Adaptive Quizzing Chapter 37
A patient is prescribed theophylline for the treatment of chronic bronchitis. What instruction should the nurse give to the patient for safe administration of theophylline? 1 "Avoid consumption of citrus fruit." 2 "Avoid intake of a high-protein diet." 3 "Increase fluid intake up to 3 L per day." 4 "Increase intake of low-carbohydrate food."
"Avoid intake of a high-protein diet." The nurse should instruct the patient to avoid a high-protein diet, because it will reduce serum levels of theophylline in the body. The patient receives little therapeutic benefit if the serum level of theophylline is too low. Citrus fruits do not interfere with theophylline action; therefore, there is no need to avoid consumption of citrus fruit. Theophylline does not decrease body fluid levels; therefore, fluid intake need not be increased. The patient should not increase intake of low-carbohydrate food, because low-carbohydrate food interferes with theophylline action and reduces serum levels of theophylline in the body.
A nursing student is caring for a patient who is receiving ipratropium therapy. The student asks the nurse about the time required to reach the peak effect after the administration of the drug. What should the nurse tell the student? 1 "It takes about 1.6 hours." 2 "It takes about 1 to 2 hours." 3 "It takes about 4 to 5 hours." 4 "It takes about 5 to 15 minutes
"It takes about 1 to 2 hours." Ipratropium is the oldest and most commonly used anticholinergic bronchodilator. The peak effect of ipratropium occurs 1 to 2 hours after administration. The half-life elimination of ipratropium is 1.6 hours. The duration of action lasts about 4 to 5 hours. The onset of action occurs in 5 to 15 minutes.
What is the elimination half-life of theophylline? 1 1 to 2 hours 2 5.5 hours 3 7 to 9 hours 4 12 hours
7 to 9 hours Theophylline is a xanthine derivative and is used for the treatment of asthma, chronic bronchitis, or emphysema. The elimination half-life of theophylline is 7 to 9 hours. The peak effect of theophylline occurs at 1 to 2 hours after administration. The elimination half-life of salmeterol is 5.5 hours. The duration of action of theophylline is 12 hours.
The nurse should instruct a patient to avoid caffeine and stimulants when the individual is using which medication? 1 Albuterol 2 Flunisolide 3 Tiotropium 4 Montelukast
Albuterol The nurse should instruct a patient who self-administers albuterol to avoid substances such as caffeine and other stimulants that will augment the sympathetic stimulation of albuterol. Excessive stimulation may result in severe hypertension, angina, and serious dysrhythmias. Flunisolide, tiotropium, and montelukast should not induce such stimulation in the patient.
A patient with chronic obstructive pulmonary disorder (COPD) is retaining carbon dioxide. Which respiratory therapy should the nurse administer to lower the patient's carbon dioxide concentration? 1 Salmeterol 2 Albuterol nebulizer 3 Fluticasone propionate 4 Oxygen via a nasal cannula, 2 L/min
Albuterol nebulizer The patient is retaining carbon dioxide because of an impaired forced expiratory volume, so the nurse needs to administer a bronchodilator such as albuterol to increase the size of the airways and permit more ventilation. Salmeterol is also a bronchodilator, but it is administered twice a day and is not intended as rescue therapy. Fluticasone propionate, a glucocorticoid, may be used for patients with COPD to help reduce respiratory secretions and thereby improve oxygenation and ventilation, but it is intended as preventive therapy. Oxygen is not indicated unless the patient is also hypoxemic.
For what side effects should the nurse ask the patient to be watchful when administering mixed alpha/beta agonists? Select all that apply. 1 Anorexia 2 Drowsiness 3 Hypoglycemia 4 Vascular headache 5 Cardiac stimulation
Anorexia Vascular headache Cardiac stimulation Mixed alpha/beta agonists produce the most adverse effects, because they are nonselective in action. Anorexia, vascular headache, and cardiac stimulation are side effects of mixed alpha/beta agonists. Mixed alpha/beta agonists do not cause drowsiness. These drugs may cause insomnia. Mixed alpha/beta agonists do not cause hypoglycemia; instead, they may cause hyperglycemia.
