Nokea
A client is receiving theophylline. The nurse checks the client's serum theophylline level and finds it to be less than therapeutic. The nurse reviews the client's medical record, noting that which of the following might be a reason for this? Select all that apply.
- A. Nicotine
- B. Allopurinol
- C. Verapamil
- D. Phenytoin
- E. Ketoconazole
Correct Answer: A,D,E
Rationale: Nicotine, phenytoin (a hydantoin), and ketoconazole can decrease theophylline levels. Verapamil (a calcium channel blocker) and allopurinol can increase theophylline levels.
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A pediatric client is prescribed cromolyn. The nurse understands that this drug can be administered in which manner? Select all that apply.
- A. Via a nebulizer
- B. Orally
- C. Nasal spray
- D. Metered-dose inhaler
- E. Subcutaneous injection
Correct Answer: A,B,C,D
Rationale: Cromolyn may be administered via a nebulizer, as an aerosol metered spray, as a nasal spray, or orally. It is not given subcutaneously.
The nurse is reviewing the history of a client who is prescribed a long-acting beta-2 agonist. Which of the following would alert the nurse to the need to administer this drug cautiously to the client? Select all that apply.
- A. Hyperlipidemia
- B. Hypertension
- C. Glaucoma
- D. Hyperthyroidism
- E. Diabetes
Correct Answer: B,C,D,E
Rationale: Long-acting beta-2 agonists should be used cautiously in clients with hypertension, cardiac dysfunction, hyperthyroidism, glaucoma, diabetes, prostatic hypertrophy, and history of seizures.
The nurse instructs a client with asthma to always carry a rescue inhaler or quick-relief medication with him at all times. Which of the following would the client most likely carry? Select all that apply.
- A. Salmeterol (Serevent)
- B. Metaproterenol (Alupent)
- C. Tiotropium (Spiriva)
- D. Albuterol (Proventil)
- E. Formoterol (Foradil)
Correct Answer: B,D
Rationale: Short-acting beta agonists (SABAs) such as metaproterenol and albuterol are used as rescue treatment for asthma. Salmeterol and formoterol are long-acting beta agonists (LABAs). Tiotropium is a cholinergic blocking drug used to treat bronchospasm associated with COPD.
A client with exercise-induced bronchospasm calls the physician's office to obtain a refill for his breathing medication. The client would most likely be prescribed which of the following? Select all that apply.
- A. Beclomethasone (Qvar)
- B. Levalbuterol (Xopenex)
- C. Theophylline (Theo-Dur)
- D. Mometasone (Asmanex)
- E. Bitolterol (Tomalate)
Correct Answer: B,E
Rationale: Beta-2 agonists, such as levalbuterol and bitolterol, are used to treat exercise-induced bronchospasm. Beclomethasone and mometasone are inhaled corticosteroids. Theophylline is a xanthine derivative.
A nurse is caring for a client who is receiving cromolyn orally. Which of the following instructions would the nurse include in the client's teaching plan?
- A. Do not take the drug at bedtime.
- B. Swallow the drug without chewing.
- C. Take the drug with food or milk.
- D. Take the drug at least 30 minutes before meals.
Correct Answer: D
Rationale: When administered orally, cromolyn is given 30 minutes before meals and at bedtime. The oral form of the drug comes in an ampule. The ampule is opened and the contents are poured into a glass of water. The nurse stirs the mixture thoroughly. The client must drink all of the mixture. The drug may not be mixed with any other substance (e.g., fruit juice, milk, or foods).