Nokea
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.
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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.
A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment?
- A. An anticholinergic such as ipratropium
- B. A short-acting beta agonist such as albuterol
- C. A long-acting beta agonist such as salmeterol
- D. A corticosteroid such as fluticasone
Correct Answer: B
Rationale: The short-acting beta agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.
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.
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.
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.