Unit 1 Resp Meds

What antibody level must be evaluated before beginning omalizumab (Xolair)? IgG IgE IgA IgM

IgE Levels of IgE should be measured before administration of omalizumab because this helps determine the dosage to be given. Following administration of omalizumab, the levels of IgE become elevated because of the formation of omalizumab IgE complexes. IgG, IgA, and IgM are not affected by the use of omalizumab.

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. 1. Milk 2. Coffee 3. Oysters 4. Oranges 5. Pineapple 6. Chocolate

Coffee Chocolate 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.

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? 1. Platelet count 2. Neutrophil count 3. Liver function tests 4. Complete blood count

Liver function tests 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.

A patient is prescribed ephedrine (Adrenalin) for nasal congestion. The nurse questions the order after finding that the patient is also taking which medication? Penicillin Cimetidine (Tagamet) Methyldopa (Aldomet) Acetaminophen (Tylenol)

Methyldopa (Aldomet) Frequent decongestant use based on its vasoconstrictive effects inhibits the antihypertensive activity of methyldopa. Acetaminophen, cimetidine, and penicillin do not interact with ephedrine.

The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication? 1. Drowsiness 2. Tachycardia 3. Hyperkalemia 4. Hyperglycemia

Tachycardia 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.

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? 1. Just after the next meal 2. Just before the next meal 3. 4 hours after discontinuing the IV form 4. Immediately on discontinuing the IV form

4 hours after discontinuing the IV form 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.

During a respiratory assessment of a patient, the nurse noted the patient was coughing frequently and the oxygen saturation was <90%. The following lower respiratory diseases/conditions could be the cause of these findings? (Select all that apply.) 1. Pulmonary embolism 2. Chronic obstructive pulmonary disease 3. Asthma 4. Pneumonia 5. Smoking

ANS: 2, 3, 4, 5 Frequent coughing and oxygen saturation less than 90% may be caused or exacerbated by chronic obstructive pulmonary disease (COPD), asthma, pneumonia and smoking. Pulmonary embolism does not cause these symptoms. One of the first symptoms of a respiratory disease is the presence of a cough, a reflex initiated by irritation of the airway. Respiratory diseases cause narrowing of the airways through smooth muscle constriction (bronchospasm), edema, inflammation of the bronchial walls, or excess mucus secretion. Examples of obstructive lung disease are asthma and acute bronchitis. Chronic inflammation in the airways and lung tissue due to noxious particles and gases are referred to as having COPD or chronic airflow limitation disease (CALD); the terms are used interchangeably. Management principles of COPD include elimination of risk factors such as smoking, occupational dusts, fumes and gases, and indoor or outdoor pollutants.

A drug from which class will most likely help a patient reporting insomnia as a result of a persistent cough? Antitussive Antihistamine Decongestant Bronchodilator

Antitussive An antitussive is a drug that suppresses cough. Antihistamines are used to treat allergic rhinitis because they relieve sneezing, rhinorrhea, and nasal itching. Decongestants relieve nasal stuffiness. Bronchodilators relieve congestion in the bronchial tubes.

Ribavirin is prescribed for a hospitalized child with severe respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which route? 1. Oral 2. Oxygen tent 3. Intramuscular 4. Subcutaneous

Oxygen tent Ribavirin is an antiviral respiratory medication used mainly for hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent. Ribavirin is not administered orally, intramuscularly, or subcutaneously.

The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? 1. "I must take the medication exactly as prescribed." 2. "Once I start the medication, I will no longer be contagious." 3. "I will not get any colds or infections while taking this medication." 4. "This medication has minimal side effects and I can return to normal activities."

"I must take the medication exactly as prescribed." Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? 1. "I use my corticosteroid inhaler each time I feel short of breath." 2. "I see my doctor if I have an upper respiratory infection and always get a flu shot." 3. "I use my bronchodilator inhaler before walking so I don't become short of breath." 4. "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."

"I use my corticosteroid inhaler each time I feel short of breath." Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.

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? 1. "I will take the daily dose at bedtime." 2. "I need to drink at least 2 liters of fluid per day." 3. "I know to avoid changing brands of the medication without my health care provider's approval." 4. "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."

"I will take the daily dose at bedtime." 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 health care provider (HCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the HCP 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.

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? 1. "I will take the medication on an empty stomach." 2. "I won't drink alcohol while taking this medication." 3. "I won't do activities that require mental alertness while taking this medication." 4. "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

"I will take the medication on an empty stomach." 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.

Which statement made by a client taking montelukast indicates the need for further teaching? 1. "I will need to have my liver function checked." 2. "I can take the medication with food or without." 3. "I may be able to decrease the use of my metered-dose inhaler." 4. "I will take the medication when I first notice I am having trouble breathing."

"I will take the medication when I first notice I am having trouble breathing." 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.

The nurse is teaching a patient with chronic obstructive pulmonary disease about the drug ipratropium (Atrovent). Which statement by the patient indicates a need for further instruction? "I shall expect some improvement in my breathing in just a few minutes after I inhale this drug." "If I suddenly have difficulty getting my breath I will use this medicine immediately." "I can use the inhaler with this medicine no more than 12 times in a day." "My throat may get irritated when I first use ipratropium, but it should go away as I get used to the drug."

