(Solution)All ATI pharmacology proctored exams, notes and reviewed questions and answers, well elaborated; an ultimate mastery for an A grade (2023 updated).

SAUNDERS ATI PHARMACOLOGY STUDY GUIDE
Week 1: Chapter 35 “Maternity and Newborn Medications”
Questions Answers and Rationales

1. The nurse is monitoring a client who
   is receiving oxytocin (Pitocin) to
   induce labor. Which assessment
   finding would cause the nurse to
   immediately discontinue the
   oxytocin infusion?
2. Fatigue
3. Drowsiness
4. Uterine hyperstimulation
5. Early decelerations of the fetal heart rate
   Rationale: Often used to induce labor. High doses are
   often used for uterine hyperstimulation & C/S births.
   ADVERSE EFFECTS: Hyperstimulation of uterine
   contractions & non-reassuring fetal HR
   DISCONTINUE
6. A pregnant client is receiving
   magnesium sulfate for the
   management of preeclampsia. The
   nurse determines that the client is
   experiencing toxicity from the
   medication if which finding is noted
   on assessment?
7. Proteinuria of 3 +
8. Respirations of 10 breaths/ minute
9. Presence of deep tendon reflexes
10. Serum magnesium level of 6 mEq/ L
    Rationale: Mg TOXICITY RESP. DEPRESSION, LOSS
    OF TENDON REFLEXES & SUDDEN DECLINE IN FETAL
    HR, MATERNAL HR, & BP caused by Mg tx. Must
    remain within therapeutic serum levels 4–7.5 mEq/L.
    Proteinuria 3+ is expected in a pt w/ preeclampsia.
11. The nurse is monitoring a client in
    preterm labor who is receiving
    intravenous magnesium sulfate. The
    nurse should monitor for which
    adverse effects of this medication?
    Select all that apply.
12. Flushing
13. Hypertension
14. Increased urine output
15. Depressed respirations
16. Extreme muscle weakness
17. Hyperactive deep tendon reflexes
    Rationale: Mg sulfate is a CNS depressant that relaxes
    smooth muscles like the uterus. It’s used to STOP
    preterm labor contractions and for preeclampsia pts.
    to PREVENT SEIZURES. ADVERSE EFFECTS:
     Flushing
     Depressed respirations
     Depressed deep tendon reflexes
     Hypotension
     Extreme muscle weakness
     Decreased urine output
     Pulmonary Edema
     Elevated Mg serum levels
18. The nurse instructor asks a nursing
    student to describe the procedure for
    administering erythromycin ointment
    to the eyes of a newborn. Which
    student statement indicates that
    further teaching is needed?
19. “I will flush the eyes after instilling the ointment?”
20. “I will clean the newborn’s eyes before instilling
    ointment.”
21. “I need to administer the eye ointment within 1 hr.
    after delivery.”
22. “I will instill the eye ointment into each of the NB’s
    conjunctiva sacs.”
    Rationale: Eye prophylaxis protects the NB against
    Neisseria gonorrhea & Chlamydia trachomatis. The
    eyes are NOT FLUSHED AFTER INSTILLATION of med
    because the flush would WASH AWAY the

administered medication.

5. A client in preterm labor (31
   weeks) who is dilated to 4 cm has
   been started on magnesium sulfate
   and contractions have stopped. If the
   client’s labor can be inhibited for the
   next 48 hours, the nurse anticipates
   a prescription for which medication?
6. Nalbuphine (Nubain)
7. Betamethasone (Celestone)
8. Rho(D) immune globulin (RhoGAM)
9. Dinoprostone (Cervidil vaginal insert)
   Rationale: Betamethasone, a glucocorticoid
   increases the production of surfactant to stimulate
   fetal lung maturation. It is administered to clients in
   preterm labor at 28 to 32 weeks of gestation if the
   labor can be inhibited for 48 hours.
   Nalbuphine (Nubain) is an opioid analgesic.
   Rho(D) immune globulin (RhoGAM) is given to Rhnegative clients to prevent immunological condition
   aka Rh disease (hemolytic disease of NB); it takes out
   the + cells that were transported from maternal blood
   stream  fetal circulation.
   Dinoprostone (Cervidil vaginal insert) is a
   prostaglandin given to ripen and soften the cervix and
   to stimulate uterine contractions.
10. Methylergonovine (Methergine) is
    prescribed for a woman to treat
    postpartum hemorrhage. Before
    administration of
    methylergonovine, what is the
    priority nursing assessment?
11. Uterine tone
12. Blood pressure  ABC!!!
13. Amount of lochia
14. Deep tendon reflexes
    Rationale: Methylergonovine is an ERGOT ALKALOID
    prevents or controls postpartum hemorrhage by
    contracting the uterus. This med  continuous uterine
    contractions and can elevate BP CHECK BP  report
    to MD if HTN is present
15. The nurse is preparing to administer
    beractant (Survanta) to a
    premature infant who has
    respiratory distress syndrome. The
    nurse plans to administer the
    medication by which route?
16. Intradermal
17. Intratracheal
18. Subcutaneous
19. Intramuscular
    Rationale: Respiratory distress syndrome is a serious
    lung disorder caused by immaturity and the inability
    to produce surfactant hypoxia and acidosis. It is
    common in premature infants and may be due to lung
    immaturity as a result of surfactant deficiency. The
    mainstay of tx=exogenous surfactant, which is
    administered by the intratracheal route.

• Note relationship that question states “respiratory
  distress syndrome” Intratracheal

5. An opioid analgesic is administered
   to a client in labor. The nurse
   assigned to care for the client
   ensures that which medication is
   readily available if respiratory
6. Naloxone  Antidote!
7. Morphine sulfate
8. Betamethasone (Celestone)
9. Meperidine hydrochloride (Demerol)

depression occurs?