A patient who receives zafirlukast reports headache, nausea, and diarrhea. On further assessment, the nurse finds that the patient has taken the correct dose of the drug at the correct time. Which other medication taken by the patient may contribute to these adverse effects? 1 Aspirin 2 Warfarin 3 Erythromycin 4 Phenobarbital
Aspirin Headache, nausea, and diarrhea are adverse effects that are associated with zafirlukast. Aspirin interacts with zafirlukast to cause decreased clearance of zafirlukast. Thus, the concentration of the zafirlukast in the blood increases. Because the patient has taken the correct dose of the drug, it is likely that the patient is taking aspirin, which has caused the adverse effects of the zafirlukast. Warfarin interacts with zafirlukast, and this leads to increased levels of warfarin in the blood. Erythromycin interacts with zafirlukast and reduces its efficacy by decreasing the bioavailability of zafirlukast. Phenobarbital does not interact with zafirlukast. Phenobarbital interacts with montelukast and decreases its efficacy.
A patient with a history of asthma is brought to the clinic with acute dyspnea, wheezing, hypercapnia, and hypoxemia. Which type of medication will be administered first to this patient? 1 Glucocorticoids 2 Beta2 agonists 3 Anticholinergics 4 Leukotriene modifiers
Beta2 agonists This patient is experiencing an acute obstructive respiratory attack, which may be a result of asthma, bronchitis, or emphysema. The first drug that should be administered is a beta2 agonist, and it should be delivered by way of inhalation. Beta2 agonists are effective in the relief of acute bronchospasm because they act quickly. Glucocorticoids may be administered in an acute attack but only after the beta2 agonists have dilated the bronchioles; however, glucocorticoids are not indicated for rescue therapy. Anticholinergics and leukotriene modifiers are indicated in the maintenance of obstructive respiratory disease.
A patient with asthma has been prescribed albuterol. The patient reports dizziness after taking the medication. What will the nurse assess in the patient? 1 Visual acuity 2 Blood pressure 3 Respiratory rate 4 Balance reactions
Blood pressure Dizziness is a common symptom associated with low blood pressure. Albuterol is a selective beta2 agonist and relieves asthma by relaxing the muscles of the bronchial walls. Beta2 receptors in the vascular smooth muscles are also stimulated by this drug, which causes vasodilation and can ultimately lead to low blood pressure. Therefore, the nurse should check the patient's blood pressure. Altered vision also causes dizziness, but albuterol does not affect vision. Because albuterol causes bronchodilation, the respiratory rate would also be reduced. However, dizziness is not associated with a decreased respiratory rate. An impaired balance reaction would also cause dizziness, although the vestibular system is not affected by albuterol. Thus, an impaired balance reaction is an unlikely cause of dizziness in the patient.
A patient is prescribed tiotropium for the treatment of chronic obstructive pulmonary disease (COPD). How can the absorption of tiotropium be improved? 1 By taking a higher dose of tiotropium for inhalation 2 By inhaling the tiotropium continuously for some time 3 By waiting for 1 to 2 minutes before inhaling the second dose 4 By avoiding rinsing the mouth with water after inhaling the medicine
By waiting for 1 to 2 minutes before inhaling the second dose The nurse should instruct the patient to wait for 1 to 2 minutes before inhaling the second dose of tiotropium to allow for maximal lung penetration. This helps to increase the absorption of tiotropium. The nurse instructs the patient not to take a higher dose of tiotropium for inhalation, because this will result in severe adverse effects. The patient should not inhale the tiotropium continuously for some time, because this increases the concentration of the drug in the body and causes adverse effects. Tiotropium is an anticholinergic drug and therefore reduces secretions and causes mucosal irritation and dryness of the mouth. Therefore, the patient should rinse the mouth with water immediately after using tiotropium to prevent mucosal irritation and dryness of the mouth.
The nurse is counseling a patient who is prescribed a xanthine-derivative drug. Which items does the nurse advise the patient to avoid? Select all that apply. 1 Sugar 2 Coffee 3 Charcoal-broiled foods 4 Cigarettes 5 Low-protein foods 6 Low-carbohydrate foods
Coffee Charcoal-broiled foods Cigarettes Low-carbohydrate foods Xanthine derivatives taken with coffee can produce additive cardiac and central nervous system stimulation. Cigarette smoking enhances the rate of xanthine metabolism. As a result, higher dosages of theophylline and other xanthine derivatives may be needed. Charcoal-broiled, high-protein, and low-carbohydrate foods interact with xanthine derivatives. These foods may reduce serum concentrations of xanthines through various metabolic mechanisms. Sugar and low-protein foods do not have any adverse interactions with xanthene-derivative drugs.
