Psych Meds #1
A nurse is teaching a client who has been prescribed amitriptyline for depression. Which of the following adverse effects should the nurse emphasize as most common for this class of medication?
A. Hypertension and tachycardia
B. Anticholinergic effects such as dry mouth, constipation, and urinary retention
C. Insomnia and restlessness
D. Weight loss and hyperactivity
B. Anticholinergic effects such as dry mouth, constipation, and urinary retention
Rationale:
Tricyclic antidepressants (TCAs) block acetylcholine receptors, which leads to anticholinergic side effects including:
Dry mouth
Constipation
Urinary retention
Blurred vision
Orthostatic hypotension (from alpha-adrenergic blockade)
Other potential effects include sedation, seizures, and cardiac conduction abnormalities, especially in overdose. TCAs are not typically associated with hypertension, hyperactivity, or weight loss.
A client in the emergency department is experiencing severe sedation and respiratory depression after an overdose of diazepam. Which medication should the nurse anticipate administering for this client?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Atropine
A. Flumazenil
Rationale: Flumazenil is the specific antidote for benzodiazepine overdose.
Naloxone is used for opioid overdose, protamine sulfate reverses heparin, and atropine is used for bradycardia or cholinergic toxicity.
A nurse is teaching a client with asthma about possible side effects of inhaled respiratory medications. Which of the following findings should the client be instructed to report to the healthcare provider?
A. Mild hand tremors after using an albuterol inhaler
B. Throat irritation after inhaling a dose of medication
C. Dry mouth after using an ipratropium inhaler
D. White patches in the mouth after using a corticosteroid inhaler
D. White patches in the mouth after using a corticosteroid inhaler
Rationale:
B. White patches or soreness in the mouth indicate oral candidiasis (thrush), a fungal infection caused by inhaled corticosteroids (e.g., beclomethasone, fluticasone). This side effect should be reported to the provider for treatment. It can be prevented by rinsing the mouth and gargling after each use.
A. Mild tremors are a common, usually transient side effect of beta₂-adrenergic agonists like albuterol.
C. Dry mouth is an expected anticholinergic effect of ipratropium (Atrovent) and can be managed by sipping fluids or chewing sugarless gum.
D. Throat irritation can occur with many inhaled drugs and is generally not serious.
Key NCLEX Takeaways:
Beta₂ agonists (e.g., albuterol): Tremors, tachycardia, restlessness
Inhaled corticosteroids (e.g., fluticasone, budesonide): Oral thrush, hoarseness — rinse mouth after use
Anticholinergics (e.g., ipratropium): Dry mouth, cough, possible glaucoma worsening
General teaching: Always rinse mouth and clean inhaler regularly
A nurse is teaching a client about albuterol, a beta-2 adrenergic agonist. Which of the following best describes how this medication works?
A. It reduces airway inflammation by inhibiting leukotrienes.
B. It relaxes bronchial smooth muscle, causing bronchodilation.
C. It decreases mucus production by suppressing the immune system.
D. It blocks muscarinic receptors in the lungs to prevent bronchoconstriction.
B. It relaxes bronchial smooth muscle, causing bronchodilation.
Rationale:
B. Beta-2 adrenergic agonists (e.g., albuterol, levalbuterol, salmeterol) bind to beta-2 receptors in the bronchial smooth muscle, activating adenylate cyclase, increasing cAMP, and causing bronchodilation. This relieves bronchospasm and improves airflow.
A. Incorrect — this describes leukotriene receptor antagonists (e.g., montelukast).
C. Incorrect — corticosteroids, not beta-2 agonists, decrease inflammation and mucus production.
D. Incorrect — anticholinergics (e.g., ipratropium) block muscarinic receptors.
Key NCLEX Takeaways:
Short-acting beta-2 agonists (SABAs): Rescue inhalers (albuterol) for acute bronchospasm
Long-acting beta-2 agonists (LABAs): Controller therapy, not for acute attacks
Common side effects: Tremors, tachycardia, nervousness
A nurse is reviewing discharge teaching for a client taking an over-the-counter cold medication containing diphenhydramine. Which statement by the client indicates a need for further teaching?
