi
hyperkalemia
Mechanism of Action
Maintains nervous, muscular, skeletal function. Maintains normal cardiac contractility, coagulation of blood. Affects secretory activity
of endocrine, exocrine glands. Reverses the respiratory depression and potential arrhythmias caused by magnesium toxicity.
Hypotension Widening QRS complex

Bradycardia Cardiac arrest
Dysrhythmias Seizures
Nausea/Vomiting IV site extravasation
Constipation
Dry mouth
Monitor calcium and magnesium levels Add calcium rich foods to diet (dairy products, shellfish, dark
Cardiac monitoring green leafy vegetables)
Seizure precautions Decrease oxalate and zinc-rich foods: nots, legumes, chocolate,
Observe IV tubing for precipitation spinach, soy.
Carefully monitor IV site Avoid immobilization.
Class: Phosphorus
Phosphate (Phospho Hypercalcemia Hyperphosphatemia PO
Soda, Fleets enema) Hypophosphatemia Appendicitis Rectal
Constipation
Mechanism of Action
Essential in bone and teeth formation and for neuromuscular activity. Assists in energy transfer in cells. Supports acid-base balance.
Phosphorus has an inverse relationship to calcium. So if calcium is high, phosphorus is low.
Monitor calcium, magnesium and phosphorus levels.
Class: Electrolyte; Anti-Convulsant
Magnesium Salts Preeclampsia Hypersensitivity IM 1 hour Increase effect of neuromuscular
(Magnesium sulfate) Eclampsia Heart block IV 30 minutes blockers, antihypertensives,
calcium channel blockers.
Decrease effect of digoxin.
Decrease absorption of
tetracyclines, fluo oquinolones,
nitrofurantoin.
Mechanism of Action
Acts as a CNS depressant. Decreases acetylcholine from motor nerves, which blocks neuromuscular transmission and decreases
incidence of seizures. Secondary effect is reduction in BP as magnesium sulfate relaxes smooth muscles. Secondarily affects
peripheral vascular system with increased uterine blood flow caused by vaso ilation. Also inhibits uterine contractions.
Decreases BP while preventing Muscle weakness Flaccid paralysis

seizures in PIH clients Flushing and warmth Circulatory collapse
Sedation Heart block
Must be closely monitored for Confusion Hypotension
hypermagnesemia. Respiratory depression
Seizure precautions. Reason for medication. Expected results.

Monitor BP.
Cardiac monitoring.
Monitor for magnesium toxicity (thirst, confusion, decreased
DTRs)
I&O
Hourly urinary outputs
Class: Cation Exchange Resin
Sodium polystyrene Hyperkalemia GI obstruction PO Increased risk of
sulfonate (Kayexalate) Rectal hypokalemia when used
with loop diuretics and
cardiac glycosides.
Decrease effect of lithium
and thyroid hormones.
Mechanism of Action
Exchanges potassium for sodium in the large intestine.
Constipation Fecal impaction

Anorexia Hypernatremia
Nausea/vomiting Hypocalcemia
Hypomagnesemia
Cardiac monitoring Reason for medication and expected results.

Monitor electrolyte levels Low potassium diet
Assess bowel function daily
Monitor for fecal impaction
I&O
Daily weight
Class: Electrolyte/Potassium supplements
Potassium Hypokalemia Renal insufficiency or failu e PO 30 minutes Increases serum potassium
(Kaochlor, KCL, Prevention of Addison’s disease IV Rapid levels: ACE inhibitors,
Hypokalemia Potassium sparing diuretics,
Micro K, K Dur) Hyperkalemia
Hypokalemic alkalosis NSAIDS, beta-adrenergic
Severe dehydration blockers, heparin, salt
Potassium Sparing diuretics substitutes. Decreases
serum potassium: loop and
thiazide diuretics, licorice.
Mechanism of Action
Transmits and conducts nerve impulses. Conracts skeletal, smooth, and cardiac muscles.
Nausea/vomiting Hyperkalemia
Diarrhea Life-threatening dysrhythmias
Abdominal cramps Respiratory distress.
Irritability
IV site phlebitis
Give oral potassium with at least 3-8 ounces’ fluid and wi h meals. Drink a full glass of water or juice with potassium supplements.
Always put IV potassium on a pump to infuse. Take with a meal.
Monitor infusion at least hourly. Check IV site for infi tration. Signs/symptoms of hyperkalemia and hypokalemia.
Do not give potassium IVP. Do not give IM. Foods containing potassium.
Assess urine output before and during IV potassium.
Monitor serum potassium, creatinine, BUN, glucose, electrolytes,
ABGs.
Monitor for signs/symptoms of hyperkalemia.
Class: Alkalinizer
Sodium bicarbonate Severe acidosis Metabolic alkalosis IV 15 minutes Do not infuse epinephrine,
based on ABGs Respiratory alkalosis norepinephrine or
Cardiac arrest dopamine in the same site
Hypocalcemia as sodium bicarbonate as
Hypochloremia they will inactivate by the
sodium bicarbonate.
Mechanism of Action
Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises
blood pH and reverses the clinical manifestations of acidosis.
Irritability Metabolic alkalosis

Headache Tetany
Confusion Seizures
Not the first ine medication during a Irregular pulse Cardiac arrest
cardiac arrest. Edema
Can lead to alkalosis. Flatulence
Monitor ABGs About medication and expected outcome

Assess respiratory and heart rate
I&O
Daily weight
Monitor electrolytes
Class: Plasma Volume Expander
Albumin (Albumarc, Shock Hypersensitivity IV 15 minutes
Albuminar, Burns CHF
Hypoproteinemia
Plasbumin) Severe anemia
ARDS
Nephrotic syndrome Renal insufficienc
Pulmonary edema
Mechanism of Action
Exerts oncotic pressure, which expands volume of circulating blood and maintains cardiac output. When injected intravenously, it will
increase circulating plasma volume by approximately 3.5 times the volume infused within 15 minutes if the client is well hydrated. This
extra fluid educes hemoconcentration and blood viscosity.
Fever Fluid volume excess

Chills Pulmonary edema
Flushing Anaphylactic shock
Headache Hypertension
Nausea/Vomiting
Increases salivation
Assess blood studies: Hgb, Hct. Reason for medication.

Assess vital signs Report signs of hypersensitivity such as rash, itching, confusion,
I&O anxiety
Daily weight
Monitor oxygen saturation
Assess lung sounds, CVP, monitoring for signs of FVE
Class: Phosphorus Binding Drugs
Sevelamer (RenaGel), Chronic kidney Pregnancy PO Take Ciprofloxacin
Calcium acetate disease Bowel obstruction at least 2 hours
Hyperphosphatemia before or 6 hours
(PhosLo) Hypersensitivity
Hypercalcemia after sevelamer.
Mechanism of Action
Binding phosphate in the dietary tract and decreasing absorption, thus lowering the phosphate concentration in the serum.
Nausea/Vomiting Allergic Reaction

Stomach pain
Loss of appetite
Flatulence
Constipation
Dry mouth
Monitor for reduced vitamins D, E, K and folic acid levels Take with meals
Notify prescriber of severe abdominal pain, worsening
constipation.
Avoid use of calcium supplements including antacids.
Infection Control
All clients admitted to the hospital automatically are considered to be on standard precautions.
The diseases listed below require standard precautions plus additional precautions that are noted
in the isolation/precaution column.
Infection/ Isolation/ Infective Duration of Comments

Condition Precautions Material Isolation
Amebiasis Contact Feces Duration of illness-

(Entamoeba Precautions until symptom free.
histolytica)
Dysentery
Bronchiolitis Contact Respiratory Duration of illness- Various etiologic agents have been associated with this syndrome,
Precautions secretions until symptom i.e., respiratory syncytial virus (RSV), parainfluenza viruses,
(for infants and free. If respiratory adenoviruses, influenza viruses
young children syncytial virus (RSV)
only). antigen positive,
refer to RSV.
Chickenpox Airborne Airborne Until all lesions are Susceptible persons should not enter the room. Persons immune
(Varicella) and Contact droplets and crusted (at least 5 from previous varicella infection may enter the room without a
Precautions skin lesions days after onset of mask. Those immune by vaccination should wear a mask when
lesions). entering the room. A specially vented room is necessary. The door
to the client’s room should remain closed. The client must wear a
mask when leaving their room. Susceptible clients who have been
exposed should be placed on Airborne Precautions beginning
10 days after exposure and continuing through day 21 after last
exposure (up to 28 days if VZIG has been given). Clients are
considered infectious 2 days before onset of rash and up to 5 days
after onset of lesions. After exposure, use varicella zoster immune
globulin (VSIZ) as recommended by Infectious Diseases Service.
Infection Control
Infection/ Isolation/ Infective Duration of Comments

Condition Precautions Material Isolation
Clostridium Contact Feces Duration of

difficile Isolation illness-until
enterocolitis symptom free
Common cold Droplet Respiratory Duration of Rhinoviruses are most frequently associated with the
Precautions secretions illness-until common cold. Infection is usually mild in adults, but may be
(for infants symptom free severe in infants and young children. Other etiologic agents
and young such as respiratory syncytial virus (RSV) and parainfluenza
children viruses may also cause this syndrome.
only).
Conjunctivitis, Contact Eye Duration of

viral (acute Isolation drainage illness-until
hemorrhagic) symptom free
Decubitus Contact Wound Depends on Major: No dressing or dressing does not adequately
ulcer, infected, Isolation drainage the extent and contain drainage.
major condition of the
ulcer.
Infection Control
Infection/ Isolation/ Infective Material Duration of Isolation Comments

Condition Precautions
Diphtheria Contact Wound drainage Until cultures from infected

• Cutaneous Precautions sites are negative for
Corynebacterium diphtheriae
on two separate days. Collect
cultures > 24 hours apart and
not sooner than 24 hours after
the last dose of antibiotics.
• Pharyngeal Droplet Respiratory secretions Until cultures are negative for

Precautions Corynebacterium diphtheriae
on two separate days. Collect
cultures > 24 hours apart and
not sooner than 24 hours after
the last dose of antibiotics.
Ebola Contact Direct contact through Duration of illness Client rooms should have negative
and Droplet broken skin or mucous pressure and contain their own lab
Precautions membranes (eyes, nose facilities. Those treating clients or
and mouth) entering room should wear PPE:
Blood and body fluid full-body, hazmat suits. Droplet
Objects contaminated precautions are needed, but health
with Ebola virus care providers would also wear a
(needles/syringes) special respirator mask that fi ters
Infected animals airborne particles, such as an N95
mask. Client needs dedicated
medical equipment (preferably
disposable)
Infection Control
Infection/ Isolation/ Infective Duration of Isolation Comments

Condition Precautions Material
Epiglottitis Droplet Respiratory Until 24 hours after Epiglottis is often due to Haemophilus influenzae.
Precautions secretions start of effective Treatment for both systemic infection and carrier state
therapy. is needed. For recommendations regarding prophylaxis
after exposure, call Infectious Diseases Service (for clients
and family) and Occupational Health (for employees).
Escherichia coli Contact Feces

gastroenteritis Precautions
eropathogenic,
enterotoxigenic,
enteroinvasive,
entero -
hemorrahagic)
Fifth’s Disease/ Droplet Respiratory Until onset of rash

Erythema Precautions secretions (not considered
Infectiosum infectious after
(Parvovirus B19) appearance of rash).
German Measles Droplet Respiratory For 7 days after onset Susceptible persons should not enter the room. Persons
• Rubella Precautions (does secretions of rash. immune by vaccination or natural illness may enter the
not require room room without a mask. Susceptible clients who have
and urine been exposed should be placed on Droplet Precautions
with negative
beginning 7 days after exposure and continuing through
pressure and
day 21 after last exposure. Clients are considered
external exhaust) infectious a few days before to7 days after onset of rash.
Infection Control

German Contact Respiratory Isolation is required during Susceptible persons should not enter the room. Persons
Measles Precautions secretions any admission for the fi st immune by vaccination or natural illness may enter the
• Congenital (does not year after birth, unless room without a mask. Susceptible clients who have
require room
and urine been exposed should be placed on Droplet Precautions
rubella nasopharyngeal and urine
with negative cultures after 3 months of beginning 7 days after exposure and continuing through
pressure age are negative for rubella day 21 after last exposure. Clients are considered
and external infectious a few days before to7 days after onset of rash.
exhaust)
Haemophilus Droplet Respiratory Until 24 hours after start Treatment for both systemic infection and carrier state
influenzae, Precautions secretions of effective therapy. is needed. For recommendations regarding prophylaxis
invasive after exposure, call Infectious Diseases Service (for clients
and family) and Occupational Health (for employees).
• Epiglottitis
• Meningitis Droplet Respiratory Until 24 hours after start Treatment for both systemic infection and carrier
Precautions secretions of effective therapy. state is needed. For recommendations regarding
prophylaxis after exposure, call Infectious Diseases
Service (for clients and family) and Occupational
health (for employees).
Droplet Respiratory Until 24 hours after start Treatment for both systemic infection and carrier
• Pneumonia
Precautions secretions of effective therapy. state is needed. For recommendations regarding
(for infants prophylaxis after exposure, call Infectious Diseases
and young Service (for clients and family) and Occupational
children only). health (for employees).
Infection Control
Infection/Condition Isolation/ Infective Duration of Comments

Precautions Material Isolation
Hand, foot, and Contact Respiratory For 7 days after

mouth disease Precautions secretions onset
and feces
Hepatitis, viral Contact Feces Duration of

• Type A Precautions illness
(for diapered
or incontinent
clients)
Herpes simplex
• Mucocutaneous Contact Lesion Duration of

Disseminated precautions secretions illness-until
severe or primary
symptom free.
• Neonatal Contact
precautions Until lesions dry
and crusted
Infection Control

Herpes zoster Airborne Lesion and Duration of - until Persons susceptible to varicella should not
(Shingles) and Contact respiratory all lesions are enter the room.
• Disseminated Precautions secretions crusted.
Clients who have been exposed should
be managed in consultation with Infection
Control.
Impetigo Contact Lesions For 24 hours after

Precautions start of effective
antibiotic therapy.
Influenz Droplet Respiratory Duration of illness- In the absence of an epidemic, influenza may
Precautions secretions until symptom free. be difficu t to diagnose on clinical grounds.
During epidemics, the accuracy of diagnosis
increases. Co-horting of clients may be
considered during periods of high census.
Immunization is strongly encouraged for health
care providers and clients at risk for serious
complications. Contact Infectious Diseases
Service for recommendations regarding the
use of prophylaxis for non-immunized persons.
Infection Control

Lice Contact Infested Until effective Employees with direct contact should be examined for
(pediculosis) Precautions area treatment has been infestation. Clothing and bedding may be disinfected by machine
completed and washing and drying *use hot cycles). Dry cleaning or storing
room/ personal items items in a plastic bag for 10 days is also effective. Use of an
adequately disinfected. environmental insecticide is not needed.
Measles Airborne Respiratory For 4 days after onset Promptly notify Infection Control. Susceptible persons should
(rubeola, red Precautions secretions of rash. For immuno- stay out of the room. All other persons should wear a mask upon
(use a compromised entry. A specially vented room is necessary. The client must
measles) wear a mask when leaving the room. The door to the client’s
monitored patients, maintain
room should remain closed. Susceptible clients who have been
room with precautions for
exposed should be placed on Airborne Precautions beginning
negative duration of illness. 5 days after exposure and continuing through day 21 after last
pressure exposure. Clients are considered infectious 4 days before to 4
and external days after onset of rash.
exhaust)
Meningococcal Droplet Respiratory Until 24 hours after Treatment for both system infection and carrier state is
pneumonia Precautions secretions start of effective needed. For recommendations regarding prophylaxis after
(Neisseria therapy. exposure, call infectious Diseases Service (for clients and
meningitidis) family) and Occupational Health (for employees).
Infection Control

Meningococcemia Droplet Respiratory Until 24 hours Treatment for both system infection and carrier state is
(meningococcal Precautions secretions after start of needed. For recommendations regarding prophylaxis after
effective therapy. exposure, call infectious Diseases Service (for clients and
sepsis) (Neisseria family) and Occupational Health (for employees).
meningitidis)
Meningitis Droplet Respiratory Until 24 hours Treatment for both systemic infection and carrier state is
• Haemophilus Precautions secretions after start of needed. For recommendations regarding prophylaxis after
influenzae, effective therapy. exposure, call Infectious Diseases Service (for clients and
known or family) and Occupational Health (for employees).
suspected
• Neisseria Droplet Respiratory Until 24 hours Treatment for both systemic infection and carrier state is
meningitis Precautions secretions after start of needed. For recommendations regarding prophylaxis after
(meningococcal), effective therapy. exposure, call Infectious Diseases Service (for clients and
known or family) and Occupational Health (for employees).
suspected
• Viral (aseptic or Feces Duration of illness- Enteroviruses are the most common cause of aseptic
Contact
nonbacterial) until symptoms meningitis.
Precautions free.
(for infants
and young
children only
Infection Control
Infection/Condition Isolation/Precautions Infective Material Duration of Isolation Comments
Mumps Droplet Precautions Respiratory For 9 days after onset of Susceptible personnel who have
(does not require a secretions swelling. been exposed should be excluded
room with negative from work from the 12th day after
pressure and external exposure through the 26th day
after exposure, or if symptoms
exhaust)
develop until 9 days after the
onset of parotitis.
Multi Drug Resistant Contact precautions Wound drainage Until 2 cultures obtained Previously positive clients
Organisms (MDRO) and/or secretions/ after completion of must be placed on Contact
• Methicillin-resistant excretions from antibiotic treatment Precautions when readmitted
Staph. Aureus colonized/infected are negative on 2 to the hospital until repeat
(MRSA) infection or sites separate days, from all cultures are negative as per
colonization previously colonized/ criteria under “Duration of
• Vancomycin- infected sites (including Isolation.”
resistant nasal colonization, if
enterococcus (VRE) Contact precautions applicable).
Necrotizing Fasciitis Contact precautions Rarely spread from Duration of illness- Group A strep is considered
(Flesh-eating person to person. until symptom free and the most common cause,
Direct contact wounds healed. but can also be caused by
bacteria) through broken Klebsiella, Clostridium, E coli,
skin or mucous
Staph aureaus and Aeromonas
membranes (eyes,
nose and mouth) hydrophila. Good wound care
Blood and body is the best prevention. Prompt
fluid treatment with IV antibiotics
Objects is needed. Patients are usually
contaminated with managed in a burn center or
bacteria(needles/ surgical ICU setting.
syringes)
Infection Control

Pharyngitis Droplet Respiratory Until 24 hours

Precautions secretions after start of
(for infants effective therapy
and young
children only)
Plague Droplet If client requires transport, must have mask on.

