Chapter 23: Drugs for Lipid Disorders

HMG-CO A Reductase Inhibitors [generic names → -statin ]

lovastatin [Mevacor]
pravastatin [Pravachol]
rosuvastatin [Crestor]
simvastatin [Zocor]
Prototype: atorvastatin (Lipitor)
Indication: High Cholesterol
MOA: Interferes with HMG-COA reductase (Synthesizes LDLs)
Remember: First choice for lowering LDLs (bad cholesterol)
Administration Alert: At 2200 with food; No grapefruit juice
AE: Myopathy (muscle weakness), hepatotoxicity
Interactions: Grapefruit
Contraindications: Hepatic dysfunction
Pregnancy: X

Bile Acid Sequestrants

Prototype: cholestyramine (Questran)
Indication: High Cholesterol
MOA: Prevents reabsorption of bile acids from small intestines (bile acids necessary for
cholesterol absorption)
SE: Constipation, nutritional deficiencies (interferes with absorption of vitamins and
minerals)
Contraindications: Biliary dysfunction, hypoglycemia
Administration Alert: Take before meals, take other medications 2-4 hours after
Pregnancy: C
Remember: decreases cholesterol and blood glucose

Fibric Acid Drugs

Prototype: gemfibrozil (Lopid)
Indication: High Triglycerides
MOA: Unknown; all we know is it increases HDL (high-density lipoprotein)
Administration Alert: Give with food
Contraindications: Hepatic and renal dysfunction; Preexisting gallbladder disease
Remember: Raises HDL; May increase risk for gallstones.

Other Drugs for Dyslipedemias

niacin (Niaspan)
Common Names: Vitamin B3, nicotinic acid, (Niacor), (Niaspan) → extended release
Indication: High VLDL and LDL (Very-low-density lipoprotein & Low-density lipoprotein)
Dosing: Higher doses needed to lower lipids (2-3 grams) compared to OTC use of a
vitamin (~25 mg/day) [should be under medical supervision]
Remember: Causes histamine release (flushing & hot flashes) , sometimes given with
Aspirin, can cause hyperglycemia
Contraindications: Type 2 Diabetes
Other Drugs for Dyslipedemias
ezetimibe (Zetia)
MOA: Blocks absorption of cholesterol by the small intestines by as much as 50%
Remember: usually given with a statin and can reduce LDL by an additional 20% SE:
Body produces even more cholesterol (rationale for admin w/ statin); Serious side
effects are uncommon
Chapter 24: Diuretic Therapy and Drugs for Renal Failure

Loop Diuretics [generic names → -ide]

bumetanide (Bumex)
torsemide (Demadex)
Prototype: furosemide (Lasix)
Indications: Moderate to severe hypertension, edema associated with heart
failure, pulmonary edema, kidney and liver failure
MOA: Acts on the ascending limb of the loop of henle to block the reabsorption of
sodium, chloride, and water. Increases the excretion of potassium SE/AE:
Hypokalemia (low potassium → normal levels 3.5-5.0 mmol/L), hypovolemia (low
BP), orthostatic hypotension (syncope)
Administration Alert: Rapid IVP causes ototoxicity; Check BP 30 minutes prior; Do
NOT push faster than 20 mg/minute

Thiazide and Thiazide-Like Diuretics [generic names → -thiazide]

Short Acting
chlorothiazide (Diuril)
Prototype: hydrochlorothiazide (Microzide)
Intermediate Acting
metolazone (Zaroxolyn)
Indications: Moderate to severe hypertension, edema associated with heart
failure, pulmonary edema, kidney and liver failure
MOA: Inhibits Aldosterone release (Aldosterone regulates salt/water in body [BP])
SE/AE: Hypokalemia (low potassium), hypovolemia (low BP), orthostatic hypotension
(syncope), increased blood glucose levels
Nursing Responsibilities: Monitor pt closely if also on ACEIs or ARBs.

Potassium-Sparing Diuretics
triamterene (Dyrenium)
eplerenone (Inspra)
Prototype: spironolactone (Aldactone)
Indications: Moderate to severe hypertension, edema associated with heart
failure, pulmonary edema, kidney and liver failure
MOA: Inhibits aldosterone release
SE/AE: hyperkalemia, hyponatremia, hypovolemia, orthostatic hypotension Nursing
Responsibilities: Monitor pt closely if also on ACEIs or ARBs, BP, Intake and Output,
therapeutic effects, side effects.
Administration Alert: Hold if Blood Pressure is low; administer in the mornings.
Patient Teaching: Move cautiously when switching positions, side effects

Carbonic Anhydrase Inhibitor

acetazolamide (Diamox)
Osmotic Diuretic
mannitol (Osmitrol)

Chapter 25: Drugs for Fluid Balance, Electrolyte, and Acid-Base Disorders
POSSIBLE IV COMPLICATIONS
1. MechanicalFailure → Faulty IV machine
2. Infiltration→ Fluid leakage outside vein
3. Extravasation → Caustic damage to tissue (caused by fluid/chemicals in IV)
4. Phlebitis → Inflammation of vein

Hypernatremia: Cellular Dehydration

Crystalloid IV Solutions
Isotonic Solutions IV
0.9% NaCL (Normal saline or NS) → Expand Volume; Dilute Meds; Vasodialates
Lactated Ringer’s (LR) → Fluid Resuscitation
Dextrose 5% in water (D5W- ONLY isotonic in an IV bag!) → Metabolizes glucose
and becomes hypotonic once in body
Hypotonic Solutions INTERSTITIAL
0.45% NaCl (½ NS)
Hypertonic Solutions INTRAVASCULAR, ONLY ICF
3% NaCl (3% NS) → Fluid and Electrolyte Replenishment
5% dextrose in 0.45% NS (D5 & ½ NS) → Na/Volume replacement; go slow and
monitor: BP, Pulse, quality of lung sounds, serum Na, Urine Output 5%
dextrose in normal saline (D5NS) → Na/Volume replacement; go slow and
monitor: BP, Pulse, quality of lung sounds, serum Na, Urine Output 5%
dextrose in Lactated RIngers (D5LR) → Fluid Resuscitation Indication:
Symptomatic dehydration, Hypotension, Hemorrhage, Burns Nursing
Responsibilities: Be clear on indication, target goals, assessment findings. Know
Potential IV complications. Monitor intake & output.
Remember: Dehydration with hypotension is treated with normal saline. Dehydration
with normal BP is treated with hypotonic solutions.
Administration Alert: Do NOT give D5W to infants or head trauma patients, may
cause cerebral edema,

Colloids
5% albumin
Hetastarch 6% in normal saline (Hespan)
Prototype: Dextran 40 in D5W
Indications: Hypovolemic shock related to burns, hemorrhage, or surgery
Nursing Responsibilities: Be clear on indication, target goals, cardiovascular and
pulmonary assessment findings. Know Potential IV complications. Monitor: intake
& output, BP, HR, EE, SpO2
Electrolytes
Sodium
Potassium

Acid-Base Agents
Sodium
Bicarbonate
Chapter 26: Drugs for Hypertension

Blood Pressure = Cardiac Output x Systemic Vascular Resistance

1st Dose Phenomenon = Hypotension, Syncope
5 P’s (Nursing Responsibilities)
1. Pain
2. Potty
3. Position
4. Personal Belongings
5. Pump (IV)

Hypertension Side Effects and Adverse Effects: Syncope, dizziness, angina,

cardiac arrest, hypertensive shock (BP ≥ 180/120, stroke, damage to blood
vessels)
Cause of HTN: Fluid Volume overload, Vasoconstriction

NURSING RESPONSIBILITIES: WHAT TO MONITOR

Diuretics (See Previous)

ACE Inhibitors [ACEIs] [generic names → -pril]
benazepril [Lotensin]
captopril [Capoten]
fosinopril [Monopril]
lisinopril [Prinivil, Zestril]
quinapril [Accupril]
ramipril [Altace]
Prototype: enalapril [Vasotec]
Indications: Hypertension, Heart Failure
MOA: Blocks conversion of angiotensin I to Angiotensin II, causing vasodilation. inhibit
aldosterone secretion and peripheral artery constriction. Increases cardiac output by
lowering BP and blood volume.
SE: Hyperkalemia, orthostatic hypertension
AE: 1st dose phenomenon, persistent dry cough, angioedema
Pregnancy Category: D
Black Box Warning: Fetal injury or death may occur in pregnant women, Do not
administer during lactation

Angiotensin II Receptor Blockers (ARBs)

irbesartan [Avapro]
losartan [Cozaar]
olmesartan [Benicar]
valsartan [Diovan]
Indications: Hypertension
MOA: Causes vasodilation by blocking the action of angiotensin II. inhibit aldosterone
secretion and peripheral artery constriction. Increases cardiac output by lowering BP
and blood volume.
SE: Hyperkalemia, orthostatic hypertension
AE: First dose phenomenon when taken with Concurrently with ACE inhibitors
Pregnancy Category: D
Black Box Warning: Fetal injury or death may occur in pregnant women, Do not
administer during lactation

Direct Acting Vasodilators

minoxidil [Loniten]
nitroprusside [Nitropress, Nipride]
Prototype: hydralazine [Apresoline]
Indications: Hypertension
MOA: Directly relaxes vascular smooth muscles
SE/AE: reflex tachycardia, increases myocardial oxygen demand (worsens); sodium
and water retention; Nipride may cause thiocyanate toxicity
Administration Alert: Abrupt withdrawal of medication may cause rebound
hypertension and anxiety
Contraindications: Angina or in the presence of an MI — may cause reflex tachycardia
Calcium Channel Blockers [generic names → -pine]
Selective CCBs - affect just the arteries
amlodipine [Norvasc]
felodipine [Plendil]
isradipine [DynaCirc]
nicardipine [Cardene]
Prototype: nifedipine [Procardia XL]
Nonselective CCBs
nicardipine [Cardizem]
verapamil [Calan]
MOA: Blocks calcium channels and blood vessels and heart which leads to vasodilation
and decrease heart rate
SE/AE: Peripheral Edema, Reflex Tachycardia (if not given slow release)
Administration Alert: Don't administer to a patient if an impending Mi is suspected or
within 2 weeks following an MI (sudden cardiac death/overall negative outcomes)
Interactions: Grapefruit, Alcohol - Syncopal Episode

