M6P4Q PDF - Past Paper

1. What should be done before and after administration of a drug through an IV line? - Flush the IV line with 5% dextrose, 0.9% NaCl, or lactated Ringer's solution. 2. Which drugs, among omeprazole and esomeprazole, have the greatest potential for drug interactions? - Omeprazole and esomeprazole hav...

1. What should be done before and after administration of a drug through an IV line? - Flush the IV line with 5% dextrose, 0.9% NaCl, or lactated Ringer's solution. 2. Which drugs, among omeprazole and esomeprazole, have the greatest potential for drug interactions? - Omeprazole and esomeprazole have the greatest potential for drug interactions. 3. Does esomeprazole interfere with the metabolism of other drugs to a lesser degree than omeprazole? - Yes, it appears that esomeprazole interferes with the metabolism of other drugs to a lesser degree than omeprazole. 4. What is the metabolism of pantoprazole followed by? - The metabolism of pantoprazole is followed rapidly by sulfate conjugation. 5. Does pantoprazole have a high potential for drug interactions with other agents metabolized by the CYP450 system? - No, pantoprazole has the lowest potential for drug interactions with other agents metabolized by the CYP450 system. 6. Which enzyme metabolizes Rabeprazole? - Rabeprazole is metabolized by CYP2C19. 7. Which enzyme shows a strong affinity for Rabeprazole? - Rabeprazole shows a strong affinity for CYP3A4. 8. What type of pain relief may be required during acute pancreatitis? - Parenteral opioids such as morphine, fentanyl, or hydromorphone may be required for pain relief during acute pancreatitis. 9. What is the recommendation for pain management in acute pancreatitis? - The use of opioids, with assessment for their effectiveness, and altering therapy if pain is not controlled or increased. 10. What approach to pain management in patients with pancreatitis has been found effective? - Implementing the World Health Organization (WHO) analgesia ladder and using nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with opioids. 11. What should be avoided or used with caution in patients at risk for bleeding? - NSAIDs must be avoided or used with caution in patients at risk for bleeding. 12. What problems can be potentiated and aggravated by the use of high-dose opioids in early acute pancreatitis? - GI paralysis and ileus can be potentiated and aggravated by the use of high-dose opioids in early acute pancreatitis. 13. What type of pain management option requires further research for effectiveness in acute pancreatitis? - Identifying the best option for pain management in the patient with acute pancreatitis requires further research. 14. What should be followed for acute pain management in the perioperative setting? - Guidelines for acute pain management in the perioperative setting should be followed. 15. Why may antiemetic agents be prescribed in acute pancreatitis? - Antiemetic agents may be prescribed to prevent vomiting. 16. What are the objectives of therapy for acute pancreatitis? - The objectives of therapy for acute pancreatitis are to relieve pain and decrease secretion of pancreatic enzymes. 17. Which opioids are commonly used for pain management in acute pancreatitis? - Hydromorphone, morphine, or fentanyl via patient-controlled analgesia or bolus are commonly used for pain management in acute pancreatitis. 18. Which opioids may stimulate spasm of the sphincter of Oddi to some degree? - Most opioids may stimulate spasm of the sphincter of Oddi to some degree. 19. What is the most essential aspect of care in pain management of acute pancreatitis? - Ensuring patient comfort, regardless of the opioid prescribed, is the most essential aspect of care. 20. What is hydromorphone? - Hydromorphone is a Schedule II, semisynthetic derivative of morphine. 21. Is hydromorphone more potent and effective than morphine? - Yes, hydromorphone is more potent on a milligram-to-milligram basis and more effective orally than morphine. 22. How long do the effects of hydromorphone last? - The effects of hydromorphone last 4 to 5 hours. 23. How is hydromorphone metabolized and excreted? - Hydromorphone is metabolized in the liver to inactive metabolites and excreted through the kidneys. 24. What is meperidine? - Meperidine is another opioid used for pain management. 25. What is the increased risk associated with elderly patients with dementiarelated psychosis treated with perphenazine and other antipsychotic drugs? - Increased risk of death 26. What adverse effects can occur due to the use of perphenazine and other antipsychotic drugs? - Bradycardia, cardiac arrest, hypotension, catatonic-like states, extrapyramidal symptoms, and blue-gray discoloration of the skin 27. What is the prototype of the 5-HT3 receptor antagonists? - Ondansetron (Zofran) 28. How is oral ondansetron absorbed and metabolized? - Well absorbed from the GI tract and undergoes some first-pass metabolism 29. What is the half-life of oral ondansetron in most patients? What about patients with moderate or severe liver impairment? - 3 to 5.5 hours in most patients; 9 to 20 hours in patients with moderate or severe liver impairment 30. What is the onset and peak of drug action for oral forms (disintegrating tablet or soluble film) of ondansetron? - Onset in 30 to 60 minutes, peaks in about 2 hours 31. What is the onset and peak of drug action for the IV form of ondansetron? - Immediate 32. How is the bioavailability of ondansetron affected by the presence of food and antacids? - Slightly increased by the presence of food, unaffected by antacids 33. What is the action of ondansetron and other 5-HT3 receptor antagonists? - They antagonize serotonin receptors, preventing their activation by emetogenic drugs and toxins 34. In what conditions is ondansetron used to prevent or treat moderate to severe nausea and vomiting? - Cancer chemotherapy, radiation therapy, and postoperative status 35. What does the American Society of Clinical Oncology recommend regarding the use of a 5-HT3 receptor antagonist in pediatric oncology patients? - Use before administering high-dose chemotherapy or chemotherapy with high to moderate emetic risk 36. Is dosage adjustment required for patients older than 65 years of age when using ondansetron? - No, researchers have observed no overall differences in safety or effectiveness in older adults compared with younger patients 37. How is the half-life of ondansetron affected in patients with moderate to severe hepatic impairment? - Significantly increased, increasing the risk of adverse effects 38. Can oral administration of ondansetron be given in the home setting for patients receiving home care? - Yes 39. What adverse effect should the home care nurse assess for when administering ondansetron? - Diarrhea 40. What are the common adverse effects of ondansetron? - Diarrhea, headache, dizziness, constipation, fatigue, transient elevation of liver enzymes, and pain at the injection site 41. What are the contraindications for ondansetron? - Known hypersensitivity to the drug 42. Which drugs increase the clearance of ondansetron and decrease serum concentrations? - Phenytoin, carbamazepine, rifampin, and other inducers of CYP3A4 enzymes 43. What is the contraindication for using ondansetron with apomorphine? - Potential of a significant drop of blood pressure or loss of consciousness with concurrent use 44. How should the disintegrating tablet of ondansetron be administered? - Leave it in the blister pack until administration; gently peel back the blister backing and do not push the tablet through the foil 45. How does the oral film of ondansetron dissolve? - Rapidly on the tongue, without the need for water 46. What should the nurse assess for to determine the therapeutic effects of ondansetron? - Verbal reports of decreased nausea and absence of vomiting 47. Which adverse effects should the nurse pay special attention to when assessing for adverse effects of ondansetron? - Headache and diarrhea 48. What is the action of meperidine? - Meperidine is a synthetic drug similar to morphine in action and adverse effects. 49. How soon does analgesia occur after injection of meperidine? - Analgesia occurs in 10 to 20 minutes after injection of meperidine. 50. What is the peak time for analgesia after injection of meperidine? - The peak time for analgesia after injection of meperidine is 1 hour. 51. How long does the analgesic effect last after injection of meperidine? - The analgesic effect of meperidine lasts 2 to 4 hours after injection. 52. Why is meperidine infrequently prescribed for therapeutic purposes? - Meperidine is infrequently prescribed for therapeutic purposes due to its production of a neurotoxic metabolite (normeperidine). 53. What are the CNS stimulation effects of normeperidine? - Normeperidine produces CNS stimulation characterized by agitation, hallucinations, and seizures. 54. How long is the half-life of normeperidine? - The half-life of normeperidine is 15 to 30 hours, depending on renal function. 55. Are the effects of normeperidine reversible with opioid antagonist drugs? - The effects of normeperidine are not reversible with opioid antagonist drugs. 56. Why is meperidine not recommended for cancer pain management or use in older adults? - Meperidine is not recommended for cancer pain management or use in older adults. 57. What is the role of naloxone in opioid overdose cases? - Naloxone is used to reverse analgesia, CNS and respiratory depression caused by opioid agonists. 