“Pharmacology Nurse Practice Test” plus 6 more nursing article(s): NursingCrib.com Updates

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• Pharmacology Nurse Practice Test
• Rating of NLE
• Methotrexate – Drug Study
• Glomerulonephritis
• Allergic Rhinitis
• Maple Syrup Urine Disease (MSUD)
• Lobectomy

Pharmacology Nurse Practice Test Posted: 11 Nov 2010 07:25 PM PST December 2010 Nursing Board Exam Review Questions on Pharmacology. Mark the letter of your choice then click on the next button. Your score will be posted as soon as the you are done with the quiz. We will be posting more of this soon. If you want a simulated Nursing Board Exam, get a copy of our Nursing Board Exam Reviewer v1.0 and v2 now. 1.    A client is diagnosed with leukemia. Methotrexate has been prescribed by the doctor. If a very high-dose of drug is administered to the client which of the following medications should the nurse prepare to prevent fatal toxicity? a. Calcium Gluconate b. Leucovorin Calcium c. Edetate Calcium Disodium d. Phenytoin 2.    The staff nurse is carrying out doctor's order. A medication is ordered: Ampicillin 500 mg PO q6h. This is under what type of medication order? a. PRN order b. Stat Order c. Single order d. Standing Order 3.    The client on Methotrexate therapy is asking about the drug contraindications. The following are contraindications of the drug apart from: a. Pregnancy b. Allergic reaction to the drug c. Ectopic pregnancy d. Hypersensitivity 4.    The doctor's order is Acyclovir (Zovirax) ung. 5 times a day. UNG stands for: a. As directed b. Ointment c. Suspension d. Label 5.    Every drug has a side effect or adverse reaction. In Methotrexate therapy, which adverse reaction will be observed in the client? a. Anorexia b. Leukocytosis c. Increase platelet count d. Constipation 6.    A client is prescribed with mannitol. What is the classification of mannitol? a. Potassium sparing diuretic b. Loop diuretic c. Osmotic diuretic d. Potassium wasting diuretic 7.    Take thou symbol, client's name, address and age are contained in what part of prescription? a. Superscription b. Subscription c. Inscription d. Signature 8.    A nurse is providing health teaching to the client who is on Methotrexate therapy. The drug regimen must be discontinued the client would manifest which of the following symptoms? a. Abdominal pain b. Diarrhea c. Ulcerative stomatitis d. All of the above 9.    If edema and joint pains is observed in a client taking Methotrexate, which of the following medications would the nurse expect the doctor to prescribe? a. Succimer b. NSAIDs c. Salicylates d. Allopurinol 10.    Which of the following condition should the nurse withhold Mannitol administration in a client? a. Increase intracranial pressure b. Dehydration c. Toxic overdose d. Acute oliguric phase of renal failure 11.    Extreme precaution should be observed by the nurse throughout Methotrexate therapy. Specific conditions of client impose extreme precaution in administering the drug. Extra precautions in Methotrexate therapy is least likely observed in which condition: a. Trophoblastic neoplasms b. Preexisting liver damage c. Impaired renal function d. Infection 12.    The antidepressant Amitriptyline (Elavil) has the half life of 10-50 hours. What is a drug half-life? a. Drug half-life is period of time it takes for a substance undergoing decay to decrease by half b. Drug half-life is period of time it takes for a substance undergoing decay to increase by half c. Drug half-life is the period of time required for the concentration or whole amount of drug in the body to be fully metabolized. d. Letters A and C 13.    Which of the following beverages is discouraged to be taken with Methotrexate because it decreases the drug efficacy: a. Alcohol b. Milk c. Caffeine d. Water 14.    To assess for the renal function of the patient taking Mannitol, which of the following laboratory values should the nurse obtain? a. ALT, AST b. WBC and Platelet Count c. Sodium and potassium d. BUN and creatinine 15.    The client is asking regarding Methotrexate therapy. If a dose is missed what should the client do? a. It should be omitted. b. It should be taken within 4 hours after the missed dose. c. The next dose should be doubled. d. It should be taken within 24 hours after the missed dose. 16.    A prescription was given by the physician. The part where the drug name, strength and dose is written is called: a. Superscription b. Subscription c. Inscription d. Personal data 17.    