Saunders NCLEX Review Pharmacology Respiratory Medications

2.Take the tablet with a full glass of water. Rationale:Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations should not be broken open, crushed, or chewed.

A client has a prescription to take guaifenesin. The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action? 1.Watch for irritability as a side effect. 2.Take the tablet with a full glass of water. 3.Take an extra dose if the cough is accompanied by fever. 4.Crush the sustained-release tablet if immediate relief is needed.

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

A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking this medication? 1.Coffee, cola, and chocolate 2.Oysters, lobster, and shrimp 3.Melons, oranges, and pineapple 4.Cottage cheese, cream cheese, and dairy creamers

3.Drowsiness Rationale:Cetirizine is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating. Therefore, the other options are incorrect.

A client is taking cetirizine. The nurse should inform the client of which side effect of this medication? 1.Diarrhea 2.Excitability 3.Drowsiness 4.Excess salivation

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 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.

1.Coffee Rationale:Theophylline is a xanthine bronchodilator. Before a serum level of the medication is drawn, the client should avoid taking foods or beverages that contain xanthine, such as colas, coffee, or chocolate; therefore, the client is told to avoid coffee before the test. The items in the other options do not need to be avoided before this test.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? 1.Coffee 2.Oatmeal 3.Ginger ale 4.Bagel with cream cheese

2.Chart the finding as a normal response to the rifampin. Rationale:Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the PHCP. There is no indication that the client is in shock, so eliminate the options that indicate to start prescribed IV fluids and to place the client in modified Trendelenburg's position. The nurse should also inform the client that his is a harmless side effect.

A client taking rifampin 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 primary health care provider (PHCP). 2.Chart the finding as a normal response to the rifampin. 3.Immediately start prescribed intravenous (IV) fluids to prevent shock. 4.Get the client into bed, and put the bed in modified Trendelenburg's position.

4.In the middle of the therapeutic range Rationale:The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL (40 to 79 mcmol/L). A level above 20 mcg/mL (79 mcmol/L) is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.

A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value? 1.Below therapeutic range 2.In excess of the therapeutic range 3.Near the top of the therapeutic range 4.In the middle of the therapeutic range

1."I will take the daily dose at bedtime." 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 primary health care provider (PHCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the PHCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription? 1."I will take the daily dose at bedtime." 2."I need to drink at least 2 liters of fluid per day." 3."I know to avoid changing brands of the medication without my primary health care provider's approval." 4."I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."

4.Difficulty tying shoes Rationale:The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid. Dry mouth, cramping diarrhea, and frequent headaches are not concerns with administration of this medication.

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? 1.Dry mouth 2.Cramping diarrhea 3.Frequent headaches 4.Difficulty tying shoes

4.Bronchospasm Rationale:Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects 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 cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? 1.Insomnia 2.Constipation 3.Hypotension 4.Bronchospasm

4.Paradoxical bronchospasm, which must be reported to the primary health care provider (PHCP) Rationale:The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld, and the PHCP should be notified. The remaining options are incorrect interpretations.

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 primary health care provider (PHCP)

2, 4, 5 Rationale:DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the primary health care provider.

The client questions the nurse as to why the primary health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which facts? Select all that apply. 1.Dry powder inhalers have fewer side effects. 2.Dry powder inhalers pose no environmental risks. 3.Dry powder inhalers can be administered more frequently. 4.Dry powder inhalers deliver more medication to the lungs. 5.Dry powder inhalers require less hand-to-lung coordination.

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.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they 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

2.Ensure that naloxone is readily available. Rationale:Epidural analgesia is used for clients with expected high levels of postoperative pain. The nurse carefully checks the medication, notes the client's level of sedation, and makes sure that the head of the bed is elevated 30 degrees unless contraindicated. The nurse aspirates with a syringe to make sure that no CSF return occurs. If CSF returns with aspiration, the catheter has migrated from the epidural space into the subarachnoid space. The catheter is not flushed with 6 mL of sterile water. Naloxone should be readily available for use if respiratory depression should occur.

The nurse is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what should the nurse plan to do? 1.Place the head of the bed flat. 2.Ensure that naloxone is readily available. 3.Flush the catheter with 6 mL of sterile water. 4.Aspirate with a syringe to ensure a cerebrospinal fluid (CSF) return.

4.Increased pulse Rationale:Pirbuterol is an adrenergic bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The other options are not side and adverse effects of this medication.

The nurse is administering a dose of pirbuterol to a client. The nurse should monitor for which side or adverse effect of this medication? 1.Drowsiness 2.Hypokalemia 3.Hyperglycemia 4.Increased pulse

1.5 mg/mL (20 mcmol/L) Rationale:Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitors for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? 1.5 mg/mL (20 mcmol/L) 2.10 mg/mL (40 mcmol/L) 3.15 mg/mL (60 mcmol/L) 4.20 mg/mL (79 mcmol/L)

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

The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication? 1.Drowsiness 2.Tachycardia 3.Hyperkalemia 4.Hyperglycemia

1."I will take the medication on an empty stomach." Rationale:Diphenhydramine 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, 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 nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1."I will take the medication on an empty stomach." 2."I won't drink alcohol while taking this medication." 3."I won't do activities that require mental alertness while taking this medication." 4."I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

2.Pyridoxine Rationale:Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Gabapentin is used to prevent seizures and for peripheral neuropathy, and cyanocobalamin is used to treat anemia.

The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid? 1.Niacin 2.Pyridoxine 3.Gabapentin 4.Cyanocobalamin

4.Sputum culture Rationale:Pyrazinamide is an antituberculosis medication given with other antituberculosis medications. Pyrazinamide might not be discontinued if sputum cultures continue to be positive. The remaining options are not related directly to the use of this medication.

A client has been taking pyrazinamide for 1 month. The client asks the nurse whether the therapy is due to be terminated soon. The nurse determines that the medication probably will be continued based on a positive finding in which report? 1.Blood culture 2.Urine culture 3.Wound culture 4.Sputum culture

4.Decongestants Rationale:In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1.Diuretics 2.Antibiotics 3.Antilipemics 4.Decongestants

4.Aspartate aminotransferase (AST) 55 U/L (55 U/L) Rationale:Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1.Platelet count 325,000 mm3 (325 × 109/L) 2.Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3.Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4.Aspartate aminotransferase (AST) 55 U/L (55 U/L)

1, 2, 3, 5 Rationale:Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and 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 flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

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

3.Diabetes mellitus Rationale:Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution? 1.Osteoarthritis 2.Hypothyroidism 3.Diabetes mellitus 4.Polycystic disease