Pharma Reviewer

Ballescas, Detaro, Diego, Guiyab, Nohay

GASTROINTESTINAL DRUGS
Role of Pancreas
The system: ● Amylase = enzyme degrades
Process food and transfer nutrients that will sugars; carbohydrates into simple
be used for energy, protein production and sugar
tissue maintenance ● Proteases= enzymes that
breakdowns protein
● Lipase (breakdown lipids) + Bile
● Bicarbonate = base; neutralize/
alkalanized acidic chyme
● Insulin (glucose lowering effect) +
Glucagon (stimulate liver to produce
stored glucose; increases blood
glucose)

Colon
● Process and store fecal matter
● Water reabsorption
● Vitamin K (coagulant effect)
*greenish and fluid stool = ileum / ileostomy
* hard stool; more foul odor= colon/
colostomy

Sphincter= prevent reflux; GERD Drugs
Heartburn = Gastro-oesophageal GERD and Peptic Ulcer
sphincter; cardio something
A. Antacids
Power of Hydrogen ● Weak bases that combine readily
● pH 2-3 with Hcl to neutralize it
● Atp + proton pump + parietal cells = ● Above a pH of 4, pepsin is
hydrogen ions and chloride inactivated
(hydrochloric acid) ● For mild GERD and dyspepsia
● Antacids= alkalinizing agents
Digesting containing aluminum or magnesium
- Eating stimulates PNS compounds
- PNS release ACh in the gastric ● Alginates= extracted from
mucosa to release gastrin and seaweeds, forms a barrier between
histamine mucosa and stomach contents

● Usually OTC; e.g: Alka-Seltzer, Milk ● Advise to avoid cigarettes

of Magnesia, Amphogel, Gaviscon, (increased HCl) and ulcerogenic
Maalox, Tums OTC drugs (NSAID, aspirin)
● Avoid Alcohol (CNS depressant)
GERD ● Small frequent meals advised
● Stomach acid regurgitating from the ● Educate about GI bleeding (black
cardiac sphincter causing irritation tarry stool/ melena, coffee ground
● Increases with heavy lifting, emesis
coughing, triggered by certain foods
(spicy, extremely sweet and 1. Proton Pump Inhibitors
extremely salty) ● Treatment of peptic ulcers,
● Management= Small frequent meals dyspepsia and GERD
and do not lie down after meals; ● E.g esomeprazole, lansoprazole,
abdominal binder omeprazole, pantoprazole,
rabeprazole
H2 Receptor Antagonists ● Inhibits proton pump in the parietal
● For GERD, DOC for peptic and cells
duodenal ulcers
● Histamines binds to H2 receptors Nursing Implications
and stimulates release of HCl Capsules and tablets swallowed intact
● Blocks histamine effects and - Take esomeprazole 1 hour before
reduces HCl meals and omeprazole just before
● E.g cimetidine, famotidine, eating
nizatidine, ranitidine
2. Mucosal Protectant
Peptic Ulcer ● Sucralfate - forms a barrier over the
● Gastric ulcer/ duodenal ulcer ulcer crater(temporary)
● Erosion of the mucosa ● Misoprostol (cytotec) = stimulates
exposing the tissue to mucus and bicarbonate secretion;
stomach acid pampalaglag
● Caused by H. Pylori =
capable of eroding the Nursing Process: Assessment
mucosa ● Obtain past and present history
● Pain, vomiting, reduction in ● Assess bowel patterns; changes in
appetite and weight loss bowel habits
● Perform thorough cardiac history
Nursing Implications and assessment
● Use in caution in px with renal/ ● For H2 receptor antagonist: assess
hepatic dysfunction renal and liver function
● For PPIs, assess swallowing ● Charcoal- activated form may be

capacity adsorb gases and poisons
preventing intestinal absorption
Nursing Diagnosis
● Constipation related to the adverse Constipation
effects of aluminum- containing Rome II Criteria for Constipation
antacids and other drugs used to Adults
treat hyperacidity Two or more of the following for at least 12
● Diarrhea r/t adverse effects of weeks (not necessarily consecutive) in the
magnesium- containing antacids preceding 12 months:
● Deficient knowledge r/t lack of ● Straining during more than 25% of
information about medications bowel movements
● including use and potential adverse ● Lumpy or hard stools for more than
effects 25% of bowel movements
● Sensation of incomplete evacuation
Nursing Implementation for more than 25% of bowel
● Antacids needs to be given with at movements
least a glass of water to enhance ● Manual maneuvers (e.g. digital
absorption evacuation; support of the pelvic
● Antacids should not be taken within floor) to facilitate more than 25% of
1-2 hrs of their medications bowel movements
● Advise px to discontinue: ● Power than three bowel movements
- Abdominal pain/distention per week
- N&V ● Loose stools not present, and
- Hematemesis/ black tarry stools insufficient criteria to permit of
irritable bowel syndrome
ANIFLATULENTS Infants and Children
● Several liters of gas are formed ● Pebble-like, hard stools for a
everyday and escape unnoticed majority of bowel movements for at
● Accumulation may cause discomfort least 2 weeks
and pain ● Firm stools twice a week or less for
● Surface tension of GI fluids may at least 2 weeks
make the bubbles blogger and ● No evidence of structural, endocrine
easier to release or metabolic disease
Examples
● Simeticone - mostly included in Laxatives
antacid preparations; may provide ● Ease and stimulate defecation
protection in the gut; used to relieve ● May soften stool, increase stool
colic volume, hasten fecal passage
● LAXATIVE effect - production of Osmotic action retains water that

soft, formed stool over 1 or more promotes peristalsis
● CATHARSIS - prompt, flid E.g magnesium hydroxide,
evacuation of bowel magnesium sulfate, magnesium
Indications citrate, sodium phosphate,
1. Facilitation of bowel movement polyethylene glycol
2. Reduction of ammonia absorption Others
(hepatic encephalopathy) - lactulose ● Mineral oil - administered by enema
3. Drug induced/ pregnancy to treat fecal impaction
constipation ● Lactulose - poorly absorbed and not
4. Removal of toxic substances digestible; exerts mild osmotic
5. Facilitation of defecation in action to produce soft formed stool
megacolon in 1-3 days
6. Preparation for colonic diagnostic ● PolyEthylene Glycol (GoLYTELY) -
procedures for bowel movement cleansing;
Kinds of Laxatives commence 1 hr after treatment
1. Bulk forming Laxatives
● Absorbs water, softening Nursing Implications
and enlarging fecal mass ● Increase fluid intake to avoid
and promotes peristalsis dehydration
● Given with full glass of water ● Osmotic laxative and castor oil
or juice should not be given at bedtime d/t
● E.g methylcellulose; rapid onset
psyllium, polycarbophil ● Laxatives are CI for patients with
2. Surfactant Laxatives s/sx of appendicitis, fecal impaction
● Cause secretion of water and and obstruction of the bowel
electrolytes into intestines to soften
stools Anti- Emetics
● E.g. docusate sodium; docusate - Prevent vomiting
calcium Emesis
3. Stimulant Laxatives - activation of the vomiting center in
● Stimulate peristalsis the medulla oblongata
● Increase secretion of water
and electrolytes Serotonin Receptor Antagonist
● Decrease water and ● DOC for suppressing N&V from
electrolyte absorption anti-cancer drugs, radiotherapy and
● Eg. bisacodyl, sennosides, anesthesia
castor oil ● E.g ondasentron, granisetron,
4. Osmotic Laxatives dolasetron, palonosetron
Substance P/ Neurokinin Antagonists
Blocks substance P in the CTZ ● stimulates CTZ and acts directly on
Preventing post- op Nausea and vomiting gastric mucosa
E.g aprepitant fosaprepitant Use
● Induces vomiting after toxic
Dopamine Antagonist substances
● Suppress emesis by blocking Caution
dopamine receptors in the CTZ ● Avoid vomiting if substance is
● E.g Phenothiazine caustic or petroleum
(prochlorperazine) butyrophenones ● If vomiting contraindicated,
(haloperidol, droperidol) activated charcoal is given
● May induce extrapyramidal
reactions, anticholinergic effects, Administration
hypotension and sedation ● Take with a glass of water or fluid,
not with milk or carbonated
Prokinetic: Metoclopramide beverage
● Reglan suppresses emesis through ● Vomiting occurs in 15 to 30 mins
blockage of dopamine receptors ● If vomiting does not occur, give
● Increases upper GI motility by activated charcoal
enhancing ACh action ● Gastric lavage may be needed if
● Treatment of delayed gastric vomiting does not occur
emptying, GERD, and emesis
Glucocorticoids DIARRHEA
● Dexamethasone (Decadron) - Characterized by stools of
● Methylprednisolone (Sulu-Medrol) = excessive volume by fluidity
use cancer therapy - A symptom and not a disease
Cannabinoids *Rice water stool
● Dronabinol (marinol)
● Side effects OPIOIDS
○ Drowsiness,dizziness, dry - Diphenoxylate
mouth, impaired thinking, - Difenoxin
euphoria, mood changes, - Loperamide (Imodium,Pepto)
headaches, confusion, - Most effective anti-diarrheal agent
depersonalization, - Activating opioid receptors
nightmares, -Decreases intestinal motility which
incoordination,memory allows
lapse, anxiety
EMETICS NURSING INTERVENTION
Ipecac (OTC) - Monitor BP, RR
Action - Report more than 10-15 mmHg
decrease in BP
- Monitor frequency of bowel raw or processed ingredients from

movements and bowel sounds one or more plants”
- Assess for evidence of dehydration
- Monitor electrolytes Types of Herbal Medicines
- Avoid fried foods, milk, and 1. RAW PLANT MATERIALS – fresh or
sedatives dry plant materials which are
- If diarrhea persist after 48 hrs, notify marketed whole or simply cut into
physician small pieces

2. PROCESSED PLANT MATERIALS –
DOH Approved Medicinal Plants
plant materials treated according to
RA NO. 8423 traditional procedures to improve
TRADITIONAL AND ALTERNATIVE safety and efficacy, to facilitate
MEDICINE ACT [TAMA] clinical use or make medicinal
- An Act Creating Philippine Institute Of preparations
Traditional And Alternative Health Care
[PITAHC] 3. MEDICINAL HERBAL PRODUCTS –
finished, labelled pharmaceutical
Medicinal Plant products in dosage forms that
contain one or more of the
- A plant which has been used for
following: extracts, powdered,
medical purposes at one time or
purified substances from plant
another and which although not
materials
necessarily a product or available
for marketing, is the original material
Herbal plants in the Philippines
of herbal medicines
● 80 Philippine medicinal plants

passed safety and efficacy testing
Herbal Medicines ● Out of these, 10 are actively being
promoted by the DOH as a
● “Used to provide first-line and basic
component of Primary Health
health service to people where it is
Care
the only available health service or
● 3 medicinal plants are now included
where it offers the only affordable
in the National Drug Formulary
remedy”

● “Herbal medicines are not
Gathering, Storing and Using Herbs
necessarily always safe because
❏ Never gather plants after a rain
they are natural”
❏ Dry the plant upside down away
● “HERBAL MEDICINE –
from pests, animals and air pollution
plant-derived materials or products
❏ One dose does not fit all
with therapeutic or other human

health benefits which contains either
Decoction ○ 7-12 y/o: 3 tbsp

1. Usually the preparation of choice ○ >13 y/o: 6 tbsp Cool and
2. Select a ceramic pot with fitting lid strain
3. Proportions: Other uses:
- I cup chopped fresh herbs ● Bath for mothers who newly
- Less than ½ cup of dried delivered
herbs Parts used:
- 2 cups of water ● Leaves
4. Turn on the heat and bring to a ● Seeds
roiling boil ● Roots
5. Simmer for 15 mins or until half of Indications:
the water is left ● Bronchitis, tracheobronchitis
6. Strain mixture to a teacup ● Asthma, cough, sinusitis
7. Use within the day ● Common cold, fever,
● Adjuvant therapy to
Infusion or Tea anti-inflammatory drugs
1. Used for flowers, delicate leaves or ● Analgesic
fresh tender plants
2. Water is brought to a boil Dosage:
3. Pour over herbs, steep for 10-15 ● Decocted Leaves: 1 cup, 3-4x/day
mins Leaves: 300mg/cap
4. Stirring a few times while steeping is Side effects:
helpful ● Overdose causes tachycardia
5. Strain the infusion is using chopped ● Not for children below 3 y/o
herbs ● Not for pregnant/lactating mothers
6. Taken on the same day it was
prepared
YERBA BUENA: Mentha X Cordifolia
7. Refrigerate remainder
Common Names:

● Hierba Buena
LAGUNDI: Vitex Negundo ● Hilbas
Common Names: ● Mint
● Lagundi ● Peppermint
● Dangla ● Marsh Mint
● Five-leaved Chaste Tree DOH-approved use:
● Tugas ● Body Pain
DOH-approved use: ● Preparation:
● Cough ○ Boil fresh leaves
● Preparation: boil grated fresh leaves ○ Drink in equal amounts 3x/
in 2 cups of water day
○ 2-6 y/o: 1 ½ tbsp ● Alternatively:
○ Crush fresh leaves and apply 3. Best to use ceramic pot with lid

on areas with pain [avoid metal pots] and stir
Other uses: Or
● None 1. 1-2 teaspoon of powdered herb in
Parts Used: 180-250ml of water
● Leaves 2. Stir once halfway through the
● Stem steeping time and let the powder
Indications: settle to the bottom
● Antibacterial, anti-febrile 3. Drink infusion off the top while
● Analgesic, antimutagenic leaving the sediment
● Antiteratogenic, local vasodilation
● Pruritus, urticaria *Infusions are best prepared as needed and
● Antihelminthic, antispasmodic taken the same day it was prepared either
● Catarrh of the Upper Respiratory hot, warm or cold
tract *One teacup, 2,3,5x/day
● Anti-asthmatic
SAMBONG: Blumea Balsamifera
● Stimulant, dyspepsia
Common Names:
● Abdominal distension, flatulence
● Blumea Camphor
Dosage:
● Bukadkad
● Prepared as an infusion 3-5x/day
● Sambong
Dried and powdered plant
● Subsob
250-350mg /cap
DOH-approved use:
Side effects:
● Edema
● Do not use near the eyes and
● Decrease the size and weight of
mucous membranes
urinary calculi
● Mint and mint oil generally
● Preparation:
recognized as safe not to be
○ Boil fresh leaves in 2 cups of
ingested patients with kidney or gall
water
bladder stones
○ Divide and drink decoction in
● Not to be recommended for use in
equal amount in the morning,
pregnant or lactating women
afternoon and evening
Interactions:
Watch out:
● Animal study indicates that use of
● Not used for urinary infections
peppermint oil may increase
Parts Used:
cyclosporine levels
● Mature leaves
Infusion Preparation
Indications:
1. Water is brought to a boil and
● Urolithiasis
poured over the herb
● Diuretic
2. Covered with saucer and allowed to
● Hepatoprotectant
steep for 10-15 mins
Dosage:
● Fresh or dried leaves in decoction: ● Half of the amount for children
○ 4-8 cups/day under 12 y/o
● Leaves, dried and pulverized: ● Capsules 250-300mg/cap
○ 250mg/cap Considerations:
● Drink 2 or more liters of water/day ● Patients with diarrhea have to
Balneotherapy: rehydrate
● Add 600-900 ml of decoction to Contraindication:
bath water, soak for 10 mins ● Not for pregnant or lactating
Side effects: mothers
● Prolonged internal use should be
avoided
NIYOG- NIYOGAN: Quisqualis Indica
● Not be used for children below 3y/o
Common Names:
● Not to be used during menstruation
● Chinese Honey Suckle
and during first four months of
● Niyog-niyogan
pregnancy
DOH approved use:

● Intestinal worms and parasites
TSAANG GUBAT: Carmona Retusa [anti-helminthic]
Common Names: Other uses:
● Wild Tea ● Inflammation of kidneys
● Alangitngit ● Boils
● Kalimong ● Skin ulcers
DOH-approved use: ● Headache
● Anti-motility ● Fever
● Against tooth decay ● Diarrhea
Other uses: ● Dysuria
● Anti-allergic Parts Used:
● Anti-oxidant ● Leaves
● Antispasmodic ● Flowers
Parts Used: ● Fruits
● Leaves ● Seeds
Indications: Indications:
● Anti-motility ● Antihelminthic–seeds are dried and
● Antispasmodic taken orally
● Anti-allergy ● Inflammation of the kidney-fruits
● Anticaries taken orally
● Antimutagenic ● Boils, skin ulcer, headache –leaves
● Antioxidant are used as poultice
Dosage: Dosage:
● Decoction 3-6x/day ● Follow steps if used for infusion:
○ Deworming= 4-7 seeds for ● Wound cleaning: soak gauze sheet

children and 8-10 seeds for in the tincture
adults ● Reapply 3-5x/day
Side Effects: Interaction:
● Diarrhea ● May potentiate effects of
● Abdominal pain antidiarrheal meds
● Distention Contraindication:
● Hiccups ● Pregnant/lactating mother
Contraindications:
● Avoid heavy intake during
AKAPULKO: Cassia Alata
pregnancy and breastfeeding
Common Names:
mothers
● Ringworm bush
● Allergic reaction
● Akapulko