The nurse is providing health teaching on a client who is on Methotrexate therapy. The following actions should be observed by the client throughout the course of therapy except: a. Use a soft-bristled toothbrush. b. Use sunscreen and protective clothing. c. Use electric razor in removing mustache. d. Use OTC drugs and salicylates in treating fever. 18.    A nurse is carrying out the doctor's order. Which of the following drugs should the nurse question if the doctor prescribed it to a client on Methotrexate therapy, who has been observed with bleeding gums, blood in stools, urine and vomitus? a. Naproxen b. Allopurinol c. Leucovorin d. Vincristine 19.    A client on Mannitol therapy is also taking Digoxin, a cardiac glycoside. Which of the following electrolyte level should the nurse monitor to assess for the risk of digoxin toxicity? a. Potassium b. Sodium c. Creatinine d. Platelet 20.    The following adverse effects are observed in a client taking Mannitol apart from: a. Nausea and vomiting b. Hypokalemia c. Blurred vision d. Bradycardia 21.    Acyclovir (Zovirax) is classified as: a. Anti-infective b. Antiviral c. Antihypertensive d. NonSteroidal Anti-Inflammatory Drug 22.    To fully understand how a drug works, basic pharmacology information should be understood. The action of the drug on the human body is called: a. Pharmacokinetics b. Half-life c. Pharmacodynamics d. Potency 23.    The physician is discussing about the medication regimen to the patient. The doctor said that only a small dosage of a high potency drug is required to induce a large response in the body. Potency is defined as: a. The process of absorbing, distributing, metabolizing and excreting the drug. b. Refers to the maximum response achievable from a drug. c. Measure of the concentration of a drug at which it is effective. d. A reduction in response to an agonist while it is continuously present at the receptor, or progressive decrease in response upon repeated exposure to an agonist. 24.    Directions about the number of tablets or amount to be dispersed are located in which part of prescription? a. Superscription b. Subscription c. Inscription d. Signature 25.    The novice nurse on a unit is reviewing the medication orders of the physician. One client has an order of Decadron 10 mg qd x 5 days. This medication order is an example of: a. PRN order b. Stat Order c. Single order d. Standing Order Related posts: Nursing Board Review: Fundamentals of Nursing Practice Test Part 2 Nursing Board Review: Maternal and Child Health Nursing Practice Test Part 1 Nursing Board Review: Maternal and Child Health Nursing Practice Test Part 2

Rating of NLE Posted: 11 Nov 2010 06:00 PM PST It is roughly a month before the December 2010 Nursing Board Exam, shall we take a look at how rating of the Nurse's Licensure Examination is produced. According to Section 15 of R. A. 9173 or the Philippine Nursing Act of 2002, in order to pass the examination, an examinee must obtain a general average of at least 75% with the rating of not below 60% in any subject. An examinee who obtains an average rating of 75% or higher but gets a rating of below 60% in any subject must take the examination again but only with the subject or subjects where he or she failed. He or she must have an average of 75% to pass that test item. Renewal examination. The examiner who failed in the first test taking must process his or her papers for the next board examination within two (2) years after the last failed examination. Reconsideration of Ratings. There are cases that the examiner really passed such item in the exam, but the problem was on the clerical or mechanical part of checking the examination. The examinee could then submit a request for reconsideration of rating to the Commission within ninety (90) days from the date of the official release of the examination results. Right from experience, it is better to take the Nursing Licensure Examination in one strike. The efforts in processing the papers as well as sleepless nights are not everyday activities that an individual who aspires to be a professional nurse, so give your best so as to get a passing rate of 75% or above in this upcoming board exam. Related posts: Nursing Practice Test III – Set A Nursing Practice Test IV – Set A Protected: Nursing Practice Test III – Set B

