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A physician prescribes albuterol and beclomethasone inhalers for an asthmatic patient. The nurse should: 1. question the prescription; two inhalers should not be prescribed concurrently. 2. administer the albuterol first; wait 5 minutes; and administer the beclomethasone. 3. administer either inhaler; wait 30 minutes; and administer the other inhaler. 4. administer the beclomethasone first; wait 5 minutes; and administer the albuterol.
2
What is the most effective drug group for treating both seasonal and perennial rhinitis? 1. Sympathomimetics 2. Intranasal glucocorticoids 3. Systemic antihistamines 4. Intranasal cromolyn sodium
2
When monitoring a patient for the most common side effect of oral antihistamines, the nurse would assess the patient's: 1. heart rate and rhythm. 2. alertness. 3. respiratory rate. 4. bowel sounds.
2
When nedocromil is administered, the most common adverse effect is: 1. osteoporosis. 2. a bad taste in the mouth. 3. fungal infections in the throat. 4. tachycardia.
2
Women using long-term inhaled glucocorticoids should be advised to: 1. avoid weight-bearing exercise. 2. ensure adequate calcium and vitamin D intake. 3. discontinue the agents when anticipating exertional activities. 4. weigh themselves daily.
2
A nurse evaluates an asthmatic patient who has developed tachycardia and dysrhythmias. Which laboratory result would confirm that these signs are the result of theophylline toxicity? 1. A serum theophylline level below 10 mcg/mL 2. A serum theophylline level above 25 mcg/mL 3. A serum theophylline level between 12 and 15 mcg/mL 4. A serum theophylline level above 1 mcg/mL
2
A patient begins to experience nocturnal attacks of asthma. Which intervention may be indicated? 1. Oral theophylline 2. An inhaled beta2 antagonist 3. Subcutaneous epinephrine 4. Nebulized corticosteroid
1
An asthmatic patient is admitted to the emergency department with severe bronchospasm. The nurse should prepare to administer: 1. a nebulized beta2 agonist. 2. a salmeterol-type inhaled agonist. 3. an oral beta2 agonist. 4. an inhaled corticosteroid.
1
The physician prescribes zileuton for an asthmatic patient. By which route would the nurse prepare to administer this drug? 1. Oral 2. Subcutaneous 3. IV 4. Inhalation
1
When converting a patient from oral to inhaled glucocorticoids, the nurse should plan to: 1. taper the oral agents gradually. 2. instruct the patient to use two extra puffs daily to compensate for the change. 3. rapidly discontinue the oral agent to prevent long-term side effects. 4. avoid ever using these two agents simultaneously.
1
Which antihistamine is available as a nasal spray? 1. Azelastine 2. Cromolyn sodium 3. Sertraline 4. Ipratropium
1
A patient has been advised to add a local sympathomimetic decongestant to the regimen of supportive care for a cold. The nurse should instruct the patient to: 1. expect the effects to be delayed at least 1 week. 2. limit the use of this agent to 3-5 days. 3. continue the agent until nasal stuffiness has resolved. 4. avoid the use of this agent if a fever develops.
2
A patient is starting azelastine spray for allergic rhinitis. The nurse should discuss which common side effect during patient education? 1. Hemoptysis 2. A bitter taste 3. Cough 4. Increased stuffiness for the first month of therapy
2
. A hospitalized patient receives codeine as an antitussive. How does codeine produce the antitussive effect? 1. Through suppression of respiration 2. Through elevation of the cough threshold 3. Through reduction of pain 4. Through central nervous system depression
2
. An asthmatic patient has right-sided paralysis because of a stroke 3 years ago. When a metered-dose inhaler is ordered, which type should the nurse recommend for this patient? 1. An inhaler without a spacer 2. A dry-powder inhaler 3. An inhaler with chlorofluorocarbon propellant 4. No particular inhaler is easier to use than the others
2
. Ipratropium bromide is: 1. a cholinergic agent used for perennial rhinitis. 2. an anticholinergic used for allergic rhinitis and colds. 3. used only in patients with asthma. 4. inappropriate for use in patients with allergic rhinitis.
2
. Which statement is correct regarding the contrast between oral and topical sympathomimetic agents? 1. The duration of action is longer for the topical agents. 2. Systemic effects are more problematic with oral agents. 3. Oral agents work more rapidly. 4. Topical agents are completely safe and therefore should be used for most patients.
2
A nurse counsels a patient using two different types of asthma inhalers: a short-acting beta2 agonist and a corticosteroid. When the patient questions the purpose of the steroid inhaler, the nurse's best response would be that glucocorticoids: 1. work rapidly in acute attacks. 2. are used as prophylaxis for chronic asthma. 3. help prevent respiratory infections. 4. are to be used only when one is exposed to allergens in the environment.
2
A patient has been using an intranasal sympathomimetic for allergic rhinitis for 10 days. While reducing the medication, the patient notices increased stuffiness. The nurse's best response would be: 1. "Restart the nasal spray and continue it indefinitely because you have chronic rhinitis." 2. "Do not restart the spray. You will need systemic glucocorticoids to relieve the symptoms." 3. "Discontinue drug use in one nostril at a time to decrease this rebound congestion." 4. "These agents were inappropriate for use in your condition, and you should never use them again."
