1
Q
Five main groups for anti-depressant medications
A
- SSRI’s
- SNRI’s
- atypical anti-depressants
- TCA’s
- MAOI’s
2
Q
SSRI’s
A
(-INE, -PRAM)
FLUOXETINE
-citalopram
-escitalopram
-paroxetine
-sertraline
-fluvoxamine
3
Q
SNRI’s
A
(-faxine, -pran, + duloxetine)
VENLAFAXINE
-desvenlafaxine
-duloxetine
-levomilnacipran
4
Q
Atypical Antidepressants
A
BUPROPRION
-vilazodone
-mirtazapine
-nefazodone
-trazodone ER
5
Q
TCA’s (tricyclic antidepressants)
A
-MINE, -LINE, -PIN(e)
all sound like “een”
- AMITRIPTYLINE
- Imipramine
- Doxepin
- Nortriptyline
- Amoxapine
- Trimipramine
- Desipramine
- Clomipramine
6
Q
MAOI’s
A
- Phenelzine
- Isocarboxazid
- Tranylcypromine
- Selegiline
7
Q
class overview for SSRI’s
A
first line treatment for depression.
Blocks reuptake of serotonin
1-3 weeks for effect
8
Q
class overview of SNRI’s
A
blocks reuptake of norepinephrine and serotonin
9
Q
class overview for TCAs
A
Amitriptyline
high toxicity risk (cardiac)
blocks NE and serotonin
10
Q
Class overview for MAOI’s
A
Phenelzine
high risk of hypertensive crisis with tyramine
11
Q
Common complications with SSRI’s
A
- sexual dysfunction (decreased libido)
(an atypical antidepressant (buproprion) has fewer sexual dysfunction adverse effects)
- Inability to sleep, agitation, anxiety
(take dose in AM, avoid caffeine)
- Neuroleptic Malignant syndrome
(monitor for fever, resp distress, tachy, seizure activity)
12
Q
A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for PTSD. Which of the following statements should the nurse include in the teaching?
a. you can have a decreased desire for intimacy while taking this medication
b. you should take this medication at bedtime to promote sleep
c. you will have fewer urinary adverse effects if you urinate just before taking this medication
d. you should wear sunglasses when outdoors due to the light sensitivity caused by this medication.
A
a. “you can have a decreased desire for intimacy while taking this medication”
13
Q
What is serotonin syndrome?
A
can occur 2-72 hours after starting (SSRI’s/SNRI’s)
lethal
14
Q
manifestations of serotonin syndrome
A
-confusion/agitation
-fever (hyperpyrexia)
-tremors
-hyperreflexia
-disorientation/hallucinations
15
Q
A nurse is assessing a client who has been taking sertraline for the past 2 days. the nurse should identify that which of the following findings can indicate the client is developing serotonin syndrome?
a. bruising
b. tinnitus
c. fever
d. rash
A
B. fever
16
Q
Contraindications/precautions for SSRI’s
A
- SSRIs during late pregnancy can cause pulmonary HRN of newborn
- most are considered safe during lactation (except paroxetine)
- contraindicated in clients taking MAOI’s or TCA’s. SSRI’s need to be discontinues at least 2 weeks before starting MAOI
- Use cautiously in pts who have liver and kidney issues, cardiac disease, seizure disorders, diabetes, ulcer, hx of GI bleeds
17
Q
Interactions: ___ increases the risk of serotonin syndrome
A
MAOI’s, TCA’s, and St. John’s wort (increases risk of GI bleed) increases the risk
18
Q
Adverse effects of SNRI’s
A
- nausea
- weight loss
- HTN
- tachycardia
- dizziness, blurred vision
19
Q
SNRI’s specific warning
A
Venlafaxine can cause mydriasis (dilated pupils) and can worsen glaucoma
20
Q
A client who has depression and a new prescription for venlafaxine should be monitored for which of the following manifestations as an adverse effect?
a. mydriasis
b. decreased libido
c. dizziness
d. alopecia
e. hypotension
A
A. Mydriasis
B. Decreased libido
C. Dizziness
21
Q
A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching?
a. expect therapeutic effect in 24-48 hours
b. discontinue the medication after a week of improved mood
c. change positions slowly to minimize dizziness
d. decrease dietary fiber intake to control diarrhea
e. chew sugarless gum to prevent dry mouth
A
C, E
the nurse should take actions when teaching a client who has a new prescription for amitriptyline and instruct to change positions slowly to decrease the risk of orthostatic hypotension.
