NCLEX unit 3 questions

A. Rationale:In treating an acute asthma attack, a short-acting β2-agonist such as albuterol will be given to produce bronchodilation. Options 2, 3, and 4 are long-term control (preventive) medications.

A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which medication first? A. A β2-agonist B. Oral corticosteroids C. A leukotriene modifier D. A nonsteroidal anti-inflammatory

B Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness. The client should contact the PHCP if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

A client has a prescription to take guaifenesin every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client makes which statement? A "I will watch for irritability as a side effect." B. "I will take the tablet with a full glass of water." C. "I will take an extra dose if the cough is accompanied by fever." D. "I will crush the sustained-release tablet if immediate relief is needed."

B. via face mask Rationale:Ribavirin is an antiviral respiratory medication that may be used in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if administered within the first 3 days of the infection.

Ribavirin is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which route? A. orally B. via face mask C. intravenously D. intramuscularly

C. 5 minutes Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Albuterol acts in 5 to 10 minutes and lasts for 3 to 4 hours. Since the medications are at the same time waiting 5 minutes allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse has a prescription to give a client albuterol (two puffs) and beclomethasone dipropionate (two puffs) by metered-dose inhaler. How much time should the nurse place between administering the albuterol and then the beclomethasone dipropionate? A. 1 minute B. 2 minute C. 5 minute D. administer immediately

C. Cimetidine D. Corticosteroids E. Fluoroquinolone's Rationale: Theophylline has many medication interactions. Medications that increase the risk of theophylline toxicity include cimetidine, nonselective é-blockers, erythromycin, clarithromycin, oral contraceptives, corticosteroids, interferons, fluoroquinolones, disulfiram, mexiletine, fluvoxaMINE, high doses of allopurinol, influenza vaccines, interferon, and benzodiazepines. Medications that decrease the effectiveness of theophylline include nicotine products, adrenergics, barbiturates, phenytoin, ketoconazole, and rifampin.

The nurse is reviewing the medication profile of a client taking theophylline. Which medications can increase the risk of theophylline toxicity? Select all that apply. A. Rifampin B. Phenytoin C. Cimetidine D. Corticosteroids E. Fluoroquinolone's

A. wearing goggles Rationale:Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not necessary. A mask may be worn. Hand washing is to be performed before and after any child contact.

Which precautions should the nurse specifically take during the administration of ribavirin to a child with respiratory syncytial virus (RSV)? A. wearing goggles B. wearing a gown C. wearing a gown and mask D. hand washing before administration

A, B, C, and E Rationale:The normal therapeutic range for theophylline levels is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 19 mcg/mL places the client near the top of the therapeutic range. Theophylline relaxes the bronchial smooth muscle and causes bronchial dilation. Therapeutic response includes decreased dyspnea and clear lung fields bilaterally. Symptoms of toxicity include insomnia, flushing, nausea, vomiting, headache, tinnitus, delirium, seizures, tachycardia, cardiac arrhythmias, and blood pressure changes.

The nurse is checking a client who is taking theophylline for possible toxicity. Which signs and symptoms indicate theophylline toxicity? Select all that apply. A. flushing B. insomnnia C. headache D. decreased wheezing E. nausea and vomiting F. serum theophylline level of 19 mcg/mL

D. suction equipment Rationale:Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

A client is receiving acetylcysteine, 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for a possible adverse event after giving this medication? A. Ambu bag B. intubation tray C. nasogastric (NG) tube D. Suction equipment

Rationale: Ibuprofen is a nonsteroidal anti-inflammatory medication that has an analgesic effect and allows the client to cough and deep breathe more effectively. Options 1, 2, and 3 are incorrect

A client diagnosed with pleurisy is being started on medication therapy with ibuprofen. Which statement by the nurse accurately describes the purpose of the medication for the client? A. Ibuprofen is a topical anesthetic that alleviates surface pain. B. Ibuprofen is a mild opioid analgesic to allow the client to deep breathe C. Ibuprofen is a corticosteroid to decrease the inflammatory response at the site D. Ibuprofen is a nonsteroidal anti-inflammatory medication to enhance coughing and deep breathing.

B. Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

A client has begun therapy with theophylline. The nurse tells the client to limit the intake of which while taking this medication? A. Oranges and pineapple b. Coffee, cola, and chocolate c. Oysters, lobster, and shrimp d. Cottage cheese, cream cheese, and dairy creamers

C. Seizures E. irregular heartbeat Rationale: Theophylline is a bronchodilator. Irregular heartbeats and seizures are signs of toxicity and require immediate primary health care provider notification. Anxiety and insomnia are common side effects and do not require immediate action. Diarrhea is not specifically associated with theophylline toxicity.