Methotrexate – Drug Study Posted: 11 Nov 2010 05:55 PM PST Methotrexate Brand Name: Amethoptertin, Folex, Trexall Classification: Antineoplastic, antirheumatic, immunosuppressant, antimetabolite Indications Trophoblastic neoplasms (choriocarcinoma, Hydatidiform Mole) Leukemia Breast, head and neck carcinoma Severe psoriasis and rheumatoid arthritis unresponsive to conventional therapy Ectopic pregnancy Lymphosarcoma Mycosis fungoides Methotrexate Pill Action Methotrexate works against folic acid metabolism which leads to the inhibition of DNA synthesis and cell production. The drug's principal mechanism is through competitive inhibition of the enzyme folic acid reductase. For the cells to proliferate and replicate, folic acid must be reduced to tetrahydrofolic acid by this enzyme (folic acid reductase) in the process of DNA synthesis and cellular replication. With the administration of Methotrexate, the reduction of folic acid to tetrahydrofolic acid is inhibited thus, interfering with the tissue cell reproduction. Because of this function, death of rapidly replicating cells (e.g. cancer cells, choriocarcinoma, leukemia, carcinoma in different body parts and ectopic pregnancy) specifically the malignant ones is made possible. It also has an immunosuppressive activity. Contraindications Known allergic hypersensitivity to the drug Pregnancy Methotrexate has caused fetal death and/or congenital anomalies, therefore, it is not recommended in women of childbearing potential unless there is imperative medical evidence that the benefits can be expected to outweigh the considered risks. Pregnant psoriatic patients should not receive this drug. Concomitant use of other drugs that has a hepatotoxic potential (including alcohol) should be avoided. Adverse Reactions Dizziness Drowsiness Headaches Malaise Anorexia Nausea and vomiting Hepatoxicity Alopecia Ulcerative stomatitis Leukopenia Chills and fever Photosensivity Thrombocytopenia Hyperurecemia Dosage Choriocarcinoma and similar trophoblastic neoplasms PO/IM: 15-30 mg daily for a 5-day course. The courses are usually repeated 3-5 times as required with a rest period of 1 week or more in between. Leukemia PO (adults): 3.3 mg/m2 in combination with Prednisone 60 mg/m2 daily for the induction phase of the therapy. PO/IM (adults): 20-30 mg/m2 twice weekly for the maintenance phase of the therapy. IV (adults): 2.5 mg/kg every 2 weeks IT (adults): 12 mg/m2 or 15 mg IT (children >3 years): 12 mg IT (children 2 years): 10 mg IT (children 1 yr): 8 mg IT (children <1 yr): 6 mg Psoriasis PO (Adults): 2.5-5 mg every 12 hours for 3 doses or every 8 hours for 4 doses once weekly (not to exceed 30 mg/week) Nursing Considerations Assessment Monitor the client taking Methotrexate for: Abdominal pain, diarrhea or ulcerative stomatitis. Therapy may be discontinued with the presence of these toxic effects otherwise, hemorrhagic enteritis and death from intestinal perforation may occur. Symptoms of pulmonary toxicity, which may manifest early as a dry and nonproductive cough. Symptoms of gout due to increased uric acid. (edema, joint pain) Laboratory Tests CBC (WBC and Platelet) Renal function (BUN and Creatinine) Hepatic function (AST, ALT, bilirubin) Serum Uric Acid concentration Precautions Extra precautions in administering Methotrexate should be observed in the following conditions: Preexisting liver damage or impaired hepatic function Methotrexate may be hepatotoxic. Even without previous signs of GI or hematologic toxicity such as liver atrophy, necrosis and cirrhosis. Special caution should be observed in clients with preexisting liver damage or impaired hepatic function. Presence of infection, peptic ulcer, ulcerative colitis, geriatric patients or patients with chronic debilitating illnesses. This drug has an immunosuppressive action. Thus, extreme caution should be observed in patients where immune responses may be vital for healing from a certain disease. Impaired renal function Toxicity and Overdose If Methotrexate is administered in high doses, the patient must receive Leucovorin Calcium rescue within 24-48 hours to prevent fatal toxicity. Interventions Solutions for injection must be prepared in a biologic cabinet. Gloves, gown and mask are worn while preparing and handling the medication. Administer Allopurinol per doctor's order to decrease uric acid levels. Instruct patient to avoid caffeine as it may decrease the efficacy of the drug. To prevent hematologic toxicity (platelet levels are decreased) salicylates, NSAIDs, phenytoin, tetracycline and chlorampenicol should be avoided. images from bedfordlabs.com, johnsonintegrativehealth.com Related posts: Drug Study – Folic Acid Drug Study – Gentamicin Sulfate Drug Study (Paracetamol)