• Pneumonic Precautions
Pneumonia Droplet and Respiratory Duration of

• Adenovirus Contact secretions illness-until
Precautions and feces symptom free.
(for infants
and young
children only)
• Bacterial Droplet Respiratory Duration of
not listed Precautions secretions illness-until
elsewhere (for infants symptom free.
(including and young
gram-negative children only)
bacteria
Infection Control
Infection/Condition Isolation/Precautions Infective Duration of Isolation Comments

Material
Pneumonia (con’t) Droplet Precautions (for infants Respiratory Duration of illness-

• Etiology and young children only). Use secretions until symptom free.
unknown Contact Precautions during RSV If respiratory syncytial
season, during an RSV outbreak, virus (RSV) antigen
positive, refer to RSV.
or if RSV is in the diagnostic
differential. Resume Droplet
Precautions if RSV is ruled out.
• Haemophilus Droplet Precautions (for infants Respiratory Until 24 hours after

influenza and young children only) secretions start of effective
therapy.
• Herpes simplex Droplet Precautions Respiratory Duration of illness-

secretions until symptom free
• Meningococcal Until 24 hours after

(Neisseria Droplet Precautions Respiratory
start of effective
meningitidis) secretions therapy.
Infection Control
Infection/Condition Isolation/ Infective Duration of Isolation Comments

Precautions Material
Respiratory Contact Respiratory Until symptom free and To avoid the possibility of false-negative
syncytial virus precautions secretions nasopharyngeal antigen test test results, the “calgi swab” method
(RSV) infection or is negative for RSV (at least should be used to obtain nasopharyngeal
suspected 1 week after positive test) specimens.
on 2 consecutive days.
Rotavirus Contact Feces Duration of illness and stool

infection Precautions study negative for rotavirus
on 2 separate days.
Rubella Droplet Respiratory For 7 days after onset of Susceptible persons should not enter the
• German Precautions secretions rash room. Persons immune by vaccination or
Measles (does not natural illness may enter the room without
require room a mask. The client must wear a mask when
with negative
leaving the room. Susceptible clients who
pressure
have been exposed should be placed on
and external
exhaust) Droplet Precautions beginning 7 days after
exposure and continuing through day 21
Contact Respiratory Isolation is required after last exposure. Clients are considered
• Congenital Precautions secretions during any admission for infectious a few days before to 7 days after
Rubella (does not the first year after bir h, onset of rash. (applicable to both types)
require room unless nasopharyngeal
with negative and urine cultures after
pressure 3 months of age are
and external negative for rubella
exhaust)
Infection Control

SARS (Severe Airborne Respiratory

Acute and Contact droplets
Respiratory Precautions with
Syndrome) goggles over
eyes
Scabies Contact Infested For 24 hours after Employee with direct contact should be
precautions area start of effective examined for infestation. Clothing and bedding
therapy and may be disinfected by machine washing
room/ personal and drying (use hot cycles). Dry cleaning or
items adequately storing items in a plastic bag for 10 days is also
disinfected. effective. Use of an environmental insecticide is
not needed.
Scarlet fever Droplet Respiratory For 24 hours after

Precautions (for secretions effective therapy
infants and young
children only)
Shingles (Herpes Airborne Lesion Duration of illness Persons susceptible to varicella should not enter the
zoster) and Contact secretions until all lesions are room. Persons immune from prior natural illness or
• Disseminated Precautions (use crusted vaccination may enter without a mask. The door
a monitored to the client’s room should remain closed and the
room with client must wear a mask when leaving. Susceptible
negative clients who have been exposed should be managed
pressure and in consultation with Infection Control. Clients are
external exhaust) considered infectious 2 days before onset of rash
and up to 5 days after onset of lesions.
Infection Control
Infection/Condition Isolation/ Infective Material Duration of Comments

Precautions Isolation
Smallpox Airborne and Large and small Onset of rash Private rooms preferred. In event of large
Contact respiratory droplets, to separation outbreak, clients with same diagnosis can
Precautions skin lesions, secretions. of scabs share respiratory isolation room.
(strict gown/ (approximately Limit client transport, if necessary, client
glove) 3 weeks) wears mask.
Syphilis Contact Lesion secretions, For 24 hours

• Skin and mucous Precautions blood, body fluid after start
membrane, of effective
including therapy.
congenital,
primary, and
secondary
Tuberculosis Airborne Airborne droplet nuclei A specially vented room is necessary.

• Pulmonary, Precautions The door to the patient’s room should
confirmed or (use a
suspected (sputum
remain closed. Persons entering the
monitored room should wear specially fi ted NIOSH
smear is AFB
room with
positive and/ approved respiratory protection. The
negative
or chest x-ray client should leave the room only for
appearance pressure
and external essential purposes, particularly if the
strongly suggests
active TB, i.e., exhaust) client has multidrug-resistant TB. When
cavitary lesions; or leaving the room, the client should
laryngeal. wear a high-fi tration surgical mask; for
mechanically-supported ventilation,
add a bacterial fi ter to fi ter the client’’
exhaled air.
Infection Control
Infection/ Isolation/Precautions Infective Duration of Isolation Comments

Condition Material
Typhoid fever Contact Precautions Feces Duration of illness -

(Salmonella (for diapered and until symptom free.
typhi) incontinent children)
Whooping Droplet Precautions Respiratory For 7 days after start of For recommendations regarding
cough secretions effective therapy. prophylaxis after exposure, call Infectious
(pertussis) Diseases Service (for clients and family)
and Occupational Health (for employees).
Zika Virus Standard/Contact Body fluids Pregnancy: Men should Patients post exposure should protect
Precautions only - (blood, wait for 6 months after themselves for 3 weeks from mosquito bites
unless in the labor urine, symptoms started (if they order to prevent further spread of virus. Zika
and delivery setting. saliva and get sick) before trying virus is primarily transmitted through the bite
Apply practices and to conceive with their of the mosquito, but sexual transmission has
amniotic
personal protective partner. Women should also been documented. Zika virus RNA has
fluid)
equipment (PPE) to wait at least 8 weeks after been detected in body fluids (blood, urine,
prevent exposure travel (or 8 weeks after saliva and amniotic fluid). Zika can also be
as indicated by symptoms started if they spread during pregnancy from mother to fetus
labor and delivery get sick) before trying to causing birth defects. There are no reports
procedure. get pregnant. The waiting of transmission through breastfeeding. CDC
period is longer for men does not recommend Zika virus testing for
because Zika stays in asymptomatic men, children, or women who
semen longer than in are not pregnant.
other body fluids

Infection Control Precautions
(CDC, Guidelines for isolation procedure, 2007)
Standard Precautions
• Standard Precautions apply to 1) blood; 2) all body fluids, sec etions, and
excretions except sweat, regardless of whether or not they contain visible
blood; 3) nonintact skin; and 4) mucous membranes.
• Use Standard Precautions, or the equivalent, for the care of all clients.
A. Handwashing
• Wash hands after touching blood, body fluids, sec etions, excretions, and
contaminated items, whether or not gloves are worn.
• Wash hands immediately after gloves are removed, between client contacts,
and when otherwise indicated to avoid transfer of microorganisms to other
clients or environments.
• It may be necessary to wash hands between tasks and procedures on the same
client to prevent cross-contamination of different body sites.
• Use soap and water for routine handwashing.
B. Gloves
• Wear gloves (clean, nonsterile gloves are adequate) when touching blood,
body fluids, sec etions, excretions, and contaminated items.
• Put on clean gloves just before touching mucous membranes and nonintact skin.
• Change gloves between tasks and procedures on the same client after contact
with material that may contain a high concentration of microorganisms.
• Remove gloves promptly after use, before touching noncontaminated items

and environmental surfaces, and before going to another client, and
wash hands immediately to avoid transfer of microorganisms to other clients
or environments.
C. Mask, Eye Protection, Face Shield
• Wear a mask and eye protection or a face shield to protect mucous

membranes of the eyes, nose, and mouth during procedures and
client-care activities that are likely to generate splashes or sprays of
blood, body fluids, sec etions, and excretions.
D. Gown
• Wear a gown (a clean, nonsterile gown is adequate) to protect skin

and to prevent soiling of clothing during procedures and client-care
activities that are likely to generate splashes or sprays of blood, body
fluids, sec etions, or excretions.
• Remove a soiled gown as promptly as possible, and wash hands to

avoid transfer of microorganisms to other clients or environments.
E. Client-Care Equipment
• Handle used client-care equipment soiled with blood, body fluids,

secretions, and excretions in a manner that prevents skin and mucous
membrane exposures, contamination of clothing, and transfer of
microorganisms to other clients and environments.
• Ensure that reusable equipment is not used for the care of another
client until it has been cleaned and reprocessed appropriately.
• Ensure that single-use items are discarded properly.
F. Linen
• Handle, transport, and process used linen soiled with blood, body
fluids, sec etions, and excretions in a manner that prevents skin and
mucous membrane exposures and contamination of clothing and that
avoids transfer of microorganisms to other clients and environments.
G. Needle Disposal
• Used needles and any “sharps” are placed directly into puncture -
resistant containers. Do not recap or use two hand technique. Sharps
with built-in safety features are used when available.

Contact Precautions
• Contact Precautions are designed to reduce the risk of transmission of

microorganisms by direct or indirect contact.
• Direct-contact transmission involves skin-to-skin contact and physical

transfer of microorganisms to a susceptible host from an infected or
colonized person, such as occurs when personnel turn clients, bathe
clients, or perform other client-care activities that require physical contact.
• Direct-contact transmission also can occur between two clients.
• Indirect-contact transmission involves contact of a susceptible host with a

contaminated intermediate object, usually inanimate, in the client’s
environment.
In addition to Standard Precautions, use Contact Precautions, or the equivalent,

for specified clients known or suspected to be infected or colonized with
epidemiologically important microorganisms that can be transmitted by direct
contact with the client (hand or skin-to-skin contact that occurs when performing
client-care activities that require touching the client’s dry skin) or indirect contact
(touching) with environmental surfaces or client-care items in the client’s
environment.
A. Client Placement
• Place the client in a private room.
• When a private room is not available, place the client in a room with a
client(s) who has active infection with the same microorganism but with
no other infection
B. Gloves and Handwashing
• In addition to wearing gloves as outlined under Standard Precautions,

wear gloves (clean, nonsterile gloves are adequate) when entering the room.
• During the course of providing care for a client, change gloves after having
contact with infective material that may contain high concentrations of
microorganisms (fecal material and wound drainage).

• Remove gloves before leaving the client’s room and wash hands immediately
with an antimicrobial agent or a waterless antiseptic agent. For a client with
a C. difficil do not use an alcohol-based, hand rub because it is not effective
on C. difficil . Instead use soap and water.
• After glove removal and handwashing, ensure that hands do not touch
potentially contaminated environmental surfaces or items in the client’s
room to avoid transfer of microorganisms to other clients or environments.
C. Gown
• In addition to wearing a gown as outlined under Standard Precautions,

wear a gown (a clean, nonsterile gown is adequate) when entering the
room if you anticipate that your clothing will have substantial contact
with the client, environmental surfaces, or items in the client’s room, or if
the client is incontinent or has diarrhea, an ileostomy, a colostomy, or
wound drainage not contained by a dressing.
• Remove the gown before leaving the client’s environment.
• After gown removal, ensure that clothing does not contact potentially
contaminated environmental surfaces to avoid transfer of microorganisms
to other clients or environments.
D. Client Transport
• Limit the movement and transport of the client from the room to essential
purposes only.
• If the client is transported out of the room, ensure that precautions are
maintained to minimize the risk of transmission of microorganisms to
other clients and contamination of environmental surfaces or equipment.
Airborne Precautions
• Airborne Precautions are designed to reduce the risk of airborne transmission of

infectious agents.
• Airborne Precautions apply to clients known or suspected to be infected with

pathogens that can be transmitted by the airborne route.
In addition to Standard Precautions, use Airborne Precautions, for clients known or

suspected to be infected with microorganisms transmitted by airborne droplet nuclei or
evaporated droplets containing microorganisms that remain suspended in the air and
that can be dispersed widely by air currents within a room or over a long distance.
A. Client Placement
• Place the client in an airborne infection isolation room (AIIR), which is a

private room that has: 1) monitored negative air pressure in relation to the
surrounding areas, 2) 6 to 12 air changes per hour, and 3) appropriate
discharge of air outdoors or monitored high-efficiency filtration of oom air
before the air is circulated to other areas in the hospital.
• Keep the room door closed and the client in the room.

• Client should have a private room.

• When a private room is not available, place the client in a room with a client
who has active infection with the same microorganism but with no other infection.
B. Respiratory Protection
• Wear respiratory protection (N95 respirator) when entering the room of a client
with known or suspected infectious pulmonary tuberculosis.
• Susceptible persons should not enter the room of clients known or

suspected to have measles (rubeola) or varicella (chickenpox) if other immune
caregivers are available. If they must enter, they should wear a respirator mask.
C. Client Transport
• Limit the movement and transport of the client from the room to essential
purposes only.
• If transport or movement is necessary, place a surgical mask on the client.

Droplet Precautions
• Droplet Precautions are designed to reduce the risk of droplet transmission

of infectious agents.
• Droplet transmission involves contact of the conjunctivae or the mucous

membranes of the nose or mouth of a susceptible person.

• Droplets are generated from the source person primarily during coughing,
sneezing, or talking and during the performance of certain procedures such
as suctioning and bronchoscopy.
• Transmission via large-particle droplets requires close contact between

source and recipient persons, because droplets do not remain suspended
in the air and generally travel only short distances, usually 3 ft or less,
through the air.
• Because droplets do not remain suspended in the air, special air handling
and ventilation are not required to prevent droplet transmission.
• Droplet Precautions apply to any client known or suspected to be infected

with pathogens that can be transmitted by infectious droplets.
In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a client
known or suspected to be infected with microorganisms transmitted by droplets.
A. Client Placement
• Place the client in a private room.
• When a private room is not available, place the client in a room with a
client(s) who has active infection with the same microorganism but with no
other infection.
B. Mask
• In addition to wearing a mask as outlined under Standard Precautions, wear

a mask when working within 3 ft of the client. (Logistically, some hospitals
may want to implement the wearing of a mask to enter the room.)
C. Client Transport
• Limit the movement and transport of the client from the room to essential purposes
only.
• If transport or movement is necessary, place a surgical mask on the client.

Isolation Precautions Exercise
What type of isolation precaution will the client be on with the following diseases?
1. Human Immunodeficienc Virus (HIV)
2. Multidrug- resistant organisms (MDROs) (e.g., MRSA, VRE, VISA/VRSA,

ESBLs, resistant s. pneumoniae)
3. Candidiasis (Thrush)

4. Varicella Zoster (Chicken pox)
5. Clostridium Difficil Enterocolitis (C. Diff)
6. Infectious Mononucleosis (Mono)

7. Rubella (German Measles)
8. Meningococcal Meningitis

9. Impetigo
10. Seasonal Influenz
11. Rubeola (Measles)
12. Tuberculosis (TB) with pulmonary involvement
13. Infectious Parotitis (Mumps)
14. Rotavirus
15. Pertussis (Whooping Cough)
16. Tetanus
17. Escherichia Coli Gastroenteritis (E coli)

18. Herpes zoster (Shingles) Localized
19. Herpes zoster (Shingles) Disseminated disease
20. Respiratory Syncytial Virus (RSV)
21. Lice (head)
22. Lyme disease
ANSWERS:
1. Standard
2. Standard/ Contact*
3. Standard
4. Airborne and contact
5. Contact
6. Standard
7. Droplet
8. Droplet for 24 hours
9. Contact for 24 hours
10. Droplet
11. Airborne
12. Airborne
13. Droplet for 9 days
14. Contact
15. Droplet
16. Standard-not transmitted person to person
17. Standard-contact for diapered incontinent persons
18. Standard-localized
19. Airborne and contact
20. Contact
21. Contact-isolation up to 24 hours
22. Standard-not transmitted person to person
*Contact Precautions recommended in settings with evidence of ongoing

transmission, acute care settings with increased risk for transmission or wounds that
cannot be contained by dressings.

