Yes. Any reaction that is negative is the responsibility of the nurse.
No. Nurses are only responsible for published interactions.
No. Nurses are not responsible for reaction. The Dr. and Pharmacists are the final say on interactions.
No. The nurse has a responsibility to question orders that present with a potential interaction that will will adversely affect the patient.
No. Dr. Gangley is big on passing the buck.
Yes. Dr. Gangley should have known the possible interactions along with the Pharmacist. It is ultimately their responsibility.
Yes. The nurse could not have known with certainty that the medications would have interacted in such a bad way.
It is not wise to question the doctors orders.
Patients using their own meds save the hospital money and resources.
Controlled substances, although not preferable, can be discarded as long as she notes the chart.
Patients must always be reassessed for effectiveness, side effects, adverse reactions to medications and indications of drug interactions.
Accurate accounting of all drugs.
A counter signature to administer.
Records to be kept.
No documentation for wasting but requires documentation for discarding.
Right drug, Right dose, Right route, Right Time, Right Documentation, Right Reaction
Right drug, Right dose, Right patient, Right Time, Right Documentation, Right Reaction
Right drug, Right dose, Right Patient, Right Route, Right Time, Right Documentation
Right drug, Right Patient, Right Route, Right Time, Right Documentation, Right Reaction
Ask the CNA to give the patient in 102 his med. It's only a lasix and not a controlled substance.
Nick shouldn't go anywhere until the GI bleed lab comes back.
Ask the CNA to give the patient in RM 103 a bed bath, give 102 their med, and then check back in on the lab work.
Give the med in RM 102 and then wait on the GI bleed lab. Patient in RM 103 will have to wait.
The six rights of the patient are our most important guideline.
Signing out and counting narcotics must be done in every case.
We do the last safety check based on our education, judgment, and resources.
Nurses are held accountable for all interactions.
EC medications are designed to have better first pass than non EC medications.
Topicals are absorbed into the blood stream and have a minimal first pass affect.
IV drugs and Oral drugs are not given in the same strength.
First Pass affect only applies to medications that are a Class IV medication.
Topical drugs give a consistent, time released stream of medication.
Topical drugs have an unpredictable rate of absorption and bypass first pass affect.
Patch medication can be cut for lower doses.
Topicals are never applied to compromised skin.
IM and SQ meds are inconsistent, water soluble, and can also be given IV.
IM and SQ meds do not cause tissue damage.
IM and SQ meds, when used properly, are less likely to cause reaction.
IM and SQ meds are inconsistent rate of absorption, can be water soluble, and cannot be given IV.
Oral meds are inexpensive, have an constant absorption rate, always has a first pass affect.
Oral meds are reversible only if caught within 5 minutes or administering.
Oral meds have a negative affect on the stomach and causes GERD.
Oral meds are inexpensive, have an inconsistent absorption rate, may have a first pass affect, and are potentially reversible.
IV meds have the most rapid rate of absorption, reversible, are more expensive, and may cause IV site complications.
IV meds are absorbed in the system quickly and can be circulated within one minute.
IV meds have the most rapid rate of absorption, not reversible, are more expensive, first pass affected, and can cause IV site complications.
IV meds are pushed at a high rate to ensure therapeutic levels reach their potential as fast as possible.
Inhalation drugs deliver narcotics most quickly through the alveoli when pain needs immediate suppression.
Inhalation drugs are most used for anesthetics.
COPD must use oral or IV meds as the COPD has little success due to alveoli damage.
Inhalation drugs are not dangerous when used properly.
Absorption, Excretion, Metabolism, Chemical reaction.
Metabolism, Protein Binding, Excretion
Absorption, Metabolism, Distribution, Excretion
Absorption, Metabolism, Physical Reaction, Excretion
Receptor binding, Physical Reaction, Chemical Reaction, Excretion
Receptor binding, Physical Reaction, Chemical Reaction
Receptor binding, Physical Reaction, Metabolism, Excretion
Receptor binding, Chemical Reaction, Absorption, Distribution
The rate the drug takes to leave the site of administration and reach the blood.