9. Rho(D) immune globulin (RhoGAM) is
   prescribed for a client after delivery
   and the nurse provides information to
   the client about the purpose of the
   medication. The nurse determines
   that the woman understands the
   purpose if the woman states that it
   will protect her next baby from which
   condition?
10. Having Rh-positive blood
11. Developing a rubella infection
12. Developing physiological jaundice
13. Being affected by Rh incompatibility
    Rationale: Rh incompatibility can occur when an Rhnegative mother becomes sensitized to Rh antigen.
    Sensitization may occur when an Rh-negative woman
    becomes pregnant with a fetus who is positive
    maternal circulation mother’s immune system to
    form antibodies against Rh+ blood. This medication
    prevents mothers from developing antibodies against
    Rh+ blood by providing passive antibody protection
    against Rh antigen.
14. Methylergonovine (Methergine) is
    prescribed for a client with
    postpartum hemorrhage. Before
    administering the medication, the
    nurse contacts the health care
    provider who prescribed the
    medication if which condition is
    documented in the client’s medical
    history?
15. Hypotension
16. Hypothyroidism
17. Diabetes mellitus
18. Peripheral vascular disease
    Rationale: Ergot alkaloids are contraindicated in
    clients with significant cardiovascular disease,
    peripheral vascular disease, hypertension,
    preeclampsia, or eclampsia. The vasoconstrictive
    effects of the ergot alkaloids worsen these conditions.
    Chapter 49: “Pediatric Med. Administration and Calculations”
    Questions Answers and Rationales
19. The nurse is providing medication
    instructions to a parent. Which
    statement by the parent indicates a
    need for further instruction?
20. “I should cuddle my child after giving the
    medication.”
21. “I can give my child a frozen juice bar after he
    swallows the medication.”
22. “I should mix the medication in the baby food and
    give it when I feed my child.”
23. “If my child does not like the taste of the medicine, I
    should encourage him to pinch his nose and drink the
    medication through a straw.”
    Rationale: It may give an unpleasant taste to the food,
    and the child may refuse to accept the same food in the
    future. In addition, the child may not consume the
    entire serving and would not receive the required
    medication dosage.
24. A health care provider’s prescription
    reads “ampicillin sodium 125 mg IV
    every 6 hours.” The medication
    label reads “1 g and reconstitute
    with 7.4 mL of bacteriostatic water.”
    The nurse prepares to draw up how
    many mL to administer one dose?
25. 1.1 mL
26. 0.54 mL
27. 7.425 mL
28. 0.925 mL
    Rationale: 1 g= 1000 mg
    

ATI PHARMACOLOGY

1. A nurse is providing teaching to a group of new parents about medications. The nurse
   should include that aspirin is contraindicated for children who have a viral infection due
   to the risk of developing which of the following adverse effects?
   a. Reye’s syndrome
   b. Visual disturbances
   c. Diabetes mellitus
   d. Wilm’s tumor
   ANS: A
2. A nurse is providing teaching to a client who has chronic kidney failure with an AV
   fistula for hemodialysis and new prescription for epoetin alfa. Which of the following
   therapeutic effects of epoetin alfa should the nurse include in the teaching?
   a. Reduces blood pressure
   b. Inhibits clotting of fistula
   c. Promotes RBC production
   d. Stimulates growth of neutrophils
   ANS: C
3. A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which
   of the following medications should the nurse plan to administer?
   a. Ibuprofen (NSAIDS)
   b. Naproxen (NSAIDS)
   c. Aspirin (NSAIDS)
   d. Acetaminophen (anlagesics)
   ANS: D
4. A nurse is caring for a client who has prescription for clopidogrel. The nurse should
   monitor the client for which of the following adverse effects?
   a. Insomnia
   b. Hypotension
   c. Bleeding
   d. Constipation
   ANS: C
5. A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The
   nurse should include a severe allergy to which of the following medications as
   contraindication to ceftriaxone?
   a. Gentamicin
   b. Clindamycin
   c. Piperacillin
   d. Sulfamethoxazole-trimethroprim
   ANS: C
   1

ATI PHARMACOLOGY

6. A nurse is providing teaching to a newly licensed nurse about metoclopramide. The
   nurse should include in the teaching that which of the following conditions is a
   contraindication to this medication?
   a. Hyperthyroidism
   b. Intestinal obstruction
   c. Glaucoma
   d. Low blood pressure
   ANS: B
7. A nurse is assessing a client who has a new prescription for chlorpromazine to treat
   schizophrenia. The client has a mask like facial expression and is experiencing
   involuntary movements and tremors. Which of the following medications should the
   nurse anticipate administering?
   a. Amantadine
   b. Bupropion (aytpical antidepressant)
   c. Phenelzine (MAOI)
   d. Hydroxyzine (Antihistamine)
   ANS: A
8. A nurse is administering subQ epinephrine for a client who is experiencing anaphylaxis.
   The nurse should monitor the client for which of the following adverse effects?
   a. Hypotension
   b. Hyperthermia
   c. Hypoglycemia
   d. Tachycardia
   ANS: D
9. A nurse is providing teaching to a client who has UTI and new prescription for
   phenazopyridine and ciprofloxacin. Which of the following statements by the client
   indicates the need for further teaching?
   a. If the phenazopyridine upsets my stomach, I can take it with meals.
   b. The phenazopyridine will relieve my discomfort, but the cipro will get rid of the
   infections.
   c. I need to drink2 liters of fluid per day while I am taking cipro.
   d. I should notify my provider immediately if my urine turns an orange color.
   ANS: D
10. A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime
    to promote sleep. The nurse should plan to monitor the client for which of the following
    adverse effects?
    a. Ecchymosis
    b. Decreased urine output
    c. Increased blood pressure
    d. Dizziness
    2

ATI PHARMACOLOGY
ANS: D

11. A nurse is reviewing laboratory values for a client who reports fatigue and cold
    intolerance. The client has an increased thyroid stimulating hormone (TSH) level and a
    decreased total T3 and T4 level. The nurse should anticipate a prescription for which of
    the following medications?
    a. Methimazole
    b. Somatropin
    c. Levothyroxine
    d. Propylthiouracil
    ANS: C
12. A nurse is providing teaching to a client who has a new prescription for
    hydrochlorothiazide 50mg po daily to treat hypertension. Which of the following
    instructions should the nurse include in the teaching?
    a. Take the hydrochlorothiazide as needed for edema
    b. Check your weight once each week
    c. Take the hydrochlorothiazide on an empty stomach
    d. Take the hydrochlorothiazide in the morning.
    ANS: D
13. A nurse is caring for a client who is at 28 weeks of gestation and is experiencing preterm
    labor. Which of the following medications should the nurse plan to administer?
    a. Oxytocin
    b. Nifedipine
    c. Dinoprostone
    d. Misoprostol
    ANS: B
14. A nurse is providing teaching to a client who has cirrhosis and new prescription for
    lactulose. The nurse should instruct the client that lactulose has which of the following
    therapeutic effects?
    a. Increases blood pressure
    b. Prevents esophageal bleeding
    c. Decreases heart rate
    d. Reduce ammonia levels
    ANS: D
15. A nurse is caring for an older adult client who has a new prescription for amitriptyline to
    treat depression. Which of the following diagnostic tests should the nurse plan to perform
    prior to starting the client on this medication?
    a. Hearing examination
    b. Glucose tolerance test
    c. Electrocardiogram
    d. Pulmonary function test
    3
    

