Nokea
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.
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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.
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.
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.
The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.)
- A. I will rinse my mouth with water after using the inhaler and then spit out the water.
- B. I will gargle after using the inhaler and then swallow.
- C. I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling.
- D. I will use this inhaler for asthma attacks.
- E. I will continue to use this inhaler, even if I am feeling better.
- F. I will use a peak flow meter to measure my response to therapy.
Correct Answer: B,D
Rationale: The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient's response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.
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.