Pharmacology HESI - Respiratory System Drugs
**Albuterol** Levalbuterol
Class: Beta2-Agonists, bronchodilator, adrenergic agonist Indications: bronchospasm in asthma or COPD Action: Binds to beta2 -adrenergic receptors in airway smooth muscle --> increased levels of cAMP --> inhibit the phosphorylation of myosin and decrease intracellular Ca --> relaxation of smooth muscle airways Therapeutic effect/ Outcome: bronchodilaton/ relief of bronshospasm Side effects: chest pain, palpitations, angina, arrhythmias, nervousness, tremor, restlessness
Acetylcysteine
Class: Mucolytic, antidote for acetamenophen Indications: conditions associated with thick viscid mucous secretions -- hepatotoxic overdose of acetaminophen Action: Degrades mucus, allowing easier mobilization and expectoration -- Decreases the buildup of a hepatotoxic metabolite in acetaminophen overdosage Therapeutic effect: Prevention or lessening of liver damage following acetaminophen overdose -- Lowers the viscosity of mucus Desired outcomes: Decreased dyspnea and clearing of lung sounds -- Decreased acetaminophen levels Side effects: rash, urticaria, N/V, bronchospasm, tachycardia, hypotension, drowsiness Life threatening: analhylaxis, angioedema Teaching: cough deeply to clear secretions before taking aerosol inhalation treatment -- there is an unpleasant odor to drug -- suctioning may be needed after therapy -- report nausea, vomiting, and urticaria Assess: plasma acetaminophen levels -- S/S of fluid overload (dyspnea, edema, increased BP)
Anticholinergics: **Tiotropium** Ipratrioium aclidinium bromide
Class: anticholinergics, bronchodilator Indications: COPD (long-term treatment of bronchospasm, Reduce exacerbations) and asthma Action: inhibits cholinergic receptors in bronchial smooth muscle tissue --> decreased concentration of cGMP --> bronchodilaton Therapeutic effects: Decreased incidence and severity of bronchospasm in COPD and asthma Caution: glaucoma, don't use Tiotropium concurrently with ipratropium Side effects: can't see, pee, spit, or shit, dizziness, sore throat, bronchospasm Life threatening: angioedema Assessment: breath sounds, pulse oximerty, CXR -- have suction catheters and normal saline at bedside (anticholinergic inhalers promote plugging of mucus in clients w/ a trach) Teaching: pulmonary fxn tests will be scheduled -- when multiple medications are being used: beta2-adrenergic agonists (adrenergics) --> this class --> seteroids
Diphenhydramine
Class: antihistamine, antitussive (syrup) Indications: seasonal allergic rhinitis, anaphylaxis, allergic dermatoses Action: Decreases frequency and severity of asthma attacks -- CNS depressant and anticholinergic properties Therapeutic effects: Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness, urticaria) -- suppression of cough Side effects: blurred vision, drowsiness, *can't see, pee, spit, or shit*, nausea Teaching: avoid driving or other activities involving alertness until response to drug is known -- increase fluid intake -- discontinue 3 days before allergy skin tests -- take with food
**Montelukast** Zafirlukast Zyleuton
Class: bronchodilator, leukotriene receptor antagonist Indications: Prevention and chronic treatment of asthma -- seasonal allergic rhinitis -- exercise induced bronchoconstriction (EIB) Action: Antagonizes the effects of leukotrienes (mediators of inflammatory resp) -- decreases airway edema and smooth muscle constriction Therapeutic effects/ desired outcomes: Decreased frequency and severity of acute asthma attacks -- Decreased severity of allergic rhinitis -- Decreased attacks of EIB Side effects: headache, dizziness, weakness, N/V, increased liver enzymes, fever Life threatening: Stevens-johnson syndrome, toxic epidermal necrolysis, SI, Churg-Strauss syndrome (angiitis, vasculitis) Teaching: Not used for rescue -- long-term therapy requires periodic assessment of liver and renal fxn
**Theophylline** Aminophylline
Class: bronchodilator, xanthines Indication: Long-term control of reversible airway obstruction caused by asthma or COPD Action: Inhibit phosphodiesterase --> increased tissue concentrations of cAMP --> bronchodilation, CNS stim, diuresis, gastric acid secretion, and Positive inotropic and chronotropic effects Desired outcome: Increased ease in breathing Side effects: anxiety, tachycardia, angina, N/V Life threatening: seizures, arrhythmias Assess: monitor I&O, CXR, resp ease, pulse oximerty, K and Mg levels Teaching: increase fluid intake -- avoid caffeine -- minimize intake of xanthine-containing foods or beverages (colas, coffee, chocolate) and not to eat charcoal-broiled foods daily -- supplement vitamin B6 -- avoid alcohol -- blood will be drawn (10 - 15 mcg/mL is norm) for lab tests every 6-12 months
Corticosteroids: **Beclomethasone** Budesonide Mometasone Triamcinolone Ciclesonide