The Five Rights of Delegation
(The National Council of State Boards of Nursing, 1997)
1. Right task
• The task must be within the capabilities of the auxiliary

nursing staff. This is define by federal and state statutes (Nurse Practice Act),
organizational policies and procedures; job descriptions and accreditation
guidelines.

• Assess each client before delegating. Ensure there is match between the
client’s needs and the skills, abilities and experience of the Auxiliary Nursing
Staff. Consider the client’s condition, the personnel’s capabilities, the
complexity of the task, and how much supervision will be required.
• Assistive personnel should not be assigned duties requiring ongoing

assessment, evaluation or decision making.
2. Right circumstances
• The care setting should be taken into consideration. For example, the role of
the LPN may differ in an acute care setting in comparison to their role in a long
term care setting. Registered nurses are accountable to know the laws and
regulations that apply to each setting.
• Client stability as well as the desired client outcomes should also be taken into
consideration.
3. Right person
• Know your facility’s competency standards!
• Know the job descriptions of co-workers!
• Has the personnel been trained on the task?
• Identify personal strengths and weaknesses of Auxiliary Nursing Staff.

4. Right direction/ communication
• The Registered Nurse is responsible for providing clear, concise,

correct, and complete communication to Auxiliary Nursing
Personnel at the time of delegation as well as providing
continued direction on an ongoing basis.
• Communicate clearly about the delegated task.
• Be specifi about how and when he/she should report back to you.
• Make sure the personnel understands what is expected, and do not

hesitate to ask them if they know how to perform the task.
5. Right supervision and evaluation
• You cannot just merely assign the task. You must guide, supervise,
and evaluate the carrying out of the delegated task.
• You must ensure the work meets your expectations. If it does not,
you must step in.
• Give credit and praise for accomplishments. Do not hesitate to offer

observations and share concerns.
• You should give the personnel feedback and ask for theirs.
• Encourage input on how to resolve care issues and reach agreement

on future course of action.
• You must evaluate the client’s outcome and the results of the task to
ensure the desired outcome is achieved.
REMEMBER: You may delegate a task, but the responsibility remains with you,
the RN!!
Prioritization, Delegation, and Assignment Principles
• Consider outcome expectations of the client and family.
• Maintain compliance with your state’s Nurse Practice Act as well as the
healthcare facility’s guidelines and job descriptions.
• Tailor the level of supervision to the experience and knowledge level of

staff assigned delegated duties.
• Be cognizant that accountability for nursing judgment decisions

remains with the Registered Nurse.
• The Registered Nurse is also accountable for maintaining the

appropriate level of supervision for delegated duties.
• The Nursing Process and clinical judgment cannot be delegated by the

Registered Nurse to Nursing Assistive Personnel.
• It is imperative for the Registered Nurse to be familiar with the client

and their clinical presentation in order to prioritize, delegate and assign
care.
• Be aware that client conditions and clinical situations can change;

the Registered Nurse must be able to re-evaluate and re-assign care as
the client’s needs or the nursing team’s abilities change.
(La Charity, Kumagi, and Bartz 2011)

EMERGENCY DEPARTMENT TRIAGE REVIEW
Scenario:
You work in a busy emergency department (ED) and are assigned as the triage RN
for a 12-hour shift. After your initial assessment of each of the 4 clients in each of
the 10 questions, which client would you take to a room immediately? Remember,
as a triage nurse it is your responsibility, based on your assessment skills, to classify
clients into 1 of 3 categories: Emergent, Urgent, and Non-urgent. The following
defini ions for these 3 categories will better help you answer these questions and
get more right than wrong.
Emergent – Life-threatening illness or injury at time of arrival.

Urgent – Stable on arrival, but needing medical intervention in timely
manner.
Non-urgent- Stable on arrival; are not in immediate need of emergency
treatment.
It is also imperative to realize your limitations and know when to ask for
assistance from other RN’s if more than 1 emergent client presents that
requires immediate intervention.
Place a checkmark by the category that best classifies he following clients.
Place an asterick (*) by the client requiring immediate intervention.
1. A. Client with cough/congestion and productive sputum of yellow

color x 1 week. Chest pain upon inspiration. SaO2 98% on room air
with respiratory rate of 18.
Emergent ____ Urgent ____ Non-urgent ____
B. Client who slammed her right index finger in a car door with no
obvious deformity seen, but gross edema present. Cap refill < 2 sec.
Limited range of motion. P-120, R-18, BP-142/87.

Emergent ____ Urgent____ Non-urgent ____
C. Infant 10 months old with audible stridor, SaO2 88% on room air.
P -193, R - 52. Mother states infant reached in her purse and was
found playing with coins.

Emergent____ Urgent____ N on-urgent____
D. Client who bought his 12 y/o son a BB gun. While loading the
BB gun for the first time, a malfunction occur ed firing a BB pellet
into the father’s left calf. No active bleeding noted. All motor/sensory
intact. Cap refill < 2 sec. Father denies pa esthesias.
+ Dorsalis pedal pulse. P-72, R-20, BP-138/79.


2. A. Client reports sore throat, runny nose, and cold x 10 days.
B. Client with history of bipolar disorder. States “I feel angry and want
to hurt someone.” Prior to your initial triage assessment, client was
yelling at other clients in the waiting room, claiming she was Jesus.
Emergent____ Urgent____ Non-urgent____
C. Client reports urinary frequency and dysuria x 1 week.
D. Client with chronic back pain. Was involved in a motor vehicle

crash 10 years ago. Has had multiple back surgeries. Denies new injury.
States ran out of pain medications.

3. A. Client reports shortness of breath on exertion, gradually
progressive x 3 days. Denies chest pain. Ran out of Lasix 4 days ago.
P- 99, R- 26, BP- 154/92. SaO2 95% on room air.
B. Client states, “I just don’t feel good.” Denies pain or shortness

of breath. No nausea or vomiting. Decreased appetite. Alert &
oriented x 3. Color good/pink. T- 102.2, P-92, R- 22, BP 160/100,
SaO2 – 99%.

C. Client states, “I have nowhere to go.” Left personal care home

1 week ago. Denies pain. States, “I’m hungry.” T- 98.7, P- 68, R- 18,
BP-178/80.
D. Client reports shortness of breath and chest heaviness x 30 min. prior

to arrival. Denies nausea or vomiting or pain radiation. + diaphoresis.
P-181, R-42, BP-87/42, SaO2-91% on room air.

4. A. 67 y/o client with sudden onset slurred speech, headache, and
right-sided weakness 1 hour prior to arrival. Attempts to speak,
but words are garbled. BP-199/119, P-117, R-22, SaO2 -96% on
room air.
B. 5 y/o client with 1 inch laceration to forehead. Was jumping on

trampoline and fell striking head on metal railing. Bleeding controlled.
Witnessed by mom. Alert & oriented x 3. Mother denies loss of
consciousness. T-98.5, P-118, R-24, BP-80/54, SaO2-99% on room air.
C. Client reports severe generalized abdominal pain. No bowel

movement x 1 week. History of lung cancer. Last chemo treatment
4 days ago. Decreased appetite. T-100.0, P-102, R-18, BP 162/91,
SaO2 -95% on room air.
D. Client 1-week post-op hysterectomy. Denies pain, but reports yellow

exudate @ incision site. States site has “come open.” T-103, P-91,
R-16, BP-132/60.

5. A. Car pulls up outside of triage dumping a 16 y/o male on the sidewalk.
Upon initial assessment you find a gun shot wound to abdomen.
Client unresponsive, profuse hemorrhaging noted.
B. Client with severe left-sided chest pain, shortness of breath,

diaphoresis with heavy pressure radiating to left arm, neck, and
shoulder. Client is clutching left side of chest.

C. Truck driver who drives a fuel truck reports gasoline splashed into eyes.
States “I can’t see.”
D. Client with severe headache, history of chronic tension headaches

and reports being under great deal of stress at home and work.

6. A. Client sliced left ring finger above nail bed at work. Full range of
motion. Denies paresthesias. Cap. Refill < 2 seconds. Bleeding
controlled.
B. 3 month old infant with inconsolable crying. Mother states infant has
been pulling on right ear x 1 day. T-101.9 rectal, P-158, R-30, SaO2-98%
on room air.
C. Client states glucose has been too high. Alert and oriented x 3. No
diaphoresis. Ate lunch 1-hour prior to arrival. States, “ran out of
insulin”. Capillary glucose finger stick in triage esulted a glucose of
267 mg/dl. T-98, P-99, R-18, BP 152/71. SaO2 97% on room air.
D. Client, 37 weeks gestation states, “My water broke.” Also with

moderate bleeding. Onset 45 minutes prior to arrival and abdominal
pain with contractions < 10 minutes apart. T-99, P-139, R-24,
BP-180/110.
Emergent____ Urgent____ Non-urgent____

7. A. Client reports suprapubic abdominal pain. Last menstrual period 2
months ago. Denies vaginal bleeding, or passage of clots. Admits
to unprotected sexual intercourse approximately 1 month ago.
Last bowel movement today was normal. T-98, P-74, R-16, BP-110/82,
SaO2-98% on room air.
B. Client presents with shortness of breath and chest pain, 1 hr. post
hemodialysis. States, “I get chest pain sometimes, but this time it
seems different.” Diaphoretic. P-147, R-40, BP 92/71, SaO2-90% on
room air.

C. Client with pain/edema to left great toe. Denies recent injury.

Limited range of motion. Difficulty ambulating. -98.9, P-79, R-22,
BP-147/62, SaO2-99% on room air.
D. Client with sudden onset of nausea & vomiting 6 hrs. prior to arrival.
No history of diabetes. Denies pain or hematemesis. Had lunch
outside of home with family today where she ate baked chicken.
T-99.7, P-121, R-22, B- 159/86, SaO2-98% on room air.

8. A. Client is ambulatory to triage after being involved in a 1 car motor
vehicle crash. Car vs. light-pole. Refused ambulance care at the scene.
Occurred approximately 2 hours prior to arrival. Speed of impact
40 MPH. Unrestrained driver, struck head on windshield. Reports
severe neck pain and “tingling to toes.” P-109, R-18, BP-172/104,
B. Client 1-week post TURP. Reports urinary retention x 30 minutes.

Passed clots earlier today. States is in moderate pain. Pain # 4 on
1-10 scale P-104, R-20, BP-159/93. SaO2-96% on room air.
C. 3 y/o toddler with rash x 1 week. Afebrile with temp of 98.9 rectal.
R-28, SaO2-100% on room air.
D. Client with vertigo and blurred vision x 3 days. Denies headache or

any other pain. Denies injury. Has had family problems at home.
T-98.5, P-101, R-18, BP-145/94, SaO2-99% on room air.

9. A. Client reports left shoulder pain. Onset 1 day ago after moving heavy
furniture. Constant in nature. T-98.4, P-77, R-20, BP-148/62,

B. Client with rectal bleeding x 4 hours. Color pale. + shortness of

breath on exertion. Skin cool/clammy. States bowel movement
was dark and tarry. T-96, P-141, R-26, BP 97/49, SaO2-95% room air.
C. Client reports left knee pain. + Dorsalis pedal pulse. Full range of
motion. Negative for paresthesias. Was wrapped with ace
bandage prior to arrival. T-98.4, P-99, R-20, BP-131/87, SaO2-99%.
D. Client reports severe lower abdominal cramping and irregular

menses with heavy blood flow x 4 months. -97.4, P-96, R-22,
BP-115/70, SaO2-100% on room air.

10. A. Client fell approximately 5 feet off ladder while painting at home.
Landed on lawn with left ankle trapped under buttocks. + edema, no
gross deformity. + dorsalis pedal pulse. Moderate pain. T-98.8, P-122,
R-26, BP- 141/89, SaO2-98% on room air.
B. Client, restrained driver struck 18-wheeler from behind. + airbag

deployment. Approximate speed of impact 45 MPH. Head struck
windshield of van. Fully spinal immobilized with c-collar in place.
Alert to person only. T-99, P-133, R-28, BP-168/81, SaO2-93% on 40%
O2 facemask.
C. Client in per EMS after “bumping into neighbor’s house” with car.
Approximate speed of impact 10 MPH. Denies loss of consciousness.
Alert and oriented x 3. Denies headache, chest pain, or shortness
of breath. Restrained driver. T-97.8, P-72, R-22, BP 128/69, SaO2-99%
on room air.
D. Client ambulatory reports right wrist pain. Tripped in flower bed

2 days ago. + right radial pulse. Cap refill < 2 seconds. No obvious
deformity.T-97.3, P-101, R-18, BP-175/101, SaO2-96% on room air.

EMERGENCY DEPARTMENT TRIAGE REVIEW
ANSWER KEY
(Letters with * signifies answer
1. A. Non-urgent
B. Urgent
C. Emergent *
D. Urgent.
2. A. Non-urgent
B. Emergent *
N
C. on-urgent
N
D. on-urgent
3. A. Urgent
B. Urgent
N
C. on-urgent
D. Emergent *
4. A. Emergent *
B. Urgent
C. Urgent
D. Urgent
5. A. Emergent * ( All 3 answers for A-C are emergently classifie and

B. Emergent * require immediate attention from all RN’s. This
C. Emergent * question was written to assist you in critical thinking
D. Urgent * skills so you may realize as the triage RN you must
ask for help.)

6. A. Urgent
B. Urgent
C. Urgent
D. Emergent *
7. A. Non-urgent
B. Emergent *
C. Urgent
D. Urgent
8. A. Emergent *
B. Urgent
N
C. on-urgent
D. Urgent
9. A. Urgent
B. Emergent *
C. Urgent
D. Urgent
10. A. Urgent
B. Emergent *
C. Urgent
D. Urgent

DISASTER TRIAGE REVIEW
Disaster versus Emergency Triage: What is the difference?
Triage occurs in two different circumstances. The original intent of triage was
to sort and allocate treatment to patients to maximize the number of survivors.
It began as a method of treating victims of war and of disasters. During war
and disaster, priorities must be made because there is a lack of emergency
personnel and resources to care for all the victims. In mass casualty situations,
triage is used to decide who is most urgently in need of transportation to a
hospital for care (generally, those who have a chance of survival but who
would die without immediate treatment) and whose injuries are less severe
and must wait for medical care.
In contrast, the purpose of triage in the emergency department (ED) is to

prioritize incoming patients and to identify those who cannot wait to be seen.
The triage nurse performs a brief, focused assessment and assigns the patient
a triage acuity level, which is a proxy measure of how long an individual
patient can safely wait for a medical screening examination and treatment.
So here is the deal.
In order to optimize overall patient outcomes in a catastrophic situation,

there is a shift from doing what is best for the individual patient to doing the
greatest good for the largest number of people. A system of triage must be
utilized to determine who will receive treatment and who will not.
Color Coding Triage System for Disasters
Advanced triage implemented by nurses or other skilled personnel involves a

color-coding scheme using red, yellow, green, and black tags:

Red Tag (Immediate of Priority)

Labels those individuals who cannot survive without immediate treatment but
who have a chance of survival. The victim has life-threatening injuries (airway,
bleeding, or shock) that demand immediate attention to save his or her life;
rapid, lifesaving treatment is urgent, and they should be the firs ones sent
to the hospital when firs responders arrive.
Who will you tag Red?
Breathing when airway opened.

Respirations over 30/min.
If capillary refil takes over 2 seconds and pulses weak or absent.
If circulation poor and bleeding heavily, instruct someone else to apply pressure
(or tourniquet if trained).
If coma, decreased responsiveness, or unable to answer simple questions.
Yellow tags (Delayed/Observation or Priority 2)
Labels those individuals who require observation (and possible later re-triage).
Their condition is stable for the moment and, they are not in immediate danger
of death. Injuries do not jeopardize the victim’s life. The victim may require
professional care, but treatment can be delayed. They have severe bleeding
that can be stopped and maintained, and severe limb injuries that will require
hospitalization or possibly surgery. These victims will still need hospital care
and would be treated immediately under normal circumstances.
Who will you tag Yellow?
If confused but able to respond to questions.

Broken legs
Severe pain
Confusion
Large burns
Breathing symptoms (not bad enough for red tagging)
Green tags - (Minimal/Wait or Priority 3)
Labels those individuals who are considered to be “walking wounded”. They

have minor injuries and will need medical care at some point, after more critical
injuries have been treated. They may have cuts, scrapes, injured extremities or
other minor injuries.
Who will you tag Green?
Ambulatory patients never need urgent care.

