Lithium Carbonate: What You Need to Know

Lithium Carbonate Must-Knows

The NCLEX consists of four core topics, with Physiological Integrity as one of them. Under this section is ‘pharmacological and parenteral therapies,’ undoubtedly one of the hardest subjects in the exam.

As such, it is important that you familiarize yourself with the common medications found in the NCLEX, one of which is Lithium Carbonate. Here are some important facts you need to know about this drug:

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Indication for Use

Lithium Carbonate is an anti-manic drug, used in the treatment of manic episodes in individuals with bipolar disorder. It is also used as a maintenance drug, in order to decrease the intensity and frequency of ensuing manic outbreaks.

Lithium Carbonate, also known by the names Eskalith, Eskalith CR, Lithobid, Lithonate and Lithotabs, works by inhibiting dopamine and norepinephrine release. Placed under Pregnancy Category D, this drug is known to cross the placenta and the milk ducts.

Lithium ToxicityNursing Considerations

As a nurse, you need to know that Lithium Carbonate interacts with a lot of drugs and supplements. Toxicity can occur if it is taken in conjunction with Thiazide diuretics such as Hydrochlorothiazide and Indapamide. CNS toxicity can also occur if it is taken with Carbamazepine.

Plasma Lithium Carbonate levels, on the other hand, can increase and become toxic if it taken in conjunction with NSAIDs (i.e. Ibuprofen and Meloxicam) and Indomethacin.

Prior to administering Lithium Carbonate, make sure to take the patient’s history. Note if the patient has a severe heart or kidney problem. Assess if the patient takes diuretics, or if he suffers from tartrazine hypersensitivity.

Also remember to monitor the patient’s vital signs, weight, orientation and affect prior to administering Lithium Carbonate. Check his fluid intake and output as well. Do not forget to evaluate the baseline results of the following exams: CBC, Urinalysis, ECG, Thyroid and Renal function tests.

Nursing Interventions

Because of this risk of toxicity associated with Lithium Carbonate, religiously check the serum levels of the patient, especially if he is dehydrated, debilitated, or diagnosed with heart or kidney diseases. Remember that the therapeutic level for this drug is 0.6 to 1.2 mEq/L.

The efficacy or toxicity of Lithium Carbonate depends on the patient’s salt and fluid intake. As such, instruct your client to maintain adequate salt and fluid intake, which is 2.5 to 3 liters per day.

Important Teaching Points

Nurses are patient educators, so you need to remind them of essential drug pointers, especially if they will be taking Lithium Carbonate at home.

Make sure to advise your patient to take Lithium Carbonate after meals with food or milk. Remind him about maintaining a normal salt and fluid intake for optimum effectiveness.

Inform your patient about the expected side effects of Lithium Carbonate, which are drowsiness, dizziness, GI upset, mild thirst, increased urine volume and fine hand tremor.

Most importantly, instruct your patient to coordinate with you or another healthcare provider if he experiences the signs of toxicity, which include tremor, vomiting, diarrhea, drowsiness, muscular weakness and lack of coordination.

 

Lithium is just one of the many medications you can expect in your forthcoming NCLEX exam. Master this drug – among many others – at NCLEXpreceptor.com’s practice NCLEX questions.

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Resources:

http://web.squ.edu.om/med-lib/med_cd/e_cds/Nursing%20Drug%20Guide/mg/lithium.htm

http://www.mayoclinic.org/drugs-supplements/lithium-oral-route/description/drg-20064603

 

 

Nursing Diagnostics for Hypertension

Diagnostics for Hypertension

Think about high blood pressure.  Learning NCLEX nursing interventions is a great way to study.  Use this nursing guide to learn nursing diagnostics for hypertension patients.  Fill in the blanks and list the nursing diagnostics for hypertension:

nursing diagnostics for hypertenstion

Blood Test for Hypertension

  1. Blood urea nitrogen (BUN) and creatinine (Cr): What is the purpose of this test?
  2. Glucose: A glucose test will measure the amount of glucose in the blood. Hyperglycemia (high glucose levels) may be caused from increased catecholamine levels. High catecholamine levels raises blood pressure. Diabetics are also at higher risk of hypertension.
  3. __(Name this test)____________:  This test is used to determine the possible cause of hypertension.  It also identifies if an important electrolyte is low due to diuretic therapy.
  4. __(Name this test)____________:  This lab test for HDL and LDL levels.
  5. List 2 other blood test should you consider evaluating as diagnostics for hypertension?

