Pharmacology – LPN Flashcards

Flashcards at practical and vocational nurse depth, focused on safe administration by oral and other basic routes, monitoring for expected and adverse effects, reinforcing teaching, and knowing what to report to the registered nurse. Cover the term, then recall the answer before revealing it.

Safe Administration Basics

List the rights of medication administration.

Right patient, right drug, right dose, right route, right time, right documentation, right reason, right response, right to refuse, and right education.

How many times is the label checked, which identifiers are used, and when is the dose documented?

The label is checked three times: when removing the medication from storage, when preparing it, and at the bedside before giving it. Two identifiers are used, such as full name, date of birth, or medical record number, checked against the identification band; the room number is never an identifier. Documentation occurs immediately after administration, never before.

Which oral medications must never be crushed?

Enteric-coated and extended-release forms, identified by labels such as EC, SR, XR, XL, CR, and LA, plus sublingual tablets and capsules containing coated beads unless the manufacturer permits opening. Crushing can deliver the entire dose at once. If a client cannot swallow, report it and request a different formulation.

What should the nurse do with an order written as ".5 mg"?

Clarify it with the prescriber and have it rewritten as 0.5 mg. A leading zero is always used before a decimal, and a trailing zero is never used, because missed decimal points cause tenfold and hundredfold overdoses.

May the practical nurse give a medication that another nurse prepared?

No. The nurse who administers the medication must be the nurse who prepared and verified it.

Name three actions generally outside the practical or vocational nurse scope of practice.

Performing the initial patient assessment, pushing intravenous medications and titrating continuous infusions such as heparin or vasopressors, administering blood products, and creating the initial patient teaching plan. The practical nurse reinforces teaching the registered nurse initiated. Always verify the state nurse practice act and facility policy.

Cardiovascular

What is checked before giving digoxin, and when is it held?

The apical pulse counted for a full minute. Hold and report if the rate is below 60 in an adult. Also report anorexia, nausea, vomiting, visual changes such as yellow-green halos, and unusual fatigue, which suggest toxicity.

What is checked before giving a beta blocker such as metoprolol?

Heart rate and blood pressure. Hold and report a pulse below 60 or a systolic blood pressure below 90 unless the provider has ordered otherwise. Teach the client never to stop the drug abruptly.

Why must a client with diabetes taking a beta blocker be taught carefully about hypoglycemia?

Beta blockers mask the early warning signs of tachycardia and tremor, so the client may only notice sweating or confusion. Teach the client to check the blood glucose rather than rely on symptoms.

Which foods are encouraged for a client taking furosemide?

Potassium-rich foods such as bananas, oranges, potatoes, tomatoes, and spinach, unless the client has kidney disease or takes a potassium-sparing diuretic. Also teach morning dosing, daily weights, and rising slowly to prevent dizziness.

Which diuretic causes high potassium rather than low potassium?

Spironolactone, a potassium-sparing diuretic. Teach the client to avoid salt substitutes, which contain potassium chloride, and to report muscle weakness or an irregular heartbeat. Gynecomastia is another reported effect.

What is the sublingual nitroglycerin teaching for chest pain?

Sit or lie down before taking it, place one tablet under the tongue and let it dissolve, and repeat every 5 minutes up to three doses. Call emergency services as directed if pain is not relieved. Expect headache and dizziness. Store in the original dark container. Never combine with erectile dysfunction drugs such as sildenafil.

What should a client on a statin be taught to report?

Unexplained muscle pain, tenderness, or weakness, especially with dark urine, which may signal rhabdomyolysis. Also teach avoiding grapefruit juice with simvastatin, lovastatin, and atorvastatin.

Endocrine

Which insulin is cloudy, and what is the mixing rule?

NPH is the only routinely cloudy insulin. When mixing regular with NPH, draw up clear before cloudy after injecting air into both vials. Long-acting insulins such as glargine and detemir are never mixed with other insulins.

Treatment of hypoglycemia in a conscious client?