A. "I should avoid driving until I know how this medication affects me."
B. "I may feel drowsy or dizzy while taking this medication."
C. "It’s safe to drink alcohol with this medication to help me sleep."
D. "I will report any difficulty urinating or constipation to my healthcare provider."
C. "It’s safe to drink alcohol with this medication to help me sleep."
Rationale:
Diphenhydramine is a first-generation antihistamine with significant sedative and anticholinergic effects.
Alcohol and other CNS depressants can increase sedation, dizziness, and risk of respiratory depression, so they should be avoided.
Statements A, B, and D indicate proper understanding of safe use and side effects.
A client with type 2 diabetes is starting phenelzine for depression. The nurse should monitor the client closely for which potential adverse effect related to the combination of MAOIs and antidiabetic therapy
A. Hypoglycemia
B. Hyperglycemia
C. Hypernatremia
D. Hypokalemia
A. Hypoglycemia
Rationale:
MAOIs, such as tranylcypromine, can potentiate the effects of insulin and oral hypoglycemic agents, increasing the risk of hypoglycemia.
Clients should be taught to monitor blood glucose frequently, recognize hypoglycemia symptoms (sweating, shakiness, confusion, dizziness), and carry a fast-acting carbohydrate.
Hyperglycemia, hypernatremia, and hypokalemia are not commonly associated with MAOIs.
A nurse is caring for a client with bipolar disorder who is taking lithium carbonate. The client presents to the emergency department with complaints of nausea, vomiting, and diarrhea for the past 24 hours due to suspected viral gastroenteritis. Which of the following actions should the nurse take first?
A. Administer prescribed antiemetic and antidiarrheal medications.
B. Encourage the client to drink sports drinks to replace lost fluids.
C. Notify the healthcare provider and obtain an order for a serum lithium level.
D. Hold the next scheduled dose of lithium until symptoms resolve.
C. Notify the healthcare provider and obtain an order for a serum lithium level.
Rationale:
Gastroenteritis causes fluid and electrolyte loss, leading to dehydration. Dehydration reduces renal clearance of lithium, which can cause toxic accumulation even if the client is taking the prescribed dose.
The priority is to assess for lithium toxicity by obtaining a serum lithium level and notifying the provider immediately.
Option A: Symptomatic treatment may be ordered later, but it does not address the potential for lithium toxicity.
Option B: Oral fluids may help, but monitoring lithium levels and medical evaluation take priority.
Option D: Holding the dose may be appropriate, but this should be done after consulting the provider.
A nurse is assessing a client who was recently started on sertraline and is also taking duloxetine for insomnia. The client reports agitation, confusion, sweating, and muscle tremors. Which of the following is the nurse’s priority action?
A. Encourage the client to drink more water.
B. Hold the medications and notify the healthcare provider immediately.
C. Document the findings and continue monitoring.
D. Administer acetaminophen for discomfort.
B. Hold the medications and notify the healthcare provider immediately.
Rationale:
The client is exhibiting signs of serotonin syndrome, a potentially life-threatening condition caused by excess serotonergic activity, often due to combining SSRIs with other serotonergic drugs (like tramadol). Key symptoms include:
Neuromuscular: tremor, hyperreflexia, clonus
Autonomic: hyperthermia, diaphoresis, tachycardia
Cognitive/behavioral: agitation, confusion, hallucinations
Immediate action includes discontinuing the serotonergic medications and notifying the provider.
A nurse is teaching a client who has asthma about a new prescription for montelukast (Singulair). Which of the following statements by the client indicates that the teaching has been effective?
A. “I will take this medication as soon as I start having trouble breathing.”
B. “I can use this medication in place of my albuterol inhaler if I have sudden wheezing.”
C. “I should use this medication every evening to help prevent asthma attacks.”
D. “I only need to take this medication when I feel short of breath.”
C. “I should use this medication every evening to help prevent asthma attacks.”
Rationale:
C. Montelukast is a leukotriene receptor antagonist (LTRA) used for long-term control and prevention of asthma symptoms. It works by reducing airway inflammation and bronchoconstriction caused by leukotrienes. It is taken once daily, usually in the evening, because asthma symptoms often worsen at night.