Other Diagnostic for Hypertenstion

  1. Electrocardiogram (ECG):  What is the purpose of this test?
  2. __(Name this test)_____________:  This test will test for hyperuricemia.  Hyperuricemia is a risk factor for the  development of hypertension.

Answers are Below


 

 

diagnostics for hypertenstion

 

Blood Test

  1. Blood urea nitrogen (BUN) and creatinine (Cr): Provides information about renal perfusion and function and can  reveal cause if hypertension is related to kidney dysfunction.  BUN measures the amount of urea nitrogen in the blood. Cr measures the amount of creatinine in blood or urine.
  2. Glucose: A glucose test will measure the amount of glucose in the blood. Hyperglycemia (high glucose levels) may be caused from increased catecholamine levels. High catecholamine levels raises blood pressure. Diabetics are also at higher risk of hypertension.
  3. Serum Potassium Level:  This test is used to determine the possible cause of hypertension.  It also identifies if an important electrolyte is low due to diuretic therapy
  4. Serum Lipid Panel This lab test for HDL and LDL levels.
  5. Thyroid studies: Blood test and scan to evaluate thyroid function; most commonly used laboratory test is the measurement of thyroid-stimulating hormone (TSH).Serum/urine aldosterone level: May be done to assess for primary aldosteronism as cause of hypertension.Renin: An enzyme that activates the renin-angiotensin system and screens for essential, renal, or renovascular hypertension.
    Other Diagnostic for Hypertenstion

Other Diagnostics for Hypertension

I you want to pass nursing school and NCLEX then you should know other diagnostics for hypertension.  These are also NCLEX nursing interventions that you may have to assess.

  1. Electrocardiogram (ECG): This radiology test assesses electrical activity of the heart.  The test can identify enlarged hearts or abnormal heart rates and rhythms.  A broad notched P wave is one of the first signs of hypertension.
  2. Uric Acid test assess for high amounts of urea in the urine.   A high urea level is called hyperuricemia.  Hyperuricemia is a risk factor for the  development of hypertension.

It is important that you know NCLEX nursing interventions and diagnostics for hypertension patients.

Resources for hypertensive patients:
http://www.cdc.gov/bloodpressure/materials_for_patients.htm

http://www.hypertensionfoundation.org/patients.cfm

American Heart Association

Top NCLEX Meds

NCLEX Questions:  Top NCLEX Meds  3rd edition

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  • Bonus:  Get NCLEX practice questions to prepare for the real test
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Chapter 1
A NCLEX Review on ACE Inhibitors

What are ACE Inhibitors?

ACE Inhibitors or Angiotensin Converting Enzymes are any of a group of antihypertensive drugs that relax arteries and promote renal excretion of salt and water by inhibiting the activity of an angiotensin converting enzyme.

These are enzymes responsible for reducing vasculature resistance without increasing cardiac output, rate or contractility.

NCLEX Alert! ACE Inhibitors are one of the most frequently tested antihypertensive drugs on NCLEX.

These are the diseases that ACE Inhibitors treat:
1. Hypertension
2. Congestive heart failure

And, they lower the risk of stroke and heart attack.

You must remember that these inhibitors have side effects in our body, such as:
1. Postural hypotension (commonly known as ‘head rush’ or ‘dizzy spell’)
2. Fatigue
3. Loss of appetite
4. Nausea, vomiting, diarrhea
5. Hyperkalemia
6. Insomnia
7. Could exacerbate non-productive cough
8. Angiodema

Some of the commonly used ACE Inhibitors are Benazepril, Captopril, Enalapril and Fosinopril. Also included in this classification are Lisinopril, Moexipril or Perindopril.

Now, what should be your nursing considerations in giving medications? As a nurse, you also have to educate your clients in taking these drugs. Here are some medical considerations:
1. You have to remember that these medications cause retention of potassium. Hence, monitor the electrolytes.
2. Take note that elderly clients are at highest risk for postural hypotension.
3. Always instruct your clients not to abruptly discontinue medications because rebound hypertension can occur.
4. Do not forget to monitor the blood pressure frequently.
5. If your client has impaired renal function, you have to be cautious if they will be using these drugs
6. Finally, notify the client’s physicians if dizziness still persists.