The 15-15 rule: give 15 grams of fast-acting carbohydrate such as 4 ounces of juice or regular soda, 3 to 4 glucose tablets, or a tablespoon of honey, then recheck the glucose in 15 minutes and repeat if still low. Follow with a protein-containing snack if the next meal is not soon, and report the episode. Signs to recognize: shakiness, sweating, rapid heartbeat, hunger, headache, irritability, blurred vision, and confusion. Never give anything by mouth to a client who is not fully awake and able to swallow.

How is levothyroxine taken?

In the morning on an empty stomach with a full glass of water, at least 30 to 60 minutes before food, and separated from calcium, iron, and antacids by about 4 hours. Report palpitations, weight loss, heat intolerance, or insomnia, which suggest too high a dose. Therapy is usually lifelong.

Key teaching for a client on prednisone?

Take with food, never stop abruptly because the dose must be tapered, monitor blood glucose, report signs of infection since fever may be blunted, weigh regularly because of fluid retention, and expect mood changes and increased appetite.

Gastrointestinal and Musculoskeletal

What is expected with oral iron therapy, and what improves absorption?

Black or dark green stools and constipation are expected and harmless. Vitamin C, such as orange juice, improves absorption. Use a straw with liquid forms to protect tooth enamel, and increase fluid and fiber.

How is alendronate taken?

In the morning on an empty stomach with 6 to 8 ounces of plain water, remaining upright for at least 30 minutes with nothing else by mouth during that time, to prevent esophageal irritation and ulceration.

What is the main teaching point for antacids?

Separate antacids from other medications by 1 to 2 hours because they interfere with absorption. Aluminum-containing products cause constipation and magnesium-containing products cause diarrhea.

What opioid side effect does not improve with time?

Constipation. A bowel regimen with a stimulant laxative and stool softener, plus fluids, fiber, and activity as tolerated, is started along with the opioid. Report increasing sedation, which precedes respiratory depression.

Anti-infectives

Why must a client finish the entire antibiotic course?

Stopping early allows surviving organisms to regrow and promotes antibiotic resistance, even though symptoms improve first. Report rash, itching, difficulty breathing, or severe diarrhea.

What must be avoided with metronidazole?

All alcohol during therapy and for at least 3 days after the last dose, because of a disulfiram-like reaction with severe nausea, vomiting, flushing, and headache. Check mouthwash and liquid cold preparations for alcohol. A metallic taste and dark urine are expected.

Which drugs must be separated from dairy products, antacids, calcium, and iron?

Tetracyclines including doxycycline, and fluoroquinolones such as ciprofloxacin and levofloxacin. These bind the drug and block absorption, so separate them by at least 2 hours. Both classes also cause photosensitivity, so teach sun protection.

What is expected with rifampin, and what is reported?

Expected: orange discoloration of urine, sweat, saliva, and tears, and permanent staining of soft contact lenses. Rifampin also reduces the effectiveness of oral contraceptives. Report yellowing of the eyes or skin, dark urine, nausea, or right upper quadrant pain, which may signal liver injury.

Why is pyridoxine, vitamin B6, given with isoniazid?

To prevent peripheral neuropathy, which presents as numbness and tingling in the hands and feet. Report those symptoms and any signs of liver injury.

Other High-Yield Points

What must be done before applying a new transdermal patch?

Remove the old patch, cleanse the skin, apply the new patch to a different intact, clean, dry site, and document removal of the old patch. Wear gloves, do not cut a patch, and avoid heat sources over the patch because heat increases absorption.

What is the correct order for using a bronchodilator and an inhaled corticosteroid?

Bronchodilator such as albuterol first to open the airways, then the corticosteroid, and rinse the mouth afterward to prevent oral thrush. A spacer improves delivery.

What should the nurse do first after a medication error is discovered?

Assess the client and provide any needed care, then notify the registered nurse and provider, document the facts objectively in the medical record, and complete the occurrence report. The occurrence report is not filed in the chart.

What does the nurse do when a competent client refuses a medication?

Explain the purpose and consequences, respect the refusal, document it, and notify the registered nurse or provider. A medication is never hidden in food or given by deception.

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