"If I suddenly have difficulty getting my breath I will use this medicine immediately." Ipratropium exerts an initial bronchodilator effect in just a few minutes after inhaling it, but the maximal effect does not occur for 1 to 2 hours. Therefore, it is not well suited to treat acute episodes of breathing difficulty; rather, it is best used for prophylaxis. Thus, the patient's statement about using the drug for sudden onset shortness of breath indicates a need for further education about the correct use of ipratropium. The patient would be correct in stating that he can use the inhaler no more than 12 times per day, to expect some throat irritation that will resolve, and that some improvement in breathing should be experienced a few minutes after using the medication.

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? 1. "Inhaled glucocorticoids cure the condition." 2. "Inhaled glucocorticoids treat this condition more effectively." 3. "Inhaled glucocorticoids decrease the symptoms more quickly." 4. "Inhaled glucocorticoids are preferred because of decreased adverse effects."

"Inhaled glucocorticoids are preferred because of decreased adverse effects." 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.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? 1. "I have a severe headache." 2. "My feet are quite swollen." 3. "I am nauseated and may vomit." 4. "My lips and tongue are swollen."

"My lips and tongue are swollen." Omalizumab is an antiinflammatory 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

Which information does the nurse include in the teaching plan for a patient starting on antihistamine therapy for seasonal allergies? "Take medication 45 to 60 minutes before going outdoors during pollen season." "Do not expect relief from allergy symptoms until the medication has been taken for at least 3 days." "Drink at least six 8 ounce glasses of fluid daily to compensate for the drying effects of the antihistamine." "If drowsiness occurs, contact the prescriber for a change in drug because tolerance to antihistamines does not develop."

"Take medication 45 to 60 minutes before going outdoors during pollen season." Antihistamines are most effective when taken 45 to 60 minutes before exposure to the offending allergen. Relief of symptoms by antihistamines can be immediate. Tolerance does develop to antihistamines, so drowsiness from the medication can decrease with time. The patient should drink at least eight 8 ounce glasses of fluid per day to make up for the drying effects of antihistamines.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? 1. "Clear the nasal passages after use." 2. "Take the medication only as needed." 3. "The medication should start to work immediately." 4. "The medication works locally and decreases inflammation."

"The medication works locally and decreases inflammation." 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.

Which instruction does the nurse give to a patient who is prescribed both tiotropium bromide (Spiriva) and fluticasone-salmeterol (Advair Diskus)? "First, use the Advairand follow immediately with the Spiriva." "Take the Advair, wait several minutes, then use the Spiriva." "Either medication may be used first." "Use the Spiriva, wait several minutes and then use the Advair."

"Use the Spiriva, wait several minutes and then use the Advair." The bronchodilator (Spiriva) is used first to open the airways so that the steroid (Advair) can penetrate deeply into the bronchial tree. Several minutes are allowed to elapse to provide time for the smooth muscles of the bronchial tree to relax and allow the air passages to dilate. The steroid is then used. If the steroid is used first, penetration into the bronchial tree is limited. If the steroid is used immediately after the bronchodilator, penetration is still limited because the bronchodilator has not had time to exert its full effect.

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? 1. 4 months 2. 6 months 3. 9 months 4. 12 months

12 months For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

How long does it take for a patient to achieve the maximal effect of intranasal corticosteroids after beginning therapy? Immediately 1 to 3 days 5 days 2 weeks

2 weeks Maximal effects of intranasal corticosteroids may not be evident for 2 weeks after beginning therapy. If symptoms do not improve within 3 weeks, therapy is discontinued. Maximal effects from intranasal corticosteroids are not immediate. Some improvement is noted within 3 days of starting the therapy; however, maximal effects are not achieved in a minimum of 3 days.

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? 1. 5 mg/mL (20 mcmol/L) 2. 10 mg/mL (40 mcmol/L) 3. 15 mg/mL (60 mcmol/L) 4. 20 mg/mL (79 mcmol/L)

5 mg/mL (20 mcmol/L) 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 monitor 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.

Which patient must be observed closely when taking acetylcysteine (Mucomyst)? A 50 year old with narrow angle glaucoma A 40 year old with hypothyroidism A 30 year old with quadriplegia A 60 year old with a gastric ulcer

A 30 year old with quadriplegia A quadraplegic patient may have difficulty clearing the increased secretions caused by this medication. Mechanical suctioning may be necessary to maintain airway patency. Acetylcysteine may be given in patients with narrow angle glaucoma, hypothyroidism, and gastric ulcer; however, it may not be given in patients with hyperthyroidism.

Which patient must avoid taking alpha-adrenergic decongestants? A 30 year old with gout A 60 year old with renal failure A 45 year old with hyperthyroidism A 25 year old with chronic obstructive pulmonary disease

A 45 year old with hyperthyroidism Alpha-adrenergic decongestants should not be given to patients with hyperthyroidism. Alpha-adrenergic agents used as nasal decongestants have the ability to stimulate alpha receptors at other sites in the body. They may be used in patients with gout. Alpha-adrenergic decongestants stimulate alpha receptors. The primary receptors in the lungs are beta receptors, so this type of drug would not have an effect on this patient. Alpha-adrenergic decongestants do not have a significant effect on patients with renal disease.

Which supplies should the nurse obtain for the administration of ribavirin to a hospitalized child with respiratory syncytial virus (RSV)? 1. A mask and pair of goggles 2. Isolation gown and sterile gloves 3. An intravenous (IV) pole and hood 4. Intramuscular (IM) syringe and needle

A mask and pair of goggles Ribavirin is administered via hood, face mask, or oxygen tent and is not administered by the IV or IM route. Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A mask may be worn. A gown is not necessary. The medication used for the prevention of RSV is palivizumab, a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV.

