Pharmacology Success: NCLEX®-Style Q&A Review Third Edition

Book Preface

PHARMACOLOGY TEST-TAKING HINTS

The test taker must know medications, and memorization is part of administering medications safely. This chapter contains some tips to assist the test taker in learning about medications. These tips apply to all the questions in this book. First, learn the specifi c classifi cation of a medication, including the actions, side effects,  and adverse effects. Also, learn how to safely administer a medication in the classifi cation.  Generally speaking, medications in a classifi cation share characteristics. However, be sure  not to be too broad in the classifi cation. For example, do not combine all medications  administered for hypertension in the same category. Angiotensin-converting enzyme (ACE)  inhibitors, beta blockers, and calcium channel blockers do not work in the same manner  and are not in the same classifi cation, even though they may all be used to treat hypertension. Similarly, medications for diabetes mellitus and diuretics fall into several classifi cation  groups, and the facts about each specifi c classifi cation must be learned. This knowledge will  assist the nurse in administering medications, as medications in a specifi c class will have  similar safety requirements and similar effects/side effects. For example, ALL beta blocker  medications require the nurse to monitor the blood pressure and apical pulse (AP) prior to  administering the medication.

The biggest change for a nursing student regarding learning to administer medications  and being able to pass the RN-NCLEX is that the RN-NCLEX examination no longer provides the test taker with the classifi cation or the trade name of the medication. This requires  the test taker to recognize the medication and its effects and side effects by memorization  of the generic name. Because of this change, all medications in the stems of the questions  will list only the generic names. The classifi cation of the medication and a trade name will  be provided in the answers section so the test taker will become familiar with several ways  to recognize the medications. The exception to this will be when the test taker is required  to use a medication administration record (MAR). In some clinical facilities, MARs contain  both the generic names and trade names of the medications, so some MARs will contain  both in this book.

When administering medications for a group of clients, the test taker must realize that  time is a realistic issue. It is not feasible for the nurse to look up 50 to 60 medications and  administer them all within the dosing time frame, so it is imperative that the nurse learn  about the most common medications.

One tip for learning about medications is for the test taker to complete handmade drug  cards. This is better than buying ready-made cards because in completing the drug cards the  test taker uses more than one method of learning—reading, deciding which information to  put on the card, and writing the pertinent information on the card. All of this assists the test  taker in memorizing the information

When the test taker is deciding which information is the most important to write on a  drug card, the following fi ve questions can be used as a guide. The test taker should always  ask why an intervention is being implemented. That is the key to critical thinking.

1. What classifi cation is the medication that the nurse is administering to the client, and  why specifi cally is this client receiving this medication? Many medications are categorized  in one classifi cation group, but the client is receiving the medication for a different reason.  For example, the medication trazodone is labeled as an antidepressant, but in reality it is  prescribed as a sedative medication (sleeper) because its sedating effects are more powerful  than its antidepressant effects. What action does the medication have on the body? This is  known as the scientifi c rationale for administering the medication.

Example #1: digoxin (Lanoxin) 0.25 mg po generic name (Trade Name)
• The classification of this medication is a cardiac glycoside.
• The medication is administered to clients with congestive heart failure (CHF) or rapid  atrial fi brillation.
• Cardiac glycosides increase the contractility of the heart and decrease the heart rate. (In  heart failure, the medication is administered to increase the contractility of the heart, but  in atrial fi brillation, the medication is administered to slow the heart rate.)

Example #2: furosemide (Lasix) 40 mg IV push (IVP) generic name (Common Trade Name)
• The classifi cation of the medication is a loop diuretic.
• The medication is administered to clients with essential hypertension or CHF or with any  other condition in which there is excess fl uid in the body.
• This medication helps remove excess fl uid from the body.
• Loop diuretics remove water from the kidneys along with potassium.
2. When should the nurse question administering this medication? Does the medication have  a therapeutic serum level? Which vital signs must be monitored? Which physiological parameters should be monitored when the medication is being administered? Example #1: digoxin (Lanoxin)

• Is the AP less than 60 beats per minute (bpm)?
• Is the digoxin level within the therapeutic range?
• Is the potassium level within normal range?

Example #2: furosemide (Lasix)
• Is the potassium level within normal range?
• Does the client have signs/symptoms of dehydration?
• Is the client’s blood pressure below 90/60?
3. What interventions must be taught to the client to ensure the medication is administered  safely in the hospital setting? What interventions must be taught for taking the medication  safely at home?

Example #1: digoxin (Lanoxin)
• Explain the importance of having serum levels checked regularly.
• Teach the client to take his or her radial pulse and not to take the medication if the pulse
is less than 60 bpm.
• Inform the client to take the medication daily and to notify the HCP if not taking the
medication.
Example #2: furosemide (Lasix)
• Teach about orthostatic hypotension.
• Instruct the client to drink a limited amount of water to replace insensible fl uid loss. • Because the medication is IVP, inform the client about how many minutes the medication
should be pushed, what primary IV is hanging, and whether the IV is compatible with Lasix

4. What are the side effects and potential adverse reactions? Side effects are undesired  effects of the medication, but they do not warrant discontinuing or changing the medication.
Adverse reactions are any situations that would require notifying the HCP or discontinuing  the medication.
Example #1: digoxin (Lanoxin)
• Decrease in heart rate to below 60 bpm.
• Signs of toxicity—nausea, vomiting, anorexia, and yellow haze.
Example #2: furosemide (Lasix)
• Side effects—dizziness, light-headedness.
• Adverse effects—hypokalemia; tinnitus if administered too quickly in IVP.
5. How does the nurse know the medication is effective?
Example #1: digoxin (Lanoxin)
• Have the signs/symptoms of CHF improved?
• Is the client able to breathe easier? How many pillows does the client have to sleep on  when lying down? Is the client able to perform activities of daily living (ADLs) without  shortness of breath? What do the lung fi elds sound like?
Example #2: furosemide (Lasix)
• Is the client’s urinary output greater than the intake?
• Has the client lost any weight?
• Does the client have sacral or peripheral edema?
• Does the client have jugular vein distention?
• Has the client’s blood pressure decreased?