Which antiasthmatic drugs work by preventing the inflammation commonly provoked by the substances released from mast cells? 1 Corticosteroids 2 Anticholinergics 3 Mast cell stabilizers 4 Xanthine derivatives
Corticosteroids Corticosteroids prevent the inflammation commonly provoked by the substances released from mast cells. Anticholinergics prevent the binding of cholinergic substances that cause bronchoconstriction and increase secretions. Mast cell stabilizers (cromolyn and nedocromil) stabilize the cell membranes of the mast cells in which antigen-antibody reactions take place, thereby preventing the release of substances such as histamine that cause constriction. Xanthine derivatives raise intracellular levels of cyclic adenosine monophosphate.
Which drug is a long-acting beta agonist (LABA) inhaler? 1 Formoterol 2 Terbutaline 3 Levalbuterol 4 Metaproterenol
Formoterol Formoterol is a LABA inhaler. LABAs take longer for the onset of action; therefore, LABAs should never be used for acute treatment. Terbutaline, levalbuterol, and metaproterenol are short-acting beta agonist (SABA) inhalers. These drugs require less time to show their effect.
The primary health care provider has prescribed epinephrine for a patient to treat an allergic reaction. After reviewing the patient's history, the nurse finds that the patient takes metformin for treatment of diabetes. What changes may the nurse expect in the primary health care provider's prescription for safe drug administration? 1 Increase in dose of metformin 2 Increase in dose of epinephrine 3 Replacement of metformin with aminophylline 4 Replacement of epinephrine with aminophylline
Increase in dose of metformin Administration of epinephrine increases blood glucose levels in the body. The patient is already taking metformin for treatment of diabetes. Therefore, the primary health care provider should increase the dose of metformin to prevent hyperglycemia in the patient. Epinephrine should not be administered to the patient in a higher dose, because this may lead to symptoms related to sympathetic stimulation. Metformin should not be replaced with aminophylline, because this will lead to hyperglycemia in the patient. There is no need to replace epinephrine with aminophylline, because the patient is not resistant to epinephrine.
A patient is prescribed albuterol. The nurse is explaining the most common route of administration of albuterol to the patient. Which route should the nurse discuss? 1 Inhalation 2 Intravenous 3 Subcutaneous 4 Intramuscular
Inhalation The most preferred route of administration of albuterol is inhalation. Oral routes also are sometimes used. Intravenous, subcutaneous, and intramuscular routes are not suitable for administering albuterol.
Which condition is a contraindication for the administration of montelukast? 1 Diabetes 2 Joint pain 3 Peanut allergy 4 Lactose allergy
Lactose allergy The nurse should check for a history of lactose allergy in the patient, because lactose is an inactive ingredient used in the formulation of montelukast. If montelukast is administered to a patient with lactose allergy, a severe allergic reaction may occur. Montelukast does not cause any complication with diabetic patients; therefore, administration of montelukast is safe for a diabetic patient. Montelukast has no effect on skeletal muscle tissue; therefore, it is safe for a patient who has joint pain. Administration of montelukast to a patient who has peanut allergy is safe, because it does not cause any anaphylactic reaction.
A patient who is prescribed albuterol to treat bronchospasm develops tachycardia. Which medication should the nurse expect to administer instead of albuterol? 1 Salmeterol 2 Formoterol 3 Levalbuterol 4 Arformoterol
Levalbuterol Albuterol is used for the treatment of bronchospasm. However, it should be avoided in patients with tachycardia, because it may increase the heart rate, worsening the tachycardia. Therefore, the levorotatory isomeric form of albuterol—that is, levalbuterol—is prescribed as an alternative to albuterol. Salmeterol, formoterol, and arformoterol are long-acting beta agonist inhalers and have a longer onset of action. These drugs are not used for acute treatment.
A patient who is taking ipratropium for asthma is complaining of a dry cough. Which action should the nurse implement first? 1 Administer rescue therapy. 2 Listen to the patient's lungs. 3 Instruct the patient to drink water. 4 Administer 30 mg of dextromethorphan.