Glomerulonephritis Posted: 11 Nov 2010 05:50 PM PST Glomerulonephritis This renal condition can be classified into two: acute and chronic. Acute Glomerulonephritis Acute glomerulonephritis refers to a group of kidney diseases in which there is an inflammatory reaction in the glomeruli. It is not an infection of the kidney, but rather the result of the immune mechanisms of the body. The glomerular injury is the result of antigen-antibody deposits within the glomeruli. In less than 60 days, patients regain normal renal function. Pathophysiology: The initial reaction is usually either an upper respiratory infection or skin infection due to group A beta-hemolytic streptococcus. This leads to the formation of an antigen-antibody reaction. It is followed by the release of a membrane-like material from the organism into the body’s circulation. Antibodies produced to fight the invading organism also react against the glomerular tissue, thus forming immune complexes. The immune complexes become trapped in the glomerular loop and cause an inflammatory reaction in the affected glomeruli. Changes in the glomerular capillaries reduce the amount of the glomerular filtrate, thereby allowing passage of blood cells and protein into the infiltrate, and reducing the amount of sodium and water that is passed into the tubules for reabsorption. This affects the vascular tone and permeability of the kidney, resulting to tissue injury. Clinical Manifestations: History of infection such as pharyngitis or impetigo Tea-colored urine and oliguria Puffiness of face and edematous extremities Fatigue and anorexia with possible headache High blood pressure Anemia from loss of RBCs into the urine Diagnostic Evaluation: Urinalysis for hematuria, proteinuria, cellular elements and various casts. 24-hour urine collection to determine protein and creatinine clearance. Elevated BUN and serum creatinine levels, low albumin level, increased antistreptolysis titer and decreased serum complement. Needle biopsy of the kidney reveals obstruction of the glomerular capillaries from proliferation of endothelial cells. Complications: Hypertension, heart failure, endocarditis Hyperkalemia, hyperphosphatemia, hypervolemia Malnutrition Hypertensive enecephalopathy, seizures ESRD Medical Management: It depends on the symptoms and includes antihypertensives, diuretics, drugs to manage hyperkalemia, H2 blockers and phospate-binding agents. Antibiotic therapy is initiated to eliminate infection. Fluid intake is restricted. Dietary protein is restricted moderately if there is oliguria and the BUN is elevated. Carbohydrates are increased liberally to provide energy and reduce catabolism of protein. Potassium and sodium intake is restricted in presence of hyperkalemia, edema or signs of heart failure. Nursing Management: Promote renal function. Strictly measure and monitor intake and output and maintain dietary restrictions. Encourage rest to facilitate diuresis and until renal function test levels normalize. Administer medications as ordered and evaluate effectiveness of treatment. Improve fluid balance. Carefully monitor fluid balance and and replace fluids according to patient’s fluid losses. Get daily weight. Monitor for signs and symptoms of heart failure and hypertensive encephalopathy. Chronic Glomerulonephritis This can be due to repeated episodes of acute glomerulonephritis, hypertensive nephrosclerosis, hyperlipidemia, chronic tubulointerstitial injury or hemodynamically mediated glomerular sclerosis. The kidneys are reduced to as little as one-fifth of their normal size. Bands of scar tissue distort the remaining cortex, making the surface of the kidney rough and irregular. Numerous glomeruli and their tubules become scarred and the branches of the renal artery are thickened. The result is severe glomerular damage that can progress to ESRD. Clinical Manifestations: Feet are slightly swollen at night Loss of weight and strength Irritability Nocturia Headaches and dizziness Digestive disturbances Appears poorly nourished Yellow-gray pigmentation of the skin Periorbital and peripheral dependent edema Retinal hemorrhage Cardiomegaly Crackles in the lungs Peripheral neuropathy Medical Management: Symptomatic management; medications are prescribed based on the exhibited symptoms. Weight is monitored daily. Proteins of high biologic value are given, as well as ensuring adequate caloric intake. UTI must be treated promptly. Initiation of dialysis must be considered. Related posts: Acute Renal Failure Renal Problems – Renal Calculi Nursing Care Plan – Renal Failure

Allergic Rhinitis Posted: 11 Nov 2010 05:43 PM PST Allergic rhinitis a form of allergic reaction in the respiratory system which is characterized by seasonal occurrences. Children and adolescents are mostly affected by this. Over all this is the most common allergic reaction that happens on all age groups and it has a family origin also. Etiology: Pollens from trees, grass and weed which usually increases during spring, summer and fall respectively. Harsh environmental factors like pollution, smoke and strong smells. Other triggering factors can cause year-round symptoms that do not appear to be associated with specific triggers. Dust mite and animal exposure are called perennial allergens. There is a tendency also for chronic symptoms to appear. Pathophysiology: The immunoglobulin (Ig) E increases whenever an inhaled allergen stays on the mucosal surface. It combines with nasal mucosa. The nasal mucosa  then becomes edematous and leukocytes infiltrated it. There is tissue edema since capillary permeability increases. Signs and Symptoms: Itching, burning nasal mucosa Copious mucous secretions causing runny nose Red, burning, teary eyes Sneezing Pale, boggy nasal mucosa Diagnostic evaluation: Nasal smears indicates eosinophil in nasal secretions. Peripheral blood count – lymphocytes increase above 1,200 mL Elevated serum IgE Skin test positive among various allergens Radioallergosorbent test – specific test for IgE, antibodies are present when they combine with the radiolabeled allergens Medical management: Prescription of use of anti-histamines. There non-drowsing anti-histamines that are available in the market. Immunotherapy. This is advised for clients with specific inhalant allergens like house dust and pollens which is unavoidable. Nursing management: Administer antihistamines, decongestants and topical corticosteroids. Caution clients to avoid driving vehicles whenever he or she is on antihistamines or decongestants. Teach the client the proper use of saline nasal sprays by blowing his nose first then administer the nasal medication. Assist the client when he or she is advised for immunotherapy. Encourage a routine cleaning of the house, furnitures and equipments which may house dust and other pollens. There are second generation anti-histamines that are non-drowsing. These are appropriate for clients who cannot avoid working while the allergy is going on. Their work won’t be interfered. Photo credits: www.nlm.nih.gov Related posts: Head-To-Toe Assessment (M. Nose and Paranasal Sinuses) Stages of Illness Behavior Asthma Case Study

Maple Syrup Urine Disease (MSUD) Posted: 11 Nov 2010 05:16 PM PST Maple Syrup Urine Disease Definition Maple syrup urine disease (MSUD) is a rare inherited disorder where the body cannot break down certain parts of protein. The urine of the child smells like a maple syrup. Incidence This disorder occurs in about 1 case per 180,000 newborns. Causes Maple Syrup Urine Disease is an inherited disorder which follows an autosomal recessive pattern. In this disease the branched-chain alpha-keto acid dehydrogenase complex (BCKDH) responsible for metabolizing some amino acids is absent or deficient. In some cases, MSUD can damage the brain during infection, fever, fasting or any physical stress experienced by the child. Repeated periods of physical stress result to catabolism of cells releasing amino acids (including leucine, isoleucine and valine) into the bloodstream thereby, leading to mental retardation. Pathophysiology Branched-chain alpha-keto acid dehydrogenase complex (BCKDH) is combination of enzymes that is responsible for the breakdown of the branched chain amino acid. These branched chain amino acids include leucine, isoleucine and valine. In maple syrup urine disease, the branched chain alpha-keto acid dehydrogenase complex (BCKDH) is absent or deficient resulting to the accumulation of the branched chain amino acids (leucine, isoleucine, and valine) into the urine and blood. Elevated components of leucine, isoleucine and valine that are not metabolized spill out in the urine giving the waste product a distinctive sweet-smelling odor similar to that of maple syrup, hence, the name of the disease. The buildup of the toxic by-products of these amino acids leads to the cerebral degeneration (brain damage) similar to that observed in children diagnosed with Phenylketonuria (PKU) and death, if left untreated. Clinical Manifestations Infants with the disorder tend to appear well