Class: corticosteroids, anti-inflammatory (steroidal) Indications: asthma Action: locally acting anti-inflammatory and immune modifier Therapeutic effects/ desired outcomes: Decreases frequency and severity of asthma attacks -- improves asthma symptoms Side effects: adrenal supression, decreased growth (children), headache, bronchospasm, cough, wheezing, hypersensitivity rxns Assess: respiratory status and lung sounds -- adrenal fxn tests may be ordered -- assess for increased serum and urine glucose Teaching: use bronchodilator first (if using), allow 5 minutes to elapse, then use corticosteroid -- DON'T USE FOR RESCUE -- rinse mouth after using
Guaifenesin
Class: expectorant Indication: Coughs associated with viral upper respiratory tract infections Action: Reduces viscosity of tenacious secretions by increasing respiratory tract fluid Therapeutic effect: Mobilization and subsequent expectoration of mucus Expected outcome: Easier mobilization and expectoration of mucus from cough Side effects: dizziness, headache, N/V, diarrhea, stomach pain, rash, urticaria Teaching: cough effectively -- may cause dizziness, as avoid activities that involve alertness until effect of drug is known -- limit talking, stop smoking, maintain moisture in environment -- sugarless gum and candy can help keep mouth moist -- contact HCP if cough causes gagging, lasts longer than a week, or is accompanied by a fever, rash, or sore throat -- take with a full glass of water -- ER tabs should be swallowed whole (don't crush, chew or break)
The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication? a. "I feel like my heart is racing." b. "I feel more bloated than usual." c. "My eyes have been watering lately." d. "I haven't had a bowel movement in 4 days."
a. "I feel like my heart is racing." Rationale: Albuterol/ipratropium is a combination agent—one is a β2-adrenergic agonist and the other is an anticholinergic medication, and in combination they produce an overall bronchodilation effect. Common side and adverse effects include headache, dizziness, dry mouth, tremors, nervousness, and tachycardia. Therefore, option 1 is correct. Options 2, 3, and 4 are not specifically associated with this medication. Strategy: Begin to answer this question by eliminating options 2 and 4 first, noting they are comparable or alike. Next, eliminate option 3 because this medication causes anticholinergic effects such as dry eyes and dry mouth.
A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription? a. "I will take the daily dose at bedtime." b. "I need to drink at least 2 liters of fluid per day." c. "I know to avoid changing brands of the medication without my primary health care provider's approval." d. "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."
a. "I will take the daily dose at bedtime." Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the primary health care provider (PHCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the PHCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias. Strategy: Note the strategic words, need for further education. These words indicate a negative event query and the need to select the incorrect statement. Use of basic medication administration principles will direct you to the correct option. Also, think about the action of the medication, and note that a daily dose is prescribed. This will assist you in answering correctly.
The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? a. "I will take the medication on an empty stomach." b. "I won't drink alcohol while taking this medication." c. "I won't do activities that require mental alertness while taking this medication." d. "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."
a. "I will take the medication on an empty stomach." Rationale: Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use. Strategy: Note the strategic words, needs further instruction. These words indicate a negative event query and ask you to select an option that is incorrect. Knowing that the medication has a sedative effect helps you eliminate options 2 and 3 first because they are comparable or alike. Recalling that the medication causes a dry mouth helps you choose the correct option as the answer, according to the way the question is stated.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? a. 5 mg/mL (20 mcmol/L) b. 10 mg/mL (40 mcmol/L) c. 15 mg/mL (60 mcmol/L) d. 20 mg/mL (79 mcmol/L)
a. 5 mg/mL (20 mcmol/L) Rationale: Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitors for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased. Strategy: Focus on the subject, the need to increase the medication. This focus and recalling the therapeutic blood serum level will direct you to the correct choice because it is the lowest value in all of the options.
