NCLEX Review Pharmacological and Parenteral

NCLEX Review Pharmacological and Parenteral Therapies Updated Questions and Answers 2023 2024

Administration of blood and blood products - Answer Implementation:

• Obtain basline vital signs
• Use 18g needle for access (done to avoid lysing of the cells)
• Start slowly with 0.9% NaCl
• Run slowly (5ml/min) first 15 min
• Stay with patient first 15-30 minutes
• Infuse in 4h or less

Adrenergics - Answer Examples: Levophed (norepinephrine), Intropin (dopamine), Adrenalin (epinephrine), Dobutrex (dobutamine)

Action: stimulate B-2 receptors in lungs, increase peripheral resistance and increase bronchodilation

Uses: cardiac arrest, COPD

Side Effects: dysrhytmias, tremors, anticholinergic effects

Nursing Considerations: Monitor BP, monitor peripheral pulses, check output, patient may become drowsy (safety)

Allogenic Blood Transfusion - Answer Blood transfused from another person

Antacids - Answer Examples: Amphojel (aluminum hydroxide), Milk of magnesia (magnesium hydroxide), Maalox (both)

Action: neutralize gastric acids, not coat the stomach, they work systemically

Uses: Peptic ulcer, indigestion, reflux esophagitis

Side Effects:constipation, diarrhea, acid rebound

Nursing Considerations: Interferes with absorption of antibiotics, iron preparations, INH (tx TB), oral contraceptives (also antibiotics) , monitor bowel function. All antacids should be given 1-2 hours after eating and other medications. F&E balance monitor lab shifts. Mg is an electrolyte that affect the CNS.

Anti-anxiety agents - Answer Examples: Librium, Xanax, Ativan, Vistaril, Equanil

Action: affects neurotransmitters

Uses: anxiety disorders, manic episodes, panic attacks

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Side Effects: sedation, confusion, hepatic dysfunction

Nursing Considerations: potential for addiction/overdose, avoid alcohol, monitor liver function, look at ALT, AST and LDH, discontinue the meds very slowly need to be tapered off, smoking and drinking caffeine will decrease effectiveness of med,

Anti-anxiety: Benzodiazapenes - Answer Most meds end with "pam"

Non-Benzo

Herbal: Kava

Antibiotics - Answer General Side Effects

• Allergic, anaphlayxis
• Super-infection
• Organ toxicity - liver and kidney

Teaching: take until gone, do C&S first, encourage fluids, check expiration date

*Aminoglycosides*

Examples: Gentamycin, Neomycin, Streptomycin, Tobramycin

Action: inhibits protein synthesis in gram negative bacteria

Uses: Pseudomonas, E.Coli

Side Effects: Ototoxicity, nephrotoxicity, anorexia, nausea, vomiting, diarrhea

Nursing considerations: Check 8th cranial nerve (hearing), check renal function (BUN, urinary output), take for 7-10 days, encourage fluids 3000mL Peaks (taken 1 hour after med is given) Trough (taken the lowest the medication with be usually before the next dose)

*Cephalosporins* Examples: Ceclor (cefaclor), Ancef (cefazolin), Keflex (cephalexin), Rocephin (ceftriaxone), Mefoxin (cefoxitin)

Action: inhibits synthesis of bacterial cell wall

Uses: tonsillitis, otitis media, peri operative prophylaxis, meningits

Side Effects:bone marrow depression (check labs), superinfections, rash

Nursing considerations: Take with food (cause gi upset), cross allergy with PCN, avoid alcohol (can cause flushing, dizziness), obtain c&s before first dose, may give a false positive for protienuria and glucosuria 2 / 3

*Fluoroquinolones*

Examples: Cipro (ciprofloxin)

Action: interferes with DNA replication in gram-negative bacteria

Uses: E.Coli, Pseudomonas, S.aureas, Anthrax

Side Effects: Diarrhea, decreased WBC and hematocrit, elevated liver enzymes (AST, ALT) elevated alk phos

Nursing Considerations: C&S before starting therapy, encourage fluids (3000mL/day), take 1h ac or 2h pc (after meals) food will slow the absorption of the medication. Do not take with antacids or iron preparations as it interferes with the absorption of the medication. Can be given with probenicid (a gout medication) it is enhances the effect of the medication.

*Macrolides*

Examples: Erythromycin, Cleocin (clindamycin)

Action: binds to cell membrane and changes protein function

Uses: acute infections, acne, URI, prophylaxis before dental procedures if allergic to penicillin

Side Effects: diarrhea, confusion, hepatotoxicity, superinfections

Nursing Considerations: Take 1h ac or 2-3h pc, monitor liver function, increases the effectiveness of coumadin and theophyllin

*Penicillins*

Examples: Amoxil (amoxicillin), Ampicillin, Augmentin (amoxicillin/clavulanate)

Action: Inhibits synthesis of cell wall

Uses: Moderate to sever infections, syphilis, gonococcus infections, Lyme disease

Side Effects: stomatitis, diarrhea, allergic reactions, renal and hepatic changes

Nursing Considerations: Airway management is key when dealing with adverse reactions such as anaphylaxis . Check for hypersensitivity, give 1-2h ac or 2-3h pc, cross allergy with cephalosporins. Multiple exposures increase the risk for a allergic reaction.

*Sulfonamides* Examples: Gastrisin (acetyl sulfisoxazole), Bactrim (co-trimoxazole), Azulfidine (sulfasalazine)

Action: antagonize essential component of folic acid synthesis

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