A and B. Incorrect — montelukast is not a rescue medication and will not relieve acute bronchospasm. A short-acting beta₂ agonist (e.g., albuterol) should be used for sudden symptoms.
D. Incorrect — montelukast must be taken regularly, not as needed, to be effective.
Key NCLEX Takeaways:
Classification: Leukotriene receptor antagonist
Use: Controller medication for chronic asthma and allergic rhinitis
Not a rescue drug — does not treat acute attacks
Administration: Taken daily, often in the evening
Report: Mood changes or suicidal thoughts (rare adverse effect)
A nurse is teaching a client about bronchodilator medications such as albuterol. Which part of the nervous system do these medications primarily activate to produce bronchodilation?
A. Parasympathetic nervous system
B. Sympathetic nervous system
C. Central nervous system directly
D. Somatic nervous system
B. Sympathetic nervous system
Rationale:
B. Bronchodilators like beta-2 adrenergic agonists activate the sympathetic nervous system by stimulating beta-2 receptors in the bronchial smooth muscle. This leads to bronchodilation and relief of airway obstruction.
A. Incorrect — the parasympathetic nervous system causes bronchoconstriction; it is not activated by these medications. **Ipratropium blocks parasympathetic stimulation in the bronchial smooth muscle (which normally causes bronchoconstriction). By blocking the parasympathetic pathway, ipratropium produces bronchodilation**
C. Incorrect — although bronchodilators can cause some CNS effects like nervousness or tremors, they do not act directly on the CNS to open the airways.
D. Incorrect — the somatic nervous system controls voluntary muscle movement, not bronchial smooth muscle.
A nurse is preparing to administer diphenhydramine to a client. Which of the following conditions would be a contraindication for this medication?
A. Benign prostatic hyperplasia (BPH)
B. Acute angle-closure glaucoma
C. Mild seasonal allergies
D. Motion sickness
B. Acute angle-closure glaucoma
Rationale:
Diphenhydramine has anticholinergic effects, which can increase intraocular pressure and worsen acute angle-closure glaucoma, making it a contraindication.
A. BPH is a caution, not an absolute contraindication, because anticholinergic effects may worsen urinary retention.
Allergy relief and motion sickness are indications for diphenhydramine.
Nursing Considerations:
Monitor elderly clients for sedation, confusion, and falls.
Educate clients to avoid alcohol and other CNS depressants while taking diphenhydramine.
Encourage reporting urinary retention, palpitations, or severe dizziness.
A nurse is teaching the parent of a child who takes methylphenidate for ADHD. The nurse explains that a “drug holiday”” may be recommended. What is the primary purpose of a drug holiday?
A. To permanently stop the medication
B. To prevent tolerance and reduce adverse effects
C. To treat comorbid anxiety or depression
D. To enhance the euphoric effects of the medication
B. To prevent tolerance and reduce adverse effects
Rationale:
A drug holiday is a planned temporary break from stimulant medication (often on weekends or during school breaks).
It can help reduce adverse effects such as loss of appetite, growth suppression, or insomnia, and may help prevent tolerance to the medication’s effects.
Drug holidays are not meant to permanently stop the medication, nor to treat other psychiatric conditions.
Enhancing euphoric effects is not a therapeutic goal and could increase risk of misuse.
A nurse is caring for a client receiving valproic acid for bipolar disorder. Which of the following laboratory findings requires immediate intervention?
A. AST 78 (Normal limits: 10-40)
B. Platelet count 180,000 (Normal limits: 150,000-400,000)
C. Valproic acid level 65 (Normal limits: 50-100)
D. Sodium 140 (Normal limits: 135-145)
A. AST 78 (Normal limits: 10-40)
Rationale: Valproic acid is associated with hepatotoxicity and thrombocytopenia.
A nurse is caring for a client who is taking haloperidol for schizophrenia. Which of the following findings should the nurse recognize as an extrapyramidal symptom?
