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Opioid agonist Indications: Moderate to severe pain. SE: Respiratory depression, nausea Ask: What should the nurse do if the client has a respiratory rate of 10 while on IV Hydromorphone? Answer: Stop hydromorphone ; contact the provider [have naloxone on hand if needed, oxygen 2L/BNC]

Side effects Respiratory depression, nausea

Long acting insulin [ Onset 1-2 hours, duration up to 24 hours] Indication: Type 1 & 2 diabetes mellitus. SE: Nausea, vomiting, hypoglycemia, Ask: Is detemir given prior to meals to control postprandial blood glucose? Answer: No, peak time is 6-8 hours. [May be taken in evenings]

Side effects Nausea, vomiting, hypoglycemia,

Oral anti-diabetic; [biguanide] Indication: Type 2 diabetes SE: Anorexia, nausea, and diarrhea. [Toxicity results in lactic acidosis. Glucophage is held 48 hours before and after iodinated contrast dye because the dye may cause renal failure, which would increase the harm from lactic acidosis.] Ask: Is hypoglycemia an expected effect? Answer: It is a rare occurrence unless combined with other medications that lower glucose.

Side effects Anorexia, nausea, and diarrhea. [Toxicity results in lactic acidosis. Glucophage is held 48 hours before and after iodinated contrast dye because the dye may cause renal failure, which would increase the harm from lactic acidosis.] Ask: Is hypoglycemia an expected effect? Answer: It is a rare occurrence unless combined with other medications that lower glucose.

Ergot Alkaloid Indication: Postpartum bleeding. SE: Nausea, headache; [life-threatening] hypertension Ask: What places a woman at risk for postpartum hemorrhage? Answer: Uterine atony, laceration, impaired maternal clotting, retained placenta fragments Common causes of uterine atony include: Multiple gestation pregnancy (twins, large baby - over-stretched uterus) Long labor, grand multipara ( overworked uterus)

Side effects Nausea, headache; [life-threatening] hypertension Ask: What places a woman at risk for postpartum hemorrhage? Answer: Uterine atony, laceration, impaired maternal clotting, retained placenta fragments

Antineoplastic; Immunosuppressant Indication: Some types of cancer; rheumatoid arthritis (RA); psoriasis, Crohn’s Disease SE: Nausea, vomiting, diarrhea, elevated LFTs, fatigue, renal failure, pulmonary fibrosis Ask: How does methotrexate improve symptoms of RA? Answer: Immunosuppression [reduces inflammatory processes]

Side effects Nausea, vomiting, diarrhea, elevated LFTs, fatigue, renal failure, pulmonary fibrosis Ask: How does methotrexate improve symptoms of RA? Answer: Immunosuppression [reduces inflammatory processes]

Anticonvulsant Indication: Partial seizures, neuropathic pain SE: Drowsiness, dizziness, fatigue Ask: Why is gabapentin most effective 3 x/day? Answer: Doses peak in 2-3 hrs [Gabapentin is rapidly absorbed following oral dosing and reaches peak plasma levels in 2 to 3 hours] RA is an autoimmune condition. Methotrexate causes immunosuppression which will help decrease inflammation caused by RA. Nitroglycerin 7. Don’t take this medication with tadalafil! (Cialis)Class: Organic Nitrate Indication: Angina SE: Headache, hypotension, tachycardia Ask: What safety precautions should the nurse implement? Answer: Fall Risk ( vasodilation causes dizziness)

Side effects Drowsiness, dizziness, fatigue Ask: Why is gabapentin most effective 3 x/day? Answer: Doses peak in 2-3 hrs [Gabapentin is rapidly absorbed following oral dosing and reaches peak plasma levels in 2 to 3 hours] RA is an autoimmune condition. Methotrexate causes immunosuppression which will help decrease inflammation caused by RA.

