Pharm questions: 3

The nurse is preparing to administer albuterol (Proventil) and beclomethasone (Beconase) inhalers to an asthmatic patient, as ordered by the prescriber. The nurse should administer The nurse is preparing to administer albuterol (Proventil) and beclomethasone (Beconase) inhalers to an asthmatic patient, as ordered by the prescriber. The nurse should administer a. the albuterol only; these meds should not be given concurrently. b. the albuterol first, wait 5 minutes, and then administer the beclomethasone. c. either inhaler, wait 5 full minutes, then administer the other. d. the beclomethasone first, wait 5 minutes, then administer the albuterol.

ANS: B Delivery of the glucocorticoid to the bronchial tree may be enhanced by inhaling a short-acting beta2 agonist 5 minutes before the glucocorticoid is inhaled. Administering albuterol only is not correct. It is given to vasodilate the lungs prior to the administration of the glucocorticoid. Albuterol should be given prior to beclomethasone. The albuterol should be administered first to vasodilate the lungs prior to administration of the beclomethasone.

3. A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin: a. dries secretions to help suppress coughing so patients can rest. b. helps stimulate the flow of secretions to increase cough productivity. c. helps to relieve chest pain associated with a cough. d. stimulates the body's natural immune responses.

ANS: B Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions, because it does not have anticholinergic effects. Guaifenesin does not alleviate pain associated with cough. Guaifenesin does not stimulate immune responses

1. The client is prescribed montelukast and asks the nurse what classification this medication is. The nurse's best reply is: a. phosphodiesterase inhibitor. b. adrenergic receptor stimulants. c. leukotrience receptor antagonist. d. acetylcholine antagonist.

ANS: C

A patient with asthma is prescribed albuterol Proventil) as needed and salmeterol (Serevent) every 12 hours. When the patient asks why two inhaler drugs are needed, what is your best response? a. "Albuterol opens your airways and salmeterol decreases the inflammation." b. "I will check with the prescriber to determine whether you can just use one drug." c. "Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks." d. "Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange."

ANS: C

The patient with neurogenic shock is receiving a phenylephrine (Neo-Synephrine) infusion through a right forearm IV. Which assessment finding obtained by the nurse indicates a need for immediate action? a. The patient's heart rate is 58 beats/minute. b. The patient's extremities are warm and dry. c. The patient's IV infusion site is cool and pale. d. The patient's urine output is 28 mL over the last hour.

ANS: C The coldness and pallor at the infusion site suggest extravasation of the phenylephrine. The nurse should discontinue the IV and, if possible, infuse the medication into a central line. An apical pulse of 58 is typical for neurogenic shock but does not indicate an immediate need for nursing intervention. A 28-mL urinary output over 1 hour would require the nurse to monitor the output over the next hour, but an immediate change in therapy is not indicated. Warm, dry skin is consistent with early neurogenic shock, but it does not indicate a need for a change in therapy or immediate action.

1. A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action? a. Apply pressure to the nose after spraying. b. Administer the spray while in the supine position. c. Insert the spray while sitting up. d. Exhale deeply while injecting the nasal spray.

ANS: C The patient should insert the spray while sitting up to avoid it being absorbed systemically.

Albuterol sulfate (Proventil) has a short half-life and duration of action. Based on this information, what should the nurse select as an appropriate dosing schedule for this drug? a. Once a day b. Once every other day c. 3 or 4 times a day d. 2 times a day

ANS: C A short half-life indicates that a medication must be given more frequently.

A nurse is assessing a 10-year-old child with asthma. The child and parents report daily symptoms, but the child only wakes up coughing once or twice a week, uses an albuterol (Ventolin) inhaler daily, nd is occasionally prevented from participating in physical activity by symptoms. What asthma severity classification does the nurse assign to the child? A. Intermittent B. Mild persistent C. Moderate persistent D. Severe persistent

ANS: C The child's symptoms place him or her in the moderate persistent category.

