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(BQ) Part 2 book Pharmacology success presentation of content: Musculoskeletal system, integumentary system, immune inflammatory system, cancer treatments, mental health disorders, sensory deficits, emergency nursing, nonprescribed medications, administration of medications, comprehensive examination.
3905_Ch08_213-234 22/01/14 10:22 AM Page 213 Musculoskeletal System Never regard study as a duty, but as the enviable opportunity to learn to know the liberating influence of beauty in the realm of the spirit for your own personal joy and to the profit of the community your later work belongs —Albert Einstein QUESTIONS A Client With Low Back Pain The client is diagnosed with low back pain and is prescribed the muscle relaxant cyclobenzaprine (Flexeril) Which instructions should the clinic nurse teach the client? Select all that apply Take the medication just before leaving home for work each day Drink a full glass of water with each dose of medication The medication can cause drowsiness that will make driving unsafe Divide the dose of medication between early morning and bedtime Suck on hard candy if the client experiences a dry mouth The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with back pain Which HCP order should the charge nurse question? Physical therapy for hot packs and massage CBC and CMP (complete metabolic panel) Hydrocodone (Vicodin), an opioid analgesic, PRN Carisoprodol (Soma), a muscle relaxant, po, b.i.d The nurse is administering medications to clients on an orthopedic unit Which medication should the nurse question? Ibuprofen (Motrin), an NSAID, to a client with back pain and a history of ulcers Morphine, an opioid analgesic, to a client with back pain rated as Methocarbamol (Robaxin), a muscle relaxant, to a client with chronic back pain Propoxyphene (Darvon N), a narcotic agonist, to a client with mild back pain The client diagnosed with low back pain is prescribed morphine sulfate, an opioid analgesic Which interventions should the nurse implement? Select all that apply Discuss with the HCP starting the client on a stool softener Teach the client about rating the pain on a numeric pain scale Inform the client to rise quickly from a supine position Administer anticonvulsant medications around the clock Tell the client to call for assistance when getting out of bed 213 3905_Ch08_213-234 22/01/14 10:22 AM Page 214 214 PHARMACOLOGY SUCCESS The client diagnosed with low back pain is scheduled to have a steroid injection into the intrathecal space Which statement by the client indicates the client understands the procedure? “I will have to curl up like a Halloween cat.” “This procedure will cure my back pain.” “I will have an injection in each of my hips.” “There is no risk with this procedure.” The nurse is completing the preoperative checklist for a client diagnosed with a herniated disc Which information is priority for the nurse to notify the operating room staff? The client is complaining of a headache The client is allergic to iodine and aspirin The client has not had anything to drink The client’s hematocrit is 43% The client presents to the outpatient clinic complaining of back pain Which assessment question should the nurse ask first? “What activity did you to hurt your back?” “Which over-the-counter medications have you taken?” “Have you used illegal drugs to treat the back pain?” “Did you miss any work time because of this pain?” The client with chronic low back pain has been taking baclofen (Lioresal), a muscle relaxant Which instruction should the nurse review with the client? The medication can cause gastric ulcer formation The client may consume no more than one glass of wine per day The medication must be tapered off when discontinued The client should not take the medication before bedtime The nurse is administering 0900 medications to clients on a medical unit Which medication should be administered first? MS Contin, a narcotic analgesic, to a client with low back pain Chlorzoxazone (Parafon Forte), a muscle relaxant, to a client on bedrest Acetaminophen (Tylenol), an analgesic, to a client with a headache Diazepam (Valium), a benzodiazepine, to a client with muscle spasms 10 The client is admitted with severe low back pain and prescribed the muscle relaxant methocarbamol (Robaxin), IVPB every hours Which nursing intervention has priority when administering this medication? Ask the client to lie flat for 15 minutes following the IV infusion Infuse at a rapid rate of 200–250 mL/hr via an infusion pump Assess the IV site for extravasation after the infusion is complete Monitor liver function laboratory tests daily A Client With Renal Osteoarthritis 11 The client with osteoarthritis is prescribed the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID) Which statement by the client warrants intervention by the nurse? “I take aspirin daily to help prevent heart disease.” “I am allergic to penicillin and aminoglycosides.” “I know I am overweight and need to lose 50 pounds.” “I walk 30 minutes at least three times a week.” 3905_Ch08_213-234 22/01/14 10:22 AM Page 215 CHAPTER MUSCULOSKELETAL SYSTEM 12 The client with severe osteoarthritis of the left knee is receiving sodium hyaluronate (Hyalgan) injected directly into the left knee Which information should be discussed with the client? Explain that this medication will cause some bleeding into the joint Instruct the client to avoid any strenuous activity for 48 hours after injection Discuss that the medication will be injected daily for days Tell the client that strict bed rest is required for 24 hours after the injection 13 The nurse is preparing to administer the following medications Which medication should the nurse question administering? Ibuprofen (Motrin), an NSAID, to a client receiving furosemide (Lasix) Nabumetone (Relafen), a COX-2 inhibitor, to a client receiving digoxin (Lanoxin) Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin) Ketorolac (Toradol), an NSAID, intramuscularly to a client on a morphine PCA 14 The client is taking acetylsalicylic acid (ASA) four to five times a day for severe osteoarthritic pain Which teaching interventions should the nurse discuss with the client? Select all that apply Do not drink any type of alcoholic beverages Keep the ASA bottle out of the reach of children Inform the dentist about taking high doses of ASA Maintain a serum salicylate level between 15 and 30 mg/dL Explain that ringing in the ears is a common side effect 15 At 0900 the charge nurse observes the primary nurse crushing an enteric-coated aspirin in the medication room Which action should the charge nurse implement? Take no action because this is an acceptable standard of practice Correct the primary nurse’s behavior in the medication room Explain that enteric-coated medication should not be crushed Complete an adverse occurrence report on the primary nurse 16 The client with osteoarthritis of the hands is prescribed capsaicin (Capsin) cream, a nonopioid topical analgesic Which intervention should the nurse discuss with the client concerning this medication? Wash the hands immediately after applying the cream Remove cream immediately if burning of the skin occurs Apply a heating pad to the affected area after applying the cream Do not remove the cream for at least 30 minutes after application 17 The elderly client in the hospital is complaining of arthritic pain Which intervention should the nurse implement? Administer meloxicam (Mobic), an NSAID COX-2 inhibitor Administer acetylsalicylic acid (ASA), a salicylate Administer acetaminophen (Tylenol), a nonnarcotic analgesic Administer morphine intravenous push, a narcotic analgesic 18 The female client with osteoarthritis tells the clinic nurse that she started taking the herb ginkgo Which intervention should the nurse implement? Determine what medications the client is currently taking Praise the client because this herb helps decrease inflammation Notify the health-care provider that the client is taking ginkgo Examine why the client thought she needed to take herbs 19 The HCP is administering an intraarticular corticosteroid mixed with lidocaine to a client with severe osteoarthritis in the right knee Which statement by the client warrants intervention by the nurse? “I have taken off work tomorrow so I can rest my knee.” “I am attending physical therapy once a week.” “I alternate heat and ice on my knee when I am having pain.” “I had one of these just last month and it really helped the pain.” 215 3905_Ch08_213-234 22/01/14 10:22 AM Page 216 216 PHARMACOLOGY SUCCESS 20 The client with osteoarthritis who is taking the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID), calls the clinic and reports having black, tarry stools Which intervention should the clinic nurse implement? Ask if the client is taking any type of iron preparation Tell the client to not take any more of the Celebrex Instruct the client to bring a stool specimen to the clinic Explain that this is a side effect of the medication A Client With Renal Osteoporosis 21 The postmenopausal client is prescribed alendronate (Fosamax), a bisphosphonate, to help prevent osteoporosis Which information should the nurse discuss with the client? Select all that apply Chew the tablet thoroughly before swallowing Eat a meal prior to taking the medication Drink one glass of water when taking the medication Take the medication first thing in the morning Remain upright 30 minutes after taking the medication 22 The client with postmenopausal osteoporosis is prescribed calcitonin (Calcimar) intranasal Which instruction should the nurse discuss with the client? Notify the health-care provider if nausea and vomiting occur Decrease calcium and vitamin D intake during drug therapy Remove the nasal spray from the refrigerator immediately before using Expect to experience rhinitis when taking the medication 23 The client is prescribed raloxifene (Evista), a selective estrogen receptor modulator (SERM) Which information should the nurse discuss with the client? Instruct the client to walk for 10 minutes every hour when traveling in a car Encourage the client to decrease smoking cigarettes and drinking alcohol Explain that Evista will decrease the hot flashes experienced with menopause Discuss the importance of performing non-weightbearing activities 24 The long-term care nurse is preparing to administer calcium gluconate (Kalcinate) to a client with osteoporosis Which data warrants the nurse questioning administering this medication? The client asks the nurse for a walker to ambulate The client’s oral intake is 850 mL and urinary output is 1250 mL The client is lethargic, is drowsy, and has increasing weakness The client has abnormal bleeding when brushing the teeth 25 Which statement best describes the scientific rationale for administering calcitonin (Calcimar) to a client diagnosed with osteoporosis? It blocks estrogen receptors in the uterus and breast It inhibits bone reabsorption by suppressing osteoclast activity It increases bone density and reduces the risk of vertebral fractures It increases the progesterone and estrogen levels in the blood 26 The nurse is discussing ways to prevent osteoporosis to a group of elderly women A woman in the audience asks, “Why aren’t doctors prescribing hormone replacement therapy?” Which statement by the nurse is most appropriate? “There are many other, better ways to treat osteoporosis than HRT.” “HRT treatment is very expensive and many insurances will not pay.” “There is an increased risk of cancer and deep vein thrombosis associated with HRT.” “Research has shown that it is not effective in treating osteoporosis.” 