The rate the drug takes to leave the site of administration and be taken in by cells.
The rate the drug takes to leave the site of administration and be taken in by fat cells.
The rate the drug takes to bind to protein.
The transportation of the drug by the protein to the site of action.
The transportation of the drug by the blood to the site of action.
The transportation of the drug through the GI to be metabolized.
The transportation of the drug to the first pass affect.
The chemical interaction in the first pass that sheds unwanted drug.
The rate at which the drug in the gut.
The biologic transformation of the drug.
The rate the body prepares the excretion.
The loss of drugs through the kidneys, skin pores, mucus membranes.
The loss of drugs through the lungs.
The loss of drugs through exertion.
The loss of drugs through the kidneys.
Route of administration, presence of food but not fluids, GI function, and dosage form.
Route of administration, presence of fluids but not food, GI function and dosage form.
Route of administration, presence of fluids and food, GI function, and dosage form.
Route of administration, Physical reaction, GI function, and dosage form.
Circulation, Chemical Reaction, Blood Brain Barrier
Circulation, Physical Reaction, Blood Brain Barrier
Circulation, Protein Binding, Blood Brain Barrier
Circulation, Hydrostatic Pressure, Blood Brain Barrier
Disease, medications, first pass affect
Disease, medication, blood brain barrier
Disease, medication, protein binding
Disease, medication, circulation
Renal failure decreases amount of drug in the system.
Low function kidneys will push medication out into urine before Na.
Kidney disease increases excretion and decreases drug action
Kidney disease decreases excretion and increases drug action.
Onset is the beginning phases of the disease.
Onset is the time the drug reaches a maximum effective concentration in the body.
Onset is the time the drug reaches a minimum effective concentration in the body.
Onset is is the moment medication is given.
Peak is when the patient feels the best.
Peak is the time for the drug to reach highest plasma concentration and maximum therapeutic affect.
Peak is the strongest point of infection for the patient.
Peak is the time for the drug to reach lowest plasma concentration and maximum therapeutic affect.
Length of time the drug has a pharmacologic effect.
The beginning of recovery for an infectious patient.
Length of time the drug has to completely be excreted from the system.
Length of time the drug has a sedation affect for the patient.
The patient has a return to normal VS.
Loading doses should be repeated on a regular basis.
Regularly scheduled doses of medication are always important.
When patients are removed from ICU and transferred to Med Surg.
Once a drug has gone through one half-life, another dose will need to be given to keep the steady state.
First Pass affects a drugs half life the most.
High excretion lessens a drugs half life.
Half-life is constant and consistent in every patient except those with renal failure.
A loading dose is used in all IV meds.
Loading doses are used to reach a maximum effective concentration rapidly.
Loading doses should be repeated q 30 minutes until desired outcome has been met.
Loading doses need extra care as the minimum effective concentration can happen quickly.
When a patient is on certain drugs that have a narrow therapeutic index, it is the nurses responsibility to order and monitor a peak and trough through the lab.
A trough is the minimum therapeutic level of a drug while the peak is the point that toxicity happens.
Peaks determine the safe level of drug by keeping the therapeutic level lower than the toxic level and trough's ensure that the patient has adequate therapeutic levels.
Peak and trough are drawn on medications that have a wide therapeutic index to ensure that maximum amounts of drug are available to the patient.
Peak is drawn 30 minutes before next dose.
Trough is drawn 30 minutes after drug administration.
Peak and Trough are drawn at the same time.
Peak is drawn 30 minutes after oral digestion and 30 minutes before next administration of oral drug.
None of the above.
Nomogram or age
Nomogram or weight
Nomogram or surface area calculator
Age or surface area calculator
Percentage of drug absorbed and rate of absorption may be slower.
Rate of absorption may decrease because of increased body fat.
Rate of absorption may be slower because of decreased blood flow and GI motility, but the drug percentage absorbed not changed.
