NCLEX EXAM 2 NURS 2474 STUDY GUIDE 2024 A | Exams Nursing

NCLEX EXAM 2 NURS -2474 STUDY GUIDE 2024 A+

General tips for studying:

1. Memorize names of medication categories from the presentation

2. Memorize key drugs from categories above (there are many questions with specific drug names)

3. Use generic names

4. When reviewing particular drugs note category, indications, common side effects, toxicity

signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or antagonizing

which receptors)

5. Read question instructions (there will be ‘select all that apply’ questions)

Topics to review:

1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.).

a. For any patient prescribed an inhaler, the RN should ensure the client can self administer

the medication.

i. Teach back needed

b. The patient should wait 1-2 minutes between puffs

c. The patient should wait 5 minutes between 2 different inhalers

d. The patient should take a bronchodilator before a corticosteroid medication (B before C)

e. The patient must keep track of doses on their inhaler

f. If opening a new inhaler, the patient should shake it and test before use.

g. If dexterity is limited, a spacer can be used to get more medication in the airway.

h. If the patient uses a steroid, they must wash their mouth out after use.

i. If not, fungal infection may occur

i. The patient should hold breath 10 seconds after receiving a puff.

2. Know the difference between short and long term treatments for asthma and COPD

a. Short term asthma treatment:

i. Bronchodilator: albuterol

1. Acts as a rescue inhaler during asthma attacks.

2. Onset is in 5 minutes and will last longer.

ii. Xanthine Derivatives: theophylline

1. Dilates airways

2. Can have high drug interactions in the body

iii. IV/ inhaled glucocorticoids.

b. Long term asthma treatment:

i. Bronchodilator: salmeterol.

1. Used to control symptoms of asthma

2. Never is used alone (often with steroid)

ii. Anticholinergics: ipratropium bromide

1. For long term asthma prevention

2. Works very slowly.

3. Fast onset, short duration

* Tiotropium has longer duration that Ipratropium

iii. Corticosteroids: fluticasone or Budesonide

1. Non bronchodilation

2. Can take several weeks to show

c. COPD treatment:

i. Bronchodilator- short acting albuterol

ii. Steroid

iii. Must keep o2 saturation between 88-92%

3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what is for

long term management)

a. Rescue inhalers: albuterol, epinephrine, metaproterenol, IV steroid

Partial preview of the text

Download NCLEX EXAM 2 NURS 2474 STUDY GUIDE 2024 A and more Exams Nursing in PDF only on Docsity!

NCLEX EXAM 2 NURS -2474 STUDY GUIDE 2024 A+

General tips for studying:

Memorize names of medication categories from the presentation
Memorize key drugs from categories above (there are many questions with specific drug names)
Use generic names
When reviewing particular drugs note category, indications, common side effects, toxicity signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or antagonizing which receptors)
Read question instructions (there will be ‘select all that apply’ questions)

Topics to review:

Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.). a. For any patient prescribed an inhaler, the RN should ensure the client can self administer the medication. i. Teach back needed b. The patient should wait 1-2 minutes between puffs c. The patient should wait 5 minutes between 2 different inhalers d. The patient should take a bronchodilator before a corticosteroid medication (B before C) e. The patient must keep track of doses on their inhaler f. If opening a new inhaler, the patient should shake it and test before use. g. If dexterity is limited, a spacer can be used to get more medication in the airway. h. If the patient uses a steroid, they must wash their mouth out after use. i. If not, fungal infection may occur i. The patient should hold breath 10 seconds after receiving a puff.
Know the difference between short and long term treatments for asthma and COPD a. Short term asthma treatment: i. Bronchodilator: albuterol 1. Acts as a rescue inhaler during asthma attacks. 2. Onset is in 5 minutes and will last longer. ii. Xanthine Derivatives: theophylline
Dilates airways
Can have high drug interactions in the body iii. IV/ inhaled glucocorticoids. b. Long term asthma treatment: i. Bronchodilator: salmeterol. 1. Used to control symptoms of asthma 2. Never is used alone (often with steroid) ii. Anticholinergics: ipratropium bromide
For long term asthma prevention
Works very slowly.
Fast onset, short duration

Tiotropium has longer duration that Ipratropium iii. Corticosteroids: fluticasone or Budesonide