A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication? a. Coffee, cola, and chocolate b. Oysters, lobster, and shrimp c. Melons, oranges, and pineapple d. Cottage cheese, cream cheese, and dairy creamers
a. Coffee, cola, and chocolate Rationale: Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate. Strategy: Focus on the subject, food items that need to be limited. Recall that theophylline is a xanthine bronchodilator and that intake of excessive amounts of foods naturally high in xanthines needs to be limited. Also, recalling that these medications cause cardiac and central nervous system stimulation will direct you to the correct option.
The primary health care provider (PHCP) has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse should teach the client to monitor for which side effect of the medication? a. Constipation b. Painful coughing c. Increased urination d. Difficulty swallowing
a. Constipation Rationale: Codeine sulfate is an opioid analgesic, and a frequent side effect is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication. Strategy(ies): Focus on the subject, a side effect of codeine. Think about the medication classification. Remember that codeine sulfate is an opioid and that most opioids can cause constipation.
Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse should monitor for which side and adverse effects of rifabutin? Select all that apply. a. Signs of hepatitis b. Flu-like syndrome c. Low neutrophil count d. Vitamin B6 deficiency e. Ocular pain or blurred vision f.Tingling and numbness of the fingers
a. Signs of hepatitis b. Flu-like syndrome c. Low neutrophil count e. Ocular pain or blurred vision Rationale: Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid. Strategy: Focus on the subject, side and adverse effects of rifabutin. Specific knowledge is needed to answer correctly. Remember that hepatitis, flu-like syndrome, neutropenia, and uveitis can occur.
A client has begun a course of therapy with rifampin. The home care nurse instructs the client on which measure due to an anticipated side effect? a. Wear dark clothing to avoid staining. b. Always take the medication with food or antacids. c. Double the next medication dose if one is forgotten. d. Stop the medication if symptoms disappear in 2 months.
a. Wear dark clothing to avoid staining. Rationale: Rifampin causes orange-red discoloration of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. Strategy: Options 3 and 4 are eliminated first in accordance with general medication administration principles. Regarding the remaining choices, eliminate option 2 because of the closed-ended word "always."
A client has begun therapy with a xanthine bronchodilator. The nurse determines that the client understands dietary alterations if the client states to limit which items while taking this medication? Select all that apply. a. Milk b. Coffee c. Oysters d. Oranges e. Pineapple f. Chocolate
b. Coffee f. Chocolate Rationale: The nurse teaches the client to limit the intake of xanthine-containing foods while taking a xanthine bronchodilator. These include coffee and chocolate. The other food items are acceptable to consume. Strategy(ies): Focus on the subject, foods to avoid with a xanthine bronchodilator. To answer this question correctly, it is necessary to know that intake of excessive amounts of foods naturally high in xanthines, such as caffeine-containing foods, should be avoided. With this in mind, eliminate each of the incorrect options in turn because dairy products (milk), citrus and other fruits (oranges and pineapple), and shellfish (oysters) do not contain xanthines.
The client questions the nurse as to why the primary health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which facts? Select all that apply. a. Dry powder inhalers have fewer side effects. b. Dry powder inhalers pose no environmental risks. c. Dry powder inhalers can be administered more frequently. d. Dry powder inhalers deliver more medication to the lungs. e. Dry powder inhalers require less hand-to-lung coordination.
b. Dry powder inhalers pose no environmental risks. d. Dry powder inhalers deliver more medication to the lungs. e. Dry powder inhalers require less hand-to-lung coordination. Rationale: DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the primary health care provider. Strategy: Focus on the subject, client information about a DPI. All medications delivered by the inhalant route carry side effects and must be used on a prescribed basis, so eliminate options 1 and 3. DPIs do not require the coordination needed with the use of other inhalers, so choose options 4 and 5. Because they are powders, they are not propellants, so choose option 2.
