Pharmacology Respiratory Saunders

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?

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.

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client would the nurse note as an expected side effect of this combination medication?

"I feel as though my heart is racing." Albuterol/ipratropium is a combination agent—one is a β2-adrenergic agonist and the other is an anticholinergic medication. In combination they produce an overall bronchodilation effect. Common side and adverse effects include headache, dizziness, dry mouth, tremors, nervousness, and tachycardia. Therefore, option 1 is correct. Options 2, 3, and 4 are not specifically associated with this medication.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement?

"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, their ability to identify 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?

"I will take the daily dose at bedtime." The client taking a single daily dose of theophylline, a xanthine bronchodilator, would 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 would take in at least 2 L of fluid per day to decrease viscosity of secretions. The client would check with the primary health care provider (PHCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also would check with the PHCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.

Which statement made by a client taking montelukast indicates the need for further teaching?

"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.

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?

"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 with asthma. Which statement by the client alerts the nurse of a life-threatening effect?

"My lips and tongue are swollen." Omalizumab is an antiinflammatory and monoclonal antibody used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication would 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.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How would the nurse reply?

"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 needs to be instructed to clear the nasal passages before use for best medication effectiveness. The client would 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.

Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The parent of the child asks the nurse how long the child will need to take the medication. For how long would the nurse tell the parent the medication will need to be taken?

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.

A client has begun to use a methylxanthine bronchodilator. What beverage would the nurse plan to teach the client to avoid while taking this medication?

Coffee Cola, coffee, and chocolate contain methylxanthine and need to 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 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 would the nurse schedule the first dose of the oral medication?

4 hours after discontinuing the IV form With immediate-release preparations, oral theophylline would 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 would be administered immediately on discontinuation of the IV infusion. Therefore, the remaining options are incorrect.

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?

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 monitors for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.

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?

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 that 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?

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 35 U/L). The other options are not monitored routinely and are also normal.

A client has been given a prescription for benzonatate. Which observation would the nurse look for to evaluate the effectiveness of the medication?

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 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.

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.

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication would be used with caution?

Diabetes mellitus Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It needs to 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 they will immediately report which finding?

Difficulty in discriminating the color red from green

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint would most concern the nurse?

Difficulty tying shoes The client complaint that would 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.

A client is taking cetirizine. The nurse would inform the client of which side effect of this medication?

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.

A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value?

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 would the nurse anticipate as a result of the naloxone administration?

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 the 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.

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 they will perform which action?

Increase water intake when taking the medication

A client with tuberculosis is starting antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse would ensure that which baseline study has been completed?

Liver enzyme levels

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?

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 would be performed to obtain a baseline, and the levels need to be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication.

The nurse is preparing to administer albuterol to a client. Which parameters would the nurse assess before and during therapy?

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.

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?

Paradoxical bronchospasm, which must be reported to the primary health care provider (PHCP) 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 would be withheld, and the PHCP needs to 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?

Peripheral neuritis

The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid?

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.

A client is to begin a 6-month course of therapy with isoniazid. The nurse would plan to teach the client to take which action?

Report yellow eyes or skin immediately.

A client is to begin a 6-month course of therapy with isoniazid. The nurse would teach the client to take which action?

Report yellow eyes or skin immediately. Isoniazid is hepatotoxic; therefore, the client is taught to immediately report signs and symptoms of hepatitis, such as yellow skin and sclera. For the same reason, alcohol would be avoided during therapy. The client needs to 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 light-headedness. 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 would the nurse plan to have at the client's bedside?

Resuscitation equipment

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment would the nurse plan to have at the client's bedside if needed?

Resuscitation equipment The nurse administering naloxone for suspected opioid overdose would 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 would administer the medication using which procedure?

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. The nurse would monitor for which side and adverse effects of rifabutin? Select all that apply.

Signs of hepatitis Flulike syndrome Low neutrophil count Ocular pain or blurred vision

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication would the nurse monitor? Select all that apply.

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 bodily 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?

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.

The nurse would monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication?

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 with suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information?

These are signs of opioid withdrawal.

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?

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?

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 monitoring the client for signs and symptoms of liver injury are the priority. Dark urine is a sign of liver injury, and the client would be taught to report this, and the nurse would 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?

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?

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 needs to be taken on an empty stomach unless it causes gastrointestinal upset; then it may be taken with food. Antacids, if prescribed, would be taken at least 1 hour before the medication. Rifampin needs to be taken exactly as directed, and doses would not be doubled or skipped. The client would not stop therapy until directed to do so by a primary health care provider.

The nurse is teaching a client about the effects of diphenhydramine, an ingredient in the cough suppressant prescribed for the client. The nurse would plan to tell the client to take which measure while taking this medication?

Avoid activities requiring mental alertness. Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client would avoid the use of alcohol or central nervous system depressants, operating a car, or engaging in other activities that require mental acuity. It needs to 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 cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and would tell the client that which undesirable effect is associated with this medication?

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 started on long-term therapy with rifampin. The nurse would provide which information to the client about the medication?

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 needs to be taken exactly as directed. Doses would not be doubled or skipped. The client would not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset; then it may be taken with food. Antacids, if prescribed, need to 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?

Chart the finding as a normal response to the rifampin.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse would question the client to ensure that the client has not ingested which substance before the blood sample is drawn?

Coffee Theophylline is a xanthine bronchodilator. Before a serum level of the medication is drawn, the client needs to 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 would teach the client to limit the intake of which items while taking this medication?

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.

Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's medical history requires caution by the nurse?

Diabetes mellitus Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It is 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 is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what would the nurse plan to do?

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 the 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 needs to be readily available for use if respiratory depression should occur.

The nurse is administering a dose of pirbuterol to a client. The nurse would monitor for which side or adverse effect of this medication?

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?

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.

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?

Liver function tests

The primary health care provider prescribes cromolyn for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect?

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 the 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?

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 needs to 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?

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 would 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 they will perform which action?

Take the tablet with a full glass of water. Guaifenesin is an expectorant and needs to be taken with a full glass of water to decrease the viscosity of secretions. Extra doses would not be taken. The client would contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.

A client has a prescription to take guaifenesin. The nurse would conclude that the client understands the most effective use of this medication if the client states the need to take which action?

Take the tablet with a full glass of water. Guaifenesin is an expectorant and needs to 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 needs to contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations would not be broken open, crushed, or chewed.

A client with tuberculosis (TB) has a prescription for rifampin. What instruction would the nurse include in the client's teaching plan?

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) would 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 primary health care provider (PHCP) has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse would teach the client to monitor for which side effect of the medication?

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 needs to be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client would be questioned about the use of which medication?

Decongestants In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client needs to be questioned about the use of these medications if the client has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.

A client taking albuterol by inhalation cannot cough up secretions. What would the nurse suggest that the client do to assist in expectoration of secretions?

Drink increased amounts of fluids every day. A client needs to 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 would not take additional medication.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse would ensure that which baseline study has been completed?

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.

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?

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 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?

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.