Cuts with bleeding controlled
Small burns,
Broken arms (firs aid is adequate initial treatment).
Black tags - (Expectant or No Priority)
Labels used for the deceased and for those whose injuries are so extensive that
they will not be able to survive given the care that is available. There are limited
resources available. No respirations after 2 attempts to open the airway.
Because CPR is a one-on-one care and is labor intensive, CPR is not performed
when there are many more victims than rescuers. There are going to be those
who are obviously deceased because of their injuries, and those who are critically
injured requiring lots of resources to possibly save them.
This category can be the most challenging from an ethical and emotional
perspective. While it is logical to help the greatest number of victims in a
disaster, it is difficul to walk away from a person who is on the verge of dying
due to severe injuries. The World Medical Association reminds us, “It is unethical
for a physician to persist, at all costs, at maintaining the life of a patient beyond
hope, thereby wasting to no avail scarce resources needed elsewhere”.
Who will you tag Black?
Obviously dead person

Not breathing after opening airway
Disaster Tagging Examples
Example 1
Victim pulled from smoking building reports shortness of breath. Respirations 28/
minute. Radial pulse palpable at 102/minute. Follows verbal commands.
Tag: Yellow
Treatment: None required at this time.
Why? This victim has a patent airway, respirations are less than 30/minute, a
palpable pulse, and follows commands appropriately. This victim is not in
immediate danger of death. Injuries do not jeopardize the victim’s life. The
victim may require professional care, but treatment can be delayed.
Example 2
Unresponsive victim found with abdominal wound that is bleeding profusely. Res-
pirations 32/min. Radial pulse palpable at 116/minute.
Tag: Red
Treatment: Apply pressure to stop bleeding.
Why? This client is unresponsive with a respiratory rate greater than 30/minute
and is bleeding profusely from an abdominal wound. These assessment finding
place this victim in the Red category. The victim has life-threatening injuries
(airway, bleeding, or shock) that demand immediate attention to save his or her
life; rapid, lifesaving treatment is urgent, and they should be the firs ones sent to
the hospital when firs responders arrive.
Example 3
Unresponsive victim found with agonal respirations and weak, palpable radial
pulse. Two attempts made to open airway with 15 seconds of ventilation without
response.
Tag: Black
Treatment: None
Why? This victim’s injuries are so extensive that the victim will not be able to
survive given the care that is available. Remember, there are limited resources
available during a disaster. No respirations after 2 attempts to open the airway.
Because CPR is a one-on-one care and is labor intensive, CPR is not performed
when there are many more victims than rescuers.
Example 4
Ambulating victim who is alert and oriented with numerous cuts and abrasions
Responds to verbal commands Capillary refil 1 second. Respirations 20/minute.
Radial pulse 88/minute.
Tag: Green
Treatment: None
Why? This victim has minor injuries and will need medical care at some point, af-
ter more critical injuries have been treated. Ambulatory victims never need urgent
care.
Exercise 1: Matching
Match the client injury with the disaster tag that should be assigned to the client.
Tag Assignment Client Assessment Triage Tags

Client ambulates to A. Red
nurse. Alert and crying
with obvious broken arm.
Respirations are 20,
Radial pulse 122. He is
awake, alert, and crying.
Awake and alert client B. Black
states “can’t move or feel
legs” Respirations - 28
Radial pulse 112.
Unconscious client with C. Yellow
open head wound. Bleed-
ing controlled. Respira-
tions - 18, Radial pulse 88
Unresponsive client D. Green
gurgles but can’t main-
tain open airway and
is not breathing. Weak
Carotid Pulse

Exercise 2: Disaster Triage
There has been an explosion at a local plant. You have been sent to the scene to
triage victims. Tag each client as Red, Black, Yellow, or Green.
_______________ 1. Confused victim with no obvious injury. Responds to

questions with mumbling, unintelligible speech. Skin
pale and sweaty, with visible tremors. Respirations –
32/min. Apical pulse 138/min. A Med Alert tag indicates
client is a diabetic.
_______________ 2. Unconscious victim with large areas of red blistered

burns on arms, chest, and face. Singed hair on face
and head. Respirations – 5/min, shallow/irregular. No
change after attempt to open airway.
_______________ 3. Conscious, alert, but agitated victim who is 8 months

pregnant. Reports shortness of breath. Respirations
36/shallow/strained. Skin pale, cool and dry, capillary
refil 4 seconds. Difficult answering questions.
_______________ 4. Victim wandering around without purpose, mumbling.

Some scratches and abrasions, but no obvious injury.
No breathing difficulties Able to provide name and
address, but speech is bizarre. Believes terrorists are
nearby and will shoot anyone leaving.
_______________ 5. Unresponsive, limp victim lying prone, has a large bloody

wound to the occipital head. Blood has saturated
through clothing in many spots. Left pupil is fixe and
dilated. Respirations 10/irregular. Radial pulse 60/irregular.
_______________ 6. Victim trapped under a heavy piece of equipment.

A hematoma noted on the forehead. RR 24, pulse 120.
Dazed and confused, unable to extricate self or answer
questions, speech garbled.
_______________ 7. Alert victim with blistered skin covering both legs

anteriorly and posteriorly. Reports severe pain 10/10.
Respirations - 20. Radial pulse 110. Good capillary refill
_______________ 8. Alert victim lying on ground with severe leg pain 9/10
and light-headedness. Answers questions appropriately.
No respiratory distress. Respirations 28. Radial pulse
120/minute. Leg deformity with bone sticking out
through wound. Minimal bleeding noted.
_______________ 9. Alert, pale and diaphoretic victim reporting severe chest

pain, radiating to jaw, with nausea and light-headedness.
Respirations - 28. Radial pulse weak at 128. No
signs of injury.
_______________ 10. Victim walking around the triage area. Pale, shaking,
and crying. No obvious injuries. Follows commands.
A disaster has been issued in a small town where a major traffi accident with
numerous casualties has occurred. You have been sent to the scene to triage vic-
tims. Tag each client as Red, Black, Yellow, or Green.
_______________ 1. Unconscious victim. Chest not rising. Respirations 0/min.

Radial pulse 0/min. Blood oozing from head wound.
Finger tips gray.
_______________ 2. Alert and responsive victim with large piece of metal

imbedded into right thigh. Respirations 34/minute.
Radial pulse 132/minute. Capillary refil 3 seconds.
_______________ 3. Alert and oriented victim with amputated right arm.

Bleeding controlled with a tourniquet. Respirations
18/min. Radial pulse 110/minute. Capillary refil 4 seconds.
_______________ 4. Alert and oriented victim with facial injuries. Able to

ambulate to safety. Respirations 16/minute. Radial pulse
76/minute. Capillary refil 2 seconds.
_______________ 5. Unresponsive victim with no visible injury. Has blank

stare. No chest or air movement after attempt to open
airway twice. Color does not return to finge tips.

_______________ 6. Alert, victim who walked up to triage area holding right
arm. Deformity noted. Respirations 20/minute. Radial
pulse 92/minute. Capillary refil 1 second.
_______________ 7. Alert and oriented victim lying supine with deformities

noted to both legs. Reporting pain 8/10. Respirations
28/min. Radial pulse 106/minute. Capillary refil 2 seconds.
_______________ 8. Alert and oriented victim reporting chest pain. Pain on

palpation to right side of chest wall. Respirations
38/minute. Radial pulse 122/minute. Capillary refil 2
seconds.
_______________ 9. Alert and oriented victim with deformity and swelling

to the left ankle. Respirations 22/minute. Radial pulse
90/minute. Capillary refil 1 second.
_______________ 10. Alert victim who becomes dizzy when sitting. Severe
cut on right thigh, heavy bleeding. Respirations
26/minute. Radial pulse weak at 152/minute Capillary
refil 4 seconds.

Exercise Answers
Exercise 1: Matching
Answers
Tag Assignment Client Assessment Triage Tags
D. Green Client ambulates to A. Red
nurse. Alert and crying
with obvious broken arm.
Respirations are 20,
Radial pulse 122. He is
awake, alert, and crying.
C. Yellow Awake and alert client B. Black
states “can’t move or feel
legs” Respirations - 28
Radial pulse 112.
A. Red Unconscious client with C. Yellow
open head wound. Bleed-
ing controlled. Respira-
tions - 18, Radial pulse 88
B. Black Unresponsive client D. Green
gurgles but can’t main-
tain open airway and
is not breathing. Weak
Carotid Pulse

Answers
1. Red. This victim might have a low blood sugar instead of injury. If paramedics
give glucose, the client could improve to yellow.
2. Black. This breathing pattern is a near-death sign. Treat like someone who is
not breathing at all. The lungs probably look like the skin – even with a ventilator,
prognosis is dismal.
3. Red. Respiration over 30 and trouble answering. Injury unclear. Could have
lung or inhalation injury. Could have unrelated illness. Monitor for pregnancy
complication or premature delivery.
4. Green. This victim is walking. There is no physical injury, but there may be a
psychiatric illness either from stress or from underlying mental health problems.
5. Black. This victim is not expected to survive with this level of coma. The assess-
ment suggests severe open head injury. The pupils indicate increasing intracranial
pressure.
6. Red. Unable to answer simple questions due to probable closed head injury.
7. Yellow. This victim’s breathing, circulation, and mental status are normal. Partial
thickness burns to legs can wait several hours for treatment if closely monitored
to make sure victim remains stable.
8. Yellow. An open leg fracture needs medical attention today, but the care can
be delayed a few hours. The bleeding isn’t enough to affect circulation, so treat-
ment can be delayed.
9. Red. This victim is exhibiting signs of a probable myocardial infarction. Heart

attacks need urgent care, so even though the victim passed circulation (pulses
OK), this client would still be tagged red. On the other hand, if the client’s heart
stopped, do not do CPR in this setting.
10. Green. Remember if the victim is walking, urgent care is not needed.
Answers
1. Black. This victim is already dead, so should be tagged black.
2. Red. This victim’s respirations are over 30/min. with tachycardia and a capillary
refil over 2 seconds. The victim has an impaled object in the thigh likely to be
causing internal bleeding/shock.
3. Red. This victim has an amputated arm that is bleeding enough to require the
use of a tourniquet and capillary refil is over 2 seconds.
4. Green. Remember if the victim is walking, urgent care is not needed. This client
has minor injuries that can be treated after other much later.
5. Black. This victim is already dead, so should be tagged black.
6. Green. Remember if the victim is walking, urgent care is not needed. This client
has a broken arm that firs aid can manage.
7. Yellow. This victim is stable for the moment and, is not in immediate danger of
death. The victim will require professional care for the two broken legs, but
treatment can be delayed. There is severe limb injuries that will require
hospitalization or possibly surgery. This victim will still need hospital care and
would be treated immediately under normal circumstances.
8. Red. This victim’s respirations are over 30/min. with tachycardia and possible
rib fractures which could puncture a lung. This victim needs immediate care in
order to survive.
9. Yellow. This victim is stable for the moment and, is not in immediate danger.
The victim will require professional care for the broken leg, but treatment can be
delayed.
10. Red. This victim is exhibiting signs of shock with hemorrhage, dizziness,
tachycardia and prolonged capillary refill Immediate care is needed for survival.

Asthma Handout
I. Asthma
A. Pathophysiology:
Chronic inflammatory disorder of the airway
What is happening in the person’s airway?

- Edema
- Inflammation
- Tenacious secretions,
- Smooth muscle spasms (wheezing and bronchospasm)
- Decreased expiratory airflow
Causes/Triggers:
- Allergy
- Environmental allergens (dust mites and roaches)/Dust
- Smoke (any form)
- Medication
- Pets
- Exercise

- Change in the weather (cold air)
- Strong emotions
- Change in environment (moving to new home or new school)
- Food

B. Signs and Symptoms:
- Recurrent episodes of wheezing
- Can’t catch their breath, dyspnea
- Cough
- Fatigue
- Chest tightness/pain
- Retraction in infants
- Hyperresonance of chest with percussion
- Course and loud breath sounds
- Repeated episodes = barrel chest
- Symptoms usually worse at night.
- Symptoms of acute asthma attack: Child may start to report itching

in the front of their neck or their upper back; will start out feeling
restless and report a headache; will be tired, irritable, with a
hacking non – productive cough; their chest begins to tighten as
secretions increase and their cough becomes rattling and productive
(clear frothy sputum).
- As the attack becomes more severe: The child will try to breathe
more deeply; the expiratory phase will be prolonged with
audible wheezing; appearance will be pale and may become
cyanotic; restlessness increases; anxious expression; sweating;
younger children may assume the tripod sitting position, whereas
the older child will sit up with shoulders hunched over with hands on
legs or bed to facilitate use of accessory muscles.
C. Diagnosis:
- Difficult to diagnose asthma in infants (many conditions can cause

wheezing and retractions).
- Chronic cough with no signs of infection and/or diffuse wheezing

during expiration is sufficient to diagnose asthma.
- Pulmonary function test: Helps to determine the presence and

degree of lung disease and response to respiratory therapy.
- Spirometry function test reliable for children older than 5 or 6 years.
- Peak expiratory flow rate (PEFR): Max airflow that can be forcefully
exhaled in one second.
- Each child’s PEFR based on age, race, height and gender.

D. Treatment:
- Chest Physiotherapy
- Percussion, vibration, squeezing the chest and breathing exercises

(blowing bubbles)
- Do not administer this therapy during an acute episode
- Monitor O2 sat
- Allergy shots (Allergy proof the house) **Only administer allergy

shots if emergency equipment is available in case of anaphylactic
shock
- Small frequent meals – to prevent abdominal distention and help

prevent the diaphragm from expanding
- Encourage fluids to thin secretions, but no extremely cold fluids be

cause cold can induce a bronchospasm
- Evaluate participation in exercise activities on an individual basis
- Humidified O2
- Refer to Respiratory System Medications in Pharmacology under

the Resource Documents

Immunizations Birth - 6 years
1. Hepatitis B (Hep B) 8. Measles, Mumps, Rubella (MMR)

#1 @ birth #1 @ 12 -15 months
#2 @ 1 – 2 months #2 @ 4 – 6 years
#3 @ 6 – 18 months
2. Rotavirus vaccine (RV) 9. Varicella

#1 @ 2 months #1 @ 12 – 15 months
#2 @ 4 months #2 @ 4 – 6 years
#3 @ 6 months
3. Diphtheria, Tetanus, Pertussis (DTaP) 10. Hepatitis A

#1 @ 2 months #1 @ 12-23 months
#2 @ 4 months
#3 @ 6 months
#4 @ 15 – 18 months
#5 @ 4 – 6 years
4. Haemophilus influenzae type B (Hib)

#1 @ 2 months
#2 @ 4 months
#3 @ 6 months
#4 @ 12 – 15 months
5. Pneumococcal conjugate Vaccine (PCV)

#1 @ 2 months
#2 @ 4 months
#3 @ 6 months
#4 @ 12 – 15 months
6. Inactivated Poliovirus Vaccine (IPV)

#1 @ 2 months
#2 @ 4 months
#3 @ 6 – 18 months
#4 @ 4 – 6 years
7. Influenza: @ 6 months and yearly

Immunizations 7 -18 years
1. Diphtheria, Tetanus, Pertussis (Tdap)
#1 @ 11 – 12 years and every 10 years
2. Human Papillomavirus Vaccine (HPV)

#1 @ 11 -12 years (3 doses series)
3. Influenza: Yearly
• A severe febrile illness and a known allergic response to a previously

administered vaccine are both contraindication for immunization. A
contraindication to live virus vaccines (MMR and Varicella) is recently
acquired passive immunity.
** Varicella, MMR vaccines are contraindicated if there is a known hypersensitivity to

neomycin or gelatin.
** Influenza vaccine is contraindicated if there is a known egg or chicken protein
allergy
** DTaP is contraindicated with a known gelatin allergy
Administering Vaccines
**All immunizations are given IM, with the exception of the MMR and Varicella which
are given SQ
**Influenza may be given via intranasal spray
**Rotovirus is given orally
**When administering SQ injections use a 23-25 gauge needle, needle length for
infants (1-12 months) is 5/8”, children 12 months and older 5/8”
If giving IM injection use 22-25 gauge needle, needle length first 28 days 5/8”, infants
(2-12months) 1” for anterior thigh, toddlers and children, use a 1-1 ¼” for
anterolateral thigh and a 5/8” needle for the deltoid.
The Recommended Immunization Schedule for Persons Aged 0 through 18 years are approved by
the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/recs/acip), the Ameri-
can Academy of Pediatrics (http://www.aap.org), and the American Academy of Family Physicians
(http://www/aafp.org). DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR
DISEASE CONTROL AND PREVENTION

Specific Pediatric Heart Defects
A. Acyanotic Defects
1. Ventricular Septal Defect (VSD):
This is when there is an opening between the left and right ventricle (in
the septum)
This increases the volume on the right side of the heart. The right side
is having to pump harder so this can lead to right sided heart failure.
Many close spontaneously during the first year of life, but if not will have
surgical repair.
Signs and Symptoms:
- Signs of heart failure
- Murmur
2. Coarctation of Aorta:
The aorta has a narrowing (pretend there is a tourniquet tied around the
aorta). This makes it harder for the LV to pump so the client may wind up
with left sided heart failure.
Signs and Symptoms:

- Hallmark Sign: There is a BIG difference in the pulses and BP of the
upper and lower extremities. For example, you may have a pediatric
client with an Upper extremity BP = 100/60 and Lower extremity
BP = 70/40
- The upper pressures are much greater than the lower pressures.
Treatment:
- Surgery
- Angioplasty in some
3. Patent Ductus Arteriosus (PDA):
Normal fetal circulation: Blood goes Right Atrium….Right Ventricle….

Pulmonary Artery…doesn’t go to lungs….instead when blood leaves PA
it goes straight over to the aorta via the ductus arteriosis. Why does the
blood do this? Because in utero the baby’s lungs are collapsed, and the
baby gets oxygen through the placenta.