A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a. Hypercalcemia b. Peripheral neuritis c. Small blood vessel spasm d. Impaired peripheral circulation
b. Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question. Strategy: Focus on the data in the question, numbness, paresthesias, and tingling in the extremities. Options 3 and 4 would not cause the symptoms presented in the question but instead would cause pallor and coolness. From the remaining options, you should know that peripheral neuritis is an adverse effect of isoniazid, and that these signs and symptoms do not correlate with hypercalcemia.
The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid? a. Niacin b. Pyridoxine c. Gabapentin d. Cyanocobalamin
b. Pyridoxine Rationale: Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Gabapentin is used to prevent seizures and for peripheral neuropathy, and cyanocobalamin is used to treat anemia. Strategy: Focus on the subject, medication regimen for a client taking isoniazid. Niacin is used to treat cholesterol elevations, so eliminate option 1. Gabapentin is used to treat seizures and peripheral neuropathy, so eliminate option 3. Remembering that cyanocobalamin is used to treat anemia and that this is not related to isoniazid helps you eliminate option 4. To answer this question, it is important to know that the adverse effect of isoniazid is neuropathy, which is prevented by administration of pyridoxine.
A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a. Use alcohol in small amounts only. b. Report yellow eyes or skin immediately. c. Increase intake of Swiss or aged cheeses. d. Avoid vitamin supplements during therapy.
b. Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine, because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy. Strategy: Focus on the subject, client teaching for isoniazid. Because alcohol intake is prohibited with the use of many medications, eliminate option 1 first. Because the client receiving this medication typically is given supplements of vitamin B6, option 4 is incorrect and is eliminated next. Recalling that the medication is hepatotoxic will direct you to the correct option.
The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a. Beclomethasone first and then the salmeterol b. Salmeterol first and then the beclomethasone c. Alternating a single puff of each, beginning with the salmeterol b. Alternating a single puff of each, beginning with the beclomethasone
b. Salmeterol first and then the beclomethasone Rationale: Salmeterol is an adrenergic type of bronchodilator, and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective. Strategy: Focus on the subject, the procedure for administering inhaled medications. To answer this question correctly, you must know two different things. First, you must know that a bronchodilator is always given before a glucocorticoid. This would allow you to eliminate options 3 and 4, because you would not alternate the medications. To select between the remaining option and the correct option, you must know that salmeterol is a bronchodilator, whereas beclomethasone is a glucocorticoid
The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication? a. Drowsiness b. Tachycardia c. Hyperkalemia d. Hyperglycemia
b. Tachycardia Rationale: Albuterol is a bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The items in the other options are not side and adverse effects of this medication. Strategy: Focus on the subject, a side or adverse effect of albuterol. To answer this question accurately, it is necessary to understand that this medication is a bronchodilator. Thinking about the physiological effects of a bronchodilator will assist you in answering correctly. Remember that tachycardia is a side or adverse effect.
A client with suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information? a. The client may next become suicidal. b. These are signs of opioid withdrawal. c. These effects will last only a few moments. d. The client may otherwise sign out against medical advice.
b. These are signs of opioid withdrawal. Rationale: Signs of opioid withdrawal include increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. Time of onset may be anywhere from a few minutes to a few hours after administration of naloxone hydrochloride, depending on the opioid involved, the degree of dependence, and the dose of naloxone. The remaining options are incorrect interpretations. Strategy: Focus on the data in the question. Eliminate option 3 first because the signs and symptoms identified in the question are not likely to disappear in a few moments. Option 1 is eliminated next because no supporting information is provided in the question. Regarding the remaining options, recalling that the client with opioid overdose may well have a history of prior chronic use will direct you to the correct option.
Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? a. Skin color b. Urine color c. Hydration status d. Respiratory effort
b. Urine color Rationale: Isoniazid is an antituberculosis medication. The most serious adverse effect associated with isoniazid is hepatic injury, which on rare occasions has been fatal; therefore, monitoring of liver function tests and for signs and symptoms of liver injury is the priority. Dark urine is a sign of liver injury and the client should be taught to report this, and the nurse should assess for this. Skin color, hydration status, and respiratory effort are not directly related to adverse effects of this medication. Strategy: Note the strategic word, priority. Focus on the subject, an adverse effect of isoniazid. For most long-term anti-infectives, possible damage to the liver is a usual adverse effect; knowledge of this adverse effect leads you to option 2.
A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication? a. Just after the next meal b. Just before the next meal c. 4 hours after discontinuing the IV form d. Immediately on discontinuing the IV form
c. 4 hours after discontinuing the IV form Rationale: With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication. If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion. Therefore, the remaining options are incorrect. Strategy: Focus on the subject, changing from an IV form to an immediate-release oral form of theophylline. The words immediate-release tell you that delayed absorption of this medication will not occur. Coupled with this knowledge, a review of the options will assist in directing you to the correct choice.
A client has been given a prescription for benzonatate. Which observation should the nurse look for to evaluate the effectiveness of the medication? a. Increasing the client's comfort level b. Decreasing the client's anxiety level c. Calming the client's persistent cough d. Eliminating the client's nausea and vomiting
c. Calming the client's persistent cough Rationale: Benzonatate is a locally acting antitussive that decreases the intensity and frequency of cough without eliminating the cough reflex. The other options are not intended effects of this medication. Strategy: Note the strategic word, effectiveness. Knowledge of the classification of benzonatate is needed to answer this question. Recalling that benzonatate is a locally acting antitussive will direct you to the correct option.
A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? a. Should always be taken with food or antacids b. Should be double-dosed if 1 dose is forgotten c. Causes orange discoloration of sweat, tears, urine, and feces d. May be discontinued independently if symptoms are gone in 3 months
c. Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Strategy: Options 2 and 4 are comparable or alike and are inaccurate, based on general guidelines for medication administration; the client should not double-dose or discontinue medication independently. Eliminate option 1 next because of the closed-ended word "always."
Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's medical history requires caution by the nurse? a. Osteoarthritis b. Hypothyroidism c. Diabetes mellitus d. Polycystic disease
c. Diabetes mellitus Rationale: Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels. Focus on the subject, cautions for using terbutaline. Specific knowledge regarding the contraindications and cautions associated with the use of this medication is needed to answer this question. Remember that terbutaline is used with caution in the client with diabetes mellitus.
A client is taking cetirizine. The nurse should inform the client of which side effect of this medication? a. Diarrhea b. Excitability c. Drowsiness d. Excess salivation
c. Drowsiness Rationale: Cetirizine is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating. Therefore, the other options are incorrect. Strategy(ies): Focus on the subject, side effect of cetirizine. To answer this question correctly, it is necessary to know that cetirizine is an antihistamine. Knowledge of the effects of antihistamines and that antihistamine use typically causes drowsiness helps you eliminate each incorrect option.
Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a. Platelet count b. Neutrophil count c. Liver function tests d. Complete blood count
c. Liver function tests Rationale: Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication. Strategy: Eliminate options 2 and 4 first because they are comparable or alike, noting that a complete blood count would include a neutrophil count. From the remaining options, you would need to know that this medication affects hepatic function.
The nurse is preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? a. Nausea and vomiting b. Headache and level of consciousness c. Lung sounds and presence of dyspnea d. Urine output and blood urea nitrogen level
c. Lung sounds and presence of dyspnea Rationale: Albuterol is an adrenergic bronchodilator. The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum. Strategy: Knowing that this medication is a bronchodilator allows you to eliminate each of the incorrect options. Use the ABCs-airway, breathing, and circulation-to answer the question. The correct option is the only one that addresses airway.
The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside? a. Nasogastric tube b. Paracentesis tray c. Resuscitation equipment d. Central line insertion tray
c. Resuscitation equipment Rationale: The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors. Strategy: Focus on the subject, supportive medical equipment. Note the words opioid overdose. Recalling the effects of these types of medications will direct you to the correct option. The correct option is also the umbrella option.
The primary health care provider prescribes cromolyn for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? a. Promote bronchodilation b. Decrease the risk of infection c. Suppress an allergic response d. Eliminate the need for a rescue inhaler
c. Suppress an allergic response Rationale: Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast cell stabilizer, antiasthmatic, and antiallergic. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It is not a bronchodilator. It does not decrease the risk of infection. It does not eliminate the need for the rescue inhaler. Strategy(ies): Focus on the subject, the expected effect of cromolyn. Specific knowledge of this medication is needed to answer this question. Note the name of the medication and remember that cromolyn is a mast cell stabilizer, antiasthmatic, and antiallergic.
A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? a. Report any change in urine color. b. Take both medications with food. c. Take both medications together once a day. d. Expect to take the medications for 2 to 3 weeks.
c. Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks. Strategy: Focus on the subject, medications used to treat active tuberculosis. Specific knowledge of the administration of these medications is required to answer this question. Eliminate option 4 because of the short time period noted. Recall that rifampin produces a harmless red-orange color in all body fluids; this will assist you in eliminating option 1. For the remaining options, recall that these medications are taken together.
A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that she or he will perform which action? a. Take an extra dose if fever develops b. Take the medication with meals only c. Take the tablet with a full glass of water d. Decrease the amount of daily fluid intake
c. Take the tablet with a full glass of water Rationale: Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals. Strategy: Begin to answer this question by eliminating option 1 first, recalling that extra doses of medication should not be taken. Next, eliminate option 2 because of the closed-ended word "only." Next, knowing that increased fluid helps liquefy secretions for more effective coughing directs you to the correct option.
Which statement made by a client taking montelukast indicates the need for further teaching? a. "I will need to have my liver function checked." b. "I can take the medication with food or without." c. "I may be able to decrease the use of my metered-dose inhaler." d. "I will take the medication when I first notice I am having trouble breathing."
d. "I will take the medication when I first notice I am having trouble breathing." Rationale: Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening. The remaining options are correct statements. Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Montelukast is not used as a rescue inhaler; this leads you to option 4.
A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? a. "Inhaled glucocorticoids cure the condition." b. "Inhaled glucocorticoids treat this condition more effectively." c. "Inhaled glucocorticoids decrease the symptoms more quickly." d. "Inhaled glucocorticoids are preferred because of decreased adverse effects."
d. "Inhaled glucocorticoids are preferred because of decreased adverse effects." Rationale: Triamcinolone is an adrenocorticosteroid. Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. COPD is a progressive condition and cannot be cured. Options 2 and 3 are incorrect. Strategy: Focus on the subject, tapering an adrenocorticosteroid medication and changing from an oral route to an inhalation route. Recall that COPD cannot be cured; this will help you to eliminate option 1. Next, recall that inhaled glucocorticoids are not absorbed systemically.
The nurse has just administered the first dose of omalizumab to a client. Which statement by the client alerts the nurse of a life-threatening effect? a. "I have a severe headache." b. "My feet are quite swollen." c. "I am nauseated and may vomit." d. "My lips and tongue are swollen."
d. "My lips and tongue are swollen." Rationale: Omalizumab is an antiinflammatory and monoclonal antibody used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an anaphylaxis. The client statements in options 1, 2, and 3 are not indicative of an adverse reaction. Focus on the subject, a life-threatening effect. Recall that anaphylactic reactions can occur with the administration of omalizumab. Knowing the signs of a reaction will direct you to the correct option.
A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? a. "Clear the nasal passages after use." b. "Take the medication only as needed." c. "The medication should start to work immediately." d. "The medication works locally and decreases inflammation."
d. "The medication works locally and decreases inflammation." Rationale: Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation. Strategy: Focus on the subject, instructions on use of a nasal corticosteroid. To answer this question accurately, recall the functions of this medication. Also, eliminate option 1 because of the word after. Eliminate option 2 because of the closed-ended word "only." Eliminate option 3 because of the word immediately.
Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? a. 4 months b. 6 months c. 9 months d. 12 months
d. 12 months Rationale: For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended. Strategy: Focus on the subject, the length of medication therapy, and on the child's diagnosis. Noting that the child has HIV infection will direct you to the correct option, the longest length of treatment time.
A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a. Chills, fever, and generalized rash b. Vomiting, diarrhea, and increased thirst c. Blurred vision, headache, and insomnia d. Anorexia, nausea, weakness, and fatigue
d. Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia. Strategy: Focus on the subject, adverse effects of glucocorticoids. To answer this question accurately, it is necessary to know that tapering of a glucocorticoid could result in adrenal insufficiency and to know what the typical signs and symptoms of adrenal insufficiency are. Because option 2 seems most compatible with dehydration, eliminate that option first. Option 3 implies central nervous system involvement, so it can be eliminated next. From the remaining options, choose option 4 because option 1 seems to describe a hypersensitivity reaction.
A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? a. Platelet count 325,000 mm3 (325 × 109/L) b. Serum creatinine 1.0 mg/dL (88.3 mcmol/L) c. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) d. Aspartate aminotransferase (AST) 55 U/L (55 U/L)
d. Aspartate aminotransferase (AST) 55 U/L (55 U/L) Rationale: Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal. Strategy: Note the strategic words, need for follow-up. Eliminate the options that contain normal laboratory values because they are comparable or alike. Also, recall that isoniazid is hepatotoxic; this will direct you to the correct option.
A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? a. Insomnia b. Constipation c. Hypotension d. Bronchospasm
d. Bronchospasm Rationale: Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia. Strategy: Note the words undesirable effect. This should assist in directing you to the correct option. In addition, use the ABCs—airway, breathing, and circulation—to select the correct option. The correct option addresses the airway.
A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? a. Diuretics b. Antibiotics c. Antilipemics d. Decongestants
d. Decongestants Rationale: In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate. Strategy: Focus on the subject, medications that could exacerbate or contribute to urinary retention in the client with benign prostatic hyperplasia. Recalling that medications that contain anticholinergics may cause urinary retention will direct you to the correct option.
The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? a. Impaired sense of hearing b. Gastrointestinal side effects c. Orange-red discoloration of body secretions d. Difficulty in discriminating the color red from green
d. Difficulty in discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin. Strategy: Note the strategic word, immediately. Option 2 is the least likely symptom to report; instead, it should be managed by taking the medication with food. To select among the other options, you must know that this medication causes optic neuritis, resulting in difficulty with red-green discrimination.
A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? a. Dry mouth b. Cramping diarrhea c. Frequent headaches d. Difficulty tying shoes
d. Difficulty tying shoes Rationale: The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid. Dry mouth, cramping diarrhea, and frequent headaches are not concerns with administration of this medication. Strategy: Focus on the subject, an adverse effect of isoniazid. Note the strategic word, most. It is necessary to know the side and adverse effects of this medication to answer correctly. Eliminate options 1, 2, and 3 because they should not be of the greatest concern. Having difficulty tying shoes is a motor or neurological disorder and must be addressed.
A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value? a. Below therapeutic range b. In excess of the therapeutic range c. Near the top of the therapeutic range d. In the middle of the therapeutic range
d. In the middle of the therapeutic range Rationale: The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL (40 to 79 mcmol/L). A level above 20 mcg/mL (79 mcmol/L) is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range. Strategy: Focus on the subject, the therapeutic medication level for theophylline. Specific knowledge of the therapeutic level for this medication is required to answer this question. Remember that this therapeutic range for theophylline is 10 to 20 mcg/mL (40 to 79 mcmol/L).
Cromolyn sodium is prescribed for the client with allergic asthma. What goal does the nurse expect to achieve by administration of this medication? a. Dilation of the bronchi b. Increase in the number of eosinophils c. Promotion of the migration of eosinophils into the inflammatory site d. Inhibition of the release of mediators from mast cells after exposure to an antigen
d. Inhibition of the release of mediators from mast cells after exposure to an antigen Rationale: Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway hyperresponsiveness in some clients with asthma. It has no bronchodilating action. Strategy: Eliminate options 2 and 3 related to eosinophils first because they are comparable or alike. From the remaining choices, it is helpful to know that cromolyn sodium has no bronchodilating action. Also, note the relationship between the words antigen in the correct option and allergic in the question.
A client has been taking pyrazinamide for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? a. Urine b. Blood c. Wound d. Sputum
d. Sputum Rationale: Pyrazinamide is an antituberculosis medication that is given in conjunction with other antituberculosis medications. Its use may be discontinued by the prescriber if sputum cultures become negative. The remaining options are incorrect. Strategy: Note the strategic word, effective. Focus on the name of the medication, and think about its classification. Recalling that this medication is an antituberculosis medication will direct you to the correct option.
A client is scheduled to receive acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect as a result of the administration of this medication? a. Bronchodilation b. Decreased coughing c. Absence of wheezing d. Thinning of respiratory secretions
d. Thinning of respiratory secretions Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The remaining options are the outcomes of respiratory medication therapy but not of acetylcysteine. Strategy(ies): Focus on the subject, the expected outcome of acetylcysteine. Focus on the name of the medication. Recalling that it is a mucolytic agent will direct you to the correct option.