ATI NR293 Pharmacology Final Review Questions & Answers/rationale.
1) A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following
findings is a manifestation of levothyroxine overdose?
a) Insomnia
i) Rationale: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include
Insomnia, tachycardia, and hyperthermia.
b) Constipation
i) Rationale: Constipation is a manifestation of hypothyroidism and indicates an inadequate dose of
levothyroxine.
c) Drowsiness
i) Rationale: Drowsiness is a manifestation of hypothyroidism and indicates an inadequate dose of
levothyroxine.
d) Hypoactive deep-tendon reflexes
i) Rationale: Hypoactive deep-tendon reflexes are manifestations of hypothyroidism and indicate an
inadequate dose of levothyroxine.
2) A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?
a) Decrease in level of thyroxine (T4)
i) Rationale: If the dose of this medication has been adequate, the nurse should see an increase in the T4.
b) Increase in weight
i) Rationale: If the dose of this medication has been adequate, the nurse should see a decrease in weight, as
hypothyroidism causes a decrease in metabolism with weight gain.
c) Increase in hr of sleep per night
i) Rationale: If the dose of this medication has been adequate, the nurse should see a decrease in the hr of
sleep per night, as hypothyroidism causes sluggishness with increased hr of sleep.
d) Decrease in level of thyroid stimulating hormone (TSH).
i) Rationale: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no
endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior
pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroidhormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.
3) A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse
should recognize which of the following medications can cause glucose intolerance?
a) Ranitidine
i) Serum creatinine levels
b) Guafenesin
i) Drowsiness and dizziness
c) Prednisone
i) Glucose intolerance and hyperglycemia, patient might require increased dosage of hypoglycemic med.
d) Atorvastatin
i) Thyroid function tests.
4) A nurse is caring for a client receiving mydriatic eye drops. Which of the following clinical manifestations indicates
to the nurse that the client has developed a systemic anticholinergic effect?
a) Seizures
b) Tachypnea
c) Constipation

i) Mydriatic eye drops can cause systemic anticholinergic effects such as constipation, dry mouth,
photophobia, and tachycardia.
d) Hypothermia
5) A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which
of the following electrolyte imbalances?
a) Hypernatremia
i) Rationale: The nurse should monitor the client who is receiving IV furosemide for hyponatremia.
b) Hyperuricemia
i) Rationale: The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should
instruct the client to notify the provider for any tenderness or swelling of the joints.
c) Hypercalcemia
i) Rationale: The nurse should monitor the client who is receiving IV furosemide for hypocalcemia.
d) Hyperchloremia
i) Rationale: The nurse should monitor the client who is receiving IV furosemide for hypochloremia.
6) A nurse is talking to a client who is taking a calcium supplement for osteoporosis. The client tells the nurse she is
experiencing flank pain. Which of the following adverse effects should the nurse suspect?
a) Renal stones
7) A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following
laboratory values should the nurse monitor for a therapeutic effect of warfarin?
a) Hemoglobin
b) Prothrombin time (PT)
i) Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant
therapy,should typically be approximately two to three times the normal value, depending on the
indication for therapeutic anticoagulation.
c) Bleeding time
d) Activated partial thromboplastin time (aPTT)

8) A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, “I don’t need thismedication. I am not constipated.” The nurse should explain that in clients who have cirrhosis, lactulose is used to
decrease levels of which of the following components in the bloodstream?
a) Glucose
b) Ammonia
i) Rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents
absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in
pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing
hepatic encephalopathy or coma.
c) Potassium
d) Bicarbonate
9) A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following
statements should the nurse include in the teaching?
a) “Clients who have glaucoma should not take warfarin.”
b) “Clients who have rheumatoid arthritis should not take warfarin.”
c) “Clients who are pregnant should not take warfarin.”
i) Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta
and places the fetus at risk for bleeding.
d) “Clients who have hyperthyroidism should not take warfarin.”
10) A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?
a) “I have started taking ginger root to treat my joint stiffness.”
i) Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for
bleeding. This statement indicates the client needs further teaching.
b) “I take this medication at the same time each day.”
i) Rationale: The client should take warfarin at the same time each day to maintain a stable blood level.
c) “I eat a green salad every night with dinner.”
i) Rationale: Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of
warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a
consistent intake of vitamin K in order to control the therapeutic effect of the medication.
d) “I had my INR checked three weeks ago.
i) ” Rationale: Clients who have been taking warfarin for more than 3 months should have their INR level checked every
2 to 4 weeks.
11) A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will
follow which principles of warfarin therapy? (Select all that apply.)
a) Teach proper subcutaneous administration
b) Administer the oral dose at the same time every day
c) Assess carefully for excessive bruising or unusual bleeding
d) Monitor laboratory results for a target INR of 2 to 3
e) Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value

1
Pharmacology Midterm

1. A nurse is caring for a 4-year-old child who is resistant to taking medication. Which of
   the following strategies should the nurse use to elicit the child’s cooperation?
   a. Offer the child a choice of taking the medication with juice or water
   b. Tell the child it is candy
   c. Hide the medications in a large dish of ice cream
   d. Tell the child he will have a shot instead
2. A nurse is caring for a client who has difficulty swallowing medications and is prescribed
   enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to
   make it easier to swallow. Which of the following responses should the nurse provide?
   a. “Crushing the medication might cause you to have a stomachache or indigestion.
   i. Rationale: The pill is enteric-coated to prevent breakdown in the stomach
   and decrease the possibility of GI distress. Crushing destroys protection.
   b. “Crushing the medication is a good idea, and I can mix it in some ice cream for
   you.”
   c. “Crushing the medication would release all the medication at once, rather than
   over time.”
   d. “Crushing is unsafe, as it destroys the ingredients in the medication.”
3. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily.
   The client refused breakfast and is complaining of nausea and weakness. Which of the
   following actions should the nurse take first?
   a. A. Check the client’s vital signs.
   i. Rationale: It is possible that the client’s nausea is secondary to digoxin
   toxicity. Assess for bradycardia, a symptom of digoxin toxicity. The nurse
   should withhold the medication and call the provider if the client’s heart
   rate is less than 60 bpm.
   b. Request a dietitian consult.
   c. Suggest that the client rests before eating the meal.
   d. Request an order for an antiemetic.
4. A nurse is caring for a client who has thrombophlebitis and is receiving heparin by
   continuous IV infusion. The client asks the nurse how long it will take for the heparin to
   dissolve the clot. Which of the following responses should the nurse give?
   a. “It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level.”
   b. “A pharmacist is the person to answer that question.”
   c. “Heparin does not dissolve clots. It stops new clots from forming.”
   i. Rationale: This statement accurately answers the client’s question.
   d. “The oral medication you will take after this IV will dissolve the clot.
5. A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1
   year. Before administering the medication, the nurse should check to see that which of
   the following tests have been completed?
   a. Thyroid hormone assay
   i. Rationale: Thyroid testing is important because long-term use of lithium
   may lead to thyroid dysfunction.
   b. Liver function tests:
   i. Rationale: LFTs must be monitored before and during valproic acid
   therapy
   c. Erythrocyte sedimentation rate

2
Pharmacology Midterm
i. Rationale: This is not a necessary test related to lithium therapy.
d. Brain natriuretic peptide