Non bronchodilation
Can take several weeks to show c. COPD treatment: i. Bronchodilator- short acting albuterol ii. Steroid iii. Must keep o2 saturation between 88-92%
Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what is for long term management) a. Rescue inhalers: albuterol, epinephrine, metaproterenol, IV steroid

b. Long term: salmeterol, ipratropium, theophylline, montelukast ,fluticasone

Treatment of acute asthma a. Oxygen use b. Short acting bronchodilator- albuterol c. Corticosteroid- ipratropium bromide IV d. Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction.
Administration of bronchodilator (MOA,SE,Considerations) a. MOA: mimics the sympathetic NS and opens up the lungs and stimulates beta receptors b. Fast acting: used for acute asthma relief, Long acting is for chronic asthma management and COPD c. AE: tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia. d. Considerations: ensure patient takes medication as prescribed and does not overuse short acting bronchodilator. Never use it alone with asthma treatment.
Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt. education) a. MOA: works to stop the inflammatory process in the lungs, preventing bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting substances, increases bronchial smooth muscle beta adrenergic stimulation. b. Inhaled: used for asthma and is the most tolerated and fast acting, but can also be IV for systemic effects on the body. c. AE: throat and mouth irritation, dry mouth, oral fungal infections. d. Must be used with another drug for asthma control. e. Nursing interventions: must teach patients to rinse mouth out after steroid use to prevent oral fungal infections, take bronchodilator 5 mins before steroid.
Tiotropium administration, onset, and therapeutic level timeframes a. It is an anticholinergic medication used to treat maintenance therapy and bronchospasm in patients with COPD. Will block muscarinic receptors in lungs b. Inhaled form. c. Not for asthma d. Therapeutic effects start 30 min post inhalation, peaks in 3 hrs, and lasts 24 hrs. With consistent dosing, bronchodilation will improve after 8 days. e. AE: dry mouth. Can minimize by drinking fluids or sucking on hard candy.
OTC sympathomimetics (e.g., decongestants) use in cardiac patients a. Sympathomimetics stimulate the immune system. b. OTC decongestants such as pseudoephedrine are sympathomimetics. c. Patients with cardiac problems must have caution with use of these drugs and hypertension treatment.
Treatment principles of cold symptoms in children (treat individual symptoms) a. Many medications used OTC to treat colds are combination medications. b. In children, it can be dangerous if used as a combination medication for a cold. c. The parent should treat the symptoms only with individual agents and only with agents indicated for pediatric use.
Ulcer prevention with chronic NSAID use (identify specific med class) a. NSAIDs inhibit prostaglandin biosynthesis and reduce blood flow, mucus and bicarb. b. They increase risk of ulcers forming. c. Best treatment of NSAID ulcers is with H2 receptor blockers and PPI. d. Must also stop NSAID use as well.
Antacids and Cimetidine (patient education) a. Antacids are used to help neutralize acid secretions and promote gastric mucosal defenses in many ways and reduce pain associated with acid related disorders. i. Many different types such as Magnesium Salts, calcium carbonate, sodium bicarbonate, simethicone, etc.

ii. Decrease strain to prevent vasovagal stimulation. iii. Empty the bowel before treatment procedures iv. Obtain a fresh stool sample. v. Assist with loss of bowel tones.

