Nokea
A nurse is providing care to a client receiving theophylline. The client has received two loading doses and the nurse is evaluating the client's theophylline levels. Which finding would the nurse interpret as a therapeutic drug level?
- A. 5 mcg/L
- B. 8 mcg/L
- C. 13 mcg/L
- D. 20 mcg/L
Correct Answer: C
Rationale: Therapeutic theophylline levels range from 10 to 20 mcg/L. The possibility of toxicity increases with levels over 15 mcg/L, with toxicity indicated with levels over 20 mcg/L.
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A client is prescribed an inhaled corticosteroid. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply.
- A. Fungal infection
- B. Pharyngeal irritation
- C. Blurred vision
- D. Bradycardia
- E. Insomnia
Correct Answer: A,B
Rationale: Adverse reactions of inhaled corticosteroids include oral, laryngeal, and pharyngeal irritation and fungal infection. Blurred vision, bradycardia, and insomnia are not associated with inhaled corticosteroids.
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.
A 10-year-old child with asthma is prescribed high doses of an inhaled corticosteroid. The nurse would discuss which of the following with the child and parents as being affected?
- A. Blood pressure
- B. Skin turgor
- C. Urine output
- D. Rate of growth
Correct Answer: D
Rationale: The nurse should monitor the rate of growth of the child. Children are at risk for a reduction in growth when oral corticosteroids or higher doses of the inhalant form are used. Blood pressure, skin turgor, and urine output are not altered with corticosteroid therapy.
A nurse is developing a teaching plan for a client who is to use a dry powder inhaler. Which of the following would the nurse include in the teaching plan? Select all that apply.
- A. Place device in water to clean.
- B. Swallow capsules provided.
- C. Hold inhaler 1 to 2 inches from mouth.
- D. Hold breath for 10 seconds.
- E. Inhale quickly.
Correct Answer: D,E
Rationale: To properly use a dry powder inhaler, the client should do the following: prepare the medication for inhalation, place the mouthpiece close to the lips, inhale quickly, hold breath for 10 seconds, not swallow capsules provided, and not place the inhaler in water.
A client is demonstrating how to use a peak flow meter. The nurse determines that the client is successful when he does which of the following? Select all that apply.
- A. Inhales as forcibly as possible
- B. Stands upright to allow the best inhalation possible
- C. Makes sure indicator is at lowest level on scale
- D. Makes sure lips are sealed tightly around the mouthpiece
- E. Measures peak flow rate at different times each day
Correct Answer: B,C,D
Rationale: When teaching a client to use a peak flow meter, instruct the client to make sure the indicator is at the lowest level, stand upright, make sure the lips form a tight seal around the mouthpiece, exhale as forcibly and as quickly as possible, and test peak flow at the same time each day.