6. A nurse is providing discharge teaching to a client who has asthma and new prescriptions
   for cromolyn and albuterol, both by nebulizer. Which of the following statements by the
   client indicates an understanding of the teaching?
   a. “If my breathing begins to feel tight, I will use the cromolyn immediately.”
   b. “I will be sure to take the albuterol before taking the cromolyn.”
   i. Rationale: The client should always use the bronchodilator (albuterol)
   prior to using the leukotriene modifier (cromolyn). Using the
   bronchodilator first allows the airways to be opened, ensuring that the
   maximum dose of medication will get to the client’s lungs.
   c. “I will use both medications immediately after exercising.”
   d. “I will administer the medications 10 minutes apart.”
7. A nurse is completing a medication history for a client who reports using over-thecounter calcium carbonate antacid. Which of the following recommendations should the
   nurse make about taking this medication?
   a. Decrease bulk in the diet to counteract the adverse effect of diarrhea.
   b. Take the medication with dairy products to increase absorption.
   c. Reduce sodium intake.
   d. Drink a glass of water after taking the medication.
   i. Calcium carbonate is a dietary supplement used when the amount of
   calcium taken in the diet is not enough. Calcium carbonate may also be
   used as an antacid to relieve heartburn, acid indigestion, and stomach
   upset. The client should drink a full glass of water after taking an antacid
   to enhance its effectiveness.
8. A nurse is caring for a client who has deep vein thrombosis and has been on heparin
   continuous infusion for 5 days. The provider prescribes warfarin PO without
   discontinuing the heparin. The client asks the nurse why both anticoagulants are
   necessary. Which of the following statements should the nurse make?
   a. “Warfarin takes several days to work, so the IV heparin will be used until the
   warfarin reaches a therapeutic level.”
   i. Rationale: However, these medications work in different ways to achieve
   therapeutic coagulation and must be given together until therapeutic levels
   of anticoagulation can be achieved by warfarin alone, which is usually
   within 1 to 5 days. When the client’s PT and INR are within therapeutic
   range, the heparin can be discontinued.
   b. “I will call the provider to get a prescription for discontinuing the IV heparin
   today.”
   c. “Both heparin and warfarin work together to dissolve the clots.”
   d. “The IV heparin increases the effects of the warfarin and decreases the length of
   your hospital stay.”
9. A nurse is providing teaching to a client who has asthma and a new prescription for
   inhaled beclomethasone. Which of the following instructions should the nurse provide?
   a. Check the pulse after medication administration.
   b. Take the medication with meals.
   c. C. Rinse the mouth after administration.

3
Pharmacology Midterm
i. Rationale: Use of glucocorticoids by metered dose inhaler can allow a
fungal overgrowth in the mouth. Rinsing the mouth after administration
can lessen the likelihood of this complication.
d. Limit caffeine intake.

10. A nurse is teaching a client who has a new prescription for colchicine to treat gout.
    Which of the following instructions should the nurse include?
    a. “Take this medication with food if nausea develops.”
    b. B. “Monitor for muscle pain.”
    i. Rationale: This medication can cause rhabdomyolysis. The client should
    monitor and report muscle pain.
    c. “Expect to have increased bruising.”
    d. “Increase your intake of grapefruit juice”
11. A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be
    started on intravenous rifampin therapy. The nurse should instruct the client that this
    medication can cause which of the following adverse effects?
    a. Constipation
    b. Black colored stools
    c. Staining of teeth
    d. Body secretions turning a red-orange color
    i. Rationale: Rifampin is used in combination with other medicines to treat
    TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears
    to turn reddish-orange to reddish-brown.
12. A nurse caring for a client who has hypertension and asks the nurse about a prescription
    for propranolol. The nurse should inform the client that this medication is contraindicated
    in clients who have a history of which of the following conditions?
    a) Asthma
13. Rationale: Propranolol, a beta-blocker, is contraindicated in clients who
    have asthma because it can cause bronchospasms. Propranolol blocks the
    sympathetic stimulation, which prevents smooth muscle relaxation.
    b) Glaucoma
    c) Depression
    d) Migraines

ATI Pharmacology
IMPORTANT LAB VALUES
 Sodium (Na): 136-145 mEq/L
 Calcium: 9.0-10 mg/dL
 Chloride: 98-106 mEq/L
 Bicarb HCO3: 21-28 mEq/L
 Potassium: 3.5-5.0 mg/L
 Phosphorus PO4 : 3.0-4.5 mg/dL
 Magnesium: 1.3- 2.1 mEq/L
 Cholesterol:
o Total <200mg/dL o LDL (“bad”) <100 o HDL (“good) >40
o Triglycerides <150mg/dL
 Liver enzymes
o ALT/SGPT 8-20 units/L
o AST/SGOT 5-40 units/L
o ALP 42-128 units/L
o Total protein 6-8 gm/dL
 Pancreatic enzymes
o Amylase 56-90 IU/L
o Lipase 0-110 units/L
o Prothrombin time 0.8-1.2
 Glucose:
Preprandial (fasting) 70-110 mg/dL
Postprandial 70-140 mg/dL
 RBC: Females 4.2-5.4 million/uL; Males 4.7-6.1 million /uL
 WBC: 5000 -10,000
 Iron: Females 60-160 mcg/dL; Males 80-180 mcg/dL
 Platelets: 150,000-450,000
 Hemoglobin (Hgb): Females 12-16 g/dL; Males 14-18 g/dL
 Hematocrit (Hct): Females 37-47%;Males 42-52%
 Prothrombin Time (PT): 11-14 seconds: therapeutic range 1.5-2x normal or control
value
 Urine specific gravity: 1.015-1.030
 Urine pH: average 6.0; range 4.6-8.0
 BUN: 10-20 mg/dL
 Creatinine: female 0.5-1.1, males 0.6 – 1.2 mg/dL;
 Creatinine phosphokinase MB (CK-MB): normal 30-170 units/L
*increase 4-6 hrs after MI and remains elevated 24-72hrs
 Troponin normal: <0.2 ng/dL *gold standard for MI