Listen to the patient's lungs. Before making a recommendation, the nurse completes a patient assessment to rule out an exacerbation of asthma, because the cough may be a clinical indicator of a more serious problem in a patient who has asthma. If the patient is wheezing, rescue therapy may be indicated. Ipratropium is an anticholinergic bronchodilator that can cause dry mucous membranes, so to loosen the secretions and facilitate expectoration, the nurse might instruct the patient to drink water. Dextromethorphan, an antitussive, is effective in eliminating a cough; however, this therapy may not be indicated, depending on the findings of the nurse's assessment.
Which medication disrupts the inflammatory response and is indicated in the treatment of asthma? 1 Salmeterol 2 Ipratropium 3 Montelukast 4 Theophylline
Montelukast Montelukast is a leukotriene-receptor antagonist indicated for the treatment of asthma and allergic rhinitis and acts by binding to the D4 leukotriene receptor in the respiratory tract. Salmeterol causes bronchodilation and plays a small role or none in the inflammatory response. Ipratropium is the oldest and most commonly used anticholinergic drug used in the treatment of chronic obstructive pulmonary disorder. Theophylline is a xanthine derivative that causes bronchodilation by increasing the levels of the energy-producing substance cyclic AMP.
A patient who has asthma is prescribed ipratropium. The nurse instructs the patient to rinse the mouth with water immediately after inhaling ipratropium. This is done to prevent which complication of therapy? 1 Oral candidiasis 2 Throat infection 3 Nasal congestion 4 Mucosal irritation and dryness
Mucosal irritation and dryness The nurse advises the patient to rinse the mouth with water immediately after using inhaled ipratropium to prevent mucosal irritation and dryness of the mouth. Ipratropium has anticholinergic activity, so it reduces secretions and causes dryness of the mouth. Oral candidiasis, throat infection, and nasal congestion are not side effects of ipratropium inhaler use. Use of a corticosteroid inhaler can cause oral candidiasis.
The administration of beta agonists is contraindicated in which type of patients? 1 Patients with diabetes mellitus 2 Patients with bronchial asthma 3 Patients with pulmonary disease 4 Patients with a high risk of stroke
Patients with a high risk of stroke Administration of a beta agonist is contraindicated in patients who have a high risk of stroke. Beta agonists have vasoconstrictive action, which therefore increases blood pressure. Excessive blood pressure in the cerebral blood vessels may ultimately lead to hemorrhagic stroke. Administration of beta agonists is safe for diabetic patients, provided adjustment of hypoglycemic drugs is done. Bronchial asthma and pulmonary disease are indications for administration of beta agonists.
A patient is prescribed ipratropium for the treatment of chronic obstructive pulmonary disease. For what should the nurse assess to ensure safe administration of ipratropium? 1 Joint pain 2 Peanut allergy 3 Banana allergy 4 Migraine headaches
Peanut allergy Ipratropium is an anticholinergic drug commonly prescribed for the treatment of chronic obstructive pulmonary disease. The nurse should ask the patient about peanut allergy, because ipratropium causes severe anaphylactic reactions in patients who have peanut allergy. A history of joint pain, banana allergy, or migraine pain does not have any impact on ipratropium therapy; therefore, ipratropium is safe for patients with these conditions.
A patient with chronic bronchitis is prescribed theophylline. An alteration in which parameter should lead the nurse to immediately notify the primary health care provider? 1 Serum level of drug 2 Serum calcium levels 3 Serum uric acid levels 4 Serum creatinine levels
Serum level of drug During each follow-up visit, the nurse should monitor the serum level of drug. Blood levels of theophylline need to be between 5 and 15 mcg/mL and must be frequently monitored. If the level of theophylline is too high, unwanted adverse effects will occur. If the level of theophylline is too low, then the patient receives little therapeutic benefit. If any change occurs in the serum level of theophylline, the nurse should report it to the primary health care provider. Theophylline does not affect calcium, uric acid, or serum creatinine levels. Therefore, these changes are not related to the theophylline treatment.
A patient is prescribed an inhaled corticosteroid for the treatment of asthma. Which biochemical test may be performed in the patient before drug administration? 1 Sputum test 2 Hemoglobin test 3 Liver enzyme test 4 Prothrombin time
Sputum test A sputum test is performed before administration of inhaled corticosteroids to the patient. This test is done to check for the presence of Candida organisms in the patient. Administration of corticosteroid increases susceptibility to infection. If the sputum test of the patient is positive, then administration of corticosteroids is contraindicated in the patient to prevent further complications. Corticosteroids do not affect hemoglobin levels, clotting time, or liver enzymes and do not produce any complications associated with these. Therefore, a hemoglobin test, prothrombin time, and liver enzyme test are not as important as the sputum test.