A. Dry mouth and constipation
B. Tremors, rigidity, and restlessness
C. Weight gain and increased appetite
D. Dizziness when standing up quickly
B. Tremors, rigidity, and restlessness
Rationale:
Extrapyramidal symptoms (EPS) are movement-related side effects of antipsychotic medications, especially first-generation (typical) antipsychotics like haloperidol. Common EPS include:
Parkinsonism: tremor, rigidity, bradykinesia
Akathisia: inner restlessness, inability to sit still
Dystonia: muscle spasms, abnormal postures
Tardive dyskinesia: repetitive, involuntary movements (often late onset)
Anticholinergic effects (dry mouth, constipation) are not EPS. Orthostatic hypotension (dizziness) and metabolic side effects (weight gain) are also different adverse effects.
A nurse is reviewing laboratory results for a client who has been taking theophylline for chronic asthma management. The client reports nausea, restlessness, and insomnia. Which of the following actions should the nurse take?
A. Hold the medication and notify the healthcare provider of possible toxicity.
B. Administer the next dose as scheduled since these are expected effects.
C. Encourage the client to take the medication with an antacid to reduce side effects.
D. Instruct the client to take the next dose at bedtime to minimize symptoms.
A. Hold the medication and notify the healthcare provider of possible toxicity.
Rationale:
A. Theophylline has a narrow therapeutic range (10–20 mcg/mL). Early signs of toxicity include nausea, vomiting, restlessness, insomnia, and tremors. Severe toxicity can cause seizures and dysrhythmias, which can be life-threatening. The nurse should hold the dose and notify the provider immediately.
B. These are not normal effects and indicate possible toxicity.
C. Taking with antacids does not prevent toxicity and may interfere with absorption.
D. Changing the timing of the dose does not address the underlying risk of overdose.
**Avoid caffeine with theophylline!**
A nurse is teaching a client who has been prescribed oral corticosteroids for asthma. Which of the following symptoms should the client be instructed to report immediately to the healthcare provider?
A. Mild weight gain and increased appetite
B. Swelling of the face or hands, rapid weight gain, or unusual bruising
C. Temporary insomnia or nervousness
D. Mild heartburn relieved by antacids
B. Swelling of the face or hands, rapid weight gain, or unusual bruising
B. These symptoms may indicate fluid retention, electrolyte imbalances, or Cushing syndrome, which are potentially serious adverse effects of corticosteroids and require prompt reporting.
A. Mild weight gain and increased appetite are common, non-emergent side effects.
C. Insomnia and nervousness are expected minor CNS effects.
D. Mild heartburn is a common GI side effect and usually not urgent.
Adverse effects to monitor/report:
Signs of infection (corticosteroids suppress immune system)
Cushingoid features: moon face, buffalo hump, rapid weight gain, edema
Unusual bruising or bleeding
Hyperglycemia symptoms (polyuria, polydipsia)
Teaching points:
Take with food to reduce GI upset
Do not stop abruptly; taper as prescribed
Monitor blood pressure, weight, and blood glucose if long-term therapy
A nurse is teaching a client with seasonal allergies and mild cough about over-the-counter (OTC) cold medications. Which statement by the client indicates correct understanding of safe medication use?
A. "I will take a combination cold medicine that contains a decongestant, antihistamine, and cough suppressant all at once."
B. "I should use individual medications to treat specific symptoms rather than taking a combination product."
C. "It’s fine to double up on combination products if my symptoms are worse."
D. "I don’t need to read the label as long as I take the recommended dose."
B. "I should use individual medications to treat specific symptoms rather than taking a combination product."
Rationale:
Combination cold products often contain multiple active ingredients, increasing the risk of duplicate therapy, adverse effects, and drug interactions.
Using individual medications allows targeted treatment of specific symptoms and reduces the risk of overdose.
Statements A, C, and D indicate misunderstanding and unsafe use of OTC medications.
A nurse is teaching a client who has been prescribed rifampin for tuberculosis. Which of the following statements by the client indicates the teaching has been effective?
A. “I may notice that my urine, sweat, or tears turn orange-red while taking this medication.”
B. “I'm glad I can continue taking my oral contraceptive pill every day without a backup method.”
C. “It is safe to use rifampin with all other medications without checking with my healthcare provider.”
D. “I do not need to take this medication for the full course since I feel better after a few weeks.”
A. “I may notice that my urine, sweat, or tears turn orange-red while taking this medication.”
Rationale:
A. Rifampin commonly causes harmless red-orange discoloration of body fluids, including urine, sweat, and tears. Clients should be warned ahead of time to prevent alarm.