• Safe Medication Administration and Error Reduction: Reviewing a Medication
  Administration Record (RN QSEN – Teamwork and Collaboration, Active Learning
  Template – Nursing Skill, RM Pharm RN 7.0 Ch. 2)
  1) Report all errors, and implement corrective measures immediately
  2) Complete an incident report within the time frame the facility specifies, usually 24 hr.
  3) Do not reference or include this report in the client’s medical record
  4) Evaluate clients’ responses to medications, and document and report them.
  5) Identify side and adverse effects, and document and report them.
  Chapter 12
• Substance Use Disorders: Therapeutic effect of chlordiazepoxide (Ch. 12 pg.85)
• Substance Use Disorders: Smoking cessation using bupropion (Ch. 12 pg. 87)
• Substance Use Disorders: Treatment for Cocaine Toxicity (Active Learning Template –
  System Disorder, RM Pharm RN 7.0 Ch. 12)
  1) First line treatment = Benzodiazepines (to reduce CNS & cardiovascular effects)
  2) Chlordiazepoxide, diazepam, lorazepam, clorazepate, oxazepam
  3) Provide seizure precautions
  4) Manifestations include nausea; vomiting; tremors; restlessness and inability to sleep;
  depressed mood or irritability; increased heart rate, blood pressure, respiratory rate, and
  temperature; diaphoresis; and tonic-clonic seizures. Illusions are also common
  5) Monitor vitals and neurological status on a regular basis
  Chapter 13
• Chronic Neurologic Disorders: Adverse effects of neostigmine (Ch. 13 pg. 91)
  Adverse effects:
  Excessive muscarinic stimulation
  Cholinergic crisis
• Chronic Neurologic Disorders: Medications that interact with Carbamazepine (Ch. 13 pg.
  99)
• Carbamazepine causes a decrease in the effects of oral contraceptives and warfarin due to
  stimulation of hepatic medication-metabolizing enzymes.
• Grapefruit juice inhibits metabolism, and thus increases carbamazepine levels.
• Phenytoin and phenobarbital decrease effects of carbamazepine.
• Chronic Neurologic Disorders: Adverse Effects of Phenytoin (RN QSEN – Safety, Active
  Learning Template – Medication, RM Pharm RN 7.0 Ch. 13)
  1) CNS effects: Nystagmus, sedation, ataxia, double vision, cognitive impairment
  2) Gingival hyperplasia: Softening and overgrowth of gum tissue, tenderness, and bleeding gums
  (consider folic acid supplement)
  3) Skin rash (stop medication if rash appears)
  4) Cardiovascular effects: dysrhythmias, hypotension (administer slow; 50 mg/min and in dilute
  solution)
  5) Endocrine and other effects: Coarsening of facial features, hirsutism, and interference with
  vitamin D metabolism (consume enough Vitamin D)

6) Interference with vitamin K-dependent clotting factors causing bleeding in newborns.

• Miscellaneous Central Nervous System Medications: Treating Malignant Hyperthermia
  (Active Learning Template – Medication, RM Pharm RN 7.0 Ch. 15)
  1) Depolarizing neuromuscular blockers: Succinylcholine
  2) Manifestations include muscle rigidity accompanied by increased temperature, as high as
  43°C (109.4°)
  3) Administer oxygen at 100%.
  4) Initiate cooling measures including administration of iced 0.9% sodium chloride, applying a
  cooling blanket, and placing ice bags in groin and other areas
  5) Administer dantrolene to decrease metabolic activity of skeletal muscle.
• Airflow Disorders: Therapeutic Action of Montelukast (Active Learning Template –
  Medication, RM Pharm RN 7.0 Ch. 17)
  1) Leukotriene modifiers: suppress the effects of leukotrienes, thereby reducing inflammation,
  bronchoconstriction, airway edema, and mucus production.
  2) Long-term therapy of asthma in adults and children, and to prevent exercise-induced
  bronchospasm
  3) Depending on therapeutic intent, effectiveness is evidenced by long-term control of asthma
  4) Advise clients to take montelukast once daily at bedtime. 5) For exercise-induced
  bronchospasm, take 2 hr. before exercise. Instruct clients taking daily montelukast to not take an
  additional dose for exercise induced bronchospasm
• Upper Respiratory Disorders: Client Teaching Prior to Allergy Testing (Active Learning
  Template – Medication, RM Pharm RN 7.0 Ch. 18)
  1) Medications that can interfere with skin tests include: antihistamines, Tricyclic
  antidepressants, heartburn medications, asthma medication omalizumab (Xolair)
  2) May need to discontinue certain meds 10 days prior
  3) If you are running a fever or have an attack of hay fever or asthma, testing should be delayed
  4) Do not change your diet before the test.
• Medications Affecting Blood Pressure: Titrating Continuous Nitroprusside Infusion (RN
  QSEN – Safety, Active Learning Template – Medication, RM Pharm RN 7.0 Ch. 20)
  1) Nitroprusside (centrally-acting vasodilator)
  2) Direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure
  (decreased preload and after load
  3) Used for hypertensive crisis
  4) Administer medication slowly because rapid administration will cause blood pressure to go
  down to rapidly
  5) Prepare medication by adding to diluent for IV infusion.

ATI Pharmacology Review
Nervous System Medications
Anxiety and Trauma/ Stressor-related DO
Benzodiazepines
● lorazepam/ Ativan, alprazolam/ Xanax, clonazepam/ Klonopin, diazepam/ Valium,
chlordiazepoxide, clorazepate, oxazepam
● Enhances GABA NT (inhibitory NT)
● Indications: 1st line short term TX of GAD and panic DO. Alcohol withdrawal. SZ.
● SE: CNS depression, anterograde amnesia, acute toxicity (TX with flumazenil).
Paradoxical response. Withdrawal effects in long-term use (diaphoresis, tremors,
delirium, SZ. TX with tapered long term benzos)
● CI: Avoid in preggo. Glaucoma. Caution with liver DZ.
● Interactions: Increased effects if taken with CNS depressants (ETOH, antipsychotics,
TCAs, antihistamines, opioids). Decreased effects with caffeine, cigarettes.
● No lab work required.
Atypical nonbarbiturate anxiolytic: Buspirone/ Buspar
● Indication: long term TX of anxiety, panic DO, OCD and related.
● Nonsedating, no highs, no cross tolerance with ETOH or sedatives. Fewer drug
interactions.
● Takes 1-6 weeks for onset of full effect.
● CI: MAOIs. No grapefruit, erythromycin, or St John’s Wort due to potentiation.
● SE: Dizzy and mild drowsiness (but it’s non-sedating..? ATI sux)
● Nsg consideration: take with meals, at same time everyday.
SSRI
● Paroxetine/ Paxil, sertraline/ Zoloft, citalopram/ Celexa, escitalopram/ Lexapro,
fluoxetine/ Prozac, fluvoxamine
● Inhibits serotonin reuptake, does not block uptake of dopamine or NorE.
● Indications: GAD, panic DO, OCD, PTSD, depression, dissociative DOs.
● Takes up to 4 wks for full effect.
● SE: Sexual dysfunction (tx with lowering dose, drug holiday, or bupropion). Also:
insomnia, agitation (decrease caffeine, take in AM, relaxation skills). HA, GI upset,
bruxism. Wt loss short term, or wt gain in the long term. Hyponatremia (in elderly

