Q1
Define each of the following

- Pharmacokinetics
- Pharmacodynamics
- Pharmacotherapeutics
- Toxicology

Q2

Common drugs - below is a list of commonly used brand names.

Please discuss the following points for EACH of the drugs listed (please use AusDi database or the Australian Medicines Handbook [online] in the TAFE Library where possible)

- The major drug group/class these brand names come under
- What they are prescribed for and their common routes e.g. IV, imi, sc, po etc.
- How do they work (mode of action)
- Common side effects and possible adverse interactions with other drugs
- Nursing implications

1. Glyceryl Trinitrate
2. Warfarin
3. Actrapid Insulin

Q3
a. As an EN administering medications - aside from the national EN competency and state competencies - what are the most important aspects of the drug administration process?

b. Download the ‘Enrolled Nurses and Medication Administration' Fact Sheet 2014 from the Additional Resources section of your Medications unit in my.TAFE. When reading through this document, who is ultimately responsibility for correct drug administration?

Q4

Mrs A is a 71 year old widow admitted to your ward this morning with chronic heart failure and osteoarthritis who has recently been exhibiting quite unusual behavior. Over the last 2-3 months, Mrs A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her usual prescribed medications are:
- Frusemide 40 mg daily in the morning
- Digoxin 250 micrograms daily
- Mylanta suspension, 20 ml prn

a. Explain the mode of action for digoxin (how does it work?)

b. Review the side effects of digoxin; discuss aspects of Mrs A's history that may be related to these side effects.

c. Explain the mode of action and the rationale for administering Frusemide (how it works and why it's given)

d. Review Mrs A's prescribed medications and discuss any possible interactions that may occur

e. Age related changes alter the pharmacodynamics and pharmacokinetics of drugs, please briefly discuss the influence of Absorption, distribution, metabolism and excretion of drugs in general for the older client.

Q5

Case Study Mr B

Mr B is a 65 year old man admitted to your ward, diagnosed with community-acquired pneumonia. At 10am, the Registered Nurse dilutes his intravenous Amoxicillin 1gm in 100ml minibag and connects it to his IV cannula. He has frail veins so the flow rate is set to run slowly via gravity infusion.

After a short period of time Mr B buzzes for a nurse, when you enter the room, Mr B states that he is feeling itchy all over (especially the chest area). You note that he has noisy breathing and he can't talk properly because his tongue is swelling. Mr B is having trouble breathing, and pointing to his chest, indicating chest tightness.

a. Define adverse drug reaction.

b. Describe your role as an EN responding to Mr B's nurse call bell. Include in your answer,

- Your immediate priority's, (remember he has a IV)
- Follow-up assessments you as the EN may do over the next 15mins,
- Who would you consult with throughout this event
- What would you need to document?

c. Discuss the education (regarding his new allergy) that should be provided to Mr B after he recovers from this event?

d. How would you evaluate your clients understanding of their new allergy

e. Identify the changes that should be added to his medication chart? (you must refer to the national medication chart for this answer)

Q6

According to the "Australian commission on safety and quality in health care" there are certain medications that have a heightened risk of causing serious or catastrophic harm when used in error. Please refer to the web address provided and identify each group of drugs that apply to: A.P.I.N.C.H.S

Q7

Case Study Amelia Bling

Amelia Bling is a 65 year old Aboriginal woman who has been admitted to the orthopaedic ward following a fall in her bathroom. She had a 3 day history or vomiting and diahroea
On admission to emergency she was noted to be significantly dehydrated. Amelia stated that she felt dizzy when standing up and just woke up on the floor with a sore hip. X-ray confirmed a left fractured neck of femur.

Her medical history includes:
Type 2 diabetes
Hypertension
Obesity, BMI 31.5.