B. Incorrect — rifampin interacts with oral contraceptives, leading to decreased effectiveness of the birth control pill.
C. Incorrect — rifampin is a potent inducer of liver enzymes and interacts with many drugs (e.g., oral contraceptives, warfarin). Clients must check with the healthcare provider before taking other medications.
D. Incorrect — stopping rifampin early can lead to treatment failure and antibiotic resistance.
Key NCLEX Points:
Class: Antitubercular, rifamycin
Adverse effects: Orange-red body fluids, hepatotoxicity (monitor LFTs), GI upset
Teaching: Take on an empty stomach if possible, avoid alcohol, and complete full course
Drug interactions: Many — including oral contraceptives, anticoagulants, and certain HIV medications
A nurse is providing dietary teaching to a client who has been prescribed phenelzine for depression. Which of the following foods should the client avoid to prevent a hypertensive crisis?
A. Fresh apples and bananas
B. Aged cheddar cheese and cured meats
C. Cooked chicken and rice
D. Steamed broccoli and carrots
B. Aged cheddar cheese and cured meats
Rationale:
MAOIs (Monoamine Oxidase Inhibitors) inhibit the breakdown of tyramine, a substance found in certain foods. High tyramine foods—such as aged cheeses, cured or smoked meats, fermented foods, and some alcoholic beverages—can cause hypertensive crisis if ingested while taking MAOIs.
A client is prescribed nortriptyline for depression. Which statement by the client indicates a need for further teaching?
A. "I may notice a dry mouth or constipation while taking this medication."
B. "It is safe to take this medication and drink grapefruit juice every day."
C. "I should rise slowly from sitting or lying to avoid dizziness."
D. "I should call my provider if I notice irregular heartbeats."
B. "It is safe to take this medication and drink grapefruit juice every day."
Rationale:
TCAs can interact with certain substances, and grapefruit juice may affect drug metabolism. Key adverse effects of TCAs include anticholinergic effects (dry mouth, constipation, urinary retention), orthostatic hypotension, and cardiac conduction changes. Clients should be taught to report palpitations or irregular heartbeats and rise slowly to prevent falls.
A nurse is providing teaching to a client who has been prescribed oral prednisone for a severe asthma exacerbation. Which of the following statements by the client indicates a need for further teaching?
A. “I should take this medication exactly as prescribed and not stop it suddenly.”
B. “I may experience increased appetite, high blood sugar, and weight gain while taking this medication.”
C. “I can take this medication with food to help reduce stomach upset.”
D. “It is safe to stop this medication as soon as I feel better.”
D. “It is safe to stop this medication as soon as I feel better.”
Rationale:
D. Oral corticosteroids must not be stopped abruptly, especially after prolonged use, because sudden withdrawal can cause adrenal insufficiency, which is potentially life-threatening. A tapering schedule is usually required.
A. Correct — adherence to the prescribed schedule is essential, including tapering.
B. Correct — increased appetite, weight gain, hyperglycemia, and fluid retention are common side effects. Antidiabetic med dosing may need to be increased while taking corticosteroids.
C. Correct — taking corticosteroids with food helps reduce gastrointestinal irritation and risk of ulcers.
Key NCLEX Takeaways:
Indications: Severe asthma, COPD exacerbations, autoimmune conditions, inflammation
Adverse effects: Hyperglycemia, weight gain, fluid retention, hypertension, mood changes, osteoporosis (long-term)
Teaching points:
Take with food
Avoid abrupt cessation
Monitor blood pressure, glucose, and weight
Long-term use may require bone protection strategies
A nurse is evaluating a client who has just used a beta-2 adrenergic agonist inhaler for asthma. Which of the following findings indicates that the medication is working effectively?
A. The client reports increased shortness of breath and wheezing persists
B. The client’s respiratory rate is elevated and oxygen saturation decreases
C. The client’s wheezing decreases, breathing is easier, and oxygen saturation improves
D. The client develops tremors and palpitations
C. The client’s wheezing decreases, breathing is easier, and oxygen saturation improves
Rationale:
C. Beta-2 agonists (e.g., albuterol) cause bronchodilation, which relieves bronchospasm, improves airflow, and increases oxygenation. Signs of effectiveness include:
Decreased wheezing
Easier breathing
Improved oxygen saturation
A & B. Indicate that the medication is not effective, as symptoms are unchanged or worsening.
