Nokea
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.
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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.
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 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.
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.
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.