Nokea
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.
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After receiving a nebulizer treatment with a beta agonist, the patient states she is feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response?
- A. This is an expected adverse effect. Let me take your pulse.
- B. The next scheduled nebulizer treatment will be skipped.
- C. I will notify the physician about this adverse effect.
- D. We will hold the treatment for 24 hours.
Correct Answer: A
Rationale: Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.
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.
The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast to treat asthma. The nurse will emphasize which point about this medication?
- A. The proper technique for inhalation must be followed.
- B. The patient needs to keep it close by at all times to treat acute asthma attacks.
- C. It needs to be taken every day on a continuous schedule, even if symptoms improve.
- D. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.
Correct Answer: C
Rationale: LTRAs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.
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.
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for quick relief of asthma attacks? (Select all that apply.)
- A. Salmeterol inhaler
- B. Albuterol nebulizer solution
- C. Intravenous systemic corticosteroids
- D. Montelukast
- E. Fluticasone inhaler
Correct Answer: B,C
Rationale: Albuterol (a short-acting beta agonist) and intravenous systemic corticosteroids are used to provide quick relief for asthma. Salmeterol is a long-acting beta agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.