especially. Obtain baseline serum NA and then monitor). GI bleed (interacts with
warfarin, NSAIDS. Monitor PT and INR). [Fluox and paroxetine are teratogenic]
● Serotonin syndrome: 2-72 hrs after starting TX.
○ TX by withholding med and notify
○ S/S: ALOC, SZ, tachycardia, BP changes, N/V/D, high fever, ataxia, coma
● CI: MAOI, TCA, ETOH, bipolar (causes mania). Caution with liver/ renal/ SZ.
● Interactions: MAOI/ TCA/ St John Wort (serotonin syndrome), Warfarin (increases
bleeding time), lithium (increased lithium levels), NSAIDS/ anticoags (risk of bleeding)
● Nsg teaching: Take in morning, with food, obtain baseline Na levels. Fluoxetine and
escitalopram approved for children.
● Depression takes several weeks to work. For PMS takes a few days.
● Washout is 5 weeks.
● Efficacy: normal sleep patterns, anxiety reduction, social activity participation
Depressive DO
SNRI
● Venlafaxine/ Effexor, duloxetine/ Cymbalta
● Inhibits uptake of serotonin and NorE; minimal inhibition of dopamine
● Indications: major depression, panic, GAD
● SE: CNS stim (HA, agitation, anxiety, dry mouth, insomnia), Hyponatremia (with
diuretics), Wt loss, sexual dysfxn
● CI: ETOH, MAOI
● Interactions: MAOI/ St John Wort (serotonin syndrome), NSAIDS/ anticoags
Atypical Antidepressants
● Bupropion/ Wellbutrin
● Inhibits dopamine uptake
● Indications: Alternative to SSRI that cause sexual dysfunction. SAD, depression,
smoking cessation
● SE: CNS stimulation, Wt loss, SZ at high doses.
● CI: SZ, MAOI, eating DO. Increased risk of SZ with SSRIs.
TCA
● Amitriptyline, imipramine, doxepin, nortriptyline, amoxapine, trimipramine
● Blocks reuptake of NorE and serotonin.
● Indications: Depression. Also bipolar, anxiety.
● SE: orthostatic hypotension, sedation, anticholinergic effects, TOXICITY (give no more
than a week supply for risky pts, obtain baselines, monitor for toxicity), wt gain,
decreased SZ threshold

● CI: SZ, increased SI risk, MI, glaucoma.
● Interactions: MAOI (HTN crisis), additive anticholinergic effects, CNS depressants,
sympathomimetics.
● Washout 2 weeks
● Nsg teaching: Take at bedtime, dysrhythmias. No smoking.
MAOI
● Phenelzine/ Nardil, selegiline (as a patch- also used for parkinson’s)
● Block MAO in the brain, thereby increasing NorE, dopamine, and serotonin
● Indications: Depression, bulimia, atypical depression
● SE: CNS stim, orthostatic hypotension
● Hypertensive Crisis: especially with intake of tyramine
○ Tyramine foods: cheese, cured meats, beer, grapefruit/ citrus, overripe bananas/
avocados.
○ TX with IV phentolamine or nifedipine
● CI: SSRI or TCA (serotonin syndrome), DM, SZ, CV DZ, renal DZ, pheochromocytoma.
● Interactions: CNS stimulants, TCA, SSRIS, HTN meds
● Nsg teaching: No other meds unless approved. No tyramine foods.
● Washout is 2 weeks.
Also SSRI and Other atypical antidepressants
Bipolar DO
Lithium Carbonate
● Mood stabilizer; Increases serotonin, decreases neuronal atrophy.
● Indications: bipolar, limits mania, decreases SI, prevents return of depression
● Olanzapine (antipsychotic) can be administered to calm manic pt while waiting for lithium
to kick in.
● SE:
○ N/V/D, GI pain – take with food/milk
○ Fine hand tremors – give lower dosage, beta-ad blocker, tell client to report
tremors
○ Polyuria/thirst – potassium-sparing diuretic like spironolactone, tell client to drink
1.5 to 3L of fluid
○ Weight gain – diet/exercise
○ Goiter/hypothyroidism – annual T3/T4/TSH, monitor for hypothyroidism,
administer levothyroxine
○ Renal toxicity – Monitor I/O, assess baseline BUN/Creat
○ Hepatotoxicity – Routine monitoring of LFTs req’d

○ Bradyarrhythmias/hypotension/electrolyte imbalances – maintain sodium intake
● Lithium toxicity: occurs at lithium levels > 1.5
○ Initial S/S: N/V/D, polyuria, fine tremors, slurred speech, lethargy
■ Withhold med and notify. Adjust dose based on lithium/ Na levels
○ Progressive S/S: coarse tremors, ALOC, tinnitus, ataxia, SZ, stupor, severe
hypotension, coma, death
■ Can treat with aminophylline
■ Emetic or lavage. Hemodialysis.
● CI: teratogenic. Liver/ renal/ cardiac DZ, schizophrenia, hypovolemia. Caution with
DM, SZ, thyroid DZ
● Interactions: Diuretics (they cause Na secretion which leads to increased lithium levels
in body). NSAIDS (increases renal reabsorption of lithium and toxicity – use ASA
instead). Lithium and SSRI taken together can lead to serotonin syndrome.
● Nsg considerations: Increase water intake to 1.5-3 L/day. Monitor levels q 2-3 days
initially, then q 1-3 months. Therapeutic range of 0.4-1.4. Toxic > 1.5. Full effects
within 2-3 weeks. Take with food. Maintain normal Na intake.
Mood Stabilizing AntiSZ Meds
● carbamazepine/ Tegretol, valproate/ Depakote, lamotrigine/ Lamictal
● Potentiate GABA and slow entrance of Na and Ca prolonging neuronal refractory period.
● Indications: bipolar
● carbamazepine/ Tegretol:
○ SE: Blood dyscrasias (monitor CBCs and for indications of infection)
■ Teratogenic
■ FVE/ hypoosmolarity (monitor Na, edema, urine output, HTN)
■ Rash (SJS)
■ CNS effects (vision changes, vertigo, HA)
○ CI: Bone marrow suppression, bleeding DOs
○ Interactions: Warfarin, oral contraceptives (makes these drugs ineffective).
Grapefruit juice (increases plasma levels). SZ meds (decreased therapeutic
effect).
○ Nsg considerations: start low and titrate. SE should subside. Take at bedtime.
Monitor plasma levels of the medication.
● lamotrigine/ Lamictal:
○ SE: CNS stim (vision changes, N/V, HA, dizzy)
■ Rash (SJS)
○ Interactions: Oral contraceptives (decreased effectiveness)
○ Nsg consideration: Start low and titrate
● valproate/ Depakote:
○ SE: GI upset
■ Hepatotoxic
■ Pancreatitis
■ Blood dyscrasias (monitor for increased bleeding, plt counts, PTT/INR)

VATI Pharmacology Remediation

1. Complete an ATI Focused Review® and send a detailed summary (2-3 sentences each) of
   4 concepts that you learned from the focused review to me in the messaging system.