22
Q
Adverse effects/complications of MAOI’s
A
- CNS stimulation: agitation, anxiety, mania
- Orthostatic hypotension
- HYPERTENSIVE CRISIS (results from intake of dietary tyramine)
23
Q
A nurse is assessing a client who has a new prescription for phenelzine for the treatment of depression. Which of the following findings can indicate the client has developed an adverse effect of this medication?
a. orthostatic hypotension
b. GI bleeding
c. hearing loss
d. weight loss
A
A
24
Q
INTERACTIONS for MAOI’s!
A
- MAOIs should not be used within 10-14 days before or after surgery due to the interaction with anesthetics
- avoid OTC decongestants and cold remedies
- TYRAMINE RICH FOODS -> hypertensive crisis!
-aged cheese
-pepperoni
-salami
-avocados
-figs
-bananas
-smoked fish
-beer & red wine
25
For SSRIs and SNRI's, what do you avoid and what should you obtain for older clients
Avoid MAOI's
Obtain a baseline sodium level for older adults taking diuretics and monitor periodically
26
Client edication for SSRI's and SNRI's
-take meds in morning
-take meds with food
-these meds cause sexual adverse effects
27
For all atypical antidepressants, what do you avoid?
the use of MAOI's
28
TCA's: what should be monitored and how to administer TCA's
-monitor for toxicity manifested by CARDIAC dysrhythmias
-monitor for clients "cheeking" or hoarding tca's due to lethality in toxicity
-administer at bedtime due to sedation and risk for orthostatic hypotension
29
What to do for clients taking MAOI's and what is the client education?
-give them a list of tyramine-rich foods so hypertensive crisis does not occur
-avoid taking any other prescription/non-prescription meds unless approved by PCP
30
A nurse is assessing a client who is taking Amiodarone to treat a-fib. which of the following findings can be an indication of Amiodarone toxicity?
a. light yellow urine
b. report of tinnitus
c. productive cough
d. blue-gray skin discoloration
C. Productive cough
the nurse should analyze the cues form the CM's and determine that a productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for cough, chest pain, and SOB.
31
A nurse is caring for a client who received IV verapamil to treat SVT. the clients pulse rate is now 98/min and the BP is 74/44. The nurse should expect a prescription for which of the following?
a. calcium gluconate
b. potassium chloride
c. sodium bicarbonate
d. magnesium sulfate
A. Calcium Gluconate
the nurse should plan to address the clients hypotension which includes the administration of calcium gluconate, given slowly IV. the calcium counteracts vasodilation caused by verapamil. other measures to increase the BP include IVF and placing client in modified Trendelenburg position.
32
A nurse is preparing to administer propranolol to a client with a dysrhythmia. Which of the following actions should the nurse plan to take?
a. hold propranolol for an apical pulse greater than 100/min
b. administer propranolol to increase the clients BP
c. assist the client when sitting up or standing after taking this med
d. check for hypokalemia frequently due to the risk of propranolol toxicity
C. Assist the client when standing or sitting
the nurse should plan to address the clients potential orthostatic hypotension - assess for dizziness during ambulation
32
A nurse is assessing a client who is taking digoxin to treat heart failure. which of the following findings is a manifestation of digoxin toxicity?
a. bruising
b. report of metallic taste
c. muscle pain
d. report of anorexia
D. Anorexia
The nurse should analyze cues from the CM's and determine that anorexia, blurred vision, stomach pain, and diarrhea are manifestations of dig toxicity
33
4 main classification groups of antidysrhythmics
1. sodium channel blockers
2. beta-adrenergic blockers
3. potassium channel blockers
4. calcium channel blockers
34
what is a major concern for anti-dysrhythmic meds
Toxicity!