Lab. Value Alert:
• Calcium 8.8 – 10.3 mg/dL
• Calcium, ionized 2.24 – 2.46 mEq/L
• Chloride 95 – 107 mEq/L
• Magnesium 1.6 – 2.4 mEq/L
• Phosphate 2.5 – 4.5 mEq/dL
• Potassium 3.6 – 5.2 mmol/L
• Sodium 135 – 145 mEq/L

If your client is on ACE inhibitors, you should see these desirable outcomes:
1. Blood pressures controlled within normal limits
2. Improved survival rates for clients suffering from acute MI
3. Decreased workload on cardiovascular system
4. Decrease or absence of chest pain

If you see these positive results, then you are on the right track!

NCLEX Tips to remember about these medications:
Tip #1: Most ACE drugs end with the suffix –pril, as in Ramipril, Quinapril, Trandolapril
Tip #2: If your client is taking diuretics, notify the physician before they take Lisonipril
Tip #3: Always double-check the drugs and their side effects with the client

Frequently Asked Questions (FAQs):
Q: What are the brand names of ACE Inhibitors?
A: Lotensin, Capoten, Vasotec, Monopril, Prinivil, Zestril, etc.

Q: Should the medications be taken immediately after eating?
A: No. The drug’s absorption will be decreased if taken with food. So you should allot at least 1 hour before taking the meds.

You are now ready to take these NCLEX sample practice questions. Just remember the guidelines given to you, and you can answer the following correctly:

1. Which statement, if made by the hypertensive client taking Lisinopril, indicates the need for further teaching?
a. “I will take the medication with my Spironolactone.”
b. “I will inform the physician if my dizziness persists.”
c. “I will not stand up immediately after taking the medication.”
d. “I will have my daughter take my blood pressure from time to time.”

2. The nurse correctly enumerates which of the following side effects in taking ACE Inhibitors. Select all that apply:
1. Headache
2. Hypertension
3. Fatigue
4. Vomiting
5. Diarrhea
6. Cough
7. Loss of consciousness

3. A nurse is making her daily rounds. She remembers that Mrs. Rose is taking Perindopril (Aceon); which of the following statement, when made by Mrs. Rose, would warrant notification of the attending physician?
a. “The first time I took the medication, I had a headache.”
b. “I took my medication an hour before meals.”
c. “I’ve had a blood extraction today to determine my potassium level.”
d. “I have been feeling dizzy for three days now.”

4. Mrs. Sommers, a 53-year-old female diagnosed with Congestive Heart Failure is taking Fosinopril (Monopril) 10 mg tablet once a day. Which of the following results would require the need to notify the physician?
a. Creatinine 1.0 mg/dL
b. Potassium 12 mEq/L
c. Albumin 5 U/L
d. BUN 10 mg/dL

5. You are the nurse caring for Mrs. Jones, a 44-year-old client with hypertension. An hour after taking Ramipril (Altace), you took her blood pressure and noted that it is 80/50. Which of the following nursing interventions should you do first?
a. Call the attending physician
b. Elevate her legs by adjusting the bed and placing her on a Trendelenburg position
c. Give her Furosemide (Lasix)
d. Give supplemental oxygen via nasal cannula at 3 lpm

ACE Inhibitors practice test answers:
1. A
2. 1,3,4,5,6
3. D
4. B
5. B

Bonus: NCLEX Questions mobile application for Android and Apple Devices Download Today at www.nclexpreceptor.com

Chapter 2
NCLEX Tips on Alpha Blockers

How do you define Alpha Blockers?

Alpha blockers help relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins.

What will happen then if they block that effect?

When they block that effect, the vessels will remain open and relaxed.

As a nurse, you must know the diseases that Alpha blockers treat:
1. Hypertension
2. Benign Prostatic Hyperplasia or BPH
3. Raynaud’s Disease
4. Pheochromocytoma or commonly known as Adrenal gland tumors

In every drug, there will always be side effects. In giving Alpha blockers to your clients, you could expect them to have signs of nausea, drowsiness, nasal congestion, weight gain and edema. In addition, orthostatic hypotension and sodium and water retention might occur.

NCLEX tip #1: Drugs usually ending in suffix –zosin are used as alpha blockers; such as:
1. Alfuzosin
2. Prazosin
3. Tamsulosin
4. Doxazosin
5. Silodosin
6. Terazosin

NCLEX Question #1: As a nurse, what are your considerations in using alpha blockers?
Answer: Monitor fluid retention, edema and blood pressure. It is also a must to avoid over-the-counter medications, and possibly decrease salt intake. Finally, when waking up in the morning, breathe deeply for a few minutes and then slowly sit up before standing as to avoid orthostatic hypotension.

Now that you are aware of the above-mentioned nursing health teachings, what are the possible outcomes when the client is already using the drugs?