A client is monitoring a client receiving theophylline to treat symptoms of chronic obstructive pulmonary disease (COPD). Which adverse effects require immediate consultation with the primary health care provider? Select all that apply. A. anxiety B. diarrhea C. seizures D. insomnia E. irregular heartbeat

C. drowsiness Rationale:A frequent side effect of cetirizine hydrochloride, an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

A client is taking cetirizine hydrochloride. The nurse should check for which side effect of this medication? A. Diarrhea B. Excitability C. Drowsiness D. Excess salivation

B. Bronchospasm Rationale:The most common undesired clinical responses associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

A hospitalized client with allergic asthma has been started on cromolyn sodium inhaler. The nurse assists in preparing a plan of care and includes monitoring for undesirable side effects associated with the use of this medication. The nurse places the highest priority on monitoring for which side effect? A. cough B. bronchospasm C. throat irritation D. nasal congestion

A. cocoa Rationale:Levalbuterol is a bronchodilator. This medication stimulates the beta receptors in the lungs, relaxes bronchial smooth muscle, increases vital capacity, and decreases airway resistance. Central nervous system (CNS) stimulation can occur with the use of this medication. The client is instructed to avoid caffeine-containing products such as coffee, tea, colas, and chocolate because these products can cause further CNS stimulation. Options 2, 3, and 4 are food items that are high in potassium which should be encouraged if the side effect hypokalemia presents.

Levalbuterol via inhalation is prescribed for a client with a diagnosis of emphysema. The nurse reinforces instructions to the client regarding the medication and teaches the client about the dietary restrictions that must be implemented while taking this medication. The nurse determines that the client understands the dietary instructions when the client states he will avoid which food choice? A. cocoa B. Bananas C. orange juice D. Baked potatoes

D. "I need to drink plenty of fluids, so I will drink more coffee and tea." Rationale:Theophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. The client needs to take the pulse since toxicity will increase the pulse. Smoking decreases drug blood levels and terminal half-life so the dosage may have to be changed. Theophylline should be with food or milk to decrease any GI effects. It should not be taken before bedtime because it may keep the client awake. The client should increase fluids to 2 L/day to decrease secretion viscosity; however, the client should not drink alcohol or caffeine products (tea, coffee, chocolate, colas).

The nurse is giving discharge instructions to the client concerning theophylline. Which client statement indicates a need for further teaching? A. "I need to learn how to take my pulse." B. "I will start a smoking cessation program." C. "I will take my pill in the morning at breakfast." D. "I need to drink plenty of fluids, so I will drink more coffee and tea."

A. Bronchospasm, which must be reported to the primary health care provider Rationale: The client taking a bronchodilator may experience bronchospasm, which is evident by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld, and the primary health care provider should be notified. Options 2, 3, and 4 are incorrect interpretations.

The nurse has observed a client self-administer a dose of metaproterenol sulfate via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. Which interpretation should the nurse make of this occurrence? A. Bronchospasm, which must be reported to the primary health care provider B. Insufficient dosage of the medication, which needs to be increased C. Probable interaction of this medication with an over-the-counter cold remedy D. Tolerance to the medication indicating a need for a stronger type of bronchodilator

A. Rationale:The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the PHCP before changing brands of the medication. The client also checks with the PHCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects increasing the side effects of theophylline and causing dysrhythmias

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. The nurse determines that the client needs further teaching about the medication if the client makes which statement? A. "I will take the daily dose at bedtime." B. "I will drink at least 2 L of fluid per day." C. "I will avoid over-the-counter (OTC) cough and cold medications unless approved by the PHCP." D. "I will avoid changing brands of the medication without primary health care provider (PHCP) approval."

D. "I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate." Rationale:Albuterol is an adrenergic type of bronchodilator. Fluticasone propionate is a glucocorticoid. Bronchodilators are always 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. Options 1, 2, and 3 are incorrect.

Albuterol, two puffs and fluticasone propionate, two puffs by metered-dose inhaler have been prescribed for a client with chronic obstructive pulmonary disease. The nurse caring for the client provides instructions regarding administration of the medication. Which statement by the client indicates an understanding of how to take these medications? A. "I will alternate a single puff of each, beginning with the albuterol." B. "I will alternate a single puff of each, beginning with the fluticasone propionate." C. "I will take the two puffs of the fluticasone propionate first and then the two puffs of the albuterol." D. "I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate."

D. liver function test Rationale: Zafirlukast is a leukotriene receptor antagonist that is used in the prophylaxis and chronic treatment of bronchial asthma. It is used with caution in clients with impaired hepatic function. Liver function laboratory values should be obtained as a baseline and should be monitored during administration of the medication. Options 1, 2, and 3 are not specifically related to the use of this medication.

The nurse is collecting data on a client admitted to the hospital with a diagnosis of a respiratory infection unresponsive to oral antibiotics. The nurse discovers that the client has a history of bronchial asthma and has been taking zafirlukast. The nurse assists in developing a plan of care for the client and suggests monitoring of which data? A. gastric pH B. platelet counts C. urinary output D. Liver function test