3905_Ch08_213-234 22/01/14 10:22 AM Page 217 CHAPTER MUSCULOSKELETAL SYSTEM 27 Which assessment data best indicates to the nurse that the medication therapy for a client with osteoporosis has been effective? The client’s serum calcium level is 7.5 mg/dL The client does not experience any pathological fractures The client has adequate urinary output The client loses less than inch in height 28 The client with osteoporosis is prescribed sodium fluoride, a mineral Which information should the nurse discuss with the client? Select all that apply Monitor serum fluoride levels every months Have bone mineral density studies monthly Maintain an adequate calcium intake Sprinkle medication on food Walk 30 minutes a week on a hard surface 29 Which statement indicates the 30-year-old client does not understand the teaching concerning how to prevent osteoporosis? “I need to take at least 1500 mg of calcium daily.” “Milk and dairy products are good sources of vitamin D.” “I must get shots weekly to increase my calcium level.” “I should take steps to prevent osteoporosis now.” 30 Which statement indicates the postmenopausal client with osteoporosis understands the medication teaching concerning the bisphosphonate alendronate (Fosamax)? “I not use sunscreen when working outside in my yard.” “I take the medication with 6–8 ounces of tap water.” “I drink orange juice when I take the medication at breakfast.” “I may experience some heartburn when taking this medication.” A Client Undergoing Orthopedic Surgery 31 The client who had surgery for a hip fracture is complaining of severe pain 45 minutes after the nurse administered morphine IVP Which intervention should the nurse implement first? Administer another dose of morphine Turn on the television to distract the client Assess the client’s affected leg for alignment Notify the health-care provider of the problem 32 The client postoperative from hip surgery is scheduled to ambulate with the physical therapist Which intervention should the nurse implement to assist the client to be able to perform the therapy? Assist the client to the bedside chair with the therapist’s help Administer pain medication 30 minutes before the therapy Ask the unlicensed assistive personnel to brush the client’s hair Allow the client to delay the therapy until late in the day 33 The 84-year-old female client with a fractured knee is unable to rate her pain on a numeric pain scale Which intervention should the nurse implement? Have the client use a pediatric faces scale Do not try to get the client to rate the pain The nurse should decide the amount of pain Check the pulse and blood pressure for elevation 217 3905_Ch08_213-234 22/01/14 10:22 AM Page 218 218 PHARMACOLOGY SUCCESS 34 The male client who has had bilateral knee replacement surgery calls the nurse’s desk and reports that he noticed bruises on both sides of his abdomen while taking his bath The client’s MAR notes Ancef, an antibiotic; morphine, a narcotic analgesic; and Lovenox, a low-molecular-weight heparin Which statement is the nurse’s best response to the client? “This is a reaction to the antibiotic you are receiving and it will need to be changed.” “This is caused by straining when trying to have a bowel movement.” “This occurs because of the positioning during the surgical procedure.” “This happened because of the medication used to prevent complications.” 35 The client who has had a total knee surgery returns to the room with an autotransfusion drainage system (cell saver) device inserted into the wound Which interventions should the nurse implement? Select all that apply Monitor the drainage in the collection chamber every 30–45 minutes Take the drainage to the blood bank when it reaches 200 mL Attach a filter to the drainage before administering Have a second nurse verify the client’s ID band Monitor vital signs every 5–15 minutes when transfusing the blood 36 The 78-year-old client who had hip surgery is to receive a unit of packed red blood cells (PRBC) The nurse’s assessment reveals bilateral crackles in the lungs and 2+ edema of the sacrum The PRBCs contain 250 mL of cells and 60 mL of preservative solution At what rate will the nurse set the IV infusion pump after the initial 15 minutes? Answer 37 A 10-year-old child sustained a compound fracture of the left forearm and has just returned to the unit after an open reduction and internal fixation (ORIF) Which interventions should the nurse implement? Select all that apply Assess the child’s ability to rate the pain on a pain scale Ask the parent to determine when the child needs pain medication Apply a heat pack to the cast until the cast is completely dry Check the child’s fingertips for warmth and color every 15 minutes Administer the prophylactic antibiotic as prescribed by surgeon 38 The nurse is administering medications at 2100 Which medication should the nurse question? An NSAID to a 24-year-old female client recovering from an arthroscopy An opioid analgesic to a 50-year-old male client with a fractured femur A sedative hypnotic to a 65-year-old female client with a total knee replacement A muscarinic antagonist to an 89-year-old male client with a hip fracture 39 The client is postoperative for a cervical laminectomy and is prescribed meperidine (Demerol), a narcotic analgesic, by patient-controlled analgesia (PCA) pump Which instruction regarding pain control should the nurse teach the client? Notify the nurse when needing pain medication Press the button on the pump when the client feels pain Have the significant other push the button on the pump frequently Use the pain medication sparingly to prevent narcotic addiction 40 The nurse and unlicensed assistive personnel (UAP) are caring for clients on an orthopedic unit Which action by the UAP requires immediate intervention? The UAP obtains a fracture pan for a client with a laminectomy to use The UAP attempts to ambulate an elderly client immediately after receiving pain medication Prior to bedtime, the UAP provides a back rub to a client with low back pain The UAP places moisture barrier cream on a client’s perineal area ANSWERS AND RATIONALES 3905_Ch08_213-234 22/01/14 10:22 AM Page 219 ANSWERS AND RATIONALES The correct answer number and rationale for why it is the correct answer are given in boldface blue type Rationales for why the other possible answer options are not correct are also given, but they are not in boldface type A Client With Low Back Pain 1 Taking the medication before leaving the house could be a danger to the client and others because this medication can cause drowsiness The client should not be driving or operating equipment until the client has determined the effect of the medication on his or her body There is no need to drink a full glass of water when taking Flexeril The medication acts on the central nervous system and can cause drowsiness The client should be warned not to drive until the client understands the effects on his or her body Driving could be dangerous for the client and others This is prescribing The HCP will prescribe how frequently the dose should be administered A side effect of Flexeril is a dry mouth, so using hard candy is an appropriate intervention Physical therapy for heat and massage is standard therapy for back pain There is no reason to question this order Many medications can affect the kidneys or the liver and the blood counts Baseline data should be obtained There is no reason to question this order This medication order is incomplete The nurse should contact the HCP for a time limitation Soma comes in one strength, so this order is complete There is no reason to question this order MEDICATION MEMORY JOGGER: All medication orders must be complete, and the nurse is responsible for determining all the parameters before administering a medication NSAIDs decrease prostaglandin production in the stomach, increasing the client’s risk of developing ulcers This client has a known risk of peptic ulcer disease The nurse should question the medication and discuss this with the HCP Opioid analgesics are administered for pain The client is in the moderate to severe pain range The nurse would administer this medication Muscle relaxant medications are administered to clients with back pain to relax the muscles and decrease the pain The nurse would administer this medication Darvon N is a pain medication The nurse would administer this medication Narcotic pain medications slow peristalsis in the small and large intestines, increasing the risk for constipation and fecal impaction The nurse should discuss a bowel regimen with the HCP The nurse should attempt to have the client quantify the pain so that the effectiveness of interventions can be evaluated The numeric pain scale is one method of objectifying the pain Rising quickly from a flat-on-the-back (supine) position could increase the client’s pain Some of the medications administered for back pain can cause orthostatic hypotension The nurse should teach the client to turn on the side and push up on the elbow slowly when getting out of bed The client may be taking antispasmodic and pain medications, but there is no reason for anticonvulsant medications This is a safety issue The client should call for assistance to prevent falls Intrathecal indicates into the central nervous system via a lumbar puncture The client will be positioned with the back arched, much like a Halloween cat, for the HCP to be able to insert the needle between the vertebrae The procedure provides temporary relief of inflammation of affected nerves The injections are into the intravertebral space, not into the hips An injection in the hips indicates an intramuscular injection There is risk with any procedure In this procedure, nerve damage is the greatest risk The client’s complaint of a headache occurs frequently when clients have not been able to eat or drink, especially caffeine drinks This is not a priority at this time The standard surgical scrub is a povidoneiodine (Betadine) antiseptic skin preparation This should be brought to the attention of the surgical nurse who will 219 3905_Ch08_213-234 22/01/14 10:22 AM Page 220 220 PHARMACOLOGY SUCCESS be preparing the surgical site so that a substitute can be used Clients going to surgery should be NPO for several hours to prevent aspiration during anesthesia This is a normal hematocrit This is important, but it is not priority during the initial assessment The nurse should determine how the client has been treating the injury This would be the second query, not the first The priority at this time is to determine what medications have been tried in order to assess the full extent