Bulk forming laxatives administration principles a. Bulk forming laxatives work by absorbing water to increase bulk and soften stool. It also causes bowel distention to initiate reflex bowel activity. b. Administration: the patient must take a bulk forming laxative with a full cup (240ml) of juice or water.
Opiate use related constipation and treatment a. Opiates work to decrease bowel motility and reduce pain by relief of muscle spasms. They also decrease transit time of stool through the bowel, allowing more time for water and electrolytes to be absorbed. b. Used for patients with frequent diarrhea, to decrease stool in ileostomy and decrease diarrhea from opioid withdrawal. c. If a patient takes too much of an opiate due to its dependent effects, a patient may experience s/s similar to morphine and may cause an increased constipation. The patient will need naloxone to help reverse this cause.
Senna side effects a. Senna is a stimulant of the intestines and works to increase peristalsis via intestinal nerve stimulation. b. A big side effect of Senna use is that the patient may have a yellow/brown or pink color to the urine that is harmless.
Stool softeners and surgical patients a. Stool softeners will help the stool pass easier through the hypoactive bowel. It will not stimulate bowel activity. b. Will help with post surgical constipation.
Ondansetron side effects a. Ondansteron is a serotonin agonist that blocks receptors located in the vagal nerve, GI tract, and chemoreceptor trigger zones in the CNS. b. Used to treat CINV, prevention of post-op nausea and vomiting. c. Side Effects: HA, diarrhea, dizziness, prolonged QT interval, risk of torsades de pointes.
Concurrent use of Digoxin and Furosemide (monitoring, interactions) a. Furosemide, a loop diuretic, causes excretion of both sodium and potassium from the body. b. A patient taking digoxin is at risk for having a life threatening arrhythmia due to low potassium levels. c. Nausea and vomiting may also play into the role of having hypokalemia. d. Because of this interaction, the patient should cease use of furosemide and use a potassium sparing diuretic that will hold onto potassium. e. We must monitor digoxin levels, potassium levels, telemetry, and advise the client to eat foods rich in potassium or a supplement to increase potassium in the body if needed.
Potassium wasting vs potassium sparing diuretic use (specific med examples from each) a. Potassium wasting diuretic is Loop Diuretic or Thiazide diuretic. i. These drugs work to block absorption of Na, K ,Cl and water. ii. Causes rapid diuresis. iii. Treats: HF, Hypertension, edema, renal disease, liver failure. iv. AE: hypotension ,dehydration, hyponatremia, hypokalemia, hypochloremia. v. May need K supplements to help maintain normal K levels. b. K sparing diuretic is spironolactone. i. This drug works to block absorption of Na and water, and causes the body to

hold onto K. ii. Makes Na and water become excreted from the body, K is held on. iii. Used for hypertension and HF iv. AE:hypotension, hyperkalemia (the person holds onto more potassium), drowsiness, metabolic acidosis, gynecomastia, breast tenderness, irregular menstrual cycle, impotence. v. We must monitor ECG so we can assess for arrhythmia related to high K levels, no salt substitutes should be used.

Concurrent use of Furosemide and gentamicin a. Furosemide is a diuretic that is ototoxic b. Gentamicin is an antibiotic that is also ototoxic. c. Must have caution when taking these drugs together. d. Teach patients to recognize tinnitus and report it to HCP if taking these 2 medications.
Angioedema (common meds that cause it, interventions) a. Angioedema is an adverse effect with ACE inhibitors and A2RB use. b. S/S: facial and tongue swelling. Can be fatal. c. Can be treated with epinephrine for initial reaction. d. The patient with angioedema must discontinue ACE inhibitors or A2RB drugs and never use them again.
ACE inhibitors and coughing (interventions) a. A side effect with ACE inhibitor use includes a dry cough. This is due to bradykinin being at increased levels. b. If a patient does not like coughing, we must notify HCP and switch the patient to another medication.
ACE inhibitors side effects and patient education a. SE: 1st dose hypotension, dry cough, angioedema, hyperkalemia, fetal injury. b. Education: i. Change positions slowly due to 1st dose hypotension. ii. Teach about relief methods for dry cough like sucking on hard candy or cough drop. However, if they cannot handle the medication because of a cough, they must notify the provider to switch medication. iii. Teach about s/s of angioedema and what to report to the provider. The patient will not take ACE drugs again if this occurs. iv. Educate patients to avoid foods high in potassium. They also must avoid salt substitutes as they are full of potassium. v. For fetal harm, they should notify HCP if they are pregnant or plan to be pregnant while on the medication. vi. Will interact with K sparing diuretics and cause even more increased levels of potassium, so must educate patients to not take spironolactone.
Nifedipine and metoprolol concurrent use (review why and who needs it) a. Nifedipine works on the blood vessels, causing dilation. However, a response that may occur is reflex tachycardia. This response may cause more pain in those with angina. b. Because of this, one may use a beta blocker like metoprolol to prevent reflex tachycardia.
Beta blockers mechanism of action, SE, contraindications a. MOA: beta blockers bind to beta 1 and 2 receptors and block responses.