This ductus arteriosis is supposed to close when the baby is born and
takes their first breath. When it closes then blood flows from the
Pulmonary Artery to the lungs etc….just like in the adult. But when it
doesn’t……

This leads to increased workload on the left side of the heart and therefore
left sided heart failure.
Some blood is going like it’s supposed to, but some is going over to the right
side because the left side is pushing it to the right.
Signs and Symptoms:
- May be asymptomatic
- May be in heart failure
- They have a machinery - like murmur
Treatment:
- Indomethacin (Indocin®) (prostaglandin inhibitor) will close PDA
- May need surgery to close the ductus

B. Cyanotic Defects
1. Transposition of the Great Vessels:
Think about the normal blood flow in the heart (remember the square heart
in your cardiac lecture?)
In transposition of the great vessels, the pulmonary artery and the aorta
have swapped places. The aorta is still going to the right side of the heart
and the pulmonary artery is going to the left but they never connect or
cross.
So you wind up with 2 separate sets of circulation going in and out of the
heart. Yes, some blood is getting out to the systemic circulation, or the
client would be dead at birth. Instead, the baby is cyanotic at birth, but
alive. What’s keeping the baby alive?
- Usually there is some other defect that is allowing that baby to get
just enough oxygen to stay alive. (often it is a PDA)
Signs and Symptoms:
- Usually cyanotic at birth
- If not picked up on until older……decreased growth, poor feeding
Treatment:
- Surgery
2. Tetralogy of Fallot:
Consists of 4 defects:
a. Ventricular Septal Defect (VSD)
b. Pulmonary Artery Stenosis
c. Overriding Aorta

d. Right Ventricular Hypertrophy
Signs and Symptoms:
- Infants may be cyanotic at birth: others may have mild cyanosis that
progressively worsens during first year
- Murmur
- Acute cyanotic or hypoxic spells (blue spells/Tet spells)
*usually seen during crying, after feeding, during bowel movements
*at risk for sudden death, seizures
- Older children: Squatting, nail clubbing, poor growth, exercise

intolerance
Treatment:
- Surgery

Understanding Growth and Development
Infants
Infancy is birth to 12 months of age: Trust vs Mistrust (Erikson)
Basic Principles:
• This is a time when the primary source of activity is through

the mouth; examples are rooting and sucking reflex, feeding,
and pacifier.
• Repeated use of reflexes develops experiences
• Young infants are totally self-centered; they have little tolerance

for delayed gratification
• At 4-8 months they can perform a desired activity that will produce
a result. Example: secures object by pulling on a string
• Late infancy: develops the concept of object permanence-

understands parents are present even if not in line of vision,
works to get toy that is out of reach
• Comprehends simple commands and meaning of words

• Can say bye-bye and blow kisses
• Begins to explore their surroundings
• Infants trust that their needs will be meet (feedings, diaper

changes, comfort, stimulation)
• The trust developed during infancy is the foundation for all

relationships and for the progression of further development
• The single most important element in developing trust is consistency

in caregivers. Infants love routines! So do things like having a
regular feeding schedule, bathe every night then give a bottle and
go to bed.
Assessment Guidelines
• Important things to focus on when assessing an infant
– Head control: should have no head lag by 4 months
– Pincer grasp: should have established pincer grasp by

11 months of age. Remember up until 1 month of age
hands are closed, grasping at 2-3 months is a reflex.
By 5 months, infants can voluntarily grasp an object.
– Rolling over: should be able to roll over from abdomen

to back at 5 months of age. No your baby isn’t advanced
if they rolled over at 2 months…..it was an ACCIDENT!!
• Weight: gain 5-7oz weekly for first 6 months; at 2 weeks, the

infant should have gained back to their birth weight, then
weight should double around 5 months of age and triple by age 1
• Posterior fontanel closes by 2 months of age anterior fontanel

closes by 18 months of age

• Verbal skills: should be able to imitate sound around 6 months,
by 8 months combines syllables like dada but doesn’t know the
meaning, 9 months responds to simple commands, comprehends
no-no, 10 months says dada and mama with meaning attached,
12 months says 3-5 words
Developmental Milestones
• Some important developmental milestones to remember:
– By 2 months can try to pull up with some head control
– By 7 months should bear weight on feet, can sit with support,

transfers object from one hand to the other
– By 8 months can move from sitting to kneeling, sits

without support
– By 9 months can stand holding onto furniture, creeps on hands

and knees
– 9-10 months takes deliberate steps
– By 12 months walks with 1 hand held, can sit down from standing
position without help
Pain Assessment
• What are some signs an infant may be in pain?
– Facial grimaces
– Postural changes, thrashing
– Crying loud and excessively
– Inconsolable
Pain Scales
CRIES
• Used for neonates and infants; 2 points are scored for each area for
a total possible score of 10. 0= no pain, 10=worst pain
– Crying
– Requires increased oxygen
– Increasing vital signs
– Expression
– Sleepless

Toddlers
Toddlers are age 12 months to 36 months: Autonomy vs. Shame and Doubt (Erikson)
Basic Principles:
• The primary source of activity is continued until about 18 months of age

and then the toddler transitions into a focus on elimination needs.
• The child learns to control his bowels, but if this process doesn’t happen
an “anal” fixation may develop and can lead to obsessive/perfection or
disorganized behaviors.
• Cognitive development is characterized by EGOCENTRISM
– Curious about their environment
– Leaves parents for extended period of time
– Searches for objects through hiding places
– Imitates words and sounds and adult behavior
– Engages in parallel play
– LOVES ROUTINE!!!
– Uses 2-3 words together
– Possessive of their toys; uses the word MINE
– Follows direction
– Egocentrism is observed in the behaviors and play

• The toddler has entered the world of NO NO NO NO NO!
– Toddlers are aware of their will and control over others but they
are conflicted with exerting autonomy and relinquishing the
much enjoyed independence on others
– Holding on and letting go are evident in how the toddler uses his
hands, mouth, eyes: “No don’t touch”, spitting out food, etc.
– NEGATIVEISM and RITUALISM are typical
– Toddlers learn to behave based on the restrictions that are

placed on their actions
– If the child’s behavior is punished they learn it is bad; if it is

rewarded, it is positive
– By 36 months you may see developmental aspects of a

conscience
• Important things to focus on when assessing the toddler
– Steady growth in weight and height
– Development of body image; they learn to associate body parts

with meanings
– Gender identity is developed by age 3
– Developing self-image, avoid using negative terms like skinny

legs or chubby legs.
• Play is important so provide enough space for play; encourage

pretend play
• Permit child to help with adult tasks - they want to feel productive
• Provide toys or activities that help with expression of feelings: language

skills aren’t developed enough to express all feelings
• When assessing the child let them hold and touch equipment-this will
greatly reduce their fear.
– Gross motor: walks without help, creeps up stairs, kneels without

support
– Fine motor: builds tower of 2 cubes, holds 2 cubes in one hand,

scribbles, uses cup well but struggles with a spoon
– Language: says 4-5 words, including name, points and ask for
objects, understands simple commands, says 10 or more words,
uses 2-3 phrases, TALKS ALL THE TIME
– Tolerates separation from parents
– TEMPER TANTRUMS are normal
– May develop a dependency on security item – like a special

blanket or stuffed animal
Pain Assessment
• What are signs a toddler maybe in pain?
• Toddlers don’t understand why or what is causing them to have pain so

they express:
– Extreme emotional upset

– Physical resistance
– Excessive activity
– Restlessness
– Loud crying
– Attempts to push stimulus away
Pain Scales
FLACC
• FLACC- used for ages 2 months to 7 years (if unable to communicate

pain level)
• 2 points are scored for each area for a total possible score of 10.
0= no pain, 10=worst pain
– Face
– Legs
– Activity
– Cry
– Consolability

Preschoolers
Preschool is ages 3-5 years: Initiative vs Guilt (Erikson)
Basic Principles:
• This is a time when the primary source of activity is related to their

sexual identity and relationship with parents.
• Becomes rival with same sex parent, develops sexual desires for
opposite sex parent. This is sometimes referred to as the Oedipus
Complex for boys and Electra Complex for girls
• Develops a fear they will be punished for these feelings by same

sex parent and this fear eventually leads the child to learn to identify
with the same sex parent
• The preschooler’s thinking transitions from egocentric thought to social

awareness is often referred to as “magical thinking.” They believe their
thoughts are all powerful; for instance, if they wish their sister would die
and something happens and she dies, they think it is their fault
• Literal thinkers- if you tell them they were bad for hitting a child, they
literally think they are bad, they can’t understand it’s the behavior that
was bad not THEM!
• Poor body boundaries, they think when they have a cut all their blood is
going to come out. That’s why they always want a million Band-Aids.
• Important things to focus on when assessing the preschooler
– Usual weight gain is 4-6 pounds per year; good rule of thumb:
4 years, 40 pounds, 40 inches. Average weight of 5 year old is
42.1 pounds.
• The preschooler begins to move from parallel play to associative play.

This is group play that is similar but without rigid organization rules.
For example: everyone is sitting around playing with their blocks.

• Imaginative and imitative play are also very important as a way for
children to express their feelings when they don’t have the vocabulary
yet to describe what they are feeling.
• Use drawing and pictures to help child express how they are feeling
with procedures and interventions; allow them to help when safe for
the child, such as with dressing changes or bandages.
Some important developmental milestones to remember:
– Gross motor: Rides tricycle, jumps off bottom step, Skip and
hop on one foot, catch a ball, jumps rope
– Fine motor: Builds a tower of 9 blocks, when drawing can copy

circles, Use scissors usefully to cut out pictures, ties shoelaces
– Vocabulary of 900 - 2100 words as they grow

– Uses complete sentences starting with 3-4 words up to 6-8 words
– Continues to talk all the time- even if no one is listening!!

Tells exaggerated stories and asks WHY, WHY, WHY?

Pain Assessment
• What are signs a preschooler may be in pain?
• Preschoolers do not understand pain is related to illness, but may

relate it to an injury-remember they are magical thinkers
• Responds well to distractions
– Can verbally communicate about their pain

– Cling to parents or caregiver
– Fearful about what may happen, may request procedure to
stop
Pain Scales
Faces
• Faces Scale is used for age 3 and up
– Have the child choose the facial expression that best fits their
pain level
– It’s very important that they are able to understand the

difference between pain and feeling sad. We aren’t try to
determine how sad they are!!
Oucher
• Oucher is used for children age 3-12 years
• Consist of 6 photographs of faces representing no hurt to biggest

hurt
• Benefit over Faces scale: it has faces from different ethnicities

School - Age
School Age is 6-12 years: Industry vs Inferiority (Erikson)
Basic Principles:
• The child starts to place importance on privacy. Plays mostly with same
sex peers. When caring for this age be sure to provide gowns and
covers when performing procedures. Always knock on the door before
entering.
• Has an increased need to understand the body and functions of the

body.
• One of the major tasks is mastering conservation. They learn that

physical matter doesn’t change when its form is altered. They are no
longer magical thinkers. An example of this being achieved: They
understand that if a girl cuts her hair short she doesn’t become a boy,
their gender doesn’t change by having a haircut.
– Does not reason logically, may use symbols or objects, either

words or images. Understands relationship between things and
ideas, allow the child to handle equipment-this will help increase
their understanding.
• Children become more flexible. They are now able to see and
understand things from anothers point of view, no longer rigid
thinkers. They are no longer so egocentric. This is the beginning of
logical thought formation which leads to the development of morality
.
• They use cooperative play. They work hard in school, sports, and in
their family to fill a sense of accomplishment.
– They want to be productive and successful!!
– The goal of this stage of development is to develop a sense

industry. This will help in building self-confidence. They continue
to improve their social skills.

– Eager to build skills and participate in meaningful and
socially useful work. They must balance this with the knowledge
that although they are improving and successful there is always
more to learn.
– If the child DOESN’T develop a sense of accomplishment this

may result is a sense of inferiority.
• As children move from egocentrism to more logical thinking they are

also developing a conscience and moral standards. These standards are
based on the teachings and beliefs of others such as teachers and
parents.
• Important things to focus on when assessing the school age child:
– Height and weight gain slows, appears in bursts, can grow at

least 2 inches in height per year
– Repeats activities in order to master them
– Develops concept of numbers, knows when its morning or night,

by age 8 gives similarities and differences between two things
from memory, can repeat days of the week
– Age 6 able to use knife to spread butter, by age 8 helps with

routine housework, looks after own meals
– Socially at age 6 can share and cooperate, likes to compete in

games, enjoy spending time with others of the same age
on projects and discussing the activities of the day, develops
modesty: these are import ant consideration when they are
in an acute care setting.

Pain Assessment
• What are signs a school age child may be in pain?
• They can understand disease or injury causes pain
– Muscle rigidity
– Clenched fist
– Wrinkled forehead
– Able to verbalize pain by telling you location and intensity
– Stalling behaviors
Pain Scales
Faces
• Faces Scale is used for age 3 and up
– Have the child choose the facial expression that best fits their
pain level
Oucher
• Oucher is used for children age 3-12 years
• Consist of 6 photographs of faces representing no hurt to biggest

hurt
• Benefit over Faces scale: it has faces from different ethnicities
Numeric Scale
• Use for children ages 5 and up
– Uses straight line with end points identified as no pain and

worst pain
– Be sure the child is able to count!! Some 5 year olds haven’t

mastered this skill yet.

Adolescents
Adolescents are age 12-18 years: Identity vs. Confusion (Erikson)
Basic Principles:
• Adolescents primary focus is on peers and developing relationships out

side of the family.
– Have the ability for mature abstract thoughts and ideas, can think
in hypothetical terms
– As the adolescent physically matures and thought and ideas

become more complex, a new sense of identity is developed.
This identity consists of a picture of oneself that includes past,
present, and future.
– Peer groups play a large role in developing a sense a self and

self-esteem, with the key to identity achievement being based
on interaction with others.
– Barriers to developing identity would be lack of role models,

inability to identify a meaningful sense of self, and lack of
opportunities to explore alternative roles.
• Establishes personal ethics on which to base decisions. Increase in

reasoning and social cognition

• Understands abstract thoughts and understands opinions of others.
Takes into account the opinions of others when making decisions
• Physical changes related to sex and growth hormone effects; is varied in

rate and timing based on gender and family genetics/influences
• Be clear, concise and honest when communicating with the adolescent,

particularly with body and sexuality issues.
– Nursing considerations: give both written and verbal instructions,

give clear and complete information about disease process,
interventions, and hospitalization.
– GIRLS develop more quickly than BOYS. Adolescents grow

stronger and more muscular.
– Increased communication and time with peer group; enjoys

activities like movies, dances, driving, sporting events
– Preoccupied with body image, very self-centered;

relationship with peers is the most important relationship
– Feelings of “being in love” and dating forms stable

relationships and attachments to others
– Emotional and physical separation from parents; becomes

more independent
Pain Assessment
• What are signs an adolescent may be in pain?
• Able to describe pain but may be fearful of telling
– Less vocal protest

– Less motor activity
– Move verbal expressions like “it hurts” or “stop you’re hurting
me”
– Muscle tension
Pain Scales
Numeric Scale
• Use for children ages 5 and up
– Uses straight line with end points identified as no pain and worst
pain, usually defined by describing the pain on a scale of 1-10

ABG Interpretation Practice Problems
PROBLEM NORMAL
pH: 7.32 ________________ pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 41 ________________ PCO2: basic  35 – 45  acidic
HCO3: 20 ________________ HCO3: acidic  22 - 26  basic
Interpretation: _____________________________________________________
PROBLEM NORMAL
Interpretation: _____________________________________________________
PROBLEM NORMAL
Interpretation: _____________________________________________________
PROBLEM NORMAL
Interpretation: _____________________________________________________

ABG Interpretation Practice Problems
PROBLEM NORMAL
pH: 7.32 acidosis pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 41 normal PCO2: basic  35 – 45  acidic
HCO3: 20 acidosis (acidic) HCO3: acidic  22 - 26  basic
Interpretation: Metabolic Acidosis
PROBLEM NORMAL
pH: 7.56 alkalosis pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 31 alkalosis (basic) PCO2: basic  35 – 45  acidic
HCO3: 25 normal HCO3: acidic  22 - 26  basic
Interpretation: Respiratory Alkalosis
PROBLEM NORMAL
pH: 7.26 acidosis pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 51 acidosis (acidic) PCO2: basic  35 – 45  acidic
HCO3: 29 alkalosis (basic) HCO3: acidic  22 - 26  basic
Interpretation: Respiratory acidosis with partial compensation
PROBLEM NORMAL
pH: 7.45 normal (~alkalosis) pH: acidosis  7.35 – 7.45  alkalosis
PCO2: 52 acidosis (acidic) PCO2: basic  35 – 45  acidic
HCO3: 35 alkalosis (basic) HCO3: acidic  22 - 26  basic
Interpretation: Fully compensated Metabolic alkalosis

A GREAT WAY TO REMEMBER THE...
12 CRANIAL NERVES
“On Old Olympus Towering Top A Finn And German Viewed Some Hops”
Cranial Nerve Major Function(s)

I Olfactory Smell
II Optic Vision
III Oculomotor Eyelid and eyeball movement
IV Trochlear Innervates superior oblique

Turns eye downward and laterally
V Trigeminal Chewing
Face & mouth - touch & pain
VI Abducens Turns eye laterally
VII Facial Controls most facial expressions

Secretion of tears & saliva; Taste
VIII Vestibulochochlear Hearing
(auditory) Equilibrium sensation
IX Glossopharyngeal Taste
Senses carotid blood pressure
X Vagus Senses aortic blood pressure; Slows
heart rate; Stimulates digestive organs;
Taste
XI Spinal Accessory Controls trapezius &
sternocleidomastoid; Controls
swallowing movements
XII Hypoglossal Controls tongue movements

CRITICAL THINKING EXERCISES

Making Room Assignments
RULE: “LIKE ILLNESSES” CAN BE PUT IN THE SAME ROOM TOGETHER.
IN THE STEM OF THE QUESTION, THE NCLEX® LADY WILL TELL YOU THAT THE TWO
CLIENTS HAVE THE EXACT SAME CONDITION.
NCLEX® CRITICAL THINKING EXERCISE FOR MAKING ROOM

ASSIGNMENTS:
The nurse is caring for a client with AIDS that is in a semi-private room. Which
client is best to assign in the room with the client who has AIDS?
1. The client with asthma.
2. The client that is 8 hours post-appendectomy.
3. The client with bronchitis.
4. The client with partial thickness burns.
Answer:
1. Correct: Asthma because that’s the only one that’s not infectious.
2. Incorrect: You would never put a fresh incision in a room with somebody that’s
HIV positive. Cross contamination could occur.
3. Incorrect: Bronchitis can be bacterial or viral, right?
4. Incorrect: This is similar to the post-appendectomy situation; someone with a

partial thickness burns would be at risk for cross contamination also.
NCLEX® CRITICAL THINKING EXERCISE:
An 18 month old is admitted to the ED with a diagnosis of rotavirus and severe
dehydration. The client has no tears and has not wet a diaper in 5 hours. The
primary healthcare provider has prescribed D5 ¼ NS with 20mEq of KCL at
20 mLs per hour per pump. What would be the best action by the nurse?
Answer:
Based on the information, it’s clear that fluids a e needed. So what are you
worried about? Potassium. Why are you worried about potassium? Because they
have not wet a diaper in five hours. Does the baby still need the fluid? es, but if
the kidneys are not working and you go ahead and give the potassium, you will
make the client go into renal failure!
So, what you do is you go ahead and start your IV, right? Yes. You get the
D5¼ NS going and call the primary healthcare provider and say, “Look, I am not
giving this baby any potassium until they start wetting their diaper, okay?”
We will not start giving the baby potassium in their fluid until the baby has star -
ed to void----wetting diapers. Is that what they want you to do? Yes.
Primary healthcare providers want you to look at the prescriptions or orders.