3
An adult with asthma is being treated with cromolyn. The patient asks how this drug helps the attacks. Select the nurse's best response. 1. Cromolyn is used to abort an ongoing attack. 2. Cromolyn is used to open the airway rapidly when an attack first begins. 3. Cromolyn prevents attacks by suppressing airway inflammation. 4. Cromolyn stabilizes inflammatory cells and promotes the release of histamine.
3
Very young asthmatic children should be treated at home with which maintenance therapy? 1. An MDI 2. A DPI 3. Nebulized budesonide 4. Intravenous prednisone
3
What is the best advice a nurse can give a patient with viral rhinitis who intends to purchase an over-the-counter combination cold remedy? 1. "These remedies provide precise dosing for each symptom that you are experiencing." 2. "These agents are used best in conjunction with an antibiotic medication." 3. "It is more prudent to use a single-agent preparation if you are experiencing only one symptom." 4. "Because these agents are available over the counter, it is safe to use any of them as long as needed."
3
After discharge from the hospital for an acute asthma attack, an adult asthmatic patient is likely to be placed on which drug(s) for long-term control? You may select more than one answer. 1. Inhaled albuterol 2. Oral prednisone 3. Salmeterol inhaler 4. Oral aminophylline 5. Formoterol inhaler
3,5
. A patient with a history of angina asks the nurse whether it is safe to use pseudoephedrine for allergic rhinitis. Select the nurse's best response. 1. "It is safe, provided you follow the instructions on the label." 2. "It is safe to use this agent if you are also using nitroglycerin." 3. "Rebound congestion is more common when a person with angina takes pseudoephedrine." 4. "These agents should not be used by patients with any form of heart disease."
4
A patient with a pneumonia-related cough has been advised to add guaifenesin to the regimen of antibiotics. When the patient asks about its purpose, the nurse should reply, "The guaifenesin will: 1. potentiate the antibiotics that you are taking to fight the infection." 2. relieve any pain associated with your cough." 3. help dry your secretions so that you produce less mucus with your cough." 4. help stimulate the flow of secretions and help you bring them up."
4
An asthmatic patient begins therapy with montelukast. When should the maximum effects be experienced? 1. Immediately 2. Within 30 minutes to 1 hour 3. In about 12 hours 4. Within 24 hours
4
When educating a patient recently started on inhaled glucocorticoids regarding common side effects, the nurse should include: 1. fatigue and depression. 2. anxiety and peripheral neuropathy. 3. headache and rapid heart rate. 4. oral candidiasis and dysphonia.
4
When instructing an asthmatic client to use a metered-dose inhaler properly, the nurse should include which of the following instructions? 1. Avoid shaking the canister. 2. Administer three puffs, wait 2 minutes, and administer two more. 3. Puff the inhaler doses in rapid succession. 4. An interval of at least 1 minute should separate the first puff from the second
4
Which statement is correct regarding the use of antihistamines for the treatment of allergic rhinitis? 1. These drugs have been replaced by newer-generation agents. 2. First-generation agents are now preferred, as they cause less sedation. 3. These are the most effective drugs for reducing nasal congestion in allergic rhinitis. 4. These agents should be taken prophylactically before symptoms appear.
4
A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. Pseudoephedrine (Sudafed) B. Montelukast (Singulair) C. Mometasone (Nasonex spray) D. Oxymetazoline (Afrin spray)
A. Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.
A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. Pseudoephedrine (Sudafed) B. Montelukast (Singulair) C. Mometasone (Nasonex spray) D. Oxymetazoline (Afrin spray)
A. Pseudoephedrine (Sudafed) Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.
A nurse should establish which outcomes on the care plan for a patient taking oral terbutaline (Brethine)? (Select all that apply.) A. Absence of tachycardia B. No reports of chest pain C. Less irritation of gum tissue D. Decrease in bronchospasm E. No jaundice or dark urine
A, B, D Terbutaline is an oral beta2 agonist. It promotes bronchodilation through activation of beta2 receptors in the lung, which relieves bronchospasm. It also stimulates the beta receptors of the heart and can result in tachycardia and chest pain if dosing is excessive. Irritated mucosal tissue of the gums, jaundice, and dark urine are not adverse effects of the medication.
Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.) A. More of the drug is delivered to the lungs and less to the oropharynx. B. Use of a spacer is not necessary. C. Less propellant is needed to deliver the medication. D. Less hand-lung coordination is required. E. DPIs pose no environmental risk.
A, B, D, E DPIs deliver more drug to the lungs (20% of the total released, compared to 10% for MDIs). Spacers are not necessary with DPIs; they are recommended for use with MDIs to increase the delivery of drug to the lungs rather than the oropharyngeal mucosa. DPIs do not require the hand-lung coordination needed with MDIs. DPIs present no environmental hazard, because no propellant is required for delivery.
Which medication is indicated for suppression of cough? A. Benzonatate (Tessalon) B. Guaifenesin (Mucinex) C. Acetylcysteine (Mucomyst) D. Fluticasone furoate (Flonase)
A. Benzonatate suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. Guaifenesin is an expectorant. Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.
The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? A. Age B. Developmental stage C. Body weight D. Swallowing ability
A. Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.
Which instruction should be included in the teaching for a patient for whom fluticasone propionate (Flovent) MDI has been ordered? A. "Gargle after using your inhaler." B. "Take the medication immediately at the onset of an attack." C. "Take your albuterol first, followed by the Flovent 5 minutes later." D. "Make sure you monitor your fingerstick blood glucose level each morning."
A. "Gargle after using your inhaler." Patients should be taught to gargle after using inhaled glucocorticoids, such as fluticasone propionate, to minimize dysphonia and oropharyngeal candidiasis. The medication is not used to abort an acute attack. Short-acting bronchodilators, such as albuterol, should be administered 5 minutes before inhaled glucocorticoids to enhance delivery to the bronchial tree. Oral glucocorticoids pose a risk of hyperglycemia.
The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? A. Age B. Developmental stage C. Body weight D. Swallowing ability
A. Age Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.
Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI (Proventil) at which of these times? A. Whenever needed (PRN) as a quick-relief agent B. Twice daily combined with an inhaled glucocorticoid C. Only with a long-acting beta2 agonist (LABA) D. If night time awakenings occur more than 2 days a week
A. Whenever needed (PRN) as a quick-relief agent For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasm. For patients at step 1, no long-term control medications are taken. A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more often than 2 days a week. For patients at steps 2 to 6, albuterol is considered a quick-relief medication taken PRN.
A patient asks the nurse if any of the antihistamines are available as a nasal spray. Which of the following medications should the nurse instruct the patient to discuss with the prescriber? a. Azelastine (Astelin) b. Mometasone (Nasonex) c. Sertraline (Zoloft) d. Ipratropium bromide (Atrovent)
ANS: A Azelastine is the only intranasal antihistamine available. Mometasone is an intranasal glucocorticoid spray. Sertraline is an oral selective serotonin reuptake inhibitor used for depression. Ipratropium bromide is an anticholinergic medication, not an antihistamine.
A patient who has been taking oral glucocorticoids for a month comes to the clinic for a follow-up appointment. After assessment and review of the patient's medications, the prescriber plans to convert the glucocorticoids from an oral route to an inhaler. When providing education, the nurse should inform the patient that a. the oral glucocorticoids will be tapered gradually. b. oral glucocorticoids should be discontinued immediately. c. the mouth should be rinsed prior to use of the inhaler. d. an oral agent and an inhaler should never be used simultaneously.
ANS: A Patients who are switched from oral glucocorticoids to inhaled glucocorticoids must be given supplemental oral glucocorticoids to allow the adrenocortical function to recover. The medication should not be discontinued abruptly, especially if given in a high dose, because the patient will not be able to produce enough endogenous glucocorticoids as a result of adrenal suppression. The mouth should be rinsed after an inhaler is used, not before. An oral agent and an inhaler may be used simultaneously, especially in situations of high stress.
An asthmatic patient comes to the emergency department (ED) with edema of the glottis, chest tightening, and wheezing. The nurse suspects severe bronchospasm and should prepare to administer a(n) (Select all that apply.) a. nebulized albuterol treatment. b. levalbuterol (Xopenex) treatment. c. oral beta2 agonist. d. inhaled corticosteroid. e. leukotriene modifier.
ANS: A, B A nebulizer is the quickest delivery method, and short-acting beta-adrenergic agonists, such as albuterol and levalbuterol, treat acute bronchospasm. An oral medication would not work quickly enough for a severe bronchospasm attack. An inhaled corticosteroid would help inflammation but would not be the most effective choice. A leukotriene modifier is effective as a mucolytic, therefore it would not be the correct choice.
A patient is starting azelastine (Astelin) spray for allergic rhinitis. The nurse should discuss which common side effect during patient education? a. Hemoptysis b. Bitter taste c. Cough d. Increased stuffiness for the first month of therapy
ANS: B A bitter taste in the mouth occurs in about 20% of patients using azelastine nasal spray. Patients should be informed of this side effect. Hemoptysis, cough, and increased nasal stuffiness are not common side effects.
A patient has been advised to add a topical sympathomimetic decongestant to the regimen of supportive care for a cold. The nurse should instruct the patient to a. expect the effects to be delayed at least 1 week. b. limit the use of this agent to 3 to 5 days. c. continue the agent until nasal stuffiness has resolved. d. stop using this agent if a fever develops.
ANS: B Because of the potential for rebound nasal congestion, topical application should be limited to 3 to 5 days. With topical administration, vasoconstriction is rapid and intense, leading to a quick reduction in nasal congestion. Rebound nasal congestion can occur if the drug is used for longer than 5 days, therefore the drug should not be continued until the problem resolves. Topical sympathomimetics are not contraindicated if a patient has a fever.
The nurse is preparing to administer albuterol (Proventil) and beclomethasone (Beconase) inhalers to an asthmatic patient, as ordered by the prescriber. The nurse should administer a. the albuterol only; these meds should not be given concurrently. b. the albuterol first, wait 5 minutes, and then administer the beclomethasone. c. either inhaler, wait 5 full minutes, then administer the other. d. the beclomethasone first, wait 5 minutes, then administer the albuterol.
ANS: B Delivery of the glucocorticoid to the bronchial tree may be enhanced by inhaling a short-acting beta2 agonist 5 minutes before the glucocorticoid is inhaled. Administering albuterol only is not correct. It is given to vasodilate the lungs prior to the administration of the glucocorticoid. Albuterol should be given prior to beclomethasone. The albuterol should be administered first to vasodilate the lungs prior to administration of the beclomethasone.
An asthmatic patient has right-sided paralysis caused by a stroke 3 years ago. The prescriber orders an inhaler. Which type of inhaled device would the nurse expect to be ordered for this patient? a. Inhaler without a spacer b. Dry-powder inhaler c. Glucocorticoid d. Nebulizer
ANS: B Dry powder inhalers are breath activated and do not require the hand-lung coordination needed with MDIs. They would be easier for a patient with hemiparesis to use. Use of an MDI requires hand-lung coordination and would not be the best choice for a patient with hemiparesis. A glucocorticoid is not necessarily an inhaled device. A nebulizer must be set up and would be more difficult for a patient with hemiparesis.
Which statement made by a patient indicates the need for further teaching about the use of diphenhydramine (Benadryl) for the treatment of allergic rhinitis? a. "This drug will help reduce nasal itching but not nasal congestion." b. "I should start taking the antihistamine as soon as my symptoms appear." c. "I'll need to be careful, because this medication may make me sleepy." d. "I may develop a dry mouth from this medication."
ANS: B For treatment of allergic rhinitis, antihistamines, such as diphenhydramine, are most effective when taken prophylactically and are less helpful when the symptoms appear. This statement indicates that further teaching is required. Diphenhydramine is effective against sneezing, rhinorrhea, and nasal itching. It does not reduce nasal congestion. No further teaching is required. The most common complaint with antihistamines is sedation, which often occurs with first-generation antihistamines, such as diphenhydramine. No further teaching is required. Anticholinergic side effects, such as constipation, urinary retention, and dry mouth, commonly occur with first-generation antihistamines. No further teaching is required.
A nurse counsels a patient using two different types of asthma inhalers: a short-acting beta2 agonist and a corticosteroid. When the patient questions the purpose of the steroid inhaler, the nurse's best response would be that glucocorticoids a. work rapidly in acute attacks. b. are used as prophylaxis for chronic asthma. c. help prevent respiratory infections. d. are used only when exposed to environmental allergens.
ANS: B Glucocorticoids are used for prophylaxis of chronic asthma. The short-acting inhaled beta2 agonist, not the glucocorticoid, is for an acute asthma attack. Glucocorticoids do not help prevent respiratory infections and are not used for exposure to allergens.
A clinic patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis? Which of the following would be an accurate response by the nurse? a. Pseudoephedrine (Sudafed) b. Fluticasone propionate (Fluticasone) c. Loratadine (Claritin) d. Intranasal cromolyn sodium (Atrovent)
ANS: B Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids.
Ipratropium bromide (Atrovent) is a. a cholinergic agent used for perennial rhinitis. b. an anticholinergic used for allergic rhinitis and colds. c. used only in patients with asthma. d. inappropriate for use in patients with allergic rhinitis.
ANS: B Ipratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea. Ipratropium bromide is an anticholinergic. In addition to asthma, ipratropium bromide can be used for allergic rhinitis and the common cold. Ipratropium bromide can be used for allergic rhinitis.
A hospitalized patient receives codeine as an antitussive. Beside cough suppression, what other assessments should the nurse make? a. Assess the heart rate for tachycardia. b. Observe for slowing of respirations. c. Check the blood pressure for hypertension. d. Assess for hyperalertness.
ANS: B Like other opioids, codeine can suppress respirations, therefore the patient's respiratory rate should be monitored closely for any declines in rate or depth. The nurse should assess for bradycardia and hypotension, which are side effects of codeine. Because the drug is a central nervous system (CNS) depressant, the nurse should assess the patient for sedation, not hyperalertness.
Which statement by a patient during education by the nurse best demonstrates understanding of glucocorticoids? a. "They can reduce glucose levels." b. "They can promote bone loss in premenopausal women." c. "They should not be taken with milk, but with vitamin C." d. "They can promote bone loss in postmenopausal women."
ANS: B Oral glucocorticoids promote bone loss in premenopausal women. This statement best demonstrates understanding. Glucocorticoids increase glucose levels and may be taken with milk; further teaching is needed. Oral glucocorticoids do not promote bone loss in postmenopausal women, but they do in premenopausal women; further teaching is needed.
Comparing the effects of oral and topical sympathomimetic agents, the nurse tells the patient a. "The duration of action is longer for topical agents." b. "Systemic effects are more of a problem with oral agents." c. "Oral agents work more rapidly." d. "Topical agents are completely safe and therefore should be used by most patients."
ANS: B Systemic effects, such as vasoconstriction and CNS stimulation, occur primarily with oral agents while topical agents elicit these responses only when the dosage is too high. The duration of action is longer with oral agents, not topical agents. Topical sympathomimetic agents act more quickly than oral agents. Topical sympathomimetic agents can lead to systemic effects if taken in doses that are too high, therefore they are not completely safe.
A nurse evaluates an asthmatic patient who has developed tachycardia and dysrhythmias. The laboratory result that would suggest that these signs are the result of theophylline toxicity is a serum theophylline level _______ mcg/mL. a. below 10 b. above 30 c. between 20 and 25 d. above 2.5
ANS: B The laboratory result that would confirm severe toxicity, which would lead to tachycardia and dysrhythmias, is a serum theophylline level above 30 mcg/mL. A serum theophylline level of 5 to 15 mcg/mL is appropriate for most patients. This level falls within that range and does not demonstrate toxicity. At serum theophylline level of 20 to 25 mcg/mL, the patient may experience relatively mild reactions, such as nausea, vomiting, diarrhea, insomnia, and restlessness. A serum theophylline level below 2.5 is most probably subtherapeutic, not toxic.
When monitoring a patient for the most common side effect of oral first-generation antihistamines, the nurse would assess a. heart rate and rhythm. b. alertness. c. respiratory rate. d. bowel sounds.