● Kapurko
BAYABAS: Psidium Guajava DOH-approved Use:
Common Names: ● Ringworms
● Guava ● Fungal infection
● Bayabas Other uses:
● Bayabo ● Bronchitis
● Tayabas ● Asthma
DOH-approved Use: ● Diuretic
● Wound cleansing [antiseptic] ● Cough
Other uses: ● Fever
● Diarrhea Parts Used:
● Toothache ● Leaves
● Gum infection Indications:
● Tooth decay ● Broad spectrum antibacterial
● Skin diseases ● Anti-candida
Parts Used: ● Analgesic
● Leaves ● Anti-inflammatory
Indications: ● Laxative
● Bronchitis Dosage:
● Anti-diarrheal ● Infusion: 1cup, 2x/day 250mg/cap
● Antispasmodic Contraindications:
● Antimicrobial ● Children below 12y/o
● Hepatoprotective ● Pregnant/lactating mothers
Dosage:
● 1-4 cups of leaf decoction/day
PANSIT-PANSITAN: Peperomia pellucida
● 500mg/cap, 3x/day
Common Names:
● Ulasimang Bato Other uses:

● Pansit-pansitan ● Infection
● Pepper Elder ● Rheumatism
● Shiny bus ● Toothache
DOH approved use: Parts Used:
● Rheumatism ● Cloves
● Gout Indications:
Other uses: ● Hypolipidemic
● Eye inflammation ● Fibrinolytic
● Sore throat ● Diuretic vasodilator
● Hypertension ● Antimicrobial
● Wounds ● Antifungal
● Burn Dosage:
● Fever ● 300-500mg/cap 3x/day
● Abdominal pains ● Oil extract: 1 tbsp, 3x/day during
Parts Used: meals
● Stems Side Effects:
● Leaves ● Overdose causes skin irritation and
Indications: stomach irritation
● Analgesic Contraindications:
● Anti-inflammatory ● Children below 12 y/o
● Antioxidant Consideration:
● Antibacterial ● Always use fresh cloves
● Uric acid reduction
Dosage:
AMPALAYA: Momordica Charantia
● Follow steps for decoction
Common Names:
● Can be eaten raw [as salad] or
● Bitter gourd
cooked with other vegetables
● Bitter melon
Contraindications:
● Ampalaya
● Pregnant and lactating women
DOH-approved Use:
● Allergies
● Hypoglycemic in Type II-NIDD

Other uses:
BAWANG: Allium Sativum ● Weight reduction
Common Names: ● Skin burns
● Garlic ● Scalds
● Bawang ● Hemorrhoids
● Ajos Parts Used:
DOH approved use: ● Fruits
● Antilipemic ● Leaves
● Decreases blood pressure Indications:
● Hypoglycemic agent ● Heart block

● Weight management ● Acute MI
Dosage: ● Renal insufficiency
● Juice 1-2 fresh fruit, drink 1 cup ● Electrolyte abnormalities
2x/day Drug Interaction
●Follow procedure for decoction ● Diuretics
○ 250mg/cap, 3x/day (K+–losing)-hypokalemia-inc.effect
Side Effects: of digoxin = toxicity
● Hypoglycemia ● Glucocorticoids-promote Na
● Hypokalemia retention and K excretion =
Contraindication: hypokalemia
● Pregnant/ lactating women ● Antacids-dec. digitalis absorption
● Children below 12 y/o ● Herbal interactions-inc. or dec.
Consideration: digitalis absorption
● Seeds may cause acute hemolytic NORMAL therapeutic level: 0.5-2ng/ml
anemia and Abortifacient effects Side Effects/Adverse Effects
● HA
● Weakness
Drugs Affecting the Cardiac System
● Drowsiness

● Vision changes
Cardiac Glycosides
● GI upset
Functions:
Digitalis toxicity
● Positive inotropic action
Signs and symptoms:
=myocardial contraction
● Anorexia
● Negative chronotropic action= dec
● Diarrhea
heart rate
● N/V
● Increase stroke volume
● Bradycardia
Examples:
● PVC
● Digoxin (Lanoxin, Lanoxicaps)
● Cardiac dysrhythmias
● Digitoxin (Crystodigin)
● Headache

● Malaise
1. Cardiac Glycosides: Digoxin ○ Blurred vision
○ Visual illusions
Indications: ○ Confusion
● CHF ○ delirium
● Atrial flutter Antidote for digitalis toxicity
● atrial fibrillation ● Digoxin immune Fab (ovine,
● paroxysmal atrial tachycardia Digibind)
Contraindications: Nursing Process:Assessment
● Ventricular tachycardia or fibrillation ● Drug and herbal history
● VS, PR, ECG, renal function, serum Available forms:

electrolytes ● Sublingual
● s/sx of digitalis toxicity ● Ointments
Planning ● Buccal
● Intervention ● Transdermal patches
● Monitor pulse rate. ● Chewable tablets
● Maintain desired potassium level by ● Inhalable sprays
eating foods high in potassium. ● Capsules
● Digoxin-half life 36hrs vs. ● Intravenous solutions
Digitoxin-half life 4-9days MOA
● DO NOT administer if pulse rate is ● Cause vasodilation due to relaxation
less than 60 bpm. of smooth muscles
Drug compliance ● Potent dilating effect on coronary
● Avoid OTC drugs. arteries
Digoxin: NO IM Indications
● Weigh daily ● Used for prophylaxis and treatment
of angina
ANTIANGINAL AGENTS Contraindications
● Head trauma or cerebral
Angina Pectoris (Chest Pain) hemorrhage
- When the supply of oxygen and Examples:
nutrients in the blood is insufficient a. Nitroglycerin (Nitrobid, Nitrostat)
to meet the demands of the heart, - Prototypical nitrate
the heart muscle aches. - Large first-pass effect with PO
Therapeutic Objectives: forms
● Increase blood flow to ischemic - Used for symptomatic treatment of
heart muscle ischemic heart conditions (angina)
● Decrease myocardial oxygen - IV form used for BP control in
demand perioperative hypertension,
● Minimize the frequency of attacks treatment of CHF, ischemic
and decrease the duration and pain,and pulmonary edema
intensity of anginal pain associated with acute MI
● Prevent or delay the worst possible b. isosorbide dinitrate (Isordil,
outcome, MI Sorbitrate, Dilatrate SR)
Antianginal Agents c. isosorbide mononitrate (Imdur,
1. Nitrates Monoket, ISMO)
2. Beta blockers Side Effects
3. Calcium channel blockers ● Headache

1. Nitrates
○ Usually diminish in intensity

3. CALCIUM-CHANNEL BLOCKERS
and frequency with
MOA:
continued use
● blocks the binding of calcium to its
● Dizziness
receptors
● Weakness
● preventing muscle contraction
● postural hypotension
● smooth muscle relaxation
● Reflex Tachycardia
● decreased peripheral smooth
● Tolerance may develop
muscle tone, decreased systemic

vascular resistance
2. Beta- Blockers ● Result: decreased myocardial
MOA: oxygen demand
● Block beta adrenergic receptors Indications
● Decrease the HR ● First-line agents for treatment of
● resulting in decreased myocardial angina, hypertension, and
oxygen demand and increased supraventricular tachycardia
oxygen delivery to the heart ● Short-term management of atrial
● Decrease myocardial contractility, fibrillation and flutter
helping to conserve energy or Side Effects:
decrease demand Very acceptable side effect and safety
Indications profile
● Antianginal ● Dizziness
● Antihypertensive ● Lightheadedness
● Cardioprotective effects, especially ● HA
after MI ● Hypotension
Side Effects: ● Palpitations
● Dizziness ● tachycardia or bradycardia
● Fatigue ● Constipation
● mental depression ● Nausea
● Lethargy ● dyspnea
● Drowsiness Examples
● unusual dreams ● verapamil (Calan)
● Impotence ● diltiazem (Cardizem)
● Wheezing ● nifedipine (Procardia)
● Dyspnea
Examples: Nursing Process
● atenolol (Tenormin) Intervention: NITROGLYCERIN
● metoprolol (Lopressor) Monitor VS. (hypotension?)
● propranolol (Inderal) ● Instruct to rise slowly to a standing
● nadolol (Corgard) position.

● Offer sips of water before sublingual ● These medications should never be
(SL) nitrates. abruptly discontinued due to risk of
● Apply nitrates ointment to the rebound hypertensive crisis.
designed mark. ● Inform patients that these
● DO NOT USE FINGERS, USE medications are for long-term
GLOVES. prevention of angina, not for
● Do not apply nitrates ointment in immediate relief.
any area in the chest with
defibrillator-cardioverter paddle Intervention: CALCIUM CHANNEL
placement. BLOCKERS
● proper technique and guidelines ● Blood levels should be monitored to
● Instruct patients never to chew or ensure they are therapeutic
swallow the SL form. ● Oral CCBs should be taken before
● Instruct patients that a burning meals and as ordered.
sensation felt withSL forms ● Patients should be encouraged to
indicates that the drug is still potent. limit caffeine intake.
● Instruct patients to take prn nitrates
at the first hint of anginal pain. ANTIDYSRHYTHMIC AGENTS
○ If pain persists, repeat in Dysrhythmia
5minutes. - Any deviation from the normal
○ DO NOT GIVE MORE THAN rhythm of the heart
3 TABLETS. Antidysrhythmics
● If experiencing chest pain, the - Drugs used for the treatment and
patient taking SL NTG should be prevention of disturbances in
lying down to prevent or decrease cardiac rhythm
dizziness and fainting that may - Antidysrhythmic Agents
occur due to hypotension. Vaughan Williams Classification:
● Monitor VS frequently during acute A. Class 1
exacerbations of angina and during 1.Class Ia
IV administration. 2.Class Ib
3.Class Ic
Intervention: BETA-BLOCKERS B. Class II
● Monitor pulse rate daily and report C. Class III
any rate lower than 60 beats per D. Class IV
minute.
● Dizziness or fainting should also be
A. Class I
reported.
● Constipation is a common problem. ● Membrane-stabilizing agents
–adequate fluids and eat high-fiber ● Fast sodium channel blockers
foods. ● Divided into Ia, Ib, and Ic agents,
according to effects
Moricizine ● Encainide
● General Class I agent ● Flecainide
● Has characteristics of all three ● propafenone
subclasses ● Block sodium channels (more
● Used for symptomatic ventricular pronounced effect)
and life-threatening dysrhythmias MOA:
● Little effect repolarization
Indications:
1. Class Ia
● Used for severe ventricular
Examples:
dysrhythmias
● Quinidine
● May be used in atrial
● Procainamide
fibrillation/flutter
● disopyramid

● Block sodium channels B. Class II: Beta Blockers:
MOA: Examples:
● Delay repolarization ● Atenolol
Indications ● Esmolol
● Used for atrial fibrillation ● Metoprolol
● premature atrial contractions ● Propranolol
● premature ventricular contractions
● ventricular tachycardia ● Depress phase 4 depolarization
● Reduce or block sympathetic
nervous system stimulation
2. Class Ib
● reduce transmission of impulses in
Examples:
the heart’s conduction system
● Tocainide
● General myocardial depressants for
● Mexiletine
both supraventricular and ventricular
● Phenytoin
dysrhythmias
● Lidocaine

● Block sodium channels C. Class III
MOA: Examples:
● Accelerate repolarization ● Amiodarone
Indications: ● Bretylium
● Used for ventricular dysrhythmias ● Sotalol
only ● ibutilide
MOA:
● prolong repolarization in phase 3
3. Class Ic
Indications:
Examples:
● Used for dysrhythmias that are

difficult to treat Periods of the Cardiac Cycle
● Life-threatening ventricular Diastole
tachycardia or fibrillation, atrial - Period of rest
fibrillation or flutter—resistant to - Blood is returned to the heart by
other drugs veins
● Sustained ventricular tachycardia Systole
- Period of contraction, or systole
- Blood is pumped out of the heart
D. Class IV

Examples:
Elements Determining Blood Pressure
● Verapamil
● Heart rate
● Diltiazem
● Stroke volume
● Calcium channel blockers
○ Amount of blood that is
MOA:
pumped out of the ventricle
● Depress phase 4 depolarization
with each heartbeat
Indications:
● Total peripheral resistance
● Used for paroxysmal
○ Resistance of the muscular
supraventricular tachycardia
arteries to the blood being
● rate control for atrial fibrillation and
pumped through
flutter
● Control of Blood Pressure
Side effects:
● Baroreceptors in the aorta and
ALL antidysrhythmics can cause
carotid sinus
dysrhythmias!!
● Vasomotor center in the medulla

● Hormones: antidiuretic hormone
Hypersensitivity reactions:
(ADH), atrial natriuretic peptide
● Nausea
(ANP), brain natriuretic peptide
● Vomiting
(BNP)
● Diarrhea
● Control of Blood Pressure
● Dizziness
○ The Renin–Angiotensin
● Blurred vision
System
● Headache

Categories Rating the Severity of
Nursing Process:Intervention
Hypertension and Classification of Blood
● Monitor VS. (hypotension?)
Pressure
● Monitor ECG
1. Primary Hypertension
● Drug compliance
● Specific cause unknown
● Instruct to avoid alcohol, caffeine
● 90% of the cases
and tobacco.
● Also known as essential or

idiopathic hypertension
ANTIHYPERTENSIVE MEDICATIONS
2. Secondary Hypertension 4. Diuretic

● Cause is known (such as eclampsia - Decreases serum sodium
of pregnancy, renal artery disease,) levels and blood volume
● 10% of the cases
Conditions Related to Untreated
1. Adrenergic Agents
Hypertension:
A. Alpha1 blockers
● CAD and cardiac death
B. Beta blockers (cardioselective and
● Stroke
nonselective)
● Renal failure
C. Centrally acting alpha blockers
● Loss of vision
D. Peripheral-acting adrenergic agents
Stepped Care Approach to Treating
E. Combined alpha-beta blockers
Hypertension

● Step 1:Lifestyle modifications are
instituted A. Alpha1 blockers (peripherally
● Step 2:If the measures in step 1 are acting)
not sufficient, drug therapy is added MOA:
● Step 3:If the patient’s response is ● Block the alpha1-adrenergic
inadequate, drug dose or class may receptors
be changed or another drug added ● The SNS is not stimulated
● Step 4:Includes all of the above Result: DECREASED blood pressure
measures with the addition of more ● Stimulation of alpha1-adrenergic
antihypertensive agents until blood receptors causes HYPERtension
pressure is controlled ● Blocking alpha1-adrenergic
receptors causes decreased blood
Types of Drugs Used to Control Blood pressure
Pressure Examples:
1. Adrenergic agents ● doxazosin (Cardura)
- Leads to a decrease in heart ● prazosin (Minipress)
rate and strength of ● terazosin (Hytrin)
contraction as well as Indications:
vasodilation ● Alpha1 blockers (peripherally acting)
2. ACE inhibitor ● Treatment of hypertension
- Blocks the conversion of ● Relief of symptoms of BPH
angiotensin I to angiotensin ● Management of severe CHF when
II; an angiotensin II receptor used with cardiac glycosides and
blocker; blocking effects of diuretics
angiotensin on blood vessels
3. Calcium channel blocker
B. Beta blockers
- Cause smooth muscle
relaxation MOA:
● ↓Sympathetic response to ● SNS (peripheral adrenergic nerves)

decrease basal sympathetic tone is not stimulated
● ↓Vascular resistance and heart rate Result: decreased blood pressure
● Result: decreased blood pressure Examples:
Examples: Beta-Adrenergic Blockers (-olol) ● Reserpine
Contraindications/ Cautions: (ABCDE) ● guanadrel (Hylorel)
● Asthma ● guanethidine (Ismelin)
● Block (heart block) Indications:
● COPD ● Hypertension
● Diabetes mellitus ● Seldom used because of frequent
● Electrolyte (hyperkalemia) side effects

Side Effects:
C. Central-Acting Adrenergics
Most common:
MOA: ● dry mouth
● Stimulate alpha2-adrenergic ● Drowsiness
receptors ● Sedation
● Sympathetic outflow from the CNS ● Constipation
is decreased Other:
Result: decreased blood pressure ● Headaches
Examples: ● sleep disturbances
● clonidine (Catapres) ● Nausea
● methyldopa (Aldomet) (drug of ● Rash
choice for hypertension in ● cardiac disturbances (palpitations)
pregnancy)
Indications:
2. ACE Inhibitors
● Hypertension
● Also may be used for treatment of Angiotensin-Converting Enzyme (ACE)
severe dysmenorrhea, menopausal Inhibitors
flushing, glaucoma - Large group of safe and effective
● Clonidine is useful in the drugs
management of withdrawal - Often used as first-line agents for
symptoms in opioid-or CHF and hypertension
nicotine-dependent persons - May be combined with a thiazide
diuretic or calcium channel blocker
MOA
D. Adrenergic Neuronal
● ACE Inhibitors block the angiotensin
Blockers(peripherally acting)
converting enzyme, thus preventing
MOA: the formation of angiotensin II.
● Inhibit release of norepinephrine ● Also prevent the breakdown of the
● Also deplete norepinephrine stores vasodilating substance, bradykinin
Result: decreased systemic vascular - Well-tolerated

resistance (afterload), vasodilation, and - Do not cause coughing
therefore, decreased blood pressure MOA
Examples: ● Allow angiotensin I to be converted
● Captopril(Capoten) to angiotensin II, but block the
○ Short half-life, must be receptors that receive angiotensin II
dosed more frequently than ● Block vasoconstriction and release
others of aldosterone
● Enalapril (Vasotec) Examples:
○ The only ACE inhibitor The -sartans:
available in oral and ● losartan (Cozaar)
parenteral forms ● eprosartan (Teveten)
● Lisinopril (Prinivil and Zestril) & ● valsartan (Diovan)
quinapril(Accupril) ● irbesartan (Avapro)
○ Newer agents, long ● candesartan (Atacand)
half-lives, once-a-day dosing ● telmisartan (Micardis)
Indications: Side effects
● Hypertension ● Upper respiratory infections
● CHF (either alone or in combination ● Headache
with diuretics or other agents) ● May cause occasional dizziness
● Slows progression of left ventricular ● inability to sleep
hypertrophy after an MI ● Diarrhea
● Renal protective effects in patients ● Dyspnea
with diabetes ● Heartburn
● Drugs of choice in hypertensive ● nasal congestion
patients with CHF ● back pain
Side effects: ● fatigue
● Fatigue
● Dizziness
3. Calcium Channel Blockers
● Headache
MOA:
● Mood changes
● blocks the binding of calcium to its
● Impaired taste
receptors preventing muscle
● Dry, nonproductive cough, reverses
contraction
when therapy is stopped
● smooth muscle relaxation
NOTE: first-dose hypotensive effect may
decreased peripheral smooth
occur!!
muscle tone, decreased systemic

vascular resistance
Angiotensin II Receptor Blocker (A II Result: decreased blood pressure
Blockers or ARBs)
Examples:
- Newer class ● diltiazem(Cardizem, Dilacor)
● verapamil(Calan, Isoptin) ● Act directly on the ascending limb of

● amlodipine(Norvasc) the loop of henle To inhibit sodium
● bepridil(Vascor) and chloride resorption.
● nicardipine(Cardene) ● Increase renal prostaglandins,
● nifedipine(Procardia) resulting in the dilation of blood
● nimodipine(Nimotop) vessels and reduced peripheral
Indications: vascular resistance.
● Angina Examples:
● Hypertension ● bumetanide (Bumex)
● Dysrhythmias ● ethacrynic acid (Edecrin)
● Migraine headaches ● furosemide (Lasix)
Contraindications Drug Effects
● Heart block ● Potent diuresis and subsequent loss
**Normally, not prescribed with of fluid
beta-blockers. ● Decreased fluid volume causes:
Side effects ○ Reduced BP
● Hypotension ○ Reduced pulmonary vascular
● Palpitations resistance
● Tachycardia ○ Reduced systemic vascular
● Constipation resistance
● Nausea ○ Reduced central venous
Other–rash, flushing, peripheral edema, pressure
dermatitis ○ Reduced left ventricular
end-diastolic pressure
● Potassium depletion
4. Diuretics

MOA:

● Decrease the plasma and
Indication:
extracellular fluid volume
● Edema associated with CHFor
Results:decreased preload decreased
hepatic or renal disease
cardiac output, decreased total peripheral
● Control of hypertension
resistance
Side effects:
● Overall effect: decreased workload
of the heart, and decreased blood BODY EFFECT
SYSTEM
pressure
CNS ● Dizziness
A. Loop Diuretics ● Headache
● Tinnitus
MOA: ● Blurred vision
GI ● Nausea
Amiloride:
● Vomiting
● diarrhea ● Treatment of CHF

Hematologic ● Agranulocytosis
● Neutropenia BODY EFFECT
● thrombocytopenia SYSTEM
Metabolic ● Hypokalemia CNS ● Dizziness

● Hyperglycemia ● Headache
● hyperuricemia
GI ● Cramps
● Nausea
● Vomiting
● Diarrhea
B. Potassium-Sparing Diuretics
MOA: OTHER ● Urinary frequency
● Weakness
● Work in collecting ducts and distal
● Hyperkalemia
convoluted tubules
● Interfere with sodium-potassium
exchange Side Effects:
● Competitively bind to aldosterone Spironolactone:
receptors ● Gynecomastia
● Block the reabsorption of sodium ● amenorrhea, irregular menses
and water usually induced by
aldosterone Vasodilator
Examples: MOA:
● amiloride (Midamor) ●Directly relaxes arteriolar smooth
● spironolactone (Aldactone) muscle
● triamterene (Dyrenium) Result:decreased systemic vascular
Drug Effects response, decreased afterload, and
● Prevent potassium from being PERIPHERAL VASODILATION
pumped into the tubule, thus
preventing its secretion Examples:
● Competitively block the aldosterone ● diazoxide (Hyperstat)
receptors and inhibit its action ● hydralazine HCl (Apresoline)
● The excretion of sodium and water ● minoxidil (Loniten, Rogaine)
is promoted ● sodium nitroprusside (Nipride,
Indication: Nitropress)
spironolactone and triamterene: Indications:
● Hyperaldosteronism ● Treatment of hypertension
● Hypertension
● Reversing the potassium loss
caused by potassium-losing drugs
● Sodium nitroprusside and diazoxide ● Monitor for side/adverse effects

IV are reserved for the management (dizziness, orthostatic hypotension,
of hypertensive emergencies fatigue)and for toxic effects.
Side Effects: ● Hot tubs, showers, or baths;hot
Hydralazine: weather; prolonged sitting or
● Dizziness standing; physical exercise; and
● Headache alcohol ingestion may aggravate low
● Anxiety blood pressure, leading to fainting
● Tachycardia and injury. Patients should sit or lie
● Nausea and vomiting down until symptoms subside.
● Diarrhea
● Anemia Antilipemic Agents
● Dyspnea - Drugs used to lower lipid levels
● Edema
● nasal congestion Triglycerides and Cholesterol
Sodium nitroprusside: ● Two primary forms of lipids in the
● Bradycardia blood
● Hypotension ● Water-insoluble fats that must be
● possible cyanide toxicity bound to apoproteins, specialized
lipid-carrying proteins
NURSING PROCESS ● Lipoprotein is the combination of
Assessment: triglyceride or cholesterol with
● health history apoprotein
● Contraindications/cautions
● VS, BP
Bile Acid Sequestrants
● Medication, herbal history
MOA:
● Renal and liver status
● Prevent resorption of bile acids from
Intervention
small intestine
● Monitor BP.
● Bile acids are necessary for
● Drug compliance
absorption of cholesterol
● Instruct client to rise slowly from a
Examples:
lying or sitting to a standing
● cholestyramine (Questran)
position. (orthostatic hypotension)
● colestipol hydrochloride (Colestid)
● Inform that drugs may cause sexual
● HMG-CoAReductaseInhibitors
dysfunction.
(HMGs or statins)
● Non-pharma management
● 3-hydroxy-3 methyl-glutaryl co
● DO NOT TAKE any OTC
enzyme A reductase
drugs/herbal meds.
Indications:
● Type II hyperlipoproteinemia
● Relief of pruritus associated with ● Girl during pregnancy

partial biliary obstruction ● Growing children
(cholestyramine) Interactions:
Side Effects: ● Coumarin/ Cyclosporine
● Constipation Antilipemics: HMG-CoA Reductase
● Heartburn Inhibitors (HMGs or statins)
● Nausea
● Belching
Fibric Acid Derivatives
● Bloating
MOA:
These adverse effects tend to disappear
● Believed to work by activating
overtime
lipase, which breaks down

cholesterol
● HMG-CoA Reductase Inhibitors ● Also suppress release of free fatty
MOA: acid from the adipose tissue, inhibit
● Inhibit HMG-CoA reductase–which synthesis of triglycerides in the liver,
is used by the liver to produce and increase the secretion of
cholesterol cholesterol in the bile
● Lower the rate of cholesterol Examples:
production ● Clofibrate
Examples: ● gemfibrozil (Lopid)
● lovastatin(Mevacor) ● fenofibrate (Tricor)
● pravastatin(Pravachol) Indications:
● simvastatin(Zocor) ● Treatment of type IV and V
● atorvastatin(Lipitor) hyperlipidemias
● cerivastatin(Baycol) ● Treatment of type III, IV, and V
● fluvastatin(Lescol) hyperlipidemias
○ Most potent LDL reducers Side effects:
Indications: ● Abdominal discomfort
● Treatment of type IIa and IIb ● Diarrhea
hyperlipidemias ● Nausea
○ Reduce LDL levels by 30 to ● Blurred vision
40% ● Increased risk of gallstones
○ Increase HDL levels by 2 to ● Prolonged prothrombin time
15% ● Liver studies may show increased
○ Reduce triglycerides by 10 to function
30%
Side effects:
Niacin (Nicotinic Acid)
● Hepatotoxicity
- Vitamin B3
● Myositis [aka rhabdomyolysis]
Contraindications:
- Lipid-lowering properties require ○ HMG-CoA Reductase

much higher doses than when used Inhibitors –at night
as a vitamin ● Powder forms must be taken with a
- Effective, inexpensive, often used in liquid, mixed thoroughly but not
combination with other stirred, and NEVER taken dry.
lipid-lowering agents ● Other medications should be taken
MOA: 1 hour before or 4 to 6 hours after
● Thought to increase activity of meals to avoid interference with
lipase, which breaks down lipids absorption
● Reduces the metabolism or ● Clofibrate often causes
catabolism of cholesterol and constipation;instruct patients to
triglycerides increase fiber and fluid intake to
Indications: offset this effect.
● Effective in lowering triglyceride, ● To minimize side effects of niacin,
total serum cholesterol, and LDL start on a low initial dose and
levels gradually increase it, and take with
● Increases HDL levels meals.
● Effective in the treatment of types ● Small doses of aspirin or NSAIDs
IIa, IIb, III, IV, and V hyperlipidemias may be taken 30 minutes before
Side Effects: niacin to minimize cutaneous
● Flushing (due to histamine release) flushing.
● Pruritus ● Inform patients that these agents
● GI distress may take several weeks to show
effectiveness.
Nursing process ● Instruct patients to report persistent
Assessment GI upset, constipation, abnormal or
● health and medication history. unusual bleeding, and yellow
● Assess dietary patterns, exercise discoloration of the skin.
level, weight, height,VS, tobacco ● Monitor for side effects, including
and alcohol use, family history. increased liver enzyme studies.
● Contraindications/ cautions ● Monitor for therapeutic effects:
○ biliary obstruction ○ Reduced cholesterol and
○ liver dysfunction/ active liver triglyceride levels
disease.
● liver function studies Anticoagulants, Antiplatelets And
● long-term therapy :supplemental Thrombolytics
fat-soluble vitamins (A, D, K). Thrombosis
Intervention - Clot formation in the arterial or
● Take with meals to decrease GI venous vessel
upset.
1. Anticoagulants A. Anticoagulants: Direct Thrombin

Inhibitors
MOA:
● Inhibit clot formation MOA:
● DO NOT dissolve clots, rather, they ● inhibit thrombin from converting
act prophylactically to prevent new fibrinogen to fibrin
clots from forming ● Administered intravenously
Examples: ○ Argatroban (Acova)
● Low-molecular-weight heparin ○ Bivalirudin (Angiomax)
(LMWH) ○ Lepirudin (Refludan)
○ Enoxaparin sodium ● Administered subcutaneously
(Lovenox) ○ Desirudin (Iprivask)
○ Dalteparin sodium (Fragmin) ● Oral anticoagulants
○ Danaparoid (Orgaran)
○ Tinzaparin sodium (Innohep) B. Anticoagulants: Warfarin
Contraindications: (Coumadin)
● Stroke
MOA:
● Peptic ulcer ● Inhibit hepatic synthesis of vita-min
● Blood anomalies
K, thus affecting the clotting factors
Side effects:
II, VII, IX and X.
● bleeding
Indications:
● Direct Thrombin Inhibitors: ● Thromboembolic conditions
○ Parenteral Anticoagulants II
● Thrombophlebitis
Indications:
● Pulmonary embolism
● Venous and arterial vessel disorders
● Embolism formation d/t atrial
○ DVT (Deep vein thrombosis) fibrillation
○ Pulmonary embolism
Side Effect:
○ Coronary thrombosis
● Bleeding
○ Artificial heart valves
Drug Interactions
○ CVA (cerebrovascular ● Aspirin, NSAIDS
accident)
● Sulfonamides
Nursing Implications :
● Phenytoin
PROLONGS clotting time:
● Cimetidine
● MONITOR PTT(partial ANTIDOTE: Vitamin K (Phytonadione)
thromboplastin time) and

aPTT(activated partial
Mnemonics
thromboplastin time)
WePT:
Anticoagulant antidote: Protamine ● Warfarin works on the extrinsic
sulfate (IV)
pathway and is monitored by PT.

SLOW
Has a slow onset of action. A quicK Vitamin

K antagonist, though.
3. Thrombolytics
Small lipid-soluble molecule
MOA:
Liver: site of action
● Promote the fibrinolytic mechanism
Oral route of administration.
(converting plasminogen to plasmin,
Warfarin
which destroys the fibrin in the

blood clot)
Nursing Process
Examples:
Assessment
● Alteplase (t-PA)
● History of abnormal clotting
● Streptokinase
● Drug or herbal meds
● Urokinase
● PT
● Reteplase
Intervention
● Tenecteplase
● Monitor VS.
● Thrombolytics
● Monitor PT
Indications:
● Monitor for bleeding
● Pulmonary embolism
● Advise
● DVT
○ use of soft toothbrush
● Non Coronary Arterial occlusion
○ Electric shave
● Thrombotic Stroke
● Instruct not to smoke.
○ thrombolytic drugs should
● Teach how to control external
be administered within 3
hemorrhage.
hours of thrombotic stroke!!

Adverse effects:
2. Antiplatelet ● Hemorrhage
MOA: ● vascular collapse (streptokinase)
● Suppress platelet aggregation by Antidote: aminocaproic acid (Amicar)
blocking the binding of adenosine
diphosphate (ADP) to the platelet Mnemonic:
ADP receptor. USA
● ADP-mediated activation of the ● Urokinase
glycoprotein (GP) IIb/IIa complex ● Streptokinase
inhibits platelet aggregation ● Alteplase (tPA)
Examples: Nursing process
● Clopidogrel (Plavix) Assessment
● ticlopidine (Ticlid) ● VS
● dipyridamole (Persantine) ● CBC
Indications ● PT,
● Prevent MI or stroke ● Medical and drug history
Drug-drug Interactions Intervention
● Herbal products ● Monitor VS
● Monitor for bleeding ● Acute pharyngitis

● Check for bleeding for 24 hours *itis- inflammation; vasodilation; congestion
after thrombolytic therapy has been Symptoms of common
discontinued.
● Observe for anaphylaxis reaction to
1. Antihistamines
streptokinase
MOA:
● Avoid aspirin or NSAID
- Compete with histamine receptors
● Safety precautions
sites to prevent histamine response

- Reduces nasopharyngeal
Drugs Acting On Respiratory System secretions, itching, sneezing
Upper Respiratory System Use:
● Nares - Treat acute allergic rhinitis
● Nasal Cavity Contraindications/cautions:
● Pharynx - Severe liver disease
● Larynx - narrow-angle glaucoma (because of
Lower Respiratory Tract blurring of vision)
● Trachea - urinary retention (side effect of
● Bronchi (2) antihistamine)
● Bronchioles
● Alveoli (most important) H1 blockers (antagonist)
● (gas exchange; problem= cyanosis)
Alveolo-capillary membrane A. First generation antihistamines
● Diphenhydramine (Benadryl)
Drugs Affecting Upper Respiratory B. Second Generation antihistamines
System - Better than first
- Less sedation
1. Upper respiratory infections - Fewer anticholinergic effects
● Common cold - Dry mouth, blurred vision,
Contagious period of common cold wheezing, urinary retention
- 1-4 days before onset of symptoms Examples:
- During first 3 days of cold ● Cetirizine (Zyrtec)
Symptoms: ● Fexofenadine (Allegra)
○ Cough (defense mechanism; ● loratadine(Claritin)
increase mucosal layer) Administration:
○ Increased mucosal - Oral, IM, IV
secretions Drug interaction:
○ Nasal discharge - Alcohol
○ Nasal congestion - CNS depressants
● Acute rhinitis Side Effects:
● Sinusitis
- Drowsiness ( nx responsibility: MOA:

advise to not go home driving; let px ● Stimulate alpha adrenergic
lie down ) receptors:
- Dry mouth (antialerna) ● Produces nasal vascular
- Dizziness vasoconstriction
- Blurred vision ● Shrinks nasal mucous
- Wheezing ● Reduces nasal secretion
- Photosensitivity (light; sunscreen) Administration:
- Urinary Retention ● Nasal spray
- Constipation (additional fluids) ● Nasal drops
- GI distress (nx responsibility: take it ● Tablet
with food) ● Capsule
- Blood dyscrasias (destruction of ● Liquid
CBC Drug-drug Interactions
- May increase restlessness
NURSING PROCESS - Palpitations with caffeine (coffee,
tea)
Assessment Side effects
- s/sx of urinary dysfunction (because - Nervous, jittery, restless
side effect is urinary retention) - Alpha adrenergic effect
- CBC (because of blood dyscrasias) (hypertension, hyperglycemia,
diabetes mellitus) (nx responsibility:
*focus on side effects and include on check BP if high, inform the dr.;
assessment check lab if diabetic, if none ask px
if may history)
Diagnosis Examples:
Planning - Oxymetazoline (Afriin
Nursing interventions: - Naphazoline (Allerest)
- Obtain list of environmen - Pseudoephedrine (Sudafed)(most
- Give with food to decrease GI common)
distress
- Avoid operating motor NURSING PROCESS
vehicles if drowsiness occurs
- Avoid alcohol and other CNS Assessment:
depressants ● Allergy
- Use sugarless candy or gum, as well ● Glaucoma
as ice chips for temporary relief of ● HTN
mouth dryness ● DM
● Thyroid problem (manifestation:
irritability and restlessness)
2. Nasal Decongestants

4. Antitussives
Diagnosis
MOA:
Planning
- Act on the cough-control center in
Intervention :
the medulla to suppress the cough
- DO NOT USE for more than 5 days
reflex.
Rebound congestion (nx
Use
responsibility= take note the days,
- Non-productive cough (walang
remind dr)
tunog)
- Safety precautions
-viscosity of tenacious secretions
- Increase fluid intake
(lapot, it could liquify)

CI and Caution:
3. Intranasal Glucocorticoids ● COPD (it has big problem in
- Steroids bronchi) (like asthma or
MOA: emphysema)
- Anti inflammatory ● Chronic productive cough
Use: ● Hypersensitivity
-Treat for allergic rhinitis ●Some products contain alcohol and
-May be used alone or combination should be avoided in patients with
with H1 known intolerance
CI and Caution: Side Effects:
- Presence of acute infection (mucus) ● Drowsiness
Side Effects: ● Dizziness
● Local burning ● Nausea
● Irritation Examples:
● Dryness of mucosa ● Dextromethorphan hydrobromide
● Headache (benylin)

Nursing Process Nursing Process

Assessment Assessment
● Respirations ● History (signs and symptoms)
● Adventitious sound ● s/sx
● Temperature Intervention
Intervention ● Cough (what type of cough? If it is
● Teach proper administration. productive or non-productive
● Clear nasal passages before cough)
administration.
● Assess for development of acute
5. Expectorants
infection.
MOA:

- Loosen bronchial secretions by ● Permanent irreversible damage to

reducing surface tension of the lung tissue
secretions = decrease viscosity (it
will liquify the secretion to easily Restrictive Lung Diseases
expectorated) *lung cannot expand properly
Use Pathophysiologic changes:
- Dry, nonproductive cough ● Decrease in total lung capacity from:
Side effects: ○ Fluid accumulation
● Drowsiness (safety of the patient) ○ Loss of elasticity of the lung
● Nausea/vomiting tissues
● GI distress (orally with food) Etiology
Examples: ● Pulmonary fibrosis, pneumonitis,
● Guaifenesin (Robitussin) (helps the lung tumors
secretions to decrease the viscosity ● Thoracic deformities (scoliosis)
and liquify to lessen and easily ● Myasthenia gravis
expectorated
● Mucolytics BRONCHODILATORS
● Acetylcysteine (Mucomyst) 1. BETA-ADRENERGIC AGONIST
● Dornase alfa (Pulmozyne) - Cyclic Adenosine Monophosphate
(cAMP)
Drugs Acting on Lower Respiratory - ATP converted to cAMP →activates
System cAMP-dependent protein kinase
COPD - Facilitates smooth muscle relaxation
Pathophysiologic changes: AND inhibits mast cell degranulation
- Airway obstruction with increased
airway resistance to airflow
Alpha-and Beta2-Adrenergic Agonist
(difficulty in breathing)
MOA:
Major disorders:
● Sympathomimetics
● Chronic bronchitis
● Increase cAMP
● Bronchiectasis
● Dilation of the bronchioles.
● Emphysema
● Relaxation of smooth muscle of
● Asthma
bronchi
Etiology
A. Stimulate alpha1, beta1(cardiac),
● Cigarette smoking, inflammation
and beta2(respiratory) receptors
● Chronic lung infections
Example: Epinephrine
● Allergens
B. Nonselective beta-adrenergics
Characteristic symptoms
-
Stimulate both beta1 and beta2
● Dyspnea, excess mucus secretions
receptors.
● Airway obstruction, bronchospasm
Example: isoproterenol (Isuprel)
C. Selective beta2 drugs
- Stimulate only beta2 receptors.

Example: albuterol
Anticholinergic

MOA:
Beta2-Adrenergic Agonist
● block the action of acetylcholine at
Use:
vagus nerve
- To treat bronchospasm (especially
● Relaxation of smooth muscle in
asthma = reversible)
bronchi
- Used in the treatment of reversible
● Bronchodilation
airway obstruction due to asthma.
Use:
CI and Caution:
- COPD (irreversible = emphysema
● Hypersensitivity
and chronic bronchitis)
● Cardiac dysrhythmias/Cardiac
Examples:
disease (hypertension, diabetes
● Ipratropium (Atrovent)
mellitus)
CI and Caution:
● HTN
● Pregnancy
● Hyperthyroidism
● Allergy
● DM
● Lactation
Adverse Effects:
● Narrow-angle glaucoma
● Nervousness
● Prostatic hypertrophy
● Tremors
● Anticholinergic
● Restlessness
Adverse Effect:
● Insomnia
When absorbed SYSTEMATICALLY:
● Headache
● Dizziness
● Nausea
● Headache
● Vomiting
● Fatigue
● Hyperglycemia
● Nervousness
● Muscle cramping in extremities
● Dry mouth
(pain in muscles)
● Sore throat
● Tachycardia
● Palpitations
● Palpitations (cause arrhythmia)
● Urinary retention
● Hypertension
Drug-drug Interactions
● Dysrhythmias
● Anti-histamines
Drug-drug Interaction:
● Potential increase fluorocarbon
- Decrease with beta blockers
toxicity when used with other
Examples:
inhalation bronchodilators having a
● Epinephrine (adrenaline)
fluorocarbon propellant.
● Isoproterenol (Isuprel)

● Terbutaline (Brethine)
● Metaproterenol (Alupent) Xanthines
● Albuterol (Proventil,Ventolin)
- Methylxanthine (titrate,regulate)
MOA: ● Respiratory condition

- Inhibit the enzyme ● Medical history
phosphodiesterase Interventions:
- increasing cAMP ● Monitor VS.
- bronchodilation ● Cardio??
Use: ● Take with or immediately after
- COPD, asthma meals.
Examples: ● Monitor serum level of Theo. ( 5-15
● Aminophylline (Somophyllin) mcg) (Greater than 20mcgL/ml =
● Theophylline (Theo-Dur) toxicity)
● Oxtriphylline (Choledyl) ● STOP SMOKING! ~~
CI and Caution: ● Non-pharma mngt
● Seizure ● Proper use of inhaler
● cardiac, renal, or liver disorders ● Surgarless candy –dry mouth
Side Effects: ● Xanthines: avoid food containing
● Dysrhythmias xanthine derivatives.(caffeine)
● Nervousness ● Food containing caffeine: Coffee,
● Irritability Tea, cola
● Insomnia
● Dizziness
Leukotriene Receptor Antagonist
● Flushing
MOA:
● Dizziness
- reduce inflammatory process
● Hypotension
- Decrease bronchoconstriction
● Seizures
Use:
● GI distress
-prophylactic and maintenance for
● intestinal bleeding
chronic asthma
● Hyperglycemia
Side Effects:
● Tachycardia
● Dizziness
● Palpitations
● Headache
● cardiorespiratory collapse
● GI distress
Drug-drug Interactions
● abnormal liver enzymes
- Beta-blockers, cimetidine
● nasal congestion
(Tagamet), propranolol (Inderal) and
● Cough
erythromycin barbiturate and
● pharyngitis
carbamazepine
Examples:
- Beta-adrenergic agonist
● Zafirlukast (Accolate)
- Nicotine
● montelukast (Singulair)

Nursing Process: Bronchodilators
Nursing Process (LRA)
Assessment:

Assessment ● Benzene
- Allergy ● Asbestos
- Herbal? ● Tobacco
- Respiratory system condition ● Excessive sun exposure
Intervention Curing cancer
- Monitor respiratory status - Surgery
- Increase fluid intake - Radiation therapy
- STOP SMOKING (number one - Chemotherapy
cause) ● Using chemical agent to
treat diseases
● Attempts to destroy tumor
Cromolyn and Nedocromil
cells by interfering with
MOA:
cellular functions and
- antiinflammatory effect and
reproduction
suppresses the release of histamine
● May be the primary for of
Use:
treatment for cancer
- Prophylactic treatment of bronchial
● Can be combined with
asthma
radiation and surgery
- Not to be used for acute asthmatic
Drugs used to destroy cancer cells are
attack
called by:
Administration:
● Anti cancer drugs
- Inhalation
● Chemotherapeutic Agents
Side effects:
● Antineoplastic drugs
● Cough
● Cytotoxic drugs
● bad taste

● rebound bronchospasm
Classifications:

1. Cell cycle specific
Chemotherapy - Interfere with specific phases
of the cell cycle
Cancer
2. Cell cycle non-specific
- are group of disease in which
- Works regardless of phases of cell
abnormal cells grow out of control
cycle.
and may spread to the different
Cell cycle
areas of the body
1. G0 phase
-
Caused is damage to the DNA
- Resting stage, few hours to few
within the cell
years
Factors influencing cancer development:
2. G1 phase
● Diet
- Cells start to make proteins 18-30
● Radiation
hrs
● Bacteria
3. S phase
● Viruses
- start of genetic codes are copied - So called because it is derived from

18-20hrs. plants
4. G2 2phase - Most sensitive of M-phase
- Prepares to split into 2-10 hours Examples:
5. M phase (mitosis) - Vincristine
- Cells split into two 30-60 min - Vindesine
- Vinblastine
- Teniposide
Metastasis
2. Cell cycle non-specific
- Spread of cancer cells from a
- Acts on cells during any phase of
primary tumor to distant sites
reproduction, some even on resting
- “Breaking away”
phase.
- Only malignant cells has the
- Dose dependent= more dose more
capability
cells destroyed
- Lymph, blood, angiogenesis
- Less selective- can damage normal
*primary tumor= where it came from;
cells more
primary incito
- Katakot na kasi magsalita kay dean
1. Cells Cycle Specific

- Acts on cells during a specific phase
A. Alkylating agent:
- Most effective when large numbers
- Directly damages DNA to prevent
of cells are dividing
cancer from reproducing
- Divided does produce better
- Usually indicated in almost all
cytotoxic effects
chemotherapy regimens; commonly

used
Antimetabolites Examples:
● Cyclophosphamide
- Interferes with RNA and DNA
● Mechloretamine
growth, substitutes building blocks
● Chlorambucil
of RNA and DNA
● Busulfan
- Specific for the S-Phase - replaces
● Cisplatin
building blocks of DNA so cells

can’t divide
B. Antitumor antibiotics
Examples:
- Binds with DNA to prevent RNA
● Methotrexate
synthesis
● 6- mercaptopurine
- Acts like alkylating agents
● 5- fluorouracil
Examples:
● Cytarabine
● Doxorubicin
● Hydrea
● Bleomycin

● Daunorubicin
Plant Alkaloids ● Adriamycin
● Plicamycin - Combined for the synergistic activity

C. Nitrosoureas OTHER CHEMOTHERAPEUTIC DRUG:
- Alkylating agents that are stronger; ● Elspar- enzyme for treatment of
has greater ability to attack cells in lymphocytic leukemia
resting phase ● Ulexin - antiandroggen used for
- Crosses the blood brain barrier prostate cancer
Examples: ● Taxol - used to treat ovarian, breast
● Streptozocin and cell lung cancer
● Carmustine (BiCNU)
● lomustine(CCNU) GOALS OF CHEMOTHERAPY
Cure
D. Miscellaneous agents/ - To cure malignancies an eradication
Procarbazine of cancer
- Used in chemotherapy but no exact - survivor ; free of cancer
mechanism Control
- If cure is not possible, aimed to
E. Hormonal agents prolong survival and improve quality
- Works in all cell cycles of life
- Used in therapy to affect the Palliation
hormonal environment of cells - Cure and control is not possible,
- Affect the growth of geared towards client comfort
hormone-dependent tumors Routes of Administration
- Steroids interfere with synthesis of ● Oral
proteins ● IM (90 degrees) and SC (45 degrees)
- Antihormones deprive the tumor of ● Intravenous = most common
necessary hormones. ● Central venous catheter infusion
Examples (hydrocortisones): ● Vascular Access Device
● Decadron ● Intraarterial
● DES ● Intraperitoneal
● Halotestin ● Ommaya Reservoir
● Tamoxifen ○ Administered direct to CSF
● prednisone ○ For tumors that cannot be
removed surgically
COMBINATION THERAPY ○ Continuously assess for ICP
- More effective; best cure Dosage and timing
- Enhances the response rate - Clients body surface are and mass
- drugs that are effective alone are - Time lapses allow recovery of
combined to act on erratically normal cells
dividing cells
- Side effects and whey they are likely ● Wear PPE when handling body
to occur fluids of patients, these fluids may
- Liver and kidney functions be contaminated even after 48 hrs
● Handle linens according to the
Precautions facility`s SOP
● Antineoplastic drugs are potentially ● If chemo drugs came in contact with
harmful to the personnel (HCW) skin
● May cause teratogenic and/ or ○ Wash with soap and water
carcinogenic effects ○ Do not abrade skin with
● Safety precautions must be scrub
observed ● If in contact with eyes
● Safety guidelines by the ○ Flush with copious amounts
Occupational Safety and Health of water, holding eyelids for
Administration (OSHA) 5mins
● Obtain special training for drug ○ Go to Emergency
administration Department
● Wear surgical latex gloves at least ● When infusing vesicant drugs, stop
.007 thickness infusion at first sign of
● Wear disposable, closed, long extravasation(IVfluid with med is out
sleeved gown of lane), remove IV fluid and follow
● Use Luer-lock syringes recommended protocol.
● Label drugs appropriately NX:responsibility: Check if may back flow,
● Double bag chemotherapeutic itaas mo tapos kapag wala ibig sabihin may
drugs before transport mali.
● Have the spill kit ready
● Dispose waste materials in the Extravasation
hazardous waste container (yellow) - Vesicant drug are those that can
● Dispose needles and syringe intact cause tissue necrosis to tendons,
● Be aware of the facility's SOP in nerve and blood vessel
administration - pH is thought to be responsible for
● Double check chemotherapy orders severe inflammatory reaction
with another nurse - Full extent of damage may be
● Read the material safety data sheets evident after several weeks
before administration - Skin grafts may be necessary
● Use PPE depending on extent
● Wash hands before donning gloves
and after taking them off Examples:
● After the infusion, dispose ● dactinomycin
equipment in puncture proof ● Daunorubicin
containers properly labelled. ● Doxorubicin
● Nitrogen mustard Erythema

● Mitomycin Ulcertions
● Vinblastine
● Vincristine Interventions
● Bindensine ● Good oral hygiene
● mouthwashes
Assess for: ● Sofr, bland and tepid diet
● Absence of blood return from IV ● Avoid acidic, sharp, and spicy food
catheter
● Resistance to flow of IVF NAUSEA VOMITING AND ANOREXIA
● Swelling, pain or redness -stimulation of the vomiting center in the
If extravasation is suspected: medulla
● Stop the infusion -anorexia may brought about by stomatitis
● Apply ice to site Interventions
● Inform Physician - Antiemetics
- Support change in food preference
SIDE EFFECTS AND NURSING - Small frequent meals
MANAGEMENT Alopecia
Side Effects are usually caused by the - Bald
mechanism of action of potent drugs on - Hair loss- damage to rapidly
normal cells proliferating cells the hair follicles
● Rapidly proliferating cells are usually - Begins 2 to 3 weeks after chemo
most affected - Regrowth follows through the
○ Bone marrow cells course
○ Epithelial cells of GIT *the hair can regrow but not as healthy as
○ Hair follicles before
○ Cells of the gonads Interventions
● Not rapidly reproducing cells are not ● Scalp hypothermia
usually affected; except where ● Scalp tourniquet
there is injury and repair ● Mild shampoo and conditioner; pat
● Nadir - time of most severe dry
depression of cells ● Use wide toothed com
● Prevent trauma to scalp
Mucositis- oral cavity through GIT ● Wig
- Nausea and vomiting Disturbance in Elimination
- Anorexia - When clients do no eat well
- Fluid and electrolyte imbalance - Exercise
- Dietary Insufficiency and stomatitis - Mucositis

Assess for: Assessment:
- Elimination oattern
Reproductive System
- Fluid and nutrutional sratus
- Testicular and ovarian functions
Diarrhea/ or Constipation may be affected
- Toxicity to the mucosal lining - Possibility of sterility
- Caused by affection of nerve ending Men :
GIT ● Temporary or permanent
- Bland diet and low residue azoospermia
- Add more fiber ad liquid to diet ● Chromosomal abnormalities in
- Avoid milk and dairy products offspring
- Food high potassium’ ● Sperm banking is advised
- Stool softeners; may use vegetable Women:
laxatives - Disruption in normal ovulation
- Early menopause

Renal system
Interventions
- Damage the kidneys during - Education about possible changes
excretion and accumulation of end - Continue to adhere to birth control
products during cell lysis method
- Rapid tumor cell lysis increase uric
acid excretion Neurologic system
- Uric acid crystals may form - Plant alkaloids can cause neurologic
Interventions damage
● Monitor BUN, Seru, creatinine and - Usually reversible and disappears
creatinine clearance after therapy
● Hydration - Educate patient about symptoms
● Alkalinization of urine ● Peripheral neuropathies
● allopurinol ● Loss of deep tendon reflexes
● Paralytic ileus
● Hearing loss
Cardiopulmonary system

● Chemotherapy (anti tumor
Fatigue
antibiotics) can produce cardiac
- Response to the systemic changes
toxicities - dosage if 550 mg/m2
- Distressing for patients
● Cardiac ejection fraction and signs
- Debilitating that may last for months
of CHF must be monitored
- Goal is geared toward to increasing
● Bleomycin, carmustine and busulfan
tolerance to activities
may cause pulmonary fibrosis
Hematologic disruptions:
● Monitor for pulmonary function
- Damage to bone marrow cell

(myelosuppression)
○ Leukopenia (WBC less than - If the venipuncture, draw all blood

5000/mm) for lab work with one venipuncture
● Granulocytes are the more
suppressed Added info:
● More susceptible to bacterial Benign
infection: - Enlarging and expanding but
○ Skin localized
○ Lungs - Encapsulated and can be surgically
○ Urinary Tract removed
○ Blood - After removal no recurrence
Assess for signs of infection - Prognosis = good
● Fever, chills, sore throat Malignant
● Goal os to prevent infection - infrentrating cell tissue
● Meticulous aseptic technique for IV - Absence of capsule
Therapy - Cancerous
● Handwashing - Can recur
● Avoiding exposure to infected - Prognosis: poor/bad
persons
○ Thrombocytopenia (platelet
The Immune System
less than 150,000/cu mm)
- Predispose clients to bleeding - The immune system consists of a
- Gums, nose easy bruising, heavier network of lymphatic organs,
menstrual flow tissues, and cells. These structures
are supported by the
Assess for signs of bleeding: reticuloendothelial system: loose
- Petechiae connective tissue with a network of
- Hgb / Hct count other labs reticular fibers.
- Frank or occult bleeding
*check mucosa of mouth Body’s Defenses:
*very pale 1. First Line of Defense
*ask if may blood ang stool ● Innate Defense
Prevention of bleeding: ● Physical and chemical
- Soft bristles barriers are the body's first
- Electric shavers line of defense
- Care with trimming nails (emery ● Physical/Mechanical Barriers
board) ● Skin
- Avoid rectal temperature taking, ● Mucous Membranes
enemas, suppositories ● Nose
- Avoid activities that increase ICP ● Lungs
● Mouth and Pharynx
● Digestive system
● Urinary tract d. Pulse below 60 beats/min and

● Etc. irregular rate
2. Second Line of Defense
● Non-specific responses 4. The client is also taking a diuretic
● Inflammatory Response that decreases her potassium level.
Complement System
● The nurse expects that a low
Interferons
● potassium level (hypokalemia) could
have what effect on the digoxin?
PHARMACOLOGY CARDIOVASCULAR a. Increase the serum digoxin
DRUGS NCLEX sensitivity level
b. Decrease the serum digoxin
1. A newly admitted client takes sensitivity level
digoxin 0.25 mg/day. The nurse c. Not have any effect on the serum
knows that which is the serum digoxin sensitivity level
therapeutic range for digoxin? d. Cause a low average serum
a. 0.1 to 1.5 ng/mL digoxin sensitivity level
b. 0.5 to 2.0 ng/mL
c. 1.0 to 2.5 ng/ml 5. When a client first takes nitrate, the
d. 2.0 to 4.0 ng/mL nurse expects which symptom that
often occurs?
2. The client's serum digoxin level is
3.0 ng/mL. What does the nurse a. Nausea and vomiting
know about this serum digoxin b. Headaches
level? c. Stomach cramps
a. It is in the high (elevated) range. d. Irregular pulse rate
b. It is in the low (decreased) range.
c. It is within the normal range. 6. The nurse acknowledges that beta
d. It is in the low average range. blockers are as effective as
antianginals because they do what?
3. The nurse is assessing the client for a. Increase oxygen to the systemic
possible evidence of digitalis circulation.
toxicity. The nurse acknowledges b. Maintain heart rate and blood
that which is included in the signs pressure.
and symptoms for digitalis toxicity? c. Decrease heart rate and decrease
myocardial contractility.
a. Pulse (heart) rate of 100 d. Decrease heart rate and increase
beats/min myocardial contractility.
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min 7. The health care provider is planning
and irregular rate to discontinue a client's beta
blocker. What instruction should the b. "Apply the patch to the same site

nurse give the client regarding the each day."
beta blocker? c. "If you have a headache, remove
the patch for 4 hours and then
a. The beta blocker should be reapply."
abruptly stopped when another d."If you have chest pain, apply a
cardiac drug is prescribed. second patch next to the first
b. The beta blocker should NOT be patch."
abruptly stopped; the dose should
be tapered down. 10. A nurse is monitoring a client with
c. The beta blocker dose should be angina for therapeutic effects of
maintained while taking another nitroglycerin. Which assessment
antianginal drug. finding indicates that the
d. Half the beta blocker dose should nitroglycerin has been effective?
be taken for the next several weeks.
a. Blood pressure 120/80 mm Hg
8. The beta blocker acebutolol b. Heart rate 70 beats per minute
(Sectral) is prescribed for c. ECG without evidence of ST
dysrhythmias. The nurse knows changes
what is the primary purpose of the d. Client stating that pain is 0 out of
drug? 10

a. To increase the beta1 and beta2 11. The nurse is monitoring a client
receptors in the cardiac tissues during IV nitroglycerin infusion.
b. To increase the flow of oxygen to Which assessment finding will cause
the cardiac tissues the nurse to take action?
c. To block the beta1-adrenergic
receptors in the cardiac tissues a. Blood pressure 110/90 mm Hg
d. To block the beta2-adrenergic b. Flushing
receptors in the cardiac tissues c. Headache
d. Chest pain

9. A client is to be discharged home 12. Which statement made by the client
with a transdermal nitroglycerin demonstrates a need for further
patch. Which instruction will the instruction regarding the use of
nurse include in the client's teaching nitroglycerin?
plan?
a. "Apply the patch to a non-hairy a. "If I get a headache, I should keep
area of the upper torso or arm." taking nitroglycerin and use Tylenol
for pain relief."
b. "I should keep my nitroglycerin in

a cool, dry place."
c. "I should change positions slowly 15. What will the nurse instruct the
to avoid getting dizzy." client to do to prevent the
d. "I can take up to five tablets at development of tolerance to
3-minute intervals for chest pain if nitroglycerin?
necessary."
a. Apply the nitroglycerin patch
every other day.
13. Which client assessment would b. Switch to sublingual nitroglycerin
assist the nurse in evaluating when the client's systolic blood
therapeutic effects of a calcium pressure elevates to more than 140
channel blocker? mm Hg.
c. Apply the nitroglycerin patch for
a. Client states that she has no 14 hours and remove it for 10 hours
chest pain. at night.
b. Client states that the swelling in d. Use the nitroglycerin patch for
her feet is reduced. acute episodes of angina only.
c. Client states that she does not
feel dizzy.
d. Client states that she feels 16. Before the nurse administers
stronger. isosorbide mononitrate (Imdur),
what is a priority nursing
14. What statement is the most assessment?
important for the nurse to include in
the teaching plan for a client who a. Assess serum electrolytes.
has started on a transdermal b. Measure blood urea nitrogen and
nitroglycerin patch? creatinine.
c. Assess blood pressure.
a. "This medication works faster d. Monitor level of consciousness.
than sublingual nitroglycerin works."
b. "This medication is the strongest 17. The client asks the nurse how
of any nitroglycerin preparation nitroglycerin should be stored while
available." traveling. What is the nurse's best
c. "This medication should be used response?
only when you are experiencing
chest pain." a. "You can protect it from heat by
d. "This medication will work for 24 placing the bottle in an ice chest."
hours and you will need to change b. "It's best to keep it in its original
the patch daily." container away from heat and light."
c. "You can put a few tablets in a rate of 16 breaths/min. What is the
resealable bag and carry it in your nurse's priority action?
pocket."
d. "It's best to lock them in the a. Assess the client's lung sounds.
glove compartment to keep them b. Decrease the intravenous
away from heat and light." nitroglycerin by 10 mcg/min.
18. Which statement indicates to the c. Stop the nitroglycerin infusion for
nurse that the client understands 1 hour, and then restart.
sublingual nitroglycerin medication d. Recheck the client's vital signs in
instructions? 15 minutes but continue the
a. "I will take up to five doses every infusion.
3 minutes for chest pain."
b. "I can chew the tablet for the 21. The nurse is monitoring a client
quickest effect." taking digoxin (Lanoxin) for
c. "I will keep the tablets locked in a treatment of heart failure. Which
safe place until I need them." assessment finding indicates a
d. "I should sit or lie down after I therapeutic effect of the drug?
take a nitroglycerin tablet to prevent
dizziness." a. Heart rate 110 beats per minute
b. Heart rate 58 beats per minute
c. Urinary output 40 mL/hr
19. What instruction should the nurse d. Blood pressure 90/50 mm Hg
provide to the client who needs to
apply nitroglycerin ointment? 22. A client's serum digoxin level is
drawn, and it is 0.4 ng/mL. What is
a. Use the fingers to spread the the nurse's priority action?
ointment evenly over a 3-inch area.
b. Apply the ointment to a non-hairy a. Administer the ordered a dose of
part of the upper torso. digoxin.
c. Massage the ointment into the b. Hold future digoxin doses.
skin. c. Administer potassium.
d. Cover the application paper with d. Call the health care provider.
ointment before use.
23. A client is taking digoxin (Lanoxin)
20. A client receiving intravenous 0.25 mg and furosemide (Lasix) 40
nitroglycerin at 20 mcg/min mg. When the nurse enters the
complains of dizziness. Nursing room, the client states, "There are
assessment reveals a blood yellow halos around the lights."
pressure of 85/40 mm Hg, heart rate Which action will the nurse take?
of 110 beats/min, and respiratory
a. Evaluate digoxin levels. c. Monitor blood pressure

b. Withhold the furosemide continuously.
c. Administer potassium. d. Maintain an infusion of lactated
d. Document the findings and Ringers with Primacor infusion.’
reassess in 1 hour.
27. A client's recently drawn serum
24. Which assessment finding will alert lidocaine drug level is 3.0 mcg/mL.
the nurse to suspect early digitalis What is the nurse's priority
toxicity? intervention?
a. Increase the lidocaine infusion.
a. Loss of appetite with slight b. Decrease the lidocaine infusion.
bradycardia c. Continue to monitor the client.
b. Blood pressure 90/60 mm Hg d. Stop the IV drip for 1 hour.
c. Heart rate 110 beats per minute
d. Confusion and diarrhea 28. A client is admitted to the
emergency department with
25. The nurse reviews a client's paroxysmal supraventricular
laboratory values and finds a tachycardia. What intervention is the
digoxin level of 10 ng/mL and a nurse's priority?
serum potassium level of 5.9 mEq/L.
What is the nurse's primary a. Administration of digoxin IV push
intervention? b. Administration of oxygen, 2 lpm
c. Rapid IV bolus of Adenosine
a. To administer atropine (Adenocard)
b. To administer digoxin immune d. Instructing client to "bear down"
FAB
c. To administer epinephrine 29. A nurse is caring for a client who
d. To administer Kayexalate has been started on ibutilide
(Corvert). Which assessment is a
26. A client is to begin treatment for priority for this client?
short-term management of heart
failure with milrinone lactate a. Blood pressure measurement
(Primacor). What is the priority b. BUN and creatinine
nursing action? c. ECG
d. Lung sounds
a. Administer digoxin via IV infusion
with the Primacor. 30. Which assessment finding will alert
b. Administer Lasix (furosemide) via the nurse to possible toxic effects of
IV infusion after the Primacor. amiodarone?
a. Heart rate 100 beats per minute
b. Crackles in the lungs

c. Elevated blood urea nitrogen a. Hemoglobin and hematocrit
d. Decreased hemoglobin b. Blood urea nitrogen (BUN)
c. Arterial blood gases
31. What must the nurse monitor when d. Serum glucose (sugar)
titrating intravenous nitroglycerin for 35. A client has heart failure and is
a client? (Select all that apply.) prescribed Lasix. The nurse is aware
that furosemide (Lasix) is what kind
a. Continuous oxygen saturation of drug?
b. Continuous blood pressures
c. Hourly ECGs a. Thiazide diuretic
d. Presence of chest pain b. Osmotic diuretic
e. Serum nitroglycerin levels c. High-ceiling (loop) diuretic
f. Visual acuity d. Potassium-sparing diuretic

32. A client is taking 36. The nurse acknowledges that which
hydrochlorothiazide 50 mg/day and condition could occur when taking
digoxin 0.25 mg/day. What type of furosemide?
electrolyte imbalance does the a. Hypokalemia
nurse expect to occur? b. Hyperkalemia
c. Hypoglycemia
a. Hypocalcemia d. Hypermagnesemia
b. Hypokalemia
c. Hyperkalemia 37. For the client taking a diuretic, a
d. Hypermagnesemia combination such as triamterene
and hydrochlorothiazide may be
33. What would cause the same client's prescribed. The nurse realizes that
electrolyte imbalance? this combination is ordered for
which purpose?
a. High dose of digoxin
b. Digoxin taken daily a. To decrease the serum potassium
c. Hydrochlorothiazide level
d. Low dose of hydrochlorothiazide b. To increase the serum potassium
level
34. A nurse teaching a client who has c. To decrease the glucose level
diabetes mellitus and is taking d. To increase the glucose level
hydrochlorothiazide 50 mg/day. The
teaching should include the 38. The client has been receiving
importance of monitoring which spironolactone (Aldactone) 50
levels? mg/day for heart failure. The nurse
should closely monitor the client for 41. What is the best information for the
which condition? nurse to provide to the client
who is receiving spironolactone
a. Hypokalemia (Aldactone) and furosemide (Lasix)
b. Hyperkalemia therapy?
c. Hypoglycemia
d. Hypermagnesemia a. "Moderate doses of two different
39. A client who has angina is diuretics are more effective than a
prescribed nitroglycerin. The nurse large dose of one."
reviews which appropriate nursing b. "This combination promotes
interventions for nitroglycerin (Select diuresis but decreases the risk of
all that apply.) hypokalemia."
c. "This combination prevents
a. Have the client lie down when dehydration and hypovolemia."
taking a nitroglycerin sublingual d. "Using two drugs increases the
tablet. osmolality of plasma and the
b. Teach the client to repeat taking a glomerular filtration rate."
tablet in 5 minutes if chest pain
persists. 42. The nurse is assessing a client who
c. Apply Transderm-Nitro patch to a is taking furosemide (Lasix). The
hairy area to protect skin from client's potassium level is 3.4
burning. mEq/L, chloride is 90 mmol/L, and
d. Call the health care provider after sodium is 140 mEq/L. What is the
taking 5 tablets if chest pain nurse's primary intervention?
persists.
e. Warn clients against ingesting a. Mix 40 mEq of potassium in 250
alcohol while taking nitroglycerin. mL D5W and infuse rapidly.
b. Administer Kayexalate.
40. Which laboratory value will the nurse c. Administer 2 mEq potassium
report to the health care provider as chloride per kilogram per day IV.
a potential adverse response to d. Administer PhosLo, two tablets
hydrochlorothiazide (HydroDIURIL)? three times per day.

a. Sodium level of 140 mEq/L 43. A nurse admits a client diagnosed
b. Fasting blood glucose level of with pneumonia. The client has a
140 mg/dL history of chronic renal insufficiency,
c. Calcium level of 9 mg/dL and the health care provider orders
d. Chloride level of 100 mEq/L furosemide (Lasix) 40 mg twice a
day. What is most important to
include in the teaching plan for this

client? a. A decrease in bicarbonate level
b. An increase in urinary output
a. That the medication will have to be c. A decrease in arterial pH
monitored very carefully owing to the d. An increase in PaO2
client's diagnosis of pneumonia.
b. The fact that Lasix has been proven to 47. A client is ordered furosemide
decrease symptoms with pneumonia. (Lasix) to be given via intravenous
c. The fact that Lasix has shown efficacy in push. What interventions should the
treating persons with renal insufficiency. nurse perform? (Select all that
d. That the medication will need to be given apply.)
at a higher than normal dose owing to the
client's medical problems. a. Administer at a rate no faster than
20 mg/min.
44. A client taking spironolactone b. Assess lung sounds before and
(Aldactone) has been taught about after administration.
the therapy. Which menu selection c. Assess blood pressure before
indicates that the client understands and after administration.
teaching related to this medication? d. Maintain accurate intake and
a. Apricots output records.
b. Bananas e. Monitor ECG continuously.
c. Fish f. Insert an arterial line for
d. Strawberries continuous blood pressure
monitoring.
45. Which client would the nurse need
to assess first if the client is 48. A client is prescribed Thalitone
receiving mannitol (Osmitrol)? (chlorthalidone). What is the most
a. A 67-year-old client with type 1 important information the nurse
diabetes mellitus should teach the client?
b. A 21-year-old client with a head
injury a. "Do not drink more than 10
c. A 47-year-old client with anuria ounces of fluid a day while on this
d. A 55-year-old client receiving medication."
cisplatin to treat ovarian cancer b. "Take this medication on an
empty stomach."
46. A nurse is caring for a client c. "Take this medication before bed
receiving acetazolamide (Diamox). each night."
Which assessment finding will d. "Wear protective clothing and
require immediate nursing sunscreen while on this
intervention? medication."
b. Monitor for side effects of

49. A client with hyperaldosteronism is hypoglycemia.
prescribed spironolactone c. Assess potassium levels.
(Aldactone). What assessment d. Monitor for Hypernatremia.
finding would the nurse evaluate as 53. The client asks the nurse why the
a positive outcome? health care provider prescribed
acetazolamide (Diamox), a diuretic,
a. Decreased potassium level to treat gout. What is the nurse's
b. Decreased crackles in the lung best response?
bases
c. Decreased aldosterone a. It causes an alkaline urine, which
d. Decreased ankle edema facilitates the elimination of uric
acid.
50. A client with acute pulmonary b. It increases alkalinity of urine,
edema receives furosemide (Lasix). thus decreasing the formation of
What assessment finding indicates uric acid.
that the intervention is working c. It causes an acid urine, which
facilitates the elimination of uric
a. Potassium level decreased from acid.
4.5 to 3.5 mEq/L. d. It decreases alkalinity of urine,
b. Crackles auscultated in the thus decreasing the formation of
bases. uric acid.
c. Lungs clear.
d. Output 30 mL/hr. 54. A client's blood pressure (BP) is
145/90. According to the guidelines
51. Which assessment indicates a for determining hypertension, the
therapeutic effect of mannitol nurse realizes that the client's BP is
(Osmitrol)? at which stage?

a. Decreased intracranial pressure a. Normal
b. Decreased potassium b. Prehypertension
c. Increased urine osmolality c. Stage 1 hypertension
d. Decreased serum osmolality d. Stage 2 hypertension’

52. Which intervention will the nurse 55. The nurse acknowledges that the
perform when monitoring a client first-line drug for treating this
receiving triamterene (Dyrenium)? client's blood pressure might be
which drug?
a. Assess urinary output hourly. a. Diuretic
b. Alpha blocker
c. ACE inhibitor c. Upset stomach

d. Alpha/beta blocker d. Constant, irritating cough
60. A client is prescribed losartan
56. The nurse is aware that which (Cozaar). The nurse teaches the
group(s) of antihypertensive drugs client that an angiotensin II receptor
are less effective in blocker (ARB) acts by doing what?
African-American clients?
a. Inhibiting angiotensin-converting
a. Diuretics enzyme
b. Calcium channel blockers and b. Blocking angiotensin II from AT1
vasodilators receptors
c. Beta blockers and ACE inhibitors c. Preventing the release of
d. Alpha blockers angiotensin I
d. Promoting the release of
57. The nurse knows that which diuretic aldosterone
is most frequently combined with an
antihypertensive drug? 61. During an admission assessment,
the client states that she takes
a. chlorthalidone amlodipine (Norvasc). The nurse
b. hydrochlorothiazide wishes to determine whether or not
c. bendroflumethiazide the client has any common side
d.potassium-sparing diuretic effects of a calcium channel blocker.
The nurse asks the client if she has
58. The nurse explains which beta which signs and symptoms? (Select
blocker category is preferred for all that apply.)
treating hypertension?
a. Insomnia
a. Beta1 blocker b. Dizziness
b. Beta2 blocker c. Headache
c. Beta1 and beta2 blockers d. Angioedema
d. Beta2 and beta3 blockers e. Ankle edema
f. Hacking cough
59. Captopril (Capoten) has been
ordered for a client. The nurse 62. Which statement indicates that the
teaches the client that ACE client needs additional instruction
inhibitors have which common side about antihypertensive treatment?
effects?
a. "I will check my blood pressure
a. Nausea and vomiting daily and take my medication when
b. Dizziness and headaches it is over 140/90."
b. "I will include rest periods during nursing intervention is a priority for
the day to help me tolerate the this client?
fatigue my medicine may cause."
c. "I will change my position slowly a. Assessment of blood glucose
to prevent feeling dizzy." levels
d. "I will not mow my lawn until I see b. Respiratory assessment
how this medication makes me c. Orthostatic blood pressure
feel." assessment
d. Teaching about potential
63. A nurse is caring for a client who is tachycardia
taking an angiotensin-converting
enzyme inhibitor and develops a 66. Which client will the nurse assess
dry, nonproductive cough. What is first?
the nurse's priority action?
a. The client who has been on beta
a. Call the health care provider to blockers for 1 day.
switch the medication. b. The client who is on a beta
b. Assess the client for other blocker and a thiazide diuretic.
symptoms of upper respiratory c. The client who has stopped
infection. taking a beta blocker due to cost.
c. Instruct the client to take d. The client who is taking a beta
antitussive medication until the blocker and Lasix (furosemide).
symptoms subside.
d. Tell the client that the cough will 67. The nurse is caring for a client with
subside in a few days. hypertension who is prescribed
Clonidine transdermal preparation.
64. The nurse is reviewing a medication What is the correct information to
history on a client taking an ACE teach this client?
inhibitor. The nurse plans to contact
the health care provider if the client a. Change the patch daily at the
is also taking which medication? same time.
b. Remove the patch before taking a
a. docusate sodium (Colace) shower or bath.
b. furosemide (Lasix) c. Do not take other
c. morphine sulfate antihypertensive medications while
d. spironolactone (Aldactone) on this patch.
d. Get up slowly from a sitting to a
65. A client is prescribed a non standing position.
cardioselective beta1 blocker. What
68. The client taking Methyldopa a. "Your blood pressure should be
(Aldomet) has elevated liver function checked by a health care provider at
tests. What is the nurse's best least once a year."
action? b. "Increasing fluid and fiber in your
diet can help prevent the side effect
a. Document the finding and of constipation."
continue care. c. "Intense exercise or prolonged
b. Notify the health care provider. standing is not a problem with
c. Immediately stop the medication. clonidine as it can be with other
d. Change the client's diet. antihypertensive agents."
d. "If you are having difficulty with
69. A client taking prazosin has a blood the common side effect of drooling,
pressure of 140/90. The client is notify your health care provider so
complaining of swollen feet. What is your dosage can be adjusted."
the nurse's best action?
72. During assessment of a client
diagnosed with
a. Hold the medication. pheochromocytoma, the nurse
b. Call the health care provider. auscultates a blood pressure of
c. Determine the client's history. 210/110 mm Hg. What is the nurse's
d. Weigh the client. best action?

70. A calcium channel blocker has been a. To ask the client to lie down and
ordered for a client. Which condition rest
in the client's history is a b. To assess the client’s dietary
contraindication to this medication? intake of sodium and fluid
c. To administer phentolamine
a. Hypokalemia (Regitine)
b. Dysrhythmias d. To administer nitroprusside
c. Hypotension (Nipride)
d. Increased intracranial pressure
73. Which is a priority nursing diagnosis
71. A client who takes clonidine for a client taking an
(Catapres) is to be discharged to antihypertensive medication?
home. Which instruction will the
nurse include when teaching this a. Alteration in cardiac output
client? related to effects on the sympathetic
nervous system
b. Knowledge deficit related to
medication regimen
c. Fatigue related to side effects of d. A four-times shorter half-life than
medication heparin
d. Alteration in comfort related to
nonproductive cough 77. The nurse is teaching a client about
clopidogrel (Plavix). What is
74. When a newly admitted client is important information to include?
placed on heparin, the nurse
acknowledges that heparin is a. Constipation may occur.
effective for preventing new clot b. Hypotension may occur.
formation in clients who have which c. Bleeding may increase when
disorder(s)? (Select all that apply.) taken with aspirin.
d. Normal dose is 25 mg tablet per
a. Coronary thrombosis day.
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT) 78. A client is prescribed dalteparin
d. Cerebrovascular accident (CVA) (Fragmin). LMWH is administered
(stroke) via which route?
e. Venous disorders
a. Intravenously
b. Intramuscularly
75. A client who received heparin c. Intradermally
begins to bleed, and the physician d. Subcutaneously
calls for the antidote. The nurse
knows that which is the antidote for 79. A client is being changed from an
heparin? injectable anticoagulant to an oral
anticoagulant. Which anticoagulant
a. protamine sulfate does the nurse realize is
b. vitamin K administered orally?
c. aminocaproic acid
d. vitamin C a. enoxaparin sodium (Lovenox)
b. warfarin (Coumadin)
76. A client is prescribed enoxaparin c. bivalirudin (Angiomax)
(Lovenox). The nurse knows that d. lepirudin (Refludan)
low-molecular-weight heparin 80. A client is taking warfarin 5 mg/day
(LMWH) has what kind of half-life? for atrial fibrillation. The client's
international normalized ratio (INR)
a. A longer half-life than heparin is 3.8. The nurse would consider the
b. A shorter half-life than heparin INR to be what?
c. The same half-life as heparin
a. Within normal range
b. Elevated INR range d. Low-molecular-weight heparin

c. Low INR range (LMWH)
d. Low average INR range 84. A client is receiving an intravenous
heparin drip. Which laboratory value
81. Cilostazol (Pletal) is being will require immediate action by the
prescribed for a client with coronary nurse?
artery disease. The nurse knows
that which is the major purpose for a. Platelet count of 150,000
antiplatelet drug therapy? b. Activated partial thromboplastin
time (aPTT) of 120 seconds
a. To dissolve the blood clot c. INR of 1.0
b. To decrease tissue necrosis d. Blood urea nitrogen (BUN) level of
c. To inhibit hepatic synthesis of 12 mg/dL
vitamin K
d. To suppress platelet aggregation 85. A client who has been taking
warfarin (Coumadin) is admitted with
82. A client is to undergo a coronary coffee-ground emesis. What is the
angioplasty. The nurse nurse's primary action?
acknowledges that which drug is
used primarily for preventing a. Administer vitamin E.
reocclusion of coronary arteries b. Administer vitamin K.
following a coronary angioplasty? c. Administer protamine sulfate.
d. Administer calcium gluconate.
a. clopidogrel (Plavix)
b. abciximab (ReoPro) 86. The client has an international
c. warfarin (Coumadin) normalized ratio (INR) value of 1.5.
d. streptokinase What action will the nurse take?

83. A client is admitted to the a. Administer an additional dose of
emergency department with an warfarin (Coumadin).
acute myocardial infarction. Which b. Hold the next dose of warfarin
drug category does the nurse (Coumadin).
expect to be given to the client early c. Increase the heparin drip rate.
for the prevention of tissue necrosis d. Administer protamine sulfate.
following blood clot blockage in a
coronary or cerebral artery? 87. A client is receiving warfarin
(Coumadin) for a chronic condition.
a. Anticoagulant agent Which client statement requires
b. Antiplatelet agent immediate action by the nurse?
c. Thrombolytic agent
a. "I will avoid contact sports."

b. "I will take my medication in the a. Draw up the medication in a
early evening each day." syringe with a 22-gauge, 1-½ inch
c. "I will increase dark-green, leafy needle.
vegetables in my diet." b. Utilize the Z-track method to
d. "I will contact my health care inject the medication.
provider if I develop excessive c. Administer the medication into
bruising." subcutaneous tissue.
d. Rub the administration site after
88. A client is taking enoxaparin injecting.
(Lovenox) daily. Which client
statement requires additional 91. The client asks what the difference
monitoring? is between dalteparin (Fragmin) and
heparin. What is the nurse's best
a. "I take aspirin daily for response?
headaches."
b. "I take ibuprofen (Motrin) at least a. "There is no real difference.
once a week for joint pain." Dalteparin is preferred because it is
c. "Whenever I have a fever, I take less expensive."
acetaminophen (Tylenol)." b. "Dalteparin is a
d. "I take my medicine first thing in low-molecular-weight heparin that is
the morning." more predictable in its effect and
has a lower risk of bleeding."
89. The client is receiving tirofiban c. "I'm not sure why some health
(Aggrastat). What is an essential care providers choose dalteparin
nursing intervention for this client? and some heparin. You should ask
your doctor."
a. Have protamine sulfate available d. "The only difference is that
in case of an overdose. heparin dosing is based on the
b. Weigh the client before client's weight."
administration.
c. Have vitamin K available in case 92. A client has been admitted through
of an overdose. the emergency department and
d. Assess intake and output. requires emergency surgery. The
client has been receiving heparin.
90. A nurse is preparing to administer What nursing intervention is
enoxaparin sodium (Lovenox) to a essential?
client for prevention of deep vein
thrombosis. What is an essential a. Teach the client about the
nursing intervention? phenytoin.
b. Administer protamine sulfate.

c. Assess the INR before surgery. a. "Your concern is valid. I will call
d. Administer vitamin K. the doctor to discontinue the
heparin."
93. What nursing intervention is b. "It usually takes about 3 days to
essential for the client receiving achieve a therapeutic effect for
alteplase? warfarin, so the heparin is continued
until the warfarin is therapeutic."
a. Assess for reperfusion c. "Because of your valve
dysrhythmias. replacement, it is especially
b. Monitor liver enzymes. important for you to be
c. Administer vitamin K if bruising is anticoagulated. The heparin and
observed. warfarin together are more effective
d. Monitor blood pressure and stop than one alone."
the medication if blood pressure d. "Because you are now up and
drops below 110 systolic. walking, you have a higher risk of
blood clots and therefore need to be
94. A client who is taking warfarin on both medications."
(Coumadin) requests an aspirin for
headache relief. What is the nurse's 96. The nurse evaluates that the client
best response? understood discharge teaching
regarding warfarin (Coumadin)
a. Administer 650 mg of based on which statement?
acetylsalicylic acid (ASA) and
reassess pain in 30 minutes. a. "I will double my dose if I forget to
b. Teach the client of potential drug take it the day before."
interactions with anticoagulants. b. "I should keep taking ibuprofen
c. Explain to the client that ASA is for my arthritis."
contraindicated and administer c. "I should decrease the dose if I
ibuprofen as ordered. start bruising easily."
d. Explain that the headache is an d. "I should use a soft toothbrush
expected side effect and will for dental hygiene."
subside shortly.
97. What intervention is essential before
95. A client is started on warfarin the nurse administers tenecteplase
(Coumadin) therapy while still (TNKase)?
receiving intravenous heparin. The
client questions the nurse about the a. Perform all necessary
risk of bleeding. How should the venipunctures.
nurse respond?
b. Administer aminocaproic acid

(Amicar). a. It is lower than the desired level of
c. Have the client void. HDL.
d. Assess for allergies to iodine. b. It is the desired level of HDL.
c. It is higher than the desired level
98. Which nursing diagnosis would be of HDL.
possible for a client receiving d. It is a much lower HDL level than
intravenous heparin therapy? desired

a. Potential for fluid volume 102. The nurse realizes that which is
excess the laboratory test ordered to
b. Potential for pain determine the presence of the
c. Risk for injury amino acid that can contribute to
d. Potential for body image cardiovascular disease and stroke?
disturbance
a. antidiuretic hormone
99. A client has a serum cholesterol b. Homocysteine
level of 265 mg/dL, triglyceride level c. ceruloplasmin
of 235 mg/dL, and LDL of 180 d. cryoglobulin
mg/dL. What do these serum levels
indicate? 103. A client is taking lovastatin
(Mevacor). Which serum level is
a. Hypolipidemia most important for the nurse to
b. Normolipidemic monitor?
c. Hyperlipidemia
d. Alipidemia a. Blood urea nitrogen
b. Complete blood count
100. The nurse knows that the c. Cardiac enzymes
client's cholesterol level should be d. Liver enzymes
within which range?
104. The client is taking rosuvastatin
a. 150 to 200 mg/dL (Crestor). What severe skeletal
b. 200 to 225 mg/dL muscle adverse reaction should the
c. 225 to 250 mg/dL nurse observe for?
d. Greater than 250 mg/dL
a. Myasthenia gravis
101. A client's high-density b. Rhabdomyolysis
lipoprotein (HDL) is 60 mg/dL. What c. Dyskinesia
does the nurse acknowledge d. Agranulocytosis
concerning this level?
105. When a client is taking ezetimibe a. "I will take Questran 1 hour before

(Zetia), she asks the nurse how it my other medications."
works. The nurse should explain b. "I will increase fiber in my diet."
that Zetia does what? c. "I will weigh myself weekly."
d. "I will have my blood pressure
a. Inhibits absorption of dietary checked weekly."
cholesterol in the intestines.
b. Binds with bile acids in the 108. The nurse plans which
intestines to reduce LDL levels. intervention to decrease the flushing
c. Inhibits HMG-CoA reductase, reaction of niacin?
which is necessary for cholesterol
production in the liver. a. Administer niacin with an antacid.
d. Forms insoluble complexes and b. Administer aspirin 30 minutes
reduces circulating cholesterol in before nicotinic acid.
blood. c. Administer diphenhydramine
hydrochloride (Benadryl) with niacin.
106. A client is diagnosed with d. Apply cold compresses to the
peripheral arterial disease (PAD). He head and neck.
is prescribed isoxsuprine
(Vasodilan). The nurse 109. The nurse is reviewing
acknowledges that isoxsuprine does instructions for a client taking an
what? (Select all that apply.) HMG-CoA reductase inhibitor
(statin). What information is essential
a. Relaxes the arterial walls within for the nurse to include?
the skeletal muscles
b. May cause hypotension, chest a. "Take this medication on an
pain, and palpitations empty stomach."
c. Increases the rigidity of b. "Take this medication at the same
arteriosclerotic blood vessels time each day."
d. May increase intermittent c. "Take this medication with
claudication breakfast."
e. May lead to hypertension and d. "Take this medication with an
bradycardia antacid."
f. Commonly causes an adverse
effect of rhabdomyolysis 110. A client is prescribed gemfibrozil
107. Which statement indicates the (Lopid) for treatment of
client understands discharge hyperlipidemia type IV. What is
instructions regarding important for the nurse to teach the
cholestyramine (Questran)? client?

a. "Take aspirin before the 113. A nurse is caring for a client
medication if you experience facial taking cholestyramine (Questran).
flushing." The client is complaining of
b. "You may experience headaches constipation. What will the nurse
with this medication." do?
c. "You will need to have weekly
blood drawn to assess for a. Call the health care provider to
hyperkalemia." change the medication.
d. "Cholesterol levels will need to be b. Tell the client to skip a dose of
assessed daily for one week." the medication.
c. Have the client increase fluids
111. Which statement made by the and fiber in his diet.
client indicates understanding about d. Administer an enema to the
discharge instructions on client.
antihyperlipidemic medications?
114. Which statement indicates to the
a. "Antihyperlipidemic medications nurse that the client needs further
will replace the other interventions I medication instruction about
have been doing to try to decrease colestipol (Colestid)?
my cholesterol."
b. "It is important to double my dose a. "The medication may cause
if I miss one in order to maintain constipation, so I will increase fluid
therapeutic blood levels." and fiber in my diet."
c. "I will stop taking the medication b. "I should take this medication 1
if it causes nausea and vomiting." hour after or 4 hours before my
d. "I will continue my exercise other medications."
program to help increase my c. "I might need to take fat-soluble
high-density lipoprotein serum vitamins to supplement my diet."
levels." d. "I should stir the powder in as
small an amount of fluid as possible
112. A client is prescribed ezetimibe to maintain potency of the
(Zetia). Which assessment finding medication."
will require immediate action by the
nurse? 115. Which assessment finding in a
client taking an HMG-CoA
a. Headache. reductase inhibitor will the nurse act
b. Slight nausea. on immediately?
c. Muscle pain.
d. Fatigue. a. Decreased hemoglobin
b. Elevated liver function tests
c. Elevated HDL
d. Elevated LDL a. cholestyramine (Questran)
b. colestipol (Colestid)
116. A 70-year-old client who is c. gemfibrozil (Lopid)
taking several cardiac d. simvastatin (Zocor)
antidysrhythmic medications has
been prescribed simvastatin (Zocor) 119. The nurse would question an
80 mg/day. What is essential order for cholestyramine (Questran)
information for the nurse to teach if the client has which condition?
the client?
a. Impaction
a. "This dose may lower your b. Glaucoma
cholesterol too much." c. Hepatic disease
b. "These factors may put you at d. Renal disease
higher risk for myopathy."
c. "You should not take this drug 120. The nurse reviews the history for
with cardiac medications." a client taking atorvastatin (Lipitor).
d. "This combination will cause you What will the nurse act on
to have nausea and vomiting." immediately?

117. A client diagnosed with a. Client takes medications with
hypercholesterolemia is prescribed grape juice.
lovastatin (Mevacor). The nurse is b. Client takes herbal therapy
reviewing the client's history and including kava kava.
would contact the health care c. Client is on oral contraceptives.
provider about which of these d. Client was started on penicillin for
conditions in the client's history? a respiratory infection.

a. Chronic pulmonary disease ANTIHYPERTENSIVE DRUGS
b. Hepatic disease
c. Leukemia 121. The nurse is administering
d. Renal disease antihypertensive drugs to older
adults patients. the nurse knows
which adverse effect is of most

concern for these patients?
118. A nurse is caring for a client with

elevated triglyceride levels who is a. dry mouth
unresponsive to HMG-CoA b. Hypotension
reductase inhibitors. What c. restlessness
medication will the nurse d. constipation
administer?

122. When giving antihypertensive possibly occurring when this drug is

drugs the nurse will consider giving taken to treat hypertension?
the first dose at bedtime for which
class of drugs? a. Diarrhea
b. Nausea
a. alpha blockers such as doxazosin c. dry, nonproductive cough
(cardura) d. Sedation
b. diuretics such as furosemide
(lasix) 125. A patient has a new prescription
c. ACE inhibitors such as captopril for an ACE inhibitor. during a review
(capoten) of the patients list of current
d. vasodilators such as hydralazine medications, which would cause
(apresoline) concern for a possible interaction
for a new prescription?
123. a 46 year old man started
antihypertensive drug therapy 3 a. benzodiazepine taken as needed
months earlier and is in the office for for allergies
a follow up visit. while the nurse is b. potassium supplement taken
taking his bp, he informs the nurse daily
that he has had some problems with c. oral anticoagulant taken daily
sexual intercourse. which is the d. an opioid used for occasional
most appropriate response by the severe pain
nurse?’ e. an NSAID taken as needed for
headaches
a. not to worry. eventually tolerance 126. The nurse is assessing a patient
will develop who will be starting antihypertensive
b. the physician can work with you therapy with an ACE inhibitor. which
on changing the dose and/ or drugs condition, if present in the patient,
c. sexual dysfunction happens with would be a reason for cautious use?
this therapy, and you will learn to
accept it a. Asthma
d. this is an unusual occurrence, but b. rheumatoid arthritis
it is important to stay on your c. hyperthyroidism
medications d. renal insufficiency

124. when a patient is being taught GASTROINTESTINAL DRUGS
about the potential adverse effects
of ACE inhibitors, which of these 127. A physician has written an order
effects should the nurse mention as for ranitidine (Zantac) once daily.
The nurse schedules the
medications for which of the should plan to administer this
following times? medication if the client has:
A. At bedtime [ranitidine (Zantac) is
an H2 blocker] A. constipation
B. After lunch B. abdominal pain
C. With supper C. episode of diarrhea
D. Before breakfast D. Hematest-positive nasogastric
128. A client has been taking tube drainage
omeprazole (Prilosec) for 4 weeks.
The nurse determines that the client 131. A client is taking docusate
is receiving the optimal intended sodium (Colace). The nurse
effect of the medication if the client monitors which of the following to
reports absence of which of the determine whether the client is
following symptoms? having a therapeutic effect from this
medication?
A. Diarrhea
B. Heartburn A. Abdominal pain
C. Flatulence B. Reduction in steatorrhea
D. Constipation C. Hematest-negative stools
D. Regular bowel movements
omeprazole (Prilosec) is used for
GERD 132. A nurse teaches a client taking
metoclopramide (Reglan) to
129. A physician prescribes bisacodyl discontinue the medication
(Dulcolax) for a client in preparation immediately and call the physician if
for a diagnostic test and wants the which side effect occurs with long-
client to achieve a rapid effect from term use?
the medication. The nurse then tells
the client to take the medication: A. Excessive excitability
B. Anxiety or irritability
A. With a large meal C. Uncontrolled rhythmic
B. On an empty stomach movements of the face or limbs
C. At bedtime with a snack D. Dry mouth not helped by the use
D. With two glasses of juice of sugar-free hard candy

bisacodyl (Dulcolax) is a stool 133. A client has just taken a dose of
softener trimethobenzamide (Tigan). The
nurse plans to monitor this client for
130. A client has a PRN order for relief of:
loperamide (Imodium). The nurse
A. Heartburn
B. Constipation 137. A histamine (H2) - receptor
C. Abdominal Pain antagonist will be prescribed for a
D. Nausea and vomiting client. The nurse understands which
medications are H2- receptor
134. A client has a PRN order for antagonists, one of which could be
ondansetron (Zofran). The nurse prescribed. Select all that apply.
would administer this medication to
the postoperative client for relief of: 1. Nizatidine (Axid)
2. Ranitidine (Zantac)
A. paralytic ileus 3. Famotidine (Pepcid)
B. incisional pain 4. Cimetidine (Tagamet)
C. urinary retention 5. Esomeprazole (Nexium)
D. Nausea and vomiting 6. Lansoprazole (Prevacid)

ondansetron (Zofran): Antiemetic 138. A client with a gastric ulcer has
an order for sucralfate (Carafate), 1
135. A client has an order to take g orally four times a day. The nurse
magnesium citrate to prevent schedules the medications for which
constipation following a barium of the following times?
study of the upper gastrointestinal
(GI) tract. The nurse plans to A. With meals and at bedtime
administer this medication: B. Every 6 hours around the clock
C. One hour after meals and at
A. chilled bedtime
B. with fruit juice only D. One hour before meals and at
C. room temp bedtime
D. with a full glass of water
139. A client with a history of
136. A client has begun medication duodenal ulcer is taking calcium
therapy with pancrelipase carbonate chewable tablets. The
(Pancreas). The nurse determines nurse determines that the client is
that the medication is having the experiencing optimal effects of the
optimal intended benefit if which medication if:
effect is observed?
A. Heart burn is relieved
A. Weight loss B. Muscle twitching stops
B. Relief of heartburn C. Serum calcium levels rise
C. Reduction of steatorrhea D. Serum phosphorus levels
D. Absence of abdominal pain decrease
144. A hospitalized client asks the

140. The patient asks how stool nurse for sodium bicarbonate to
softeners relieve constipation. relieve heartburn following a meal.
Which of the following would be the The nurse reviews the client's
best response by the nurse? Stool medical record, knowing that the
softeners relieve constipation by: medication is contraindicated in
which of the following conditions?
a. stimulating the walls of the
intestine 1. urinary calculi
b. promoting the retention of 2. chronic bronchitis
sodium in the fecal mass 3. metabolic alkalosis
c. promoting the retention of water 4. respiratory acidosis
in the fecal mass
d. lubricating the intestinal walls 145. An 80- year-old client has
recently been started on cimetidine
141. The nurse administers (Tagamet). The nurse monitors the
antidiarrheal drugs: client for which most frequent
central nervous system (CNS) side
a. after each loose bowel movement effect of this medication?
b. hourly until diarrhea ceases
c. with food 1. Tremors
d. BID, in the AM and at bedtime 2. Dizziness
3. Confusion
142. the pregnancy category for the 4. Hallucination
antiflatulent drug simethicone is:
a. category A 146. A client is relying on OTC
b. category C laxatives for regular elimination.
c. category unknown Which of the following pieces of
d. category X information is most important for the
nurse to provide to the client?
143. When recording the
administration of diphenoxylate for A. daily bowel movements are not
multiple loose stools: necessary for good intestinal health
a. document the daily number of B. Excessive laxative use may cause
drugs given decreased sodium levels
b. record all stools once each shift C. Chronic use of laxatives can lead
c. indicate all stools on the MAR to dependency of elimination
next to the drug D. The client should increase intake
d. document each dose on the MAR of high-fiber diet

Excessive laxative use causes G.I.

system to become dependent on A. " I don't pass gas a often"
external methods to achieve B. "my abdomen is no longer firm"
elimination C. "I don't have pain in my
- Laxative dependence weakens stomach"
peristalsis and musculature of colon D. " I have regular BM's"

147. A nurse is caring for a client with 150. A nurse is talking with a client
cirrhosis who has a new prescription who has peptic ulcer disease and is
for cephulac (Lactulose). Following starting therapy with sucralfate
administration, the nurse will (Carafate). The nurse should instruct
monitor the client for which adverse the client to take this medication:
effect of this medication?
A. with antacid
A. Dry mouth B. 1 hr before meals
B. Diarrhea C. with food or milk
C. Headache D. immediately after meals
D. Peripheral edema
151. A nurse is reviewing medications
148. A charge nurse and a newly for a client who has a diagnosis of
licensed nurse are providing care for small bowel obstruction. The nurse
a client who reports nausea and has should withhold Senna (Senokot)
a prescription for metoclopramide prescribed orally based on an
(Reglan) as an antiemetic. Which of understanding of which of the
the following statements by the following?
newly licensed nurse indicates a
correct understanding of the actions A. laxatives are contraindicated in
of the medication. clients who have small bowel
"Metoclopramide": obstruction
B. Only bulk-forming laxatives such
A. depresses vagal nerve activity as psyllium (Metamucil) should be
B. decreases gastric acid secretions prescribed
C. slows peristalsis C. Medication should be
D. promotes gastric emptying administered via NG tube than oral
route
149. A nurse is caring for a client who D. Opioid analgesics, rather than
is receiving esomeprazole (Nexium) laxative should be prescribed to
to manage GERD. Which of the alleviate discomfort
following best indicates the desired
therapeutic effect?
Laxatives are contraindicated in C. the client's stools become clear
clients who have fecal impaction, liquid
bowel obstruction, and acute D. the client's bladder fills with urine
abdominal surgery to prevent
perforation. GOLYTELY is given as a colonic
lavage. Within 30 minutes of
152. A client has been taking ingesting the 1st volume of the
omeprazole (Prilosec) for the past 4 solution, the client should
weeks. The nurse determines that experience the 1st of many bowel
the medication is effective when the movements. The bowel must be
client reports? clear of feces for the colonoscopy to
be effective! The solution is
A. nausea preferable to other forms of bowel
B. diarrhea cleansing its less likely to deplete
C.headache electrolytes or cause water
D. acid indigestion intoxication

Omeprazole, a proton pump 154. After drinking the prescribed
inhibitor, reduces gastric acid dose of GOLYTELY and having
secretion and treats duodenal and numerous stools, the client reports
gastric ulcers, prolonged dyspepsia, feeling chest palpitations to the
gastrointestinal reflux disease and nurse. The nurse suspects an
erosive esophagitis electrolyte imbalance and requests
a physician order for Lab work.
153. A physician orders a Which ones concern you?
colonoscopy b/c of the client's
persistent diarrhea. The nurse 1. sodium 126 mEq/ L
instructs the client to drink 250 mL 2. potassium 2.8 mEq/L
of an electrolyte solution called 3. chloride 90 mEq/L
GOLYTELY every 15 minutes over a 4. calcium 9.4 mEq/dL
2 hour period. Which observation by 5. phosphorus 3.5 mEq/dL
the nurse provides the best 6. Blood Urea nitrogen (BUN) 16
evidence that the solution has mg/dL
achieved its primary purpose?
The physician prescribes docusate
A. the client's serum electrolyte sodium (Colace) for the client. The
levels are normal client asks the nurse to explain why
B. the client's intake approximates the medication is needed. Which
the output explanation given by the nurse
correctly states the purpose of 158. How should the patient be
medication? taking (Prilosec) Omeprazole?

A. To ease bowel evacuation and its A. take drugs 2 hours after a meal
related discomfort B. take 1 hour before meals and
B. To irritate the bowel and promote swallow tablets as whole
stool elimination C. take it with juice and crush
C. To stimulate peristalsis to remove tablets
wastes after the digestion D. all of the above
D. To reduce intestinal activity and
decrease stool size 159. What do you tell patients to do
with tablets (antacid)?
155. Your client is dx with end stage
liver failure and receiving A. take drugs 30 minutes before
lactulose/granulocyte. Which lab meals
test tells you it is effective? B. crush it and mix with orange juice
C. take 1 hour after meal
A. serum ammonia D. chew thoroughly and take with
B. BUN full glass of water
C. sodium
D. serum Creatinine ANTILIPEMIC DRUGS
1. The nurse provides discharge
156. Your elderly pt is being instructions to a patient prescribed
administered Lomotil, what kind of cholestyramine (Questran). Which
drug? statement by the patient indicates
teaching was effective for this drug?
A. Antiflatulent
B. Laxative I will increase fiber in my diet and
C. Antidiarrheal (narcotic) drink more fluids
D. Emetic
2. Dosing of Cholestyramine and other
157. The Patient has GERD and they drugs
are prescribed( Prilosec)
Omeprazole What kind of a drug is All other drugs should be taken 1
it? hour before or 4-6 hours after
cholestyramine
A. Antacid
B. Histamine H2 Antagonist 3. To decrease the skin flushing
C. Anticholinergic adverse effect rxn of niacin (nicotinic
D. Proton Pump Inhibitor
acid), which action should the nurse 8. By which action does atorvastatin
take? (lipitor) decrease lipid levels

administer aspirin 30 minutes before It's an HMG-CoA reductase
each dose inhibitor, which then prevents
biosynthesis of cholesterol in the
4. Hydroxymethylglutaryl-coenzyme A liver
(HMG-CoA) reductase inhibitors
(statins) are generally administered 9. To assess for a potentially serious
at which time of the day? EVENING adverse effect to HMG-CoA
reductase inhibitors, the nurse
5. What is the mechanism of action of should monitor which laboratory
ezetimibe (Zetia) results?

It selectively inhibits absorption of Liver function studies
cholesterol in the small intestine HMG-CoA reductase inhibitors can
cause hepatotoxicity. LFT measures
6. Which statement by the nurse ever 6-8 weeks during the first 6
explains to the pt the action of months of statin therapy and every
cholestyramine (questran) to 3-6 months after that
decrease blood lipid levels?
10. The nurse is providing discharge
Binds to bile in the intestinal tract, teaching for a patient about
forming an insoluble complex that is potential serious adverse effects of
excreted in feces simvastatin (zocor). Which
symptoms may indicate the pt is
7. Which statement by the pt indicates experiencing a serious adverse
a need for further instruction about effect to this medication?
colestipol (colestid) from the nurse?
Muscle pain, can lead one to
"I will mix and stir the powder suspect rhabdomyolysis- should
thoroughly w/ at least 1 to 2 oz of report immediately
fluid"
11. The nurse would question a
Rationale: it needs at least 4-6 oz to prescription for simvastatin (zocor)
mix with, all to avoid esophageal in a patient with which condition?
irritation or obstruction and
intestinal obstruction Hepatic disease, simvastatin can
cause an increase in liver enzymes
and should not be used in pts w/ c. hydrolysing mucus
preexisting liver disease d. inhibiting production of mucus

12. A patient with elevated triglyceride 3. If a client is hospitalised with an
levels unresponsive to HMG-Coa upper respiratory tract infection,
reductase inhibitors will most likely what type of oxygen administration
be prescribed which drug? is suitable?
a. Non-rebreathing mask
Gemfibrozil (lopoid) b. Nasal catheter
it's a fibric acid derivative, c. Metered dose inhaler
promotes catabolism of d. Ventimask
triglyceride rich lipoproteins
4. Which is not a mediator of asthma?
a. Leukotrienes
13. The nurse would question a b. Allergens
prescription for colesevelam c. Corticosteroids
(Welchol) in a pt with which d. Prostaglandins
condition? Bowel obstruction
5. Which drug would be used as a
14. The nurse will asses a patient reliever in asthma treatment?
receiving gemfibrozil (lopid) and a. Beclomethasone
warfarin (coumadin) for the b. Sodium cromoglycate
increased risk of which adverse c. Salbutamol
effect? d. Propranolol
Bleeding
6. The proposed mechanism of action
of salbutamol is:
RESPIRATORY DRUGS a. stimulation of beta2-adrenoceptors
1. If a client presents with status b. blockade of inflammatory mediators
asthmaticus, what percentage of c. activation of parasympathetic nerves
oxygen should be administered? d. stimulation of adenosine receptors.
a. 100
b. 10-25 7. In Australia, the currently accepted
c. 25 model for managing asthma is the:
d. 50-90 a. national asthma plan
b. six-point asthma plan
2. Expectorant drugs exert their c. asthma 3+ visit plan
actions by: d. World Health Organization plan.
a. irritating mucous membranes
b. stimulating mucus secretions
8. Allergic rhinitis would not be relieved 13. Parasympathetic innervation to

by: respiratory system causes
a. beta-adrenoceptor agonists a. Ach secretion
b. corticosteroids b. Bronchodilation
c. antihistamines c. Stimulates 2 receptors
d. mast-cell stabilisers. d. Adrenaline secretion

9. Indications for the use of carbon 14. Which Oxygen below is used to
dioxide include: treat certain infections & circulatory
a. decompression sickness problems?
b. acidosis a. Hyperbaric oxygen
c. altitude sickness b. Oxygen free radicals
d. carbon monoxide poisoning. c. Atmospheric oxygen
d. 80-100% oxygen
10. When used as a decongestant,
which would not be considered to 15. Excess carbon dioxide in your
be a side effect of system can cause all of the
pseudoephedrine? following except...
a. Insomnia a. acidosis
b. Hypotension b. lack of respiratory centre response
c. Hypertension c. narcosis (sleepiness and confusion)
d. Rebound nasal congestion d. Stimulates depth and rate of ventilation

11. Airway Efficiency is not determined 16. An asthmatic patient being treated
by which of the following? for a severe exacerbation
a. Shape and size of each segment (eg experiences tachycardia. The most
alveolar sacs) likely drug responsible for the
b. Presence of ciliated, mucous-secreting adverse reaction is:
epithelium a. Budesonide
c. Pressure gradients b. Cromolyn
d. Presence of foreign substances in the c. Salbutamol
lumen d. None of the above

12. Muco-ciliary blanket is produced by Upper Respiratory
a. goblet cells 1. A patient tells the nurse that he has
b. Bronchial glands started to take an over-the-counter
c. alveolar cells antihistamine, diphenhydramine. In
d. Both a and c teaching about side effects, what is
the most important for the nurse to
tell the patient?
- avoid driving a motor vehicle - avoid alcohol and other

until stabilize on the drug central nervous system
depressants
2. A patient complains of a sore throat - Notify a healthcare provider
and has been told it is due to Beta- if confusion or hypotension
hemolytic streptococcal infection. occurs
The nurse anticipates that the - use sugarless candy, gum,
patient has which acute condition? or ice chips for temporary
- Pharyngitis relief of dry mouth
- Avoid handling dangerous
3. A patient is prescribed a equipment or performing
decongestant nasal spray that dangerous activities until
contains oxymetazoline. What will stabilize avoid handling
the nurse teach the patient? dangerous equipment or
- Limited use of the drug to 5 performing dangerous
to 7 days to prevent rebound activities until stabilized on
nasal congestion. the medication

4. A patient has been prescribed Lower Respiratory
guaifenesin. The nurse understands 1. Fluticasone propionate and
that the purpose of the drug is to salmeterol combination inhalation is
accomplish work? ordered for a patient with chronic
- Loosen bronchial secretions obstructive pulmonary disease.
so coughing and eliminate What does the nurse know about
them this medication? Select all that
apply.
5. Beclomethasone has been - It is delivered as a
prescribed For a patient with allergic dry-powder inhaler
rhinitis. What should the nurse teach - It is taken as one puff two
the patient regarding this times a day
medication? - It promotes bronchodilation
- With continuous use,
dryness of the nasal 2. A patient with chronic obstructive
mucosa/ lining may occur. pulmonary disease has an acute
bronchospasm. The nurse
6. The nurse is teaching a patient anticipates that the healthcare
about diphenhydramine. Which provider will prescribe which
instruction should the nurse include medication?
in the patient's teaching plan? - Epinephrine
Select all that apply.
3. A patient is prescribed Take the drug 30-60min before activities

aminophylline-theophylline. For that trigger nausea, avoid activities that
what adverse effect should the require alertness, and increase fluid and
nurse monitor the patient? fiber intake
- Increased heart rate
When administering prochlorperazine
4. A patient is receiving intravenous (Compazine), the nurse should monitor the
aminophylline. The nurse checks the patient for which of the following adverse
patient’s lab values and seed the effects?
serum theophylline level id 32 hypotension, restlessness, sedation, urinary
mcg/mL. What action should the retention
nurse take?
- notify the healthcare provider A healthcare professional is caring for a
of the level patient who takes phenytoin (Dilantin) for a
seizure disorder and is about to begin
5. A patient with chronic obstructive sucralfate (Carafate) therapy to treat a
pulmonary disease is taking the duodenal ulcer. Patient should take the
leukotriene antagonist montelukast. drug 2hrs apart why?
The nurse is aware that this Sucralfate interferes with the absorption of
medication is given for which phenytoin
purpose?
- Maintenance treatment of A healthcare professional should question
asthma the use of misoprostol (Cytotec) for a
patient who has which of the following?
GI DRUGS a positive pregnancy test - it's a
prostaglandin category X
When talking with a patient about taking
psyllium (Metamucil) to treat constipation, When talking with a patient about taking
the healthcare professional should include omeprazole (Prilosec) to treat a duodenal
which of the following instructions? ulcer, then nurse should include which of
Increase fluid and fiber intake and take the the following instructions?
drug with at least 8oz of fluid Swallow the capsule whole - do not chew
delayed-release tablets and do not take
A nurse is caring for a patient who is about with food because it can reduce absorption
to begin using dimenhydrinate (Dramamine)
to prevent motion sickness. Which of the A primary care provider should use caution
following instructions should the nurse when prescribing sulfasalazine (Azulfidine)
include with the patient about taking the for a patient with?
drug
aspirin sensitivity - sulfa drugs are Diarrhea - this drug INCREASES peristalsis
contraindicated because it is metabolized
into an acid by intestinal bacteria What actions should be taken by a nurse
who is about to administer ondansetron
A nurse is caring for an older adult patient (Zofran) to a patient who is receiving
who is about to begin taking cimetidine chemotherapy?
(Tagamet) for a duodenal ulcer. The nurse Infuse 30min prior to chemotherapy to
should tell the patient to report which of the prevent nausea and vomiting. Infuse the
following reactions? drug slowly over 15min. Repeat the dose
Lethargy 4hr after chemo for maximum
effectiveness.
A nurse is caring for a patient who is about
to begin taking alosetron (Lotronex) to treat Metoclopramide (Reglan) should not be
IBS. The patient should report which of the taken with which other drug?
following adverse effects? Digoxin (Lanoxin) - because reglan can
Abdominal pain interfere with this drugs absorption

A healthcare professional should question A primary care provider should use caution
the use of diphenoxylate/atropine (Lomotil) when prescribing bisacodyl (Dulcolax) for a
for a patient who has which of the following patient who has?
disorders? anorexia nervosa
Inflammatory bowel disease - can cause
severe complication of the toxic megacolon This drug has protocols that require
patients to meet specific risk-management
A nurse should conclude that alosetron criteria treatment before administration
(Lotronex) therapy is effective when a Alosetron (Lotronex)
patient reports which of the following
one formed stool per day - since the drug The nurse should include what when talking
treats diarrhea and pain of IBS to a patient about taking Reglan to treat
GERD?
When talking to a patient about taking chew gum or suck on hard candy
loperamide (Imodium), the health care
professional should include which of the A nurse should question the use of
following instructions? dimenhydrinate (Dramamine) for a patient
Avoid activities that require alertness - who has what disorder?
opioid agonist causing sedation and Angle-closure glaucoma - dramamine is
dizziness anticholinergic therefore can increase IOP

Lubiprostone (Amitiza) should not be taken
if the patient has?
Which drug requires monitoring of A patient is taking ranitidine. What

phosphorous levels for a patient taking this information should the nurse teach the
drug for peptic ulcers? patient about this drug? Select all that
Aluminum hydroxide apply.
- The drug must be administered
The patient who is taking azathioprine separately from an antacid by at
(Imuran) to treat IBD should report what least one hour
adverse effects? - smoking should be avoided while
Bruising, jaundice, sore throat, nausea taking this drug
- Foods high in vitamin B12 should be
A patient taking prochlorperazine increased in the diet
(Compazine) should report which serious
adverse reaction?
Facial spasms When a patient complains of pain
accompanying a peptic ulcer, why should
Colace prevents straining - True or False? the nurse give an antacid?
TRUE - antacid neutralize hydrochloric acid
and reduce pepsin activity
When administering sulfasalazine
(Azulfidine) to a patient, the nurse should A patient is taking famotidine to inhibit
check what to help identify adverse effect gastric secretions. Which side effects of
of drug? famotidine will the nurse teach the patient?
skin integrity, temp, CBC - dizziness, headaches, erectile
dysfunction
A patient is diagnosed with peptic ulcer
disease. The nurse realizes that which of The patient is taking esomeprazole
these is a predisposing factor for this magnesium for erosive gastroesophageal
condition? reflux disease. Which should the nurse
- Helicobacter pylori include in patient teaching?
- This medication decreases stomach
A student nurse is preparing to administer acid secretion
sucralfate to a patient. Which statement by
the student nurse demonstrates
understanding of sucralfate’s mode of
action?
- Sucralfate combines with protein to
form a viscous substance that forms
a protective covering over the ulcer

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Ballescas, Detaro, Diego, Guiyab, Nohay

● Usually OTC; e.g: Alka-Seltzer, Milk ● Advise to avoid cigarettes

● For PPIs, assess swallowing ● Charcoal- activated form may be

● LAXATIVE effect - production of Osmotic action retains water that

- Monitor frequency of bowel raw or processed ingredients from

Decoction ○ 7-12 y/o: 3 tbsp

○ Crush fresh leaves and apply 3. Best to use ceramic pot with lid

○ Deworming= 4-7 seeds for ● Wound cleaning: soak gauze sheet

● Ulasimang Bato Other uses:

● Hypoglycemic agent ● Heart block

● VS, PR, ECG, renal function, serum Available forms:

○ Usually diminish in intensity

● Used for dysrhythmias that are

2. Secondary Hypertension 4. Diuretic

● ↓Sympathetic response to ● SNS (peripheral adrenergic nerves)

Result: decreased systemic vascular - Well-tolerated

● verapamil(Calan, Isoptin) ● Act directly on the ascending limb of

Metabolic ● Hypokalemia CNS ● Dizziness

● Sodium nitroprusside and diazoxide ● Monitor for side/adverse effects

● Relief of pruritus associated with ● Girl during pregnancy

- Lipid-lowering properties require ○ HMG-CoA Reductase

1. Anticoagulants A. Anticoagulants: Direct Thrombin

Has a ​s​low onset of action. A quicK Vitamin

● Monitor for bleeding ● Acute pharyngitis

- Drowsiness​ ( nx responsibility: MOA:

- Loosen bronchial secretions by ● Permanent irreversible damage to

- Stimulate only beta2 receptors.

MOA: ● Respiratory condition

- start of genetic codes are copied - So called because it is derived from

● Plicamycin - Combined for the synergistic activity

● Nitrogen mustard Erythema

○ Leukopenia (WBC less than - If the venipuncture, draw all blood

● Urinary tract d. Pulse below 60 beats/min and

blocker. What instruction should the b. "Apply the patch to the same site

b. "I should keep my nitroglycerin in

a. Evaluate digoxin levels. c. Monitor blood pressure

b. Crackles in the lungs

include in the teaching plan for this

b. Monitor for side effects of

c. ACE inhibitor c. Upset stomach

b. Elevated INR range d. Low-molecular-weight heparin

a. "I will avoid contact sports."

b. Administer protamine sulfate.

b. Administer aminocaproic acid

105. When a client is taking ezetimibe a. "I will take Questran 1 hour before

122. When giving antihypertensive possibly occurring when this drug is

144. A hospitalized client asks the

Excessive laxative use causes G.I.

8. Allergic rhinitis would not be relieved 13. Parasympathetic innervation to

- avoid driving a motor vehicle - avoid alcohol and other

3. A patient is prescribed Take the drug 30-60min before activities

Which drug requires monitoring of A patient is taking ranitidine. What

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Has a slow onset of action. A quicK Vitamin

- Drowsiness ( nx responsibility: MOA: