Chapter 48: Respiratory Medications

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

1, 2, 3, 5 Rationale: Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal (GI) disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid. Ethambutol also causes peripheral neuritis. Test-Taking Strategy: Focus on the subject, side and adverse effects of rifabutin. Note the name of the medication to assist in answering the question. Recalling that vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid and ethambutol, not rifabutin, will assist in answering.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesia, 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

2 Rationale: A common adverse effect of isoniazid is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This adverse effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, a problem associated with isoniazid. Options 3 and 4 would not cause the symptoms presented in the question but instead would cause pallor and coolness. From the remaining options, you need to know either that peripheral neuritis is an adverse effect of the medication or that the data in the question do not correlate with hypercalcemia.

Cycloserine is added to the medication regimen for a client with tuberculosis. Which instruction would the nurse reinforce in the client-teaching plan regarding this medication? 1. To take the medication 1 hour before meals 2. To return to the clinic weekly for serum drug-level testing 3. Alcohol intake is acceptable when taking this medication. 4. Expect to experience skin rashes while taking this medication.

2 Rationale: Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication needs to be taken after meals to prevent GI irritation. The client needs to be instructed to notify the PHCP if a skin rash or signs of central nervous system toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity. Test-Taking Strategy: Focus on the subject, client teaching regarding the use of cycloserine. Eliminate options 3 and 4 first, using guidelines related to general medication administration principles. From this point, knowing that the medication level needs to be monitored will assist with selecting the correct option.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states to report which occurrence immediately? 1. Impaired sense of hearing 2. Problems with visual acuity 3. Gastrointestinal (GI) side effects 4. Red-orange discoloration of body secretions

2 Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Red-orange discoloration of secretions occurs with rifampin. Test-Taking Strategy: Focus on the subject, client understanding of instructions given regarding ethambutol. Also note the strategic word, immediately. Option 3 is the least likely symptom to report; rather, it would be managed by taking the medication with food. To select from the other options, it is necessary to know that this medication causes optic neuritis, resulting in difficulty with red-green discrimination.

A client has a prescription to take sustained-released guaifenesin every 4 hours, as needed. The nurse determines that the client understands how to most effectively use this medication if the client makes which statement? 1. "I will watch for irritability as a side effect." 2. "I will take the tablet with a full glass of water." 3. "I will take an extra dose if the cough is accompanied by fever." 4. "I will crush the sustained-release tablet if immediate relief is needed."

2 Rationale: Guaifenesin is an expectorant. It needs to be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations are not to be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness. The client needs to contact the primary health care provider (PHCP) if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Test-Taking Strategy: Note the strategic words, most effectively. Begin to answer this question by eliminating option 4 first. Sustained-release preparations are not crushed or broken. Option 3 is eliminated next because fever indicates infection, and an "extra dose" of an expectorant is not helpful in treating infection. From the remaining options, recalling that increased fluids help liquefy secretions for more effective coughing will direct you to the correct option.

A client is to begin a 6-month course of therapy with isoniazid. The nurse would plan to provide which information to the client? 1. Drink 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.

2 Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs/symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol needs to be avoided during therapy. The client would 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. Test-Taking Strategy: Focus on the subject, signs/symptoms to report associated with use of isoniazid. Alcohol intake is avoided when the client is taking a prescribed medication, so option 1 would be eliminated first. Because the client receiving this medication typically is supplemented with pyridoxine (vitamin B6), option 4 is incorrect and is eliminated next. From the remaining options, recalling that the medication is hepatotoxic will direct you to the correct option.

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

3 Rationale: 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 greater than age 50 or abuses alcohol. Test-Taking Strategy: Focus on the subject, laboratory monitoring associated with isoniazid. In order to answer this question correctly, it is necessary to know that this medication can be toxic to the liver.

A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse needs to check the client for which sign/symptom? 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

3 Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse needs to check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication. Test-Taking Strategy: Focus on the subject, the purpose and effect of administering naloxone hydrochloride. Recalling that this medication is an antidote to opioid analgesics will assist with directing you to option 3. Remember that this medication will cause sudden pain in the postoperative client or return of pain in the client who received opioid analgesics.

A client has been started on long-term therapy with rifampin. Which information about this medication would the nurse provide to the client? 1. Always take the medication with food or antacids. 2. Double-dose the medication if one dose is forgotten. 3. Red-orange discoloration of sweat, tears, urine, and feces may occur. 4. May be discontinued independently if symptoms are gone in 3 months

3 Rationale: Rifampin needs to be taken exactly as directed. Doses are not to be doubled or skipped. The client would not stop therapy until directed to do so by a PHCP. The medication needs to be administered on an empty stomach unless it causes GI upset, and then it may be taken with food. Antacids, if prescribed, need to be taken at least 1 hour before the medication. Rifampin causes red-orange discoloration of body secretions and will permanently stain soft contact lenses. Test-Taking Strategy: Focus on the subject, client teaching associated with rifampin. Use of general medication administration principles will assist with eliminating options 2 and 4. Eliminate option 1 next because of the closed-ended word, always.

A client is receiving acetylcysteine, 20% solution diluted in 0.9% normal saline by nebulizer. The nurse needs to have which item available for a possible adverse event after giving this medication? 1. Ambu bag 2. Intubation tray 3. Nasogastric tube 4. Suction equipment

4 Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic needs to have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions. Test-Taking Strategy: Focus on the subject, equipment necessary in the administration of acetylcysteine. To answer this question, it is necessary to know that acetylcysteine may be given for either acetaminophen overdose or as a mucolytic agent. It is also necessary to know that the inhalation route is only used for mucolytic effects. With this in mind, options 1 and 2 are eliminated because it is unlikely that the client will need resuscitation. Option 3 is eliminated as well because a nasogastric tube may be used in the client with acetaminophen overdose but is not necessary when used as a mucolytic.