ANS: B The most common complaint of patients about antihistamines is sedation, therefore the nurse should assess the patient's alertness. Because the most common effect is sedation, the nurse should focus the assessment on the neurologic system
The nurse is providing education to a group of women using long-term inhaled glucocorticoids. Which of the following statements by one of the women indicates a need for further teaching? a. "I should begin weight-bearing exercises." b. "I need to avoid calcium and vitamin D intake because they interfere with absorption." c. "I will adhere to a stress management program." d. "I should inspect my mouth for white, patchy areas."
ANS: B The patient should take calcium and vitamin D supplements; this statement indicates a need for further teaching. The patient should perform weight-bearing exercises; no further teaching is needed. A stress management program is important for reducing stress and preventing the need for extra doses of glucocorticoids; no further teaching is needed. The patient should monitor for oral candidiasis; no further teaching is needed.
A patient has been admitted with acute asthma and has had nausea and vomiting. Drug history reveals that the patient has been taking theophylline (Elixophyllin) for 3 weeks. Prior to the administration of theophylline the nurse should check the orders for a. renal function tests. b. a plasma drug level. c. a basal metabolic panel (BMP). d. complete blood count. (CBC).
ANS: B Toxicity may be related to theophylline levels, so the priority is to assess the drug level. At the first indication of toxicity administration of the theophylline should cease. Reactions include nausea, vomiting, diarrhea, and restlessness. Renal function tests are not indicated with these symptoms nor are a BMP or a CBC.
Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Oriented to time, place, and person C. Respiratory rate of 12 to 24 breaths per minute D. Effective productive cough
C. Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one-tenth those needed to relieve pain), so orientation and peripheral effects are minimal.
What is the best advice a nurse can give a patient with viral rhinitis who intends to purchase an over-the-counter (OTC) combination cold remedy? a. "These remedies provide precise dosing for each symptom you are experiencing." b. "These agents are best used in conjunction with an antibiotic medication." c. "It is more prudent to use a single-agent preparation if you are experiencing only one symptom." d. "Because these agents are available over the counter, it is safe to use any of them as long as needed."
ANS: C A single agent would be a better choice, so that the patient is not taking unnecessary ingredients. Although convenient, combination cold remedies have disadvantages. These combinations all contain fixed doses, so there is a chance that one ingredient will be therapeutic, whereas another may be excessive or subtherapeutic. Antibiotics are not indicated for the common cold. Treatment is purely based on symptoms. Just because a cold remedy can be purchased over the counter, the patient should not assume it is safe. Many cold remedies contain two or more medications. Patients should read labels carefully and check with the prescriber or pharmacist.
A patient has been using an intranasal sympathomimetic for allergic rhinitis for 10 days. While reducing the medication, the patient notices increased stuffiness. Select the nurse's best response. a. "Restart the nasal spray and continue it indefinitely, because you have chronic rhinitis." b. "Do not restart the spray. You will need systemic glucocorticoids to relieve the symptoms." c. "Discontinue drug use in one nostril at a time to reduce this rebound congestion." d. "These agents were inappropriate for use in your condition, and you should never use them again."
ANS: C Rebound congestion can occur when intranasal sympathomimetics are used for prolonged periods, requiring the patient to increase the frequency of doses. This can be stopped by abrupt decongestant withdrawal, which can be extremely uncomfortable. A less drastic approach is to discontinue the drug in one nostril at a time. Rebound congestion develops when topical agents are used for longer than a few days. Restarting the spray would cause the patient to use progressively larger and more frequent doses to overcome the rebound congestion. This would not be an appropriate recommendation. Glucocorticoids would not reverse the rebound congestion. Intranasal sympathomimetics are appropriate for allergic rhinitis, but their use should be limited to 3 to 5 days to minimize rebound congestion.
The nurse is providing education to a patient who has just been prescribed an albuterol (Proventil) inhaler, 2 puffs every 4 to 6 hours when needed. The nurse correctly teaches the patient that albuterol should be administered a. as prophylaxis for asthma. b. by taking 1 puff, waiting 5 minutes, then taking another puff. c. by taking 1 puff, waiting 1 full minute, then taking another puff. d. by means of a nebulizer and spacer.
ANS: C When 2 puffs are needed, an interval of 1 minute or longer should separate them. During this interval, some bronchodilation develops, which facilitates penetration of the second puff. Albuterol is not indicated for prophylaxis. It is short acting and is used to relieve an acute attack Waiting 5 minutes in between is necessary only when two different inhalers are used concurrently. The inhaler is not used with a nebulizer but may be used with a spacer.
The nurse has received an order for an asthmatic patient for a metered-dose inhaler (MDI), 2 puffs BID. While instructing the asthmatic patient in the proper use of an MDI, the nurse should include which of the following instructions? a. "Inhale after activating the device." b. "Administer 2 puffs, wait 1 minute, and administer 2 more." c. "Wait 1 minute between the first and second puff." d. "Puff the inhaled doses in rapid succession."
ANS: C When 2 puffs are needed, an interval of at least 1 minute should separate the first puff from the second. The inhale should be just prior to activation of the device. If the medication is ordered 2 puffs BID, the patient would not administer 2 puffs followed by 2 more puffs in 1 minute. There should be at least a 1 minute interval between puffs. They should not be taken in rapid succession.
