NCLEX Review Week
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Rights of delegation: | Task, person, communication, feedback/supervision, circumstances
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| LPN's cannot do: | Admissions assessments, IV meds, nursing dx, teaching (can reinforce), complex skills, acute conditions, unstable clients
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| LPN's can do: | Vitals, stable clients, chronic diseases, oral and IM meds
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| UAP's can do: | Feeding, basic hygiene, basic skills, stable clients, chronic diseases, ambulation
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| Steps in processing ethical dilemma | Gather info, examine/determine own vales, verbalize the problem, consider possible courses of action, negotiate the outcome, evaluate the the action
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| Rights of Medication Administration | Patient, route, dose, time, med, right to refuse
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| Antidote for insulin | Glucagon
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| Antidote for magnesium sulfate | Calcium gluconate
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| Antidote for heparin | Protamine sulfate
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| Antidote for digoxin | Digibind
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| Antidote for narcotics | Narcan
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| Antidote for benzodiazapines | Romazicon
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| Antidote for coumadin | Vitamin K
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| Antidote for tylenol | Mucamyst
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| Which do you administer first? Bronchodilators or steroids? | Bronchodilators are administered before steroids
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| Infiltration s/s and interventions | S/S: edema, pain, coolness. Interventions: elevate, compress, apply warm or cold.
(This is not an infection, but it does cut off perfusion to tissues)
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| Phlebitis s/s and interventions | S/S: heat, redness, tenderness, not swollen. Interventions: warm, moist compress
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| Hold antineoplastics for platelets <? and neutrophils <? | Platelets: <75,000
Neutrophils: <2,000
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| Side effects of antineoplastics | Alopecia, stomatitis, anorexia, N/V/D, anemia (give epogen), neutropenia (give neupogen), thrombocytopenia (give interluken-11), elevated uric acid levels (give allopurinol), and tissue irritation at site
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| Antithyroid medications | Tapazole, PTU, iodine
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| Thyroid hormones | Synthroid- needs to be taken on empty stomach, once daily, before breakfast, no multivitamin, antacids, or iron 4 hrs before or after administration
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| Glucocorticoids | Must be tapered; take in AM with food; all end in "-one" or "-sone". Side effects: decreased immune response, decreased inflammation, hyperglycemia, hypokalemia, Na/H2O retention, GI irritation, mood swings.
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| Uses of glucocorticoids | Adrenal insufficiency, arthritis, allergic reactions, cerebral or spinal cord edema, asthmatic attacks, shock, ARDS.
Decreases effects of insulin/oral hypoglycemics, diuretics, and K supp. Mask signs of infection
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| Side effects of estrogens | HTN, storke, MI, blood clots, HA, vomiting; exacerbated by smoking
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| Sulfonylureas | Stimulate beta cells to produce more insulin; can cause hypoglycemia; glipizide, glyburide, glimepiride; don't take with ETOH
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| Biguanide | Decrease sugar production in liver and increase insulin sensitivity; metformin (Glucophage); doesn't cause hypoglycemia; give with meals; SE: diarrhea, lactic acidosis
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| Thiazolidinediones | Decrease liver glucose production and enhance insulin utilization; Actos and Avandia
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| Meglitinides | Stimulate release of insulin from beta cells; fast acting/short duration; Starlix, Prandin; Take with meals, don't take if meal is skipped
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| Rapid acting insulin | Must eat immediately, end in "-log"
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| Regular insulin | Short acting, take 20-30 min before meals, used for SS coverage, ONLY insulin that can be given IV
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| Which is mixed first? Regular or NPH | Regular is drawn up before NPH
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| Lantus | Continuous, no peak, usually once a day at bedtime. Can't be mixed with other insulin
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| Sick days (Insulin) | Increased metabolic rate increases need for insulin; check q4-6h; increase intake of high carb fluids
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| Exercise (Insulin) | Body uses more carbs for energy so there is decreased need for insulin; eat a high carb snack before exercise
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| PPI's | Only PO, give before meals, end in "-zole"
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| Antacids | Allow 1 hr between AA and other meds. Aluminum containing=constipation, contain Na; magnesium containing=diarrhea, do not give with renal failure
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| H2 Receptor Antagonists | Block action of histamine which triggers gastric acid secretions; cause diarrhea; end in "-dine"
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| Anticonvulsants | Dilantin, phenobarbital, benzodiazapines (end in "-pam")
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| Dilantin | Used for tonic-clonic seizures; therapeutic blood level: 10-20; SE: drowsiness, gingival hyperplasia, aplastic anemia; give with meals; toxicity: nystagmus, confussion, nausea
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| Valium (Benzodiazapine) | For status epilepticus; CNS depressant, don't take with ETOH; SE: drowsiness, hypotension, tachycardia, resp depression, hepatotoxicity; antidote: romazicon
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| Phenobarbital (Barbiturate) | Longer acting; causes respiratory depression; don't take with ETOH; SE: angioedema and laryngospasm
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| Sulfonamides | Maintain alkaline urine; force fluids. Good for UTI's
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| Tetracycline | Photosensitivity; no milk products 1 hr before and after; drink through straw
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| Aminoglycocides | Oto- and nephrotoxicity (check BUN and Cr); get peak and trough levels
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| Cipro | Force fluids
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| SSRI | Many drug interactions, avoid ETOH; serotonin syndrome if given with MAOI or cold medicine (tachypnea, high temp- CV response); end in "-pram" or "-ine" (citalopram, sertraline)