of the injury This is the first intervention Adult clients will frequently only seek the HCP’s advice and treatment when over-the-counter remedies have failed This is an accusatory statement and most likely will make the client mistrust the nurse’s objectives This should not be asked at this time This is the third query the nurse could ask Missed work time is important, but to treat the client, the HCP must be aware of the attempted treatments This medication is not known to increase the risk of ulcers The client should be warned not to consume any alcohol while taking baclofen Baclofen is a central nervous system depressant, as is alcohol The combination of alcohol and baclofen could intensify the depressant effects Baclofen must be tapered off when being discontinued Abrupt withdrawal after prolonged use can cause anxiety, agitated behavior, hallucinations, severe tachycardia, acute spasticity, and seizures The medication can cause drowsiness, which might assist the client to rest Administration at bedtime is preferred if this is so MEDICATION MEMORY JOGGER: There is rarely any medication for which the client will be told that concurrent administration with alcohol is appropriate MS Contin is a sustained-release tablet This medication is to provide relief of chronic pain over the course of the day It does not need to be the first medication administered The client prescribed bed rest usually takes a muscle relaxant as a routine medication; it does not need to be administered first A headache that is to be treated with Tylenol (for mild pain) would not be the first medication for the nurse to administer A client having muscle spasms is a priority for the nurse Muscle spasms can be extremely painful This medication should be administered first 10 The client should be kept recumbent during and for at least 15 minutes following the administration of Robaxin IV to reduce the risk of orthostatic hypotension The medication must be administered slowly at a rate of no greater than 300 mg per minute, not by rapid infusion The IV site should be assessed prior to the initiation of the medication to prevent complications from extravasation of the medication into the tissues Robaxin is detoxified by the kidneys, not the liver A Client With Renal Osteoarthritis 11 The client should not take aspirin with an NSAID because it can increase the risk of gastrointestinal upset and possible gastrointestinal bleeding Allergies to antibiotics are not a contraindication to the use of NSAIDs Obesity is not contraindicated in clients taking NSAIDs Exercising is recommended for clients with osteoarthritis unless it causes pain; therefore, this activity would not warrant the client not taking Celebrex 12 Any bleeding into the joint is a complication Bleeding into a joint would not be the expected benefit of any type of medication After the injection the client can walk and perform routine daily activities, but running, bicycling, or strenuous activity should be avoided Hyalgan is a preparation of a chemical normally found in high amounts in the synovial fluid The injection replaces or supplements the body’s natural hyaluronic acid that deteriorates as a result of the inflammation of osteoarthritis The treatment includes three to five injections; the client receives one injection every week This injection is done in an HCP’s office, and the client will be able to walk out of the clinic after the injection 3905_Ch08_213-234 22/01/14 10:22 AM Page 221 CHAPTER MUSCULOSKELETAL SYSTEM MEDICATION MEMORY JOGGER: The nurse should realize that the joint must have time for the medication to be effective and injecting daily would not allow this The nurse should realize that a medication should not cause an abnormal body function, such as bleeding into the joint 13 NSAIDs not interfere with the effectiveness of loop diuretics; therefore, the nurse would not question administering the Motrin COX-2 inhibitors not interfere with the effectiveness of cardiac glycosides; therefore, the nurse would not question administering the Relafen Aspirin displaces warfarin from proteinbinding sites and will increase the client’s bleeding; therefore, the nurse should question administering the aspirin Toradol is often administered around the clock to a client in pain, along with a narcotic analgesic Toradol decreases the inflammation to help decrease the pain 14 Alcohol displaces warfarin from proteinbinding sites and will increase the client’s bleeding; therefore, the nurse should instruct the client not to drink alcohol ASA poisoning can kill children, and all medications, prescription or nonprescription, should be kept out of the reach of children High doses of ASA can cause bleeding; therefore, the dentist should be made aware of the client’s medication use Aspirin toxicity can occur when the client is taking ASA four to five times a day; therefore, the serum level should be kept within normal limits (15–30 mg/dL) Mild toxicity occurs with serum levels above 30 mg/dL and severe toxicity occurs above 50 mg/dL Tinnitus (ringing in the ears) is a sign of aspirin toxicity and should be reported to the health-care provider 15 Enteric-coated aspirin should not be crushed The charge nurse should not correct the primary nurse in front of other staff and, at 0900, there would be other nurses in the medication room The charge nurse should explain to the primary nurse that enteric-coated ASA should not be crushed because the coating that ensures the ASA will dissolve only in the small intestine, where the coating dissolves The aspirin will be absorbed in the stomach if the coating is crushed Because the client did not receive the crushed enteric-coated ASA, no adverse occurrence report needs to be completed This form is completed if the client’s condition has been compromised in some way 16 This medication is being administered for the hands; therefore, the client should not wash off the medication immediately after application The client should know that transient burning occurs with the application The client should not apply heat because this will increase the burning of the skin secondary to the cream application Burning is increased by heat, sweating, bathing in warm water, humidity, and clothing The topical cream should be kept in place at least 30 minutes after application because it is being administered for osteoarthritis of the hands If not being applied for hands, the cream should be washed off immediately 17 These medications are administered around the clock and are not specifically for acute pain Aspirin has side effects, such as gastrointestinal discomfort, and is not the drug of choice for elderly clients Acetaminophen is generally preferred for use in older clients because it has fewer toxic side effects Morphine is a narcotic, is not used to treat chronic arthritis pain, and should be used cautiously in elderly clients 18 The first intervention the nurse should implement is to determine if the client is taking any medication that will interact with the herb Ginkgo, along with dong quai, feverfew, and garlic, when taken with NSAIDs may cause bleeding Gingko is used to treat allergic rhinitis, Alzheimer’s disease, anxiety or stress, dementia, tinnitus, vertigo, and poor circulation It is not known to decrease inflammation The nurse should determine what medications the client is currently taking and if gingko interacts with them prior to notifying the HCP The nurse does not need to know why the client thought he or she needed to take the herb; this is an accusatory intervention 221 3905_Ch08_213-234 22/01/14 10:22 AM Page 222 222 PHARMACOLOGY SUCCESS The nurse should support alternative-type medicine if it does not interfere with other medications the client is currently taking MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client The nurse should always be the client’s advocate 19 Resting the knee after the injection is an appropriate action for the client to take It would not warrant intervention by the nurse Physical therapy for range-of-motion exercises is an acceptable conservative treatment for osteoarthritis The client should inform the physical therapist of the treatment, but this statement does not warrant immediate intervention by the nurse Alternating ice and heat is an acceptable conservative treatment for easing the pain secondary to osteoarthritis This statement would not warrant intervention by the nurse This procedure does provide marked pain relief, but it should not be done more than every 4–6 months because it can hasten the rate of cartilage breakdown This statement should be reported to the HCP Clients often go to more than one HCP 20 Iron preparations can cause black, tarry stool, but because the client is taking an NSAID the nurse should realize tarry stools are a sign of gastrointestinal distress, which is a complication of NSAID medications NSAIDs are notorious for causing gastrointestinal upset and peptic ulcer disease Black, tarry stool indicates GI bleeding; therefore, the client should stop taking the medication A specimen is not sent to the laboratory when the stool is black and tarry The nurse should know these are signs of GI bleeding This is not an expected side effect of the medication, and the NSAID should be discontinued immediately MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications A Client With Renal Osteoporosis 21 The client should swallow the medication The client should not crush, chew, or suck on the medication The medication should be taken on an empty stomach at least 30 minutes before eating or drinking any liquid Foods and beverages greatly decrease the effect of Fosamax The medication should be taken on an empty stomach at least 30 minutes before eating or drinking any liquid Foods and beverages greatly decrease the effect of Fosamax The medication will irritate the stomach and esophagus if the client lies down; therefore, the medication should be taken when the client can remain upright for at least 30 minutes first thing in the morning This client must remain upright to facilitate the passage of the medication to the stomach and minimize the risk of esophageal irritation 22 Nausea and vomiting occur during the initial therapy and will disappear as the treatment continues; therefore, the client does not need to notify the HCP The client should consume an adequate amount of calcium and vitamin D while taking this medication The nasal spray should be room temperature before using The nasal spray is not kept in the refrigerator Rhinitis, a runny nose, is the most common side effect with calcitonin nasal spray, but the client should not quit taking the medication if this occurs 23 Evista increases the risk of venous thrombosis; therefore, the client should avoid prolonged immobilization including driving long distances in a car The client should not just decrease smoking and alcohol The client needs to stop both of these activities because they interact with the medication Evista will not reduce hot flashes or flushes associated with estrogen deficiency and may cause hot flashes 3905_Index_471-488 22/01/14 10:39 AM Page 474 474 INDEX Carisoprodol (Soma), 213, 219, 434, 452 Carvedilol (Coreg), 438 Cascara, 381, 385 Catapres (clonidine), 69, 74, 330, 334, 438 Category D medications, 186, 199 Cefaclor (Ceclor), 441, 449, 452, 454 Ceftriaxone (Rocephin), 78, 86, 105, 124, 407, 422 Celecoxib (Celebrex), 229, 232, 456 black, tarry stools, 216, 222 Celexa (citalopram), 457 Cellulitis, 246, 249 Cellulose sodium phosphate (Calcibind), 184, 197 Cephalosporins Ancef, 95, 99 penicillin, cross-sensitivity with, 181, 193 Cephulac (lactulose), 106, 107, 125–126, 127, 142, 145, 408, 423 Cerebyx (fosphenytoin), 9, 20 Cerebrovascular accidents (CVAs), 10–11, 21–22, 32, 35, 364, 367, 414, 429 embolic stroke, 21 hemorrhagic stroke, 21 thrombotic stroke, 21 Cervidil (dinoprostone), 187, 200 Cetirizine (Zyrtec), 454 Chantix (varenicline) smoking cessation, 407, 421 Charcoal, activated, 355, 356, 363, 461 Chasteberry, 381, 384, 463 Chemotherapy, 275–277, 276t–277t, 286–287 Chest pains, aspirin for, 70, 74 Children abuse, 311, 323 administering IV fluids, 397, 401 administering medication, 5, 390, 394 attention deficit–hyperactivity disorder, 311–312, 323–325 bruises, 311, 323 eardrops, administering, 397, 400 gastroenteritis, 109–110, 129–131, 130t immunizations, 257–258, 265–267 diabetes and, 257, 266 flu vaccine, 257, 266 hepatitis B, 257, 266 inactivated poliovirus vaccine (IPV), 258, 267 injection site, 257, 266 measles, mumps, and rubella vaccine, 257, 286 permanent record of, 257, 265–266 varicella vaccine, 257, 266 poisoning, 355–356, 362–363 rating pain, 217, 224 reactive airway disease, 81–82, 90–91 Chlamydia trachomatis, 185, 198 pelvic inflammatory disease and long-term effects, 206, 209 Chlordiazepoxide (Librium), 152, 162, 314, 326 alcohol withdrawal, 407, 421 Chlorine, 352, 359 Chlorothiazide (Diuril), 439 Chlorpheniramine maleate, 454 Chlorpromazine (Thorazine), 252, 260, 458 dosage, 331, 331f, 335 tardive dyskinesia, 309, 321 Chlorpropamide (Diabinese), 155, 166, 448 Chlorzoxazone (Parafon Forte), 228, 231, 410, 424–425 Cholesterol, 39, 55–56 Cholestyramine (Questran), 39, 55, 109, 129, 437 Chondroitin, 228, 231 Chorigon (chorionic gonadotropin), 166–167 Chorionic gonadotropin (Chorigon), 166–167 Chronic kidney disease, 179–180, 191–192 Chronic obstructive pulmonary disease (COPD), 78–79, 86–88, 94–95, 98 Chronic pain, 284, 295 See also Pain cancer treatments, 283–285, 294–296 compazine and morphine compatible in same syringe, 285, 296 hydrocodone with acetaminophen (Vicodin), 284, 295 medications, teaching, 283, 294 morphine (Roxanol), 285, 296 MS Contin, 285, 296 narcotic prescriptions, 284, 295 sleeping medication, 284, 295 spiritual distress and, 284, 295 whatever the client says it is, 283, 294–295 Chronulac (lactulose), 106, 107, 125–126, 127, 142, 145, 408, 423 Cimetidine (Tagamet), 332, 335, 444 side effects of, 102, 119 Crixvan (indinavir), 455 Citalopram (Celexa), 457 Citric acid (Bicitra), 449 Citrucel (methylcellulose), 105, 124 Clarinex (desloratadine), 454 Claritin (loratadine), 454 Clarithromycin (Biaxin), 347, 350 Clemastine (Tavist), 254, 263 Clindamycin (Cleocin), 46, 453 Clinical trials, 297, 301 Clomiphene (Clomid), 188, 201 Clonazepam (Klonopin), Clonidine (Catapres), 69, 74, 330, 334 Clopidogrel (Plavix), 40, 56–57, 300, 303–304, 438 Clostridium difficile, 109 Clotrimazole (Lotrimin), 453 Clozapine (Clozaril), 308, 319–320, 320, 457 Cluster headaches, 28 Cocaine abuse, signs of, 330, 334 overdose, 315, 328 Code, client experiencing, 354–355, 360–362 Codeine, 434, 445, 450, 451, 459 Codone (hydrocodone), 32, 36, 94, 97, 229, 232, 434, 445, 450–451, 459 constipation and, 78, 86 Cogentin (benztropine), 14, 25, 433 Colace (docusate sodium), 105, 106, 124–125, 125, 445 Colestipol (Colestid), 437 Colloid solutions, 358 CombiDerm dressing, 237, 241–242 Compazine (prochlorperazine), 110, 131, 457 Comprehensive examination, 403–432 administering medications, 396–402 answers and rationales, 399–402 adrenal disorders, 170–177 answers and rationales, 174–177 answers and rationales, 418–432 cancer treatments, 297–304 answers and rationales, 301–304 3905_Index_471-488 22/01/14 10:39 AM Page 475 INDEX cardiovascular system, 69–76 answers and rationales, 73–76 emergency nursing, 364–370 answers and rationales, 367–370 gastrointestinal system, 140–147 answers and rationales, 144–147 genitourinary system, 205–211 answers and rationales, 208–211 immune inflammatory system, 268–274 answers and rationales, 272–274 mental health disorders, 329–336 answers and rationales, 333–336 musculoskeletal system, 227–233 answers and rationales, 230–233 neurological system, 30–36 answers and rationales, 33–36 nonprescribed medications, 381–387 answers and rationales, 384–387 pulmonary system, 94–100 answers and rationales, 97–100 questions, 403–417 sensory deficits, 345–350 answers and rationales, 348–350 Comtan (entacapone), 14, 25 Concussion, 414, 428–429 Condoms, 374, 380 allergic reaction to, 190, 203 Conduction problems and dysrhythmias, 42–44, 42f–44f, 58–59 Congestive heart failure, 41–42, 56–57 signs and symptoms, 74 symptoms, 41, 56 weight gain and, 41, 56 Constipation, 112–113, 133–135, 404, 419 preventing, 113, 134 Contraceptives condoms, 374, 380 allergic reaction to, 190, 203 oral, 189, 190, 203–204 breastfeeding and, 189, 203 28-day pack, 190, 204 decreased risk for several disorders, 203 ineffective with some antibiotics, 205, 208 stroke and, 10, 22 Contrast dye, CT with, 403, 418 COPD (chronic obstructive pulmonary disease), 78–79, 86–88, 94–95, 98 CoQ10, 383, 387, 463 Cordarone (amiodarone), 43, 58, 71, 403, 418, 436, 461 Coreg (carvedilol), 438 Coricidin HBP, 374, 379 Corns, 229, 232 Cornstarch, 141, 144 Coronary artery disease, 39–40, 40t, 54–56 Cor pulmonale, 18 Corticosteroids increasing dose during stress or surgery, 153, 163, 164t inhalers, 94, 97 Cortisone, 448 Cotazym (pancrelipase), 409, 423–424, 448 Coumadin (warfarin), 44, 49, 59, 64–65, 83, 92, 414–415, 429–431, 436, 441 AquaMEPHYTOIN (vitamin K), 83, 91 overdose, 71, 75 Cozaar (losartan), 435 Cranberry juice, 180, 192 Creon, 448 Crohn’s disease, 52, 67 Cromolyn inhalers, 81–82, 90–91, 442 inappropriate for acute asthma attack, 94, 97–98 CT scan with contrast dye, 8, 18–19 Curling’s ulcer, 123, 241 Cushing’s disease/syndrome, 153–154, 164–165 CVAs (cerebrovascular accidents), 10–11, 21–22, 32, 35, 364, 367, 414, 429 Cyanide poisoning, 353, 360 Cyanocobalamin (Cyanabin), 373, 378, 382, 385, 466 Cyclobenzaprine (Flexeril), 213, 219, 452 Cyclopentolate (Cyclogyl), 458 Cyclosporine (Neoral), 207, 210, 270, 274 Cylert (pemoline), 330, 334 Cymbalta (duloxetine), 306, 457 Cyproheptadine (Periactin), 329, 333 Cytadren (aminoglutethimide), 446 Cytotec (misoprostol), 365, 369, 445 contraindicated in pregnancy, 104, 122 Cytovene (ganciclovir), 253, 260 D Dabigatran (Pradaxa), 437 Dalmane (flurazepam), 456 Danazol (Danocrine)449 Dantrolene (Dantrium), 452 Darbepoetin (Aranesp), 278, 289, 300, 303 DDAVP (desmopressin), 155–156, 166–167, 417, 432, 446 Debrox, 346, 350 Decadron (dexamethasone), 12, 23, 280, 290, 414, 429, 444, 448 Decongestants, rationale for, 406, 420 Deep vein thrombosis (DVT), 49–50, 50f, 64–66, 227, 230–231 Dehydration, 106, 125 Delavirdine (Rescriptor), 455 Demerol (meperidine), 12, 23, 218, 225–226 tapering off, 153, 163 Depakote (valproic acid), 9, 20, 307, 318, 457 Depo-Provera (medroxyprogesterone), 190, 204 DermaDress dressing, 238, 242–243 DES (diethylstilbestrol), 280, 290 Desipramine (Norpramin), 332, 336 Desloratadine (Clarinex), 454 Desmopressin (DDAVP, Vasopressin), 155–156, 166–167, 417, 432, 446 Desoximetasone (Topicort), 453, 455 Despramine (Norpramin), 457 Detemir (Levemir) insulin, 447 Detrol-LA (tolterodine), 205, 208 DEXA (dual energy x-ray absorptiometry), 228, 232 Dexamethasone (Decadron), 12, 23, 280, 290, 414, 429, 444, 448 Dexedrine, 111, 132 Dextran, 357, 439 Dextromethorphan, 77, 85, 459 Dey-Drop (silver nitrate), 346, 349 Diabeta (glyburide), 171, 175, 448 Diabetes diabetes insipidus, 155, 166, 170, 174 immunizations and, 257, 266 475 3905_Index_471-488 22/01/14 10:39 AM Page 476 476 INDEX type 1, 149–150, 158–160, 159t, 366, 369 type 2, 9, 20, 150–152, 160–162, 364, 368 Diabetic ketoacidosis, 150, 158 Diabinese (chlorpropamide), 155, 166, 448 Diamox (acetazolamide), 345, 348, 459 Diarrhea, 112–113, 133–135 Diazepam (Valium), 9, 20, 310, 312, 323, 345, 348, 434, 456, 3235 Diazepoxide (Librium) alcohol withdrawal, 407, 421 Diazoxide (Proglycem), 440 Dibucaine (Nupercainal), 383, 387, 455 Dicyclomine hydrochloride (Bentyl), 444 Didanosine (Videx), 455 Diethylstilbestrol (DES), 280, 290 Digitoxin, 438 Digoxin (Lanoxin), 2–3, 4f, 8, 19, 41–42, 42, 56, 57, 70, 70f, 75, 407, 421, 438, 461 administering, 389 overdose, 69–70, 73 Dihydroxyaluminum sodium (Acid Relief), 443 Dilantin (phenytoin), 8–11, 11, 13, 19–24, 20, 23, 30, 32, 35, 406, 421, 433, 461 Dilaudid (hydromorphone), 229, 232, 434, 445, 450, 451 Diltiazem (Cardizem), 32, 438, 461 Dimenhydrinate (Dramamine), 35, 459 Dinoprostone (Cervidil), 187, 200 Diovan (valsartan), 435 Diphenhydramine (Benadryl), 254, 262, 312, 325, 374, 379, 433, 453–454 Diphenoxylate and atropine (Lomotil), 113, 134, 140, 144, 443 glaucoma and, 141, 145 Dipyridamole (Persantine), 438 Disease-modifying antirheumatic drugs (DMARDs), 456 Diuril (hydrochlorothiazide), 41, 57, 69, 73, 180, 192, 439 Diverticulosis/diverticulitis, elderly client with, 105–106, 124–125 DMARDs (disease-modifying antirheumatic drugs), 456 Dobutamine (Dobutrex), 41, 56, 355, 361, 438, 461 infusion pump, 352, 358 Docusate calcium (Kaopectate, Surfak), 445 herbs and, 106, 125 Docusate sodium (Colace), 105, 106, 124–125, 125, 445 Dofetilide (Tikosyn), 461 Donepezil (Aricept), 14–15, 26–27 Alzheimer’s disease, 414, 429 Dong quai, 205, 209, 371, 376, 463 taken with NSAIDs, may cause bleeding, 221–222 Donnazyme (pancreatin), 152, 162, 171, 175–176, 417, 432 Dopamine, 352, 357, 358, 438, 460 extravasation, 352, 358 incompatible with other IV fluids, 355, 361 Doxycycline, 366, 370 Dramamine (dimenhydrinate), 35, 459 Dressings, pressure ulcers Accuzyme papain-urea, 237, 242 avoid cutting, 236, 241 bio-occlusive transparent dressing, 237, 242 cadexomer iodine (Iodosorb gel), 237, 242 CombiDerm dressing, 237, 241–242 DermaDress dressing, 238, 242–243 foul odor, 237, 241 hydrogels, 237, 242 removing, 237, 241 roped dressing, 237, 242 Dronabinol (Marinol), 143, 146 Droperidol (Inapsine), 458 Drug cards, 3–4, 3f–4f Drug charts, 433–466 Dual energy x-ray absorptiometry (DEXA), 228, 232 Dulcolax (bisacodyl), 269, 273, 416, 431, 445 Duloxetine (Cymbalta), 306, 457 Duoderm dressing, 228, 231 Dutasteride (AVODART), 182–183, 194–195 DVT (deep vein thrombosis), 49–50, 50f, 64–66, 65, 227, 230–231 Dysrhythmias and conduction problems, 42–44, 42f–44f, 58–59 E Ear infections, 338–340, 342–344 Echinacea purpura, 372, 377, 464 Edentate calcium diodium, 462 Edrophonium (Tensilon), 252, 259–260 Elavil (amitriptyline), 306, 317, 329, 333, 457 Eldepryl (selegiline), 26, 31, 34 Elderly clients abuse of, 366, 369 medication administration, Electroconvulsive therapy, 30, 33 Embolic stroke, 21 Emergency contraception, 206, 210 Emergency nursing, 351–370 bioterrorism, 352–354, 359–360 code, client experiencing, 