Case Study
Case: A 22-year-old patient with asthma presents to the clinic for routine follow-up. The provider prescribes albuterol.
Q: Which statement by the patient indicates a need for further teaching?
A. I will rinse my mouth after using this inhaler
B. I will avoid using aspirin with this medication
C. I will take this medication after my corticosteroid
D. I will report any palpitations or chest pain
Explanation: Albuterol (a short-acting beta-agonist) should be used before corticosteroids to open airways.
A patient is prescribed metoprolol. What should the nurse monitor for?
A. Increased heart rate
B. Bronchodilation
C. Bradycardia and orthostatic hypotension
D. Hypoglycemia
Case: A patient with allergic rhinitis and asthma is prescribed montelukast.
Q: Which instruction should be included?
A. Use this during asthma attacks
B. Take only as needed
C. Take every night at bedtime
D. Combine with high doses of caffeine
Explanation: Montelukast is a preventive leukotriene antagonist, taken daily at bedtime.
Case: A 45-year-old patient with persistent asthma is prescribed fluticasone/salmeterol.
Q: What teaching should the nurse prioritize?
A. Use this during acute asthma attacks
B. Stop using once symptoms improve
C. Use bronchodilator before this inhaler
D. No need to rinse your mouth after use
Explanation: Bronchodilators should be used first to enhance the steroid’s delivery; rinse mouth to prevent thrush.
Case: A 62-year-old male with a history of hypertension and a previous MI is prescribed metoprolol tartrate. His current vitals are: HR 56 bpm, BP 128/78.
Q: What is the nurse's next action?
A. Administer the medication as scheduled
B. Hold the dose and notify the provider
C. Give the medication with food
D. Encourage the patient to drink water before administration
Explanation: Beta blockers like metoprolol should be held if HR < 60 bpm to prevent severe bradycardia.
Case: A patient on lisinopril for hypertension reports a dry cough.
Q: What is the nurse’s best response?
A. This is a common side effect
B. Stop taking the medication immediately
C. Take it with grapefruit juice
D. Add potassium supplements
Explanation: ACE inhibitors commonly cause dry cough due to bradykinin buildup.
Case: A 70-year-old with COPD is prescribed ipratropium bromide.
Q: Which instruction should the nurse include?
A. Use this during acute asthma attacks
B. Increase fluid intake to help with dry mouth
C. Expect more mucus production
D. Use after your rescue inhaler
Ipratropium is an anticholinergic that dries secretions, often causing dry mouth.
Case: A patient taking atenolol complains of feeling lightheaded when standing up quickly.
Q: What is the nurse’s best response?
A. “That’s unusual and should be reported right away.”
B. “That means the medication is working too well.”
C. “Try standing up slowly to prevent orthostatic hypotension.”
D. “Stop taking the medication until your provider follows up.”
Explanation: Beta blockers like atenolol may cause orthostatic hypotension, especially in older adults.
Case: A patient recently prescribed losartan asks how soon it will work.
Q: What is the most accurate response?
A. Immediately
B. Within 1–2 days
C. It can take 3–6 weeks
D. After the first dose
Explanation: ARBs like losartan may take several weeks to reach full effectiveness.
Case: A 34-year-old presents with flu symptoms for 3 days. Oseltamivir is prescribed.
Q: What should the nurse explain to the patient?
A. The medication will still be effective
B. Stop the medication immediately
C. It should have been started within 48 hours
D. Double the dose to make up for delay
Explanation: Antivirals like oseltamivir are most effective within 48 hours of symptom onset.
Case: A 55-year-old with asthma and hypertension is prescribed propranolol for blood pressure control.
Q: Which action should the nurse take?
A. Educate the patient to monitor HR at home
B. Administer the medication with a full glass of water
C. Question the order and contact the provider
D. Encourage deep breathing after taking the medication
Explanation: Propranolol is contraindicated in asthma due to risk of bronchospasm (blocks beta-2 receptors in lungs).
Case: A patient taking clopidogrel develops bruising.
Q: What should the nurse assess first?
A. Potassium level
B. Fluid intake
C. Risk for bleeding
D. Blood glucose
Explanation: Clopidogrel is an antiplatelet medication; bruising suggests bleeding risk.
Case: A patient with COPD is taking theophylline. Lab reports show: Theophylline level = 22 mcg/mL.
Q: What action should the nurse take?
A. Document and continue medication
B. Administer next dose with food
C. Notify provider immediately
D. Encourage caffeine to boost effect
Explanation: Theophylline toxicity occurs at levels >20 mcg/mL. Risk: arrhythmias, seizures.
Case: A patient with a history of migraines and essential tremors is started on propranolol.
Q: What teaching point is most appropriate?
A. Take this medication only when symptoms occur
B. This medication can cause drowsiness and bradycardia
C. Stop the medication immediately if tremors return
D. Take it with grapefruit juice to enhance absorption
Explanation: Propranolol (a non-selective beta-blocker) slows the heart rate and can cause fatigue, dizziness, and hypotension.