Before initiating antihistamine medications, the nurse knows that the patient's history should be checked for which of the following? (Select all that apply.) 1. Hypertension 2. Hypothyroidism 3. Glaucoma 4. Urinary retention 5. Prostatic hyperplasia

ANS: 1, 3, 4, 5 Before initiating antihistamine medications, the nurse needs to review the patient's history for other diseases currently being treated (e.g., hypertension, glaucoma, asthma, prostatic hyperplasia) that may contraindicate the concurrent use of some upper respiratory medications. If any one of these is present, consult the healthcare provider before initiating therapy. Antihistamines may also cause urinary retention and should be used with caution by older men who have an enlarged prostate gland. A history of hypothyroidism has no relationship to taking antihistamines.

A patient asked the nurse about the frequent upper respiratory illnesses that he was experiencing. The best response by the nurse would be 1. "Your respiratory system is designed to warm, filter, and humidify the air you breathe, as well as allow you to smell things. When you have an infection, the normal functioning can be impaired. Avoid irritants such as smoke, chemicals, or allergens that might make your nasal passages more susceptible to infections." 2. "Sometimes when this happens your respiratory system will stop working properly and you will need to get a flu shot to get it back on track." 3. "Studies show that once you get an infection, it never really leaves your system, so you will be having this problem regularly." 4. "Your respiratory system can become overwhelmed with too many infections and then it doesn't work anymore."

ANS: 1 The best response by the nurse is, "Your respiratory system is designed to warm, filter, and humidify the air you breathe, as well as allow you to smell things. With an infection, normal functioning can be impaired. Patient should avoid irritants such as smoke, chemicals or allergens that might make nasal passages more susceptible to infections." The nose warms, humidifies, and filters the air inhaled to prepare it for the lower respiratory airways. A flu shot will not help the patient to get back on track and especially should not be given when the patient is having a respiratory illness or infection. An infection can impair the respiratory system but it does not mean that it will never really go away, or that it is ongoing. Also, telling the patient that too many infections can overwhelm the respiratory system so it doesn't work anymore is incorrect. Respiratory infections can be successfully treated.

During an evaluation of a patient who came into the clinic complaining of shortness of breath and increased sputum production, the nurse asks the patient for further information by the following statements: (Select all that apply.) 1. "Tell me about your cough. Does it wake you at night?" 2. "What activities would you say make you short of breath?" 3. "When you cough up sputum, what color is it?" 4. "Is there anyone at home to help you?" 5. "Have you had any constipation or diarrhea recently?"

ANS: 1, 2, 3, 4 Further information requested from a patient complaining of shortness of breath and increased sputum production include: "Tell me about your cough, does it wake you at night?"; "What activities would you say make you short of breath?"; "When you cough up sputum what color is it?"; and "Is there anyone at home to help you?" The presence or absence of constipation or diarrhea has no bearing on shortness of breath and increased sputum production. It is essential for the nurse to adapt the assessment and prioritization of the examination to the degree of respiratory impairment present.

The nurse was instructing the patient on the drug tiotropium bromide (Spiriva) that was being started instead of continuing ipratropium bromide (Atrovent) and included the following statements in the education: (Select all that apply.) 1. "Spiriva uses the HandiHaler device for administration." 2. "The effects of Spiriva last much longer than Atrovent so you only have to take it once a day." 3. "This drug is used to treat acute bronchospasms." 4. "This comes as a capsule with dry powder inside that the inhaler device will activate." 5. "When taken correctly, this drug should result in reduced wheezing and easier breathing."

ANS: 1, 2, 4 The nurse is instructing a patient who was taking Atrovent about Spiriva that has now been ordered. The nurse needs to tell the patient that: "Spiriva uses the HandiHaler device for administration."; "The effects of Spiriva last much longer than Atrovent so you only have to take it once a day."; and "Spriva comes as capsule with dry powder inside that the inhaler device will activate." Tiotropium (Spiriva) is administered with a HandiHaler by dry powder inhalation and produces bronchodilation by competitive inhibition of cholinergic receptors on bronchial smooth muscle. It is similar in action to ipratropium, but has a much longer duration of action. The usual dose is one capsule daily, administered through the HandiHaler inhaler device. Spriva is more appropriately used for maintenance treatment of bronchospasm associated with COPD and should not be used as a rescue medicine in acute episodes of bronchospasm. Short-acting beta agonists (e.g., albuterol, levalbuterol, pirbuterol, terbutaline, metaproterenol) have a rapid onset (a few minutes) and are used to treat acute bronchospasm. Beta-adrenergic bronchodilator therapy is used to reduce wheezing and encourage easier breathing.

After explaining allergic rhinitis to the patient, the nurse realized further teaching was needed when the patient stated the following: 1. "I have to be careful with nasal decongestants so I don't get that rebound effect, where after I take them, once the drug wears off, my nose gets stuffy again, then I wind up taking it again." 2. "So this antihistamine will stop my running nose and itchy eyes as well as my nasal congestion." 3. "As I understand it, I need to keep taking my antihistamine so I don't get complications such as nasal polyps from my allergy." 4. "So my nasal congestion is caused from reacting to the pollen in the air, which I will get every season."

ANS: 2 Further patient teaching is needed when the patient tells the nurse that the antihistamine will stop the running nose and itchy eyes as well as my nasal congestion. Antihistamines, or H1-receptor antagonists, are the drugs of choice for treating allergic rhinitis but they do not reduce nasal congestion. When treating allergic rhinitis, decongestants are often administered in conjunction with antihistamines to reduce nasal congestion and counteract the sedation caused by many antihistamines. Decongestants do not have a rebound effect. They cause vasoconstriction of the nasal mucosa and significantly reduce nasal congestion. Antihistamines do not cause nasal polyps. Sometimes patients may develop a tolerance to the antihistaminic effects. When this occurs, changing to another antihistamine is usually effective. Nasal congestion is not only caused by reacting to the seasonal pollen in the air.

The nurse is preparing the antitussive agent benzonatate (Tessalon Perles) for a patient with a dry cough and knows the action of this drug will 1. dissolve thick sticky mucus. 2. suppress the cough reflex response in the brain. 3. stimulate an increase in bronchial gland secretions. 4. reduce the release of leukotrienes.

ANS: 2 The antitussive agent benzonatate will suppress the cough reflex response in the brain. Antitussive agents (cough suppressants) like benzonatate act by suppressing the cough center in the brain. It will not stop the cough completely, but should decrease its frequency and suppress the severe spasms that prevent adequate rest at night. It does not dissolve thick sticky mucus so must be used on patients who have dry, hacking, nonproductive coughs. Mucolytic agents help reduce the stickiness and viscosity of pulmonary secretions by acting directly on the mucus plugs to cause dissolution. This eases the removal of the secretions by suction, postural drainage, and coughing. Also, one expected outcome guaifenesin therapy is thinning of bronchial secretions for expectoration of mucus in the respiratory tract. Leukotrienes along with prostaglandins, thromboxanes, and eicosanoids are released when inflammatory cells are triggered by irritants such as smoke, allergens, or viruses. This causes many of the signs and symptoms of asthma, such as bronchoconstriction, vascular permeability leading to edema, and mucus hypersecretion. Expectorants stimulate an increase in bronchial gland secretions and liquefy mucus by stimulating the secretion of natural lubricant fluids from the serous glands. Expectorants help to liquefy thick mucus that can obstruct narrow bronchioles.

The nurse is preparing to administer both a bronchodilator and a steroid by inhalation and knows that these medications should be administered first: 1. the steroid. 2. the bronchodilator. 3. it does not make a difference. 4. bronchodilators and steroids should not be taken together.

ANS: 2 The bronchodilator should be administered first to allow bronchodilation so that when the second drug, such as a steroid, is given, the drug is more likely to reach the lower portions of the airway. Administer the bronchodilator as the first puff of medication and then wait a few minutes before administering the second medication. Bronchodilators and steroids can be administered together but specific sequencing of these drugs does make a difference.

The nurse knows that intranasal corticosteroids are used for short periods to treat seasonal allergies, and explains to the patient that the following needs to be done: (Select all that apply.) 1. Rinse mouth prior to application 2. Blow nose prior to application 3. Use nose drops of topical decongestants if ordered prior to application 4. Suck on hard candy or ice chips after application 5. Blow nose after application

ANS: 2, 3 Before using intranasal corticosteroids, patients need to blow their noses thoroughly and administer a topical decongestant just before using the intranasal corticosteroid. Rinsing the mouth prior to application and sucking on hard candy or ice chips after application are not reasonable interventions related to the administration of nasal corticosteroids. Also, blowing the nose after application is definitely contraindicated because the medications will just be blown away. Patients with allergic seasonal rhinitis who do not respond to antihistamines and sympathomimetic agents may be given corticosteroids to relieve the symptoms of their allergies

The expectorant guaifenesin (Robitussin), used for relief of conditions such as the common cold and bronchitis, works by these actions: (Select all that apply.) 1. Suppressing the cough reflex response in the brain 2. Decreasing mucus viscosity 3. Stimulating an increase in bronchial secretions 4. Promoting ciliary action 5. Reducing the release of leukotrienes

ANS: 2, 3, 4 Guaifenesin (Robitussin) works by decreasing mucus viscosity, stimulating an increase in bronchial secretions and promoting ciliary action. Expectorants liquefy mucus by stimulating the secretion of natural lubricant fluids from the serous glands. The flow of serous fluids helps liquefy thick mucus masses that may plug the narrow bronchioles. A combination of ciliary action and coughing will then expel the phlegm from the pulmonary system. Antitussives act by suppressing the cough center in the brain, and are used for patients who have dry, hacking, nonproductive coughs. Guaifenesin has no relationship to leukotrienes. Leukotriene modifiers like cromolyn and roflumilast are a class of anti-inflammatory agents. These agents block leukotriene formation which is part of the inflammatory pathway that causes bronchoconstriction.

The nurse is preparing to administer the beta-adrenergic bronchodilator albuterol, but first performs the following preassessment of the patient: (Select all that apply.) 1. Checks liver function test results 2. Checks for a history of glaucoma, diabetes mellitus, or peptic ulcer disease 3. Performs an assessment of the baseline mental status 4. Asks about concurrent use of antihistamines or nasal decongestants 5. Assessing for the presence of palpitations and dysrhythmias

ANS: 2, 3, 5 Prior to administering albuterol, the nurse should: check for a history of glaucoma, diabetes mellitus or peptic ulcer disease; perform an assessment of the baseline mental status; and assess for the presence of palpitations and dysrhythmias. Liver function test results and use of antihistamines or nasal decongestants are not relevant to administration of albuterol. With any bronchodilator, check for history of closed-angle glaucoma. Patients with diabetes mellitus may be particularly sensitive to adverse reactions and must be observed closely. Ask the patient about any gastrointestinal medications being taken. Administer the medication with food and a full glass of water or milk. The nurse must conduct an assessment of the patient's baseline mental status (e.g., degree of anxiety, nervousness, and alertness), and also check for any palpitations and dysrhythmias before administration of beta-adrenergic agents. If suspected, always contact the healthcare provider and ask whether therapy should be started.

When cromolyn sodium is prescribed for patients with severe allergic rhinitis, the nurse knows this drug will have the following effect: 1. Bronchodilator 2. Antihistamine 3. Indirect anti-inflammatory agent 4. Decongestant

ANS: 3 When cromolyn sodium is prescribed for a patient with severe allergic rhinitis, and works as an indirect anti-inflammatory agent. It is a mast cell stabilizer that inhibits the release of histamine and other mediators of inflammation. It must be administered before the body receives a stimulus to release histamine, such as an antigen that initiates an antigen-antibody allergic reaction. It has no bronchodilator, histamine, or decongestant properties.

After the administration of inhaled steroid medications, the nurse instructs the patient to do which of the following: (Select all that apply.) 1. Hold the breath for 30 seconds. 2. Rinse the mouth and swallow. 3. Rinse the mouth with water and spit out the water. 4. Nothing is required. 5. Use the bronchodilator first before the inhaled steroid when both are ordered

ANS: 3, 5 The nurse instructs the patient to rinse the mouth with water and spit out the water, and to use the bronchodilator first before the inhaled steroid when both are ordered. The nurse does not tell the patient to hold the breath for 30 seconds, to rinse with water and swallow, or that nothing is required. The nurse should advise the patient to rinse the mouth (rinse and spit) and not swallow following inhalation of steroid medications. Whenever both a bronchodilator and a steroid are prescribed, give the bronchodilator as the first puff of medication and then wait a few minutes before administering the second medication. This causes bronchodilation so that when the second drug, such as a steroid, is given, the drug is more likely to reach lower portions of the airway.

The nurse is teaching a patient about an antihistamine that was prescribed. Which statement by the patient indicates that further teaching is needed? 1. "I should drink 8-10 glasses of water every day." 2. "If my vision starts to blur, I will need to call my doctor.'" 3. "I can suck on candy or chew gum when my mouth gets dry from this drug." 4. "I will be able to drive without any problem because I will know when I am impaired."

ANS: 4 More antihistamine education is needed if a patient tells the nurse, "I will be able to drive without any problem, because I will know when I am impaired". The most common adverse effect of many antihistaminic agents is sedation. Although some patients do not feel a sense of sedation after taking an antihistamine, their cognitive functions (e.g., attention, memory, coordination, psychomotor performance) can be significantly impaired. These patients are often not aware that their cognitive abilities are impaired and are at risk of performing potentially dangerous activities (e.g., driving). Drinking 8-10 glasses of water every day, calling the doctor if vision starts to blur, and sucking on candy or chewing gum when dry mouth occurs are correct responses.

A patient is admitted to the emergency department after overdosing on acetaminophen (Tylenol). The nurse anticipates that the physician will order which medication to treat this patient? Acetylcysteine (Mucomyst) Atropine Flumazenil (Romazicon) Naloxone (Narcan)

Acetylcysteine (Mucomyst) Acetylcysteine is the antidote used to treat acetaminophen toxicity. Atropine is used to treat bradycardia. Flumazenil is the reversal agent for the respiratory depressant and sedative effects of benzodiazepine medications. Naloxone is an opiate antagonist and is used to reverse the effects of opiate drugs.

The client has a prescription to receive pirbuterol 2 puffs and beclomethasone dipropionate 2 puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? 1. Administering the pirbuterol before the beclomethasone 2. Alternating a single puff of each hourly, beginning with the beclomethasone 3. Alternating a single puff of beclomethasone with pirbuterol; repeating the steps 4. Administering the pirbuterol; waiting 30 minutes and administering the beclomethasone

Administering the pirbuterol before the beclomethasone Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are 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.

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? 1. Chills, fever, and generalized rash 2. Vomiting, diarrhea, and increased thirst 3. Blurred vision, headache, and insomnia 4. Anorexia, nausea, weakness, and fatigue

Anorexia, nausea, weakness, and fatigue 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.

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? 1. Platelet count 325,000 mm3 (325 × 109/L) 2. Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4. Aspartate aminotransferase (AST) 55 U/L (55 U/L)

Aspartate aminotransferase (AST) 55 U/L (55 U/L) 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.

Which medication taken, if taken with zafirlukast (Accolate), may cause toxic levels of zafirlukast? Theophylline Warfarin (Coumadin) Erythromycin (E Mycin) Aspirin

Aspirin Aspirin will significantly increase the activity of zafirlukast. If concurrent therapy is required with aspirin, the initial dosage of zafirlukast should be started at half the normal dose. When given in combination with zafirlukast, theophylline will decrease the levels of zafirlukast. When warfarin is given in combination with zafirlukast, the activity of warfarin is increased; the nurse should closely monitor the patient for increased bleeding and bruising. When erythromycin is given in combination with zafirlukast, erythromycin will decrease the levels of zafirlukast.

The nurse is teaching a client about the effects of diphenhydramine, an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication? 1. Take it on an empty stomach. 2. Avoid activities requiring mental alertness. 3. Use alcohol for additional effect in reducing cough. 4. Avoid chewing sugarless gum or using oral rinses mouth.

Avoid activities requiring mental alertness. Diphenhydramine has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. 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 that require mental acuity. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

A patient is prescribed promethazine hydrochloride (Phenergan). For which anticholinergic effect does the nurse monitor the patient? Diarrhea Paresthesias Blurred vision Increased salivation

Blurred vision The symptoms of blurred vision, constipation, urinary retention, and dryness of mouth, throat, and nasal mucosa are all anticholinergic effects produced by the antihistamine promethazine hydrochloride. The symptom of constipation is an anticholinergic effect of antihistamines. The symptoms of constipation and dryness of mouth, throat, and nasal mucosa are anticholinergic effects of antihistamines. Paresthesias is not an anticholinergic effect.

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? 1. Insomnia 2. Constipation 3. Hypotension 4. Bronchospasm

Bronchospasm 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.

A client has been given a prescription for benzonatate. Which observation should the nurse look for to evaluate the effectiveness of the medication? 1. Increasing the client's comfort level 2. Decreasing the client's anxiety level 3. Calming the client's persistent cough 4. Eliminating the client's nausea and vomiting

Calming the client's persistent cough 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.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if 1 dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

Causes orange discoloration of sweat, tears, urine, and feces 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 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.

A client taking rifampin reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? 1. Notify the health care provider (HCP). 2. Chart the finding as a normal response to the rifampin. 3. Immediately start prescribed intravenous (IV) fluids to prevent shock. 4. Get the client into bed, and put the bed in modified Trendelenburg's position.

Chart the finding as a normal response to the rifampin. Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the HCP. There is no indication that the client is in shock, so eliminate the options that indicate to start prescribed IV fluids and to place the client in modified Trendelenburg's position. The nurse should also inform the client that his is a harmless side effect.

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? 1. Coffee 2. Orange juice 3. Mineral water 4. Cranberry juice

Coffee Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects. Orange juice, mineral water, and cranberry juice are fluids that are allowed.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? 1. Coffee 2. Oatmeal 3. Ginger ale 4. Bagel with cream cheese

Coffee Theophylline is a xanthine bronchodilator. Before a serum level of the medication is drawn, the client should avoid taking foods or beverages that contain xanthine, such as colas, coffee, or chocolate; therefore, the client is told to avoid coffee before the test. The items in the other options do not need to be avoided before this test.

A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster, and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese, and dairy creamers

Coffee, cola, and chocolate 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.

The health care provider (HCP) 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? 1. Constipation 2. Painful coughing 3. Increased urination 4. Difficulty swallowing

Constipation 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.

A patient is taking cromolyn sodium (Nasalcrom) for prophylactic management of asthma. Which adverse effect does the nurse instruct the patient to report to the healthcare provider immediately? Coughing Constipation Urinary retention Green yellow visual halos

Coughing The patient should be instructed to notify the healthcare provider if bronchospasm or coughing occurs. Constipation, green yellow visual halos, and urinary retention are not adverse effects of this drug.

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution? 1. Osteoarthritis 2. Hypothyroidism 3. Diabetes mellitus 4. Polycystic disease

Diabetes mellitus 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.

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 he or she will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green

Difficulty in discriminating the color red from green 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.

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? 1. Dry mouth 2. Cramping diarrhea 3. Frequent headaches 4. Difficulty tying shoes

Difficulty tying shoes 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.

Which antitussive has a combination of antihistamine and antitussive properties? Diphenhydramine (Diphen) Guaifenesin (Robitussin) Codeine Dextromethorphan (Robitussin)

Diphenhydramine (Diphen) Diphenhydramine combines antihistamine and antitussive properties that will decrease the frequency of a cough. Guaifenesin is an expectorant and will increase the productivity of a cough. Codeine is a cough suppressant; however, it does not contain antitussive and antihistamine properties. Dextromethorphan does not contain antitussive and antihistamine properties; however, it is as effective a cough suppressant as codeine.

A client taking albuterol by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? 1. Get more exercise each day. 2. Use a dehumidifier in the home. 3. Drink increased amounts of fluids every day. 4. Take an extra dose of albuterol before bedtime.

Drink increased amounts of fluids every day. A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions. This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake. Additional exercise will not effectively clear bronchial secretions. A dehumidifier will dry secretions, making the situation worse. The client should not take additional medication.

A client is taking cetirizine. The nurse should inform the client of which side effect of this medication? 1. Diarrhea 2. Excitability 3. Drowsiness 4. Excess salivation

Drowsiness 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.

The nurse is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what should the nurse plan to do? 1. Place the head of the bed flat. 2. Ensure that naloxone is readily available. 3. Flush the catheter with 6 mL of sterile water. 4. Aspirate with a syringe to ensure a cerebrospinal fluid (CSF) return.

Ensure that naloxone is readily available Epidural analgesia is used for clients with expected high levels of postoperative pain. The nurse carefully checks the medication, notes the client's level of sedation, and makes sure that the head of bed is elevated 30 degrees unless contraindicated. The nurse aspirates with a syringe to make sure that no CSF return occurs. If CSF returns with aspiration, the catheter has migrated from the epidural space into the subarachnoid space. The catheter is not flushed with 6 mL of sterile water. Naloxone should be readily available for use if respiratory depression should occur.

A patient has just been prescribed diphenhydramine hydrochloride (Benadryl) for a dermatologic reaction. The nurse questions the order after finding that the patient currently has which condition? Glaucoma Osteoarthritis Crohn's disease Meniere's syndrome

Glaucoma Diphenhydramine hydrochloride has anticholinergic adverse effects. The nurse should contact the healthcare provider if the patient has a history of glaucoma, prostatic hyperplasia, or asthma. Diphenhydramine hydrochloride is not contraindicated for a patient with Crohn's disease, Meniere's syndrome, or osteoarthritis.

When evaluating the effectiveness of zafirlukast (Accolate), which factor of acute asthma attacks does the nurse determine? Duration Number Frequency Severity

Number The primary therapeutic outcome of treatment with zafirlukast is fewer episodes of acute asthmatic symptoms. Therefore, the best measure of the drug's effectiveness is the number of asthma attacks. Duration of asthma attacks and frequency of asthma attacks are not the best measurement of the therapeutic effects of zafirlukast. Zafirlukast does not affect the severity of an acute asthma attack.

A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value? 1. Below therapeutic range 2. In excess of the therapeutic range 3. Near the top of the therapeutic range 4. In the middle of the therapeutic range

In the middle of the therapeutic range 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.

A postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. The client develops respiratory depression and requires naloxone administration. Which finding should the nurse anticipate as a result of the naloxone administration? 1. Bradycardia 2. Decrease in sensation 3. Increase in pain level 4. Sudden onset of itching

Increase in pain level Opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. One of the side effects of naloxone is rapid pulse or tachycardia, not bradycardia. Sudden onset of itching would not be a typical reaction. Naloxone would not affect sensation.

The nurse is administering a dose of pirbuterol to a client. The nurse should monitor for which side or adverse effect of this medication? 1. Drowsiness 2. Hypokalemia 3. Hyperglycemia 4. Increased pulse

Increased pulse Pirbuterol is an adrenergic bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The other options are not side and adverse effects of this medication.

Cromolyn sodium is prescribed for the client with allergic asthma. What goal does the nurse expect to achieve by administration of this medication? 1. Dilation of the bronchi 2. Increase in the number of eosinophils 3. Promotion of the migration of eosinophils into the inflammatory site 4. Inhibition of the release of mediators from mast cells after exposure to an antigen

Inhibition of the release of mediators from mast cells after exposure to an antigen 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.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

Liver enzyme levels Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels 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 or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

The nurse is preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? 1. Nausea and vomiting 2. Headache and level of consciousness 3. Lung sounds and presence of dyspnea 4. Urine output and blood urea nitrogen level

Lung sounds and presence of dyspnea 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.

Which beta-adrenergic agonist is used for the treatment of emphysema? Cromolyn sodium (Intal) Acetylcysteine (Mucomyst) Olodaterol (Striverdi Respimat) Ipratropium bromide (Atrovent)

Olodaterol (Striverdi Respimat) Olodaterol (Striverdi Respimat) is a beta-adrenergic bronchodilating agent used to reverse airway constriction caused by bronchitis and asthma. Cromolyn sodium (Intal) is used to reduce the frequency of episodes of allergic rhinitis. Acetylcysteine (Mucomyst) is a mucolytic agent used to dissolve abnormally viscous mucous that may occur due to chronic emphysema. Ipratropium bromide (Atrovent) is an anticholinergic bronchodilating agent used to treat chronic obstructive pulmonary disease (COPD).

A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? 1. Insufficient dosage of the medication, which needs to be increased 2. Probable interaction of this medication with an over-the-counter cold remedy 3. Tolerance to the medication, indicating a need for a stronger type of bronchodilator 4. Paradoxical bronchospasm, which must be reported to the health care provider (HCP)

Paradoxical bronchospasm, which must be reported to the health care provider (HCP) The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld and the HCP should be notified. The remaining options are incorrect interpretations.

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? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

Peripheral neuritis 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.

The nurse would anticipate that the health care provider (HCP) would add which medication to the regimen of the client receiving isoniazid? 1. Niacin 2. Pyridoxine 3. Gabapentin 4. Cyanocobalamin

Pyridoxine 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.

What is the primary reason for instructing patients to avoid overuse of nasal decongestant sprays? Rebound swelling of the nasal passages can occur Superinfection caused by normal flora can develop Systemic absorption can precipitate hypertensive crisis Cracking and bleeding of the mucous membranes can occur

Rebound swelling of the nasal passages can occur Rebound swelling of the nasal passages occurs when nasal decongestant sprays are overused. Although symptom relief occurs initially, later it is followed by a return of nasal stuffiness and other symptoms. The mucous membranes of the nose may become dry with the use of decongestant sprays, but infection is rare. Decongestant sprays are topical; significant systemic absorption does not occur. The mucous membranes of the nose may become dry with the use of decongestant sprays, but related problems of significant cracking or bleeding are rare.

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? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

Report yellow eyes or skin immediately. 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.

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 if needed? 1. Nasogastric tube 2. Paracentesis tray 3. Resuscitation equipment 4. Central line insertion tray

Resuscitation equipment 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.

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? 1. Beclomethasone first and then the salmeterol 2. Salmeterol first and then the beclomethasone 3. Alternating a single puff of each, beginning with the salmeterol 4. Alternating a single puff of each, beginning with the beclomethasone

Salmeterol first and then the beclomethasone 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.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication should the nurse monitor? Select all that apply. 1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

Signs of hepatitis Flulike syndrome Low neutrophil count Ocular pain or blurred vision 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 flulike syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

A client has been taking pyrazinamide for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? 1. Urine 2. Blood 3. Wound 4. Sputum

Sputum 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.

A client has been taking pyrazinamide for 1 month. The client asks the nurse whether the therapy is due to be terminated soon. The nurse determines that the medication probably will be continued based on a positive finding in which report? 1. Blood culture 2. Urine culture 3. Wound culture 4. Sputum culture

Sputum culture Pyrazinamide is an antituberculosis medication given with other antituberculosis medications. Pyrazinamide might not be discontinued if sputum cultures continue to be positive. The remaining options are not related directly to the use of this medication

The 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? 1. Promote bronchodilation 2. Decrease the risk of infection 3. Suppress an allergic response 4. Eliminate the need for a rescue inhaler

Suppress an allergic response 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.

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? 1. Report any change in urine color. 2. Take both medications with food. 3. Take both medications together once a day. 4. Expect to take the medications for 2 to 3 weeks.

Take both medications together once a day. 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.

A client with tuberculosis receiving cycloserine orally twice daily must have blood drawn in 1 week to measure the serum concentration of the medication. The nurse prepares the client for this test by providing which information to the client? 1. Withhold the morning dose on the day of the scheduled blood test. 2. Take the morning dose and have the blood drawn 2 hours after taking the dose. 3. Withhold the evening dose before the test and the dose scheduled for the morning of the test. 4. Double the dose the evening before the test and withhold the morning dose on the day of the test.

Take the morning dose and have the blood drawn 2 hours after taking the dose. Cycloserine is an antituberculosis medication that requires weekly serum medication level determinations to monitor for neurotoxicity and other adverse effects. Peak concentrations are measured 2 hours after dosing and should be between 25 and 35 mcg/mL.

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 he or she will perform which action? 1. Take an extra dose if fever develops. 2. Take the medication with meals only. 3. Take the tablet with a full glass of water. 4. Decrease the amount of daily fluid intake.

Take the tablet with a full glass of water. 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 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.

A client has a prescription to take guaifenesin. The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action? 1. Watch for irritability as a side effect. 2. Take the tablet with a full glass of water. 3. Take an extra dose if the cough is accompanied by fever. 4. Crush the sustained-release tablet if immediate relief is needed.

Take the tablet with a full glass of water. Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations should not be broken open, crushed, or chewed.

When evaluating the effectiveness of cromolyn sodium (Intal) therapy, what must the nurse consider? Therapy is stopped as soon as the patient is symptom free. Temporary improvement followed by exacerbation is a common occurrence. A 5 to 6 week course of therapy is usually required to judge therapeutic response. The desired outcome of therapy is decreased frequency of allergic rhinitis and asthma attacks.

The desired outcome of therapy is decreased frequency of allergic rhinitis and asthma attacks. The desired therapeutic outcome of cromolyn sodium therapy is decreased frequency of attacks of allergic rhinitis and asthma. Therapy must be continued even when the patient is symptom-free. Full therapeutic benefit is consistent as long as therapy is continued. It takes 2 to 4 weeks of therapy before the clinical response can be evaluated.

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? 1. Bronchodilation 2. Decreased coughing 3. Absence of wheezing 4. Thinning of respiratory secretions

Thinning of respiratory secretions 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.

Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? 1. Skin color 2. Urine color 3. Hydration status 4. Respiratory effort

Urine color 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.

A client is taking a prescribed course of therapy with ethambutol. The home health nurse assesses the client at each home visit for which adverse effect of this medication? 1. Orange urine 2. Visual disturbances 3. Hearing disturbances 4. Gastrointestinal (GI) upset

Visual disturbances Ethambutol causes optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green. This form of color blindness poses a potential safety hazard in 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 GI upset occurs. Impaired hearing results from antituberculosis therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

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? 1. Wear dark clothing to avoid staining. 2. Always take the medication with food or antacids. 3. Double the next medication dose if one is forgotten. 4. Stop the medication if symptoms disappear in 2 months.

Wear dark clothing to avoid staining. 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 health care provider.

A client with tuberculosis (TB) has a prescription for rifampin. What instruction should the nurse include in the client's teaching plan? 1. Yellow-colored skin is common with this medication. 2. The medication must always be taken on an empty stomach. 3. Wearing glasses instead of soft contact lenses will be necessary. 4. As soon as the cultures come back negative, the medication may be stopped.

Wearing glasses instead of soft contact lenses will be necessary. Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by rifampin. Any sign of possible jaundice (yellow-colored skin) should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures give negative results.

The client questions the nurse as to why the 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. 1. Dry powder inhalers have fewer side effects. 2. Dry powder inhalers pose no environmental risks. 3. Dry powder inhalers can be administered more frequently. 4. Dry powder inhalers deliver more medication to the lungs. 5. Dry powder inhalers require less hand-to-lung coordination.

dry powder inhalers pose no environmental risks. Dry powder inhalers deliver more medication to the lungs. Dry powder inhalers require less hand-to-lung coordination. 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 health care provider.

Which information does the nurse include when teaching a patient with asthma how to administer cromolyn sodium (Nasalcrom)? Select all that apply. Discontinue use if nasal itching occurs Continue therapy even if symptom-free Full therapeutic benefits occur in 5 to 7 days Exhale through the nose during administration Avoid clearing nasal passages before administering A maximum of six sprays in each nostril may be used daily

ontinue therapy even if symptom-free Therapy must be continued even if symptom free. Therapeutic effects of cromolyn sodium are not immediate. A maximum of six sprays in each nostril may be used daily. One spray is placed in each nostril three or four times daily at regular intervals. Full therapeutic benefits require regular use and are usually evident within 2 to 4 weeks. Cromolyn sodium should be inhaled through the nose during administration. Nasal passages should be cleared before administering cromolyn sodium. Nasal irritation may be manifested by itching, and patients usually develop a tolerance to the irritation.