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NCLEX Review Shownotes:

I have mentioned before that pharmacology plays a big role and a big factor with the NCLEX exam. If we encounter the mid level which are basically the competent questions which is exactly what we need to know and what the NCSBN or Board of Nursing wants us to answer correctly in order to pass the NCLEX exam. Then it is expected from us to understand the management and prioritization aspects of certain medications that we have to know for the NCLEX.  That simply means to know and understand side effects or adverse reactions for certain medications and also how management and prioritization would be applied towards Pharmacology in correlation to the impact of the side effects or adverse reactions towards the patient. What it means is basically as a nurse or as a nurse graduate taking the NCLEX exam,  it is our job and our duty to be conscious and aware of certain side effects and how that impacts our client.  Also implications that we need to know for certain medications such as interactions or interventions that will become a priority for us as the nurse, in taking take care of our patient.  This entails knowing the specifics factors such as the ABG’s, vital signs and lab values and all of the symptomatic signs. Now let’s look at a few important examples of the most important pharmacological categories of medications that we will most likely encounter in the NCLEX exam.

NCLEX Review Cardiac Medications

Now let’s begin with the important medications that is used for hypertension, which is diuretics. Lets talk about diuretics, which helps get rid of sodium and fluid in the body. Diuretics is used to lower the blood pressure and therefore promotes excretion of sodium and water. Now with this in mind we can understand that diuretics interferes with the patient’s blood pressure (which means it can significantly drop) as a result: decrease in the preload and afterload in the body.   Therefore, a priority would be giving IV fluids to that patient.   And since there would be sodium absorption in the kidneys, it causes an increases the urine output.

Now let’s go over a specific type of diuretics and start with a potassium sparing diuretics. With a potassium sparing diuretic, it basically promotes the excretion of sodium and water while the retention of potassium (Important to know for NCLEX Review).  And basically is used usually for hypertension and edema and for a patient with hypokalemia or hypokalemic symptoms.   An example of a potassium sparing diuretics would include Spir0nolactone, which will usually be very common in the NCLEX exam. So what is the prioritization for this particular patient:  Obviously the patient could end up having too much potassium and that would cause hyperkalemia, so therefore then we would have to know the symptoms of  hypokalemia (now we all know that Potassium is needed for cells, especially nerve and muscle cells, to function properly) as a result the person can have symptoms that can include irregular heartbeat, nervousness, tingling in the hands, shortness of breath and nausea and vomiting.

Let’s talk about another category of cardiovascular medications which is beta-adrenergic blockers or beta blockers and basically beta blockers helps lower blood pressure and pulse rate.   It is also used to treat headaches, glaucoma and prevent MI or myocardial infartions by blocking the sympathetic motor response of the body.  Always try to remember that the beta blocker medications would usually end in syllables “lol” .  Common Beta Blockers that you can encounter in the NCLEX includes (Metoprolol, Carvedilol, Acebutolol).   Beta blockers block the action of catecholamines such as epinephrine (adrenaline) and as we all know this causes the fight-or-flight response of the body therefore the opposite effect can be manifested as the adverse reaction.  So, Side effects for patients taking  Beta blockers would include orthostatic hypotension, bradycardia, nausea and vomiting and diarrhea. We need to know that some of the symptoms may mask signs of hypoglycemia in the patient and is manifested as hypoglycemic symptoms.  This is due to the fact that beta blockers normally stimulate hepatic glycogen breakdown in the pancreas and causes the release of glucagon. So we need to take note of that for the NCLEX

Nursing interventions for clients with beta blockers would include interventions such as making sure that we monitor the clients blood pressure, and heart rate.  We also need to monitor the client for signs of edema.  So as the nurse, we should assess the lung sounds for the signs of rales and rhonchi which can be due to obviously fluid overload. When patients are taking beta blockers, it is also very important to monitor the changes in lab values such as protein, B UN and creatinine which can indicate nephrotic syndrome in the kidneys and that can be a problem. Nursing teaching for these patients would include teaching the client to rise slowly because the cause orthostatic hypotension which can become a safety issue and we also need to tell the patients to  report any signs of bradycardia, dizziness and confusion.

Focus on this Topic:

• Potassium Sparing Diuretics
• Beta Blockers

♣ Pharmacology Drugs for Hypertension:

DIURETICS

– HELPS GET RID OF THE SODIUM AND FLUID IN THE BODY.
– USED TO LOWER THE BLOOD PRESSURE.
– PROMOTES THE EXCRETION OF SODIUM AND WATER
– DIURETICS INTERFERES WITH THE SODIUM ABSORPTION IN THE KIDNEY.
– INCREASES THE URINE OUTPUT. DECREASES THE PRELOAD AND AFTERLOAD..
If the patients blood pressure drop to low, it is important to give IV FLUIDS to pt.

LETS GO OVER THE CATEGORIES OF DIURETICS ♠

♦ TYPES OF DIURETICS

♣ POTTASIUM SPARING DIURETICS

It promotes the excretion of soduium and water, while the retention of pottasium

Used for:

HYPERTENSION
EDEMA
HYPERALDOSTERONISM
HYPOKALEMIA
MEDICATION:

SPIRONOLACTON (ALDACTONE)
AMILORIDE (MIDAMOR)
TRIAMTERENE
Now lets go to the SIDE EFFECTS:

First, of course the person can have too much potassium or HYPERKALEMIA:

Signs of HYPERKALEMIA

IRREGULAR HEARTBEAT
NERVOUSNESS
TINGLING IN HANDS AND FEET
SHORTNESS OF BREATH
TIREDNESS OR WEAKNESS
OTHER SIDE EFFECTS:

NAUSEA AND VOMITING
CRAMPING AND DIARRHEA
DIZZINESS & HEADACHE
◊

BETA (ADRENERGIC) BLOCKERS

– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.

For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

SIDE EFFECTS:

ORTHOSTATIC HYPOTENSION
BRADYCARDIA
NAUSEA AND VOMITING
DIARRHEA
NOTE: Some of the symptoms may MASK signs of Hypoglycemia

♠ HYPOGLYCEMIC SYMPTOMS

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker. Monitor the client for signs of edema. The nurse should also assess the lungs sounds for signs of rales and ronchi. When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome. Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever. It is also very important to taper off the medication properly.

CARDIAC PHARMACOLOGY

♣ NCLEX Review Notes:.

♣ NCLEX REVIEW PHARMACOLOGY

Drugs Used for treating Hypertension:

BETA BLOCKERS
– REDUCES THE CARDIAC OUTPUT AND DECREASES THE SYMPATHETIC NERVOUS SYSTEM RESPONSE.
– BLOCKS THE BETA RECEPTOR, CAUSING A DECREASE IN BLOOD PRESSURE.
– MEDICATIONS INCLUDE THE “OLOL’S”: METROPOLOL, PROPANALOL, ACEBUTOLOL, NADOLOL.
– USED FOR HYPERTENSION, MYOCARDIAL INFARCTION AND ANGINA.
– ADVERSE EFFECTS CAN INCLUDE: BRADYCARDIA, HYPOTENSION AND HYPOGLYCEMIA (DISTRUPTS THE LIVER’S ABILITY TO CONVERT GLYCOGEN TO GLUCOSE).

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