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| Tricyclic antidepressants | Block reuptake of norepinephrine; use with MAOI's can cause HTN crisis; risk for cardiac toxicity and hypotension; give at bedtime; Tofranil, sinequan, elavil; also used for OCD, panic disorder, insomnia, neuropathic pain, and ADHD
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| MAOI's | Inhibit enzyme monoamine oxidase which results in increased levels of norepinephrine and serotonin; 3rd line drug; tyramine, decongestants, analgesics, and other antidepressant use can cause a HTN crisis. Marplan, Nardil, Parnate
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| Mood stabilizers | Tx bipolar; lithium (narrow therapeutic window 0.6-1.5) check levels q2months, increased level with dehydration, hypernatremia; toxicity leads to renal failure, coma, death
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| Abilify | Atypical antipsychotic
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| Tegretol | Seizure med. Monitor CBC (causes decreased WBC & RBC)
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| Gabapentic (Neurontin) | Diabetic neuropathy pain
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| Seroquel | Atypical antipsychotic
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| Typical antipsychotic meds | Thorazine, Haldol; extrapyramidal side effects
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| Atypical antipsychotic meds | More commonly used because of decreased incidence of extrapyramidal side effects; Abilify, Clozapine, Seroquel, Risperidone
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| Extrapyramidal side effects | Dystonias, Parkinsonism, Akathisia (restlessness, agitation), tardive dyskinesia (repetitive involuntary movements- often irreversible)
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| Neuroleptic malignant syndrome | Life threateningl muscle rigidity, increased temperature, decreased level of consciousness
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| Anticholinergic response | Dry mouth, increased pulse, urinary retention, constipation, hypotension
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| Antianxiety medications | Benzodiazepines and barbiturates; no ETOH; cause CNS depression; need to be tapered; physical dependency
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| Benzodiazepines | End in "-pam" or "-lam"; Alprazolam, Diazepam, Lorazepam
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| Barbiturates | End in "-bital"; phenobarbital, pentobarbital
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| Adrenergic medications | Stimulate the sympathetic nervous system; Epinephrine: non-selective, used as potent vaso-constrictor (shock, cardiac arrest) and as brochodilator (astham, allergic reaction)
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| Beta agonists | Stimulate beta 1&2 receptors; end in "-erol"; used as bronchodilator. Use with caution in HTN, DM, narrow angle glaucoma; Albuterol, Salmetrol
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| Anticholinergics | End in "-pium"; used as brochodilator; block muscarinic receptors in parasympathetic nervous system; SE: dry mouth, constipation; Ipratropium, Theophylline
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| Major side effects of TB meds | Liver toxicity, increased uric acid, peripheral neuritis (give vitamin B); Can't drink ETOH
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| Alpha receptor blockers | Decrease blood pressure by blocking vasoconstriction effect of norepinephrine; end in "-zosin"; Doxazosin (Minipress), Prazosin; Terazosin; can cause orthostatic hypotension; also used to tx enlarged prostate and sexual dysfunction
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| ACE Inhibitors | End in "-pril"; prevent vasoconstriction; SE: cough, increased potassium, orthostatic hypotension
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| Angiotensin receptor blockers | End in "-sartan"; prevent vasoconstriction and decrease aldosterone; SE: Increased potassium, orthostatic hypotension, angioedema
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| Beta blockers | Inhibit beta adrenergic stimulation; end in "-lol"; decrease HR and BP (decrease O2 consumption of heart); used for HTN, glaucoma, prevent MI, and migraines; contraindicated in asthma and bradycardia, mask s/s of hypoglycemia; SE: depression, hypotension
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| Calcium Channel Blockers | Decrease cardiac contractility and conductivity; promote vasodilation; check liver enzymes; "A Very Nice Drug": Amlodipine, Verapamil, Nifedipine, Diltiazem
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| Loop diuretics | Lasix; fast acting; oto- and nephrotoxic
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| Osmotic diuretics | Mannitol; used to prevent renal failure, decrease intraocular and intracranial pressure, and diuresis with chemo; given IV with inline filter; SE: pulmonary edema
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| Thiazide diuretics | HCTZ; not fast acting; causes hyperglycemia
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| Potassium sparing diuretics | Aldactone; Give with food; SE: hyperkalemia (don't give with ACE or ARB)
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| Digoxin | Adult dose: 0.125-0.25 mg; therapeutic level: 0.5-2.0; check K; hold for pulse <60 in adult, <90 in child, apical for full minute
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| Dig toxicity | More common in elderly; abdominal pain, anorexia, N/V (GI often 1st symptom), visual disturbances (yellow halo), bradycardia. Antidote: Digibind
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| Thrombolytics | Break down existing clots, end in "-ase" (streptokinase, alteplase); SE: allergic reaction, dysrhythmias; contraindicated with any kind of bleeding
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| Anticoagulants | Prevent clot formation; Coumadin: PT and INR, antidote is vitamin K
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| Heparin | APTT, antidote: protamine sulfate
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| Antiplatelet | Aspirin; prophylaxis of long term complications
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| Niacin | Decreases cholesterol and triglycerides; SE: flushing
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| Fibric acid derivatives | Tricor, Lopid; decrease triglycerides
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| HMG-CoA reductase inhibitors | Inhibit the enzyme that initiates cholesterol synthesis; Statins; SE: GI, liver toxicity, muscle cramps, fatigue- can be life threatening
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| Contact Precautions | MRSA, VRE, ESBL, CDiff; gloves and gown
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| Strict Precautions | Chicken pox, shingles; gloves, gown, N95 respirator (non-immune staff), and negative pressure room
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| Airborne precautions | TB; Mask, N95 respirator, negative pressure room
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| Droplet precautions | Meningococcal, influenza; mask, eye protection, N95 repirator, negative pressure room
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| Environmental precautions | WBC<1000 or ANC<500; Mask
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