Beta-Adrenergic Antagonists (beta blockers) [generic names → -lol]

Nonselective beta blockers - affect arteries and heart
nadolol [Corgard]
Prototype: propranolol [Inderal]
Selective beta blockers
atenolol [Tenormin]
metoprolol [Lopressor, Toprol]
carvedilol [Coreg]
labetalol [Trandate]
Indications: Hypertension, MI, Heart Failure, Migraines
MOA: cardioselective- (blocks beta I [heart] receptors) vs non-cardio selective- (blocks
beta I [heart] and beta II [lung] receptors); decreases blood pressure and heart rate.
Administration Alert: Do not administer to patients if Impending Mi is suspected or
within 2 weeks following an MI. Do not divide, crush, or have the patient chew
extended-release tablets.
Nursing Applications: Vitals: Apical pulse, Breath Sounds, Orthostatic Hypotension,
Monitor I & O, Assess for Angina
Patient Teaching: Never stop taking medication suddenly: can cause chest pain, MI,
sudden death. Do not drive until your body has adjusted to medication.
Administration Alert: Monitor for 1st dose phenomenon.
Alpha 1-Adrenergic Antagonists [generic names → -zosin]
prazosin [Minipress]
terazosin [Hytrin]
Prototype: doxazosin [Cardura]
Indication: Hypertension, Benign Prostatic Hyperplasia (BPH)
MOA: Blocks sympathetic alpha I receptors in arterioles of vascular smooth muscles —
dilates arteries and veins; and smooth muscle around prostate.
AE: Profound hypotension 2 -6 hours following first few doses
Administration Alert: Monitor for 1st dose phenomenon. Do not divide, crush, or have
the patient chew extended-release tablets.

Alpha 2-Adrenergic Agonists

clonidine [Catapres]
methyldopa [Aldomet]
Indications: Hypertension
MOA: Decreases outflow of sympathetic impulses from CNS to heart &
arterioles; similar to alpha I antagonists — slows heart rate and dilates arterioles.
Remember: Increases fluid intake
SE: drowsiness, dry mouth
AE: CNS effect: Sedation, Bradycardia, Hypotension (can be intensified by bradycardia)
Chapter 27: Drugs for Heart Failure
ACEIs, ARBs, Diuretics, Beta Blockers (see previous chapter)
Cardiac Glycosides
Prototype: digoxin [Lanoxin]
Indication: Drug of choice for heart failure secondary to positive inotropic properties
(increase force of contraction= more blood pumped with fewer heart beats), and for negative
chronotropic (decreases heart rate) and dromotropic properties (decreases conduction and
velocity; inhibits electrical impulses). Also used for atrial fib & atrial tach. MOA:
Increases cardiac output by increasing the force of myocardial contraction.
Contraindications: Apical pulse <60, hypokalemia, atrioventricular (AV) blocks.
Administration Alert: Use cautiously in geriatric and pediatric patients Antidote:
digoxin immune fab (Digibind)
SE/AE: Often given with diuretics; monitor for hypokalemia. Concurrent use with beta
blockers may intensify bradycardia. OD: digitoxcity- unusual visual effects

Vasodilators
nesiritide [Natrecor]
MOA: Decreases cardiac workload by dilating vessels and reducing preload. hBNP
enhances natriuresis (removal of large amounts of sodium through urine) SE: rapid
hypotension— monitor BP

isosorbide dinitrate (Isordil)

MOA: Organic Nitrate that works on veins. Works synergistically with hydralazine.

hydralazine (Apresoline)
MOA: Works directly on the arterioles (Not drug of choice because of numerous side effects)
SE/AE: Abrupt withdrawal can cause rebound HTN and anxiety. Reflex tachycardia from
sudden drop in BP. Sodium and water retention.

Phosphodiesterase Inhibitors
Milrinone [Primacor]
MOA: Positive inotrope (Increased contractility and efficiency); increases cardiac output by
increasing the force of myocardial contraction. Blocks the enzyme phosphodiesterase in
cardiac muscle, increasing the amount of calcium that can enter; blocks same enzyme
in the smooth muscle, causing vasodilation
SE/AE: Hypotension. 1 in 10 patients develop ventricular dysrhythmias (V. Tach)
Administration Alert: MUST use micro drip set with IV pump; 60 drops/mL
Chapter 28: Drugs forAngina Pectoris and Myocardial Infraction
Beta Blockers, CCBs (see previous chapters)

Organic Nitrates
Isosorbide dinitrate [Isordil]
Isosorbide mononitrate [Imdur]
nitroglycerin [Nitrostat, Nitro-Dur, Nitro-Bid]
Indications: Sublingual— acute angina, prior to physical activity (rapid onset, peak
plasma levels in 2 minutes); Transdermal/Oral Extended-Release— prophylaxis due to
relatively slow onset
MOA: Dilated veins, reducing the amount of blood returning back to the heart. Dilates
coronary arteries, bringing more blood to the myocardium.
Remember: If chest pain does not respond in 10-15 minutes after a single-dose
sublingual dose, it may indicate MI and emergency medical services (EMS) should be
called.
SE/AE: Rapid hypotension, headache (due to cerebral vasodilation), reflex tachycardia
(due to venous dilation).
Administration Alert: IV— glass IV bottle and special IV tubing, plastic absorbs
nitrates significantly (reduces the patient dose). Cover the IV bottle— light exposure
causes degradation of nitrates. Gloves with paste/ointment— to prevent
self-administration.
Many Routes: sublingual, PO, intravenous (IV), transmucosal, transdermal, topical, and
extended-release PO.
Interactions: Concurrent use with phosphodiesterase-5 inhibitors such as sildenafil
(Viagra), vardenafil (Levitra), or tadalafil (Cialis) may cause life-threatening hypotension
and cardiovascular collapse. Alcohol, antihypertensive drugs, hot days, and erectile
dysfunction medications may cause additive hypotension.
Contraindications: Pre-existing hypotension, high intracranial pressure, or head
trauma. Pericardial tamponade and constrictive pericarditis— the heart cannot increase
cardiac output to maintain blood pressure when vasodilation occurs.Sustained-release
to patients with glaucoma— may increase intraocular pressure. Dehydration or
hypovolemia (correct before administering)— serious hypotension may result

Adjunct Drugs for MI

Chapter 29: Drugs for Shock
Platelet Aggregation Inhibitor
aspirin [ASA]
ADP Receptor Blockers
clopidogrel [Plavix] Initial Treatment Priorities
prasugrel [Effient] ● Identify cause → start
Ticagrelor [Brilinta]
Ticlopidine [Ticlid]
specific treatment
Anticoagulant ● Connect cardiac monitor and
heparin pulse oximeter
Glycoprotein IIb/IIIa Inhibitors Fluid Replacement [In
eptifibatide [Integrlin]
abciximab [ReoPro]
Order] 1. Crystalloids
tirofiban [Aggrastat] 2. Colloids
Opioid Agonists 3. Blood Products
morphine
fentanyl

CABs of Life Support Circulation Types of Shock

Airway Anaphylactic— Acute Allergic
Breathing Reaction
 ● Administer oxygen at ● Keep patient warm and
15 L/min via quiet ● Offer Psychological
non-rebreather mask support (be caring!)
● Monitor LOC

● Severe reaction to an allergen such as penicillin, nuts, shellfish, or animal proteins

(MIld = facial flushing/hives/ rash; Severe = wheezing dyspnea, ↑anxiety, ↓ BP;
Febrile = fever, chills, anxiety, headache, tachycardia, tachypnea)
● Estimated 3% of the population is at risk of reaction from: insect stings (wasps.
Bees, ants); <100 deaths annually from insect stings
Cardiogenic— Failure of heart to pump sufficient blood to tissues ● Left heart
failure, myocardial ischemia, myocardial infarction (M I), dysrhythmias, pulmonary
embolism, or myocardial or pericardial infection
● Mortality Rate: 70%- 90% most lethal form of shock. (MI leading cause of death)
Hypovolemic— Loss of Blood Volume
● Hemorrhage, burns, excessive diuresis, or severe vomiting or diarrhea
● Mortality Rate: 10%-31%
Neurogenic—Overstimulation of PNS /Under Stimulation of SNS [Vasodilation] ●
Trauma to the spinal cord or medulla, severe emotional stress or pain, or drugs
that depress the central nervous system
Septic— Multi Organ Dysfunction due to pathogen in blood
● often a precursor to acute respiratory distress syndrome and disseminated
intravascular coagulation
● Widespread inflammatory response to bacterial, fungal, or parasitic infection;
most common in people with weakened immune defenses
● Mortality rate: 20%- 50%
Crystalloids (See Chapter 25 for more)
Normal Saline (0.9% sodium chloride)
Lactated Ringer’s (LR)
Hypertonic Saline (3% sodium chloride)
5% Dextrose in NS
Indications: Symptomatic dehydration, hypotension, hemorrhage, burns
Nursing Responsibilities: Clear goals, assessment/findings; potential IV
complications, Monitor input & output.
Remember: Dehydration with hypotension = Normal saline
Dehydration with normal BP = hypotonic solutions
Colloids (See Chapter 25 for more)
Fluid Replacement Agent
Serum Albumin [Albuminar]
MOA: Protein molecules in albumin increase the oncotic pressure of blood by causing
fluid to shift from the tissues to the intravascular space.
Indications: hypovolemic (from burns, hemorrhage, or surgery); hypoproteinemia
Contraindications: Severe anemia, cardiac failure in the presence in normal or
increased intravascular volume; previous history of allergy to albumin.
Pharmacokinetics: immediate onset of action— available in concentrations of 5%
(isotonic) and 25% (hypertonic)
SE/AE: Because it is a natural blood product, patients may have antibodies to the donor
albumin and experience transfusion reaction (allergic reaction)— uncommon.
Administration Alert: Infuse the 25% concentration slower to avoid circulatory
overload or interstitial dehydration. use a large 16G or 20G IV cannula (Albumin is
thick). Religious patients may refuse to accept any type of blood products, including
albumin.
Interactions: Albumin needs to be infused through a dedicated line
Pregnancy: C
Nursing Responsibilities: Clear target goals, Cardiovascular/Pulmonary
assessment/findings, potential IV complications
Monitor: Blood Pressure, Heart rate, Respiratory Rate, SpO2, Intake & Output