Your patient is receiving her third continuous nebulizer of albuterol (15 mg/hr). Which potential complications should you be on the lookout for? 1. Hypokalemia 2. Cardiac arrhythmias 3. Hyperglycemia 4. Premature ventricular contractions 5. Tremor a. 2 and 4 only b. 1, 2, and 5 only c. 1, 2, 4, and 5 only d. 1, 2, 3, 4, and 5

ANS: D

1. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Patients or parents should be instructed regarding the use of topical diphenhydramine that: 1. For maximum effectiveness in treating itching, combine topical with oral diphenhydramine. 2. Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak. 3. Topical diphenhydramine should not be used in children younger than age 2 years. 4. When applying topical diphenhydramine, apply the cream liberally to all areas that itch.

Answer 3

1. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed: 1. Montelukast twice a day is started when there is an asthma exacerbation. 2. Patients may experience weight gain on montelukast. 3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. 4. Lethargy and hypersomnia may occur when taking montelukast.

Answer 3

1. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed: 1. Montelukast twice a day is started when there is an asthma exacerbation. 2. Patients may experience weight gain on montelukast. 3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. 4. Lethargy and hypersomnia may occur when taking montelukast.

Answer 3

Diphenhydramine (Benadryl) is an antiemetic and is used for what other condition? 1. Headaches 2. Edema 3. Epitasis 4. Rash

Answer 4 Diphenhydramine (Benadryl) is an antihistamine that blocks histamine receptors on peripheral effector cells. It is an anticholinergic with sedative properties.

The nurse assesses a client who is on fluticasone (Flovent) and notes oral lesions. What is the nurse's best action? a. Teach the client to rinse the mouth after Flovent use. b. Have the client use a mouthwash daily. c. Start the client on a broad-spectrum anti-biotic. d. Document the finding as a known side effect.

Answer A The drug reduces local immunity and increases the risk for local infection, especially Candida albicans. Rinsing the mouth after using the inhaler will decrease the risk for developing this infection. Use of mouthwash and broad-spectrum antibiotics is not warranted in this situation. The nurse should document the finding, but the best action to take is to have the client start rinsing his or her mouth after using Flovent.

1. A patient has been using guaifenesin for a cough that accompanied a common cold. The patient calls the nurse help line and states that she thinks she is having an adverse reaction to the medication. The nurse knows that which symptoms are adverse effects of this medication? (Select all that apply.) A) Nausea B) Rash C) Constipation D) Bleeding E) Headache Answer A, B, E Feedback: Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash. Constipation and bleeding are not adverse effects of guaifenesin.

Answer A, B, E Feedback: Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash. Constipation and bleeding are not adverse effects of guaifenesin.

An adult patient's primary care provider prescribed fluticasone (Flonase) by metered-dose inhaler, which the patient states that she administers whenever she senses the onset of her allergy symptoms. How should the nurse respond to this patient's statement? A) "You need to combine a dose of this drug with an over-the-counter antihistamine to bring about allergy relief." B) "This drug has a long-term effect and won't provide immediate relief of your symptoms." C) "It's better if you can anticipate situations and places that will trigger your allergies and take a dose before you feel symptoms." D) "It sounds like you understand this drug and the best way to use it to treat your allergies."

Answer B

A client has received diphenhydramine (Benadryl) and is currently oriented but drowsy. What is the best action for the nurse to take? a. Perform a neurologic assessment every 2 hours. b. Document the response and continue to monitor. c. Prepare to administer epinephrine subcu-taneously. d. Have the nursing assistant stimulate the client every hour.

Answer B The client is experiencing normal side effects of the medication. The nurse will continue to monitor for additive effects. Performing a neurologic assessment is not necessary, nor is administra-tion of epinephrine. There is no reason for the client to be stimulated hourly.

1. A patient taking montelukast (Singulair) for the last 2 months has the following blood laboratory test values. Which value does the nurse report to the prescriber immediately? a. White blood cell count of 10,500 cells/mm3 b. Lactate dehydrogenase 950 IU/L c. Potassium 3.6 mEq/L d. Hematocrit 32%

Answer B The white blood cell count, lactate dehydrogenase, and hematocrit values are abnormal; however, only the lactate dehydrogenase level is very high (four to five times normal). This value indicates liver impairment. Leukotriene inhibitors can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

A patient is using oxymetazoline (Afrin) to relieve nasal congestion. Which of the following conditions would contraindicate the use of this drug? A) Nasal congestion B) Cough C) Hypertension D) Skin rash

Answer C Feedback: Oxymetazoline is contraindicated in patients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cough or skin rash.

