Nokea
A patient has a metered-dose inhaler that contains 200 actuations ('puffs'), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, identify how many days will this inhaler last at the prescribed dose.
Correct Answer: 50 days
Rationale: Assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four divided into 200 yields 50, that is, the inhaler will last approximately 50 days.
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The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be
- A. below the therapeutic level.
- B. at a therapeutic level.
- C. above the therapeutic level.
- D. at a toxic level.
Correct Answer: C
Rationale: Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.
A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response?
- A. Increased sputum production
- B. Increased heart rate
- C. Increased respiratory rate
- D. Increased ease of breathing
Correct Answer: D
Rationale: The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.
The nurse is providing instructions about the fluticasone propionate and salmeterol combination inhaler. Which statement about this inhaler is accurate?
- A. It is indicated for the treatment of acute bronchospasms.
- B. It needs to be used with a spacer for best results.
- C. Patients need to avoid drinking water for 1 hour after taking this drug.
- D. It is used for the prevention of bronchospasms.
Correct Answer: D
Rationale: Salmeterol is a long-acting beta agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.
When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time?
- A. Notify the prescriber that the patient is unable to use the MDI.
- B. Obtain an order for a peak flow meter.
- C. Obtain an order for a spacer device.
- D. Ask the prescriber if the medication can be given orally.
Correct Answer: C
Rationale: The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.
When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects?
- A. Fatigue and depression
- B. Anxiety and palpitations
- C. Headache and rapid heart rate
- D. Oral candidiasis and dry mouth
Correct Answer: D
Rationale: Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.