Blood Products
Packed Red Blood Cells
Fresh Frozen Plasma
Platelets
Vasopressors
phenylephrine [Neo-Synephrine]

Nonselective adrenergic agonist; inotropic drug

dopamine [Intropin]
MOA:
➢ Low dose [1 to 5 mcg/kg/minute] Selectively stimulates dopaminergic
receptors, especially in the kidneys, leading to increased renal blood flow and
urine output.
➢ Intermediate dose [6 to 15mcg/kg/min] Stimulates B1-adrenergic receptors.
Produces positive chronotropic and inotropic effects on the myocardium,
resulting in increased heart rate and cardiac contractility.
➢ High Dose [20 mcg/kg/min and over] Stimulates alpha-adrenergic receptors
causing vasoconstriction, causing BP to increase; further increased stimulation of
B1-adrenergic receptors may increase risk of tachyarrhythmias
Administration Alert: Ensure patency of IV prior to beginning infusion. Do not abruptly
stop infusion.
AE: dysrhythmias and severe hypertension (due to cardiovascular effects; must monitor
constantly). Dopamine is a vesicant drug (causes blistering) that can cause severe,
irreversible skin and soft tissue damage if the drug infiltrates. Can cause gangrene.
Black Box Warning: If extravasation occurs, administer phentolamine [Regitine] ASAP
Overdose: discontinue infusion immediately

Nonselective adrenergic agonist

norepinephrine [Levophed]
Indications: acute shock and cardiac arrest
MOA: Sympathomimetic that acts directly on alpha-adrenergic receptors in the vascular
smooth muscle, immediately raising blood pressure; also stimulates beta1-receptors in
the heart, producing a positive inotropic response.
Contraindications: patients who are experiencing hypotension due to blood volume
deficits, vasoconstriction already exists in such patients.
Administration Alert: Ensure patency of IV prior to infusion. Do not abruptly stop
infusion.
Pregnancy: D
SE/AE: Hypertension (powerful vasoconstrictor; monitor BP continuously); Reflex
Bradycardia during first administration; dysrhythmias.
-Tissue hypoxia, ischemia, and infarction (due to severe peripheral and visceral
vasoconstriction)
● Renal— decreased urine output
● Mesenteric effects— absent bowel sounds
● Peripheral vasculature— thrombosis
Black Box Warning: If extravasation occurs, administer phentolamine [Regitine] ASAP
Nonselective adrenergic agonist; Sympathomimetic
epinephrine [Adrenalin]
MOA: both alpha and beta adrenergic receptors
Alpha1 receptors → arterial vasoconstriction
Beta2 receptors → relaxes smooth muscle in the bronchi, opening the airways
Beta1 receptors → ↑ cardiac output & heart rate
Indications:
SubQ or IM— preferred drug for anaphylaxis because it can reverse many of the
distressing symptoms within minutes.
Intracardiac route— (IV) for cardiopulmonary resuscitation under extreme conditions,
usually during open cardiac massage, or when no other route is possible.
Contraindications: none in life-threatening conditions (ex: anaphylaxis); caution in
patients with: dysrhythmias, cerebrovascular insufficiency, hyperthyroidism,
narrow-angle glaucoma, hypertension, or coronary ischemia (epinephrine can worsen)
Administration Alert: Parenteral epinephrine is an irritant that may cause tissue
damage if extravasation occurs. Monitor vital signs and EKG carefully.
Pharmacokinetics: Onset: Sub Q 3-5 minutes; IM 5-10 minutes. Peak: 20 minutes.
Duration: 1-4 hours
Labs: May ↓ serum potassium and ↑ blood glucose
Overdose: If blood pressure remains high, vasodilator may be administered. AE:
Severe hypertension, headache (Stimulation of alpha-1 receptors), severe
tachydysrhythmias, palpitations (Stimulation of beta-1 receptors), nervousness, tremors,
high anxiety (Sympathomimetic effects).

Inotropes
Digoxin and dopamine [dose related]
dobutamine [Dobutrex]
Indication: Drug of choice for chronic severe HF.
MOA: Stimulates beta-1 receptor sites by increasing myocardial contraction and cardiac
output with relatively minor effects on heart rate/peripheral blood vessels.
Administration Alert: Only IV; ensure patency of IV prior to infusion. Nursing
Responsibilities: Monitor: blood pressure, heart rate, EKG rhythms

Chapter 30: Drugs for Dysrhythmias

Class I Antidysrhythmics: Sodium Channel Blockers
Class 1A phenytoin [Dilantin] existing dysrhythmias.
disopyramide [Norpace] Class 1C Reduced heart rate can
Procainamide flecainide [Tambocor] cause
quinidine propafenone [Rythmol] hypotension/syncope
Nursing
Class 1B MOA: Slows impulse Responsibilities: ECG
conduction with therapy for signs of
lidocaine [Xylocaine]
mexiletine [Mexitil] SE/AE: Potential to cardiotoxicity.
create new or worsen

Class II Antidysrhythmics: Beta-Adrenergic Antagonists (beta blockers)

esmolol [Brevibloc]
Prototype: propranolol [Inderal]
MOA: Slows heart rate and decreases conduction velocity through AV nodes. Blockage
of calcium channels in SA/AV nodes

Class III Antidysrhythmics: Potassium Channel Blockers

dofetilide [Tikosyn]
ibutilide [Corvert]
sotalol [Betapace]
Prototype: amiodarone [Cordarone]
Indication: Resistant Ventricular Tachycardia and atrial dysrhythmias
Contraindications: Severe bradycardia, atrioventricular (AV) blocks, cardiogenic shock
Administration Alert: Correct Hypokalemia and hypomagnesemia prior to therapy.
May cause digoxin toxicity.
Interactions: Interferes with warfarin metabolism

Class IV Antidysrhythmics: Calcium Channel Blockers

diltiazem [Cardizem]
verapamil [Calan]

Miscellaneous Antidysrhythmics
digoxin [Lanoxin]
adenosine [Adenocard]
Indication: Supraventricular tachycardia (SVT) that is unresponsive to
vagal maneuvers
Route: Rapid IVP (half-life = 6 seconds)
SE: brief episode of asystole or severe bradycardia
Anticholinergic
atropine sulfate
Indication: Symptomatic bradycardia
Route: IVP
AE: urinary retention
Chapter 31: Drugs for Coagulation Disorders
CLOTTING CASCADE
Prothrombin → Thrombin → fibrinogen turns to fibrin → forms blood clots

Remember!
Antiplatelet Indications: Prophylaxis for MI, CVA, coronary revascularization
Anticoagulant Indications: MyocardiaI Infarct, Pulmonary embolism, thrombosis
INR: takes 3-5 days to get to therapeutic level (2-3)
Vitamin C ↓ INR— False negative; can inhibit effects of meds
Vitamin E ↑ INR— Potentiate INR; ↑ bleeding time(Avocado, spinach, sunflower seeds)

Indirect Thrombin Inhibitors- Anticoagulants

fond aparinux (Arixtra) - commonly given for big orthopedic surgery
heparin
Indication: Prophylaxis for deep vein thrombosis (DVT) and
MOA: prevents thrombin from converting fibrinogen to fibrin
SE:headache, bleeding gums, bruising
AE: GI, Cerebral Bleed, hemorrhagic stroke
Contraindication: Bleeding, trauma, surgery.
heparin allergy— can lead to heparin induced thrombocytopenia (HIT): destroys
thrombocytes, interfering with clotting cascade and platelets (bleed out)
Antidote: Protamine Sulfate
Interactions: Garlic, Ginger, Ginkgo potentiate effects
Nursing Responsibilities: Monitor Activated Partial Thromboplastin Time (aPTT)
(normal range 1.5-2), argatroban if allergic to heparin
Labs: PTTs, INR

Vitamin K Antagonist
warfarin (Coumadin)
Antidote: Vitamin K (IV Form=Aquamephyton)
check INR & PT
MOA: inhibits the synthesis of vitamin K, preventing formation of clotting factors
Indication: thrombosis ppx, decrease risk of recurrent transient ischaemic attack (TIA)
and MI
Contraindications: Vitamin K deficiency, severe hypertension, liver disease,
alcoholism, bleeding, trauma, surgery.
SE: bleeding, red-orange urine, weakening of bones (long term use can lead to fx)
AE: Brain bleed, GI bleed
Pregnancy Category: X
Diet: Do not change your regular intake of foods high in Vitamin K, green leafy veggies,
decrease or stop= increase bleeding, increase= med isn't as effective Interactions:
Garlic, Ginger, Ginkgo potentiate effects
Patient Teaching: avoid foods high in vitamin K
Low-Molecular Weight Heparin
dalteparin [Fragmin]
enoxaparin [Lovenox]
Indication: prevent post op DVT, PE, ischemic complication in pt with MI or STEMI
Contraindication: cannot give to pt receiving heparin or ASA
SE: immune mediated thrombocytopenia, bleeding
Antidote: protamine sulfate

Direct Thrombin Inhibitors

argatroban

Factor Xa Inhibitors
apixaban [Eliquis]
rivaroxaban [Xarelto]
Indication: Used for Chronic Afib, DVT PPX, PE PPX, CVA PPX] MOA:
Selectively inhibits factors Xa, which blocks coagulation cascade -Monitor
Hemoglobin hematocrit and and liver functions
Nursing Responsibilities: Check INR