The NCLEX lady likes the word “prescription” so that is why we are using it. We
want you to feel comfortable with that word! They write prescriptions all day
long and we have to be able to look at those prescriptions and find those that
we question. They want us to question the orders if there is something to worry
about like in this scenario. There’s never anything wrong with seeking clarification.
That is the best action by the nurse in this situation to call the primary healthcare
provider before starting the potassium to clarify the order based on what is safest
for the baby.
PART I:
The charge nurse is making assignments for the shift. The staff includes an RN
pulled from the neonatal intensive care unit (NICU) who has not worked on an
adult floor in six years. What is he appropriate action by the charge nurse?
1. Send the RN back to NICU and give the nurses who are already working on
the floor an extra c ient.
2. Call the nursing supervisor and demand an RN with medical surgical
experience.
3. Attend the shift report.
4. Assign the NICU to do unlicensed assistive personnel duties.
PART II:
Which client is best to be assigned to the NICU nurse pulled to the adult medical-
surgical floor
1. 4 hour post cholecystectomy client experiencing pain every 3 - 4 hours.
2. Elderly client with unexplained syncope.
3. Teenage client 8 hours post hypophysectomy.
4. New admit diagnosed with adrenal insufficienc .
Answers: Part I
1. Incorrect : Send the RN back to NICU and give the nurses working on
the floor al eady an extra client….. Doing this is a waste of a valuable RN
resource and a waste of money. Also, it does not solve the problem.
Also, this would be unsafe…..for the clients and the nurse to have an
extra client.
2. Incorrect : Call the nursing supervisor and demand a RN with med-surg

experience. If the supervisor had a RN with med-surg experience, would
a NICU nurse have been sent to you?
3. Correct: Attend the shift report. This will allow the charge nurse to
assess the situation and to make assignments based on client and
unit needs. Assessment always comes first even with delegation
and assignments!
4. Incorrect: Assign the nurse to do nursing assistant duties. Doing this

is a waste of a valuable RN resource and a waste of money.

PART II: (repeated just for ease of reference)
Which client is best to be assigned to the NICU nurse pulled to the

adult medical- surgical floor
1. 4 hour post cholecystectomy client experiencing pain every 3 - 4 hours.

2. Elderly client with unexplained syncope.
3. Teenage client 8 hours post hypophysectomy.
4. New admit diagnosed with adrenal insufficienc .
Answers: Part II
1. Correct: 4 hours post cholecystectomy client experiencing pain

every 3 – 4 hours. Non-complicated client.
2. Incorrect: Elderly client with unexplained syncope? This client is at risk

for MI or severe electrolyte imbalance. Needs close monitoring.
3. Incorrect: Teenager client 8 hours post hypophysectomy? This client is at

risk for developing diabetes insipidus. Sinus surgery is a little close to
my pituitary gland. Needs close monitoring.
4. Incorrect: New admit diagnosed with adrenal insufficiency? This client is

deficient in all ste oids: glucocorticoids, mineralcorticoids, and
sex hormones. At risk for fluid volume deficit, and shock. This clien
is considered unstable, and is not a candidate for a pulled nurse.

The nurse is scheduled to administer the morning dose of Levothyroxine. The client
reports “fullness” in her chest that started after eating two hours ago. What is the
best action by the nurse?
1. Administer aluminum/magnesium suspension 30 mL.
2. Administer the Levothyroxine
3. Obtain a 12- lead ECG
4. Call the primary healthcare provider
Answers:
1. Incorrect: Administer aluminum/magnesium suspension 30 mL. Is

this going to help the client? No…..aluminum/magnesium
suspension will not stop a client from having an MI will it? That is what
you are telling the NCLEX lady…. the drug of choice for an MI would
be aluminum/magnesium. We need to start with Oxygen….right….
but that was not an option so we have to go with what they give us.
2. Incorrect: Administer the levothyroxine. I don’t think so… this will

make the problem worse!
3. Incorrect: Obtain a 12- lead ECG…this is delaying care! Will this fix the
problem? NO we have to select an answer that is going to fix the
problem…. if you selected that for your answer… you are looking at
the ECG over and over …. You know you have no idea what it says!
4. Correct: Call the primary healthcare provider….because you know

that levothyroxine increases the heart rate and puts an increased
workload on a heart that has CAD. So could this client be having an
MI….Yes…and the only option here that will fix the p oblem…
the fact the client is having an MI….is to call the primary healthcare
provider.

ECG Handout
Sinus Rhythm
Atrial Fibrillation
Atrial Flutter
Ventricular Tachycardia
Ventricular Fibrillation
Hurst Lab Values
Please note that normal ranges will depend on the lab performing the test.
The normal values listed are to be used as references only for adults >13 years of age
LAB NORMAL VALUES

URINALYSIS
Alb 0-8 mg/dL
pH 4.6-8.0
WBC 0-4
Glucose negative
Specific Gravity 1.005-1.030
TOTAL CHOLESTEROL <200 mg/dL (< 5.2 mmol/L)
Men: 45-49 mean (1.17-1.29 mmol/L)

HDL
Women: 50-59 mean (1.3-1.55 mmol/L)
LDL 60-180 mg/dL (1.6-4.7mmol/L)
ELECTROLYTES
Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L
Sodium 135.145 mEq/L (135-145 mmol/L)
Phosphorous/Phosphate 3.0-4.5 (0.97-1.45 mmol/L)
Magnesium 1.3-2.1 mEq/L (0.65-1.05 mmol/L)
Calcium 9.0-10.5 mg/dL 2.25-2.62 mmol/L)
GLUCOSE (serum) 70-110 mg/dL (3.9-6.1 mmol/L)
Good Control: 2.5-5.9%

HEMOGLOBIN A1C Fair Control: 6-8%
Poor Control: >8%
Total: 0.3-1.0 mg/dL

BILIRUBIN Indirect: 0.2-0.8 mg/dL
Direct: 0.1-0.3 mg/dL
AMMONIA 10-80 mg/dL
TOTAL PROTEIN 6.4-8.3 g/dL
BUN 10-20 mg/dL
Men: 0.6-1.3 mg/dL

CREATININE
Women: 0.5-1.0mg/dL
Hurst Lab Values (continued)
LAB NORMAL VALUES
Men: 4.7-6.1 million/mm3

RBC (red blood cells)
Women: 4.2-5.4 million/mm3
Men: 13.5-17.5 g/dL

HEMOGLOBIN
Women: 12.0-15.5 g/dL
Men: 42-52%
HEMATOCRIT
Women: 37-47%
aPTT (patients receiving anticoagulant

therapy: 1.5-2.5 times the control value 30-40 seconds
in seconds)
BLEEDING TIME 1-9 minutes
Men: 0-10 mm/hr

ESR (erythrocyte sedimentation rate)
Women: 0-20 mm/hr
1.3-2.0 (an INR of 3.0-4.5 may be considered therapeutic

INR (international normalized ratio)
depending on the client)
WBC (white blood cells) 5,000-10,000 mm3
PLATELETS 150,000-400,000 mm3 or 150-400 SI units
ALBUMIN 3.5-5 g/dL
DIGOXIN 0.5-2 ng/mL
TROPONIN T < 0.10 ng/mL
TROPONIN I < 0.03 ng/mL
Reference: Pagana and Pagana, Manual of Diagnostic and Laboratory Test, Mosby, St. Louis, MO, 2014

Maslow’s Hierarchy of Needs
© alan chapman 2001-4, based on Maslow’s Hierarchy of Needs

NCLEX® Strategy Questions
1. The nurse is caring for a client that has metabolic acidosis secondary to
acute renal failure. What is the initial client response to this problem?
 1. Respiratory rate increases to blow off acid.
 2. Respiratory rate decreases to conserve acid and buffer

the kidneys’ response.
 3. Kidneys will excrete hydrogen and retain bicarb.
 4. Sodium will shift to cells and buffer the hydrogens.
Rationale:
1. Correct: Yes, acute renal failure causes metabolic acidosis and the body is
trying to breathe faster to blow off some acid. The respiratory response is
fast.
2. Incorrect: No, the client’s respiratory rate is fast, not slow.
3. Incorrect: This will happen, later. Did not we say about 48 hours? Not initial
response.
4. Incorrect: Sodium is extracellular electrolyte, not an intracellular electrolyte

2. The daytime charge nurse identifie that a client was treated for what
condition during the night after reading the following chart entries?
Exhibit:
PROGRESS NOTES: LAB REPORTS:

1/22/17 – 0125 Restless, picking at sheets. Disoriented to place pH - 7.30
and time. Dyspnea on exertion. Dr. Timmons notified. Stat paO2 - 91mmHg
ABGs ordered.
– paCO2 - 50 mmHg
HCO3 - 24 mEq/L
1/22/17 – 0145 Oxygen started at 2 liters per nasal cannula.
Incentive Spirometry and deep breathing exercises initiated. (24 mmol/L)
Head of bed elevated to 30º. –
 1. Respiratory Alkalosis
 2. Respiratory Acidosis
 3. Metabolic Alkalosis
 4. Metabolic Acidosis

Rationale:
2. Correct: From the chart we see restless, so we think??? Hypoxic, Now

look at pH, its? Acid and which other lab says acid…CO2 . Is CO2 a
respiratory or metabolic chemical? Respiratory. So Respiratory Acidosis.

3. A client is hospitalized hundreds of miles from home for a bone marrow

transplant. The client is in a protective environment while undergoing
intense chemotherapy. The client’s sibling comes to visit and has obvious
manifestations of an upper respiratory infection. Which nursing action would be
most appropriate at this time?
 1. Do not allow the sibling to visit, and do not upset the client by
mentioning the sibling’s visit.
 2. Allow the sibling to wave at the client through the window or door, then
offer the use of the unit phone so they can talk.
 3. Allow the sibling to visit after donning a sterile gown, mask,

and gloves, but prohibit physical contact.
 4. Allow the sibling to visit after donning a sterile gown, mask,

and gloves, and have the client wear a mask.
Rationale:
2. Correct: This is the only safe answer for the client.
1. Incorrect: No, allow client to see from distance and talk with client.
3. Incorrect: Sibling does not need to be allowed in the room regardless of
protective clothing.
4. Incorrect: Sibling does not need to be allowed in the room regardless of
protective clothing.

4. The client has returned to the unit after an escharotomy of the forearm.
What is the priority nursing assessment?
 1. Infection
 2. Incision
 3. Pain
 4. Tissue perfusion
Rationale:
4. Correct: Yes! They do the escharotomy for circulation problems, check
circulation!
1. Incorrect: Not right away!
2. Incorrect: No, that incision is going to be bad and ugly.
3. Incorrect: Well this is the second best answer – the escharotomy for the
lack of circulation and pain is one indicator of adequate circulation, so go
with the real thing first
5. A client is admitted to the medical unit with a diagnosis of Addison’s disease.
What nursing interventions should the nurse implement for this client? Select
all that apply.
 1. Monitor for decreased potassium levels.
 2. Assist the client to select food low in sodium.
 3. Administer flud ocortisone as prescribed.
 4. Monitor intake and output.
 5. Record daily weight.

Rationale:
3., 4. & 5. Correct: The client with Addison’s disease needs sodium due to
low levels of aldosterone. If my sodium is low, then what happened to my
potassium? Fludrocortisone is a mineralocorticoid that the client will need
to take lifelong. I&O and daily weights are needed to monitor flui status.
1. Incorrect: If I do not have enough aldosterone I am losing sodium and

water and retaining potassium. So this client should be monitored for
hyperkalemia.
2. Incorrect: If I do not have enough aldosterone I am losing sodium and
water. So, this is one client that needs foods high in sodium.
6. Which statements, made by a client after receiving education regarding

bleeding precautions, would indicate to the nurse that teaching was
successful? Select all that apply.
 1. “I cannot shave while I am at risk for bleeding.”
 2. “It is important to gargle with a commercial mouthwash three

times a day.”
 3. “Stool softeners will help prevent rectal bleeding.”
 4. “Prior to sexual intercourse, I will use a water-based lubricant.”
 5. “I will use a soft toothbrush.”

Rationale:
3., 4., & 5. Correct: Stool softeners prevent constipation and straining that
may injure rectal tissue. Water-based lubricant will prevent friction and
tissue trauma. Soft toothbrush will prevent trauma to gum tissue.
1. Incorrect: The client can shave with an electric razor. An electric razor
will prevent trauma.
2. Incorrect: Commercial mouthwash should be avoided as they contain
high alcohol content that will dry oral tissues and lead to bleeding.
7. A client is reporting shortness of breath and neck pressure following a

thyroidectomy. What is the priority nursing intervention?
 1. Elevate the head of bed, remove the dressing, and stay with the
client.
 2. Call a code, open the trach set, and position the client supine.
 3. Have the client say “EEE” to check for laryngeal integrity and
assess Chvostek’s sign.
 4. Call the primary healthcare provider, and assess vital signs.
Rationale:
1. Correct: Yes! Sounds like respiratory distress, looks like respiratory

distress, get that dressing off the neck and see if they can breathe any
better.
2. Incorrect: Not yet! Do something firs to see if it gets better.

3. Incorrect: Well just look and check and look and check – do something.
4. Incorrect: Don’t leave the client.
8. The nurse observes a client in the manic phase of bipolar disorder in group
therapy. The client has interrupted the counselor’s group session multiple times
and states “I already know this information dealing with others when you are
down.” Which nursing action is appropriate?
 1. Engage the client to walk with the nurse to make a pot of coffee.
 2. Ask the group to reflec on the client’s behavior to determine if it

is appropriate.
 3. Ask the group to tell the client how they feel about the
disruptions.
 4. Instruct the client to perform jumping jacks to get rid of some
energy.

Rationale:
1. Correct: Yes! Get them away and doing something purposeful.
2. Incorrect: That is embarrassing and humiliating to the client.

