Nokea
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.
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A patient has a metered-dose inhaler that contains 200 actuations ('puffs'), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, identify how many days will this inhaler last at the prescribed dose.
Correct Answer: 50 days
Rationale: Assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four divided into 200 yields 50, that is, the inhaler will last approximately 50 days.
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.
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 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.
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.