Antiplatelet Drugs
aspirin (ASA, acetylsalicylic acid)
Indication: Prevention of MI, Stroke
Antidote: activated charcoal, gastric lavage
MOA: inhibits platelet aggregation; blocks COX-1 and COX-2
SE: GI upset, bleeding, Tinnitus
AE: GI/Cerebral bleeds, tinnitus, metabolic acidosis
Contraindication: Children = may cause Reye’s syndrome
Interactions: Alcohol, Steroids, concurrent use with other NSAIDS potentiate effects &
increase risk for gastric ulcers

ADP Receptor Blockers

prasugrel (Effient)
ticagrelor (Brilinta)
ticlopidine (Ticlid)
Prototype: clopidogrel (Plavix)

Glycoprotein IIB/IIIA Receptor Antagonists-Antiplatelet

abciximab (ReoPro)
eptifibatide (Integrlin)
tirofiban (Aggrastat)
Thrombolytics
streptokinase (Kabikinase)
reteplase (Retavase)
Prototype: alteplase (Activase, TPA)
Indications: Thromboembolic events such as stroke and MI; pulmonary embolism​,
occluded central IV’s
MOA: Converts plasminogen to plasmin, breaking up fibrogen; breaks up clots
SE: Spontaneous ecchymoses, hematomas, epistaxis
AE: Internal bleeding- will see drop in BP
Interactions: NSAIDs & anticoagulants
Contraindication: hemorrhagic stroke, history of bleed in past 3 months, recent
trauma/surgery, severe HTN
Administration Alert: Must be given within 12 hours for MI; 3 hours for stroke. Must
have at least 3 large bore IV access sites prior to administration

Hemostatic (antifibrinolytic)
Prototype: aminocaproic acid (Amicar)
MOA: Causes clotting
Indications: Augments hemostasis r/t fibrinolysis associated with heart surgery &
various other systemic bleeding disorders
Contraindications: Disseminated intravascular coagulation (DIC), severe renal
impairment
Administration Alert: Rapid IV infusion can cause ↓BP and ↓HR , Assess VS
frequently, Patient should be on EKG monitor to assess for dysrhythmias SE:
Rapid IV infusion can cause ↓BP and ↓HR
AE: Thromboembolic events
Contraindication: DIC (Clotting disease), severe renal impairment
Chapter 33: Drugs for Inflammation and Fever
Inflammation process: Vasodilation, vascular permeability (edema), cellular infiltration
(pus), Thrombosis (clots), Stimulation of nerve endings (pain)
C reactive protein (CRP): Produced in liver, biomarker for inflammation; Lab
Tests: high sensitivity crp (HS CRP); >3=high risk for DM, HTN, cardiovascular
disease
Histamine: stored and release by mast cells, causes vasodilation, smooth muscle
constriction, tissue swelling, itching
C reactive protein (CRP): Produced in liver, biomarker for inflammation;

Nonsteroidal Anti-Inflammatory Drugs [NSAIDs]

all NSAIDs are analgesics and antipyretics
Non-Selective COX Inhibitors— inhibits both COX-1 and COX-2
aspirin [ASA, acetylsalicylic acid, acetylsalicylic acid]
Ecotrin] naproxen [Aleve, Naprosyn]
indomethacin [Indocin] piroxicam [Feldene]
ketorolac [Toradol] sulindac [Clinoril

Prototype: aspirin [ASA,

MOA: Nonselective NSAID, blocks both COX-1 and COX-2. Inhibits prostaglandin
synthesis. Binds to cyclooxygenase on platelet surfaces, inhibiting formation of
Thromboxane A2 (powerful inducer of aggregation), which prevents platelet aggregation
for up to 10 days.
Contraindication: Patients on anticoagulants such as heparin and coumadin.
Administration Alert: ASA irreversibly inhibits platelet aggregation (effects can last up
to 10 days) and should be discontinued 1 week prior to any surgical procedure. Should
not be used with patients on anticoagulants such as heparin and coumadin
Pregnancy: D
SE: unusual bruising, bleeding gums, stomach pain
AE: GI and/or cerebral bleed, tinnitus, metabolic acidosis, Reye's syndrome in children
Interactions: Alcohol, steroids, other NSAIDs potentiate effects of ASA + increase the
risk for gastric ulcers. 3 G’s Potentiate.
Antidote: activated charcoal, gastric lavage
Prototype: ibuprofen [Advil, Motrin]
MOA: inhibits prostaglandin synthesis
Indication: mild to moderate pain, fever, and inflammation. Musculoskeletal disorders
(Arthritis, osteoarthritis), headache, dental pain, dysmenorrhea (menstrual cramps). SE:
At low/moderate doses SEs mild; nausea, heartburn, epigastric pain, and dizziness. AE:
At high doses for prolonged periods: GI ulceration with occult or gross bleeding;
Increased risk for MI and stroke; renal impairment.
Contraindication: treatment of perioperative pain in those undergoing CABG, Patients
with active peptic ulcers, patients with significant renal or hepatic impairment. Use
cautiously in patients With history of CVD, stroke, or MI
Administration Alert: Give on empty stomach as tolerated. If nausea, vomiting, or
abdominal pain occurs, give with food. Patients with asthma and allergy to ASA likely
hypersensitive
Pharmacokinetics: Onset: 30-60mins; Peak: 1-2hours; Duration: 4-6 hours
Pregnancy: C (D after 30 weeks gestation)
Black Box Warning: May cause an increased risk of serious thrombotic events, MI,
and stroke (Can be fatal); risk increases with duration of use. Patients with CVD/risk
factors for CVD may be at greater risk. NSAIDs increase the risk of serious GIF
Adverse Events including bleeding, ulceration, and preparation of the stomach or
intestines (can be fatal); these events more frequent in older adult patients
Interactions: 3 G’s Potentiate

Selective COX-2 Inhibitor— only inhibits COX-2

celecoxib [Celebrex]q
Centrally Acting COX Inhibitor
acetaminophen [Tylenol]
Indication: fever, mild to moderate pain when aspirin is contraindicated. MOA:
reduces fever by direct action on the hypothalamus and dilation of peripheral blood
vessels which enables sweating and dissipation of heat
Contraindication: hypersensitivity to acetaminophen/phenacetin & chronic alcoholism.
Administration Alert: Never administer to patients who consume alcohol regularly due
to the potential for drug-induced hepatotoxicity.
AE: High doses of acetaminophen increases risk for liver damage (especially important
for patients who consume alcohol)
Black Box Warning: potential to cause severe/fatal liver injury— 2011 FDA asked
manufacturers to limit 325mg/tablet to ↓ risk of acetaminophen-induced
hepatotoxicity.
Corticosteroids— anti-inflammatory
cortisone
dexamethasone
hydrocortisone (Cortef, Solu-Cortef)
methylprednisolone (Medrol)
triamcinolone (Kenalog)
Prototype: prednisone
Indication: inflammation, acute bronchospasm (asthma patients); antineoplastic agent
(anticancer) for patients with certain cancers such as Hodgkin’s disease, acute
leukemia, and lymphomas
Pharmacokinetics: Onset:1-2 hours; Peak: 1-2hours; Duration: 24-36 hours MOA:
A synthetic corticosteroid that inhibits the synthesis of prostaglandins SE:
hyperglycemia, ↑WBCs, Na+ retention; yeast infections, insomnia, hyperactivity
(short term)
AE: Immunosuppression— systemic infection, gastric ulcers,
Cushing’s syndrome (hyperglycemia, fat redistribution to the shoulders and face,
muscle weakness, bruising, bones that easily fracture)
Contraindications: Patients with active viral, bacterial, fungal, or protozoan infections.
Use with caution in patients with peptic ulcer, ulcerative colitis, or diverticulitis.
Administration Alert: Do not use if signs of a systemic infection are present. When
using the drug for more than 10 days, dose must be slowly tapered. If dose is given
IVP, use of H2 blocker (also by IVP) is indicated
Interactions: Use with diuretics ↑ potassium loss (serious for patients taking digoxin)
St. John’s wort may decrease prednisone levels and decrease its effectiveness.
Nursing Responsibilities: Obtain weights daily & report >2lb/1kg lost in 24 hours or
>5lb/2kg lost in 1 week; DO NOT suddenly stop = hypotensive or hypoglycemic shock.
Assess: high BP trends, edema, pulmonary congestion;
Monitor for hyperglycemia, hypernatremia, hypokalemia, signs of infection

Chapter 35: Drugs for Bacterial Infections

Penicillins
Natural Penicillins
Prototype: penicillin G potassium
MOA: Inhibit cell wall synthesis
Indications: Gram positive bacterial
- Streptococcal, staphylococcal, and pneumococcal infections
- Pneumonia, meningitis, blood & valve infections, skin & joints
Contraindication: Allergies, Beta-lactamase enzyme
Administration Alert: Following parenteral administration, observe for allergic
reactions for 30 minutes, especially with the 1st dose
Interactions: Do not mix penicillin with aminoglycosides in the same IV
tubing/solution. Give 1 hour apart to prevent interactions because PCN can antagonize
the action of aminoglycosides.
Antistaphylococcals
dicloxacillin
oxacillin
Broad-Spectrums
ampicillin and sulbactam [Unasyn]
amoxicillin (Amoxil)
amoxicillin-clavulanate (Augmentin)
Antisuedomonals
piperacillin
piperacillin & tazobactam (Zosyn)
ticarcillin & clavulanate (Timentin)
Cephalosporins
cephalexin (Keflex)
cefotetan (Cefotan)
cefoxitin (Mefoxin)
cefuroxime (Ceftin)
ceftazidime (Fortaz)
Ceftizoxime (Cefizox)
ceftriaxone (Rocephin)
cefepime (Maxipime)
Prototype: cefazolin (Ancef)
MOA: Inhibits cell wall synthesis
Indications: Gram-positive bacteria, Respiratory tract, urinary tract,
septicemia, endocarditis, Prophylactic use for surgical procedures
Contraindication: allergies, pathogens that produce beta-lactamase
enzyme
Tetracyclines
doxycycline (Vibramycin)
Prototype: tetracycline
MOA: Inhibits protein synthesis
Indications: broad-spectrum (gram-positive and gram negative bacteria);
Chlamydia, Rickettsia, and Mycoplasma, H. pylori for treatment of PUD
Contraindication: Allergies, Severe renal or hepatic impairment
Pregnancy: D
Interactions: milk products, iron supplements, magnesium-containing
laxatives, and antacids reduce the absorption and serum levels of
tetracyclines
Patient Teaching: Direct exposure to light can cause photosensitivity.
Children under 8 should not take this medication because it can cause
permanent yellow-brown discoloration of their permanent teeth.

