Nokea
The nurse is providing instructions about the fluticasone propionate and salmeterol combination inhaler. Which statement about this inhaler is accurate?
- A. It is indicated for the treatment of acute bronchospasms.
- B. It needs to be used with a spacer for best results.
- C. Patients need to avoid drinking water for 1 hour after taking this drug.
- D. It is used for the prevention of bronchospasms.
Correct Answer: D
Rationale: Salmeterol is a long-acting beta agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.
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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.
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 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.
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.