A patient with asthma is prescribed fluticasone and a salmeterol inhaler. This treatment is a part of which step of asthma management? 1 Step 2 2 Step 4 3 Step 5 4 Step 6
Step 6 Treatment of asthma is done following stepwise therapy consisting of six steps. In step 4 therapy, a medium dose inhaled corticosteroid is combined with a long-acting beta2 agonist (LABA). In step 2, a low-dose inhaled corticosteroid is used along with a short-acting beta agonist as needed. In step 5, a high-dose inhaled corticosteroid is combined with a LABA. In step 6, patients usually require systemic steroids.
A patient is prescribed omalizumab by the primary health care provider. Which route should the nurse use to administer this drug? 1 Oral 2 Inhalation 3 Intravenous 4 Subcutaneous
Subcutaneous Omalizumab is the newest antiasthmatic medication and is administered by injection through the subcutaneous route. Omalizumab is not administered through oral, inhalation, or intravenous routes.
In discharge teaching, the nurse will emphasize to a patient receiving a beta agonist bronchodilator the importance of reporting which side effect? 1 Hypoglycemia 2 Tachycardia 3 Bradycardia 4 Nonproductive cough
Tachycardia A beta agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.
While investigating the cause of sudden death in a patient with asthma, the nurse finds that the patient's medications were changed from systemic corticosteroids to inhaled corticosteroids. Which intervention, if followed, might have saved the patient from dying? 1 Tapering the dose of systemic corticosteroid 2 Providing an initial high dose of inhaled corticosteroid 3 Administering the same dose of systemic corticosteroid 4 Reducing the dose frequency of the inhaled corticosteroid
Tapering the dose of systemic corticosteroid When a patient's medications are suddenly switched from systemic corticosteroids to an inhaled corticosteroid, adrenal suppression takes place. This leads to adrenal failure, which can be fatal. Death can be prevented by gradually reducing the dose of systemic corticosteroids, because this prevents the withdrawal symptoms. An initial high loading dose of inhaled corticosteroids may cause localized irritation and other adverse effects. However, the initial loading dose is usually preferred for the systemic administration of medications. By continuing the administration of same dose of systemic corticosteroids, the patient would have severe adverse effects from the synergistic effects of systemic and inhaled corticosteroids. Gradual reduction of dosage frequency may not help, because an initially large amount of drug might have been accumulated in the body and would have caused an adverse reaction in the patient.
The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What should the nurse do? 1 Teach the child to use a spacer. 2 Tell the parent to hold the inhaler for the child. 3 Ask the health care provider to switch to oral medications. 4 Tell the parent that young children should not use inhalers.
Teach the child to use a spacer. If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.
A patient on theophylline therapy complains of gastroesophageal reflux during sleep. What other complications should the nurse anticipate in the patient? Select all that apply. 1 Vomiting 2 Insomnia 3 Dry mouth 4 Increased urination 5 Ventricular dysrhythmias
Vomiting Increased urination Ventricular dysrhythmias Theophylline therapy can have various adverse effects. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Vomiting, nausea, and anorexia commonly occur. Transient increased urination and hyperglycemia are other possible adverse effects. In addition, gastroesophageal reflux may occur during sleep in patients taking theophylline therapy. Insomnia and dry mouth are the adverse effects of beta-adrenergic agonists and ipratropium, respectively.
The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? 1 Monitor the patient for toxicity. 2 Increase the intravenous (IV) drip rate. 3 Continue to assess the patient's oxygenation. 4 Stop the IV for an hour then restart at a lower rate.
Continue to assess the patient's oxygenation. The therapeutic theophylline level is 10 to 20 mcg/mL. The nurse should continue interventions and monitor oxygenation. The patient's theophylline level is within the normal therapeutic range; it is not necessary to monitor for toxicity, increase the drip rate, or stop the IV.
A patient is prescribed zileuton to treat asthma. Which will be closely monitored in the patient to ensure safe drug administration? 1 Creatinine clearance 2 Liver enzyme levels 3 Complete blood count 4 Uric acid baseline level
Liver enzyme levels The nurse should assess the patient's liver enzyme levels, because administration of zileuton may lead to liver dysfunction. Zileuton has no effect on creatinine level, blood cells, or uric acid level. Therefore, testing of creatinine clearance, complete blood count, and uric acid baseline level are not required after administering zileuton.