Macrolides
clarithromycin (Biaxin)
azithromycin (Zithromax)
Prototype: erythromycin (E-Mycin)
MOA: Protein synthesis inhibitor Indications
Indications: Most gram positive and many gram negative bacteria;
Bordetella pertussis (whooping cough); Legionella pneumophila
(Legionnaires’ disease); M. pneumoniae; H. influenza
Contraindications: Allergies
Erythromycin is inactivated by stomach acid, which is why it is enteric
coated
Administration Alert: For oral suspensions, shake the bottle thoroughly to
ensure the drug is mixed well. Higher doses, especially in the elderly, can
cause hearing loss, dizziness and vertigo. High doses of IV erythromycin
can be cardiotoxic and cause fatal dysrhythmias.
Aminoglycosides
gentamicin (Garamycin)
amikacin
tobramycin
streptomycin
MOA: Inhibits protein synthesis
Indications: Serious systemic infections from E.coli, Serratia, Proteus, Klebsiella, and
Pseudomonas. Given parenterally for systemic infections. Given PO for local effect on
GI system prior to intestinal surgery
Contraindications: Allergies, Renal Failure
Black Box Warning: Neurotoxicity: can manifest as tinnitus, irreversible ototoxicity,
loss of balance, paresthesia, seizures. Extreme caution with concomitant use of ASA
and Lasix. Neuromuscular weakness: can cause respiratory paralysis. Nephrotoxicity:
can manifest as oliguria

Fluroquinolones
levofloxacin (Levaquin)
Prototype: ciprofloxacin (Cipro)
MOA: Inhibits DNA synthesis
Indications: Gram negative bacteria; newer generations can treat some gram positive
bacteria. Uncomplicated UTIs, sinusitis, pneumonia, dysentery, certain eye infections
Contraindications: Allergies; Pain or inflammation of a tendon
Black Box Warning: Tendonitis and tendon rupture can occur in patients of all ages.
Risk is especially high in patients receiving concurrent use of corticosteroids.
Interaction: Increase effects of caffeine. Dairy can decrease absorption for PO

Sulfonamides
nitrofurantoin (Macrodantin)
Prototype: trimethoprim-sulfamethoxazole (Bactrim)
MOA: Folic acid inhibitor (antimetabolite)
Indications: Broad spectrum. Pneumocystis carinii pneumonia (found with AIDs
patients). Shigella infections of the small intestine (fecal-oral route)
Contraindications: Allergies
Carbapenems
meropenem (Merrem)
Prototype: imipenem-cilastatin (Primaxin)
● Contains a beta-lactam ring that is resistant to beta-lactamase ●
Imipenem-cilastatin (Primaxin) has the broadest antimicrobial spectrum ●
meropenem (Merrem) is approved only for peritonitis and bacterial meningitis ●
Both are approved for hospital-acquired pneumonia (HAP)​and
ventilator-associated pneumonia (VAP)
Contraindication: Patients with seizure activity (can cause seizures)
Miscellaneous Antibacterials
chloramphenicol
clindamycin (Cleocin)
daptomycin (Cubicin)
lincomycin (Lincocin)
linezolid (Zyvox)
metronidazole (Flagyl)
vancomycin (Vancocin)

Antituberculars
ethambutol (Myambutol)
rifampin
pyrazinamide
Prototype: isoniazid (INH)
MOA: Inhibits mycobacterial cell wall synthesis
Contraindications: Hypersensitivity, Severe liver impairment
Administration Alert: Give on an empty stomach (2 hours after meals) Black Box
Warning: Hepatotoxicity (elevated LFTs, jaundice); ETOH can increase risk for
hepatotoxicity
SE/AE: Elevated LFTs → Hepatotoxicity;
Numbness of hands and feet → neurotoxicity (seizures, coma)
Antidote: Pyridoxine (vitamin B6) until patient regains unconsciousness Interactions:
No alcohol, food interferes with INH absorption, foods with Tyramine can increase INH
toxicity
1. Match the contraindication with the medication. You cannot select a drug more than once.
A. Hyperkalemia Altace
B. Gastrointestinal bleeding Integrilin
C. Severe bradycardia Amiodarone
D. Hypotension Nitroglycerin
E. A very rapid heart rate Atropine
F. Heart failure/pulmonary edema Albumin

2. A patient who was prescribed oral ferrous sulfate reports taking the entire bottle in a suicide
attempt. Based on the physicians order, the RN will prepare to give:
A. Fleet’s enema
B. Vitamin C
C. Benadryl
D. Desferal

3. The RN is preparing to administer adenosine to a patient who is experiencing an acute

episode of paroxysmal supra ventricular tachycardia (SVT). When giving this medication, what
is important for the RN to remember?
A. Onset of action occurs in 5 minutes
B. Asystole may occur for a few seconds after administration.
C. The medication has a long half-life, so the duration of action is very
long D. The medication must be given as a slow IV push

4. Match the medication to the patient teaching that should be done for it A. “If you notice your
skin or eyes start to have a yellowish cast, call the doctor” Acetaminophen
B. “Notify the doctor if you develop ringing in the ears” Aspirin
C. “Notify the MD if you gain 5 pounds in one week” Prednisone

5. The mechanism of action of how ibuprofen works to suppress the inflammation and reduce
pain from a muscle injury is by:
A. Interfering with neuronal pathways associated with prostaglandin
action B. Activating cycloxygenase to increase good prostaglandin
synthesis
C. Preventing COX-1 and COX-2 activity decreasing prostaglandin
effects D, direct chemical action to cause relaxation of smooth muscle

6. The RN is teaching a patient with chronic renal failure and who will begin receiving
epoetin alfa. Which statement by the patient indicates understanding of this medication
treatment?
A. “If I have to start dialysis, I will have to stop taking this drug”
B. “When I take this medication, my serum ferritin levels will increase” C.
“Taking this medication will prevent the need for dialysis in the future” D.
“Taking this drug will not eliminate the need for possible blood transfusions”

7. To maintain patient safety, which medication requires that the RN verify the patient’s blood
pressure and heart rate prior to administration?
A. Quinapril
 B. Apresoline
C. Losartan
D. Coreg
8. A patient has been diagnosed with angina and will be given a prescription for sublingual
nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, it is
important for the RN to include which instruction?
A. If the tablet does not dissolve quickly, chew the tablet for maximal
effect B. Take up to 5 doses at 15 minute intervals for an angina attack
C. If the chest pain is not relieved after one tablet, call 911
immediately D. Wait 1 minute between doses of sublingual tablets, up
to 3 doses

9. When giving a patient a carbonic anhydrase inhibitor for glaucoma, the RN will need to
monitor for which possible adverse effects?
A. Hypotension
B. Hypokalemia
C. Metabolic acidosis
D. Hypernatremia

10. Match the generic to the trade name

A. Cyclophosphamide Cytoxan
B. Methotrexate Trexall
C. Mycophenolate CellCept

11. A patient is being treated for shock following a motor vehicle accident. The physician
orders 0.9% NaCl IV. The RN should expect which therapeutic outcome as the result of this
infusion?
A. Increased interstitial fluid
B. Decreased urine output
C. Stabilization of blood pressure
D. Improved blood oxygenation

12. Match the type of shock with its definition

A. Septic Shock Systemic infection in the blood
B. Cardiogenic Shock Heart failure
C. Anaphylactic Shock Acute allergic reaction
D. Hypovolemic Shock Loss of blood volume

13. A woman who has arthritis is breast-feeding her infant and asks the nurse if is safe to take
NSAIDs while nursing. What should the RN tell this patient?
A. NSAIDs are not safe, even in small amounts
B. NSAIDSs are safe to take while breast feeding
C. She should request a prescription for narcotic analgesics
D. She should take only COX-2 inhibitors while breast-feeding

14. A patient is taking cholestyramine for high cholesterol levels. During the patient’s head to
toe assessment, what should the RN assess for? Select three answers
A. Hypoglycemia
 B. Nutritional deficiencies
C. Muscle fatigue
D. Constipation

15. A patient is being discharged home on a diuretic. The RN instructs the patient to take the
dose at which time so it will be least disruptive to the patient’s daily routine? A. With supper
B. At bedtime
C. In the morning
D. At noon

16. Which selective beta-adrenergic agonist belonging to the therapeutic class of inotropes, is
a drug choice for treating chronic severe heart failure?
A. Dopamine
B. Dobutamine
C. Epinephrine
D. Phenylephrine

17. A patient taking lisinopril and losartan for hypertension needs to patient teaching on dietary
restrictions while on these foods. Which foods should the RN recommend the patient remove
from their diet or only eat in small quantities? Select all that apply
A. A canned soup
B. Avocados
C. Bananas
D. Oranges

18. A patient with elevated lipid levels has a new prescription for niacin. The nurse informs the
patient that which adverse effects may occur with this medication?
A. Histamine release, facial flushing
B. Hypoglycemia, renal toxicity
C. Muscle fatigue, hepatotoxicity
D.??