• Contraindications
  o Sumatriptan (Triptans)
   Sumatriptan is a medication used to prevent intercranial inflammation
  of the blood vessels in the brain, ultimately relieving migraines. This
  medication is commonly contraindicated in client who are pregnant,
  who have renal failure, hypertension, history of MI’s, and heart
  disease.
• Adverse Effects
  o Dextroamphetamine
   Dextroamphetamine is used to treat ADHD, obesity, narcolepsy, and
  conduct disorder. Common adverse effects of this medication that the
  client should be informed of includes restlessness, insomnia, weight
  loss, growth suppression, decreased appetite, chest pain, dysrhythmias,
  HBP, hallucinations, depression, nausea, vomiting, headache, hives,
  muscle weakness, dizziness, palpitations, and seizures. If prescribed to
  children, the nurse should often assess the child’s growth.
  o Topotecan (Topoisomerase inhibitors)
   Topotecan inhibits replication of cancer cells ultimately killing the
  cancer cells. Common cancers it treats include ovarian cancer, cervical
  cancer, and small cell lung cancer. Adverse effects of topotecan
  includes bone marrow suppression, bruising/bleeding,
  immunosuppression, and GI discomfort.
• Treatment
  o Alcohol withdraws
   Medications used to treat signs and symptoms of alcohol withdraw
  includes diazepam, lorazepam, oxazepam, chlordiazepoxide, and
  clorazepate. The nurse should monitor vital signs when administering
  this medication as well as assess neurological status and provide
  seizure precautions.

1. Complete the following questions and review the suggested learning activities. Send me
   your answers here.
   a. A nurse is caring for a client with a latex allergy. What steps should the nurse take
   when initiating an IV line on this client?
   i. When initiating an IV-line use nonlatex gloves.
   ii. Place a warning label on IV bags stating Not to use latex injection ports.
   iii. Use a nonlatex tourniquet.

iv. Use latex free syringes when administering medications through syringe.
v. Place latex allergy identifier on patient.
vi.
b. What components should be included in a medication order? Suggested
Pharmacology Learning Activity: Medication Administration
i. Client’s full name
ii. Date order is written
iii. Medication name
iv. Dose
v. Route of administration
vi. What the medication is used for
vii. Time and frequency of administration
c. What are examples of common medication errors? What information must be
included in an incident report regarding a medication error? Suggested
Pharmacology Learning Activity: Medication Administration
i. Incorrect dose or IV medication
ii. Wrong client, route, dose, or time
iii. Administering medication to a client with an allergy to the medication
iv. Omission of a dose
d. Benzodiazepines are the first-line treatment for alcohol withdrawal due to their
ability to decrease the intensity of withdrawal symptoms. List two (2) nursing
considerations for clients on benzodiazepines. Suggested Pharmacology Learning
Activity: Psychopharmacology
i. Nursing Considerations:

1. Implement seizure precautions (include padded side rails, suction
   equipment, and ambu bag)
2. Obtain baseline vitals, monitor respiratory status, and keep
   resuscitation equipment and flumazenil readily available.
   e. A nurse is caring for a client prescribed acetaminophen as needed for pain relief.
   The nurse knows acetaminophen should not exceed __ grams per day. The
   nurse will monitor for early signs of toxicity. Name three (3) manifestations of
   toxicity. Suggested Pharmacology Learning Activity: Pain Medications
   i. The nurse knows acetaminophen should not exceed 4g per day.
   ii. Manifestations of toxicity:
3. Dehydration
4. Acidosis
5. Diaphoresis
6. Manifestations:
7. Nausea/vomiting
8. Diarrhea
9. Sweating
10. Abdominal discomfort
11. Hepatic failure

ATI Pharmacology 2019 A.
A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new
prescription for sucralfate. Which of the following actions of sucralfate should the nurse include
in the teaching?
A. Decreases stomach acid secretion
B. Neutralizes acids in the stomach
C. Forms a protective barrier over ulcers
D. Treats ulcers by eradicating H. pylori
A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for
methylprednisolone. Which of the following instructions should the nurse include? (SATA)
A. Blood glucose levels will be monitored during therapy.
B. Avoid contact with people who have known infections.
C. Take the medication 1 hr before breakfast.
D. Decrease dietary intake of foods containing potassium.
E. Grapefruit juice can increase the effects of this medication.
A nurse is providing discharge teaching about handling medication to a client who is to continue
taking oral transmucosal fentanyl raspberry flavored lozenges on a stick. Which of the following
information should the nurse include in the teaching?
A. Chew on the medication stick to release the medication.
B. Leave the medication stick in on location of the mouth until melted.
C. Allow the medication 1 hr for analgesia effects to begin.
D. Store unused medication sticks in a storage container.
A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The
nurse should identify which of the following as an indication of hypokalemia?
A. Tall, tented T-waves
B. Presence of U-waves
C. Widened QRS complex
D. ST elevation
The nurse is caring for a client who has cancer and is taking oral morphine and docusate
sodium. The nurse should instruct the client that takin the docusate sodium daily can minimize
which of the following adverse effects of morphine?
A. Constipation
B. Drowsiness
C. Facial flushing
D. Itching
A nurse is planning care for a client who is receiving mannitol via IV continuous infusion. The
nurse should monitor the client for which of the following adverse effects?

A. Weight loss
B. Increase intraocular pressure
C. Auditory hallucinations
D. Bibasilar crackles *
A nurse is providing teaching to a client who has gastric ulcer and a new prescription for
ranitidine. Which of the following instructions should the nurse include?
A. “Take the medication on an empty stomach for full effectiveness.”
B. “You may discontinue this medication when stomach discomfort subsides.”
C. “Report yellowing of the skin.”
D. “Store the medication in the refrigerator.”
A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes
the client has anxiety, hypotension, and dyspnea. Which of the following medications should
the nurse administer first?
A. Diphenhydramine
B. ALbuterol inhaler
C. Epinephrine
D. Prednisone
A nurse is planning care for a client who has hypertension and is to start taking metoprolol.
Which of the following interventions should the nurse include in the plan of care?
A. Weigh the client weekly
B. Determine apical pulse prior to administering
C. Administer the medication 30 min prior to breakfast.
D. Monitor the client for jaundice
A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weighs
44 lb. How many mg should the nurse administer per dose?
300 mg
A nurse in an emergency department is caring for a client whose family reports the client has
taken large amounts of diazepam. Which of the following medications should the nurse
anticipate administering?
A. Ondansetron
B. Magnesium sulfate
C. Flumazenil
D. Protamine sulfate
A nurse is reviewing laboratory results for a client who is receiving heparin via continuous IV
infusion for DVT. The nurse should discontinue the medication infusion for which of the
following client findings?
A. Potassium 5.0
B. aPTT 2x the control