Her current regular medications are:
Metformin daily
Ramipril 2.5mgs daily.
Metoprolol 25mg BD

You are caring for Amelia day 2 post-surgery for a total hip replacement. she has an IDC, PCA and IV therapy of Normal Saline 1 litre over 12 hrs

a. Review Amelia's fluid balance chart below and calculate the following - please state whether Amelia is in a positive or negative balance (please show your working out)

- Calculate the input
- Calculate the output
Is Amelia in a positive or negative fluid balance?

Amelia is reviewed by the pain assessment team who decide to cease her Morphine
Patient Controlled Analgesia (PCA) at 0800 hrs. The doctor prescribes:
Endone 5mgs 6Hrly
Paracetamol 1gm 4Hrly
At 1100 hrs, Amelia presses the call bell. Upon entering her room, you discover her crying and she informs you that she has ‘unbearable' pain.

c. Explain the process of completing a pain assessment on Amelia using a pain assessment tool
d. Discuss 3 complementary therapies strategies that you as the EEN may implement to alleviate Amelia's pain during her stay in hospital
e. Identify which drug schedule applies to Endone and discuss the storage requirements for this medication.
f. Provide an example of what you would write in the nursing notes when doing the documentation once the pain relieving medication has been administered -
including follow-up assessment
g. In your own words briefly discuss your understanding of traditional medicine in the context of health of Aboriginal and Torres Strait Islander people

Q8

Mrs. Marshall is a 68 year old allocated to your care for the shift. Her medical history includes:
Hypertension
Coronary heart disease
Type 2 diabetes.

Her medication prescribed medications are:
Captopril
Atenolol
Glibencamide
Glycerol trinitrate.

Her consultant decided to commence her on atorvastatin to provide her with additional cardiac protection two days previously. During the medication round on your shift, Mrs Marshall informs you that she has begun to experience the side effects of the atorvastatin and therefore has decided not to take it anymore. Mrs Marshall also informs you that as she is already on ‘a lot of medication' for her heart, she does not think it will be a problem.

From a legislative and organisational perspective, discuss your management of the above case study in regards to Mrs Marshall's refusal to take her medicine

Q9
a. Refer to the National in-patient's medication chart guidelines for this question. When a medication is written up by the doctor, according to the NIMC guidelines, what are the 7 essential elements that must be documented on a medication chart?

b. Please review the following medication chart (below) and identify the 6 errors for the drugs that have been ordered (assume all dates are correct)

c. You are in the hospital ward treatment room to check a S8 medication such as Morphine with the RN. While you are not giving this drug, you are required to witness the administration

True / False

d. What steps as an EEN are you to follow when administering a PRN medication?

Q10

a. Discuss the risk factors and complications of IV therapy
b. Outline the care of a peripheral Intravenous cannula
c. Discuss the steps for removal of a peripheral Intravenous cannula
d. In general what are the indications for the administration of Intravenous therapy
e. Please provide one medication for each of the following drug schedules
S2
S3
S4

Q11

Please read the question carefully then answer the question below

Some medications have Individualised doses based on a patient's weight and body surface area (BSA), for children, frail adults, adults: for instance, chemotherapy drugs. This is because many of these drugs are very toxic with a narrow therapeutic range. While you may not calculate these doses, you are required to have an understanding of how to do a calculation using BSA. The units of BSA are per square
millimeter (m2). BSA is calculated from a formula that employs the height and weight.

There are numerous formulas - in use here is the Mosteller formula - one of the most commonly used

Mostella formula used to calculate BSA is 

CASE STUDY

Mrs Jones is a 76yr old woman who is to commence chemotherapy. Her weight is 51kg and her height is 165cm

To calculate BSA of Mrs Jones

use a calculator with a Square root symbot √ 51 X 165 /60 = 1.52 (m²).
Therefore, Mrs Jones's BSA (m²) is 1.52 (m²).

Mrs Jones is ordered Cisplatin (for CA of the bladder) 50mgs / (m² ) as a single IV infusion.

Please calculate how many mgs will be needed using the above BSA for Mrs Jones.