Early: N,V,D, GI effects, anorexia, abdominal pain.
Late: decrease HR, vision changes- halos, green yellow blue vision, flickering lights. ii. Give digibind IV as antidote iii. Monitor lab values of serum digoxin level since they go down slowly.
Amiodarone (side effects, indications, MOA) a. Amiodarone is a potassium channel blocker that works to reverse dysrhythmias, v fib, unstable ventricular tachycardia. b. It works on the heart to reduce automaticity in SA node, reduce contractility, reduce conduction velocity, widens QRS, prolongs PR and QT intervals c. AE: pulmonary toxicity, cardiotoxicity, teratogenesis, corneal deposits, optic neuropathy. d. Do not use grapefruit juice with K channel blockers as it can increase levels of drug e. Do not use cholestyramine as it can reduce drug levels. f. Remember that all drugs that treat dysrhythmias can also cause other dysrhythmias! g. Goal: put patient in healthy sinus rhythm
Magnesium elimination in the body a. Magnesium is excreted in the kidneys. b. May take in larger amounts when a loop diuretic is used.
HMG-COA reductase inhibitors (timeframes for administration, max effect, etc.) a. These drugs are the most effective in lowering LDL and elevating HDL, reducing TG levels. b. Also has cardiac benefits of promoting plaque stability or less growth, reducing risk for CV events, and increasing bone formation. c. Must give at night once a day because it will mimic the body’s production of cholesterol. d. AE: HA, rash, GI effects e. Rare: myopathy or rhabdomyolysis- muscle breakdown, liver toxicity, new onset diabetes and cataracts with older patients. f. Do not use other lipid lowering drugs or in pregnancy. g. NO GRAPEFRUIT JUICE!
Concurrent use of Colesevelam and Insulin a. Colesevelam is a bile acid sequestrant that binds with bile in the gut, preventing absorption. b. This drug is also used for adjunct therapy in patients with type 2 diabetes and insulin to prevent hypoglycemia.
Lovastatin patient education a. At night, once a day b. Inform about the risk of myopathy and to notify the provider if muscle pain occurs.
Cholesterol lowering agents patient education a. May take a couple weeks to see lipid level changes. b. Best course of action is to maintain a diet and exercise regimen. c. Should have a lipid plasma test 2x a year that prevents us fasting. Screen every 5 years or more often. d. Take cholesterol medications at night or at evening meals. e. Stress reduction is needed.

f. Stop smoking g. TLC diet low cholesterol and fat h. Lifestyle modifications are first line, then meds. i. For cholestyramine- must dilute medication and dilute fluid in water and drink. j. Most meds will require a full glass of water with administration.

Nitroglycerin administration and patient education a. Administration: large 1 st pass effect in oral forms. Tolerance will develop fast. Place under tongue if PO and let dissolve. Burning means the drug is working. b. If using a long acting patch: can remove for 8 hrs. a day. Remove the old patch before the new one, rotate sites on the upper body. c. If using long acting cream: wear gloves while applying, remove all excess formula. d. Nursing Care: when giving patients with angina nitroglycerin, check vital signs before each dose if possible, give 5 minutes apart, hold drugs if HR is less than 60 or greater than 100 or BP less than 100/60. If not in a hospital setting, stop activity and sit down, take a sublingual tablet, and wait 5 minutes. If no relief, take a 2 nd tablet and call 911, still no relief, take a 3rd tablet and wait for EMS. DO NOT TRY TO DRIVE SELF TO HOSPITAL OR HAVE FAMILY TAKE YOU. e. Storage: store nitroglycerin in an airtight, dark glass bottle in a cool, dark place. Potency of the drug can be lost in 6 months after opening.
Nitroglycerin mechanism of action a. Nitroglycerin is a nitrate that works to treat stable and variant angina. Can be used short and long term. b. Mechanism of action: vasodilates, acts directly on vascular smooth muscle to promote vasodilation. Lowers oxygen demand. c. AE: HA, orthostatic hypotension, reflex tachycardia d. Interacts with PDE5 inhibitors, such as Viagra because these drugs not only are used for erectile dysfunction in males, but have cardiac drug effects when used with nitroglycerin. e. If we have a male with chest pain, we must ask if they use PDE5 drugs. If they report they do use these drugs, we will hold nitroglycerin. If we were to give nitroglycerin with these patients, then hypotension may occur.
Hemophilia treatment (general principles, medications) a. Hemophilia A: will need replacement therapy with factor VIII i. Factor 8 therapy: helps to increase factor 8 in the body. 1. Can be in the plasma or recombinant. 2. AE: allergy symptoms induced by the medication: hives, stuffy nose, fever 3. Treat with diphenhydramine. ii. Desmopressin- helps to stop or prevent bleeding. b. Hemophilia B: will need factor IX therapy i. Factor 9 therapy is similar to factor 8 but will work on the factor 9 receptors.
Factor VIII concentrate administration, education, side effects a. Allergy symptoms are mimics- allergy symptoms treated with diphenhydramine