58. How does naloxone prevent opioid effects? - Naloxone competes with opioids for receptor sites in the brain, preventing binding or displacing opioids already occupying receptor sites. 59. What is the recommended route of administration for naloxone to treat opioidrelated respiratory depression? - The recommended route of administration for naloxone to treat opioid-related respiratory depression is intravenous. 60. Is cautious use of naloxone necessary in neonates and children? - Yes, cautious use of naloxone is necessary in neonates and children. 61. How should naloxone be given to neonates and children? - Naloxone should be given intravenously in neonates and children, with dosage adjusted according to kilogram weight. 62. What are the considerations for using naloxone in patients with renal impairment? - Naloxone should be used with caution in patients with renal impairment, with a smaller dose recommended due to slower drug excretion. 63. What are the considerations for using naloxone in patients with hepatic impairment? - Naloxone should be used with caution in patients with hepatic impairment, with close monitoring of liver function to prevent toxicity. 64. Which patients with critical illness should not receive naloxone? - Critically ill patients with increased intracranial pressure, seizure disorders, head trauma, or respiratory depression should not receive naloxone. 65. When can naloxone be given to people with coma of unknown origin? - Naloxone may be given to people with coma of unknown origin to determine if opioids are causing the mental status change. 66. What are some adverse effects of naloxone? - Adverse effects of naloxone include tremors, drowsiness, sweating, decreased respirations, hypertension, nausea, and vomiting. 67. What are the contraindications to using naloxone? - Contraindications to using naloxone include known hypersensitivity to the drug, presence of narcotic abuse, and pregnancy. 68. What are some nursing implications for naloxone use? - Nursing implications for naloxone use include assessing for therapeutic effects, assessing for adverse effects such as decreased respirations and elevated blood pressure, being prepared to repeat the dose if necessary, and considering the return of pain. 69. What is the action of naltrexone in the brain? - Naltrexone acts in the brain to prevent opiate effects, decreasing the desire to take opiates and treating alcohol dependence. 70. For what purpose is naltrexone commonly used? - Naltrexone is commonly used as part of a complete treatment program for substance abuse, including compliance monitoring and counseling. 71. What are the goals of management for acute pancreatitis? - Relieving symptoms and preventing or treating complications. 72. What is the recommended nutritional support for patients with acute pancreatitis? - Enteral feedings. 73. What medications are used for acid suppression in acute pancreatitis? - Histamine 2 antagonists or proton pump inhibitors. 74. What is the priority for nursing care in acute pancreatitis? - Nausea and pain management. 75. Why is blood glucose management required in acute pancreatitis? - Due to pancreatic inflammation. 76. What is parenteral nutrition? - Intravenous provision of fluid and nutrients to patients unable to ingest enough due to a nonfunctional gastrointestinal tract. 77. What types of nutritional products are available for supplementation or substitution? - Vitamins, minerals, liquid enteral formulas, IV fluids and nutrition, and pancreatic enzymes. 78. What are some examples of liquid enteral formulas available for oral or tube feedings? - Ensure, Isocal, Sustacal, Resource. 79. What additional product may be necessary to meet fluid needs when using oral enteral formulas? - Additional water. 80. How much kcal does most oral products contain per mL of formula? - 1 kcal/mL. 81. When can high-protein, high-calorie foods or nutritionally complete supplements be given? - When the GI tract is functional but the patient cannot ingest sufficient food and fluid. 82. What does enteral nutrition provide for patients with a feeding tube? - Fluid and nutrients. 83. When is parenteral nutrition often given? - When the GI tract is nonfunctional. 84. What is the goal of short-term use of parenteral nutrition? - To provide adequate amounts of fluids, electrolytes, and enough carbohydrates to minimize oxidation of body protein and fat for energy. 85. What solution is frequently used for short-term parenteral nutrition? - 5% dextrose in 0.45% sodium chloride. 86. What does long-term use of parenteral nutrition aim to provide? - All nutrients required for normal body functioning, including tissue repair. 87. What do basic parenteral solutions provide? - Water, carbohydrate, protein, vitamins, and minerals. 