ATI Pharmacology
IMPORTANT LAB VALUES
 Sodium (Na): 136-145 mEq/L
 Calcium: 9.0-10 mg/dL
 Chloride: 98-106 mEq/L
 Bicarb HCO3: 21-28 mEq/L
 Potassium: 3.5-5.0 mg/L
 Phosphorus PO4 : 3.0-4.5 mg/dL
 Magnesium: 1.3- 2.1 mEq/L
 Cholesterol:
o Total <200mg/dL o LDL (“bad”) <100 o HDL (“good) >40
o Triglycerides <150mg/dL
 Liver enzymes
o ALT/SGPT 8-20 units/L
o AST/SGOT 5-40 units/L
o ALP 42-128 units/L
o Total protein 6-8 gm/dL
 Pancreatic enzymes
o Amylase 56-90 IU/L
o Lipase 0-110 units/L
o Prothrombin time 0.8-1.2
 Glucose:
Preprandial (fasting) 70-110 mg/dL
Postprandial 70-140 mg/dL
 RBC: Females 4.2-5.4 million/uL; Males 4.7-6.1 million /uL
 WBC: 5000 -10,000
 Iron: Females 60-160 mcg/dL; Males 80-180 mcg/dL
 Platelets: 150,000-450,000
 Hemoglobin (Hgb): Females 12-16 g/dL; Males 14-18 g/dL
 Hematocrit (Hct): Females 37-47%;Males 42-52%
 Prothrombin Time (PT): 11-14 seconds: therapeutic range 1.5-2x normal or control
value
 Urine specific gravity: 1.015-1.030
 Urine pH: average 6.0; range 4.6-8.0
 BUN: 10-20 mg/dL
 Creatinine: female 0.5-1.1, males 0.6 – 1.2 mg/dL;
 Creatinine phosphokinase MB (CK-MB): normal 30-170 units/L
*increase 4-6 hrs after MI and remains elevated 24-72hrs
 Troponin normal: <0.2 ng/dL *gold standard for MI

• Safe Medication Administration and Error Reduction: Reviewing a Medication
  Administration Record (RN QSEN – Teamwork and Collaboration, Active Learning
  Template – Nursing Skill, RM Pharm RN 7.0 Ch. 2)
  1) Report all errors, and implement corrective measures immediately
  2) Complete an incident report within the time frame the facility specifies, usually 24 hr.
  3) Do not reference or include this report in the client’s medical record
  4) Evaluate clients’ responses to medications, and document and report them.
  5) Identify side and adverse effects, and document and report them.
  Chapter 12
• Substance Use Disorders: Therapeutic effect of chlordiazepoxide (Ch. 12 pg.85)
• Substance Use Disorders: Smoking cessation using bupropion (Ch. 12 pg. 87)
• Substance Use Disorders: Treatment for Cocaine Toxicity (Active Learning Template –
  System Disorder, RM Pharm RN 7.0 Ch. 12)
  1) First line treatment = Benzodiazepines (to reduce CNS & cardiovascular effects)
  2) Chlordiazepoxide, diazepam, lorazepam, clorazepate, oxazepam
  3) Provide seizure precautions
  4) Manifestations include nausea; vomiting; tremors; restlessness and inability to sleep;
  depressed mood or irritability; increased heart rate, blood pressure, respiratory rate, and
  temperature; diaphoresis; and tonic-clonic seizures. Illusions are also common
  5) Monitor vitals and neurological status on a regular basis
  Chapter 13
• Chronic Neurologic Disorders: Adverse effects of neostigmine (Ch. 13 pg. 91)
  Adverse effects:
  Excessive muscarinic stimulation
  Cholinergic crisis
• Chronic Neurologic Disorders: Medications that interact with Carbamazepine (Ch. 13 pg.
  99)
• Carbamazepine causes a decrease in the effects of oral contraceptives and warfarin due to
  stimulation of hepatic medication-metabolizing enzymes.
• Grapefruit juice inhibits metabolism, and thus increases carbamazepine levels.
• Phenytoin and phenobarbital decrease effects of carbamazepine.
• Chronic Neurologic Disorders: Adverse Effects of Phenytoin (RN QSEN – Safety, Active
  Learning Template – Medication, RM Pharm RN 7.0 Ch. 13)
  1) CNS effects: Nystagmus, sedation, ataxia, double vision, cognitive impairment
  2) Gingival hyperplasia: Softening and overgrowth of gum tissue, tenderness, and bleeding gums
  (consider folic acid supplement)
  3) Skin rash (stop medication if rash appears)
  4) Cardiovascular effects: dysrhythmias, hypotension (administer slow; 50 mg/min and in dilute
  solution)
  5) Endocrine and other effects: Coarsening of facial features, hirsutism, and interference with
  vitamin D metabolism (consume enough Vitamin D)

6) Interference with vitamin K-dependent clotting factors causing bleeding in newborns.

• Miscellaneous Central Nervous System Medications: Treating Malignant Hyperthermia
  (Active Learning Template – Medication, RM Pharm RN 7.0 Ch. 15)
  1) Depolarizing neuromuscular blockers: Succinylcholine
  2) Manifestations include muscle rigidity accompanied by increased temperature, as high as
  43°C (109.4°)
  3) Administer oxygen at 100%.
  4) Initiate cooling measures including administration of iced 0.9% sodium chloride, applying a
  cooling blanket, and placing ice bags in groin and other areas
  5) Administer dantrolene to decrease metabolic activity of skeletal muscle.
• Airflow Disorders: Therapeutic Action of Montelukast (Active Learning Template –
  Medication, RM Pharm RN 7.0 Ch. 17)
  1) Leukotriene modifiers: suppress the effects of leukotrienes, thereby reducing inflammation,
  bronchoconstriction, airway edema, and mucus production.
  2) Long-term therapy of asthma in adults and children, and to prevent exercise-induced
  bronchospasm
  3) Depending on therapeutic intent, effectiveness is evidenced by long-term control of asthma
  4) Advise clients to take montelukast once daily at bedtime. 5) For exercise-induced
  bronchospasm, take 2 hr. before exercise. Instruct clients taking daily montelukast to not take an
  additional dose for exercise induced bronchospasm
• Upper Respiratory Disorders: Client Teaching Prior to Allergy Testing (Active Learning
  Template – Medication, RM Pharm RN 7.0 Ch. 18)
  1) Medications that can interfere with skin tests include: antihistamines, Tricyclic
  antidepressants, heartburn medications, asthma medication omalizumab (Xolair)
  2) May need to discontinue certain meds 10 days prior
  3) If you are running a fever or have an attack of hay fever or asthma, testing should be delayed
  4) Do not change your diet before the test.
• Medications Affecting Blood Pressure: Titrating Continuous Nitroprusside Infusion (RN
  QSEN – Safety, Active Learning Template – Medication, RM Pharm RN 7.0 Ch. 20)
  1) Nitroprusside (centrally-acting vasodilator)
  2) Direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure
  (decreased preload and after load
  3) Used for hypertensive crisis
  4) Administer medication slowly because rapid administration will cause blood pressure to go
  down to rapidly
  5) Prepare medication by adding to diluent for IV infusion.