3. Incorrect: Sometimes this will be helpful during times of therapy – but
the client is manic at this time, will she even believe them?
4. Incorrect: No, this is getting the client active, but can the group
continue with this attention seeking jumping, person? No. Get the client
away from the activity.
9. After examining the eyes of the following client, the nurse would expect which
correlating lab work?
 1. Elevated cortisol level
 2. Elevated thyroxine level
 3. Decreased parathormone level
 4. Increased calcitonin level

Rationale:
2. Correct: Exophthalmos is a classic findin in Graves’ disease. It is a

protrusion of the eyeballs from the orbits due to impaired venous drainage
from the orbit, which causes increased fat deposits and edema in the
retro-orbital tissues. To diagnose hyperthyroid or Graves’ Disease you do a
thyroxine level which when elevated indicates a hyperthyroid state.
1. Incorrect: This would indicate hyperfunctioning of the adrenal gland as in

Cushing’s syndrome.
3. Incorrect: This lab would indicate hypoparathyroidism.
4. Incorrect: Again, this level would tell you about the parathyroid.
10. Which client should the nurse identify as being at highest risk for suicide?
 1. Seventy six year old widower with chronic renal failure
 2. Nineteen year old taking antidepressants
 3. Twenty eight year old, post-partum, crying weekly
 4. Fifty year old with obsessive-compulsive disorder (OCD)
Rationale:
1. Correct: Yes- elderly with chronic disease, especially men, are very high
risk.
2. Incorrect: There is an increased incidence and risk in this population-but

look for the highest risk.
3. Incorrect: Many post-partum clients cry weekly, this is not the red fla
client.
4. Incorrect: Chronic disease, but the widower wins out as the higher risk.
11. The client is transferred to the rehabilitation facility following an ischemic
stroke affecting the right side and aphasia. Which nursing action would
promote communication with the client?
 1. Encourage client to shake head in response to questions.
 2. Speak in a loud voice during interactions.
 3. Speak using phrases and short sentences.
 4. Encourage the use of a radio to stimulate the client.
Rationale:
3. Correct: Client is having trouble communicating. Get simple. Promote

communication.
1. Incorrect: Never pick an answer that doesn’t allow the client to speak.
They haven’t told us what kind of aphasia. They could have expressive
aphasia.
2. Incorrect: Don’t yell at the client.
4. Incorrect: Use of radio will not promote communication with the
client. Radio should be turned off when communicating with client to
decrease distraction.
12. The nurse is caring for a client with pneumonia. Which nursing observation
would indicate a therapeutic response to the treatment for the infection?
 1. Oral temperature of 101º F. (38.3º C); increased chest pain with
non-productive cough
 2. Productive cough with thick green sputum; states feels tired
 3. Respirations 20, with no reports of dyspnea; moderate amount of thick,

white sputum
 4. White cell count of 10,000 mm3, urine output at 40 mL/hr,

and no sputum
Rationale:
3. Correct: You will have sputum a while after pneumonia, but if it is

white there is no infection.
1. Incorrect: Temperature is still too high and they are having chest
pains.
2. Incorrect: Green sputum means infection is still there.
4. Incorrect: If pneumonia is the problem, you do not check kidneys.
With pneumonia you will have sputum for a while.
13. An elderly client is prescribed to begin ambulation with a walker following hip
replacement surgery. Which intervention by the nurse will best help this client?
 1 Sit in a low chair for ease in getting up with a walker.
 2. Make sure rubber caps are present on all 4 legs of the walker.
 3. Begin weight-bearing on the affected hip immediately.
 4. Practice tying your shoes before using the walker.

Rationale:
2. Correct: Rubber caps on all 4 legs of walker will prevent falls.
1. Incorrect: If the client sits in a low chair, their hip may dislocate. You prevent
hip flexio greater than 90 degrees and leg adduction. Both can cause
dislocation.
3. Incorrect: We do not begin weight bearing immediately but as soon as the
physician says.
4. Incorrect: If you bend over to tie your shoes, what is your hip going to do-
dislocate. You prevent hip flexio greater than 90 degrees and leg adduction.
Both can cause dislocation.
14. A client has been admitted to the medical unit with elevated ALT, AST and
bilirubin levels.
Identify the location the nurse would anticipate discomfort. Place an “x” in the
correct location.

Rationale:
Correct: The liver is located under the right lower rib cage. The liver may be
palpable in the right upper quadrant.
15. A client had surgery for cancer of the colon and a colostomy was
performed. Prior to discharge, the client asks, “Will I still be able to
swim?” The nurse’s response would be based on which understanding?
 1. Swimming is not recommended. The client should begin looking

for other areas of interest.
 2. Swimming is not restricted if the client wears a dressing over the

stoma at all times.
 3. The client cannot go into water that is over the stoma area, but
can go into water up to the stoma area.
 4. There are no restrictions on the activity of a client with a

colostomy; all previous activities may be resumed.
Rationale:
4. Correct: With the colostomy bag providing an airtight seal they can take a
shower, bath, and go swimming.
1. Incorrect: Swimming is allowed with the airtight seal that the colostomy bag
provides.
2. Incorrect: Client will wear colostomy bag with airtight seal not a dressing
over the stoma.
3. Incorrect: No, the client can swim with the airtight seal colostomy bag.
16. The nurse is evaluating whether a client understands the procedure for
collecting a 24 hour urine sample. The nurse recognizes that teaching was
successful when the client makes which statements?
Select all that apply.
 1. “I should start the 24 hour urine collection at the time of my firs

saved urine specimen.”
 2. “If I forget to collect any urine, I will need to start over.”
 3. “It is important to ensure that no feces or toilet tissue mixes

with the urine.”
 4. “When the 24 hours is up, I need to void and collect that
specimen.”
 5. “The urine specimen should be stored in my refrigerator during

collection.”

Rationale:
2., 3., & 4. Correct: Missed specimens make the collection inaccurate. The test
should be started over. Contamination can alter the test. The last specimen
should be obtained at the end of the 24 hour period.
1. Incorrect: The time begins with the firs voiding, however, that voiding is
discarded.
5. Incorrect: Urine should be placed on ice or left at room temperature if an
additive has been used. You do not want the client to store the specimen in
their refrigerator.
17. A six year old client has been receiving chemotherapy for two weeks. The
laboratory results show a platelet count of 20,000/mcL. What is the priority
nursing action?
 1. Encourage quiet play.
 2. Avoid persons with infections.
 3. Administer oxygen PRN.
 4. Provide foods high in iron.
Rationale:
1. Correct: With a low platelet count you are at risk for bleeding, and quiet play
will decrease the risk of injury.
2. Incorrect: The priority is risk for bleeding with the low platelet count, not
infection.
3. Incorrect: There is no indication that client has low RBC’s or anemia.
4. Incorrect: There is no indication that client has low iron.
18. The nurse is caring for a client that has two IV access sites. Where is the best site
for the nurse to administer 20 mEq of potassium chloride (KCL) in 100 mL of normal
saline (NS) over 4 hours
Exhibit:
INTRAVENOUS FLOW SHEET
IV Site/Needle Continuous/ Date/Time IV Fluid/ Date/Time IV Signature

Size Saline port Initiated Blood Administered rate
Products
Left antecubital Continuous 01/01/2017 Normal 01/01/2017 KVO

@1020 Saline @1020
Double lumen Continuous 01/01/2017 Total 01/01/2017 50

central line- @1300 Parenteral @1300 mL/
Proximal line Nutrition hr
Double lumen Saline port 01/01/2017 Saline Flush 01/01/2017

central line- @1300 @1300
Distal line
Double lumen Saline port 01/01/2017 Blood draw 01/01/2017

central line- @1500 for lab. @1500
Distal line Saline Flush
 1. Central line port that is being used for lab draws
 2. Same line with the Total Parenteral Nutrition
 3. Large bore antecubital
 4. Start another peripheral IV
Rationale:
1. Correct: Yes- K is very hard on the veins, give it through the central line.
2. Incorrect: No, never put anything through a line with Total Parental Nutrition.
3. Incorrect: Second best choice- but it will burn.
4. Incorrect: No, a central line is needed.
19. The nurse is admitting a client with new onset diabetes mellitus. Which fin ings
does the nurse expect while completing the medical history and physical
examination of this client? Select all that apply.
 1. Recurrent yeast infections
 2. Reports intolerance to cold
 3. Slow, slurred speech
 4. Prescription glasses changed twice in past year
 5. Reports wanting to eat all the time
 6. Absence of menses

Rationale:
1., 4. & 5. Correct: Polyuria, polyphagia, and polydipsia are classic symptoms
of diabetes. With Type II diabetes the manifestations are often nonspecific
Common manifestations include fatigue, recurrent infections, recurrent vaginal
yeast or monilial infections, prolonged wound healing, and visual changes.
Unfortunately, the clinical manifestations appear so gradually that an individual
may blame the symptoms on another cause such as lack of sleep or increasing
age, and before the person knows it, he or she may have complications.
2. Incorrect: This is a manifestation of hypothyroidism.

20. A client is admitted for evaluation of cardiac arrhythmias. What would be the
most important information for the nurse to obtain when assessing this client?
 1. Ability to perform isometric exercises.
 2. Changes in level of consciousness or behavior.
 3. Recent blood glucose changes.
 4. Compliance with dietary fat restrictions.
Rationale:
2. Correct: The only answer that deals with cardiac output is #2. When the
cardiac output drops, then the LOC will decrease.
1. Incorrect: What do isometrics have to do with cardiac output?
3. Incorrect: What does blood glucose have to do with cardiac output?
4. Incorrect: Arrhythmias have nothing to do with fat.
21. A nurse is caring for a client diagnosed with heart failure (HF). The client currently
takes furosemide 40mg every morning, potassium 20mEq daily, and digoxin
0.25mg every day. Which client comment should the nurse assess firs in caring
for this client?
 1. “My finger and feet are swollen.”
 2. “My weight is up 1 pound (0.45 kg).”
 3. “There is blood in my urine.”
 4. “I am having trouble with my vision.”
Rationale:
4. Correct: Did you see the sign of Dig toxicity? Good Job!
1. Incorrect: History of heart failure, edema is common- may need bed rest or
additional diuretic therapy- not usually life threatening.
2. Incorrect: No, weight should not vary more than 3-5 pounds.
3. Incorrect: Needs investigation, but digoxin toxicity comes first more lethal.
22. A client with a T4 lesion is being cared for on the neuro rehabilitation unit. The client
suddenly reports a severe, pounding headache. Profuse diaphoresis is noted on the
forehead. The blood pressure is 180/112 and the heart rate is 56. What interventions
should the nurse initiate?
Select all that apply.
 1. Place the client supine with legs elevated.
 2. Assess bladder and bowel for distention.
 3. Examine skin for pressure areas.
 4. Eliminate drafts.
 5. Administer nifedipine if BP does not return to normal.
Rationale:
2., 3., 4., & 5. Correct: All appropriate interventions for autonomic dysreflexia This
condition occurs in clients with a T6 or higher injury. The autonomic nervous system
sends out a massive sympathetic response (epi and norepi) to stimuli. The stimuli is
one that would not bother a healthy person but very dangerous to a spinal injury
client, i.e. bladder or bowel distention, pressure areas in the bed, drafts, and other
simple triggers.
1. Incorrect: The client should be placed immediately in a sitting position to lower

blood pressure.
23. The nurse is caring for a client in the 8th week of pregnancy. The client is spotting, has
a rigid abdomen, and is on bed rest. What is the most important assessment at this
time?
 1. Protein in the urine
 2. Fetal heart tones
 3. Cervical dilation
 4. Hematocrit level
Rationale:
4. Correct: The client may be bleeding! And that is an emergency!
1. Incorrect: We are not worried about pre-ecclampsia right now with this situation .
2. Incorrect: We can’t hear them yet.
3. Incorrect: No vaginal exams! We don’t want any stimulation to the cervix now.
24. Which tasks would be appropriate for the nurse to delegate to an LPN/VN?
Select all that apply
 1. Prepare a client’s room from surgery.
 2. Observe for pain relief in a client after receiving acetaminophen

with codeine.
 3. Assist a client with perineal care after having diarrhea.
 4. Clean nares around a client’s NG tube.
 5. Pour a can of tube feeding into a client’s percutaneous

endoscopic gastrostomy
Rationale
2. & 5. Correct. Both of these actions are within the scope of practice for the
LPN/LVN.
1. Incorrect. This is not cost effective. The UAP can do this.
3. Incorrect. The UAP can be assigned this task. Think cost effectiveness.
4. Incorrect. Again, the UAP can do this.
25. A nurse in an urgent care clinic is assisting with triage when five clients present to
the clinic at the same time. Prioritize the order in which the nurse should attend to
the clients.
________ 1. The client who is limping after “spraining” the right ankle.
________ 2. The client who is experiencing heaviness in the chest after

eating a big meal.
________ 3. The client who is running a fever and reports muscle aches
and malaise.
________ 4. The client who is applying pressure to the hand after

sustaining a minor cut.
________ 5. The client who is having difficulty breathing after eating

shellfish.
Rationale:
(5) This client should be the nurse’s highest priority and should receive
immediate attention. Anaphylaxis is a life-threatening medical emergency.
(2) Although the client may be experiencing gastroesophageal reflu following

the ingestion of a large meal, the client should be assessed immediately to
rule out myocardial infraction or other cardiac problem.
(4) After attending to the client with heaviness in the chest, the nurse should
assist the client who has been cut and is bleeding.
(3) The nurse should then attend to the client who is running a low-grade fever
with muscle aches and malaise. This client should be isolated from the other
clients until the source of the fever can be determined.
(1) Finally, the nurse should attend to the client with a sprained ankle as this is
the client with the least emergent condition.
Test-taking tip: Use the ABC’s (airway, breathing, circulation) to help you
decide which client to help first Life-threatening or serious conditions should
take priority over less emergent conditions.
ANSWER: 5, 2, 4, 3, 1.

Orthopedic Tips: Crutches, Canes and Walkers
Crutches
• The top of the crutches should reach to 1-1 1/2 inches below the armpit while the
client is standing up straight. The handgrips of the crutches should be even with the
top of your client’s hips. The elbows should bend a bit when using the handgrips.
Don’t let the tops of the crutches press into the client’s armpits.
• When the client is going up stairs, the client should lead up with the good foot,
keeping the injured foot raised behind them. When the client is going down stairs,
hold the injured foot up in front, and hop down each stair on the good foot.
• Three Point crutch walking: Client has to bear weight on the uninjured foot and
both crutches. The affected leg does not touch the ground.
• Four point crutch walking: Client has to bear weight on both legs and both
crutches. Each leg is moved in sequence with the opposite crutch… the right leg
with the left crutch or the left leg and the right crutch.
Canes
• The top of the cane should reach to the crease in the client’s wrist when the client
is standing up straight. The elbow should bend a bit when the client holds the cane.
Hold the cane in the hand opposite the side that needs support. (See “COAL”
below)
• When the client walks, the cane and the injured leg swing and strike the ground at
the same time.
• To climb stairs, the client should grasp the handrail (if one is available) and step up
on the good leg firs , with the cane in the hand opposite the injured leg. Then
step up on the injured leg.
• To come DOWN stairs, put the cane on the step first, hen the injured leg, and
fina ly the good leg, which carries the client’s body weight.
Cane
Opposite
Affected
Leg
Walkers
• The client should use their arms to support some of the weight. The top
of the walker should match the crease in the client’s wrist when the client
is standing up straight.
• First, the client should put the walker about one step ahead of them-
selves, making sure the legs of the walker are level to the ground. With
both hands, grip the top of the walker for support and walk into it,
stepping off on your injured leg. Touch the heel of this foot to the
ground first, then flatten the foot and finally lift the toes f the ground as
the client makes a complete step with the good leg.
• To sit, the client should back up until his/her legs touch the chair. The
client should then reach back to feel the seat before he/she sits down.
• To get up from a chair, the client should push himself/herself up and

grasp the walker’s grips. Never try to climb stairs or use an escalator with
a walker.
Walk
With
Affected
Leg

Specific Types of Cancer: An Overview
1. Cervical Cancer:
a. Risk factors:
• The number one risk factor is Human Papilloma Virus.
• Repeated STDs
• Multiple sexual partners
• Smoking and exposure to second hand smoke
• Dietary factors such as certain nutritional deficiencies: folate,
beta-carotene and vitamin C.
• Prolonged hormonal therapy
• Family history.
• Immunosuppression
• Sex at a young age and multiple pregnancies
b. Signs/Symptoms:
• Often asymptomatic in pre-invasive cancer
• Invasive cancer classic symptoms: painless vaginal bleeding
• Other general S/S: watery, blood-tinged vaginal discharge, pelvic pain
(and it may occur with intercourse), leg pain along sciatic nerve, and
flank/back pain
• Excellent cure rate if detected early
c. Diagnosis:
• What is the test that helps diagnose this? a Pap Smear
What if the Pap Smear is abnormal? Repeat test
d. Treatment:
• Electrosurgical excision
• Laser
• Cryosurgery
• Radiation and chemo for late stages
• Conization- remove part of the cervix
• Hysterectomy
2. Uterine Cancer: (Endometrial Cancer)
a. Risk Factors:
• Greater than 50 years of age
• Taking estrogen therapy without progesterone
• Positive family history
• Late menopause
• No pregnancy (null parity)
b. Signs/Symptoms:
• Major symptoms: post-menopausal bleeding
• Other S/S: watery/bloody vaginal discharge, low back/abdominal
pain, pelvic pain
c. Diagnosis:
• CA-125 (blood test) to R/O ovarian involvement
• The most definitiv diagnostic test is a D&C (dilatation & curettage)
and endometrial biopsy.

d. Treatment:
1) Surgery: Hysterectomy
• TAH (total abdominal hysterectomy) = uterus and cervix only!

Bilateral oophorectomy (ovaries)
Bilateral salpingectomy (tubes)
• Radical Hysterectomy:
• May remove all of the pelvic organs

• Client may have a colostomy or ileal conduit
• The greatest time for hemorrhage following this surgery is during
the first 24 hours
• Why? Pelvic congestion of blood
• The major complication with an abdominal hysterectomy is
hemorrhage
• Major complication with vaginal hysterectomy? Think Infection!!
• Will probably have an indwelling catheter; if she doesn’t you better
make sure she does what in the next 8 hours? Void!
• Why is it so important to prevent abdominal distention after this
surgery?
We do not want tension on the suture line.
It can lead to dehiscence and evisceration.
• Why do we avoid high-fowler’s position in this client?
Because high fowlers will make more blood go to the pelvis.
• May have an abdominal and perineal dressing to check.

• As this client is at risk for pneumonia, thrombophlebitis, and
constipation, what is one thing you can do to prevent all these
complications? Early ambulation
• Avoid sex and driving.