1. The nurse clarifies that the medication montelukast (Singulair) is a leukotriene modifier, which helps the asthmatic patient: a. Liquefy and cough up mucus b. Obtain quick relief from an acute asthma attack c. Prevent or lessen the severity of an asthma attack d. By providing bronchodilation Answer C Singulair helps prevent asthma attacks through the modification of leukotrienes. It is not intended for quick relief, and it does not liquefy mucus or cause bronchodilation.

Answer C Singulair helps prevent asthma attacks through the modification of leukotrienes. It is not intended for quick relief, and it does not liquefy mucus or cause bronchodilation.

A client with rhinitis asks the nurse for a prescription for oxymetazoline (Afrin) to help with the swelling in the nose. Before asking the doctor for the prescription, the nurse should assess the client for: 1. normal kidney function. 2. presence of chest petechiae. 3. abdominal pain. 4. hypertension.

Answer: 4 1. Afrin does not have a systemic effect on the kidneys. 2. Afrin does not cause petechiae. 3. Abdominal pain is irrelevant for this medication. 4. Afrin causes constriction of blood vessels, which can cause problems for the hypertensive client.

The nurse is instructing a client who is prescribed ipratropium bromide (Atrovent) for asthma. Which should be included in this client's teaching? Select all that apply. A) Take no more than the prescribed number of doses each day. B) Rinse the mouth after taking this medication. C) Take on an empty stomach. D) Take with meals or a full glass of water. E) Use hard candy or drink extra fluids to help with a dry mouth.

Answer: A, E Appropriate teaching for a client prescribed ipratropium bromide (Atrovent) includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach

You have provided an albuterol treatment for your asthma patient and after a few minutes you reassess her. Which of the following would indicate that she is worsening rather than improving? A) She has become tachycardic. B) She is becoming lethargic. C) Her blood pressure is unchanged. D) She reports increased palpitations.

Answer: B

Albuterol Sulfate, if prescribed to the patient, is indicated for which one of the following conditions? A) Chest discomfort B) Nausea or vomiting C) Headache D) Difficulty breathing

Answer: D

A patient is being administered phenylephrine in an outpatient clinic. Which of the following conditions requires that phenylephrine be administered cautiously? A) Cataracts B) Hypothyroidism C) Diabetes mellitus D) Hypertension

AnswerD Feedback: Adrenergic mydriatics should be used cautiously in patients with hypertension, cardiac dysrhythmias, arteriosclerotic heart disease, and hyperthyroidism. Patients with cataracts, hypothyroidism, and diabetes mellitus can safely be administered phenylephrine.

1. A client has been receiving a cough medicine with guaifenesin for 48 hours. Which nursing diagnosis would this medication best address? 1. Airway Clearance, Ineffective related to large amount of tenacious mucus 2. Perfusion: Gastrointestinal, Risk for Ineffective related to abdominal distension from gas buildup in stomach. 3. Gas Exchange, Impaired related to inability to discharge carbon dioxide 4. Pain, Acute related to swollen tonsils and discomfort rated at 7 on 0-10 VAS

Correct Answer: 1 Rationale 1: Guaifenesin is an expectorant. It helps move thick mucus by increasing its production. Rationale 2: Guaifenesin does not affect perfusion. Rationale 3: Guaifenesin does not act at the alveolar level. Rationale 4: Guaifenesin does not relieve pain. Global Rationale: Expectorants reduce the thickness or viscosity of bronchial secretions, thus increasing mucus flow that can then be removed more easily by coughing. The only commonly used OTC expectorant is guaifenesin (Mucinex). It does not affect perfusion or pain and does not act at the alveolar level.

The patient is receiving albuterol (Proventil) for treatment of bronchospasm related to asthma. What is the initial nursing intervention as it relates to this medication? 1. Monitor the patient for relief of bronchospasms. 2. Monitor the patient for nausea and headache. 3. Monitor the patient's serum drug levels. 4. Provide the patient with age-appropriate education about albuterol (Proventil).

Correct Answer: 1 Rationale: Monitoring drug effects, in this case, the relief of bronchospasms, is a primary intervention that nurses perform. Nausea and headache are expected side effects, but monitoring for these side effects is not part of the initial intervention. Education about medication is important, but is not part of the initial intervention. Monitoring of serum drug levels for albuterol (Proventil) is not indicated.

A client has been prescribed beclomethasone (Beconase) for long-term management of persistent asthma. Prior to discharge, the nurse teaches the client about possible side effects, including: Select all that apply. 1. hoarseness. 2. dry mouth. 3. changes in taste. 4. nervousness. 5. insomnia.

Correct Answer: 1,2,3 Rationale 1: Hoarseness can occur as a local reaction to beclomethasone. Rationale 2: Dry mouth can occur as a local reaction to beclomethasone. Rationale 3: Changes in taste can occur as a local reaction to beclomethasone. Rationale 4: Beclomethasone is an anti-inflammatory drug and does not cause nervousness. Rationale 5: Beclomethasone is an anti-inflammatory drug and does not cause insomnia. Global Rationale: Inhaled beclomethasone produces few systemic adverse effects. Because small amounts may be swallowed with each dose, the patient should be observed for signs of corticosteroid toxicity (hypercorticism) when taking this drug for prolonged periods. Local effects may include hoarseness, dry mouth, and changes in taste. Nervousness and insomnia are not adverse effects of this drug

1. A client is prescribed oxymetazoline (OcuClear) ophthalmic solution for redness of the eye and eye irritation. Which statements are appropriate for the nurse to include in this client's teaching? Standard Text: Select all that apply. 1. Transient stinging can occur. 2. Expect some dizziness. 3. Blurred vision is possible. 4. Headache or brow pain can occur. 5. Vomiting is a common occurrence with this drug.

Correct Answer: 1,3,4 Rationale 1: Oxymetazoline (OcuClear) is an alpha-1 adrenergic agonist. Activation of these receptors in the arterioles of the eye causes vasoconstriction and stinging. Rationale 2: Oxymetazoline (OcuClear) is used as an ophthalmic solution and does not reach high levels in the blood or cause any dizziness. Rationale 3: Oxymetazoline (OcuClear) is an alpha-1 adrenergic agonist. Activation of these receptors in the arterioles of the eye causes blurred vision and sensitivity to light. Rationale 4: Oxymetazoline (OcuClear) is an alpha-1 adrenergic agonist. Headache or brow pain is a frequent side effect early on. Rationale 5: Oxymetazoline (OcuClear) is an eyedrop used for conjunctival redness and does not cause vomiting. Global Rationale: Oxymetazoline (OcuClear) is an alpha-1 adrenergic agonist. Activation of these receptors in the arterioles of the eye causes vasoconstriction and stinging, blurred vision and sensitivity to light, as well as headache or brow pain early on in treatment. Oxymetazoline (OcuClear) is used as an ophthalmic solution and does not reach high levels in the blood or cause any dizziness. Oxymetazoline (OcuClear) is an eyedrop used for conjunctival redness and does not cause vomiting.

Phenylephrine is to be used for a client to reverse hypotension caused by spinal anesthesia. For which symptoms should the nurse assess the client as contraindications to this drug? Standard Text: Select all that apply. 1. Angina 2. Parkinson disease 3. Narrow-angle glaucoma 4. Asthma 5. Severe hypertension Correct Answer: 1,3,5 Rationale 1: Phenylephrine causes vasoconstriction, which can lead to angina. Rationale 2: Phenylephrine is not contraindicated in Parkinson disease. Rationale 3: Because of its effects on the eye, phenylephrine should not be used in clients with narrow-angle glaucoma.

Correct Answer: 1,3,5 Rationale 1: Phenylephrine causes vasoconstriction, which can lead to angina. Rationale 2: Phenylephrine is not contraindicated in Parkinson disease. Rationale 3: Because of its effects on the eye, phenylephrine should not be used in clients with narrow-angle glaucoma. 1. A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action?

The nurse is preparing to administer beclomethasone (Beconase) to several clients. For which client would the nurse hold the drug and contact the physician? 1. The client who has had a myocardial infarction (MI) 2. The client who has methicillin resistant Staphylococcus aureus (MRSA) 3. The client who has diabetes mellitus 4. The client who has terminal cancer

Correct Answer: 2 Rationale 1: Beclomethasone (Beconase) is not contraindicated in clients who have had a myocardial infarction. Rationale 2: Glucocorticoids can mask the signs of infection, and are contraindicated if active infection is present. Rationale 3: Beclomethasone (Beconase) is not contraindicated in clients who have diabetes mellitus. Rationale 4: Beclomethasone (Beconase) is not contraindicated in clients who have terminal cancer.

1. The physician has prescribed phenylephrine (Neo-Synephrine) for an elderly patient. What is an important nursing assessment prior to administration of this drug? 1.A history of type 1 diabetes mellitus 2. A history of narrow angle glaucoma 3. A history of dizziness 4. A history of human immunodeficiency virus (HIV) infection

Correct Answer: 2 Rationale: Vasoconstrictors may increase intraocular pressure, so the nurse should assess for narrow angle glaucoma. Dizziness is a general symptom and not specific to this drug. Type 1 diabetes mellitus is not adversely affected by administration of a vasoconstrictor drug. Human immunodeficiency virus (HIV) infection is not adversely affected by administration of a vasoconstrictor drug.

The nurse is advising a client who been using diphenhydramine (Benadryl) over-the-counter (OTC) to induce sleep. The client complains about a dry mouth. The nurse explains that: 1. Diphenhydramine causes less dryness if taken in the liquid form. 2. Drying of the mouth membranes is common after taking diphenhydramine. 3. Drowsiness caused by the diphenhydramine caused the client to reduce fluid intake. 4. Diphenhydramine has a muscle relaxant effect, so the client is likely sleeping with the mouth open.

Correct Answer: 2 Rationale 1: Substituting the liquid form for another form will not make any difference. Rationale 2: Diphenhydramine is an antihistamine with a potent anticholinergic effect that promotes dry mouth. Rationale 3: Diphenhydramine does not reduce fluid intake in a significant way. Rationale 4: The client might sleep with the mouth open, but that is not the primary cause of the dry mouth. Global Rationale: The major adverse effect of antihistamines relates to their anticholinergic effects. Excessive drying of mucous membranes can lead to dry mouth, and urinary hesitancy may be troublesome for patients, especially those with prostatic hyperplasia. Some antihistamines produce more pronounced anticholinergic effects than others. Diphenhydramine and clemastine exhibit a significant incidence of anticholinergic adverse effects, whereas the second-generation agents—loratadine, desloratadine, and fexofenadine—produce the least. Substituting the liquid form for another form will not make any difference. Diphenhydramine does not reduce fluid intake in a significant way. The client might sleep with the mouth open, but that is not the primary cause of the dry mouth.

The client takes diphenhydramine (Benadryl), but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment by the nurse reveal? 1. The depression will not subside. 2. The client may develop seizures. 3. The diphenhydramine (Benadryl) will not control allergies. 4. The client may develop a hypertensive crisis.

Correct Answer: 4 Rationale 1: Depression is not the concern with this combination. Rationale 2: Seizures are not the concern with this combination. Rationale 3: Control of allergies is not the concern with this combination. Rationale 4: The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis.

3. After taking the medication guaifenesin (Mucinex), the client complains of coughing up phlegm. What is the best response by the nurse? 1. This requires further investigation. 2. This is indicative of an allergic reaction. 3. This means there is probably more pathology present. 4. This is normal.

Correct Answer: 4 Rationale 1: This requires further investigation is incorrect because this is the expected outcome of guaifenesin. Rationale 2: This is indicative of an allergic reaction is incorrect because this is the expected outcome of guaifenesin. Rationale 3: This means there is probably more pathology present is incorrect because this is the expected outcome of guaifenesin. Rationale 4: Guaifenesin, an expectorant, stimulates the flow of bronchial secretions. The increased secretions thin the mucus, allowing it to be removed with less forceful coughing. Global Rationale: Guaifenesin, an expectorant, stimulates the flow of bronchial secretions. The increased secretions thin the mucous, allowing it to be removed with less forceful coughing. This requires further investigation is incorrect because this is the expected outcome of guaifenesin. This is indicative of an allergic reaction is incorrect because this is the expected outcome of guaifenesin. This means there is probably more pathology present is incorrect because this is the expected outcome of guaifenesin.

1. A client taking an MAO inhibitor for hypertension asks the nurse for medication to relieve nasal congestion. The nurse should know that phenylephrine will be a poor choice for this client because it might cause which condition? 1. Tinnitus 2. Hypokalemia 3. Dizziness 4. Hypertension

Correct Answer: 4 Rationale 1: Phenylephrine does not cause tinnitus. If it is given within 21 days of an MAO inhibitor, hypertensive crisis can occur. Rationale 2: Phenylephrine does not cause hypokalemia. If it is given within 21 days of an MAO inhibitor, hypertensive crisis can occur. Rationale 3: Phenylephrine does not cause dizziness. If it is given within 21 days of an MAO inhibitor, hypertensive crisis can occur. Rationale 4: Phenylephrine should not be administered within 21 days of an MAO inhibitor, or a hypertensive crisis could occur. Global Rationale: Phenylephrine should not be administered within 21 days of an MAO inhibitor, or a hypertensive crisis could occur. Phenylephrine does not cause tinnitus, hypokalmia, or dizziness.

A patient has just received a prescription for fluticasone/salmeterol (Advair Diskus). What will the nurse include as part of the teaching for this patient about the use of this device? a. "You do not need good hand-lung coordination to use this device." b. "You will begin to inhale before activating the device." c. "You will need to use a spacer to help control the medication." d. "You will take 2 inhalations twice daily."

ANS: A The Advair Diskus is a dry powder inhaler and is activated by inhalation; therefore, hand-lung coordination is not required. There is no need for a spacer. Patients who use the Diskus take 1 inhalation twice day

The nurse is caring for a client prescribed albuterol and understands that this agent is a/an: a. beta-1 sympathomimetic agent. b. alpha-1 receptor antagonist. c. beta-adrenergic blocking agent. d. beta-2 adrenergic receptor agonist.

ANS: D Feedback A Incorrect: Albuterol is used to treat bronchoconstriction of reactive airway disease. B Incorrect: This is not the action of albuterol. C Incorrect: Albuterol is not a sympatholytic agent. D Correct: This defines both the classification and action of albuterol.

A patient is instructed to take diphenhydramine (Benadryl) after an allergic reaction. Which of the following statements by the patient indicates successful teaching concerning the safe and effective use of diphenhydramine? A) "I will still be able to have my after-dinner drink with this medication." B) "I will eat a diet low in sodium while taking this medication." C) "I should not drive my car after taking this medication." D) "I can take this medication every 2 hours until I feel better."

C Feedback: The administration of diphenhydramine (Benadryl) causes drowsiness, and the patient should not operate machinery, such as driving. The patient should not combine diphenhydramine with alcohol due to central nervous system depression. The patient will not need to limit sodium with this medication. The patient should adhere to the dosing schedule and not take the medication every 2 hours.

A nurse assesses a client who is prescribed fluticasone (Flovent) and notes oral lesions. Which action should the nurse take? a. Encourage oral rinsing after fluticasone administration. b. Obtain an oral specimen for culture and sensitivity. c. Start the client on a broad-spectrum antibiotic. d. Document the finding as a known side effect.

ANS: A The drug reduces local immunity and increases the risk for local infection, especially Candida albicans. Rinsing the mouth after using the inhaler will decrease the risk for developing this infection. Use of mouthwash and broad-spectrum antibiotics is not warranted in this situation. The nurse should document the finding, but the best action to take is to have the client start rinsing his or her mouth after using fluticasone. An oral specimen for culture and sensitivity will not provide information necessary to care for this client.

3. Which of the following conditions would an expectorant drug such as guaifenesin treat effectively? a. Acute bronchitis b. Asthma c. Smoker's cough d. Emphysema

ANS: A Expectorants such as guaifenesin are most effective in managing symptoms associated with upper respiratory infections such as bronchitis, pharyngitis, and a number of others.

While a patient is receiving an albuterol treatment, the nurse performs an ECG. The ECG shows the patient's heart rate had increased from 98 to 120 beats/min with narrow QRS complexes pre-ceded by a P wave. What is the appropriate course of treatment for this patient? a. Atropine. b. Activate the rapid response team. c. Lidocaine. d. Discontinue the treatment.

ANS: D The patient is experiencing sinus tachycardia. Most often, sinus tachycardia is caused by anxiety, pain, fever, hypovolemia, or hypoxemia. It may also be a side effect of certain medications such as beta agonist bronchodilators. Treatment for sinus tachycardia typically involves eliminating the underlying cause.

1. The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient? a. Stop using the medication after 3 days. b. Spray the medication into the nose while lying supine. c. Use frequently since systemic side effects do not occur. d. Use the medication with any other over-the-counter medications.

ANS: A Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications

1. An asthmatic patient begins therapy with montelukast (Singulair). The nurse is providing patient education. Which statement by the patient best demonstrates understanding? a. "I can anticipate immediate effects from this medication." b. "When taken even once, montelukast is just as effective as my glucocorticoid inhaler." c. "Montelukast has many serious drug interactions." d. "Maximal effects occur within 24 hours."

ANS: D Maximal effects develop within 24 hours of the first dose. This statement demonstrates understanding. Effects are not immediate, but the medication is rapidly absorbed by the body; further teaching is needed. As monotherapy, montelukast is less effective than inhaled glucocorticoids; further teaching is needed. Montelukast is not associated with any serious drug interactions; further teaching is needed.

Albuterol (Proventil) is administered to a patient to promote bronchodilation. Administration of this beta2-adrenergic agonist results in increased production of A) leukotrienes. B) cortisol. C) cyclic AMP. D) glucagon.

ANS:C Feedback: Beta-adrenergic drugs increase the production of cyclic AMP to produce bronchodilation. They do not increase the release of leukotrienes, cortisol, or glucagon.

Which of the following statements explains why diphenhydramine (Benadryl) should be used with extreme caution in clients with Alzheimer's disease? A) Diphenhydramine causes dizziness and can lead to falls. B) Diphenhydramine interferes with the acetylcholine available for neural transmission. C) Diphenhydramine can cause respiratory distress secondary to histamine release. D) Diphenhydramine can impede cerebral blood flow in susceptible people.

Ans: A Feedback: One of the most common anticholinergic medications is diphenhydramine (Benadryl), available OTC and used for allergy reactions and as a sleep aid. Because of its side effects, many people who use diphenhydramine begin to feel dizzy and lightheaded, get a dry mouth, and sometimes become confused and disoriented. Older adults who already have confusion and disorientation secondary to Alzheimer's disease will be compromised significantly if they take anticholinergic drugs. In addition to decreased cognition and confusion, other anticholinergic effects such as dry mouth, dizziness, and blurred vision can predispose older clients to falls. Even if they do not have Alzheimer's disease, giving anticholinergics routinely to any older adult is dangerous.

1. Before leaving the hospital after an acute asthma attack, a client is given a prescription for fluticasone/salmeterol (Advair) 250/50 to inhale one puff twice a day. The nurse completing the client's discharge teaching should tell the client which of the following? Select all that apply. A) Take the medication as needed. B) Continue to carry a rescue inhaler. C) Check peak flow daily. D) Rinse mouth after each use. E) Shake meter well before using.

Ans: B, C, D Feedback: The drug is a dry powder inhaler that contains an inhaled corticosteroid and a long-acting beta agonist. The medication should be taken every day as per the directions on the label to prevent future exacerbations. The client should continue to carry a rescue inhaler and check peak flow around the same time each day. Advair does not need to be shaken prior to use as it is a dry powder inhaler. The client should be advised to rinse his mouth out after each use to prevent oral thrush.

A nurse is providing care to a client with COPD. The nurse anticipates that which of the following would be appropriate to be prescribed for this client? Select all that apply. A) Darifenacin (Enablex) B) Ipratropium (Atrovent) C) Benztropine (Cogentin) D) Biperiden (Akineton) E) Tiotropium (Spiriva)

Ans: B, E Feedback: Ipratropium (Atrovent) and tiotropium (Spiriva) are inhaled cholinergic blocking drugs used in the treatment of chronic obstructive pulmonary disease (COPD).

Diphenhydramine is administered in anaphylaxis because it: A) blocks histamine receptors. B) is nonselective. C) reduces histamine release from mast cells and basophils. D) produces all of the above.

Ans: D

A patient who has been prescribed diphenhydramine (Benadryl) reports a dry mouth and feeling sleepy. What is the nurse best action? a. Document the finding and notify the prescriber. b. Remind the patient that naps provide needed rest. c. Suggest sucking on hard candy to relieve dry mouth. d. Reassure the patient that these are expected side effects.

Ans: D Diphenhydramine is an H1 receptor blocker commonly used for inflammation triggered by allergic reactions such as hives, watery eyes, and runny nose. Side effects of these drugs include dry mouth and throat as well as drowsiness. Sometimes these drugs are prescribed as a sleep aid.

Diphenhydramine is administered in anaphylaxis because it: A) blocks histamine receptors. B) is nonselective. C) reduces histamine release from mast cells and basophils. D) produces all of the above.

Ans: D produces all of the above

The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is: 1. Fluids and symptomatic care 2. Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids) 3. Guaifenesin and codeine syrup (Tussin AC) 4. Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids)

Answer 1

Phenylephrine (Neo-Synephrine) is administered to a client before a diagnostic procedure. The client education about this medication should include: 1. Driving may be difficult. 2. Tears will be yellow. 3. May cause burning. 4. Sunlight will improve vision.

Answer 1 Rationale: Phenylephrine causes pupillary dilation. The nurse should inform the client that driving with eyes dilated may cause difficulty, especially on a sunny day. Patients should be instructed to wear sunglasses to block ultraviolet (UV) exposure. The pupils are unable to react to or decrease the amount of light entering the eye. Burning is an adverse reaction to phenylephrine. Medications that numb the eye, such as Proparacaine, will cause the tears to be yellow.

A patient who has been taking montelukast (Singulair) for 3 months reports having urine the color of coffee. What is the nurse's best response? a. "You need to increase your intake of water and decrease your intake of coffee." b. "You need to stop taking this drug and notify your prescriber today." c. "Don't worry. All patients taking this drug have dark urine." d. "Do not take this drug any more often than prescribed." sent.

Answer B Montelukast is a leukotriene inhibitor and can cause liver damage. Dark urine is one sign of liver damage. The patient needs to stop taking the drug and see his or her health care provider to determine whether liver damage is pre

3. What is the mechanism of action of guaifenesin? A) Works on CNS to suppress cough centers in the medulla oblongata. B) Elevates the threshold for cough in the medulla oblongata. C) Thins mucus and lubricates the irritated respiratory tract. D) Act as vasoconstrictor and shrinks dilated blood vessels.

Answer C

A client with asthma is using ipratropium (Atrovent). What is the most appropriate teaching point for this client? 1. Limit outside activity. 2. Monitor serum glucose. 3. Increase outside activity. 4. Decrease fluid intake.

Correct Answer: 1 Rationale 1: Instruction to limit outside activity should be given to the client because ipratropium (Atrovent) is an anticholinergic, and can therefore inhibit sweat gland secretions due to direct blockade of the muscarinic receptors on the sweat glands. By limiting outside activity, especially when the weather is hot, the client avoids possible heatstroke. Sweating is necessary for clients to cool down, so this inhibition of sweating can increase their risk for hypothermia. Rationale 2: Monitoring serum glucose does not apply to this medication. Rationale 3: Ipratropium (Atrovent) is an anticholinergic, and can therefore inhibit sweat gland secretions due to direct blockade of the muscarinic receptors on the sweat glands. By limiting outside activity, especially when the weather is hot, the client avoids possible heatstroke. Sweating is necessary for clients to cool down, so this inhibition of sweating can increase their risk for hypothermia. Rationale 4: A client taking anticholinergics should increase fluid intake.