RN Pharmacology VATI Re-evaluation Assessment

The nurse should teach the client to discard any regular insulin that appears cloudy, as regular insulin should

be clear. NPH insulin has a cloudy appearance.

The nurse should teach the client to inject air into the NPH vial first. The nurse should teach the client to draw

up the regular insulin into the syringe first.

Nystatin oral suspension should be stored at room temperature. The action of nystatin is local, and it is not

absorbed through intact skin or mucous membranes. There is no reason to take the medication on an empty

stoma. Nystatin must be swallowed to maximize the medication's local effects on the mucosal lining of the

upper gastrointestinal tract.

Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements

between meals helps to increase the bioavailability of the iron. Taking the medication with food can reduce the

GI symptoms associated with it. However, taking the medication between meals maximizes absorption

Reclining immediately after taking ferrous sulfate may lead to esophageal corrosion. Clients should remain

upright for 15-30 min following administering.

The nurse should explain that feverfew interferes with platelet action and can therefore cause bleeding. It is

unsafe for the client to take during pregnancy.

Sucralfate for gastric ulcer: The nurse should administer the medication to the client on an empty stomach for

best absorption. The nurse should instruct the client to increase fluids while on sucralfate therapy to decrease

the risk of constipation related to the medication. The nurse should instruct the client to avoid taking antacids

30 min before or after the administration of sucralfate.

Packed red blood cells for anemic patient: The nurse should check the client's vital signs every 15 min at the

start of the transfusion, then every 1 hr to monitor for a transfusion reaction. (answer said “check the clients

vitals every hour) (I chose to infuse at rate of 200 ml/hr) The transfusion should infuse in 2 to 4 hr to prevent

fluid overload.

Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in

the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such

as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma.

The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress.

Crushing the pill destroys that protection. Crushing the pill will destroy the enteric coating, and the client should

be advised against this, but the enteric coating does not prevent the release of medication. Sustained release

preparations disburse the medication over time.

Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications

commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of

the client's provider. The client understands that phenytoin causes an overgrowth of the gums that makes

dental monitoring important.

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Furosemide is correct. This medication is used to reduce edema and hypertension, and an adverse effect is

orthostatic hypotension.

Telmisartan is correct. This medication is used to control hypertension, and an adverse effect is orthostatic

hypotension.

Duloxetine is correct. This medication is used to treat depression and anxiety disorder, and an adverse effect

is orthostatic hypotension.

Clopidogrel is incorrect. This medication is used to reduce the risk of MI and stroke and does not cause

orthostatic hypotension.

Atorvastatin is incorrect. This medication is used to decrease cholesterol and does not cause orthostatic

hypotension.

Captopril: neutropenia

Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client

should avoid salt substitutes, as most of them are high in potassium. The client should take captopril on an

empty stomach, 1 hr before or 2 hr after a meal, in order to not reduce the medication’s absorption.

The nurse should teach the client that extended release tablets should be taken whole and should not be

broken, crushed, or chewed.

The client should avoid activities that require alertness. Diazepam is a benzodiazepine that causes sedation

and dizziness. The client should take this medication intermittently (3 or 4 nights per week) to prevent physical

dependence.

Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid.

Hyperventilation can cause respiratory alkalosis.

Hypermetabolism, such as with fever or exercise, can cause metabolic acidosis.

Respiratory depression can cause respiratory acidosis.

The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for

lipodystrophy. (insulin) The client should inject the medication into subcutaneous tissue. The client should mix

compatible solutions, such as regular insulin and NPH insulin, to reduce the need for an additional injection and

reduce the risk for lipodystrophy.

Adverse effects of nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia.

Nalbuphine can cause constipation, cramps, and abdominal pain, but it does not have diarrhea as an adverse

effect. Nalbuphine is unlikely to cause joint pain; however, it can cause headache and abdominal cramps.

Nalbuphine is unlikely to cause oliguria; however, it can cause urinary urgency.

Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity.

The nurse should first assess the client’s airway and oxygen saturation to determine the need for respiratory

support. Intubation or tracheotomy is considered if adequate oxygenation is not maintained. The second step

the nurse should take is to call the rapid response team to provide emergency treatment in case of cardiac or

respiratory arrest. Next, the nurse should apply high-flow oxygen to increase oxygenation and then initiate an

IV site, if one is not present, and administer isotonic IV fluids to prevent hypotension and provide access for IV

medications. The nurse should then administer IV epinephrine to constrict blood vessels, dilate bronchioles,

and increase cardiac function. And finally, the nurse should administer IV antihistamines and corticosteroids to

block the effects of histamine and decrease edema.

Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's

potassium level to watch for hypokalemia.

Grapefruits and grapefruit juice can reduce metabolism of atorvastatin, which increases the risk for toxicity.

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