354–355, 360–362 comprehensive examination, 364–370 answers and rationales, 367–370 drug charts, 460–462 poisoning, children with, 355–356, 362–363 questions, 351–356 answers and rationales, 357–363 shock, 351–352, 357–358 E-Mycin (erythromycin), 436, 443, 453, 458 ophthalmic ointment, 185, 198 Enalapril (Vasotec), 11, 22, 41, 56, 435 Endocarditis, bacterial, 46, 61 Endocrine system, 149–177 adrenal disorders, 153–154, 163–166, 164t comprehensive examination, 170–177 answers and rationales, 174–177 drug chart, 446–448 pancreatitis, 152–153, 162–163 pituitary disorders, 155–156, 166–167 questions, 149–157 answers and rationales, 158–169 thyroid disorders, 156–157, 168–169 type diabetes, 149–150, 158–160, 159t type diabetes, 150–152, 160–162 Endoscopy of stomach/duodenum, 110, 130–131 Endrel (etanercept), 456 English words commonly encountered on nursing examinations, 433–436 Enoxaparin (Lovenox), 50, 65, 218, 225, 227, 230, 437, 451 Entacapone (Comtan), 14, 25 Ephedra, 372, 376, 377, 464 Epidural anesthesia, position for, 185, 197 3905_Index_471-488 22/01/14 10:39 AM Page 477 INDEX Epiglottitis, 96, 99 Epilepsy, 9, 20, 31, 34 pregnancy and, 9, 20 Epinephrine (Adrenalin, Epitrate), 94–95, 97, 99, 337, 341, 354, 360–361, 415, 430, 438, 440, 454, 458, 460 EpiPen, 254, 262 Epoetin alfa (Epogen), 450 Erectile dysfunction, antihypertensives for, 10, 21 Erythromycin (E-Mycin), 436, 443, 453, 458 ophthalmic ointment, 185, 198 Erythropoietin (Epogen, Procrit), 51, 66, 179, 191, 278–279, 288–289, 450 Eskalith (lithium), 306–307, 318–319, 411, 426, 457 toxic levels, 307, 319 Esomeprazole (Nexium), 102, 119 Estar, 246, 250 Estradiol/norgestimate (Ortho-Cyclen) stroke and, 10, 22 Estrogen, 246, 249, 451 Etanercept (Endrel), 456 Ethambutol (Myambutol), 254, 262, 442 Ethosuximide (Zarontin), Etodolac (Lodine), 256, 265 Evening primrose oil, 8, 20 Evista (raloxifene), 216, 222 reduces breast cancer risk, 289 Examination See Comprehensive examination Exelon (rivastigmine), 15 Exenatide (BYETTA) pens, 172–173, 177 Ex-Lax, 104, 113, 123, 135, 445 measuring, 390, 394 External fixation device, 227, 230 Exubera (human insulin), 173, 177 Eye disorders, 337–338, 338f, 341–342 Eye drops See Ophthalmic medications, administering Ezetimibe (Zetia), 39, 55, 437 F Famotidine (Pepcid), 236, 241, 444 Fat-soluble vitamins, 373, 378 Females of childbearing age medication administration, Ferrous sulfate, 186, 199–200, 439, 465 Feverfew, 16, 27 taken with NSAIDs, may cause bleeding, 221–222 Fexofenadine (Allegra), 254, 263, 454 Fiberall (psyllium), 105, 124, 445 Fiber supplements, 277, 287 Filgrastim (Neupogen), 298, 301, 405, 419 Finasteride (Propecia, Proscar), 182, 194, 246, 249–250 Five Rights of Medication Administration, 162, 414, 429 Flagyl (metronidazole), 185, 198, 449 Flecainide (Tambocor), 436, 461 Fleets Phospho-Soda (sodium biphosphate), 106, 125 Flexeril (cyclobenzaprine), 213, 219, 452 Flomax (tamsulosin), 182, 194 Fludrocortisone (Florinef), 154, 165, 447 Fluid resuscitation, 406, 420 Fluoxetine (Prozac), 305, 316, 329, 333, 404, 418–419, 457 sibutramine (Meridia), potentially life-threatening reaction with, 112, 133 Flurazepam (Dalmane), 456 Fluticasone (Flonase), 254, 262, 455 Folic acid, 372, 377, 381, 384, 464 folic acid deficiency anemia, 52, 67 maternal depletion can lead to fetal spina bifida, 403, 418 Folvite, 439 Fondaparinux (Arixtra), 437 Fosamax (alendronate), 153, 164, 216–217, 222, 224, 410, 424, 451 Fosphenytoin (Cerebyx), 9, 20 Fosrenol (lanthanum), 180, 192 Fracture, 366, 369 Fulvicin (griseofulvin), 453 Fungizone (amphotericin B), 253, 261–262, 453 Furosemide (Lasix), 2–3, 4f, 11, 22, 41, 56, 155, 167, 183, 196, 404, 419, 439 potassium loss and, 48, 63 G Galantamine (Reminyl), 16, 27 Gamma globulin, 268, 272, 444 Ganciclovir (Cytotec), 253, 260 Gardasil, 270, 274 Gargling, glucocorticoid inhalers and, 81, 89 Garlic, 78, 85, 372, 376, 382, 385 increases hypoglycemic effects of oral hypoglycemics, 161 taken with NSAIDs, may cause bleeding, 221–222 Gastric bleeding aspirin (acetylsalicylic acid) and, 39, 55 Gastric bypass surgery vitamin B12 supplementation, 51, 66 Gastric lavage, 355, 363 Gastroenteritis, child with, 109–110, 129–131, 130t Gastroesophageal reflux disease (GERD) asthma and, 102, 120 complications, 102, 119–120 Gastrointestinal system, 101–147 abdominal surgery with general anesthesia, 113–115, 135–136 acute pain, 117–118, 117t, 138–139 comprehensive examination, 140–147 answers and rationales, 144–147 constipation and diarrhea, 112–113, 133–135 diverticulosis/diverticulitis, elderly client with, 105–106, 124–125 drug chart, 443–445 gastroenteritis, child with, 109–110, 129–131, 130t gastroesophageal reflux, 101–102, 119–120 hepatitis, 108–109, 127–129 inflammatory bowel disease, 102–103, 120–122 liver failure, 106–107, 125–127 obesity, 110–112, 131–133 peptic ulcer disease, 104–105, 122–124 questions, 101–118 answers and rationales, 118–139 total parenteral nutrition, 115–116, 115t 136–138 Gastrostomy tube, administering medications through, 397, 400 Gemfibrozil (Lopid), 437 Genital warts, 186, 199 Genitourinary system, 179–211 benign prostatic hypertrophy and spinal anesthesia, 182–183, 194–196 birth control, 189–190, 202–204 477 3905_Index_471-488 22/01/14 10:39 AM Page 478 478 INDEX chronic kidney disease (CKD), 179–180, 191–192 comprehensive examination, 205–211 answers and rationales, 208–211 drug chart, 449–450 infertility, 188–189, 201–202 pregnancy, 186–187, 199–201 questions, 179–190 answers and rationales, 191–204 renal calculi, 183–185, 196–198 sexually transmitted disease, adolescents, 185–186, 198–199 urinary tract infection (UTI), 180–182, 192–194 Gentamycin, 87, 453, 458 Geodon (ziprasidone), 308, 320 GERD (gastroesophageal reflux disease) complications, 102, 119–120 Ginkgo biloba, 47, 62, 464 taken with NSAIDs, may cause bleeding, 215, 221–222 to treat Alzheimer’s disease, 15, 26, 30, 34, 382, 385 Ginseng, increases hypoglycemic effects of oral hypoglycemics, 151, 161 Glargine (Lantus) insulin, 447 Glasgow Coma Scale, 31, 35 Glaucoma, 337–338, 341–342, 345, 347–348 Glipizide (Glucotrol), 448 reaction with alcohol, 150, 160 Glossary, 433–436 Glucophage (metformin), 8, 19, 69, 73–74, 111, 132, 151, 160, 171, 175, 446 Glucosamine, 228, 231 Glucose monitoring strips, 383, 386 Glucose tablets, 383, 386 Glucotrol (glipizide), 448 reaction with alcohol, 150, 160 Glucovance (glyburide/metformin), 151, 160 Glyburide (Diabeta, Micronase), 151, 160, 171, 175, 448 Glycerin (Glycerol), 459 Glycopyrrolate (Robinul), 443 Glycosylated hemoglobin (A1C), 150, 159 Gold salts, 269, 273 GoLYTELY, 142, 145, 356, 363 Good Samaritan Act, 364, 367 Gout, types of, 260 Griseofulvin (Fulvicin), 453 Guaifenesin (Robitussin), 442 Guillain-Barré syndrome, 268, 272 H H pylori infection, 104–105, 122–123 HAART (highly active antiretroviral therapy), 253, 261, 410, 425 scientific rationale for, 410, 425 Haloperidol (Haldol), 31, 34, 309, 321, 457 Handwashing, 397, 400 Hawthorn, 41, 56, 372, 377, 464 HBIG (hepatitis B immune globulin), 108, 128 HCG (human chorionic gonadotropin), 188, 201–202 HCTZ (hydrochlorothiazide), 41, 57, 69, 73, 180, 192, 439 Head injury, 7–8, 18–19 Head lice (pediculosis capitis), 245, 248 Heatstroke, 367 Hemoglobin values, 405, 420 Hemorrhagic stroke, 11, 21 Heparin, 11, 22, 49–50, 65, 227, 230–231, 413, 415, 428, 430, 436–437, 441, 451 administering, 50, 50f, 66, 84, 93 pulmonary embolus, 83, 91 streptokinase (Streptase) and, 83, 91–92 subcutaneous administration, 396, 399 Hepatitis, 108–109, 127–129 Hepatitis A vaccine, 108, 127 Hepatitis A and B vaccine (Twinrix), 109, 129 Hepatitis B immune globulin (HBIG), 108, 128 Hepatitis B vaccine, 109, 128–129 Hepatitis C, 108, 128 Herbs, 371–372, 376–377, 413, 428 administering, 405, 419 stopping before surgery, 371, 376 Herpes simplex virus, 198 Hexachlorophene, 246, 249 Hiatal hernia, 102, 120 Highly active antiretroviral therapy (HAART), 253, 261, 410, 425 scientific rationale for, 410, 425 Histamine2 blockers, 101, 119 Hormone replacement therapy breast cancer risk and, 280, 291 for osteoporosis, 216, 223 Humalog insulin, 150, 159, 447 Human chorionic gonadotropin (HCG), 188, 201–202 Human growth hormone, 12, 24 Human immunodeficiency virus (HIV), 198 See also Acquired immunodeficiency syndrome(AIDS) Humatrope (somatropin), 170, 175 Humira (adalimumab), 456 Humulin insulin, 447 Humulin N insulin, 149, 158, 383, 386, 408, 423 Humulin R insulin, 153, 162, 383, 386 Hyalgan (sodium hyaluronate), 215, 220–221 Hydralazine (Apresoline), 440 Hydrochlorothiazide (Diuril, HCTZ, HydroDIURIL), 41, 57, 69, 73, 180, 192, 439 Hydrocodone (Codone, Hycodan, Vicodin), 32, 36, 94, 97, 229, 232, 434, 445, 450–451, 459 constipation and, 78, 86 Hydrocortisone, 247, 250, 434, 444, 453, 455 Hydrocortisone and pramoxine (Proctofoam), 187, 200 Hydrocortisone sodium succinate (Solu-Cortef), 251, 444, 448 Hydromorphone (Dilaudid), 229, 232, 434, 445, 450, 451 Hydroxychloroquine sulfate (Plaquenil), 255, 264 269, 273 taking with milk, 411, 425 Hydroxyzine (Atarax, Vistaril), 227, 230, 238, 243, 247, 250 Hypertension, 10–11, 21 Hyperthyroidism, 156–157, 168–169 Hypoglycemia, 366, 369 medications, yellow skin and sclera, 152, 162 Hypokalemia, 48, 57, 64, 69, 73 Hypothyroidism, 156–157, 168–169 Hypovolemic shock, 351, 357, 365, 368 Hytrin (terazosin), 183, 195, 415, 430 Hycodan (hydrocodone), 32, 36, 94, 97, 229, 232, 434, 445, 450–451, 459 constipation and, 78, 86 3905_Index_471-488 22/01/14 10:39 AM Page 479 INDEX I Ibuprofen (Motrin), 155, 167, 434, 435, 450, 451, 456 development of gastric ulcers that can hemorrhage, 122 taking with food, 45, 60 Ileostomy, 143, 146 Imferon (iron dextran), 51, 85 Imipramine (Tofanil), 457 Imitrex (sumatriptan), 16, 28, 31, 35 Immodium (loperamide), 443 Immune globulin, 108, 127 Immune inflammatory system, 251–274 acquired immunodeficiency syndrome (AIDS), 252–254, 260–262 allergies, 254–255, 262–264 autoimmune disease, 251–252, 259–260 comprehensive examination, 268–274 answers and rationales, 272–274 drug chart, 454–456 immunizations, children, 257–258, 265–267 questions, 251–258 answers and rationales, 259–267 rheumatoid arthritis, 255–256, 264–265 Immunizations, children, 257–258, 265–267 Immunohemolytic anemia, 52, 68 Implanted ports, 283, 294 Imuran (azathioprine), 103, 120–121, 273 Inapsine (droperidol), 458 Inderal (propranolol), 17, 28, 436, 461 Indinavir (Crixvan), 455 Indomethacin (Indocin), 184, 197, 434, 450, 451 Indwelling catheters, 182, 194 Infergen (interferon alfacon), 108, 128 Infertility, 188–189, 201–202 Inflammatory bowel disease, 102–103, 120–122 Inflammatory cardiac disorders, 45–46, 59–61 Inhalers, 81–82, 90–91, 442 correct way to use, 80, 89, 398, 401 corticosteroids, 94, 97 gargling and, 81, 89 inappropriate for acute asthma attack, 94, 97–98 INH (isoniazid), 442 INR (International Normalized Ratio), 83, 92 Insect bites, 410, 425 Insect removal from ears, 345, 349 Insulin diet and, 149, 158 pen injector, 149, 158 pharmacodynamics, 150, 159–160 refrigerating, 150, 159 regular, 149, 158 at times of stress or surgery, 160–161 Integumentary system, 235–250 burns, 235–236, 240–241 comprehensive examination, 245–250 answers and rationales, 248–250 drug chart, 452–453 pressure ulcers, 236–238, 241–243 questions, 235–239 answers and rationales, 240–244 skin disorders, 238–239, 243–244 Interferon alfacon (Infergen), 108, 128 Interferon alfa (Roferon), 141, 144 Interferon beta-1a (Avonex), 269, 273 Interferon (Intron A), 278, 288 International Normalized Ratio (INR), 83, 92 Intradermal administration of medications, 397, 400 Intramuscular administration of medications, 389, 393, 398, 401 Intrathecal injections, 214, 219 Intravenous dye pyelogram (IVP), 184, 197 Intravenous medications adding to IV bags, 389, 393 administering, 45, 60 fluids, reversing sickling with, 51, 66 Intron A (interferon), 278, 288 Investigational protocol for cancer treatments, 280–282, 291–292 Iodine allergy, 71, 75, 184, 197 Iodosorb gel (cadexomer iodine), 237, 242 Ipecac, syrup of, 356, 363 Iron liquid, 440 poisoning, 364, 367 skin stains and, 51, 67 stool color and, 51, 67 tablets, 372, 377–378, 381, 384, 413, 427–428 Iron-deficiency anemia, 51, 66–67 Iron dextran (Imferon), 51, 85 Isocarboxazid (Marplan), 457 Isoetharine (Bronkosol), 440, 454 Isoniazid (INH), 442 Isoproterenol, 454 Isopto-atropine (atropine), 458 Isopto Carpine (pilocarpine), 337, 341, 459 Isosorbide dinitrate, 439 Isoxsuprine (Vasodilan), 46, 61 IVP (intravenous dye pyelogram), 184, 197 J Jaundice, itching and, 143, 146 K Kalcinate (calcium gluconate), 216, 223, 447 Kaopectate (docusate calcium), 106, 125, 445 Kayexalate (sodium polystyrene sulfonate), 180, 191–192, 409, 424, 450 Kemadrin (procyclidine), 433 Kenacort (triamcinolone), 453, 455 Ketoacidosis, 150, 158 Ketoconazole (Nizoral), 154, 165, 299, 302, 446 Ketorolac (Toradol), 434, 450, 451 Kilograms, Kineret (anakinra), 279, 289 Klonopin (clonazepam), K-Pec (attapulgite), 443 Kwell (lindane), 238, 243–244, 245, 248 L Labetalol (Normodyne, Trandate), 69, 438 Lacerations, 7, 18, 366, 369 Lactaid, 146 Lactobacillus (Bacid), 112, 133 Lactulose (Cephulac, Chronulac), 106, 107, 125–127, 142, 145, 408, 423 Lanacane (benzocaine), 383, 387, 455 479 3905_Index_471-488 22/01/14 10:39 AM Page 480 480 INDEX Lanoxin (digoxin), 2–3, 4f, 8, 19, 41–42, 56, 57, 70, 70f, 75, 407, 414, 421, 429–430, 438, 461 administering, 389 overdose, 69–70, 73 Lanthanum (Fosrenol), 180, 192 Lantus (glargine) insulin, 447 Laryngotracheobronchitis, 95 Lasix (furosemide), 2–3, 4f, 11, 22, 41, 56, 155, 167, 183, 196, 404, 419, 439 potassium loss and, 48, 63 Latex allergy, 270, 273–274 Latex-free Foley catheter, 206, 209 Laxatives, 112, 133 chronic exposure to, 113, 134–135 stimulant, 112, 133 L-dopa (levodopa), 13–14, 25, 433 Leflunomide (Arava), 255, 264 Leg cramps, 41, 48, 57, 64, 69, 73 Leptin, 111, 132 Levemir (Detemir) insulin, 447 Levodopa (Carbidopa, L-dopa), 13–14, 25, 433 Levothyroxine (Synthroid), 156–157, 168–169, 171, 175, 409, 423, 448 Librium (chlordiazepoxide), 152, 162, 314, 326 alcohol withdrawal, 407, 421 Lice, 383, 386–387 Licensed practical nurse (LPN), assigning tasks to, 329, 333 Licorice, 381, 384–385, 465 Addison’s disease and, 170, 174 Lidocaine, 38, 59, 70, 74, 355, 361, 403, 418, 436, 461 Lindane (Kwell), 238, 243–244, 245, 248 Lioresal (baclofen), 214, 220, 252, 259, 434 Lipitor (atorvastatin), 407, 422 muscle injury and, 39, 54 timing of administration, 40, 40f, 56 Lisinopril (Zestril), 38, 54, 435 Lispro insulin, 447 Lithium (Eskalith, Lithobid), 306–307, 318–319, 411, 426, 457 toxic levels, 307, 319 Liver failure, 106–107, 125–127 Lodine (etodolac), 256, 265 Lomotil (diphenoxylate and atropine), 113, 134, 140, 141, 144, 145, 443 Loop diuretics, 11, 22 potassium loss and, 48, 57, 63 Loperamide (Immodium), 443 Lopid (gemfibrozil), 437 Lopressor (metoprolol), 47, 63, 438 Loratadine (Claritin), 454 Lorazepam (Ativan), 297, 301, 309, 322, 456 pregnancy and, 312, 325 Losartan (Cozaar), 435 Lotrimin (clotrimazole), 453 Lovastatin (Mevacor), 437 Lovenox (enoxaparin), 50, 65, 218, 225, 227, 230, 437, 451 Low back pain, 213–214, 219–220 Lower respiratory infection, 78–79, 86–88 LPN (licensed practical nurse), assigning tasks to, 329, 333 Lugol’s solution, 447 Lung cancer, 277, 287 Lupron LA, 290 Lye, brushing off from client, 365, 368–369 Lysodren (mitotane), 154, 165–166, 446 M Maalox, 104, 123, 141, 143, 145, 146, 445 measuring, 390, 394 Mafenide acetate (Sulfamylon), 235, 236, 240–241, 410, 425 Magaldrate (Simethicone Suspension), 443 Magnesium citrate, 445 Magnesium hydroxide, 104, 123, 445 measuring, 390, 394 Magnesium sulfate, 187, 200–201, 408, 424 overdosage, 205, 208–209 Major depressive disorders, 305–306, 316–318 Malathion, 353, 359–360 Mannitol (Osmitrol), 7–8, 12, 18–19, 23, 31, 35, 407, 421, 435, 459 filter needle, 7, 18 MAO inhibitors, diet and, 305, 316 Marcaine (bupivacaine), 229, 233 Marijuana, addiction is psychological rather than physical, 315, 328 Marinol (dronabinol), 143, 146 MAR (Medication Administration Record), 40, 40f, 56 Marplan (isocarboxazid), 457 Mebendazole (Vermox), 444 Mechanical heart valve replacements, 71, 75 Meclizine (Antivert), 32, 35–36, 345, 348, 459 Medic alert bracelet, 9, 20–21, 410, 425 Medication administration, 1–6 drug card samples, 3–4, 3f–4f five rights of, 72, 76 sixth right, 138 important data to remember, 5–6 medication memory jogger, population-specific information, elderly clients, females of childbearing age, pediatric clients, test-taking hints, 1–3 Medication Administration Record (MAR), 40, 40f, 56 Medication categories, 207, 210 Medication memory jogger, Medication overuse headaches, 16, 28 Medrol (methylprednisolone), 79, 88, 408, 422, 434, 444, 448, 453, 455 with head injury, 8, 19 Medroxyprogesterone (Depo-Provera), 190, 204 Megestrol (Megace), 279, 290 Melatonin, 313, 326, 381, 384 Mellaril (thioridazine), 457 Menotropin (Pergonal), 188, 201–202 Mental health disorders, 305–336 anxiety disorder, 309–310, 321–323 attention deficit–hyperactivity disorder, children with, 311–312, 323–325 bipolar disorder, 306–307, 318–319 comprehensive examination, 329–336 answers and rationales, 333–336 drug chart, 456–457 major depressive disorders, 305–306, 316–318 questions, 305–315 answers and rationales, 316–328 schizophrenia, 308–309, 319–321 sleep disorders, 312–314, 325–326 substance abuse, 314–315, 326–328 3905_Index_471-488 22/01/14 10:39 AM Page 481 INDEX Meperidine (Demerol), 12, 23, 218, 225–226 tapering off, 153, 163 Meridia (sibutramine), 110–112, 131–133, 416, 431 Prozac, potentially life-threatening reaction with, 112, 133 Mesalamine (Asacol), 102, 103, 120–122, 416, 431 Mestinon (pyridostigmine), 251, 259, 433 Metamucil (psyllium), 105, 124, 445 Metaproterenol (Alupent), 80, 88–89, 440, 454 Metaraminol (Aramine), 438, 462 Metered-dose inhaler, administering, 389, 393 Metformin (Glucophage), 8, 19, 69, 73–74, 111, 132, 151, 160, 171, 175, 446 Methadone, 314, 315, 327 Methantheline, 460 Methergine (methylergonovine), 187, 201 Methimazole (Tapazole), 446 Methocarbamol (Robaxin), 214, 220, 434, 452 Methotrexate (Rheumatrex), 238, 243, 256, 264, 269, 273, 410, 425 Methylcellulose (Citrucel), 105, 124 Methyldopa (Aldomet), 438 Methylergonovine (Methergine), 187, 201 Methylphenidate (Ritalin), 311–312, 314, 323–324, 326, 457 Methylprednisolone (Medrol, Solu-Medrol), 79, 88, 408, 422, 434, 444, 448, 453, 455 with head injury, 8, 19 Methylprednisolone sodium succinate (Solu-Medrol), 45 Metipranolol (Optipranolol), 459 Metoclopramide (Reglan), 444 Metoprolol (Lopressor, Toprol-XL), 47, 63, 438 Metronidazole (Flagyl), 185, 198, 449 Mevacor (lovastatin), 437 Miconazole (Aloe Vesta), 453 Micronase (glyburide), 151, 160, 171, 175, 448 Mifepristone (RU-486), 365, 369 Migraine headache, 16–17, 27–29 Milk of Magnesia (magnesium hydroxide), 104, 123, 445 measuring, 390, 394 Milrinone lactate (Primacor), 69, 73 Miotic medications, 406, 420 Mirapex (pramipexole), 13, 25 Misoprostol (Cytotec), 365, 369, 445 contraindicated in pregnancy, 104, 122 Mitotane (Lysodren), 154, 165–166, 446 Modafinil (Provigil), 314, 326 Montelukast (Singulair), 80–81, 88–90, 456 Morphine, 37, 53, 79, 87, 118, 138–139, 152, 162, 213, 217, 219, 224, 406, 420, 434, 445, 450, 451 with head injury, 8, 19 Morton’s neuroma, 229, 233 Motrin (ibuprofen), 155, 167, 434, 435, 450, 451, 456 development of gastric ulcers that can hemorrhage, 122 taking with food, 45, 60 MS Contin, 214, 220 Mucomyst (acetylcysteine), 77, 85 Mupirocin (Bactroban), 246, 249 Muscarinic poisoning, 31, 35 Musculoskeletal system, 213–233 comprehensive examination, 227–233 answers and rationales, 230–233 drug chart, 451–452 low back pain, 213–214, 219–220 orthopedic surgery, 216–217, 224–226 questions, 213–218 answers and rationales, 219–226 renal osteoarthritis, 214–216, 220–222 renal osteoporosis, 216–217, 222–224 Myambutol (ethambutol), 254, 262, 442 Myasthenia gravis, 252, 260 Myringotomy, 343 N Nabumetone (Relafen), 451 Nalbuphine (Nubain), 118, 139 Naloxone (Narcan), 118, 139, 356, 363, 462 Naproxen (Aleve), 434, 450, 451 Narcolepsy, 314, 326 Narcotics, 12, 23–24, 118, 138–139 constipation and, 12, 24 with head injury, 8, 19 if client refuses to take, a witness is required to waste it, 397, 400 Nardil (phenelzine), 329, 333, 457 diet and, 305, 316 Nasal medications, administering, 346, 347, 349, 350, 397, 400 via nasogastric tube, 396, 399 Natamycin (Natacyn Ophthalmic), 346, 349–350 Nateglinide (Starlix), 446 National Childhood Vaccine Act of 1986, 265 National Poison Control Hotline, 356, 363 Nausea and vomiting anticipatory, chemotherapy, 275, 286 Nebivolol (Bystolic), 438 Nebulizers, 80, 89 cleaning, 81, 90 Needles, disposing of, 390, 394 Neomycin sulfate, 106, 126 Neoral (cyclosporine), 207, 210, 270, 274 Neostigmine (Prostigmin), 252, 259, 271, 274, 433 Neo-synephrine (phenylephrine), 458 Neulasta (pegfilgrastim), 278, 288–289 Neumega (oprelvekin), 278, 288 Neupogen (filgrastim), 298, 301, 405, 419 Neurological system, 7–36 Alzheimer’s disease, 14–16, 26–27 donepezil (Aricept), 414, 429 ginkgo biloba, 382, 385 ginkgo biloba, 26, 30, 34 selegiline (Eldepryl), 26, 31, 34 vitamin E, 15, 26 brain tumor, 11–13, 23–24 cerebrovascular accidents, 10–11, 21–22 comprehensive examination, 30–36 answers and rationales, 33–36 drug chart, 433–435 head injury, 7–8, 18–19 migraine headache, 16–17, 27–29 Parkinson’s disease, 13–14, 24–26 questions, 7–17 answers and rationales, 18–29 seizures, 8–10, 19–21 Neutrexin (trimetrexate), 254, 262 Nevirapine (Viramune), 455 Nexium (esomeprazole), 102, 119 Nicotine patch or gum, 314, 327 481 3905_Index_471-488 22/01/14 10:39 AM Page 482 482 INDEX Nicotinic acid (niacin), 39, 55, 460 Nifedipine (Procardia), 438 Nitrofurantoin, 181, 193 Nitrogen mustard gas, 353, 359 Nitroglycerin, 37, 38, 53, 54, 72, 76, 351, 357, 439, 462 paste, measuring, 38, 38f, 54 Nitroprusside sodium, 440 Nix (permethrin), 186, 199, 383, 386–387 Nizoral (ketoconazole), 154, 165, 299, 302, 446 Nolvadex (tamoxifen) increases risk of endometrial cancer, 280, 291 reduces risk of breast cancer, 289 Nonprescribed medications, 371–387 See also Over-the-counter medications comprehensive examination, 381–387 answers and rationales, 384–387 drug chart, 463–466 herbs, 371–372, 376–377 questions, 371–375 answers and rationales, 376–380 