A patient with a pneumonia-related cough has been advised to add guaifenesin to the regimen of antibiotics. The patient asks about the purpose of the drug. The nurse's best response is, "The guaifenesin will a. potentiate the antibiotics you are taking to fight the infection." b. relieve any pain associated with your cough." c. help dry your secretions so that you produce less mucus with your cough." d. help stimulate the flow of secretions and help you bring them up."
ANS: D Expectorants, such as guaifenesin, render cough more productive by stimulating the flow of respiratory tract secretions. Guaifenesin does not increase the effects of antibiotics, relieve pain from cough, or dry up secretions.
An asthmatic patient begins therapy with montelukast (Singulair). The nurse is providing patient education. Which statement by the patient best demonstrates understanding? a. "I can anticipate immediate effects from this medication." b. "When taken even once, montelukast is just as effective as my glucocorticoid inhaler." c. "Montelukast has many serious drug interactions." d. "Maximal effects occur within 24 hours."
ANS: D Maximal effects develop within 24 hours of the first dose. This statement demonstrates understanding. Effects are not immediate, but the medication is rapidly absorbed by the body; further teaching is needed. As monotherapy, montelukast is less effective than inhaled glucocorticoids; further teaching is needed.
A patient with a history of angina asks the nurse whether it is safe to use oral pseudoephedrine for allergic rhinitis. Select the nurse's best response. a. "It is safe, provided you follow the instructions on the label." b. "It is safe to use this agent if you are also using nitroglycerin." c. "Rebound congestion is more common when a person with angina takes pseudoephedrine." d. "These agents should not be used by patients with any form of heart disease."
ANS: D Sympathomimetics cause widespread vasoconstriction, which can be hazardous to patients with hypertension and coronary artery disease. The nurse should instruct the patient not to take these agents. The use of these agents is unsafe in patients with hypertension and coronary artery disease because of their vasoconstrictive properties. Rebound congestion is not a side effect specific to angina. The drug is contraindicated in patients with angina.
The prescriber has written an order for a patient to be discharged home on triamcinolone acetonide (Azmacort). About what common side effects of this medication should the nurse forewarn the patient? a. Fatigue and edema b. Anxiety and dysphagia c. Headache and rapid heart rate d. Oral candidiasis and dysphonia
ANS: D The most common adverse effects associated with inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. Fatigue and edema are not common side effects. Anxiety and dysphasia are not associated with inhaled glucocorticoids. Headache and a rapid heart rate are not common side effects of glucocorticoids.
A patient complains of vomiting, diarrhea, and insomnia. During the assessment, the patient begins having seizures. The nurse suspects theophylline toxicity. Which of the following actions would be the nurse's priority intervention? a. Obtain a stat theophylline level. b. Call the prescriber. c. Administer charcoal. d. Protect the patient from injury and monitor the airway.
ANS: D When a patient is having a seizure, regardless of the potential cause, the priority of care is patient safety, along with airway, breathing, and circulation (ABCs). Although blood should be drawn for measurement of a stat theophylline level. it should not be done until the patient's condition has stabilized. Although the prescriber should be called, that activity can be delegated to someone else while the nurse takes care of the emergency needs of the patient. Although the symptoms of theophylline toxicity are present (nausea, vomiting, diarrhea, seizures), the diagnosis of theophylline toxicity has not been confirmed by serum values, therefore administering activated charcoal at this time would be premature.
Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn (NasalCrom)? A. "It is only moderately effective." B. "There are few adverse reactions." C. "Relief may take a week or two." D. "It suppresses histamine release."
C. Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.
A nurse should teach a patient receiving oral pseudoephedrine (Sudafed) to observe for which adverse effects? (Select all that apply.) A. Sedation B. Irritability C. Paranoia D. Anxiety E. Weight loss
B, D Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.
A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching C. Use limited to allergy season D. Absence of rebound congestion
B. Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.
Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A. "I'll gradually stop taking this so I don't have any problems with withdrawal." B. "This drug will help prevent the inflammation and irritation from my allergies." C. "I'll have to be more careful about not falling, because my bones may break more easily." D. "I realize that I only need to take this when my symptoms are really bad."
B. Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.
Which instruction should the nurse include in the teaching for a patient prescribed cetirizine (Zyrtec) for seasonal allergic rhinitis? A. "Clean the nasal applicator after use to prevent contamination." B. "Take the medication daily throughout the allergy season." C. "Expect a decrease in your nasal congestion in a day or two." D. "Take a stool softener daily to avoid the side effect of constipation."
B. For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. The medication is taken orally, not intranasally. Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. Constipation is rare in patients taking second-generation agents, such as cetirizine.
Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone (Beconase AQ) nasal spray? A. Sneezing B. Sore throat C. Runny nose D. Rebound congestion
B. Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.
A nurse should recognize that recent research has shown which statement is true about the use of zinc in children with colds? A. Efficacy is seen within the first 24 hours of signs and symptoms. B. Evidence has been inconclusive, and more research is needed. C. Lozenges with the lemon-lime formula are the most effective. D. Recovery is accelerated, and symptoms resolve quickly.
B. Studies have shown that zinc can benefit adults with colds. However, the one study done in children showed no beneficial effects. The study left unanswered questions; therefore, more research is required. Conclusions about efficacy, lozenge formula, and time to recovery are open to other possible interpretations in the one study done in children.
Which statement should the nurse include in the teaching for a patient who is to be started on zileuton (Zyflo)? A. "Use your zileuton (Zyflo) inhaler every 12 hours." B. "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." C. "Take the zileuton (Zyflo) 2 hours before eating breakfast each day." D. "Take an extra dose of zileuton (Zyflo) if you have an asthmatic attack."