19. A patient receiving spironolactone should be assessed for which complication based on
the drug’s mechanism of action?
A. Hypokalemia
B. Decreasing ICP
C. Ototoxicity
D. Hyponatremia

20. An older adult patient with congestive heart failure develops pulmonary edema. The
physician orders furosemide (Lasix). Before administering this medication, the RN reviews the
patient’s chart. Which laboratory value would cause the RN to hold the Lasix and notify the MD
that the medication is not safe to give?
A. A low serum creatinine
B. A high serum glucose
C. A low serum potassium
D. A high serum sodium
21. Match the generic drug to its trade name
A. Sulindac Clinoril
B. Indomethacin Indocin
C. Ketorlac Toradol

22. A patient with newly diagnosed hypertension is prescribed Diovan. The patient is about to
receive it for the first time. Patient teaching should emphasize which of the following potential
adverse effects?
A. Hyperkalemia
B. Severe hypotension
C. ???
D. ???
23. During aggressive antibiotic drug therapy to treat a severe pneumonia, a patient develops
diarrhea. The nurse explains to the patient that this can sometimes happen because A. Large
doses of antibiotics can kill normal flora in the GI tract
B. It is not unusual to have an allergic reaction to the antibiotics
C. The infection is spreading from her lungs to er intestines
D. The infectious bacteria are resistant to the medication

24. During an infusion of albumin, the RN monitors the patient closely for the development of
which adverse effect?
A. Fluid volume overload
B. Hypernatremia
C. Fluid volume deficit
D. Hypotension

25. A patient is on an IV infusion of Dopamine secondary to cariogenic shock. The IV site

shows early signs of extravasation and the RN knows that severe, irreversible skin and soft
tissue damage can occur if immediate actions is not taken. The RN immediately notifies the
physical and receives the following STAT order
A. Phentolamine
B. Protamine sulfate
C. Phytonadione
D. Phenylephrine

26. The RN is taking a history on a patient who will be taking propranolol. Which medical
condition, if present, may cause serious problems if the patient takes this medication?

A. Asthma
B. Glaucoma
C. Angina
D. Hypertension
27. The RN is caring for a patient who has been taking low-dose aspirin for several days. The
RN notes that the patient has copious amounts of water nasal secretions and has developed
hives. The RN should contact the physician to discuss:
A. Reducing the dose of aspirin
B. Administering SQ epinephrine
C. Giving an antihistamine
D. Changing to a first-generation NSAID

28. A patient is receiving tPA for an embolic stroke or blood clot. The patient calls the nurse to
report they are experiencing heavy bleeding from the rectum. The RN anticipates the physician
will order which medication to be administered?
A. Amicar
B. Protamine sulfate
C. Aquamephyton
D. Prasugrel

29. A patient who was in a motor vehicle accident sustained a severe traumatic head injury and
is brought into the emergency department. Which IV fluid ordered by the physician should the
RN question as unsafe to give?
A. 0.9% NaCl
B. Hetastarch (Hespan) 6%
C.Lactated Ringers
D. 5 dextrose in water

30. A patient has an infection caused by Psuedomonas aeruginosa. The physician has ordered
piperacilin and amikacin, both to be given intravenously. What should the RN do?
A. Make sure to administer the drugs at different times using different IV tubing
B. Assess the skin at the infusion site for signs of tissue necrosis
C. Watch the patient closely for allergic reactions, because this risk is increased with
this combination
D. Suggest giving a larger dose of piperacillin and discontinue the amikacin.

31. The physican has ordered filgrastim for a patient who finished chemotherapy a week ago.
The RN will provide patient teaching that includes preparing the patient for which potential side
effect from taking this medication?
A. High blood pressure
B.sensitivity to light
C. Bone pain
D. Tachycardia

32. A patient has a urinary tract infection. The RN knows that which class of drugs is especially
useful for such infections?
A. Sulfonamides
B. Carbapenems
C. Tetracyclines
D. Cephalosporins
33. Morning lab results show tat a patient has a very high serum potassium level. Which
diuretic medication ordered by the physician should the RN question because it is unsafe to
give?
A. Spironolactone (Aldactone)
B. Hydrochlorothiazide (HydroDIURIL)
C. Furosemide (Lasix)
D. Bumetanide (Bumex)

34. A patient arrives in the emergency department with severe chest pain. The patient reports
that the pain has been occurring off and on for a week now. Which assessment finding would
indicate the need for cautious use of nitrates?
A. Apical pulse rate of 110 beats/min
B. History of a MI 2 years ago
C. History of renal disease
D. Blood pressure of 88/62 mm Hg

35. The RN is caring for a patient who is receiving isotonic IV fluid at a rapid infusion rate of
125 mL/hour. The RN performs an assessment and notes a heart rate of 102 beats per minute,
an increased blood pressure of 160/85 mm Hg, and fluid in both lungs. What action should the
RN take?
A. Increase the IV fluid rate as an emergency intervention
B. Request an order for a hypertonic IV solution
C. Request an order replace the original IV with colloidal IV solution
D. Stop the IV fluid rate and notify the physician

36. During a blood transfusion, the patient begins to have chills and back pain. What should be
the RN’s first priority?
A. Slow the infusion rate of the blood transfusion
B. Stop the infusion immediately and notify the MD
C. Tell the patient that these symptoms are a normal reaction to the blood
product
D. Asses for other signs and symptoms

37. A physician has ordered Capoten for a patient with hypertension. The patient reports a
story of swelling of the tongue and lips after taking enalapril in the past. Which action by the
RN is correct?
A. Hold the dose and notify the physician of the patient’s history
B. Request an order to administer fosinopril instead of Capoten
C. Administer the Capoten and monitor for possible adverse effects
D. Reassure the patient that this is not a serious adverse effect

38. Match the generic drug name to its trade name

A. rosuvastatin Crestor
B. Simvastatin Zocor
C. Pravastatin Pravachol
D. Lovastatin Mevacor
E. Atorvastatin Lipitor
39. Match the drug to its effect
A. Pyrazinamide monitor liver enzymes as it can potentiate hepatoxicity
B. Rifampin turns urine and tears an orange/reddish/brown
C. Ethanmbutol monitor for visual changes as it can cause optic neuritis
D. Isoniazid Treatment for Overdose is Vitamin B6 (pyridoxine)

40. A patient as received an overdose of intravenous heparin and is showing signs of excessive
bleeding. Which medication is the antidote for heparin overdose?
A. Potassium chloride
B. Vitamin K
C. Vitamin E
D. Protamine sulfate

41. A reaction that can occur with the rapid infusion of IV Vancomycin is
A. A throbbing headache
B. Profuse sweating
C. Red man syndrome
D. Hypertensive crisis

42. Match the drug to the adverse effect. You cannot select a drug more than once
A. A persistent dry cough that can lead to angioedema Enalapril
B. Drug toxicity secondary to hypokalemia Digoxin
C. Severe hypertension and tachydysrhythmias Epinephrine
D. Can results in a transfusion reaction Albumin

43. Match the Black Box Warning to the correct medication. You cannot select the drug more
than once
A. Fetal injury and death may occur if take during pregnancy quinipril
B. Can cause profound water and electrolyte imbalances IV Lasix
C. Abrupt discontinuation can cause an MI in patients with ischemic heart disease
atenolol
D. Following extravasation with levophed, the patient should be treated with this SQ
medication Regitine

44. A patient has begun taking spironolactone in addition to Cozaar for the treatment of
heart failure. An important nursing intervention for this patient should include:
A. Encouraging the patient to limit their salt intake and to notify the RN if
they’re thirsty
B. Continue to give his potassium supplement daily as ordered by the physician
C. Teach the patient that sign abdominal craping is expected but tolerable D.
Monitoring the patient’s urine output and notifying the physician if it decreases

45. The cardiac monitor shows a patient has SVT with a very rapid ventricular rate of 180/
beats/minute. The RN notifies the physician and expects the physician to order which
medication to treat this condition?
A. Nicardipine
B. Atropine
 C. Nitroglycerin
D. Adenosine

46. A patient is receiving a lipid lowering agent and has now developed signs and symptoms of
hypoglycemia. This could be a side effect of which medication
A. Gemfibrozil (Lopid)
B. Pravastatin (Pravachol)
C. Ezetimibe (Zetia)
D. Cholestryamine (Questran)

47. A patient is taking isoniazid secondary to tuberculosis. Patient teaching should include
avoiding foods such as: Select all that apply
A. Red wine
B. Espresso coffee
C. ??? Any foods high in Tyramine cheese, chocolates processed/cured meats, pickled
foods
D. ???

48. When giving discharge instructions, the RN should warn the patient to do the following
before taking fibric acid drug:
A. Take aspirin 30 minutes to prevent flushing
B. Take it at night before going to bed
C. Avoid drinking grapefruit juice with this medication
D. Monitor your blood sugar because it can cause hypoglycemia

49. Match the type of anemia to the type of foods the patient should consume as part of their
treatment plan:
A. Iron deficiency anemia red meat, fish, poultry, lentils & beans
B. Vitamin B12 deficiency anemia fish, red meat, poultry, eggs, milk/milk products, &
fortified breakfast cereals
C. Folic acid deficiency anemia leafy green vegetables, citrus fruits, dried beans & peas
50. A patient is taking digoxin for the treatment of atrial fibrillation. The RN expects which
medication to be given concurrently to prevent clot formation in the atria? A. Primacor
B. Ezetimbe
C. Metolazone
D. Coumadin

51. The RN is preparing to administer digoxin to a patient who is newly admitted to the
intensive care unit. The RN reviews the patient’s admission labs and notes a seem potassium
level of 2.9 mEq/L. Which action by the RN should be the first priority?
A. Administer the digoxin as ordered and monitor the patient’s EKG closely
B. Hold the digoxin dose and notify the MD of the patient’s lab values
C. Take the apical pulse for a full minute and give the drug for a heart rate greater than
60.
D. Request an order to give potassium supplements twice a day

52. Possible contraindications related to the safe administration of ace inhibitors would be
(select all that apply)
A. Patients complains of dizziness when standing
B. A heart rate that is 60 beats per minute
C. A systolic blood pressure of 95 mm/Hg
D. A serum potassium level of 5.6 mEq/L

53. Match the indication to the drug name. You cannot select a drug more than one A.
This medication is used to treat thromboembolic events such as an MI or stoke
Reteplase (Retavase)
B. This medication is used as a renal protectant for patients with diabetes Captopril
(capoten)
C. This medication can be used to treat tachycardia Diltiazem
(Cardizem) D. This medication is used to treat heparin overdose
Protamine Sulfate
E. This medication can be used treat hypertension Amlodipine (Norvasc) F. This
medication can be used to treat severe, decompensating heart failure Nestiritide (Natrecor)