Increased Gastric pH in the elderly increase the rate of absorption.
Elderly store more lipid-soluble drugs, have an increase of drug concentration and lower protein binding.
Elderly have lower cardiac output which decreases drug concentrations.
Elderly have an increase in body fat which decreases drug concentration.
Elderly have lower body water but increase in body fat. This means that there is a decrease in drug concentration.
Elderly need to be dosed more frequently because half-life of certain drugs decreases.
Elderly have a decrease in hepatic function which may cause half-life increase.
Hepatic mass decreases to increase hepatic blood flow, keeping half-life about the same as middle adults.
Rates of drug metabolism may be altered decreasing half-life of certain drugs, leaving less medication in the system.
Drug metabolism and protein binding.
Drug distribution and concentration at site of action.
Body weight has not influence on drugs.
Drug excretion and chemical reactions.
"Thank you. I will look for another type of pain reliever."
"What type of reaction did you have to vicodin previously"
"This is what the doctor prescribed, so you should trust the doctor."
"You must have an allergy to narcotics. That will narrow the pain reliever you can have. Would you like a tylenol?"
When giving K, get serum K levels first.
Right dose, right time, right route, right person, right medication, right documentation
Patient can refuse medication.
It is the nurses obligation and responsibility to question orders.
All the above.
Have a friend of the family take the child somewhere when the family is crying and grieving the most.
Tell the child what her dead mother will look like in the casket.
Keep her away from emotional family member during the service.
Discuss what happens physiologically, in medical terms, what happens to a body when it dies.
Help her to feel comfortable with her own guilt for her mother dying. By helping her to see that her actions were part of the complications of her mothers death encourages her to behave better in the future.
Turn the oldest daughters room into a sewing room.
Waking up each morning feeling relived she has done her job well.
Feelings of grief and loss.
Planning to take a vacation with her husband.
Keep people away to keep the room quiet, even family.
Encourage the patient to cry when you feel they aren't accepting their death.
Talk about their lives and what they have done with it. Supply support to tying up loose ends.
Give them a lot of stimulus so they don't fall into depression about their impending death.
Giving medication that will calm them down will allow the family to make clearer decisions.
Giving medication that will calm them down will allow the family to think rationally and reflect on the positives of the person who passed.
Giving medication that will calm them down keeps families from grieving.
A & B
Gary is immature and needs to grow up.
Gary does no have what it takes to be a good nurse.
Gary should consider going into a different field of nursing.
Gary probably hasn't experienced death of someone close and has not accepted his own mortality yet.
Bella will be kept on life support until the mother decides otherwise.
If the mother wants Bella to stay on life support, she will have to update Bella's insurance information to her own.
Bella's life support will be turned off in 6 hours and listen to what the mother has to say. Offer support services for the mother.
Bella is going to be moved to a long term care facility as the hospital is not equipped to care for long term life support patients.
Cessation of VS.
No brain activity for 24 hours.
On the phone to a 911 operator when a hospice patient has died.
A & B
All the above
Cool, clammy skin
Dry warm skin.
Dependent area shows blood pool darkening.
Heart rate increases but BP decreases.
Increased GI motility
Decreased creatinine in urine.
Teratogenic effect and idiosyncratic response
Physical dependence and tolerance
Adverse effects, allergic reaction, side effects
C & D
When the maintenance dose has worn off
When the peak is toxic and trough is not therapeutic
When rapid minimum effective concentration is desired
When the steady state of the drug is unstable
Frequency of administration
Bed and room number of patient
Name of drug
Water soluble drugs
Drugs administered IC, IM, or SQ
Drugs that are not sustained release or enteric coated
Lipid soluble drugs
Weight and body surface area
A and b
All of the above
Peripheral vessel calcium channel blocker
Proton pump inhibitor
Pump his stomach
Call the MD
Administer O2 2L per NC
Chart the dose you gave and order a stat PT INR.
Hire a lawyer and call his family to explain what happened.
All the above