toxicity can lead to increased cardiac dysrhythmias
35
what do sodium channel blockers do (Class I)
slow cardiac conduction velocity
36
sodium channel blocker meds
1. Quinidine
2. Disopyramide
3. Lidocaine IV
4. Mexiletine
5. Phenytoin
6. Propafenone
7. Flecainide
37
What do beta adrenergic blockers do (Class II)
prevent sns stimulation of the heart
expected action = decrease HR, decrease myocardial contractility
38
Beta blocker meds
1. propranolol
2. esmolol
3. acebutolol
(-olol)
LOL, betas are laughed at in life
39
What do potassium channel blockers do (Class III)
prolong the action potential and refractory period of the cardiac cycle
dilates coronary blood vessels
40
PCB meds
1. Amiodarone
2. Dronedarone
3. Sotalol
4. Ibutilide
5. Dofetilide
41
what do CCB's do? (Class IV)
prolongs cardiac conduction, depresses depolarization, and decreases O2 demand of the heart, decreases HR
42
CCB meds
1. verapamil
2. diltiazem
3. adenosine
4. digoxin
43
Intended use for sodium channel blockers
*long term suppression of the following dysrhythmias
-SVT
-V TACH
-A. FLUTTER
-A. FIB
44
Intended therapeutic uses for Beta Blockers
1. A. FIB
2. A. FLUTTER
3. Paroxysmal SVT
4. HTN
5. Angina
6. PVC's
7. severe recurrent v-tach
45
intended therapeutic use for PCBs
1. conversion of a-fib (oral route)
2. recurrent v fib
3. recurrent v. tach
46
intended therapeutic use of CCB's
1. control ventricular rate in a. fib and flutter
2. SVT
3. HTN
4. Angina Pectoris
47
intended use for adenosine
paroxysmal SVT
48
Intended use for digoxin
1. HF
2. A fib and A flutter
3. paroxysmal SVT
49
A nurse is assessing a client who has taken quinidine to treat dysrhythmias for the last 12 months. the nurse should assess the client for which of the following manifestations?
a. HTN
b. widened QRS complex
c. narrowed QT interval
d. Tinnitus
e. Diarrhea
B, D, E
quinidine is a sodium channel blocker.
50
A nurse is teaching a client who has a new prescription for dextromethorphan to suppress a cough. the nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication?
a. diarrhea
b. sedation
c. anxiety
d. palpitations
B. sedation
the nurse should take actions and instruct the client that this med can cause sedation. advise the client to avoid activities that require alertness.
51
a nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcysteine. which of the following information should the nurse include in the instructions?
a. expect this medication to suppress your child's cough
b. expect this medication to cause euphoria
c. expect this medication to smell like rotten eggs
d. expect this medication to turn your child's urine orange
Answer: B
the nurse should instruct them that this med has a sulfur content that causes a rotten egg odor
52
a nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. the nurse should assess the client for which of the following manifestations as an adverse effect of this medication?
a. sedation
b. productive cough
c. nasal congestion
d. constipation
Answer: B
the nurse should plan to generate solutions to assess the client for potential adverse reactions. when used for over 5 days, rebound nasal congestion can occur when taking.
53
What are antihistamines used for?
used during allergic reactions
relieve itching, sneezing, and rhinorrhea, but do NOT relieve nasal congestions
54
list of antihistamines
1. Diphenhydramine (Benadryl)
2. Promethazine (Phenergan)
3. Dimenhydrinate (Dramamine)
55
A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhinitis. the nurse should instruct the client to monitor for which of the following manifestations as adverse effects?
a. dry mouth
b. non productive cough
c. skin rash
d. dowsiness
e. urinary retention
Answers:
A, D, E
when taking actions, the nurse should instruct the client to monitor for a dry mouth and urinary retention due to the anticholinergic effects. the client should also monitor for drowsiness. the medication may be taken at night for this reason.
56
What are nasal glucocorticoids used for?
decrease inflammation associated with allergic rhinitis. first line treatment for nasal congestion
57
list of nasal glucocorticoids
1. Mometasone
2. Fluticasone
58
A nurse is teaching a client about the use of fluticasone to treat perennial rhinitis. which of the following statements by the client indicates an understanding of the teaching?
a. i should use the spray every 4 hours while I am awake
b. this medication can also be used to treat motion sickness
c. it can take as long as 3 weeks before the medication takes a maximum effort
d. i can use this medical when my nasal passages are blocked
Answer: C
if having seasonal allergic rhinitis, it can take 7 days or more to get the max relief. If having perennial allergic rhinitis, it can take as long as 21 days to get max relief
59
A nurse is developing a plan of care for a patient taking furosemide. which of the following interventions should the nurse include?
a. assess for tinnitus
b. report urine output 50mL/hr
c. monitor blood potassium levels
d. initiate fall precautions
e. recommend increasing protein intake
A = an adverse effect of furosemide is ototoxicity. manifestations of tinnitus should be reported
C = a decrease in K+ is an adverse effect
D = fall precautions due to dizziness. Encouraged to use call light
60
The nurse is reviewing the lab results for the patient taking furosemide. which of the following lab results should she monitor for?
a. hypocalcemia
b. hypophosphatemia
c. hypermagnesemia
d. hyperkalemia
A
61
a nurse is providing info to a client with a new prescription for hydrochlorothiazide. which of the following information should the nurse include?
a. take the medication with food
b. plan to take the medication at bedtime
c. expect increased swelling of feet and ankles
d. fluid intake should be limited in the am
A: this is a thiazide diuretic. taking it with meals will prevent gastric upset
62
A nurse is monitoring a client who is on spirinolactone. which of the following findings should the nurse report to the MD?
a. Na+ 144
b. Urine output 120mL/4hrs
c. K+ 5.2
d. BP 140/82
Answer: C
spirinolactone causes potassium retention. the nurse should withhold the medication and notify the MD
63
a nurse is teaching a client about the use of insulin to treat type 1 DM. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hours after administration?
a. insulin glargine
b. regular insulin
c. NPH
d. Insulin lispro
C
64
Ensure ___ is available all the time of onset of insulin and during all peak times
glucose
65
a nurse is administering a new prescription of metformin. which of the following findings should the nurse instruct to the client as an adverse effect of metformin?
a. Somnolence
b. Constipation
c. Fluid retention
d. weight gain
A
metformin is used to lower blood sugar levels in type 2 DM
the nurse should instruct the client that somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. rare but very serious
66
a nurse is caring for a client who has been taking Acarbose for type 2 DM. which of the following lab tests should the nurse plan to monitor?
a. WBC
b. Platelet count
c. Amylase
d. LFT's
D
the nurse should plan to generate solutions to address potential adverse effects of this med. acarbose can cause liver toxicity when taken long-term. the nurse should monitor LFT's while taking this med. This med lowers blood sugar levels for T2DM
67
A nurse is providing teaching to a client who has T2DM and is starting Repaglinide. which of the following statements by the client indicates an understanding of the administration of the med?
a. ill take this med after I eat
b. Ill take this med 30 min before I eat
c. Ill take this med just before I go to bed
d. Ill take this med at least 1 hours before I eat
B
the nurse should instruct the pt that this med causes a rapid, short lived release of insulin. the client should take this med within 30 min before each meal so that insulin is available when food is digested
68
A nurse is assessing an infant who has otitis media for pain. which of the following should the nurse identify as findings of pain in an infant?
a. pursed lips
b. loud cry
c. lowered eyebrows
d. rigid body
e. pushes away stimulus
B, C, D
the nurse should recognize that a loud cry, lowered eyebrows, and a rigid body are manifestations of pain in an infant
69
a nurse is preparing a toddler for an IV catheter insertion using atraumatic care. which of the following actions should the nurse take?
a. explain the procedure using the child's favorite toy
b. ask the parents to leave
c. perform the procedure with the child in his bed
d. allow the child to make one choice regarding the procedure
e. apply lidocaine cream to three potential insertion sites
A, D, E
70
a nurse is completing a pain assessment on a 4 month old infant. which of the following pain scales should the nurse use?
a. FACES
b. FLACC
c, Oucher
d. non-communicating children's pain checklist
B
FLACC is recommended for infants and children between 2 months and 7 years of age
FACES is recommended for children 3 and older
Oucher is recommended between ages 3 and 13
non-communicating is recommended for non-communicating children between 3 and 13
71
a nurse is planning care for a 12 year old child following a surgical procedure. which of the following actions should the nurse include in the plan of care?
a. administer NSAIDs for pain greater than 7 on a scale of 0 to 10
b. administer intranasal analgesics PRN
c. administer IM analgesics for pain
d. administer IV analgesics on a schedule.
D
when generating solutions for a 12 year old, the nurse should plan to administer IV analgesics on a schedule to achieve optimal pain management
A. the nurse should not administer NSAIDs for a pain level of 7/10. this indicates severe pain.
B. the nurse should not include administering intranasal analgesics. they are used for clients 18 and up
C. the nurse should not include IM analgesics. they are not recommended for pain management in children.
72
A nurse is planning care for an infant who is experiencing pain. which of the following nonpharm interventions should the nurse include in the plan of care?
a. offer a pacifier
b. use guided imagery
c. use swaddling
d. initiate a behavioral contract
e. encourage kangaroo care
Answers: A, C, E
guided imagery is a nonpharm strategy used with children, not infants. Behavioral contracts is a strategy used with children, not infants.
73
A nurse is teaching a client how to self administer ear drops. which of the following client statements indicates an understanding of the teaching?
a. I will pull my ear down and back before I insert the drops
b. I will gently apply pressure with my finger to the front part of my ear after putting in the drops
c. I will chill my ear drops before I use them
d. I will place a cotton ball into my inner ear canal after the drops are in
B
74
A nurse is teaching a newly licensed RN who is caring for a client who is receiving enteral feedings, how to administer meds through a jejunostomy tube. which of the following instructions should the nurse include?
a. flush the tube before and after each medication
b. mix the meds with the enteral feeding
c. use a parenteral syringe to administer the meds
d. combine multiple meds together to administer at the same time
A
75
A nurse is preparing to inject heparin subcutaneously for a client who is postop. which of the following actions should the nurse plan to take?
a. use a 22 gauge needle
b. select a site on the clients abdomen
c. use the z-trach method to displace the skin on the injection site
d. observe for bleb formation to confirm proper placement
B
can be given in the clients abdomen, thighs, or lateral upper arms.
Use a 45 to 90 degree angle for subcutaneous injections
76
what is the antidote for heparin?
Protamine sulfate
-administer slowly IV
77
what can occur with heparin toxicity?
Hemorrhage! This occurs if med administration leads to high aPTT
78
a nurse is caring for a client who is receiving heparin by continuous IV infusion. the client begins vomiting blood. after the heparin has been stopped, which of the following meds should the nurse prepare to administer?
a. vitamin K
b. atropine
c. protamine
d. calcium gluconate
C
79
a nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe to an adult client following a THA. which of the following actions should the nurse plan to take?
a. expel the air bubble from the prefilled syringe before injecting
b. insert the needle completely into the clients tissue
c. administer the injection into the clients thigh
d. aspirate carefully after injecting the needle into the clients skin.
B
administer by deep subcutaneous injection
80
a nurse is monitoring a client who takes aspirin daily. the nurse should identify which of the following manifestations as adverse effects of aspirin?
a. HTN
b. coffee ground emesis
c. tinnitus
d. paresthesia of the extremities
e. nausea
B, C, E
81
a nurse is planning to administer IV alteplase to a client. which of the following interventions should the nurse plan to take?
a. administer IM enoxaparin along with the alteplase dose
b. obtain the clients weight
c. administer aminocaproic acid to alteplase infusion
d. prepare to administer alteplase within 8 hours of manifestation onset
B
obtaining an accurate weight is used to calculate the dosage of alteplase
ATI PRACTICE A!
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