Exam 4
A nurse is caring for a client who has a suspected adrenal insufficiency. Which of the following medications should the nurse anticipate the provider using to determine the presence of adrenal insufficiency? A. Prednisone B. Cosyntropin C. Dexamethasone D. Ketoconazole
B. Cosyntropin
A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered-dose inhaler. Which of the following statements by the parent indicates the need for further teaching? V A. "I will give my child a dose as soon as wheezing starts." B. "My child should rinse out his mouth after using the inhaler." • C. "My child should exhale completely before placing the inhaler in his mouth." D. "If my child has difficulty breathing in the dose, a spacer can be used."
Correct Answer: A. "I will give my child a dose as soon as wheezing starts." Cromolyn is a mast cell inhibitor that has a slow onset and is given for prophylactic treatment of asthma. It is not a rescue medication. Incorrect Answers: water after each use. B. Cromolyn administered by inhaler can cause mouth and throat irritation. The client should rinse or gargle with The client should exhale completely and breathe in evenly while depressing the canister. A spacer provides a chamber to hold the medication exhaled in suspension. It allows clients who have difficulty breathing in the entire dose in one inhalation to continue to receive medication in subsequent breaths.
A nurse is preparing a discharge teaching plan for a 6-year-old client with asthma who has several prescription medications using metered-dose inhalers (MDIs). Which of the following interventions should the nurse include in the plan? V A. Add a spacer to each MDI B. Instruct the child to inhale more rapidly than usual when using an MDI • C. Ask the provider to change the child's medications from inhaled to oral formulations D. Administer oxygen by facemask along with the MDI
Correct Answer: A. Add a spacer to each MDI MDIs are difficult to use correctly; even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for a lack of hand-lung coordination by increasing the amount of medication delivered to the lungs. Incorrect Answers: effectiveness. B. A client who uses an inhaler should be taught to inhale the medication slowly over 3 to 5 seconds for maximum C. There are advantages to delivering medications for asthma by inhalation, including enhanced therapeutic effects, decreased systemic adverse effects, and quick relief when short-acting bronchodilators are used. Changing the child's medications to oral formulations is not an effective intervention. D. Administering oxygen along with inhaled medications does not increase the amount of medication reaching the lungs. In addition, oxygen therapy should be administered on the basis of low oxygen saturation and other assessments. It is not appropriate to administer oxygen by facemask along with the MDI.
A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication-delivery devices for the treatment of asthma? VO A. Drv-powder inhaler (DPI) B. Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer
Correct Answer: A. Dry-powder inhaler (DPI) The nurse should identify that DIs do not require hand-breath coordination and are easier to use for clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs. Incorrect Answers: MDIs with spacer devices require hand-breath coordination in order to ensure maximum deposition of medication. This can be more difficult for a client who has deformity of the hands. Respimat inhalers deliver medication as a fine mist. Although these devices do not require as much hand-breath coordination as MDIs, they still require the client to activate the device using a twisting motion, which can be more difficult for a client who has deformity of the hands. Nebulizers are small machines that convert liquid medication into a fine mist for inhalation. The medications used with nebulizers often require twisting of small ampules to open, which can be more difficult for a client who has deformity of the hands.
A nurse is caring for a client with asthma who has been taking an inhaled glucocorticoid and long-acting beta2-agonist combination dry-powdered inhaler (DPI) for maintenance therapy. The nurse should identify that which of the following is a disadvantage of this medication? V A. Restricted dosage flexibility • B. Complicated delivery device c. Serious systemic effects • D. Limited efficacy over time
Correct Answer: A. Restricted dosage flexibility The nurse should identify that a disadvantage of an inhaled glucocorticoid and a long-acting beta2-agonist being combined is that the dosages of these medications are fixed, so the dose cannot be adjusted. Incorrect Answers: This combination medication DPI is an easy-to-use device that allows the client to self-administer medication after receiving basic instruction about its use. This combination medication DPI is delivered locally to the lungs. Systemic effects are mild and generally do not occur. This combination medication DPI is effective for long-term use for clients who have asthma.
A nurse is caring for a client who has asthma and requires long-term treatment. The nurse should identify that which of the following medications used for long-term treatment places the client at an increased risk of asthma-related death? VO A. Salmeterol B. Fluticasone c. Budesonide D. Theophylline
Correct Answer: A. Salmeterol The nurse should identify that salmeterol is a long-acting beta2-agonist. When this medication is used alone for the long-term treatment of asthma, this class of medication increases the client's risk of asthma-related death. To decrease this risk, the client should be prescribed both a long-acting beta2-agonist along with an inhaled corticosteroid. Incorrect Answers: Fluticasone is an inhaled corticosteroid used to decrease airway inflammation as a part of the long-term treatment of asthma. The use of this medication for a long period of time does not increase the risk of asthma-related death for the client. Budesonide is an inhaled corticosteroid used to decrease airway inflammation as a part of the long-term treatment of asthma. The use of this medication for a long period of time does not increase the risk of asthma-related death for the client. Theophylline is a bronchodilator that is used to alleviate bronchospasms by relaxing smooth muscle in the bronchi during an asthma attack. The use of this medication for a long period of time does not increase the risk of asthma-related death for the client.
A nurse is caring for a school-aged child who has cystic fibrosis (CF) and has been using a corticosteroid inhaler for long-term treatment. Which of the following findings should the nurse identify as an adverse effect of long-term use of this medication? O A. Small stature for age Decreased weight Poor dentition • D. Atrophied muscles
Correct Answer: A. Small stature for age The nurse should identify that an adverse effect of the long-term use of inhaled glucocorticoids can be a slowing in the rate of growth in children. Incorrect Answers: A decrease in weight is not an adverse effect of the long-term use of inhaled corticosteroids in children. Poor dentition is not an adverse effect of the long-term use of inhaled corticosteroid in children. Muscle wasting can be an adverse effect of the use of long-term systemic corticosteroids. However, it is not an adverse effect of inhaled corticosteroids in children.
A nurse is teaching a client who has asthma and a prescription for a fluticasone dry powder inhaler (DPI). Which of the following instructions should the nurse include in the teaching? A. "This medication should be taken at the start of your symptoms." V B. "Rinse your mouth after administering this medication." c. "Shake the canister prior to administering this medication." • D. "This medication relaxes your airways to decrease your symptoms."
Correct Answer: B. "Rinse your mouth after administering this medication." The nurse should include in the teaching that this medication is an oral corticosteroid. Oral corticosteroids increase the risk of the development of oral candidiasis, also known as thrush. In order to prevent this effect, the nurse should advise the client to rinse the mouth after the administration of this medication. Incorrect Answers: A. Fluticasone is an inhaled corticosteroid that is used to prevent airway inflammation. This is not a rescue-type medication and is used as long-term therapy for asthma management. DPIs should not be shaken. Instead, the nurse should instruct the client to keep the medication dispenser level to avoid the loss of medication from the device. Inhaled corticosteroids decrease inflammation in the airway, reducing symptoms. Inhaled beta-adrenergic and anticholinergic medications relax the smooth muscles surrounding the airway, decreasing symptoms.
A nurse is teaching a client with chronic asthma who has a new prescription for cromolyn. Which of the following instructions should the nurse include in the teaching? A. "Use the inhaler just before exercise." V B. "The medication's therapeutic effects can take up to several weeks to develop." C. "You will shake the medication container for 3 seconds." OD. "You will need to exhale slowly after you inhale."
Correct Answer: B. "The medication's therapeutic effects can take up to several weeks to develop." The nurse should include in the teaching that the therapeutic effects of cromolyn can take up to several weeks to develop. Incorrect Answers: A. A short-acting beta2-agonist inhaler is used prior to exercise and reduces manifestations associated with exercise-induced asthma. However, this client has chronic asthma. Cromolyn is delivered via a nebulizer, not a metered-dose inhaler. The nebulizer is a small device that the medication is poured into and converted into a mist. The client inhales the mist through a face mask or a mouthpiece. The mist is inhaled with each breath over a few minutes. The nurse should instruct the client to inhale and exhale normally as the treatment from the nebulizer is being delivered. With each breath, the client is inhaling the medication from the nebulizer.