self-prescribed medications, 373–375, 379–380 vitamins and minerals, 372–373, 377–379 Nonsteroidal anti-inflammatory drugs (NSAIDs), 42, 57, 374, 379 bleeding and, 45, 60 development of gastric ulcers that can hemorrhage, 122 taking with food, 45, 60, 251, 259 Norepinephrine, 357, 462 Normodyne (labetalol), 69, 438 Norpramin (desipramine), 332, 336, 457 Norvasc (amlodipine), 438 Norvir (ritonavir), 455 Novocain, 383, 387 Nupercainal (Dibucaine), 383, 387, 455 Nurse administering medications, 389–390, 390f, 393–394 Nurse computing math to administer medications, 390–392, 394–395 Nystatin, 347, 350, 444 O Obesity, 110–112, 131–133 medications for weight loss, 110, 131 bupropion (Zyban), 111, 132 Dexedrine, 111, 132 leptin, 111, 132 metformin (Glucophage), 111, 132 orlistat (Xenical), 111, 132, 133–134 sibutramine (Meridia), 110, 111, 112, 131, 132, 133 Octreotide (Sandostatin), 12, 24, 153, 155, 163, 166 Olanzapine (Zyprexa), 457 Omeprazole (Prilosec), 373, 379, 445 asthma and, 102, 120 warfarin, interaction with, 142, 145 Ommaya reservoir, 282, 293 Oncovin (vincristine), 156, 167 Ondansetron (Zofran), 277, 287 Ophthalmic disorders, 337–338, 338f, 341–342 Ophthalmic medications, administering, 338, 338f, 342, 345–350, 397, 400, 412, 412f, 426–427 Oprelvekin (Neumega), 278, 288 Optipranolol (Metipranolol), 459 Oral contraceptives, 189, 190, 203–204 breastfeeding and, 189, 203 28-day pack, 190, 204 decreased risk for several disorders, 203 ineffective with some antibiotics, 205, 208 stroke and, 10, 22 Oral liquid medication, administering, 398, 401 Oral replacement therapy children with vomiting or diarrhea, 109, 129–130, 130t Orinase (tolbutamide), 448 Orlistat (Xenical), 111, 132, 133–134 Oropharyngeal yeast infections, 89 Ortho-Cyclen (estradiol/norgestimate) stroke and, 10, 22 Orthopedic surgery, 216–217, 224–226 Orthostatic hypotension, 38, 54, 310, 322–323 antihypertensive medications and, 48, 63 Osmitrol (mannitol), 7–8, 12, 18–19, 23, 31, 35, 407, 421, 435, 459 filter needle, 7, 18 Osmotic diuretics, 7–8, 12, 19, 23 Osteomalacia, 228, 231 Otic drops administering, 340, 344 instilling, 345, 348 warming, 339, 342 Otitis media, 339, 342–343 Ovarian hyperstimulation syndrome, 188, 202 Over-the-counter medications See also Nonprescribed medications abuse of, 77, 85 vasoconstriction and, 77, 85 Oxycodone (Percodan), 118, 139 Oxygen, 38, 54, 79, 81, 87, 90, 355, 361, 365, 368, 408, 422 long-term oxygen therapy, 95, 98 Oxymetazoline (Afrin), 78, 86, 255, 263, 459 Oxytocin (Pitocin), 187, 200 P Pacemakers, 355, 362 Pain, 152, 162–163 See also Acute pain; Chronic pain assess client for need for medical intervention, 411, 426 control, 217, 224, 299, 303 diverticulitis, 106, 125 medications, charting, 114, 136 migraine headache, 16, 28 morphine, 107, 126 post-TURP, 183, 195 Pancreatin (Donnazyme), 152, 162, 171, 175–176, 417, 432 Pancreatitis, 152–153, 162–163 Pancrelipase (Cotazym), 409, 423–424, 448 Pantoprazole (Protonix), 101, 154, 165 Parafon Forte (chlorzoxazone), 228, 231, 410, 424–425 Parkinson’s disease, 13–14, 24–26 Parlodel (bromocriptine), 188, 201, 447 Paroxetine (Paxil), 310, 322 Partial thromboplastin time (PTT), 84, 92–93, 413, 428 Patch, transdermal, applying, 396, 399 Pathologic fractures, 217, 223 Patient-controlled analgesia (PCA), 184, 197, 218, 225–226, 236, 241, 416, 431 Peak expiratory flow rate measurement, 80, 89 Peak flow meter reading, 82, 91 zone system, 82, 90–91 Pedialyte, 109, 129 Pediatric clients See Children 3905_Index_471-488 22/01/14 10:39 AM Page 483 INDEX Pediculosis capitis (head lice), 245, 248 Pediculosis pubis, 186, 199 Pegfilgrastim (Neulasta), 278, 288–289 Pemoline (Cylert), 330, 334 Penicillin, 436, 441, 443, 449, 452, 454, 458 Pentoxifylline (Trental), 46, 61 Pepcid (famotidine), 236, 241, 444 Peptic ulcer disease, 104–105, 122–124 Pepto-Bismol (bismuth subsalicylate), 443 Percodan (oxycodone), 118, 139 Pergonal (menotropin), 188, 201–202 Periactin (cyproheptadine), 329, 333 Pericarditis, 45, 60 Permethrin (Nix), 186, 199 Persantine (dipyridamole), 438 Phenazopyridine (Pyridium), 181, 193–194 Phenelzine (Nardil), 329, 333, 457 diet and, 305, 316 Phenergan (promethazine), 145–146, 444, 458 alcohol and, 141, 144 Phenobarbital, 433, 435, 457 Phenylbutazone (Butazolidin), 256, 264 Phenylephrine (Neo-synephrine), 458 Phenytoin (Dilantin), 8–11, 13, 19–24, 30, 32, 35, 406, 421, 433, 461 Pilocarpine (Isopto Carpine), 337, 341, 459 Pioglitazone (Actos), 403, 418, 448 Pitocin (oxytocin), 187, 200 Pitressin (vasopressin), 107, 126, 446 Pituitary disorders, 155–156, 166–167 tumor, 12, 24 Plaquenil (hydroxychloroquine sulfate), 269, 273 taking with milk, 411, 425 Plavix (clopidogrel), 40, 56–57, 300, 303–304, 438 Pleuritic chest pain, 406, 421 Pneumonia, 78, 86–87, 415, 431 bacterial, 408, 422 Pneumocystis carinii pneumonia (PCP), 254, 261 thick, green sputum, 79, 88 Pneumonococcal vaccine chronic obstructive pulmonary disease (COPD), 94, 98 Poison Control Center, 364, 367 Poisoning children, 355–356, 362–363 dishwashing detergent, 412, 427 keeping medications in a safe place, 411, 426 Polycythemia vera, 51, 67, 76 Polypharmacy, African Americans and, 70, 74 Portable insulin pumps, 150, 158–159 Positive protein derivative (PPD) skin test, 96, 96t reading, 96, 96f, 100 Potassium, 42, 57 Potassium channel blockers, 43, 58 Potassium iodide, 447 Potassium-sparing diuretics, 69, 73 Povidone iodine (Betadine), allergies to, 113, 135, 182, 194 PPD (purified protein derivative), 59–60 Pradaxa (Dabigatran), 437 Pramipexole (Mirapex), 13, 25 Precose (acarbose), 446 Prednisolone, 82, 90, 268, 272, 460 Prednisone, 103, 122, 434, 444, 448, 453, 455 allergy to, 227, 230 heartburn, 140, 144 increased infection risk, 415, 430 laboratory values, 171, 176 long-term side effects, 256, 265 tapering, 79, 87, 176, 245, 248 Pregnancy, 186–187, 199–201 category D medications, 186, 199 corticosteroids, 187, 201 dinoprostone (Cervidil), 187, 200 epidural catheter, positioning for, 187, 200 ferrous sulfate (Feosol), 186, 199–200 hydrocortisone and pramoxine (Proctofoam), 187, 200 magnesium sulfate, 187, 200–201 medication categories, 207, 210 methylergonovine (Methergine), 187, 201 oral hypoglycemics, 205, 208 oxytocin (Pitocin), 187, 200 terbutaline (Brethine), 186, 200 Premarin, 170, 174–175 Preparation H (phenylephrine and cocoa butter), 382, 386 Prilosec (omeprazole), 373, 379, 445 asthma and, 102, 120 warfarin, interaction with, 142, 145 Primacor (milrinone lactate), 69, 73 PRN, Probenecid (Benemid), 452 Procainamide (Pronestyl), 436, 461 Procardia (nifedipine), 438 Prochlorperazine (Compazine), 110, 131, 457 Procrit (erythropoietin), 51, 66, 179, 191, 278–279, 288–289, 450 Proctofoam (hydrocortisone and pramoxine), 187, 200 Procyclidine (Kemadrin), 433 Progesterone, 189, 202 Proglycem (diazoxide), 440 Promethazine (Phenergan), 145–146, 444, 458 alcohol and, 141, 144 Pronestyl (procainamide), 436, 461 Propafenone (Rythmol), 461 Propantheline (Pro-Banthine), 141, 145, 443 Propecia (finasteride), 182, 194, 246, 249–250 Propranolol (Inderal), 17, 28, 436, 461 Propylthiouracil (PTU), 156, 157, 168, 169, 446 Proscar (finasteride), 182, 194, 246, 249–250 Prostate cancer, 279–280, 289–290 Prostigmin (neostigmine), 252, 259, 271, 274 Protonix (pantoprazole), 101, 154, 165, 445 administration, 105, 123 Proton-pump inhibitors, 101–102, 119 Protopic (tacrolimus), 239, 244 Provigil (modafinil), 314, 326 Prozac (fluoxetine), 305, 316, 329, 333, 404, 418–419, 457 sibutramine (Meridia), potentially life-threatening reaction with, 112, 133 Pseudoephedrine (Sudafed), 374, 380, 459 Psoriasis, 383, 386 Psyllium (Fiberall, Metamucil), 105, 124, 445 PTT (partial thromboplastin time), 84, 92–93, 413, 428 PTU (propylthiouracil), 156, 157, 168, 169, 446 Pulmonary embolus, 83–84, 91–93 483 3905_Index_471-488 22/01/14 10:39 AM Page 484 484 INDEX Pulmonary system, 77–100 comprehensive examination, 94–100 answers and rationales, 97–100 drug chart, 440–442 lower respiratory infection, 78–79, 86–88 pulmonary embolus, 83–84, 91–93 questions, 77–84 answers and rationales, 84–93 reactive airway disease, 80–82, 88–91 children, 81–82, 90–91 upper respiratory infection, 77–78, 85–86 Puncture wound, 364, 367 Purified protein derivative (PPD), 59–60 PVCs Telemetry strips, 43, 43f, 58 Pyrantel, 444 Pyridostigmine (Mestinon), 433 Q Questions administering medications, 389–392 answers and rationales, 393–395 adrenal disorders, 149–157 answers and rationales, 158–169 cancer treatments, 275–285 answers and rationales, 286–296 cardiovascular system, 37–52 answers and rationales, 53–68 emergency nursing, 351–356 answers and rationales, 357–363 gastrointestinal system, 101–118 answers and rationales, 118–139 genitourinary system, 179–190 answers and rationales, 191–204 immune inflammatory system, 251–258 answers and rationales, 259–267 mental health disorders, 305–315 answers and rationales, 316–328 musculoskeletal system, 213–218 answers and rationales, 219–226 neurological system, 7–17 answers and rationales, 18–29 nonprescribed medications, 371–375 answers and rationales, 376–380 pulmonary system, 77–84 answers and rationales, 84–93 sensory deficits, 337–340 answers and rationales, 341–344 Questran (cholestyramine), 39, 55, 109, 129, 437 Quetiapine (Seroquel), 309, 321 Quinidine, 436, 461 R Radiation exposure, 353, 360 Radiation therapy, 12, 24 Radioactive iodine I-131 treatment, 156, 168–169 Raloxifene (Evista), 216, 222 reduces breast cancer risk, 289 Ranitidine (Zantac), 104, 123, 444 Rating pain, 217, 224 children, 218, 225 Rattlesnake bite, 365, 368 Raynaud’s disease, 46, 61 RBC count, 256, 264–265 Reactive airway disease, 80–82, 88–91, 415, 430 children, 81–82, 90–91 Rocephin (ceftriaxone), 78, 86, 105, 124, 407, 422 Recombivax HB (hepatitis B vaccine), 108, 127 Reglan (metoclopramide), 444 Regular insulin, 172, 176, 177 Rehydralyte, 129 Relafen (nabumetone), 451 Reminyl (galantamine), 16, 27 Renal calculi, 183–185, 196–198 Renal osteoarthritis, 214–216, 220–222 Renal osteoporosis, 216–217, 222–224 Rescriptor (delavirdine), 455 Rescue medications, 299, 303 Resistant bacteria, aminoglycoside antibiotics for, 79, 87 Respiratory alkalosis, 95, 99 Retin-A (tretinoin), 452 Retrovir (zidovudine), 455 pregnancy and, 253, 261 Rheumatoid arthritis, 255–256, 264–265 Rheumatrex (methotrexate), 238, 243, 256, 264, 269, 273, 410, 425 RhoGAM, 207, 210 Ribavirin, pregnancy and, 108, 128 RID (pyrethrin with piperonyl butoxide), 383, 386–387 Rifampin (Rifadin, Rifaldazine), 94, 97, 442 Riopan, 104, 122 Risedronate (Actonel), 228, 231 Risperidone (Risperdal), 308, 320, 457 Ritalin (methylphenidate), 311–312, 314, 323–324, 326, 457 Ritonavir (Norvir), 455 Rivaroxaban (Xarelto), 437 Rivastigmine (Exelon), 15 Robaxin (methocarbamol), 214, 220, 434, 452 Robinul (glycopyrrolate), 443 Robitussin (guaifenesin), 442 Rocephin, 185, 198 Rofecoxib (Vioxx), 451, 456 Roferon (interferon alfa), 141, 144 Rosiglitazone (Avandia), 418, 448 Rotavirus, 110, 131 RU-486 (mifepristone), 365, 369 Rythmol (propafenone), 461 S Salmeterol (Serevent), 82, 91 Sandostatin (octreotide), 12, 24, 153, 155, 163, 166 Saw palmetto, 182, 194 Schizophrenia, 308–309, 319–321 Scopolamine, 443, 458 Seborrhea, 245, 248 Secretin, 153, 163 Sectral (acebutolol), 461 Seizures, 8–10, 19–21 Seldane (terfenadine), 454 Selegiline (Eldepryl), 26, 31, 34 Selenium, 382, 385 Self-prescribed medications, 373–375, 379–380 3905_Index_471-488 22/01/14 10:39 AM Page 485 INDEX Senna (Senokot, Ex-Lax, Agoral), 113, 135, 445 Sensory deficits, 337–350 comprehensive examination, 345–350 answers and rationales, 348–350 drug chart, 458–460 ear infections, 338–340, 342–344 eye disorders, 337–338, 338f, 341–342 questions, 337–340 answers and rationales, 341–344 Septic shock, 351, 357 Serevent (salmeterol), 82, 91 Seroquel (quetiapine), 309, 321 Serotonin syndrome, 305, 316, 416, 431 Sertraline (Zoloft), 310, 322, 329, 333 Sexually transmitted disease, adolescents, 185–186, 198–199 Sharps, disposing of, 390, 394 Shock, 104, 123, 351–352, 357–358 Shohl’s solution, 449 SIADH (syndrome of inappropriate antidiuretic hormone), 155, 167 Sibutramine (Meridia), 110–112, 131–133, 416, 431 Prozac, potentially life-threatening reaction with, 112, 133 Sickle cell anemia, 51, 66 Sildenafil (Viagra), 205, 208 nitroglycerin and, 38, 53–54 Silver nitrate, 235, 240, 346, 349 Silver sulfadiazine (Silvadene), 236, 240–241 Simethicone Suspension (magaldrate), 443 Simvastatin (Zocor), 39, 55, 437 Sinemet (carbidopa/levodopa), 13, 24–25 Singulair (montelukast), 80, 81, 88, 89–90, 456 Sinus tachycardia, telemetry strip for, 44, 44f, 59 Sixth Right of Medication Administration, 138 Skin cancer sunglasses and sunscreen, 239, 244 Sleep disorders, 312–314, 325–326 SLE (systemic lupus erythematosus), 251, 259, 269, 273 drug-induced, 252, 260 Slo-Phyllin (theophylline), 80, 82, 88, 91, 96, 99, 455 Smallpox, as a weapon, 353, 359 Smoking cessation bupropion, 331, 335 varenicline (Chantix), 407, 421 Helicobacter pylori infection and, 104, 122 increased vasoconstriction with, 46, 61 Sodium bicarbonate, 354, 360, 449, 460 Sodium biphosphate (Fleets Phospho-Soda), 106, 125 Sodium fluoride, 217, 223 Sodium hyaluronate (Hyalgan), 215, 220–221 Sodium polystyrene sulfonate (Kayexalate), 180, 191–192, 409, 424, 450 Solu-Medrol (methylprednisolone), 45, 79, 88, 408, 422, 434, 444, 448, 453, 455 with head injury, 8, 19 Soma (carisoprodol), 213, 219, 434, 452 Somatropin (Humatrope), 170, 175 Soy, 381, 384 Spermicides, 189, 202, 374, 380 Spinal anesthesia, 206, 209–210 Spironolactone (Aldactone), 107, 126–127, 170, 174, 439 administration, 69, 73 SSRIs, 305, 310, 316, 322 St John’s wort, 108, 128, 188, 201, 465 sunscreen with, 372, 376 Starlix (nateglinide), 446 Statins, muscle injury and, 54 Status epilepticus, Stomatitis, 300, 304, 375, 380 Stool softeners, 408, 423 Strattera (atomoxetine), 311, 324, 330, 334 Strep throat, 71, 75 Streptokinase (Streptase), 440 allergic reactions, 83, 92 heparin and, 83, 91–92 Streptomycin, 441, 442, 449, 452, 454 Stroke clients, administering oral mediation to, 11, 22 Subacute bacterial endocarditis, 45, 59 Subcutaneous administration, 396, 399 Sublingual medication, 396, 399 Substance abuse, 314–315, 326–328 Sucralfate (Carafate), 105, 123, 445 Sudafed (pseudoephedrine), 374, 380, 459 Suicide, 306, 316–317, 365, 368 Sulfamylon (mafenide acetate), 235, 236, 240–241, 410, 425 Sulfasalazine (Azulfidine), 102, 103, 120, 121, 256, 265 Sulfinpyrazone (Anturane), 452 Sulfisoxazole, 441, 449, 452, 454 Sumatriptan (Imitrex), 16, 28, 31, 35 Sunglasses and sunscreen skin cancer, 239, 244 Supplements, nutritional, 382, 385–386 Suppositories, inserting, 396, 399 Supraventricular tachycardia, 43, 58 Surfactants, 206, 209, 423 Surfak (docusate calcium), 106, 125, 445 Surgery allergy to iodine in povidone (Betadine), 113, 135 antiemetic, 114, 135–136 canceling if client has had something to eat, 113, 135 cancer treatments, 282–283, 293–294 client on call for administering medication, 101, 119 elevated WBC count, 115, 136 pain control, 114–115, 135–136 preoperative medication, 114, 136 preoperative scrubs, 114, 135 Symmetrel (amantadine), 14, 25, 30, 33–34, 34, 442 Syndrome of inappropriate antidiuretic hormone (SIADH), 155, 167 Synthetic lung surfactant, 206, 209 Synthroid (levothyroxine), 156–157, 168–169, 171, 175, 409, 423, 448 Syphilis, 186, 199 Systemic lupus erythematosus (SLE), 251, 259, 269, 273 drug-induced, 252, 260 T Tablets, administering, 396, 399, 413, 428 Tachycardia, 44, 44f, 59 Tacrolimus (Protopic), 239, 244 Tagamet (cimetidine), 332, 335, 444 side effects of, 102, 119 Tambocor (flecainide), 436, 461 485 3905_Index_471-488 22/01/14 10:39 AM Page 486 486 INDEX Tamoxifen (Nolvadex) increases risk of endometrial cancer, 280, 291 reduces risk of breast cancer, 289 Tamsulosin (Flomax), 182, 194 Tapazole (methimazole), 446 Tardive dyskinesia, 309, 321, 332, 335 Tavist (clemastine), 254, 263 TC&DB (turn, cough, and deep breathe), 79, 87 Tegaserod (Zelnorm), 141, 145 Tegretol (carbamazepine), 8–9, 20, 307, 319, 414, 429, 433, 457 Telemetry strips asystole (no heartbeat), 44, 44f, 59 bradycardia, 43, 43f, 58 bundle branch block (BBB), 42, 42f, 58 PVCs, 43, 43f, 58 sinus tachycardia, 44, 44f, 59 Tenecteplase (TNKase), 440 Tenormin (atenolol), 11, 22, 438 Tensilon (edrophonium), 252, 259–260 Tented skin turgor, 180, 192 Terazosin (Hytrin), 183, 195, 415, 430 Terbutaline (Brethine), 186, 200, 440, 454 Terfenadine (Seldane), 454 Tessalon Perles (benzonatate), 442 Testosterone, 189, 202 Tetanus toxoid, 236, 240 Tetracycline, 245, 248–249, 436, 441, 443, 449, 452, 454 Theophylline (Slo-Phyllin, Theo-Dur), 80, 82, 88, 91, 96, 99, 455 Thiazide diuretics, 184, 196–197 potassium loss and, 41, 57 Thioridazine (Mellaril), 457 Thorazine (chlorpromazine), 252, 260, 458 dosage, 331, 331f, 335 tardive dyskinesia, 309, 321 Thrombocytopenia, 275, 286, 299, 302 Thrombotic stroke, 11, 21–22 Thyroid disorders, 156–157, 168–169 TIA (transient ischemic attack), aspirin for, 31, 34 Ticlopidine (Ticlid), 438 Tigan (trimethobenzamide), 444, 458 Tikosyn (dofetilide), 461 Tinea pedis, 238, 243 TNKase (tenecteplase), 440 Tobramycin, 436, 441, 443, 449, 453–454 Tobramycin with dexamethasone (Tobradex), 458 Tolazoline, 460 Tolbutamide (Orinase), 448 Tolterodine (Detrol-LA), 205, 208 Topicort (desoximetasone), 453, 455 Toprol-XL (metoprolol), 47, 63, 438 Toradol (ketorolac), 434, 450, 451 Total parenteral nutrition (TPN), 103, 115–116, 115t, 121, 136–138, 153, 163, 283, 294, 408, 422–423 burn patients, 136–137 inflammatory bowel disease (IBD), 116, 137–138 tapering off, 103, 121 verifying prescription is correct, 116, 137 Trandate (labetalol), 69, 438 Transderm Scop patch, 143, 147 Transient ischemic attack (TIA), aspirin for, 31, 34 Traveler’s diarrhea, 112, 133 Trental (pentoxifylline), 46, 61 Tretinoin (Retin-A), 452 Triamcinolone (Kenacort), 453, 455 Tridil (nitroglycerin IV), 439 Trihexyphenidyl (Artane), 433 Trimethobenzamide (Tigan), 444, 458 Trimethoprim-sulfamethoxazole (Bactrim), 181, 193, 207, 211, 268, 272 Trimetrexate (Neutrexin), 254, 262 Tofanil (imipramine), 457 Tuberculosis, 94, 95, 97, 98 Tubocurarine, 30, 33 Tularemia, 353, 359, 366, 370 Twinrix (hepatitis A and B vaccine), 109, 129 Tylenol (acetaminophen), 7, 18, 247, 250, 339, 343, 374, 379, 434–435, 451, 459 generally preferred in older clients, 215, 221 from Mexico, with codeine, 382, 386 Type diabetes, 149–150, 158–160, 159t, 366, 369 Type diabetes, 9, 20, 150–152, 160–162, 364, 368 Tyramine reaction with histamine, 95, 99 reaction with INH, 95, 99 U Upper respiratory infection, 77–78, 85–86 Urecholine (bethanechol), 30, 33, 193 Urinary output, 48, 63 Urinary tract infection (UTI), 180–182, 192–194 Urine output, burn clients, 235, 240 Urokinase, 282, 293 V Vaginal contraceptive ring, 190, 203 Vaginal medication, administering, 398, 401 Valacyclovir (Valtrex), 186, 199, 247, 250, 409, 424 Valerian, 372, 376, 465 Valium (diazepam), 9, 20, 310, 312, 323, 325, 345, 348, 434, 456 Valproic acid (Depakote), 9, 20, 307, 318, 457 Valsartan (Diovan), 435 Valtrex (valacyclovir), 186, 199, 247, 250, 409, 424 Vancomycin, 87, 181, 193, 228, 231, 351, 357, 436, 441, 443, 449, 453–454 Varenicline (Chantix), for smoking cessation, 407, 421 Vasodilan (isoxsuprine), 46, 61 Vasopressin (Desmopressin), 155–156, 166–167, 417, 432, 446 Vasopressin (Pitressin), 107, 126, 446 Vasotec (enalapril), 11, 22, 41, 56 Venous stasis ulcers, 46–47, 61–62 Ventricular bigeminy, 71, 75 Verapamil (Calan), 438, 461 Vermox (mebendazole), 444 Viagra (sildenafil), 205, 208 nitroglycerin and, 38, 53–54 Videx (didanosine), 455 Vicodin (hydrocodone), 32, 36, 94, 97, 229, 232, 434, 445, 450–451, 459 constipation and, 78, 86 Vincristine (Oncovin), 156, 167 Vioxx (rofecoxib), 451, 456 Viramune (nevirapine), 455 Vistaril (hydroxyzine), 227, 230, 238, 243, 247, 250 3905_Index_471-488 22/01/14 10:39 AM Page 487 INDEX Vitamins and minerals, 372–373, 377–379 A, 373, 378, 466 overdose, 372, 377 B12, 381, 384, 440, 466 C, 375, 380–382, 384–385, 466 crystalluria, 373, 379 D, 373, 378, 448, 452, 466 deficiencies, 373, 378 E, 373, 378, 382, 385, 466 Alzheimer’s disease, 15, 26 K (AquaMEPHYTON), 49, 59, 64–65, 107, 126, 227, 230, 445, 466 antidote for Coumadin toxicity, 71, 75 newborn, 206, 209, 373, 378 water-soluble, 381, 384 Vomiting anticipatory, chemotherapy, 275, 286 increased intraocular pressure from, 346, 349 W Warfarin (Coumadin), 44, 49, 59, 64–65, 83, 92, 414–415, 429–431, 436, 441 AquaMEPHYTOIN (vitamin K), 83, 91 overdose, 71, 75 Warts, 245, 248 Water-soluble vitamins, 381, 384 Wellbutrin (bupropion) smoking cessation, 331, 335 weight loss, 111, 132 Whipple procedure, 282–283, 293–294 White blood cell count, 276, 286–287 Whole bowel irrigation, 356, 363 Wigs, 299, 302 Withdrawing medication from a vial, 389, 393 Wounds, 46–47, 61–62 dressings, 46–47, 62 steroids delay healing, 79, 87 X Xanax (alprazolam), 10, 21, 309, 310, 312, 321–323, 322–323, 325, 327 overdose, 310, 323 Xarelto (rivaroxaban), 437 Xenical (orlistat), 111, 132, 133–134 Z Zantac (ranitidine), 104, 123, 444 Zarontin (ethosuximide), Zelnorm (tegaserod), 141, 145 Zestril (lisinopril), 38, 54, 435 Zetia (ezetimibe), 39, 55, 437 Zidovudine (AZT, Retrovir), 455 pregnancy and, 253, 261 Zinc, 78, 86, 373, 378, 466 Ziprasidone (Geodon), 308, 320 Zocor (simvastatin), 39, 55, 437 Zofran (ondansetron), 277, 287 Zoloft (sertraline), 310, 322, 329, 333 Zostrix (capsaicin), 215, 221, 256, 265 Zovirax (acyclovir), 186, 199, 246, 249, 449 Zyban (bupropion) smoking cessation, 331, 335 weight loss, 111, 132 Zyloprim (allopurinol), 183–184, 196 Zyprexa (olanzapine), 457 Zyrtec (cetirizine), 454 487 3905_Index_471-488 22/01/14 10:39 AM Page 488 ... she needed to take the herb; this is an accusatory intervention 22 1 3905_Ch08 _21 3 -23 4 22 /01/14 10 :22 AM Page 22 2 22 2 PHARMACOLOGY SUCCESS The nurse should support alternative-type medicine if it... density 22 3 3905_Ch08 _21 3 -23 4 22 /01/14 10 :22 AM Page 22 4 22 4 PHARMACOLOGY SUCCESS MEDICATION MEMORY JOGGER: Few (electrolyte, hormone) levels are monitored daily, one being glucose levels 29 A woman... antidote for pain is narcotic medication If the client is resting and 22 5 3905_Ch08 _21 3 -23 4 22 /01/14 10 :22 AM Page 22 6 22 6 PHARMACOLOGY SUCCESS does not have pain, continuous administration of medication