Antihistamines and respiratory drugs; TB

A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? 1. Insufficient dosage of the medication, which needs to be increased 2. Probable interaction of this medication with an over-the-counter cold remedy 3. Tolerance to the medication, indicating a need for a stronger type of bronchodilator 4. Paradoxical bronchospasm, which must be reported to the health care provider (HCP)

4. Paradoxical bronchospasm, which must be reported to the health care provider (HCP)

The nurse would expect the health care provider (HCP) to add which medication to the regimen of the client receiving isoniazid? 1. Niacin 2. Neurontin 3. Pyridoxine (vitamin B6) 4. Cyanocobalamin (vitamin B12)

3. Pyridoxine (vitamin B6)

A nurse is providing education to a patient taking two different medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? A. Shorter onset of action B. Better side effect profile C. Quicker peak action D. Longer duration of action

D. longer duration of action

Advair(fluticasone/salmeterol): Mechanism of action & side effects

Long acting bronchodilator (the salmeterol) and corticosteroid (advair), not to be used in an acute asthma attack given twice daily

A client taking rifampin (Rifadin) reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? 1. Notify the health care provider. 2. Chart the finding as a normal response to the rifampin. 3. Get the client into bed, and put the bed in Trendelenburg's position. 4. Immediately start prescribed intravenous (IV) fluids to prevent shock.

. Chart the finding as a normal response to the rifampin

Which is the nurse's priority assessment for monitoring the client taking isoniazid? 1. Electrolytes 2. Liver function tests 3. Arterial blood gases (ABGs) 4. White blood cell (WBC) counts

2. Liver function tests isoniazid is for Tb tx but can cause hepatoxicity

A nurse is preparing to administer albuterol (Proventil HFA) to a client. Which parameters should the nurse assess before and during therapy? 1. Nausea and vomiting 2. Headache and level of consciousness 3. Lung sounds and presence of dyspnea 4. Urine output and blood urea nitrogen level

3. Lung sounds and presence of dyspnea

Most common side effects from Antihistamines

Anticholinergic (drying) effects: most common -dry mouth, difficulty urinating, constipation, changes in vision -drowsiness Avoid use in individuals with lower respiratory tract disease or risk for pneumonia because they dry up secretions which then become thick (viscous), occlude airways and lead to atelectasis

The nurse is teaching a group of patients about the use of bronchodilators. It is important to remind them that using bronchodilators too frequently may cause which adverse effects? (Select all that apply.) a. Blurred vision b. Increased heart rate c. Decreased heart rate d. Nausea e. Nervousness f. Tremors

B, D, E, F increased HR, nausea, nervousness, tremors

A client with a documented exposure to tuberculosis is being started on medication therapy with isoniazid. The nurse plans to set up appointments for the client to have which laboratory study done periodically during the course of therapy? a) Platelet count b) Liver function testing c) Serum creatinine determination d) Blood urea nitrogen determination

b) Liver function testing

A client has been taking isoniazid for 1½ months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a) Hypercalcemia b) Peripheral neuritis c) Small blood vessel spasm d) Impaired peripheral circulation

b) Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake.

The nurse should monitor the client receiving the first dose of albuterol (Proventil HFA) for which side effect of this medication? a) Drowsiness b) Tachycardia c) Hyperkalemia d) Hyperglycemia

b) Tachycardia Rationale: Albuterol is a bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. The items in the other options are not side effects of this medication.

The nurse would question a prescription for pseudoephedrine (Sudafed) in a client with a history of which condition? a. Pneumonia b. Osteoporosis c. Hypertension d. Peptic ulcer disease

c hypertension Rational: Adrenergic drugs are contraindicated in clients with hypertension, narrow-angle glaucoma, diabetes, uncontrolled cardiovascular disease, hyperthyroidism, prostatitis, or a known hypersensitivity to such drugs.

Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a) Platelet count b) Neutrophil count c) Liver function tests d) Complete blood count

c) Liver function tests Rationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication

Isoniazid is prescribed for a child with human immunodeficiency virus infection who has a positive Mantoux tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? a) 4 months b) 6 months c) 9 months d) 12 months

d) 12 months Rationale: For children with human immunodeficiency virus infection who demonstrate a positive Mantoux tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

Which statement would be included when teaching a patient about the proper use of metered-dose inhalers? A. "After you inhale the medication once, repeat until you obtain relief." B. "Make sure that you puff out air repeatedly after you inhale the medication." C. "Wait 1 to 2 minutes before you take a second puff of the same drug." D. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."

C. "Wait 1 to 2 minutes before you take a second puff of the same drug.

Nasal Decongestants: Adrenergic contraindicated with narrow angle glaucoma, CVD, hypertension, hyperthyroidism, diabetes

Constrict blood vessels, nasal secretions in the swollen mucous membranes are then better able to drain adverse: nervousness, insomnia, palpitations and tremor topically applied nasal adrenergic maybe absorbed into circulation but dosage is usually too small; but they could induce CNS stim with headaches, nervousness or dizziness

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme levels

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? 1. "I use my corticosteroid inhaler each time I feel short of breath." 2. "I see my doctor if I have an upper respiratory infection and always get a flu shot." 3. "I use my bronchodilator inhaler before walking so I don't become short of breath." 4. "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies.