For what adverse effects will the nurse monitor in a patient who is receiving tiotropium? Select all that apply. 1 Skeletal pain 2 Hyperglycemia 3 Nasal congestion 4 Heart palpitations 5 Dry mouth or throat
Nasal congestion Heart palpitations Dry mouth or throat Tiotropium is an anticholinergic drug used in the treatment of chronic obstructive pulmonary disease. Because of its anticholinergic effects, the drug may produce side effects such as nasal congestion, heart palpitations, and dry mouth or throat. Tiotropium has no effect on skeletal muscle tissue; therefore, it does not cause skeletal pain. Tiotropium does not affect insulin metabolism; therefore, it does not cause hyperglycemia.
Which are possible adverse effects of zafirlukast? Select all that apply. 1 Nausea 2 Diarrhea 3 Anorexia 4 Headache 5 Hyperglycemia
Nausea Diarrhea Headache The most commonly reported adverse effects of zafirlukast are nausea, diarrhea, and headache. Therefore, the nurse would expect these complaints from the patient during the follow-up visit. These adverse effects are temporary and will resolve after therapy is completed. Zafirlukast does not affect food metabolism; therefore, it does not cause anorexia. Zafirlukast does not affect insulin metabolism; therefore, it does not cause hyperglycemia. Anorexia and hyperglycemia are side effects of mixed alpha/beta agonists.
What is the correct dose of montelukast for an adult? 1 2 mg 2 4 mg 3 5 mg 4 10 mg
10 mg Montelukast is a leukotriene receptor antagonist. It is used for the treatment of asthma, bronchoconstriction, and mucus production. The usual dose of montelukast for adults is 10 mg. Doses of 2 mg, 4 mg, or 5 mg of montelukast are too low for adults and do not give the desired therapeutic effect. Albuterol is given in a 2-mg dose in adults. Montelukast is administered in a 4-mg dose to 2- to 5-year-old patients. Montelukast is administered in a 5-mg dose to 6- to 14-year-old patients.
A patient is prescribed ipratropium metered-dose inhaler for the treatment of asthma. The nurse instructs the patient to take two puffs four times a day. The inhaler has a capacity of 200 inhalations. How many days will the inhaler deliver the prescribed dose?
25 The dosing frequency of ipratropium is two puffs four times a day, and the inhaler has a capacity of 200 inhalations. Therefore, two puffs four times a day is equal to eight inhalations per day. Eight divided into 200 yields 25. Therefore, the inhaler will deliver the prescribed dose for up to 25 days.
A patient received methylprednisolone intravenously for 4 days for acute asthma. The nurse is preparing for the discharge of the patient with a prescription for fluticasone. Which priority instruction should the nurse include while educating the patient before discharge? 1 "Take fluticasone exactly as it is prescribed." 2 "Rinse your mouth with water after using fluticasone." 3 "Avoid situations that can expose you to the infections." 4 "Administer albuterol before other asthma medications."
"Take fluticasone exactly as it is prescribed." To prevent potentially fatal adrenal crisis resulting from too-fast withdrawal of steroids when patients are switching from parenteral to inhaled steroids, the nurse should instruct the patient to adhere to the therapeutic regimen and to take fluticasone as directed. Fungal infection is an adverse effect of inhaled corticosteroids, and rinsing the mouth after using fluticasone is desirable but not a priority. Patients should be cautioned to minimize their risk of infection. Albuterol, which is a bronchodilator, opens the airways so that the inhaled corticosteroid may be better absorbed.
A patient is prescribed ipratropium and cromolyn sodium. What should the nurse teach the patient? 1 "Take the ipratropium only in the mornings." 2 "Take the ipratropium 5 minutes before the cromolyn." 3 "Do not take these medications within 4 hours of each other." 4 "Administer both medications together in a metered-dose inhaler."
"Take the ipratropium 5 minutes before the cromolyn." When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 2 to 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
A patient is prescribed oral albuterol to treat bronchitis. What instruction should the nurse give to the patient to prevent gastrointestinal (GI) upset? 1 "Take the prescribed medication with food." 2 "Increase fluid intake up to 2500 mL a day." 3 "Avoid sleeping with the head in an elevated position." 4 "Take the prescribed medication on an empty stomach."
"Take the prescribed medication with food." Albuterol is a beta agonist. Beta agonists can cause GI. Therefore, the nurse should instruct the patient to take the medication with food to avoid GI upset. Although food may slightly decrease absorption of the drug, it has the benefit of minimizing GI upset. An increase in fluid intake is helpful for maintaining hydration but not for minimizing GI upset. Keeping the head elevated is comfortable but does not help to minimize GI upset.
A patient is in the emergency department to treat a xanthine overdose. What will the health care provider prescribe to treat this patient? 1 Formoterol 2 Arformoterol 3 Theophylline 4 Activated charcoal
Activated charcoal The health care provider will instruct the nurse to administer activated charcoal to the patient to block the xanthine action. The nurse should repeatedly administer activated charcoal to the patient to ensure complete inhibition of the action of xanthine. Administration of formoterol, arformoterol, or theophylline would not be helpful in xanthine overdose toxicity, because these drugs do not block the action of xanthine.
The health care provider prescribes albuterol and beclomethasone inhalers for a patient. What is the nurse's best action? 1 Administer each inhaler at 30-minute intervals. 2 Question the prescription; two inhalers should not be given at one time. 3 Administer beclomethasone, wait 2 minutes, and then administer albuterol. 4 Administer the albuterol, wait 5 minutes, and then administer beclomethasone
Administer the albuterol, wait 5 minutes, and then administer beclomethasone Administering the bronchodilator albuterol first allows the beclomethasone to reach deeper into the lungs as the bronchioles dilate. Corticosteroids such as beclomethasone do not cause dilation and are therefore given last. They are not given at 30 minute intervals. There is no need to change this prescription. The bronchodilator albuterol should be given first, then after 5 minutes, the beclomethasone may be administered.
A patient with a history of chronic obstructive pulmonary disorder (COPD) experiences acute bronchospasm after being exposed to peanuts on an airplane. Which medications might the patient be using? Select all that apply. 1 Albuterol 2 Salmeterol 3 Tiotropium 4 Ipratropium 5 Arformoterol
Albuterol Tiotropium Ipratropium Peanut allergy can cause severe anaphylactic reactions in patients using anticholinergic medications. Tiotropium and ipratropium are anticholinergic medications. Alpha-agonist bronchodilators such as albuterol may have a similar effect. The patient should avoid contact with the peanut antigen while taking such therapy. Individuals with peanut allergy have a greater risk of allergy to anticholinergic agents. Patients using salmeterol should avoid caffeine and similar stimulants. Arformoterol is a long-acting alpha-agonist bronchodilator that may enhance the risk of hypertension if used with monoamine oxidase inhibitors and other sympathomimetics.
A patient is prescribed ipratropium for treatment of chronic obstructive pulmonary disease (COPD). After checking the medical history, the nurse finds that the patient is taking diphenhydramine to treat allergies. What should the nurse anticipate that the provider will prescribe for this patient? 1 Discontinue the ipratropium. 2 Discontinue the dose of diphenhydramine. 3 Administer both medications as prescribed. 4 Administer both medicines simultaneously.
Discontinue the dose of diphenhydramine. Ipratropium is an anticholinergic bronchodilator, and diphenhydramine is an anticholinergic drug. Administration of an anticholinergic bronchodilator with an anticholinergic drug leads to additive toxicity. Therefore, the nurse should not administer ipratropium to the patient, because the patient is already taking diphenhydramine. Administration of diphenhydramine in a low dose may not produce a therapeutic effect. The nurse should avoid administration of medicines as per prescription, because it may result in additive toxicity in the patient. The nurse should avoid administration of both medicines simultaneously to avoid additive toxicity reaction.
A patient receiving inhaled ipratropium therapy visits the clinic for a follow-up. Which complaint should the nurse anticipate from the patient? 1 Insomnia 2 Dry mouth 3 Anginal pain 4 Vascular headache
Dry mouth The most commonly reported adverse effects of ipratropium therapy are caused by the anticholinergic effects of the drug and include dry mouth or throat, nasal congestion, heart palpitations, gastrointestinal distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety. Insomnia, anginal pain, and vascular headache are the adverse effects of alpha-adrenergic agonists.
A patient taking an oral theophylline drug is due for the next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 beats/min. The patient is irritable. What is the nurse's best action? 1 Administer oxygen at 2 L per minute via nasal cannula. 2 Continue to monitor the patient and give the medication. 3 Hold the next dose of theophylline and assess the patient. 4 Call the health care provider to request an increased dose.
Hold the next dose of theophylline and assess the patient The patient is displaying possible adverse reactions to theophylline such as tachycardia and irritability, and the blood level should be assessed before another dose of the medication is given. These symptoms may also be related to hypoxia. The nurse should assess for hypoxia before administering oxygen. The nurse should hold the medication and evaluate the cause for these symptoms. Until the serum theophylline level is known, an increased dose is not indicated.
A patient is prescribed theophylline to treat emphysema. After reviewing the patient's history, the nurse finds that the patient is taking an oral contraceptive. The nurse recommends that the patient to use another method of contraception. What is the probable reason for this? 1 Oral contraceptives inhibit theophylline action. 2 Theophylline decreases the effectiveness of contraceptives. 3 Oral contraceptives increase the serum level of theophylline. 4 Theophylline and oral contraceptives cause additive toxicity.
Oral contraceptives increase the serum level of theophylline. The beneficial effects of theophylline can be maximized by maintaining blood levels within a certain range. If these levels become too high, unwanted adverse effects will occur. An oral contraceptive increases the serum level of theophylline, which increases the risk of unwanted adverse effects. Therefore, the patient should switch to another method of contraception during theophylline treatment. An oral contraceptive does not interfere with or inhibit the action of theophylline. Theophylline does not interfere with the actions of oral contraceptives action nor cause their failure. Simultaneous administration of theophylline and oral contraceptives does not produce additive toxicity; administration of an anticholinergic bronchodilator with an anticholinergic drug leads to additive toxicity.
What over-the-counter product should the nurse instruct a patient to avoid when taking theophylline? 1 Echinacea 2 St. John's wort 3 Acetaminophen 4 Diphenhydramine
St. John's wort St. John's wort has been shown to enhance the rate of xanthine metabolism. Echinacea, acetaminophen, and diphenhydramine do not interact with theophylline.
A patient reports nausea, shortness of breath, joint pain, weakness, and fatigue. On review of the patient's history, the nurse finds that the patient is prescribed prednisone to treat asthma. The nurse also learns that the patent has abruptly discontinued the medicine shortly after getting some relief from asthma. What should the nurse interpret from the assessment? 1 The patient has Addisonian crisis. 2 The patient has coronary ischemia. 3 The patient has rheumatoid arthritis. 4 The patient has Cushing's syndrome.
The patient has Addisonian crisis. Prednisone is a systemic corticosteroid. If a systemic corticosteroid is abruptly discontinued, Addisonian crisis ensues. Nausea, shortness of breath, joint pain, weakness, and fatigue are symptoms of Addisonian crisis. Coronary ischemia causes shortness of breath, fatigue, and weakness but is not associated with discontinuation of steroid therapy. Rheumatoid arthritis is an autoimmune disease, which is not caused by abrupt cessation of corticosteroid therapy. Nausea, shortness of breath, joint pain, weakness, and fatigue do not indicate Cushing's syndrome. Therefore, the patient does not have Cushing's syndrome. Moon face, acne, an increase in fat pads, and swelling are symptoms of Cushing's syndrome.
What interaction can occur when an asthmatic patient consumes rifampin along with xanthine derivatives? 1 Theophylline levels are decreased. 2 Theophylline metabolism is decreased. 3 Additive cardiac stimulation is produced. 4 Additive central nervous system stimulation is produced.
Theophylline levels are decreased. Xanthine derivatives are used as bronchodilators in asthmatic patients. Administration of rifampin along with xanthine derivatives causes increased metabolism of theophylline, which results in decreased levels of theophylline. Additive cardiac and central nervous system stimulation is produced when caffeine is administered along with theophylline.
What are adverse effects of albuterol? Select all that apply. 1 Tremors 2 Skin rashes 3 Palpitations 4 Tachycardia 5 Hypoglycemia
Tremors Palpitations Tachycardia Albuterol is used for the treatment of asthma. If albuterol is used in larger dosages, then dose-related adverse effects may be seen. These effects may develop as the drug loses its beta2-specific actions. Therefore, the beta1 receptors are stimulated, resulting in nausea, increased anxiety, tremors, palpitations, and tachycardia. Albuterol does not affect skin integrity; therefore, it does not cause skin rashes. Albuterol does not affect insulin metabolism; therefore, it does not cause hypoglycemia.