• Also avoid girdles and douches.
• Any exercise, including lifting heavy objects that will increase pelvic
congestion and should be avoided.
• Is it possible that the client could hemorrhage 10-14 days after this
surgery? Yes!
• Is a whitish vaginal discharge okay? Yes, this is normal
• Showers OR baths? Showers, baths promote ascending infections.
2) Radiation: intra-cavitary radiation to prevent vaginal recurrence

3) Chemotherapy
4) Estrogen inhibitors
2. Breast Cancer:
a. Risk Factors:
• One has a 3 fold risk increase of developing breast cancer if a firs

degree relative (mother, sister, and daughter) had pre-menopausal
breast cancer.
• High dose radiation to thorax prior to age 20
• Period onset prior to age 12
• Menopause after age 50
• No pregnancy (null parity)
• First birth after 30 years of age
b. Signs/Symptoms:
• Change in the appearance of the breast (orange peel appearance,
dimpling, retraction, discharge from breast) or lump
• Tail of Spence is where 48% of breast tumors occur: located in upper
outer quadrant
c. Treatment:
1) Surgery
2) Chemotherapy drugs
3) Hormonal Therapy
• Estrogen receptor blocking agents
• Estrogen synthesis inhibitors
4) Radiation
4. Lung Cancer:
a. Risk Factors:
• Leading cause of cancer death worldwide
• Major risk factor: Smoking
*When you have stopped smoking for 15 years, the incidence of lung
cancer is almost like that of a non-smoker.
b. Signs/Symptoms:
• Hemoptysis, dyspnea (may be confused with TB, but TB has
night sweats), hoarseness, cough, change in endurance, chest
pain, pleuritic pain on inspiration, displaced trachea
• May metastasize to bone
c. Diagnosis:
1) Bronchoscopy
2) Chest x-ray
3) CT
4) MRI
d. Treatment:
• Surgery: The main treatment for stage I and II lung cancer

• Lobectomy: only take out part of the lung
• Chest tubes and surgical side up
• Pneumonectomy: the entire lung is removed
• Position on affected side (surgical side down, good lung up).
• No chest tubes, Why? There is not lung!
• Avoid severe lateral positioning mediastinal shift
5. Laryngeal Cancer
a. Risk Factors:
• Smoking, (any form of tobacco use), alcohol, voice abuse,
chronic laryngitis, industrial chemicals
b. Signs/Symptoms:
• Hoarseness, lump in neck, sore throat, cough, problems
breathing, earache, weight loss, no early signs
c. Diagnosis:
• Laryngeal exam, MRI
d. Treatment:
1) Surgery:
• Total laryngectomy
• Humidifie environment
* Remember, with a total laryngectomy ALL breathing is
done through the stoma.
2) Radiation
3) Chemotherapy
4) Speech Rehabilitation
• When should client teaching begin? Preoperatively at
admission
• Be a good client advocate:
Refer to International Association of Laryngectomees.
*See if there are local groups such as the
Lost Cord Group.
6. Colorectal Cancer (CRC):
a. Risk Factors:
• May start as a polyp

• 2/3s of colorectal cancer occurs in the rectosigmoid region
• Most frequent site of metastasis: the Liver
*Take bleeding precautions
• Other problems to watch for: bowel obstruction, perforation,
fistul to bladder/vagina
• Additional risk factors: inflammator bowel diseases,
genetic, dietary factors (refine carbs, low fibe , high fat, red
meat, fried and broiled foods) if you have a firs degree
relative with CRC your risk just increased 3X the norm
• 95% of those who get CRC are greater than 50 years old.
b. Diagnosis:
Screening
• Fecal occult blood testing should begin at age: 50
• The definitiv test for colorectal cancer is a colonoscopy.
c. Signs/Symptoms:
• Change in bowel habits, constipation, diarrhea, or narrowing
of stool
• Other S/S: blood in the stool, cramping abdominal pain,
weakness, fatigue, anemia, abdominal fullness, unexplained
weight loss
• May become obstructed (visible peristaltic waves with high
pitched tinkling bowel sounds)
d. Treatment:
1) Surgery, radiation, and chemo
2) May have a colostomy post op or may require an abdominoperineal
resection
• Abdominoperineal resection-removal of the colon, anus,

rectum
*Can you take a rectal temp on this client? No, there is no rectum!
*Don’t take rectal temp if thrombocytopenic, abdominoperineal resection, or

immunosuppressed*
7. Bladder Cancer:
a. Risk Factors:
• Greatest risk factor is smoking
b. Signs/Symptoms:
• Major symptom: Painless, intermittent gross/microscopic
hematuria
c. Diagnosis:
• Cystoscopy
d. Treatment:
• Surgery (remove all or part of bladder)  urinary diversion
(urostomy)
• Ileal conduit (a piece of the ileum is turned into the bladder;
ureters are placed in one end; the other end is brought to the
abdominal surface as a stoma)
• May be impotent
• Hourly outputs
• Increase fluid (2,000-3,000 ml of flui per day).
* Fluids help flus out conduit
• Is mucus in the urine normal? Yes
• The intestines always make mucus (the bladder is made from
a part of intestine).
• Change appliance in the morning (This is when output will be
at its lowest).
It is OK to place a little piece of 4X4 inside the stoma during skin care to
absorb urine....... Just don’t forget to remove it!
8. Prostate Cancer:
a. Signs/Symptoms:
• This client comes to the physician with S/S of benign prostatic

hyperplasia (BPH): hesitancy, frequency, frequent infections
(because the bladder is not completely emptied), nocturia,
urgency, dribbling. Many clients are asymptomatic.
• Most common sign is painless hematuria
• Digital rectal exam is done and if the prostate is hard/nodular;
usually means prostate cancer.
b. Diagnosis:
1) Lab work:
• PSA will be increased.

Prostate-specifi antigen (PSA)
PSA is a protein that is only produced by the prostate.
Normal is less than 4 ng/ml.
If you have two or more 1st degree relatives with prostate
cancer, start PSA screenings by at least age 45
• Alkaline phosphatase (if  means bone metastasis)
*Prostate cancer likes to go to the spine, sacrum, and pelvis.
• Increased acid phosphatase (if  means bone metastasis)
2) Biopsy:
• When prostate cancer is suspected, a biopsy must be done

for confirmatio prior to surgery.
c. Treatment:
1) Watchful waiting: in early stages (for asymptomatic, older
adults with another illness)
2) Surgery:
Radical Prostatectomy (done when the cancer is localized to

the prostate)
• Take out the prostate and the client is cancer free (if there is
no metastasis).
• May have erectile dysfunction due to pudendal nerve dam
age.
• May have incontinence (Kegel exercises)
• Client is sterile.
• If there is no lymph node involvement, no  in acid
phosphatase, and no metastasis, the surgeon will try to
preserve the pudendal nerve.
Prostatectomy (TURP- transurethral resection of the prostate)

• Usually reserved for BPH to help urine flo , NOT a cure for
prostate CA
• No incision (go through the urethra)
• Most common complication? Bleeding
• With other procedures you have to explain the risk of
impotency/infertility, because with other procedures they
have an incision.
• Is it normal to see bleeding after this surgery? Yes
• Continuous bladder irrigation – maintains patency, flushes out
clots.
3-way catheter
N o kinks
Subtract irrigant from output.
• Keep up with amount of irrigant instilled

• What drug do you give for bladder spasms?
belladonna and opium suppository (B&O suppository®),
oxybutynin (Ditropan®)
• When the catheter is removed what do you watch for?
Urinary retention
• Temporary incontinence is expected
(perineal exercises-Kegel)
• Avoid sitting, driving, strenuous exercise; do not lift too
much…Why? Can cause them to bleed

• Docusate (Colace®); avoid straining. Why? Straining will cause
them to bleed.
• Increase fluids to flus out the kidneys.
• The TURP is used for symptomatic relief of symptoms… to
allow the urine to flo out… This is not a cure for prostate
cancer.
3) Radiation
4) Chemotherapy
5) Hormone therapy
• May decrease testosterone levels through bilateral
orchiectomy
9. Stomach Cancer:
a. Risk factors:
• H-Pylori-associated with stomach cancer
• Pernicious anemia There is an increased instance of

• Achlorhydria stomach cancer with people who
have pernicious anemia and
achlorhydria.

• Related to: pickled foods, salted meats/fish nitrates,
increased salt
• Billroth II (partial gastrectomy with an anastomosis)
• Tobacco and Alcohol
b. Signs/Symptoms:
• Most common: Heartburn and abdominal discomfort
• Other S/S: loss of appetite, weight loss, bloody stools,
coffee-ground vomitus, jaundice (liver metastasis), epigastric
and back pain, feeling of fullness, anemia, stool (+) for occult
blood, achlorhydria (no HCL in the stomach), obstruction
Signs/Symptoms of an obstruction: abdominal distention,
nausea/vomiting, pain.) Treatment for obstruction: NPO, NG
tube to suction for abdominal decompression
c. Diagnosis:
• Upper GI, CT, EGD (esophagogastroduodenoscopy)

d. Tx:
1) Surgery (preferred): Gastrectomy
• Fowlers position, decreases stress on the suture line
• Will have NG tube (for decompression)
• Two major complications:
Dumping syndrome
Vitamin B-12 deficien anemia- Pernicious anemia
*Schilling’s test: Measures the urinary excretion of
Vitamin B-12 for diagnosis of pernicious anemia
No stomach  no intrinsic factor  can’t absorb oral B-12  can’t make good
RBCs  client is anemic
2) Chemotherapy
3) Radiation
*TESTING STRATEGY*
Never manually irrigate a catheter with a
fresh surgery client, without a physician’s
order.
*TESTING STRATEGY*
Always assess prior to selecting an
implementation answer. Always assess the
client first

Signs and Symptoms of Abuse
A. Signs and Symptoms of Sexual Abuse
• Shows a sexual knowledge beyond that of expected for the age

of the client
• Shows bizarre sexual behavior or is pregnant
• Overly affectionate and seems seductive with peers and other

adults
• Recurring genital infections or pain in the genital area
• Pain or itching in genital area
• Difficult walking or sitting
• Torn, stained, or bloody underclothing
• Bleeding/ bruising in external genitalia area, vaginal or anal area
• Evidence of sexually transmitted diseases (especially in pre-teens

)
• Actual report of sexual abuse
• Threatened by physical contact
• Regression of behavior (ex. Thumb sucking)
• Most children will not tell because they:
1. Think no one will believe them

2. Do not have the vocabulary to explain what happened to
them
3. Have been taught to “obey their elders”
4. Have been threatened not to reveal the abuse
B. Signs and Symptoms of Child Abuse or Neglect
I. Signs and Symptoms of Neglect
• Poor Hygiene
• Inappropriate dress for weather condition
• Dirty, tattered or torn clothes
• Unexplained hunger
• Lavish attention on everyone
• Withdrawal
• Poor dental health
• Incomplete immunization records
II. Signs and Symptoms of Abuse
• Aggressive, disruptive, or destructive behavior

• Questionable cuts, bruises, burns, abrasions
• Questionable broken bones
• Black eyes
• Human bites
• Appear to be afraid of caretaker or parent
• Reports injury by caretaker or parent
• Regression of behavior (ex. Thumb sucking)
III. Indicators that a caregiver or parent may be abusive
• Gives different and conflictin reasons for child’s injury

• Gives unbelievable causes for child’s injury
• Gives NO reason for child’s injury
• Talks about child in degrading manner
• Appears to be indifferent
• Uses harsh physical discipline measures

C. Signs and Symptoms of Domestic Abuse
I. Signs and Symptoms of Domestic Abuse noted in the victim
• Anxiety
• Anxious to please
• Confused
• Hostile
• Increasing depression
• Longing for death
• Physically injured
• Unresponsive
• Withdrawn or timid
• Vague health complaints
II.. Signs and Symptoms of Domestic Abuse noted in the abuser
• Aggressive/defensive behavior
• Conflictin stories for cause of injury
• Excusing behavior
• Resentful
• New affluenc
• N ew self-neglect
• Preoccupation or depression
• Shifting blame
• Substance abuse
D. Signs and Symptoms of Elderly Abuse
I. Signs and Symptoms of Elderly Abuse seen in the older person
• Anxiety
• Anxious to please
• Confused
• Hostile
• Increasing depression
• Longing for death
• N ew poverty
• Physically injured
• Shopping for physicians
• Unresponsive
• Withdrawn or timid
• Vague health complaints
II. Signs and Symptoms of Elderly Abuse seen in the caregiver
• Aggressive/defensive behavior
• Conflictin stories for cause of injury
• Excusing behavior
• Resentful
• New affluenc
• N ew self-neglect
• Preoccupation or depression
• Shifting blame
• Substance abuse
• Unusual fatigue
• Withholding food/ medication

TYPES OF SHOCK
Type of Shock Description Cause Treatment
Anaphylactic shock Massive vasodilation IV contrast, drugs Medication: histamine H2
caused by release (ASA, insect bites blockers (Tagamet®),
of histamines in or stings, Epinephrine (drug of
response to allergic anesthetic agents, choice), Benedryl®,
reaction vaccines, foods, Volume expanders,
materials (latex) Solumedrol®,
brochodilators. Ensure
patent airway, oxygen.
Hypovolemic shock Loss of intravascular 3rd spacing, Medication: Levophed®
volume, decrease diuresis, Neo-Synephrine®,
stroke volume, and Hemorrhage (#1 Intropin®, Pitressin®
decrease cardiac cause), burns, GI Rapid volume replacement
output fluid loss (vomiting, (blood, isotonic solutions),
diarrhea, drainage control bleeding, oxygen,
from NG tube), DI, hemodynamic monitoring.
DKA, Addison’s
disease.
Cardiogenic shock Inability of heart Myocardial Medication: Dobutamine®
to pump blood out infarction, lethal Dopamine®, Epinephrine®,
effectively (pump ventricular Primacor®, Nitroglycerin®,
failure), resulting in arrhythmias, End- Nipride®, Morphine®,
decrease cardiac stage heart failure. intra-aortic balloon pump
output (IABP), correct arrythmias,
oxygen, Intubation &
mechanical ventilation may
be necessary.
Septic shock Massive vasodilation Sepsis caused by Antimicrobial therapy,
caused by infla - any pathogenic volume replacement,
matory response of organism that cultures, vasopressors,
body due to over- invades the body hemodynamic monitoring.
whelming infection
Neurogenic shock Pooling of blood Massive Treat the cause,
-decrease venous vasodilation, vasopressors, airway and
return, decrease suppression of the ventilation support.
cardiac output, sympathetic
hypotension, brady- nervous system,
cardia injury/disease to
the spinal cord at
T6, spinal
anesthesia.

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A Critical Thinking and Application

CHAPTER 2 - INFECTION CONTROL

CHAPTER 3 - MANAGEMENT OF CARE

Dear New Graduate,

Many of you have requested more pharmacology and we always listen to

Now, here is a MUST…before you take the test, go to www.vue.com/nclex/

Go Pass that NCLEX® the first time!!

Herbal Supplement Possible Side Effect(s) Drug Interactions

• Blood and Blood products are to be administered by the RN

• Only NS may be used in conjunction with administering blood and blood

• Product instructions will be on the packet stating the maximum number of

• All blood products require a filte .

• Most of the time, blood will be given via a pump.

• You may have a separate flo sheet for administering blood

• You will need a primary healthcare provider’s order to administer

• Infusion of the blood should be started within 30 minutes of receiving

• Dispose of blood tubing and blood or blood product bag according

• Be sure to flus lines after transfusing blood or blood product with

• Document administration of blood transfusion according to hospital

• Hives or skin rash

• Headache or muscle pain with fever

• GI symptoms: nausea and vomiting

• Discontinue the transfusion IMMEDIATELY.

• Remove blood and blood tubing set.

• Check your facility’s policies and procedure manual. You may

• Check and document vital signs. Stay with client.

• Notify primary healthcare provider and monitor client closely

• Notify lab/ blood bank of transfusion reaction.

Potter and Perry, Clinical Nursing Skills and Techniques, 2010

Nursing Interventions Client Education

Hepatotoxic in large doses. Do not exceed recommended dosage to prevent toxicity.

Dizziness Drowsiness Seizures

Nursing Interventions Client Education

Gold standard for cancer pain. Constipation Respiratory depression

Nursing Interventions Client Education

Inexpensive, readily available. GI distress GI bleeding

Nursing Interventions Client Education

Interferes with protein synthesis in bacterial cells.

Confusion Depression, Seizures

Monitor peak and trough levels. Teach to report headache or dizziness.

Impairs DNA function of susceptible bacteria

Dual action on bacteria and protozoa Dark/reddish brown urine Thrombophlebitis

Nursing Interventions Client Education

Dry mouth Muscles cramps Blloody urine - Nephrotoxicity

Nursing Interventions Client Education

Monitor peak and trough levels. Teach to report headache or dizziness.

Nursing Interventions Client Education

Nausea/vomiting Diarrhea Seizures

Nursing Interventions Client Education

Inhibit bacterial cell-wall synthesis and produce a bactericidal action.

Usually well tolerated when other Nausea/vomiting Diarrhea Increased bleeding

Nursing Interventions Client Education

Prevention of bacterial DNA from duplication.

Used in the treatment of infectious Diarrhea Nausea/vomiting, Suprainfection Phototoxicity

Nursing Interventions Client Education

Good alternative for clients with penicillin Nausea/vomiting Suprainfections Hepatotoxicity

Nursing Interventions Client Education

Inhibit viral replication by interferring with viral cell synthesis

Nausea/vomiting Anorexia Anemia

Interferes with cell wall replication of susceptible organisms.

Generally, well tolerated Mild rash Anaphylaxis

Nursing Interventions Client Education

Good for clients with penicillin allergy. Nausea/vomiting Diarrhea Nephrotoxicity