at birth; however, they quickly show abnormal signs in about 2-7 days depending on the feeding regimen. Feeding difficulty Vomiting Loss of Moro reflex Irregular respirations Opisthotonos Generalized muscular rigidity Generalized seizures Sweet-smelling odor of urine similar to that of maple syrup by the first or second day Poor weight gain Increasing lethargy If the condition remains untreated, the infant may die as early as 2 to 4 weeks of age. Diagnosis Prenatal diagnostic tests Amniocentesis Chrorionic villus sampling Extrauterine diagnostic tests Plasma amino acid test Urine amino acid test Management Dietary therapy Low amino acids (leucine, isoleucine and valine) and high thiamine (Vitamin B1) diet is prescribed to the affected infant. Thiamine, also called Vitamin B1, is responsible for muscle nerve function and a coenzyme for energy metabolism. The child has to comply with the dietary therapy lifelong and must restrict intake of branched chain amino acids without impairing growth and development. This is the main reason why infants are given thiamine. Activity No activity restrictions. Hemodialysis or peritoneal dialysis This measure can be used to temporarily reduce abnormal serum levels at birth or during a childhood infection, when catabolism of cells releases increased amino acid into the blood stream. Medication Thiamine Thiamine is a necessary coenzyme in carbohydrate and amino acid metabolism. The oral absorption is poor however, the parenteral route is associated with sever adverse reactions. Related posts: Phenylketonuria (PKU) Sickle Cell Anemia – Case Study Tay-Sach's Disease

Lobectomy Posted: 11 Nov 2010 11:00 AM PST Lobectomy is a thoracic procedure, which removes a lobe of the lungs. It is performed when a disease pathology is limited to one area of the lung, bronchogenic carcinoma, giant emphysematous blebs or bullae, benign tumors, metastatic malignant tumors, bronchiectasis, and fungal  infections. The surgeon makes a thoracotomy incision: its exact location depends on the lobe to be removed. When the pleuralspace is entered, the involved lung collapses and the lobar vessels and the bronchus are ligated and divided. After the lobe is removed, the remaining lobes of the lung are re-expanded. Usually, two chest catheters are inserted for drainage. The upper tube is for air removal, the lower one is for fluid drainage. Sometimes though, only one catheter is needed. Then, the chest tube is connected to a chest drainage apparatus for several days. Pre-operative Management: Improving air clearance: Humidification, postural drainage and chest percussion after administration of prescribed bronchodilators. Antibiotics are prescribed for infection. Educating the patient: Inform the patient what to expect, from administration of anesthesia to thoracotomy and the likely use of chest tubes and a drainage system postoperatively. Tell the patient about the administration of oxygen postoperatively and the possible use of a ventilator. Explain the importance of frequent turning to promote drainage of lung secretions. Instruct the proper use of an incentive spirometry and how to perform diaphragmatic and pursed-lip breathing tecnhiques. Teach the patient to splint the incision site with hands, a pillow or a folded towel to avoid discomfort. Relieving anxiety: Listen to the patient to evaluate his or her feelings about the illness and the proposed surgery. Help the patient overcome fears and to cope with the stress of surgery by correcting any misconceptions, supporting the patient’s decision to undergo surgery and dealing honestly with questions about pain, discomfort and treatments available. Post operative Management: Vital signs are checked frequently. Oxygen is administered via cannula, mask or ventilator as long as necessary. Fluids are given at a low hourly rate to prevent fluid overload and pulmonary edema. Careful positioning of the patient is important, bed may elevated 30 to 45 degrees. Turning from back to operated side, but not completely to the un-operated side to prevent mediastinal shifting. Pain medications are administered. Encourage splinting of the incision site. Breathing exercises and spirometry are resumed to facilitate lung ventilation. Dressings are assess for fresh bleeding. Assess for signs of complications such as cyanosis, dyspnea and acute chest pain. Photo credits:  www.nlm.nih.gov Related posts: Nephrectomy TURP (Transurethral Resection of the Prostate) Aortic Aneurysm

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