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A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?
- A. Take the corticosteroid inhaler first.
- B. Take the bronchodilator inhaler first.
- C. Take these two drugs at least 2 hours apart.
- D. It does not matter which inhaler you use first.
Correct Answer: B
Rationale: An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchial relaxation/dilation before administration of the anti-inflammatory drug.
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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 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.
A patient will be receiving oral theophylline, 600 mg/day, in three divided doses. Identify how many milligrams the patient will receive per dose.
Correct Answer: 200 mg
Rationale: 600 mg/day divided by 3 doses per day = 200 mg/dose.
A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives?
- A. Diarrhea
- B. Palpitations
- C. Bradycardia
- D. Drowsiness
Correct Answer: B
Rationale: The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.
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.