B. "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." Zileuton can injure the liver, as evidenced by increased plasma levels of alanine aminotransferase (ALT). Therefore, ALT should be monitored once a month for 3 months, then every 2 to 3 months for the remainder of the first year, and periodically thereafter. Zileuton is an oral, not an inhaled, medication that is rapidly absorbed with or without food. The timing of administration with regard to meals is insignificant. Zileuton is used for asthma prophylaxis and cannot be used to abort an attack.
Which instruction should the nurse include in the teaching for a patient prescribed cetirizine (Zyrtec) for seasonal allergic rhinitis? A. "Clean the nasal applicator after use to prevent contamination." B. "Take the medication daily throughout the allergy season." C. "Expect a decrease in your nasal congestion in a day or two." D. "Take a stool softener daily to avoid the side effect of constipation."
B. "Take the medication daily throughout the allergy season." For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. The medication is taken orally, not intranasally. Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. Constipation is rare in patients taking second-generation agents, such as cetirizine.
Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A. "I'll gradually stop taking this so I don't have any problems with withdrawal." B. "This drug will help prevent the inflammation and irritation from my allergies." C. "I'll have to be more careful about not falling, because my bones may break more easily." D. "I realize that I only need to take this when my symptoms are really bad."
B. "This drug will help prevent the inflammation and irritation from my allergies." Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.
A nurse is teaching a patient about montelukast (Singulair). Which statement by the patient would indicate that the nurse's teaching was effective? A. "I'll take a dose as soon as I feel short of breath and start to cough." B. "While taking this medicine, I may be able to reduce my steroid medication." C. "This is the priority medication for preventing exercise-induced asthma symptoms." D. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."
B. "While taking this medicine, I may be able to reduce my steroid medication." Montelukast is an antileukotriene agent. Combining montelukast with an inhaled glucocorticoid medication can improve asthma symptoms and thus may allow a reduction in the glucocorticoid dosage. The effects of montelukast develop slowly, so it cannot be used as a quick-relief agent. Short-acting beta2 agonists are preferred for exercise-induced asthma. Montelukast does not affect coagulation, so bleeding and bruising do not occur.
A nurse should recognize that recent research has shown which statement is true about the use of zinc in children with colds? A. Efficacy is seen within the first 24 hours of signs and symptoms. B. Evidence has been inconclusive, and more research is needed. C. Lozenges with the lemon-lime formula are the most effective. D. Recovery is accelerated, and symptoms resolve quickly.
B. Evidence has been inconclusive, and more research is needed. Studies have shown that zinc can benefit adults with colds. However, the one study done in children showed no beneficial effects. The study left unanswered questions; therefore, more research is required. Conclusions about efficacy, lozenge formula, and time to recovery are open to other possible interpretations in the one study done in children.
To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? A. Only in an emergency B. On a continuing, daily basis C. To abort an asthma attack D. 2 weeks on, 2 weeks off
B. On a continuing, daily basis Glucocorticoid medications are first-line therapy for asthma to reduce symptoms of inflammation. They should be taken for prophylaxis on a daily basis. Therapeutic effects develop slowly, so these drugs cannot be taken to abort an asthma attack or in an emergency. They are most effective when administered on a fixed schedule, not PRN.
A history of allergy to which substance is a contraindication to the use of ipratropium/albuterol (Combivent)? A. Mold B. Peanuts C. Penicillin D. Dairy products
B. Peanuts Patients with peanut allergy should avoid Combivent, which contains soya lethicin as a carrier. Soya is in the same plant family as peanuts, and about 10% of people with peanut allergy are cross-allergic to soya. Allergy to the remainder of the options is not a contraindication.
A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching C. Use limited to allergy season D. Absence of rebound congestion
B. Relief of sneezing and itching Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.
Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone (Beconase AQ) nasal spray? A. Sneezing B. Sore throat C. Runny nose D. Rebound congestion
B. Sore throat Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.
A nurse teaches a patient with chronic obstructive pulmonary disease (COPD) about the adverse effects of tiotropium (Spiriva). Which behavior by the patient would indicate that the teaching has been effective? A. Combines tiotropium with an antacid B. Sucks on sugarless hard candy C. Prevents constipation with a stool softener D. Wears long sleeves and a wide-brim hat
B. Sucks on sugarless hard candy Tiotropium is an anticholinergic medication used to relieve bronchospasm associated with COPD. The most common adverse effect is dry mouth, and patients can suck on sugarless hard candy for symptomatic relief. It is not necessary to take an antacid medication, use a daily stool softener, or wear protective clothing when taking tiotropium.
A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? A. Chlorpheniramine (Chlor-Trimeton) B. Cetirizine (Zyrtec) C. Ephedrine D. Ipratropium bromide (Atrovent)
C. Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.
A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? A. "Restrict cold fluids to promote reduced mucus production." B. "Take the medication once a day only, usually at bedtime." C. "Increase your fluid intake to reduce the viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."
C. Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. Reduction of mucus production is unrelated to an expectorant. Expectorants may be taken several times a day and do not cause constipation.
Which finding in a patient taking oxymetazoline (Afrin) nasal spray every 2 hours would indicate that the patient has developed an adverse effect? A. Dry mouth and constipation B. Drowsiness and sedation C. Congestion and stuffiness D. Itching and skin rash
C. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.
Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine (Astelin)? A. "Take the pill in the morning before breakfast." B. "Headache may be a side effect of the medication." C. "You may experience an unpleasant taste in your mouth when using azelastine." D. "You will experience a decrease in nasal congestion if the medication is working."
C. With both formulations of azelastine (Astelin and Astepro), patients often complain of an unpleasant taste. Azelastine is administered as an intranasal metered spray. Headache is a side effect of the intranasal antihistamine olopatadine. Antihistamines do not reduce nasal congestion.
A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? A. "Restrict cold fluids to promote reduced mucus production." B. "Take the medication once a day only, usually at bedtime." C. "Increase your fluid intake to reduce the viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."
C. "Increase your fluid intake to reduce the viscosity of secretions." Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. Reduction of mucus production is unrelated to an expectorant. Expectorants may be taken several times a day and do not cause constipation.
Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn (NasalCrom)? A. "It is only moderately effective." B. "There are few adverse reactions." C. "Relief may take a week or two." D. "It suppresses histamine release."
C. "Relief may take a week or two." Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.
A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? A. "After you inhale the medication once, repeat until you obtain symptomatic relief." B. "Wait no longer than 30 seconds after the first puff before taking the second one." C. "Use a spacer with the inhaler and rinse your mouth after each dose administration." D. "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."
C. "Use a spacer with the inhaler and rinse your mouth after each dose administration." Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. When 2 puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Inhaling through the mouth just before activating the MDI is the proper technique.
Which finding in a patient taking oxymetazoline (Afrin) nasal spray every 2 hours would indicate that the patient has developed an adverse effect? A. Dry mouth and constipation B. Drowsiness and sedation C. Congestion and stuffiness D. Itching and skin rash
C. Congestion and stuffiness Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.
A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? A. Chlorpheniramine (Chlor-Trimeton) B. Cetirizine (Zyrtec) C. Ephedrine D. Ipratropium bromide (Atrovent)
C. Ephedrine Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.
A patient who takes cromolyn (Intal) for exercise-induced bronchospasm should follow which approach for maximum therapeutic effectiveness? A. It should be used infrequently because of systemic adverse effects. B. One 10-mg tablet should be taken at least 2 hours before exercising. C. It should be administered by inhalation 15 minutes before anticipated exertion. D. It should be used as a quick-relief agent if exercise triggers asthma symptoms.
C. It should be administered by inhalation 15 minutes before anticipated exertion. Cromolyn suppresses inflammation through inhibition of histamine release. It must be administered at least 15 minutes before exertion to prevent exercise-induced bronchospasm. It is administered by inhalation only. It is not a bronchodilator and cannot abort an ongoing attack. It is one of the safest antiasthma medications and has no systemic adverse effects.
Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Oriented to time, place, and person C. Respiratory rate of 12 to 24 breaths per minute D. Effective productive cough
C. Respiratory rate of 12 to 24 breaths per minute Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one-tenth those needed to relieve pain), so orientation and peripheral effects are minimal.
Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? A. Increases the daily intake of vitamin D and calcium. B. Records daily peak expiratory flow rates. C. Supplements additional doses at times of stress. D. Uses alternate-day therapy to reduce adverse effects.
C. Supplements additional doses at times of stress. Adrenal suppression can be profound with oral glucocorticoid use. It is a priority that patients take supplemental oral or intravenous doses at times of stress; failure to do so can be fatal. Alternate-day dosing, using a peak flowmeter, and minimizing bone loss with vitamin D and calcium intake are important; however, they are not as important as supplemental doses of glucocorticoid at times of stress.
Which class of drugs is most effective in preventing and treating seasonal and perennial rhinitis? A. Antitussives B. Oral antihistamines C. Oral sympathomimetics D. Intranasal glucocorticoids
D. Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and perennial rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.
A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? A. Echinacea B. Cimetidine (Tagamet) C. Sunscreen products D. Caffeine
D. Caffeine Theophylline is a methylxanthine that provides benefits through bronchodilation. It is used to reduce the frequency and severity of asthma attacks, especially those occurring at night. Caffeine also is a methylxanthine, and its pharmacologic actions may intensify the adverse effects of theophylline on the central nervous system (CNS) and heart. Sources of caffeine should be avoided. It is not necessary to avoid taking cimetidine or echinacea or using sunscreen products while taking theophylline.
A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? A. Oral theophylline (Elixophyllin) B. Subcutaneous omalizumab (Xolair) C. Inhaled mometasone furoate (Asmanex) D. High-dose albuterol (Proventil) via nebulizer treatment
D. High-dose albuterol (Proventil) via nebulizer treatment Nebulized high-dose SABAs, such as albuterol, are administered to relieve airflow obstruction. Oral theophylline is used for maintenance therapy of chronic stable asthma, not for treatment of exacerbation. Omalizumab is a second-line agent indicated for allergy-related asthma and only when preferred options have failed. Inhaled glucocorticoids, such as mometasone furoate, are not used to abort an acute attack. During an exacerbation they are administered systemically.
Which class of drugs is most effective in preventing and treating seasonal and perennial rhinitis? A. Antitussives B. Oral antihistamines C. Oral sympathomimetics D. Intranasal glucocorticoids
D. Intranasal glucocorticoids Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and perennial rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.
A nurse should teach a patient receiving oral pseudoephedrine (Sudafed) to observe for which adverse effects? (Select all that apply.) Sedation Irritability Paranoia Anxiety Weight loss
Irritability & Anxiety. Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.