Uterine stimulant Indication: Induce or augment labor; post-partum hemorrhage SE: Tachysystole, Uterine rupture, elevated BP, fetal hypoxia Ask: What is a tocolytic? Answer: The opposite of oxytocin: Relaxes myometrium Examples of tocolytics: terbutaline, indomethacin, nifedipine, nitroglycerin, atosiban Maternal hypertension, uterine tachysystole, and late FHR decelerations or other signs of fetal distress may be indications to stop the oxytocin perfusion. Uterine tachysystole is defined as more than 5 contractions within a 10 minute period, a series of contractions lasting more than 2 minutes each, or contractions of normal duration that occur within 1 minute of each other.

Side effects Tachysystole, Uterine rupture, elevated BP, fetal hypoxia Ask: What is a tocolytic? Answer: The opposite of oxytocin: Relaxes myometrium

Proton pump inhibitor (suffix: prazole) Indication: GERD SE: Diarrhea, osteoporosis, pneumonia Long-term therapy can cause: Osteoporosis and fractures (may inhibit calcium absorption) C-diff, hospital-acquired infections Hypomagnesemia Rebound reflux after discontinuing Gastric cancer, with very long-term use Ask: When and why is a client at risk for pneumonia when using pantoprazole? Answer: Initially there is an alteration in GI flora/impairment of

Side effects Diarrhea, osteoporosis, pneumonia

Atypical antipsychotic Indication: Schizophrenia, acute bipolar mania, autism SE: Weight gain, dyslipidemia, diabetes [ orthostatic hypotension and sedation]. EPS risk increases with dose. EPS risk is substantial with depot form Ask: Why does the client using risperidone need routine blood tests? Answer: To monitor for elevated cholesterol and hyperglycemia Follow-up by asking students about normal cholesterol level: Less than 200 mg/dL

Side effects Weight gain, dyslipidemia, diabetes [ orthostatic hypotension and sedation]. EPS risk increases with dose. EPS risk is substantial with depot form Ask: Why does the client using risperidone need routine blood tests? Answer: To monitor for elevated cholesterol and hyperglycemia

Glucocorticoid (suffix: solone) Indication: Inflammation SE: Euphoria, Infection, Cushing’s syndrome Ask: What are symptoms of Cushing’s syndrome? Answer: Buffalo hump, moon face, general weakness, hypokalemia, hyperglycemia, hypernatremia Budesonide/

Side effects Euphoria, Infection, Cushing’s syndrome Ask: What are symptoms of Cushing’s syndrome? Answer: Buffalo hump, moon face, general weakness, hypokalemia, hyperglycemia, hypernatremia

Glucocorticoid/bronchodilator. (suffix: terol) Indication: Prophylaxis in chronic restrictive airway diseases (asthma, COPD) SE: GI upset, infection Ask: Why does this medication place the client at risk for infection? Answer: Immunosuppression [Steroids suppress the immune system.]

Side effects GI upset, infection Ask: Why does this medication place the client at risk for infection? Answer: Immunosuppression [Steroids suppress the immune system.]

Hormone Indication: Hypothyroidism SE: Tachycardia, nervousness, insomnia Ask: Why is levothyroxine prior to eating breakfast ? Answer: Absorbed best when taken on an empty stomach; ↑ metabolic rate may cause interference with sleep Many drug interactions •Many GI drugs reduce the effect of thyroid hormone •Some antiepileptics, rifampin, sertraline increase effect •Thyroid hormone accelerates breakdown of warfarin and increases cardiac response to catecholamine's (epinephrine, dopamine, dobutamine) •Can ↑ requirements for digoxin and insulin

Side effects Tachycardia, nervousness, insomnia Ask: Why is levothyroxine prior to eating breakfast ? Answer: Absorbed best when taken on an empty stomach; ↑ metabolic rate may cause interference with sleep