Firstly, the renal blood flow of the client will be correctly maintained. Secondly, there will be a noticeable reduction in symptoms of BPH, so the urine flow rates will be improved. Lastly, blood pressure will be decreased within 15 minutes following oral administration in hypertensive clients.

NCLEX tip #2: Alpha blockers are typically NOT preferred as the first treatment option for high blood pressure.

NCLEX tip #3: If high blood pressure is difficult to control, Alpha blockers need to be combined with other drugs like diuretics.

Remember these three tips and you will be better in remembering Alpha Blockers.

You are now ready to take the NCLEX practice test. You will be able to answer the following questions once you remember the tips given to you.

1. A client taking Tamsulosin returns to the outpatient department for a follow-up. Which of the following statements made by the client indicates the need for further assessment?
a. “I get out of bed by sitting for a while first before standing up.”
b. “I always have my blood pressure taken by my niece who is taking up nursing.”
c. “Yesterday I was feeling tired and sleepy while driving to the laundromat.”
d. “I have started cooking with less salt than before.”

2. Which of the following clients can’t be prescribed with Tamsulosin?
a. Benign Prostatic hyperthropy
b. Coronary atherosclerosis
c. Raynaud’s disease
d. Pheochromocytoma

3. Which of the following foods can be taken by the client on alpha blockers?
a. Banana, oatmeal.
b. Sausage, bread
c. Egg noodles in beef broth
d. Custard, smoked ham

4. Which of the following are the side effects of Reserpine (Serpasil)?
a. Edema
b. Drowsiness
c. Weight gain
d. All of the above

5. When is the best time to take the initial dose of Prazosin (Minipress)?
a. At lunchtime
b. After breakfast
c. One hour before breakfast
d. At bedtime
NCLEX Alpha Blocker practice test answers:
1. C
2. B
3. A
4. D
5. D

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Score High in Your NCLEX: MAOI Inhibitors Must-Knows

MAOI Inhibitors Must-Knows

According to studies, depression affects more than 120 million individuals around the world. This mental disorder, unfortunately, disturbs one’s quality of life, relationships and social skills. Worst of all, it has led to approximately 850,000 cases of suicide worldwide.

Because of the prevalence of this disease, it is your responsibility as a nurse to familiarize yourself – as well as your clients – with anti-depressant medications, such as MAOI Inhibitors.

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Signs of Depression

Indications for Use

MAOI inhibitors are anti-depressants that affect neurotransmitters that serve as linkages between neurons. It addresses depression symptoms by altering the levels of such brain chemicals.

MAOI inhibitors prevent the synthesis of monoamine oxidase, which eliminates dopamine, serotonin and epinephrine from the brain. With higher levels of the aforementioned neurotransmitters, enhanced mood is experienced.

Examples of MAOI inhibitors are Phenelzine (Nardil), Selegilin (Emsam), Isocarboxazid (Marplan) and Tranylcypromine (Parnate.)

Nursing Considerations

Before administering MAOI inhibitors, the nurse should take the history of the patient. Pertinent information that should be noted are hypersensitivity to MAOI inhibitors, seizure disorders and cerebrovascular defects. Disorders such as cardiovascular disease, hypertension and hyperthyroidism should be documented as well.

As for physical examination, the nurse should obtain the client’s vital signs, reflexes, affect, orientation and urine output. Skin color and the presence of skin lesions should be checked as well. Laboratory tests that should be obtained include CBC, urinalysis, thyroid function tests, ECG and EEG.

NCLEX Nursing Interventions

The most important nursing intervention for patients taking MAOI inhibitors is to ensure that they limit the intake of tyramine-rich foods. Tyramine, whose breakdown is impeded by MAOI inhibitors, can lead to a hypertensive crisis. Symptoms include elevated BP and severe headache. At the sign of this, immediately discontinue the drug and inform the doctor.

Consequently, make sure to control the patient’s intake of cheese, alcohol, banana, liver and fermented/smoked food products. In anticipation of a hypertensive crisis, keep alpha-adrenergic blocking drugs and phentolamine at bay.

Apart from the symptoms of hypertensive crisis, MAOI inhibitors should also be discontinued at the first sign of hepatic dysfunction (jaundice.)

Important NCLEX Teaching Points

Nurses are health educators, so when teaching patients taking MAOI inhibitors, remind them to take the drug as prescribed.  Advise them not to discontinue use abruptly.

As it has been emphasized, instruct your patients to avoid tyramine-rich foods while taking MAOI inhibitors, up to 2 weeks after therapy. Alcohol, appetite suppressants and over-the-counter drugs should be averted as well.