88. What are fat emulsions used for in parenteral nutrition? - To provide additional calories and essential fatty acids. 89. What enteral formulations are available for children with special nutrient needs? - Lofenalac for phenylketonuria, Nursoy and Soyalac for soy protein allergy, Nutramigen and Pregestimil for malabsorption or other GI problems. 90. What enteral formulation is available for children receiving dialysis? - Nepro. 91. What enteral formulation is formulated for patients not receiving dialysis? - Suplena. 92. What enteral formula is available for patients with hepatic failure? - Hepatic-Aid II. 93. What special formula of amino acids is available for parenteral feeding in patients with hepatic failure and hepatic encephalopathy? - HepatAmine. 94. What are the contraindications for omeprazole? - Known hypersensitivity to omeprazole. 95. Which medications may have increased blood levels when taken with omeprazole? - Benzodiazepines (diazepam, flurazepam, triazolam), phenytoin, and warfarin. 96. What is the potential interaction between clopidogrel and PPIs? - Coadministration may reduce the cardioprotective effects of clopidogrel. 97. What is the recommended administration instruction for omeprazole? - Administer before food intake. 98. Why should omeprazole tablets or capsules be swallowed whole? - Because the drug formulations are delayed-release and long-acting. 99. What adverse effects should the nurse observe for when administering omeprazole? - Headache, diarrhea, abdominal pain, nausea, and vomiting. 100. Are there any reported herb interactions with omeprazole? - No, there have been no reported herb interactions. 101. Which drugs belong to the same class as omeprazole? - Dexlansoprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole. 102. How should dexlansoprazole capsules be taken if someone cannot swallow them? - The capsules may be opened and sprinkled on a tablespoon of applesauce. 103. What is the maximum recommended dose of dexlansoprazole during the maintenance phase? - Doses greater than 30 mg do not provide additional benefit. 104. Can esomeprazole capsules be opened and administered via a nasogastric tube? - Yes, they can be opened and mixed with 50 mL of water. 105. What should be done before and after administering IV esomeprazole? - Flush the IV line with 5% dextrose or lactated Ringer's solution. 106. Should lansoprazole and rabeprazole be used cautiously in patients with liver impairment? - Yes, they should be used cautiously and dosage should be reduced. 107. What caution should be taken regarding orally disintegrating tablets of lansoprazole? - They may contain aspartame and should be avoided by people with phenylketonuria. 108. How should oral pantoprazole be taken? - As per the manufacturer's recommendations, with or without food. 109. How should IV pantoprazole be administered? - Over 15 minutes, injecting the drug into a dedicated line or the Y-site of an IV infusion. 110. Why does the nurse avoid intravenous (IV) administration if possible? - The drug can cause severe tissue injury. 111. What should the nurse observe for as therapeutic effects? - Prevention or resolution of nausea and vomiting. 112. What adverse effects should the nurse assess for? - Associated adverse anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, acute confusion, dizziness, tachycardia). 113. What adverse effects may occur with excessive doses? - Hallucinations, convulsions, and sudden death. 114. How can the nurse assess tissue integrity? - By observing for burning and pain at the IV site. 115. When should the drug be discontinued immediately? - If there is burning and pain at the IV site. 116. What should patients taking promethazine be taught regarding dosage? - To use the lowest effective dosage. 117. What should patients taking promethazine be taught regarding other drugs? - Not to take other drugs with respiratory depressant effects concurrently. 118. What should be avoided when taking antiemetic drugs? - Driving an automobile or operating dangerous machinery when drowsy. 119. Why should patients avoid alcohol and other drugs while taking antiemetic drugs? - Several drugs interact with antiemetic drugs and can cause drowsiness. 120. What is the recommended timing for taking medication to prevent motion sickness? - Take medication 30 minutes before travel and then every 4 to 6 hours if necessary. 121. When should antiemetic drugs be taken before a nausea-producing event? - 30 to 60 minutes before the event, when possible. 122. What is the most commonly used antiemetic in the class of phenothiazines? - Prochlorperazine (Compazine). 