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Before leaving the hospital after an acute asthma attack, a client is given a prescription for fluticasone/salmeterol (Advair) 250/50 to inhale one puff twice a day. The nurse completing the client's discharge teaching should tell the client which of the following? Select all that apply.
- A. Take the medication as needed.
- B. Continue to carry a rescue inhaler.
- C. Check peak flow daily.
- D. Rinse mouth after each use.
- E. Shake meter well before using.
Correct Answer: B,C,D
Rationale: The drug is a dry powder inhaler that contains an inhaled corticosteroid and a long-acting beta agonist. The medication should be taken every day as per the directions on the label to prevent future exacerbations. The client should continue to carry a rescue inhaler and check peak flow around the same time each day. Advair does not need to be shaken prior to use as it is a dry powder inhaler. The client should be advised to rinse his mouth out after each use to prevent oral thrush.
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A nurse is developing a teaching plan about measures to reduce the risk of infection with Candida albicans from antiasthma therapy. The nurse includes this information because the client is prescribed which of the following? Select all that apply.
- A. Albuterol (Ventolin)
- B. Cromolyn (Gastrocrom)
- C. Fluticasone (Flovent)
- D. Tiotropium (Spiriva)
- E. Budesonide/formoterol (Symbicort)
Correct Answer: B,C,E
Rationale: Mast cell aerosols such as cromolyn and inhaled corticosteroids (ICSs) such as fluticasone and budesonide/formoterol have been associated with the development of oral thrush. Therefore, the client needs instructions on how to reduce his risk. Albuterol, a short-acting beta-2 agonist, and tiotropium, a cholinergic blocker, are not associated with the development of thrush.
A client with exercise-induced bronchospasm calls the physician's office to obtain a refill for his breathing medication. The client would most likely be prescribed which of the following? Select all that apply.
- A. Beclomethasone (Qvar)
- B. Levalbuterol (Xopenex)
- C. Theophylline (Theo-Dur)
- D. Mometasone (Asmanex)
- E. Bitolterol (Tomalate)
Correct Answer: B,E
Rationale: Beta-2 agonists, such as levalbuterol and bitolterol, are used to treat exercise-induced bronchospasm. Beclomethasone and mometasone are inhaled corticosteroids. Theophylline is a xanthine derivative.
When describing the drugs used to treat lower respiratory system conditions, the nursing instructor discusses chronic obstructive pulmonary disease (COPD). Which condition would the instructor include when discussing this condition related to the use of these drugs? Select all that apply.
- A. Asthma
- B. Pulmonary embolism
- C. Pulmonary hypertension
- D. Chronic bronchitis
- E. Pneumonia
Correct Answer: A,D
Rationale: COPD encompasses asthma, chronic bronchitis, chronic obstructive bronchitis, emphysema, or a combination of the conditions.
A nurse is teaching a client who is prescribed albuterol about the adverse reactions associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the client to report to the health care provider?
- A. Fall in blood pressure
- B. Increased nighttime urination
- C. Hearing impairment or deficit
- D. Headache and flushing
Correct Answer: D
Rationale: The nurse should instruct the client to contact the health care provider if palpitations, tachycardia, chest pain, muscle tremors, dizziness, headache, flushing, or difficulty with urination or breathing occurs. Fall in blood pressure, increased nighttime urination, and hearing impairment are not adverse effects associated with a sympathomimetic bronchodilator.
After teaching a group of nursing students about xanthine derivatives, the instructor determines that the teaching was successful when the students state which of the following? Select all that apply.
- A. Xanthine derivatives cause flushing.
- B. The action of xanthine derivatives leads to bradycardia.
- C. Xanthine derivatives cause a reduction in airway inflammation.
- D. Xanthine derivatives cause hypoglycemia.
- E. Xanthine derivatives stimulate the CNS to promote bronchodilation.
Correct Answer: A,E
Rationale: Xanthine derivatives can cause flushing, tachycardia, and hyperglycemia. Xanthine derivatives elicit their effects by stimulating the CNS to promote bronchodilation.