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Silvestri Chapter 49 Ed#56D

Silvestri Chapter 49 Ed#56D

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 049 (edited file)—"Respiratory Medications"10/14/08, Page 1 of 12, 1 Figure(s), 0 Table(s), 12 Box(es)
49: Respiratory Medications
PRACTICE QUESTIONS
1. A nurse is preparing to administer albuterol (Proventil) to a client. The nurse checks for which of the following before and during therapy?1. Increased urine output2. Nausea and vomiting3. Respiratory distress4. Complaints of headacheAnswer: 3Rationale: Albuterol is a bronchodilator of the adrenergic type. The nurse checks the respiratory pattern, pulse, and blood pressure prior to and during therapy. The color, character and amountof sputum are also noted. Options 1, 2, and 4 are not directly related to this medication.Test-Taking Strategy: Use the ABCs—airway, breathing, and circulation—to answer thequestion. Option 3 is the only option that addresses airway. Review this medication if you haddifficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 22.2. A nurse is administering a dose of isoproterenol (Isuprel) to a client. The nurse plans tomonitor for which side effect of this medication?1. Increased pulse and blood pressure2. Drowsiness3. Hyperglycemia4. HypokalemiaAnswer: 1Rationale: Isoproterenol is an adrenergic bronchodilator. Side effects can include tachycardia,hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others.The nurse monitors for these effects during therapy. Options 2, 3, and 4 are not side effects.Test-Taking Strategy: Use the process of elimination, recalling that this medication is a bronchodilator. Remembering that tachycardia is a side effect should assist in selecting theoption that identifies an increased pulse, option 1. Review the side effects of this medication iyou had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: PharmacologyReferences: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 133C.
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 049 (edited file)—"Respiratory Medications"10/14/08, Page 2 of 12, 1 Figure(s), 0 Table(s), 12 Box(es)
McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St. Louis:Mosby, p. 467.3. A nurse has an order to give a client metaproterenol sulfate (Alupent), two puffs, and beclomethasone (Vanceril), two puffs, by metered-dose inhaler. The nurse administers themedication by giving the:1. Beclomethasone first and then the metaproterenol2. Metaproterenol first and then the beclomethasone3. Alternating a single puff of each, beginning with the beclomethasone4. Alternating a single puff of each, beginning with the metaproterenolAnswer: 2Rationale: Metaproterenol is a bronchodilator. Beclomethasone is a glucocorticoid.Bronchodilators are always administered before glucocorticoids, when both are to be given onthe same time schedule. This allows for widening of the air passages by the bronchodilator,which then makes the glucocorticoid more effective.Test-Taking Strategy: To answer this question correctly, it is necessary to know two differentthings. First, you must know that a bronchodilator is always given before a glucocorticoid. Thiswould allow you to eliminate options 3 and 4, because you would not alternate the medications.To select between options 1 and 2, it is necessary to know that metaproterenol is a bronchodilator, whereas beclomethasone is a glucocorticoid. Review these medications if youhad difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: PharmacologyReference: McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St.Louis: Mosby, pp. 705-706.4. A client has begun therapy with oxtriphylline (Choledyl). The nurse tells the client to limitthe intake of which of the following while taking this medication?1. Oysters, lobster, and shrimp2. Coffee, cola, and chocolate3. Cottage cheese, cream cheese, and dairy creamers4. Oranges and pineappleAnswer: 2Rationale: Oxtriphylline is a xanthine bronchodilator. The nurse teaches the client to limit theintake of xanthine-containing foods while taking this medication. These include coffee, cola,and chocolate.Test-Taking Strategy: Focus on the name of the medication to determine that oxtriphylline is axanthine bronchodilator. Recalling which food items are naturally high in xanthine will directyou to option 2. Review the foods naturally high in xanthine if you had difficulty with thisquestion.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/Implementation
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 049 (edited file)—"Respiratory Medications"10/14/08, Page 3 of 12, 1 Figure(s), 0 Table(s), 12 Box(es)
Content Area: PharmacologyReference: McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St.Louis: Mosby, p. 724.5. A client with an order to take theophylline (Slo-bid) daily has been given medicationinstructions by the nurse. The nurse determines that the client needs further information aboutthe medication if the client states that he or she will:1. Avoid changing brands of the medication without physician approval.2. Avoid over-the-counter (OTC) cough and cold medications unless approved by physician.3. Drink at least 2 L fluid per day.4. Take the daily dose at bedtime.Answer: 4Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator,should take the medication early in the morning. This enables the client to have maximal benefitfrom the medication during daytime activities. Additionally, this medication causes insomnia.The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. Theclient should check with the physician before changing brands of the medication. The client alsochecks with the physician before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects, increasing the side effects of theophylline andcausing dysrhythmias.Test-Taking Strategy: Use the process of elimination. Note the key words,
needs further information
. These words indicate a false response question and that you need to select theincorrect client statement. General principles related to medication therapy will assist ineliminating options 1 and 2. Additionally, recalling that option 3 is an important measure to thinsecretions will direct you to option 4. Review this medication if you had difficulty with thisquestion.Level of Cognitive Ability: ComprehensionClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: PharmacologyReference: McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St.Louis: Mosby, pp. 723-724.6. A client is taking brompheniramine maleate (Dimetane). The nurse checks for which of thefollowing side effects of this medication?1. Excitability2. Drowsiness3. Excess salivation4. DiarrheaAnswer: 2Rationale: A frequent side effect of brompheniramine, an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth,constipation, urinary retention, and sweating.Test-Taking Strategy: Focus on the name of the medication to determine that this medication isan antihistamine. Recalling that antihistamines typically cause drowsiness will direct you to

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