123. For what conditions is chlorpromazine (Thorazine) commonly used? - Treatment of psychosis, psychotic symptoms, intractable hiccups, and nausea and vomiting associated with anesthesia. 124. What has the FDA issued a BLACK BOX WARNING for? - Perphenazine. 125. What effects can dronabinol cause? - Sedative and mind-altering effects. 126. What should patients taking dronabinol do? - Take it only when supervised by a responsible adult. 127. What should be used as an alternative form of birth control while taking aprepitant (Emend)? - Oral contraceptives. 128. When should patients avoid eating, drinking, or taking oral medications? - During acute vomiting episodes. 129. What can help subside nausea and vomiting? - Lying down. 130. What fluids should be taken to prevent dehydration? - Tea, broth, and gelatins. 131. What should be avoided when taking antiemetic drugs regularly? - Alcohol and other drugs without consulting a healthcare provider. 132. Why should drugs be taken before the causative event? - They are more effective in preventing nausea and vomiting than stopping them. 133. What is an important consideration for self or caregiver administration? - To take the drugs as prescribed and not increase dosage without consulting a healthcare provider. 134. What is the main indication for phenothiazines? - Severe nausea and vomiting that cannot be controlled by other measures. 135. What are some adverse effects of phenothiazines? - Sedation, cognitive impairment, and extrapyramidal reactions. 136. When is chlorpromazine (Thorazine) more commonly used? - For psychosis, psychotic symptoms, intractable hiccups, and anesthesia-related nausea and vomiting. 137. What caution should be taken with the use of enteral and parenteral fat preparations in patients with hepatic impairment? - Caution is warranted because medium-chain triglycerides may lead to coma in patients with advanced cirrhosis. 138. What adverse effects can be attributed to the hypertonicity of enteral and parenteral fat preparations? - Adverse effects include tachycardia, hypotension, dehydration, nausea, vomiting, diarrhea, and increased urine output. 139. What consideration should be taken with tube feeding to avoid the risk of aspiration? - The risk of aspiration of formula is a consideration with tube feeding. 140. What is the recommended practice for administering oral supplemental feedings? - It is necessary to chill liquids or pour them over ice, give them through a straw from a closed container between meals. 141. Why are liquid preparations preferred for medications in tube feedings? - Tablets or powders may stick in the tube lumen, leading to the obstruction of the tube. 142. What should be assessed for therapeutic effects in patients receiving nutritional formulas? - The nurse observes for weight gain and increased serum albumin. 143. In infants and children receiving milk substitutes, what should the nurse observe for? - The nurse observes for decreased diarrhea and weight gain. 144. What is the action of cimetidine, a histamine2 receptor antagonist? - Cimetidine inhibits the action of histamine at the H2 receptors, decreasing the amount, acidity, and pepsin content of gastric juices. 145. What adverse effects are older adults more likely to experience with cimetidine use? - Older adults are more likely to experience confusion, agitation, and disorientation. 146. Why is caution required when using cimetidine in patients with renal impairment? - Cimetidine is eliminated through the kidneys, so dosage reduction is necessary to prevent adverse effects and monitor renal function. 147. When should cimetidine be administered for patients on hemodialysis? - Cimetidine administration should occur at the end of dialysis for patients on hemodialysis. 148. What should be considered when using cimetidine in patients with hepatic impairment? - Cimetidine and other H2RAs may have higher levels than anticipated in patients with impaired liver function. 149. What are H2RAs commonly used for in critically ill patients? - H2RAs are commonly used to prevent stress-induced gastric ulceration in critically ill patients. 150. What should the nurse note about the use of ondansetron? - The nurse should note that use of ondansetron may mask a progressive ileus and gastric distension following abdominal surgery or in patients with chemotherapy-induced nausea and vomiting. 151. What caution should be advised to patients taking ondansetron? - Patients should use caution with driving or other tasks requiring mental alertness due to the potential impairment in thinking or reactions caused by ondansetron. 152. What do orally disintegrating tablets of ondansetron contain? - Orally disintegrating tablets of ondansetron contain phenylalanine, which should be considered by patients with phenylketonuria. 153. Which other drugs belong to the same class as ondansetron? - Granisetron (Sancuso, Sustol), dolasetron (Anzemet), and palonosetron (Aloxi) are other 5HT3 receptor antagonists in the same class. 154. What is the approved route for dolasetron in the treatment of chemotherapyrelated nausea and vomiting? - The oral route of dolasetron is approved for chemotherapy-related nausea and vomiting. 155. In what situations should other 5-HT3 receptor antagonists be avoided? - Other 5-HT3 receptor antagonists should be avoided in patients taking class I and class III antidysrhythmic agents due to concerns about the development of torsades de pointes, with prolongation of the QT interval. 156. What is the management approach for acute pancreatitis? - Management of acute pancreatitis focuses on symptomatic relief and complication prevention, including pain management, control of nausea and vomiting, enteral or parenteral feedings, and gastric acid suppression with histamine 2 antagonists or proton pump inhibitors. 157. What monitoring is required for patients with acute pancreatitis? - Patients with acute pancreatitis require blood glucose monitoring and insulin coverage as needed in acute care settings, which may continue with chronic pancreatitis. 158. What are some common adverse effects of cimetidine? - diarrhea, dizziness, drowsiness, headache, confusion, and gynecomastia 159. What are the contraindications for cimetidine? - known hypersensitivity to cimetidine, renal and hepatic impairment, lactating or pregnant women 160. How do antacids affect the absorption of cimetidine? - Decrease absorption, should not be given at the same time 161. What drugs can be affected by cimetidine? - lidocaine, propafenone, quinidine, warfarin, carbamazepine, phenytoin, alprazolam, diazepam, flurazepam, triazolam, labetalol, metoprolol, propranolol, theophylline, verapamil, amitriptyline, sulfonylurea antidiabetic drugs 162. How does cimetidine contribute to multiple-drug interactions? - It is a known inhibitor of many isozymes of the cytochrome P450 (CYP450) drug-metabo interferes with the hepatic metabolism of other drugs, leading to slower clearance and potential adverse effects and toxicity 163. What precautions should be taken when administering H2RAs? - Ensure appropriate formulation, dosage strength, and method of administration, measure liquid with a marked measuring spoon or medicine cup, dilute IV administration and infuse over 15 to 20 minutes 164. What should the nurse assess for as therapeutic effects of H2RAs? - Decreased epigastric pain with gastric and duodenal ulcers or decreased heartburn with GERD 165. What adverse effects should the nurse assess for with H2RAs? - diarrhea or constipation, headache, dizziness, muscle aches, fatigue, skin 166. What is the purpose of naltrexone? - To decrease the desire to drink alcohol. 167. What are the contraindications to naltrexone? - Concurrent use of opiates, including methadone. 168. How long should a person wait to start taking naltrexone after discontinuing opioids? - At least 7 days. 169. What should health care providers verify in addicted patients before starting naltrexone? - Self-reporting of opioid abstinence using urine analysis. 170. Why is it important to assess liver function in patients taking naltrexone? - Because liver problems may occur. 171. What is the prototype phenothiazine discussed in the notes? - Promethazine. 172. What are the therapeutic effects of promethazine? - Prevention and treatment of nausea and vomiting. 173. Why is promethazine contraindicated in children younger than two years of age? - Due to the risk of potentially fatal respiratory depression. 174. What are the common side effects of promethazine? - Blurred vision, urinary retention, dry mouth, photosensitivity, drowsiness, and confusion. 175. What is the preferred parenteral route of administering promethazine? - Intramuscular. 176. What do H2RAs inhibit? - Secretion of gastric acid. 177. What are the indications for H2RAs? - Prevention and treatment of heartburn, peptic ulcer disease, GERD, esophagitis, GI bleeding due to stress ulcers, and hypersecretory syndromes such as Zollinger-Ellison syndrome. 178. Name four H2RAs. - Cimetidine, famotidine, nizatidine, and ranitidine. 179. How do PPIs prevent the release of gastric acid? - They bind irreversibly to the gastric proton pump. 180. What is the function of the gastric proton pump? - To release gastric acid from parietal cells into the stomach lumen. 181. What are the indications for PPIs? - Prevention and treatment of heartburn, peptic ulcer disease, GERD, esophagitis, GI bleeding due to stress ulcers, hypersecretory syndromes such as Zollinger-Ellison syndrome. 182. Name five PPIs. - Omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole.