Pharm Assignment 2

A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse's best action? A. Continue to monitor the patient. B. Call the health care provider. C. Hold the next dose of theophylline. D. Administer oxygen 2 L/min via nasal cannula.

C

The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast in the patient teaching? A. "Take the medication as soon as you begin wheezing." B. "It will take about 3 weeks before you notice a therapeutic effect." C. "This medication will prevent the inflammation that causes your asthma attack." D. "Increase fiber and fluid in your diet to prevent the side effect of constipation."

C

What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine? A. Decreased cough reflex B. Decreased nasal secretions C. Liquefying and loosening of bronchial secretions D. Relief of bronchospasms

C

Drug selection and dosage in older adults with conditions of the lower respiratory tract need to be considered. The use of large, continuous doses of beta2-andrenergic agonist may cause which side effects in older adults? (SATA) A. Bronchoconstriction B. Constipation C. Tachycardia D. Tremors E. Urinary retention

C,D

A patient presents to the health care provider's office for a follow-up visit. The patient is taking theophylline, and the nurse is revieiwng the lab results. What level of thephyyline would fall into a therapeutic range A. 2mcg/mL B. 8mcg/mL C. 14mcg/mL D. 23mcg/mL

C- The therapeutic range for theophylline is 10-20mcg/mL

The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? A. The patient with a history of emphysema B. The patient with a history of type 2 diabetes C. The patient who is 16 years old D. The patient with atrial fibrillation with a rate of 100

D

The nurse is preparing to administer isoproterenol (Isuprel) to a patient who is experiencing an acute bronchospasm. The nurse understands that, because isoproterenol is a nonselective beta-adrenergic agonist, the patient will experience which effects? a. Alpha- and beta-adrenergic agonist effects b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects

D

The 68-year-old patient has been diagnosed with COPD. When providing health teaching for this patient, the nurse discusses the side effects that may occur with the use of bronchodilators. Which possible clinical manifestations should concern the patient? (SATA) A. Bradycardia B. Dry eyes C. Lethargy D. Nervousness E. Palpitations

D, E

A patient has taken metaproterenol. What is the nurse's priority action? A. Monitoring for heart rate >100 beats/min B. Telling the patient not to drive for 2 h C. Monitoring for sedation D. Assessing for elevated blood pressure

A

A patient is brought to the emergency department and reports having taken "a lot" of acetaminophen extra-strength tablets 16 hours prior. The nurse will expect the provider to order a. acetylcysteine (Mucomyst). b. dornase alfa (Pulmozyme). c. gastric lavage. d. renal enzyme tests.

A

The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention? A. Monitoring patient for potential chest pain B. Monitoring blood pressure continuously C. Assessing daily for hyperkalemia D. Assessing 12-lead electrocardiogram each shift

A

The patient is taking an inhaled beta agonist and a steroid for his asthma. He states "I don't have time to wait between taking drugs. I am very busy. Why do I have to do this?: What is the nurses best response? A. The inhaled drug will allow the bronchioles to dilate so the steroid works better B. This is done so you remember which one comes first C. The inhaled medication will make your heart circulate the steroid faster D. The steroid may make your nose stuffy, so you should take the inhald drug first

A

Which medications when prescribed with theophylline will concern the nurse? (SATA) A. Beta blockers B. Digitalis C. Lithium D. Stool softeners E. Phenytoin

A, B, C, E Beta blockers increase the hal-0life of theophylline. THeophylline increases the risk of digitalis toxicity and decreases the effects of lithium. Phenytoin decreases theophylline levels

Which of the following are side effects of theophylline? (SATA) A. Cardiac dysrhythmia B. Diarrhea C. Gastrointestinal bleeding D. Headache E. Seizures

A, C, D, E

The patient has exercise-induced bronchospasm and is being treated with a short-acting beta2 agonist. Which priority information will the nurse include in a review of inhaler administration for this patient? (SATA) A. Cleanse all washable parts of the inhaler equipment daily B. Hold your breath for a few seconds, remove the mouthpiece, and exhale slowly C. Keep your lips secure around the mouthpiece and inhale while pushing the top of the canister once D. Monitor your heart rate while taking this medication E. Wait 5 minutes and repeat the procedure if a second inhalation is needed.

A,B,C,D- It is not necessary to wait 5 minutes between inhalations

A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report experiencing cough and a bad taste. The nurse will instruct the patient to perform which action? a. Drink water before and after using the inhaler. b. Schedule an appointment to discuss these effects with the provider. c. Stop taking the medication immediately. d. Use the inhaler only as needed for acute bronchospasms.

ANS: A Cough and a bad taste are the most common side effects associated with cromolyn sodium, and these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm.

A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take? a. Ask the patient if herbal medications are used. b. Notify the provider to report theophylline toxicity. c. Recommend that the patient increase fluid intake. d. Request an order for renal function studies.

ANS: A Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated

A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol a. has a more immediate onset than the oral form. b. may cause more side effects than the oral preparation. c. requires an increased dose in order to have therapeutic effects. d. will not lead to tolerance with increased doses.

ANS: A Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance.

An older adult is receiving standard multidrug therapy for tuberculosis (TB). Which finding should the nurse report to the health care provider? a. Yellow-tinged sclera b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices

ANS: A Noninfectious hepatitis is a toxic effect of isoniazid, rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy. Presbycusis is an expected finding in the older adult patient. Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider

A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order? a. Albuterol, ipratropium bromide, steroid b. Albuterol, steroid, ipratropium bromide c. Ipratropium bromide, albuterol, steroid. d. Steroid, ipratropium bromide, albuterol

ANS: A Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect.

The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen? a. "I should use albuterol when my symptoms worsen." b. "I will need to take oral prednisone on a daily basis." c. "My provider will prescribe prophylactic antibiotics." d. "My symptoms are reversible with proper medications."

ANS: A Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible

The nurse is caring for a patient who is receiving intravenous theophylline. The patient complains of headache and nausea. The nurse will contact the provider to a. change the medication to an oral theophylline. b. obtain an order for a serum theophylline level. c. request an order for an analgesic medication. d. suggest an alternative methylxanthine medication.

ANS: B Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism.

The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to a. decrease the dose of theophylline. b. increase the dose of theophylline. c. keep the theophylline dose as ordered. d. discontinue the theophylline.

ANS: B Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects.

The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug? a. An extra dose should be taken when symptoms worsen. b. Anorexia and gastrointestinal upset are unexpected side effects. c. Avoid caffeine while taking this medication. d. Food will decrease the amount of drug absorbed.

ANS: C Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed.

A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason? a. To be more convenient for patients who require both medications b. To improve compliance in patients who may forget to take both drugs c. To increase forced expiratory volume, an indicator of symptom improvement d. To minimize the side effects that would occur if the drugs are given separately

ANS: C Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the forced expiratory volume in 1 second (FEV1). While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter the drug's side effects.

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which response by the nurse reflects accurate knowledge about the medication and the patient's illness? a. Ask the patient about any visual changes in red-green color discrimination. b. Question the patient about experiencing shortness of breath, hives, or itching. c. Explain that orange discolored urine and tears are normal while taking this medication. d. Advise the patient to stop the drug and report the symptoms to the health care provider.

ANS: C Orange-colored body secretions are a side effect of rifampin. The patient does not have to stop taking the medication. The findings are not indicative of an allergic reaction. Alterations in red-green color discrimination commonly occur when taking ethambutol, which is a different tuberculosis medication.

The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests? a. Cardiac enzymes and serum calcium b. Electrolytes and a complete blood count c. Liver function tests and serum glucose d. Urinalysis and serum magnesium

ANS: C The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.

After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about drug-resistant TB. b. Schedule directly observed therapy. c. Ask the patient whether medications have been taken as directed. d. Discuss the need for an injectable antibiotic with the health care provider.

ANS: C The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed.

A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication? a. Failure to respond to the medication indicates a need for a higher dose. b. Monitor for hypoglycemia symptoms when using this medication. c. Palpitations are common with this drug even at normal, therapeutic doses. d. Overuse of this medication can result in airway narrowing and bronchospasm.

ANS: D Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses

The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching? a. "I will need to have periodic laboratory tests while taking this medication." b. "I will not take ibuprofen for pain or fever while taking this drug." c. "I will take one tablet daily at bedtime." d. "I will use this as needed for acute symptoms."

ANS: D Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.

The nurse is preparing to administer epinephrine to a patient who is experiencing an acute bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and beta-adrenergic agonist, the patient will experience which effects? a. Decreased blood pressure b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects

ANS: D Nonselective sympathomimetic epinephrine is an alpha1, beta1, and beta2 agonist that is given to promote bronchodilation and elevate blood pressure. It does not have anticholinergic effects.

