pharm questions

[gaajr1, RN]

Hello Everyone,

I have some questions in pharm. I am stumped by the choices and unable to decide the answer (lol). Please can you help? I wanted the rationale behind it, for I know I will face these type of questions time and again and want to know how to tackle them. We haven't discussed many of these in class and so all the more confused.

1. Nurse is preparing to administer Labetalol (Normodyne) IV push for a patient diagnosed with hypertensive crisis. Which intervention should the nurse implement?

a) Monitor the client's labetalol serum drug level

b) keep the medications covered with tin foil

c) administer the meds slow IV push over 5 min

d) teach the client signs/symptoms of hypertension

I was debating between c and d. About IV, I know it has to be increased q10min until desired effect. But I'm not sure "over 5min" part. We haven't learned anything else about IV's etc.

I thot "d" made sense, to teach the patient but again is it applicable only when the patient is sent home?

2. The primary nurse is preparing to administer Dobutamine(Dobutrex) to a client in cardiogenic shock. Which action by the primary nurse would warrant intervention by charge nurse?

a) the primary nurse is administering the Dobutrex by gravity (it's not on an IV pump)

b) primary nurse attaches a urometer to the client's foley catheter(for accuracy measurements of urine)

c) primary nurse applies a pulse oximenter to the client's finger (oxygen readings)

d) primary nurse checks the client for any medication allergies.

I am blank once again about IV's and catheter, as we have not been taught. "c" I was wondering about it only because this drug does not increase the oxygen demand of the cardiac muscle. But does it warrant an intervention? Could it be "a", for this drug is given only by IV (I don't know anything else-by gravityetc).

3. Nurse is administering morning meds. Which combination of meds should the nurse question administering?

a) Terazosin (Hytrin) and Captopril

b) Finasteride(Proscar) and Digoxin(Lanoxin)

c) Tamsulosin(Flomax) and Metformin(Glucophage)

d) Serenoa repens(Saw Palmetto) and Metoprolol(Toprol XL)

I'm thinking it is "b".

Thanks and will appreciate guidance!

[UM Review RN, ASN, RN]

Did you try googling each medications drug monograph? Or in a drug reference book?

I know the answers to a couple of them, but you'll learn these better if you look them up yourself. Additionally, you'll become more adept at finding other medications. One thing is for sure: there are too many meds to know, so you need to know how to look them up.

I think that's the point of this particular exercise.

[gaajr1, RN]

Thanks Angie O'Plasty. I did look it up and I agree i will remember it better too. But for instance, when I looked up for question 1, didn't find a concrete answer. However, I will keep looking and this time putting drug monograph.

[Daytonite, BSN, RN]

nurse is preparing to administer labetalol (normodyne) iv push for a patient diagnosed with hypertensive crisis. which intervention should the nurse implement?

a) monitor the client's labetalol serum drug level

b) keep the medications covered with tin foil

c) administer the meds slow iv push over 5 min

d) teach the client signs/symptoms of hypertension

all my references on this (and i checked 3 of them) said the iv push dose can be administered over 2 minutes. nothing about monitoring therapeutic drug levels. in fact my lab reference doesn't even list a labetalol drug level. and, there are no light precautions with this drug solution itself. so, the answer has to be "d".

the primary nurse is preparing to administer dobutamine(dobutrex) to a client in cardiogenic shock. which action by the primary nurse would warrant intervention by charge nurse?

a) the primary nurse is administering the dobutrex by gravity (it's not on an iv pump)

b) primary nurse attaches a urometer to the client's foley catheter(for accuracy measurements of urine)

c) primary nurse applies a pulse oximenter to the client's finger (oxygen readings)

d) primary nurse checks the client for any medication allergies.

this one i know from my years of practice. the answer is "a". dobutrex is always given on an iv pump--always. this poor primary nurse will be written up for a serious medication administration error. this patient is at a serious risk of having an overdose. overdose causes hypertension, myocardial ischemia, ventricular tachycardia and/or ventricular fibrillation. most icus have written policies on how drugs like dobutrex are to be handled and administered by the staff. dobutrex is normally not even allowed to be given by staff nurses outside of the intensive care units.

nurse is administering morning meds. which combination of meds should the nurse question administering?

a) terazosin (hytrin) and captopril

b) finasteride(proscar) and digoxin(lanoxin)

c) tamsulosin(flomax) and metformin(glucophage)

d) serenoa repens(saw palmetto) and metoprolol(toprol xl)

"a". terazosin is an alpha andrenergic blocker type of antihypertensive. captopril is an ace inhibitor type of antihypertensive. both of these drugs increase/enhance the hypotensive effects of other antihypertensives when they are given together.

and now i going to watch the star wars marathon on spike tv.

[gaajr1, RN]

Daytonite,

As always thanks a ton! I really like the way you explain things. I'm glad I was thinking of the same answer choices.

You will be such a good instructor!! Did you enjoy the Star Wars?

[Daytonite, BSN, RN]

Did you enjoy the Star Wars?

I did, and I will be watching Episode II tonight!

[UM Review RN, ASN, RN]

OK, now I have a question re: the last question.

Saw palmetto will decrease the effect of Metoprolol, so that is why I would've chosen that answer.

[UM Review RN, ASN, RN]

Never mind. Now I can't find the link.

Thanks, Daytonite. We're all always learning, aren't we.

[Daytonite, BSN, RN]

OK, now I have a question re: the last question.

Saw palmetto will decrease the effect of Metoprolol, so that is why I would've chosen that answer.

My nursing reference has herbal interactions in it and saw palmetto is not listed for metropolol. However, the interactions for the two hypertensives, particularly for the captopril was in the interaction precautions. They enhance the effects of each other making the antihypertensive effects even more pronounced.