Lab values to monitor for bleeding, anemia a. Bleeding: i. VS: low BP, high HR and RR ii. RBCs= lower than 4. iii. Hemoglobin is lower than 12 iv. Hematocrit is higher than 52% b. Anemia is based on various causes, but after it is due to having small, pale RBCs. i. May need more of a certain vitamin component. ii. Maybe hemolysis also.
Filgrastim side effects a. Fligastrim is a medication used to stimulate WBC production. b. It reduces severe neutropenia and reduces need for infection, hospitalization and IV abx. c. Used often with cancer patients due to immune suppression. d. AE: Bone pain, leukocytosis (due to large stimulation). i. If AE occurs, you may need to give acetaminophen or decrease dosage.
Dabigatran administration, side effects and patient education a. Dabigatran is a direct thrombin inhibitor that directly prevents clots from forming. b. Treats :A fib, prevents VTE follow surgery and prevents DVT/PE. c. AE: bleeding, dyspepsia. d. Administration: with or without food, PO. e. Nursing consideration: does not monitor anticoagulation, little risk of adverse events, same dose can be used for all patients regardless of age or weight. f. There is NO ANTIDOTE for bleeding related to medication.
Rivaroxaban and bleeding precautions a. Rivaroxaban is an oral anticoagulant that causes inhibition of factor Xa. b. It works fast, has fixed dosage, lower bleeding risk, few drug interactions, and no need for monitoring. c. Intended for prevention of DVT/PE, prevention of stroke and PE in AFib patients d. AE: bleeding is the most common adverse effect and can occur at any site. Increased with any drug that impedes hemostasis. e. There is NO KNOWN ANTIDOTE to reverse the drug- must use activated charcoal. f. S/S bleeding: petechial, ecchymosis, tarry stool, coffee ground emesis, bleeding out of unusual places, hematuria, tachycardia, hypotension. g. Bleeding Precautions needed: use soft toothbrush, electric razor, wear good soled shoes, have safe environment, wear medical alert bracelet, do not strain while on toilet, no contact sports, decrease invasiveness of procedures such as needlesticks, blow nose gently, observe for s/s of bleeding
Review common lab values (e.g., potassium level) a. K level: 3.5- 5 i. If above 5= give K wasting diuretic ii. If lower than 3.5= give K sparing diuretic

iii. Assess telemetry with all patients receiving drugs that can alter K levels due to potential for arrhythmias that can be deadly b. Na level: 135- 145 c. Kidney labs: must look to see if kidneys are functioning and can tolerate drug effects. i. BUN:7-20 mg/dl ii. Creatine: 0.8-1.4 mg/dl iii. Specific gravity: 1.005 to 1. d. RBC: 4.7-6. i. Low RBC levels may mean anemia or bleeding someplace e. WBC: 5000- 10000 i. Low WBC count means risk for infection ii. High count means there may be active infection f. Platelet: 150000- i. Low platelet level means risk for bleeding g. H/H: 12-18/37-52% h. TG: less than 150 i. HDL: less than 40 i. Must have good physical activity to bring it up. j. LDL: less than 100 k. Digoxin level: 0.5-2. l. aPTT: 60- 80 i. Less than 60= increase the dose ii. More than 80= decrease the dose m. PT/INR: 18-24, 2- 3 i. Less than 2= increase drug dose ii. More than 3= decease drug dose

NCLEX EXAM 2 NURS 2474 STUDY GUIDE 2024 A, Exams of Nursing

Related documents

Partial preview of the text

Download NCLEX EXAM 2 NURS 2474 STUDY GUIDE 2024 A and more Exams Nursing in PDF only on Docsity!

NCLEX EXAM 2 NURS -2474 STUDY GUIDE 2024 A+

General tips for studying:

Topics to review: