Saunders Ch 55: Respiratory Meds

The client has a prescription to receive pirbuterol (Maxair Autoinhaler) two puffs and beclomethasone dipropionate (Beclovent) two puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? a) Administering the pirbuterol before the beclomethasone b) Alternating a single puff of each hourly, beginning with the beclomethasone c) Alternating a single puff of beclomethasone with pirbuterol; repeat the steps d) Administering the pirbuterol; wait 30 minutes and administer the beclomethasone

a) Administering the pirbuterol before the beclomethasone Rationale: 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 has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? a) Coffee, cola, and chocolate b) Oysters, lobster, and shrimp c) Melons, oranges, and pineapple d) Cottage cheese, cream cheese, and dairy creamers

a) Coffee, cola, and chocolate Rationale: Theophylline (Theo-24) 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.

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

b) Chart the finding as a normal response to the rifampin. Rationale: Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the health care provider.

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? a) Place the head of the bed flat. b) Ensure that naloxone is readily available. c) Flush the catheter with 6 mL of sterile water. d) Aspirate with a syringe to ensure presence of a cerebrospinal fluid (CSF) return.

b) Ensure that naloxone is readily available. Rationale: 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 client has been taking isoniazid for 1½ months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a) Hypercalcemia b) Peripheral neuritis c) Small blood vessel spasm d) Impaired peripheral circulation

b) Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake.

The nurse should monitor the client receiving the first dose of albuterol (Proventil HFA) for which side effect of this medication? a) Drowsiness b) Tachycardia c) Hyperkalemia d) Hyperglycemia

b) Tachycardia Rationale: Albuterol is a bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. The items in the other options are not side 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? a) Just after the next meal b) Just before the next meal c) 4 hours after discontinuing the IV form d) Immediately on discontinuing the IV form

c) 4 hours after discontinuing the IV form Rationale: With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication. If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion.

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? a) Electrolyte levels b) Coagulation times c) Liver enzyme levels d) Serum creatinine level

c) Liver enzyme levels 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 older than 50 or abuses alcohol.

The nurse would expect the health care provider (HCP) to add which medication to the regimen of the client receiving isoniazid? a) Niacin b) Neurontin c) Pyridoxine (vitamin B6) d) Cyanocobalamin (vitamin B12)

c) Pyridoxine (vitamin B6) Rationale: isoniazid is an anti-tuberculosis 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. Neurontin is used to prevent seizures, and cyanocobalamin is used to treat anemia.

649. A client has a prescription to take guaifenesin (Mucinex). 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? a) Take an extra dose if fever develops. b) Take the medication with meals only. c) Take the tablet with a full glass of water. d) Decrease the amount of daily fluid intake.

c) Take the tablet with a full glass of water. Rationale: Guaifenesin (Mucinex) 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 with tuberculosis (TB) has a prescription for rifampin (Rifadin). What instruction should the nurse include in the client's teaching plan? a) Yellow-colored skin is common with this medication. b) The medication must always be taken on an empty stomach. c) Wearing glasses instead of soft contact lenses will be necessary. d) As soon as the cultures come back negative, the medication may be stopped.

c) Wearing glasses instead of soft contact lenses will be necessary.

Which of the following statements by a client taking montelukast (Singulair) should indicate the need for further teaching? a) "I will need to have my liver function checked." b) "I can take the medication with food or without." c) "I may be able to decrease the use of my metered-dose inhaler." d) "I will take the medication when I first notice I am having trouble breathing."

d) "I will take the medication when I first notice I am having trouble breathing." Rationale: Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening.

Isoniazid is prescribed for a child with human immunodeficiency virus infection who has a positive Mantoux tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? a) 4 months b) 6 months c) 9 months d) 12 months

d) 12 months Rationale: For children with human immunodeficiency virus infection who demonstrate a positive Mantoux tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone (Azmacort) by inhalation. The nurse plans to monitor the client for which signs/symptoms during the change? a) Chills, fever, generalized rash b) Vomiting and diarrhea, increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue

d) Anorexia, nausea, weakness, and fatigue Rationale: Triamcinolone (Azmacort) is an adrenocorticosteroid. The client who is being changed from an oral to an inhalation glucocorticoid could experience signs of adrenal insufficiency. The nurse should monitor the client for anorexia, nausea, weakness, and fatigue. The nurse should also monitor for hypotension and hypoglycemia.

