The Pharmacology Review

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The Pharmacology Review

• Leslie Davis, MSN, RN, CS, ANP
• Clinical Associate Professor
• UNC CH, School of Nursing

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Some Test Taking Tips For the NCLEX and Beyond

• Know your normal lab values! These can have a
  Huge Impact on Meds you may give.
• Know Side Effects to Common Meds
• Know Commonly Prescribed Meds and what their
  Therapeutic Use is.

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Most important lab values to know

• K (3.5-5.0)
• Hgb/ Hct
• When to do PT/INR vs. PTT
• Toxic values to know
• Digoxin levels gt 2.0
• Lithium levels gt 2.0
• Dilantin levels gt 20.0

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Now for the Question Answer Portion of the
Afternoon.
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Question 1

• If Regular Insulin is given at 0730am when is a
  reaction most likely??
• 11am
• 2pm
• 5pm
• 9pm

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Question 2

• Which patient would you be most concerned with
  digitalis toxicity?
• Patient with constipation
• Patient with serum potassium of 4.1
• Patient taking HCTZ
• Patient taking oral diabetic agents

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Question 3

• A patient recently admitted to the ICU is having
  frequent premature ventricular contractions that
  are symptomatic. Which of the following
  medications would you expect this patient to
  receive?
• Digoxin
• Furosemide
• Lidocaine
• Levophed

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Question 4

• Which lab value would you monitor closely with a
  patient receiving IV Heparin?
• Protrombin time (PT)
• Platelet Count
• International normalized ratio (INR)
• Partial thromboplastin time (PTT)

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Question 5

• Which Lab Value would you monitor closely with a
  patient receiving warfarin (Coumadin)?
• White Blood Cell Count (WBC)
• Platelet count
• International normalized ratio (INR)
• Partial thromboplastin time (PTT)

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Question 6

• The RN instructs the client taking warfarin
  (Coumadin) about interactions. Which drug could
  increase the risk of adverse effects for the
  client?
• Furosemide (Lasix)
• Diazepam (Valium)
• Digoxin (Lanoxin)
• Acetylsalicylic Acid (Aspirin)

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Question 7

• Your pt is receiving steroid taper of Prednisone.
  The pt asks why you cant stop the medicine
  quickly. Your response is
• To avoid systemic toxicity
• To facilitate natural adrenocortical function
• To prevent glycosuria
• To prevent fluid and electrolyte imbalance

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Question 8

• What is a concern associated with long term use
  of diazepam (Valium)?
• Decreased ability to maintain balance
• Muscle atrophy
• Abrupt discontinuation of therapy
• Orthostatic hypotension

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Question 9

• A pt being treated for bipolar disorder is
  receiving Lithium therapy. Which electrolyte
  abnormality could cause toxic effects?
• Low potassium
• Low sodium
• Low calcium
• Iron deficiency

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Question 10

• Which of the following ENHANCES the effects of
  narcotic analgesics?
• Naloxone (Narcan)
• Flumazenil (Romazicon)
• Lidocaine (Xylocaine)
• Ethanol (Alcohol)

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Question 11

• What is the most serious side effect that would
  need to be assessed for with a pt starting
  selective serotonin reuptake inhibitor (SSRI)
  therapy?
• Nausea Vomiting
• Increased suicidal ideations/attempts
• Sleep pattern disturbance
• Food/Drug interaction

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Question 12

• Levothyroxine (Synthroid) is prescribed for a
  patient. The RN teaches the pt to check their HR
  and notify the MD/NP if their pulse is gt 100 bpm
  because
• Tachycardia may be an allergic reaction caused by
  this medication
• Excessive levels of the drug result in
  tachycardia
• Prolonged cardiac workload can occur as a result
  of increased weight gain
• Congestive heart failure can occur related to the
  fluid and electrolyte shifts caused by the med

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Question 13

• Acetaminophen (Tylenol) should be used with
  caution in which clients?
• Older adults with arthritis and dementia
• Children with chicken pox and a fever
• Pregnant women and teenagers with anemia
• Clients with chronic alcoholism and hepatic
  disease

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Question 14

• What medication is the antidote to acetaminophen
  toxicity?
• Furosemide (Lasix)
• Acetylcysteine (Mucomyst)
• Heparin
• Activated charchoal
• There is no antidote

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Question 15

• Pilocarpine (Pilocar) ocular therapy is
  prescribed for a client. The nurse would expect
  this client to have which medical condition?
• Glaucoma
• Amblyopia
• Astigmatism
• Cataracts

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Question 16

• An RN is providing education to a patient/family
  about proper use of a PCA Pump. What statement
  would indicate patient/family understanding?
• Family member stating that they will hit the
  button when they think the patient needs it
• Pt states that they will wait until the pain is
  very bad to use the pump
• Pt states that they will use the pump to keep
  their pain at comfortable level
• Pt states that they will wait till the nurse is
  in the room to use the PCA

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Question 17

• Antacids containing magnesium may increase the
  risk of adverse physical effects in clients with
  which condition
• Viral infection
• Cardiac disease
• Diabetes mellitus
• Renal failure

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Question 18

• Which category of meds used to treat asthma work
  by promoting smooth muscle relaxation while
  dilating the constricted bronchi and bronchioles?
• Beta-adrenergic agents
• Antihistamines
• Corticosteroids
• Anticholinergics

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Question 19

• A client who is taking a benzodiazepine for
  anxiety asks what kinds of medications he might
  need to avoid. The nurse would respond
• Cephalosporin antibiotics
• Nonsteroidal anti-inflammatory drugs
• Calcium channel blockers
• Barbituates

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Question 20

• A client is receiving morphine sulfate IV for
  post-op pain. Which assessment finding would
  warrant immediate attention?
• Blood Pressure 150/90
• Pulse Rate 110
• Pupillary constriction
• Respiratory rate 9

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Some Helpful Things You Might Want to Know..
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Insulin
Type Onset Peak Duration
Lispro (Humalog) Aspart (Novolog) 15 minutes 30-90 minutes 6-8 hours
Regular(Humulin R, Novolin R, Regular Iletin) 30-60 minutes 4-6 hours 6-8 hours
IntermediateActing NPH (Humulin N, Novlin N)lente (Humulin L, Novolin L) 1 - 1.5 hrs 1 - 2.5 hrs 4-12 hours 7-15 hours 24 hours 24 hours
Ultralente Lantus Ultralente 4-8 hoursLantus 1-2 hours 10-30 hoursno pronounced peak 36 hours24 hours
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Helpful Websites

• www.eriworld.com
• www.cdc.gov
• www.rxlist.com
• This has the top 200 drugs for 2002.
• www.rx.com

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THANK YOU FOR COMING AND GOOD LUCK!!!!

• Review material from ATI testing, Kaplan Review,
  and Eileen Horn RN MSN Pharmacology Review.
  Compiled by Lindsey Austin