Additionally, make sure to educate your patients about the expected side effects of MAOI inhibitors, which are:

  • Dizziness
  • Weakness/fainting resulting from an abrupt positional change
  • Drowsiness
  • Blurred vision (reversible)
  • Nausea and vomiting
  • Loss of appetite
  • Emotional or mental changes
  • Irritability/ nervousness

Patients should be informed about the warning signs that warrant immediate physician/nurse attention as well. They include:

  • Headache
  • Rashes
  • Darkened urine
  • Pale stools
  • Eye/skin yellowing
  • Chills and fever
  • Sore throat

Your patient’s recovery depends on your knowledge, skills and passion as a nurse. Enhance your mind and become an excellent nurse with the practice NCLEX questions at nclexpreceptor.com.

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References:

http://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/Psychiatric%20Nursing%20Care%20Plans/monographs/phenelzine%20sulfate.htm

http://assistednursingcare.net/monoamine-oxidase-inhibitors-maois-an-antidepressant-and-its-contraindications/

 

Acyclovir Pointers: What You Need to Pass Your NCLEX Quickly

Vital Acyclovir Pointers

The first anti-viral medications were created in the 1960’s, and they were all focused on curing the herpes virus family. Fortunately, through tireless effort and monitoring – Acyclovir – one of the common NCLEX medications – was invented.

Indications for Use

Known with the brand name of Zovirax, Acyclovir is an anti-viral agent that works by inhibiting DNA replication.

Whereas antibiotics are for bacterial infections, anti-virals such as Acyclovir are prescribed for certain viral illnesses. Compared to antibiotics, anti-virals can only inhibit the development of pathogens, and not destroy them.

Acyclovir is primarily prescribed in patients suffering from a Herpes infection. They include:

  • Genital herpes
  • Herpes zoster/ Herpes simplex
  • Herpes simplex encephalitis in babies 6 months and younger
  • Mucosal/cutaneous Herpes Simplex (HSV) 1 or 2 in Immunocompromised patients
  • HSV infection following transplant
  • Disseminated eczema herpeticum

herpes zosterOther indications include Cytomegalovirus infection, infectious mononucleosis and varicella pneumonia.

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Nursing Considerations

As it has been emphasized in nursing school, assessment is the first vital step to the nursing process. Before administering Acyclovir, make sure to evaluate the patient for the presence of allergies, congestive heart failure, seizures, renal disorder and lactation.

Additionally, perform a thorough physical examination of the patient. Check the client’s vital signs, orientation, lung sounds, urinary output, skin color and presence of skin lesions. Lab exams that should be requested are kidney function tests (BUN and Creatinine.)

NCLEX Nursing Interventions

When administering systemic Acyclovir, ensure that the patient is hydrated throughout the course of the therapy. Remember that this drug is nephrotoxic, which means it can have a negative effect on the kidneys.

If administering Acyclovir topically, institute treatment as soon as the first infectious signs and symptoms appear. Additionally, don a finger cot when applying the medication.

Important NCLEX Teaching Points

For patients receiving Acyclovir therapy, instruct them to complete the prescribed dose. Emphasize that they should not go beyond the recommended dose.

Additionally, remind them that it will NOT cure the disease, but it can lessen the severity signs/symptoms. Note that even with the application of the drug during symptom-free periods, prevention of recurrence is not ensured. As such, instruct the patient to wear a rubber glove/finger cot upon topical application to prevent transmission or self-inoculation.

Remember to teach the patient about the expected side effects of the drug (systemic), which include diarrhea, headache, dizziness, loss of appetite, vomiting and nausea.

Side effects for topical Acyclovir, on the other hand, are stinging, burning, itching and rashes. If these signs become more pronounced, inform the nurse/doctor right away.

Apart from the severity of the following signs, the onset of skin rashes, urination difficulty and recurrence also warrant the notification of healthcare personnel right away.

Those receiving Acyclovir therapy (both systemic and topical) should also be reminded to abstain from sexual intercourse especially if lesions are visibly present.

Anti-virals are commonly used in hospital and home settings, so it is best if you know about this medication. Master this drug – and many other therapeutic agents – with the practice NCLEX questions at nclexpreceptor.com.

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References:

http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/Principles%20&%20Practice%20of%20Intravenous%20Therapy/mg/acyclovir.htm

http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/V002.html

http://www.mayoclinic.org/drugs-supplements/acyclovir-oral-route-intravenous-route/description/drg-20068393