A client taking theophylline has a serum theophylline level of 15 mcg/mL. How does the nurse interpret this laboratory value? a) Below therapeutic range b) In excess of the therapeutic range c) Near the top of the therapeutic range d) In the middle of the therapeutic range

d) In the middle of the therapeutic range Rationale: The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.

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

a) "I use my corticosteroid inhaler each time I feel short of breath." Rationale: 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.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline (Theo-24). The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? a) 5 mg/mL b) 10 mg/mL c) 15 mg/mL d) 20 mg/mL

a) 5 mg/mL Rationale: Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL. If the laboratory result indicated a level of 5 mg/mL, the dosage of the medication would need to be increased.

A client has begun a course of therapy with rifampin (Rifadin). The home care nurse instructs the client to perform which action while taking this medication? a) Avoid wearing contact lenses. b) Always take the medication with food or antacids. c) Double the next medication dose if one is forgotten. d) Stop the medication if symptoms disappear in 2 months.

a) Avoid wearing contact lenses. Rationale: Rifampin (Rifadin) causes orange-red discoloration of body secretions and will permanently stain 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.

Ribavirin (Virazole) is prescribed for a hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which route? a) Oral b) Oxygen tent c) Intramuscular d) Subcutaneous

b) Oxygen tent Rationale: 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.

A client has a prescription to take guaifenesin (Mucinex). 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? a) Watch for irritability as a side effect. b) Take the tablet with a full glass of water. c) Take an extra dose if the cough is accompanied by fever. d) Crush the sustained-release tablet if immediate relief is needed.

b) Take the tablet with a full glass of water.

A client has been given a prescription for benzonatate (Tessalon). Which observation should the nurse look for to evaluate the effectiveness of the medication? a) Increasing the client's comfort level b) Decreasing the client's anxiety level c) Calming the client's persistent cough d) Eliminating the client's nausea and vomiting

c) Calming the client's persistent cough

A client is taking cetirizine (Zyrtec). The nurse should inform the client of which side effect of this medication? a) Diarrhea b) Excitability c) Drowsiness d) Excess salivation

c) Drowsiness Rationale: Cetirizine (Zyrtec) 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.

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

d) "My lips and tongue are swollen." Rationale: Omalizumab is an antiinflammatory 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 adverse reaction.

Which is the expected duration for the pharmacological management of latent tuberculosis (TB)? a) 10 days b) 14 days c) 1 month d) 9 months

d) 9 months Rationale: The duration of therapy for latent TB must be at least 6 months. The other time frames for administration are too short to effect resolution of the infection.

A client with an exacerbation of chronic obstructive pulmonary disease has been on oral glucocorticoids and is currently being weaned to triamcinolone (Azmacort) by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a) Chills, fever, and generalized rash b) Vomiting, diarrhea, and increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue

d) Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

The nurse is administering a dose of pirbuterol (Maxair Autohaler) to a client. The nurse should monitor for which side/adverse effect of this medication? a) Drowsiness b) Hypokalemia c) Hyperglycemia d) Increased pulse and blood pressure

d) Increased pulse and blood pressure Rationale: Pirbuterol is an adrenergic bronchodilator. Side/adverse effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy.

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? a) Constipation b) Painful coughing c) Increased urination d) Difficulty swallowing

a) Constipation Rationale: Codeine sulfate is an opioid analgesic and a frequent side effect is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

Which is the nurse's priority assessment for monitoring the client taking isoniazid? a) Electrolytes b) Liver function tests c) Arterial blood gases (ABGs) d) White blood cell (WBC) counts

b) Liver function tests

Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side/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

1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 5. Ocular pain or blurred vision Rationale: Rifabutin (Mycobutin) may be prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side/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. Ethambutol (Myambutol) causes peripheral neuritis.

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? a) "I must take the medication exactly as prescribed." b) "Once I start the medication, I will no longer be contagious." c) "I will not get any colds or infections while taking this medication." d) "This medication has minimal side effects and I can return to normal activities."

a) "I must take the medication exactly as prescribed." Rationale: 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 change in activities, especially when driving or operating machinery if dizziness occurs.

A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding his prescription? a) "I will take the daily dose at bedtime." b) "I need to drink at least 2 liters of fluid per day." c) "I know to avoid changing brands of the medication without my health care provider's approval." d) "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider (HCP)."

a) "I will take the daily dose at bedtime." Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. Additionally, 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 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.

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

a) A mask and pair of goggles Rationale: Ribavirin (Virazole) 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 (Virazole). 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 (Synagis), a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV.

A nurse is teaching a client about the effects of diphenhydramine (Benadryl), 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? a) Take it on an empty stomach. b) Avoid activities requiring mental alertness. c) Use alcohol for additional effect in reducing cough. d) Avoid chewing sugarless gum or using oral rinses mouth.

b) Avoid activities requiring mental alertness. Rationale: Diphenhydramine (Benadryl) 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 (CNS) depressants, operating a car, or engaging in other activities requiring mental acuity during use. 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 client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a) Use alcohol in small amounts only. b) Report yellow eyes or skin immediately. c) Increase intake of Swiss or aged cheeses. d) Avoid vitamin supplements during therapy.

b) Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a) Beclomethasone first and then the salmeterol b) Salmeterol first and then the beclomethasone c) Alternating a single puff of each, beginning with the salmeterol d) Alternating a single puff of each, beginning with the beclomethasone

b) Salmeterol first and then the beclomethasone Rationale: Salmeterol (Serevent Diskus) 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.

A client with tuberculosis receiving cycloserine (Seromycin Pulvules) 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? a) Withhold the morning dose on the day of the scheduled blood test. b) Take the morning dose and have the blood drawn 2 hours after taking the dose. c) Withhold the evening dose before the test and the dose scheduled for the morning of the test. d) Double the dose the evening before the test and withhold the morning dose on the day of the test.

b) Take the morning dose and have the blood drawn 2 hours after taking the dose. Rationale: Cycloserine is an antituberculosis medication that requires weekly serum drug 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 is taking a prescribed course of therapy with ethambutol (Myambutol). The home health nurse assesses the client at each home visit for which adverse effect of this medication? a) Orange urine b) Visual disturbances c) Hearing disturbances d) Gastrointestinal (GI) upset

b) Visual disturbances Rationale: 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 been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? a) Should always be taken with food or antacids b) Should be double-dosed if one dose is forgotten c) Causes orange discoloration of sweat, tears, urine, and feces d) May be discontinued independently if symptoms are gone in 3 months

c) Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin 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. The medication should be administered 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 causes orange-red discoloration of body secretions and will stain soft contact lenses permanently.

Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? a) Osteoarthritis b) Hypothyroidism c) Diabetes mellitus d) Polycystic disease

c) Diabetes mellitus Rationale: Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

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

c) Drink increased amounts of fluids every day.

Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a) Platelet count b) Neutrophil count c) Liver function tests d) Complete blood count

c) Liver function tests Rationale: Zafirlukast (Accolate) 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.

The health care provider (HCP) prescribes cromolyn (Intal) for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? a) Promote bronchodilation. b) Decrease the risk of infection. c) Suppress an allergic response. d) Eliminate the need for a rescue inhaler.

c) Suppress an allergic response. Rationale: Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast-cell stabilizer, antiasthmatic, and antiallergic. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It is not a bronchodilator. It does not decrease the risk of infection. It does not eliminate the need for the rescue inhaler.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin (Rifadin) for treatment. The nurse teaches the client to perform which action? a) Report any change in urine color. b) Take both medications with food. c) Take both medications together once a day. d) Expect to take the medication for 2 to 3 weeks.

c) Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of drug-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 nurse has administered a dose of salmeterol (Serevent Diskus) to a client. The client develops a generalized rash and urticaria, and the eyelids begin to swell. Which action should the nurse take? a) Apply a lanolin-based cream to the rash. b) Encourage the client to drink fluids quickly. c) Assess the client's vision with a Snellen chart. d) Call the health care provider (HCP) immediately.

d) Call the health care provider (HCP) immediately. Rationale: Hypersensitivity reaction can occur in clients taking salmeterol. Signs include rash, urticaria, and swelling of the face, lips, or eyelids. The nurse should call the HCP immediately if any of these occur.

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? a) Insufficient dosage of the medication, which needs to be increased b) Probable interaction of this medication with an over-the-counter cold remedy c) Tolerance to the medication, indicating a need for a stronger type of bronchodilator d) Paradoxical bronchospasm, which must be reported to the health care provider (HCP)

d) Paradoxical bronchospasm, which must be reported to the health care provider (HCP) Rationale: 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.

A client with a documented exposure to tuberculosis is being started on medication therapy with isoniazid. The nurse plans to set up appointments for the client to have which laboratory study done periodically during the course of therapy? a) Platelet count b) Liver function testing c) Serum creatinine determination d) Blood urea nitrogen determination

b) Liver function testing

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? a) Coffee b) Orange juice c) Mineral water d) Cranberry juice

a) Coffee

A nurse is preparing to administer albuterol (Proventil HFA) to a client. Which parameters should the nurse assess before and during therapy? a) Nausea and vomiting b) Headache and level of consciousness c) Lung sounds and presence of dyspnea d) Urine output and blood urea nitrogen level

c) Lung sounds and presence of dyspnea

A client has begun therapy with oxtriphylline (Choledyl). 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

2. Coffee 6. Chocolate Rationale: Oxtriphylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee and chocolate. The other food items are acceptable to consume.

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 fact? Select all that apply. 1. Dry powder inhalers have fewer side effects. 2. Dry power inhalers pose no environmental risks. 3. Dry powder inhalers deliver more medication to the lungs. 4. Dry power inhalers can be administered more frequently. 5. Dry powder inhalers require less hand-to-lung coordination.

2. Dry power inhalers pose no environmental risks. 3. Dry powder inhalers deliver more medication to the lungs. 5. Dry powder inhalers require less hand-to-lung coordination. Rationale: DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs, thus DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the health care provider.

651. The nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? a) "I will take the medication on an empty stomach." b) "I won't drink alcohol while taking this medication." c) "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth." d) "I won't do activities that require mental alertness while taking this medication."

a) "I will take the medication on an empty stomach." Rationale: Diphenhydramine (Benadryl) 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 or 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.

650. The nurse is preparing to administer a dose of naloxone hydrochloride intravenously to a client with an intravenous opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? a) Nasogastric tube b) Paracentesis tray c) Resuscitation equipment d) Central line insertion tray

c) Resuscitation equipment Rationale: The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, mechanical ventilator, and vasopressors.

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? a) Coffee b) Oatmeal c) Ginger ale d) Bagel with cream cheese

a) Coffee

Cromolyn sodium is prescribed for the client with allergic asthma. The nurse should plan care understanding that which is an action of this medication? a) Dilate the bronchi. b) Increase the number of eosinophils. c) Promote the migration of eosinophils into the inflammatory site. d) Inhibit the release of mediators from mast cells after exposure to an antigen.

d) Inhibit the release of mediators from mast cells after exposure to an antigen. Rationale: Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway hyperresponsiveness in some clients with asthma. It has no bronchodilating action.

652. A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the side and adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? a) Insomnia b) Constipation c) Hypotension d) Bronchospasm

d) Bronchospasm Rationale: Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

The nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states he or she will immediately report which finding? a) Impaired sense of hearing b) Gastrointestinal side effects c) Orange-red discoloration of body secretions d) Difficulty in discriminating the color red from green

d) Difficulty in discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

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

d) Difficulty tying shoes Rationale: The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid.

A postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. If the client develops respiratory depression and requires naloxone (Narcan) as an antidote, she may develop which complaint? a) Bradycardia b) Decrease in sensation c) Sudden onset of itching d) Increase in her pain level

d) Increase in her pain level Rationale: 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.

A client has been taking pyrazinamide (Pyrazinamide) for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? a) Urine b) Blood c) Wound d) Sputum

d) Sputum Rationale: Pyrazinamide is an antituberculosis medication that is given in conjunction with other antituberculosis medications. Its use may be discontinued by the prescriber if sputum cultures become negative.

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? a) Blood culture b) Urine culture c) Wound culture d) Sputum culture

d) Sputum culture

A client is scheduled to receive acetylcysteine (Mucomyst) 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect to see as a result of the administration of this medication? a) Bronchodilation b) Decreased coughing c) Absence of wheezing d) Thinning of respiratory secretions

d) Thinning of respiratory secretions Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The other three options are the outcomes of respiratory medication therapy, but not of acetylcysteine.