The nurse is caring for a patient diagnosed with COPD who has been prescribed tiotropium. Which statement will the nurse include in the education? a. Remove the capsules from the packaging and place in your 7-day med box. b. If you experience dry mouth, stop taking the medication immediately. c. Use tiotropium as needed for sudden breathing problems. d. Tiotropium works by relaxing and dilating the bronchioles.

ANS: D Tiotropium is an anticholinergic drug used for maintenance treatment of bronchospasms associated with COPD. It inhibits M3 receptor response to acetylcholine, thereby relaxing smooth muscle of bronchi; it dilates the bronchi. Patients should discard any capsules that are opened and not used immediately. Dry mouth is a common side effect. It is not to be used as a rescue inhaler.

A patient is prescribed ipratropium and cromolyn sodium. What will the nurse teach the patient? A. Do not take these medications within 4 h of each other. B. Take the ipratropium at least 5 min before the cromolyn. C. Administer both medications together in a metered-dose inhaler. D. Take the ipratropium only in the mornings.

B

The health care provider orders ipratropium bromide, albuterol, and beclomethasone inhalers for a patient. What is the nurse's best action? A. Question the order; three inhalers should not be given at one time. B. Administer the albuterol, wait 5 min, administer ipratropium bromide, then beclomethasone several minutes later. C. Administer each inhaler at 30-min intervals. D. Administer beclomethasone, wait 2 min, administer ipratropium bromide, then albuterol several minutes later.

B

The patient has been prescribed both ipratropium and cromolyn. How many minutes should the patient wait between using the two drugs A. 1 B. 5 C. 10 D It does not matter

B

Which of the following anticholinergic drugs has few systemic effects and is administered by aerosol? A. Albuterol B. Ipratropium C. Isoproterenol D. Tiotropium

B

Fluticasone propionate and salmeterol combination inhalation is ordered for a patient with chronic obstructive pulmonary disease. What does the nurse know about this medication? (SAP) a. it can be used to treat an acute attack b.it is delivered as a dry-powder inhaler c. it contains a beta 1 agonist and cromolyn d. it is taken as one puff two times a day e. it promotes bronchodilation

B, D, E

he patient has asthma and takes cromolyn (Nasalcrom). What statement by the patient indicates the need for more education? a. "I must take this medication every day." b. "It will stop an asthma attack that has started." c. "I can rinse my mouth out with water to get rid of the taste." d. It is important for me to take this exactly as directed."

B- Cromolyn sodium is used as a prophylactic medication to prevent asthma attacks by preventing the release of histamine and suppressing inflammation in the bronchioles. It will not stop an attack once it has started and is not a bronchodilator.

The 40-year old patient has been taking theophylline for long-term treatment of his asthma. He has also been taking ephedra to stay alert while finishing a project at work. The patient presents to the clinic with complaints of feeling ill. Vital sings are temperature 36.4* C Oral, 124bpm, 18 RR, 170/90 BP, 99% SPO2. His theophylline level is 26mcg/mL. What does the nurse susoect may be the cause of the patient's symptoms? A. Acute allergic reaction B. Asthma attack C. Stevens-Johnson syndrome D. Theophylline toxicity

D, Taking theophylline and ephedra together may increase the risk of theophylline toxicity. Hyperglycemia is a sign of theophylline toxicity.

A patient with chronic obstructive pulmonary disease is taking the leukotriene antagonist montelukast. The nurse is aware that this medication is given for which purpose? a. Maintenance treatment of asthma b. Treatment of acute asthmatic attack c. Reversing bronchospasm associated with chronic obstructive pulmonary disease d. Treatment of inflammation in chronic bronchitis

a

A patient with chronic obstructive pulmonary disease has an acute bronchospasm. The nurse anticipates that the health care provider will prescribe which medication? a. Zafirlukast b. Epinephrine c. Dexamethasone d. Beclomethasone

b

A patient is prescribed aminophylline-theophylline. For what adverse effect should the nurse monitor the patient? a. Drowsiness b. Hypoglycemia c. Increased heart rate d. Decreased white blood cell count

c

A patient is receiving intravenous aminophylline. The nurse checks the patient's lab values and sees the serum theophylline level is 32 mcg/mL. What action should the nurse take? a. Assess the patient's breath sounds for improvement. b. Increase the dosage per sliding-scale directions. c. Notify the health care provider of the level. d. Have the laboratory collect another sample to verify the results.

c