1. "I use my corticosteroid inhaler each time I feel short of breath." No you use a Short acting bronchodilator: MDI: 2 PUFFS qid -if used too often; SABA can loose its beta 2 specifc actions and cause stimulated b1 receptors resulting in increased HR, palpitations, tremors, increased anxiety, and nausea

The nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states he or she will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green

4. Difficulty in discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

Based on the nurse's knowledge of glucocorticoids, what instructions should be given for this drug? A.Take the medication every evening. B.Inform the patient that the drug can be taken with coffee. C.Advise that the drug does not have to be tapered before stopped. D.Advise to take drug with milk, other dairy products, or food

Advise to take drug with milk, other dairy products, or food. Glucocorticoids can cause gastrointestinal (GI) distress and should be given with milk or food. They should not be administered with coffee, which contains caffeine and may increase gastric irritation. The best time to give exogenous glucocorticoids is early in the morning (6 AM to 9 AM) to minimize the amount of adrenal suppression. These medications should be tapered off slowly to prevent adrenal crisis and can be administered intravenously (IV).

A client taking albuterol (ProAir HFA) by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? 1. Get more exercise each day. 2. Use a dehumidifier in the home. 3. Drink increased amounts of fluids every day. 4. Take an extra dose of albuterol before bedtime

Rationale: (Drink increased amounts of fluids every day.) A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions. This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake. Additional exercise will not effectively clear bronchial secretions. A dehumidifier will dry secretions, making the situation worse. The client should not take additional medication.

When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? a Glaucoma b Fever c Peptic ulcer disease d Allergic rhinitis

a. glaucoma

When monitoring a patient who is taking corticosteroids, the nurse ovserves for which adverse effects? a. fragile skin b. increased glucose levels c. nervousness d. hypotension e. weight loss f. drowsiness

a: fragile skin b: increased glucose levels (hyperglycemia) c: nervousness

A client is taking a prescribed course of therapy with ethambutol (Myambutol). The home health nurse assesses the client at each home visit for which adverse effect of this medication? a) Orange urine b) Visual disturbances c) Hearing disturbances d) Gastrointestinal (GI) upset

b) Visual disturbances Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green. This form of color blindness poses a potential safety hazard in driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if GI upset occurs. Impaired hearing results from antituberculosis therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin (Rifadin) for treatment. The nurse teaches the client to perform which action? a) Report any change in urine color. b) Take both medications with food. c) Take both medications together once a day. d) Expect to take the medication for 2 to 3 weeks.

c) Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of drug-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side/adverse effects of the medication should the nurse monitor? Select all that apply. 1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 5. Ocular pain or blurred vision Rationale: Rifabutin (Mycobutin) may be prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side/adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid. Ethambutol (Myambutol) causes peripheral neuriti

The nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? a) "I will take the medication on an empty stomach." b) "I won't drink alcohol while taking this medication." c) "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth." d) "I won't do activities that require mental alertness while taking this medication."

a) "I will take the medication on an empty stomach." Rationale: Diphenhydramine (Benadryl) has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses or sugarless gum or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use

The client has a prescription to receive pirbuterol (Maxair Autoinhaler) two puffs and beclomethasone dipropionate (Beclovent) two puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? a) Administering the pirbuterol before the beclomethasone b) Alternating a single puff of each hourly, beginning with the beclomethasone c) Alternating a single puff of beclomethasone with pirbuterol; repeat the steps d) Administering the pirbuterol; wait 30 minutes and administer the beclomethasone

a) Administering the pirbuterol before the beclomethasone Rationale: Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

A client has begun a course of therapy with rifampin (Rifadin). The home care nurse instructs the client to perform which action while taking this medication? a) Avoid wearing contact lenses. b) Always take the medication with food or antacids. c) Double the next medication dose if one is forgotten. d) Stop the medication if symptoms disappear in 2 months.

a) Avoid wearing contact lenses. Rationale: Rifampin (Rifadin) causes orange-red discoloration of body secretions and will permanently stain soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider.

A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if one dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

c) Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently.

A client with an exacerbation of chronic obstructive pulmonary disease has been on oral glucocorticoids and is currently being weaned to triamcinolone (Azmacort) by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a) Chills, fever, and generalized rash b) Vomiting, diarrhea, and increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue

d) Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

The nurse is administering a dose of pirbuterol (Maxair Autohaler) to a client. The nurse should monitor for which side/adverse effect of this medication? a) Drowsiness b) Hypokalemia c) Hyperglycemia d) Increased pulse and blood pressure

d) Increased pulse and blood pressure Rationale: Pirbuterol is an adrenergic bronchodilator. Side/adverse effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therap