A nurse is reviewing the medication history of a client who has mild intermittent asthma. The nurse should anticipate a prescription for which of the following inhalers for the client? • A. Ipratropium V B. Albuterol sulfate C. Tiotropium D. Budesonide
Correct Answer: B. Albuterol sulfate The nurse should anticipate a client who has mild intermittent asthma to be prescribed albuterol sulfate. Albuterol sulfate is a short-acting beta2-agonist that activates beta2-receptors in the smooth muscle of the lung, allowing the client's airway and lungs to dilate, thereby relieving bronchospasm and allowing the client to breathe. Incorrect Answers: A. Ipratropium is a form of atropine that is prescribed to treat bronchospasms related to COPD. It is not an approved medication to treat clients who have asthma. Tiotropium is a long-acting inhaled anticholinergic that is prescribed for long-term maintenance therapy for clients who have COPD. It is not an approved medication to treat clients who have asthma. Budesonide is an inhaled corticosteroid prescribed to decrease inflammation in clients who have asthma. This medication is for those with more severe forms of asthma to prevent an asthma attack.
A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change? Potentiative interaction Detrimental inhibitory interaction C. Increased adverse reaction D. Toxicity-reducing inhibitory interaction
Correct Answer: B. Detrimental inhibitory interaction A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol's therapeutic effects. Incorrect Answers: A. When a client takes 2 medications, a medication might potentiate the effects of the other. Potentiative interactions can be helpful in increasing or prolonging a medication's therapeutic effects. However, this would not explain a decrease in the effectiveness of a medication. Detrimental potentiative interactions worsen adverse effects. An example of this effect is warfarin and aspirin, which increase the risk of bleeding when used together. Some medications reduce the effects of or block the action of another, with a beneficial interaction to reduce toxicity. An example of this effect is the use of naloxone to reverse the effects of an opioid overdose.
A nurse is caring for a client who has asthma and is prescribed a short-acting beta2-agonist. Which of the following should the nurse identify as the expected outcome of this medication? O A. Reduces the frequency of attacks V B. Reverses bronchospasm Prevents inflammation Decreases chronic manifestations
Correct Answer: B. Reverses bronchospasm The nurse should identify that the expected outcome of a short-acting beta2-agonist is reversal of bronchospasm. Short-acting beta2-agonists bind to beta2-adrenergic receptors in the lungs, resulting in relaxation of bronchial smooth muscles. Incorrect Answers: A. Reducing the frequency of attacks of asthma is achieved through the use of long-term control agents such as inhaled corticosteroids and long-acting inhaled beta2-agonists. Preventing inflammation is achieved through the use of inhaled corticosteroids, not short-acting beta2-agonists. Decreasing chronic manifestations of asthma is achieved through the use of inhaled corticosteroids and long-acting inhaled beta2-agonists.
A nurse is caring for a client who has COPD and has been taking fluticasone via inhaler for many years. Which of the following findings should the nurse identify as an adverse effect of long-term use of this medication? • A. Glomerular filtration rate (GFR) <60 B. Alanine aminotransferase (ALT) 82 units/L V C. Anorexia and weakness D. Varicose veins in the lower extremities
Correct Answer: C. Anorexia and weakness The nurse should identify adrenal insufficiency as an adverse effect of the long-term use of an inhaled corticosteroid such as fluticasone. Manifestations can include anorexia, weakness, nausea, hypotension, and hypoglycemia. Incorrect Answers: Long-term use of fluticasone, an inhaled corticosteroid, does not impact kidney function and does not cause renal insufficiency. A GFR of <60 is outside the expected reference range. Long-term use of inhaled corticosteroids does not cause liver damage or disease. ALT is a liver function test, and 82 units/L is outside the expected reference range. D. Varicose veins are twisted, enlarged veins that can be a manifestation of venous insufficiency. Long-term use of inhaled corticosteroids does not cause varicose veins in the lower extremities.
A nurse is caring for a client who has diabetes insipidus. Which of the following laboratory values should the nurse identify as reflecting a contraindication to receiving vasopressin to treat this disorder? A. Sodium 152 mEg/L B. Potassium 6.0 mEq/L V C. Creatinine clearance 50 mL/min D. Aspartate aminotransferase (AST) 52 units/L
Correct Answer: C. Creatinine clearance 50 mL/ min Creatinine clearance should be above 87 mL/min for female clients and above 107 mL/min for male clients. A creatinine clearance of 50 mL/min indicates renal impairment and is a contraindication to receiving vasopressin. Renal impairment increases the likelihood of the life-threatening adverse effect of water intoxication. Incorrect Answers: This sodium level is above the expected reference range of 136 to 145 mEq/L. This level indicates hypernatremia, which is an expected finding for a client who has diabetes insipidus and is not a contraindication to receiving this medication. This potassium level is above the expected reference range of 3.5 to 5.0 mEq/L. This level indicates mild hyperkalemia. Although this is a finding that requires attention, it is not a contraindication to receiving this medication. D. The expected reference range for AST is 0 to 35 units/L. This enzyme is measured as a part of liver function tests. Although this level is elevated, it is not a contraindication to receiving vasopressin.
A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs. B. Take the medication on an empty stomach to enhance absorption. c. Schedule the medication on alternate days to decrease adverse effects. D. Treat shortness of breath with an extra dose of the medication.
Correct Answer: C. Schedule the medication on alternate days to decrease adverse effects. Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy. Incorrect Answers: A rash is not an expected adverse effect of oral glucocorticoids like prednisone. A client should not stop taking prednisone or other glucocorticoids abruptly if taking the medication for more than 10 days. The dosage should be decreased gradually to prevent withdrawal syndrome during long-term therapy. Glucocorticoids can cause significant gastrointestinal distress and lead to ulcer formation. The client should not take steroids on an empty stomach. D. Oral glucocorticoids are not used as rescue medications. The client might need a short-acting bronchodilator if acute distress occurs.
A nurse is providing teaching to a client with asthma who has a new prescription for a short-acting beta-2 agonist (SABA) bronchodilator. Which of the following pieces of information should the nurse share? O A. The SABA will provide prolonged control of asthma attacks. • B. SABAs are also available in an oral form. C. The SABA will have to be taken with an inhaled glucocorticoid. V D. Notify the provider if the SABA is needed more than twice per week.
Correct Answer: D. Notify the provider if the SABA is needed more than twice per week. SABA bronchodilators are used as a PRN rescue medication to stop an ongoing asthma attack. If the client requires the SABA more than twice per week, the provider should be notified because a prescription for a long-acting beta-2 agonist (LABA) might be required. Using a SABA more than twice per week can lead to serious adverse effects. Incorrect Answers: Prolonged control of asthma requires the use of a LABA bronchodilator. LABAs are available in inhaled or oral form. All oral bronchodilators are long-acting. SABAs are only available as inhaled preparations. LABA bronchodilators should not be used as monotherapy. LABAs should be combined with an inhaled glucocorticoid.
A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid-stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? A. Methimazole B. Somatropin V C. Levothyroxine D. Propylthiouracil
V C. Levothyroxine Correct Answer: C. Levothyroxine Levothyroxine replaces thyroid hormone for a client who has hypothyroidism. Laboratory values for hypothyroidism include an increased TSH level and decreased total T3 and T4 levels. Clinical manifestations of hypothyroidism include fatigue, cold intolerance, and a decreased body temperature and pulse. Incorrect Answers: Methimazole inhibits thyroid production for a client who has hyperthyroidism. Somatropin is a growth hormone prescribed for a client who has a growth hormone deficiency of the anterior pituitary gland. D. Propylthiouracil blocks thyroid production and is a second-line medication used to treat hyperthyroidism.