54. Causes for hypokalemia include (select all that apply)

A. Thiazide diuretics
B. Insulin therapy
C. Severe diarrhea
D. A diet high in oranges

55. A patient has been prescribed atorvastatin (lipitor) to treat elevated LDL levels. The patient
expresses concerns about taking this medication because he has heard that it can cause “bad
muscle fatigue”. What patient teaching should the RN provide?
A. “Ask your doctor about adding a vibrate medication to your regimen”
B. “Consume an increased amount of citrus fruits while takin this drug”
C. “Take coenzyme Q10 supplements which will help with muscle
energy” D. “Have your creatine kinase levels checked every 4 weeks”

56. A patient has been taking enalapril for heart failure. The RN must monitor
for: A. High blood pressure
B. Hypovolemia
C. High heart rate
D. Hyperkalemia
57. During an infusion of albumin, the RN monitors the patient closely for the
development of which adverse effect?
A. Metabolic alkalosis
B. Pulmonary edema
C. Nausea and vomiting
D. Diabetes insipidus

58. The RN will assess the patient for which potential contraindication to isoniazid
therapy? A. Heart failure
B. Hepatic impairment
C. Anemia
D. Glaucoma
59. An example of kinase inhibitor would be:
A. Mycophenolate
B. Sirolmus
C. Methotrexate
D. Tacrolimus

60. A patient is receiving Sandimmune to prevent liver transplant rejection. The patient is
experiencing shortness of breath and palpitations. The RN is concerned that the patient has
developed which condition?
A. Hypersensitivity
B. Hepatoxicity
C. Immunosuppressant anemia
D. Cardiotoxicity

61. Match the drug to its effect

A. May cause an increased risk of serious thrombotic events, MI, and stroke, which can
be fatal Ibuprofen
B. Do not use if signs of a systemic infection are present Prednisone
C. Never administer to patients who consume alcohol Acetaminophen

62. During therapy with the hematopoietic drug epoetin alfa, the RN would monitor the patient
for which possible adverse effect?
A. Constipation
B. Hypertension
C. Drowsiness
D. Anxiety

63. The patient is receiving Retavase. The RN monitors the patient for adverse effects. What is
an adverse effect of thrombolytic therapy?
A. Internal bleeding
B. Dysrhythmias
C. Hypertension
D. Nausea and vomiting

64. Match the generic drug name to the trade name

A. triamterene Dyrenium
B. Torsemide Demadex
C. Metolazone Zaroxolyn
D. Bumetanide Bumex
65. Match the medication to its antidote
A. Acetaminophen N-acetylcysteine
B. Vitamin K Protamine sulfate
C. Warfarin Vitamin K
D. Epogen Phlebotomy

66. Match the drug to its pharmacologic classification

A. Spironolactone Potassium-Sparing Diuretic
B. Acetazolamide Carbonic Anhydrase Inhibitor
 C. Metolazone Thiazide Diuretic
D. Mannitol Osmotic Diuretic
E. Furosemide Loop Diuretic

67. Which antibacterial medication is considered the drug of choice against

streptococcal, pneumonia organisms?
Penicillins
Natural Penicillins
Prototype: penicillin G potassium
Antistaphylococcals
dicloxacillin
oxacillin
Broad-Spectrums
ampicillin and sulbactam [Unasyn]
amoxicillin (Amoxil)
amoxicillin-clavulanate (Augmentin)
Antipsuedomonals
piperacillin
piperacillin & tazobactam (Zosyn)
ticarcillin & clavulanate (Timentin)

68. ???

69. Medications that have after load reduction properties include: Select all that
apply A. Hydralazine
B. Clopidogrel
C. Nitroprusside
D. Nesirititide

70. Match the generic drug name to its trade name

A. ezetimibe Zetia
B. Vitamin B3 Niaspin
C. Gemfibrozil Lopid
D. Cholestyramine Questran

71. A patient is admitted through the ER with a confirmed embolic stroke (blood clot) The
physician orders alteplase IV as part of the treatment protocol. The RN assess the patient for
possible contraindications prior to giving this medication. What will the RN need to assess for?
Select all that apply
A. Severe hypertension
B. Recent surgery
C. Traumatic brain injury
D. Elevated liver function tests
72. The RN is preparing to administer a dose of epoetin alfa to a patient has a hemoglobin level
of 11.7 gm/dL. Which action by the RN is correct?
A. Suggest that the MD increases the dose
B. Request an order for a reduced dose
C. Hold the dose and notify the provider
 D. Administer the dose as ordered

73. An RN administers an ACE inhibitor to a patient who is taking the drug for the very first
time. What should the RN do?
A. Report the presence of a dry cough to the physician
B. Make sure the patient takes a potassium supplement
C. Report the presence of a dry cough to the physician
D. Instruct the patient not to get up without assistance

74. A 60-year-old female patient is about to begin long-term corticosteroid therapy. Which of
the following actions will be important for minimizing the risk of osteoporosis? A. A no added
salt diet
B. Taking calcium and vitamin D supplements
C. Having skeletal x-rays every 3 months
D. Beginning estrogen therapy

75. The RN is assessing a patient who takes Xarelto. The RN notes that the patient’s heart rate
has been trending up and is now 102 beats per minute, while the blood pressure has been
trending down and is now 88/78 mm Hg. To evaluate the reason for these changing vital signs,
the nurse will assess the patients
A. Gums, nose and skin
B. Bowel sounds
C. Kidney function and urine output
D. Lung sounds and respiratory effort

76. Match the generic to the trade name

A. sirolimus Rapamune
B. Cyclosporin Neoral, Sandimmune
C. Tacrolimus Prograf

77. A patient is brought to the emergency department in anaphylactic shock because of a bee
sting. Which medication does the RN expel to give initially?
A. Albuterol
B. Diphenhydramine
C. Dopamine
D. ???

78. A young adult is brought to the emergency department by a parent who reports that the
patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8
and 10 hours ago. The RN will expect to administer which of the following drugs? A. Activated
charcoal
B. Respiratory support
C. Acetylcysteine (mucomyst)
D. Hemodialysis
79. A patent is brought into the emergency room wit severe hypotension following an
abdominal stab wound. The physician orders fluid replacement agents to support blood
pressure until blood products are ready for transfusion. Which fluid replacement agent should
the RN question as unsafe to give?
 A. 5% dextrose in water
B. Dextran 40 (Gentran, LMD)
C. ???
D. ???

80. Indications for the use of filgrastim include: select 3 answers

A. A patient who is receiving bone marrow transplant
B. A patient with a very low neutrophil count
C. A patient who has completed chemotherapy
D. A patient with a chronic, but not life-threatening skin wound infection

81. A patient is admitted to the hospital secondary to a heat stroke from gardening long hours
during a heat wave. Vital signs are stable but lab values show the patient is hypernatremic.
Which IV fluid does the RN anticipate the physician will order?
A. D5W
B. 0.45% normal saline (1/2 NS)
C.???
D. ???

82. ???
83.???

84. A patient is going home with a new prescription for beta-blocker atenolol. The RN should
include which information wen teaching he patient about this drug?
A. Be watchful for first-dose hypotension
B. The medication will be stopped once symptoms subside
C. If adverse effects occur, stop taking the drug for 24 hours, then
resume D. Never stop taking this medication abruptly

85. A patient is being described ezetimibe to decrease his LDL levels. He asks the RN how the
drug works. Which statement by the RN best explains this drug’s mechanism of action? A. “It
inhibits HMG-CoA reductase”
B. “It prevents resorption of bile acids from the small intestines”
C. “it blocks cholesterol absorption in the small intestine”
D. “It activates lipase, which breaks down cholesterol”

86. Match the drug classification to the administration alert

A. Abrupt withdrawal can cause rebound HTN and anxiety Direct-Acting Vasodilators
B. Monitor for 1st dose phenomenon Alpha 1-Adrenergic Antagonist
C. Do not administer to patients if an impending MI is suspected or within 2 weeks
following an MI Calcium Channel Blockers

87. The RN is providing discharge teaching to patient going home on prednisone. The patient
has a history of high blood pressure and is also a diabetic. Which instructions should be
included in the teaching plan related to the effects of this medication? Select all that apply A.
“If you get an infection, call the doctor ASAP”
B. “Eat a low sodium diet”
C. “If you lose. More than 5 pounds in 1 week, call the MD”
D. “Stop taking the drug if it makes you feel bad”
88. A patient is receiving potassium supplements three times a day. While assessing the
patient, the RN notes the patient is experiencing adverse effects related to high levels of
potassium in the body. What sign did the RN assess that indicates hyperkalemia? A.
Tetany or twitching
B. Nausea and vomiting
C. High respiratory rate
D. A very slow heart rate

89. A patient is currently receiving his third intravenous dose of penicillin G. He calls the nurse
to report that he is feeling “anxious” and is having trouble breathing. What should be the first
intervention by the RN?
A. Stop the antibiotic infusion
B. Take the patient’s vital signs
C. Notify the physician
D. Check for a rash on the patient’s chest

90. When reviewing the health history of a patient, the RN notes that a potential
contraindication to giving a potassium supplement is the patient has which problem?
A. Renal disease
B. Hypovolemia
C. Insulin therapy
D. Diarrhea

91. When a patient is receiving diuretic therapy, which of these assessment measures would
best reflect the patient’s fluid volume status?
A. Serum potassium and sodium levels
B. Measurements of abdominal girth
C. Blood pressure and pulse
D. intake, output, and daily weight

92. A patient’s wound is infected with methicillin-resistant Staphylococcus aureus. Which drug
would the RN anticipate the MD will order for treatment?
A. Metronidazole
B. Vancomycin
C.???
D.???

93. ???
94. ???

95. Match the pharmacologic classification to the drug name. You cannot select a drug more
than once
A. Nonselective adrenergic agonist Epinephrine
B. ADP Receptor Blocker Clopidogrel
C. ACEI Zestril
D. Beta-Adrenergic Antagost (Beta Blocker) Coreg

96. The RN notes in the patient’s medication orders that the patient will be starting
anticoagulant therapy. What is the primary therapeutic goal of anticoagulant
therapy? A. Stabilizing an existing thrombus
B. Dilating the vessel around a clot
C. Preventing thrombus formation
D. Dissolving an existing thrombus
97. The nurse is caring for an orthopedic post-operative patient. The RN will anticipate
administering which medication to this patient to help prevent thrombus formation caused by
venous blood flow
A. Apixban
B. Alteplase
C. Aspirin
D. Arixtra

98. Match the type of anemia to the correct nursing responsibility/assessment. You will need to
provide the knowledge needed about the medication used for treatment of each type of
anemia
A. Microytic Do not give medication within 1 hour of bedtime
B. Pernicious Assess for hypokalemia
C. Macroytic Encourage the patient to increase their intake of green leafy veggies and
fish
D. Nomocytic Monitor blood pressure and heart rate

99. Medication that require checking both heart rate and blood pressure to ensure safe
administration: Select all that apply
A. Calan
B. Lanoxin
C. Brevibloc
D. Aldactone

100. The RN is giving dietary instructions to a patient who will begin taking warfarin for atrial
fibrilation. Which goods and or vitamin supplements should the patient consume in limited
quantities because it could increase INR results? Select all that apply
A. Garlic pills
B. Vitamin E
C. Oranges
D. Green leafy vegetables

1. A patient’s wound is infected with methicillin-resistant Straphylococcous aureus. Which

drug would the RN anticipate the MD will order for treatment?
A. Tobramycin
B. Ciprofloxacin
 C. Metronidazole
D. Vancomycin

2. Which administration alert applies to the antifungal, nystatin?

A. This is a pregnancy Category X
B. Monitor closely for overdose
C. For adults with oral candidiasis, the drug should be swished in the mouth for at least
2 minutes
D. Avoid giving this medication 1 hour before the patient has consumed grapefruit juice
3. Match the patient teaching to the drug
A. “Notify the MD if you gain 5 pounds in one week” Prednisone
B. “If you notice your skin or eyes start to have a yellow-isn cash, call the doctor
Acetaminophen
C. “Notify the doctor if you develop ringing in the ears” Aspirin

4. Match the medication to its contraindications

A. Tendonitis Ciprofloxacin
B. Renal failure Tobramycin
C. Seizure activity imiprenem-cilastatin

5. Which medication are contraindicated for use in the treatment of pathogens that produce
beta-lactamase
A. Cefeprime
B.Ceftazdime
C.Clanithromycin
D. Cephalexin

6. A patient with a gram negative, uncomplicated urinary tract infection is to be placed on

antibiotic treatment. The RN knows the class of drugs especially useful for such infections
are A. Flouroquinolones

7. When a patient is on amino glycoside therapy, the RN will monitor for which signs/symptoms
that could indicate of toxicity?
A. Vertigo

8. The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which
statement by the nurse is correct?
A. “Avoid direct sunlight and tanning beds while on this medication”

9. The RN is teaching a patient about oral Cytoxan. Which statement by the patient indicates
understanding of the patient teaching?
A. “If my urine output creases or my urine looks concentrated, I should call the doctor”

10. Which medication if frequently given prior to surgery as prophylaxis for post-operative
infections?
A. Cefazolin

11. Which of the following medications are macrolides? Select all that
 apply A. Clarithromycin
B. Azithromycin

12. Match the generic to the trade name

A. Tacrolimus Prograf
B. Indomethacin Indocin
C. Ceftraxone Rocephin

13. Which administration alert applies to fluorquinolones?

A. Do not administer with grape juice
B. Administer Im injections into deep into large muscle mass sites
C. This medication is a pregnancy D category
D. Administer at least four hours before giving antacids and ferrous sulfate

14. The nurse is monitoring for therapeautic results of antibiotic therapy in a patient with an
infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?
A. Increase hemoglobin level
B. Increased red blood cell count
C. Decreased white blood cell count
D. Decreased platelet count

15. Match the medication to its indication

A. Abdominal infections Clindamycin
B. Bacterial meningitis Meropenem
C. VRE Linezolid

16. A patient is receiving ferrous sulfate for iron deficiency anemia. Which oral antibiotic drug,
when taken concurrently with iron, would cause the RN to notify the physician about a drug to
drug interaction that could decrease absorption of the antibiotic?
A. Tetracycline

17. Which is the traditional drug of choice for nonmaterial protozoan

infections? A. Flagyl

18. Which of the following medications are sulfonamides? Select all that
apply A. Trimethoprim-sulfamethoxazole
B. Nitrofuration

19. Match the immune system modulator to the infection

A. Tacrolimus treatment of eczema
B. Sirolimus prophylaxis for kidney rejection
C. Methotrexate chemotherapy

20. Prior to giving the medication cyancobalamin, the RN understands that the patient is most
likely being treated for ____________ anemia. Nursing responsibility for safe administration of
this medication include _____________.
A. Macrocytic anemia
B. Checking potassium levels

21. Match the generic name to trade name

 A. Clindamycin Cleocin
B. Celecoxib Celebrex
C. Cyclophoshamide Cytoxan

22. Match the medication to the pathogen it treats

Amoxicillin-clavulanate Augmentin
Trimethorprim-sulfamethoxazole Bactrim
piperacillin-clavulanate Timentin

23. An example of antimetabolite drug would be:

A. Mycophenolate
B. Methotrexate
*if its only one choice, pick A

24. Match the generic drug name to its trade name

B. Dalteparin Fragmin
A. Tirofiban Aggrastat
C. Eptifibatide Integrlin

25. The rN is assessing a patient who is receiving chemotherapy with the cytotoxic agent
cyclophosphamide. Which finds would be considered a serious adverse effect of this
drug? A. Rising serum creatinine
B. Decreased urine output

26. The RN provides patient teaching for someone who will being taking indomethacin, a non
selective NSAID, to treat rheumatoid arthirits. Which statement by the patient indicates a need
further teaching?
A. “I should take indomethacin on an empty stomach”

27. A patient with multiple versus thromboembol is placed n a heparin infusion but develops
heparin induced thrombocytopenia. To continue treatment for the VTE, which medication does
the RN anticipate the physician will order to replace the heparin?
A. argatroban

28. Match the medication to the pathogen it treats

A. Staphylococcal infections oxacillin
B. Chlamydia tetracycline
C. Pseudomonas gentamicin

29. A 79-year-old patient is receiving ciprofloxacin as treatment for a gram negative infection.
The RN will monitor for which common adverse effect that is associate with this drug? A.
Tendonitis and tendon rupture

30. Medications that used to treat fungal infections are (select all that apply)
A. Nystatin
B. Diflucan

31. What would be a contraindication for taking ibuprofen

A. A recent history of GI bleeding
32. Match the medication to its side or adverse effect
ethambutol Rifampin
hepatoxicity Pyrazinamide
reddish-brown urine Ethanmbtol

33. A patient is admitted to the hospital for an inflammatory exacerbation (flare-up) of SLE. The
physician orders prednisone IVP to treat the SLE inflammation. Primary medical history: SLE,
diabetes, and heart failure. Meds: patient is currently taking Digoxin, Lasix and Atenolol. At
100, the patient is scheduled to receive a prednisone, digoxin and lasix. What must the RN do,
prior to giving these drugs, to ensure they are safe to give? Select three answers check
glucose, check BP, and check K+

35. Match the contraindication to the drug classification

history of seizure activity carbapenems
pregnancy tetracyclines
tendon inflammation fluorquinolones

36. The RN is discussing adverse effects of isoniazid with a patient who has active
tuberculosis. Which potential adverse effect on tuberculosis therapy should the patient report
to the physician?
A. Numbness of hands and feet

37. The patient is admitted to the hospital with unstable angina and will undergo a procedure to
open the affected coronary artery. Which three drugs will the RN expect to administer in
combination to treat this patient’s condition?
A. Aspirin, heparin, abciximab

38. Which of the following statements by the patient taking cyclosporin would indicate the
need for further patient teaching by the RN?
A. “I will take this med at breakfast with a glass of grapefruit juice”

39. During a physical assessment, the RN notes characteristic sign/symptms of inflammation

found on the patient’s left lower calf. What were the RN’s assessment findings to the affect
area?
A. Hear or warmth at the affect side
C. Redness
D. Edema

40. Which of the following places a patient at his for vitamin B12
defiiency? A. A strict vegan diet

41. An oncology RN is preparing to administer an oral chemotherapeutic agent. What

precaution must the nurse take while administering this medication?
A. Wear impermeable gloves when giving the drug

42. Match the generic to trade name

cefuroxime Ceftin
clarithromycin Biaxin
 doxycycline Bibramycin

43. Match the generic to trade name

Mebendazole Vermox
Tolnaftate Tinacpin
Fluconazole Difluacin

44. Which Black Box Warnings apply to the medication gentamycin? Select all that apply
A. Gentamycin can cause neuromuscular weakness
B. Gentamycin can cause nephrotoxicity
C. Gentamycin can cause neurotoxicity

45. Match the generic drug name to its trade name

ticagrelor Brilinta
ticlipidine Ticlid
prasurgrel Effient

The Black Box Warning for Erythrpoietin Alfa warns the RN to monitor for:
A. Splenic rupture
B. Vasculitus
C. Leukocytopenia
D. Thromboembolic events

46. The patient is receiving an IV infusion of amphotericin B for a patient for a severe fungal
infection. During assessment rounds, the RN notes that the patient is severely hypotensive and
is going into cardiovascular collapse. What should the RN’s first nursing intervention? A.
Discontinue the infusion immediately

47. The RN is providing discharge teaching to a patient going home on prednisone. The patient
has a history of high blood pressure and is also a diabetic. Which instructions should be
included in the teaching plan related to the effects of this medication?
A. Eat a low sodium diet
B. If you get an infection, call the doctor ASAP