Supine: Dorsal recumbent position, or lying flaton the back Fowler: The supine position, with the head of thebed raised between 45° and 60° Semi-Fowler: The supine position, with the head of thebed raised between 30° and 60° Lateral: A side-lying position, lying opposite theside of the procedureTrendelenburg:The supine position, with the body andhead positioned lower than the feet Reverse Trendelenburg: The supine position, with the body andhead positioned higher than the feet Lithotomy: This is a modification of the supineposition. The legs are secured in stirrups,which elevate and abduct them. Thebuttocks are positioned evenly with thebreak or the end of the table. Prone: Laying flat with the stomach side down Kübler-Ross Phases of Grief Denial: The individual does not really believeloss has occurred and talks as if nothinghas changed. Anger: The individual is upset about the loss andmay act out, exhibiting previously unfeltagression at the lost individual. They mayblame caregivers for the loss. Bargaining: The individual tries to change the resultsof the loss and avoid consequences ofthe loss. They may ask God to changewhat happened. Depression: The individual experiences a loss ofinterest and may feel that life is fatalisticand/or not worth living. They maywithdraw from friends and family. Acceptance: The individual comes to terms with theloss and is able to cope and accept theconsequences. They fall back into anormal pattern of daily living.6. Psychology Maslow’s Hierarchy of Needs Cultural Health ConsiderationsTime: • Punctuality is the cultural norm for the United States • Latin Americans and Mexicans may consider time in relation to day/night or before/after meals rather than a clock Complementary/folk medicine: People from other countries may utilize alternative medical systems: • Chinese herbal medication • Healers • Meditation Proxemics (space considerations) : • Body-based therapies • • Coining/cuppingNorth Americans and Northern Europeans tend to want the mostTouch: space • Restrictions in touch between males• Latin Americans, Asians, Middle and females in some cultures Easterners, and Southern Europeans • Asian cultures may be upset if theoften feel comfortable standing very head is touched without permission, close to others as they believe the spirit resides in Eye contact: the head • Direct eye contact is the cultural norm in many North American and Family hierarchy: European countries In some cultures (Mexican, Asian, and • Latin Americans, Asians, Middle Middle Eastern), decisions are made by Easterners, and Southern Europeans the males or the head of the family often feel comfortable standing very rather than the individuals. close to othersSelf-actualization Esteem Love/belonging Safety Physiological

ANA Ethical Principles • Autonomy • Justice • Beneficence • Veracity • Nonmaleficence • Fidelity Levels of Disease Prevention Primary: Prevent initial occurrence of a healthproblem via immunizations, smokingcessation, fluoride supplementation of water, seat belt use, and child care seat restraints. Secondary: Identify diseases/conditions quickly andprovide prompt intervention for thetreatment and prevention of furtherdisability via BP screenings, breast andtesticular self-screening, hearing andvision screenings, mammography, andpregnancy testing. Tertiary: Prevent further progress of a disease ordisability and allow people to achievethe maximum quality of life via supportgroups, counseling, diet and exercise,stress management, and supportiveservices.ROME Method for ABG Questions When the cause for ABG imbalance is respiratory in nature, CO2 and pH will be outside the normal range. When thecause for ABG imbalance is metabolic innature, the HCO 3 and pH will be out of range. • Respiratory • Opposite • Metabolic• Equal In the ROME method, the “opposite” and “equal’” refer to the increase or decreasein pH against the increase or decrease inCO 2 (in respiratory conditions) or HCO (in metabolic conditions).3 • In respiratory acidosis, CO2 ↑ pH ↓ (opposite) Example: CO2 52, HCO3 23, pH 7.3 • In respiratory alkalosis, CO2 ↓ pH ↑ (opposite) Example: CO2 29, HCO3 24, pH 7.5 • In metabolic acidosis, HCO3 ↓ pH ↓ (equal) Example: CO2 40, HCO3 18, pH 7.2 • In metabolic alkalosis, HCO3 ↑ pH ↑ (equal) Example: CO2 36, HCO3 35, pH 7.68. Resources Free Resources Visit mometrix.com/academy to take advantage of free NCLEXpractice tests, exam information,study tips, and more. Online Prep Course SAVE 20% BY USING CODE NCLEX20