D. Tremors and palpitations are common side effects of beta-2 agonists but do not indicate therapeutic effectiveness.
Mechanism: Beta-2 agonists stimulate beta-2 receptors → bronchial smooth muscle relaxation
Effectiveness indicators:
Improved oxygen saturation
Reduced respiratory distress and wheezing
Increased ease of breathing
Common side effects: Tremors, nervousness, palpitations, mild tachycardia
A nurse is teaching a client who has been prescribed intranasal fluticasone for allergic rhinitis. Which instructions should the nurse include? (Select all that apply.)
A. Shake the bottle gently before each use
B. Prime the spray if it is the first time using it or if it has not been used for several days
C. Spray directly onto the nasal septum for best effect
D. Clean the nozzle regularly with warm water
E. Use the spray only when symptoms are severe
A. Shake the bottle gently before each use
B. Prime the spray if it is the first time using it or if it has not been used for several days
D. Clean the nozzle regularly with warm water
Rationale:
A. Shake gently: Ensures proper mixing of the medication.
B. Prime the spray: Necessary for first use or after several days to ensure correct dosing.
D. Clean nozzle regularly: Prevents clogging and contamination.
C. Spray onto the nasal septum: Incorrect – the spray should be aimed slightly outward, away from the septum, to prevent irritation or nosebleeds.
E. Use only when symptoms are severe: Incorrect – intranasal steroids like fluticasone are used regularly for best effect, not just as-needed.
Additional Patient Teaching:
May take several days to reach full effect.
Avoid sneezing immediately after use to allow absorption.
Report persistent nosebleeds or irritation to the healthcare provider.
A nurse is teaching a client who has a new prescription for isoniazid (INH) for tuberculosis. Which of the following side effects should the client be instructed to report immediately to the healthcare provider?
A. Mild fatigue and headache
B. Numbness and tingling in the hands and feet
C. Yellowing of the skin or eyes
D. Mild nausea after taking the medication
C. Yellowing of the skin or eyes
Rationale:
C. Yellowing of the skin or eyes indicates hepatotoxicity, a potentially serious adverse effect of isoniazid. Clients should be instructed to report jaundice, dark urine, or severe fatigue immediately.
B. Numbness and tingling in the hands or feet (peripheral neuropathy) is a known side effect due to vitamin B6 deficiency, but it is usually preventable with pyridoxine (vitamin B6) supplementation. While concerning, it is less urgent than signs of hepatotoxicity.
A & D. Mild fatigue and nausea are common, non-serious side effects.
Major adverse effects:
Hepatotoxicity — monitor liver function tests, report jaundice
Peripheral neuropathy — prevent with vitamin B6 supplementation
GI upset, mild fatigue, and rash may occur but are usually mild
Client teaching:
Take on an empty stomach if tolerated
Avoid alcohol to reduce liver risk
Report jaundice, dark urine, severe fatigue, or persistent nausea
A nurse is providing care for a client who has bipolar disorder and is starting lithium carbonate therapy. Which of the following laboratory tests should the nurse plan to monitor on a regular basis? (Select all that apply.)
A. Serum lithium level
B. Thyroid function tests
C. Serum sodium level
D. Blood glucose level
E. Renal function tests
A. Serum lithium level
B. Thyroid function tests
C. Serum sodium level
E. Renal function tests
Rationale:
A nurse is reviewing a client’s history before administering lorazepam. Which of the following conditions are contraindications to benzodiazepine therapy? (Select all that apply.)
A. Severe respiratory insufficiency
B. Sleep apnea
C. Acute narrow-angle glaucoma
D. Generalized anxiety disorder
E. Severe liver disease
A. Severe respiratory insufficiency
B. Sleep apnea
C. Acute narrow-angle glaucoma
E. Severe liver disease
Rationale:
Benzodiazepines are contraindicated in:
Severe respiratory insufficiency – risk of respiratory depression
Sleep apnea – may worsen airway obstruction during sleep
Acute narrow-angle glaucoma – can increase intraocular pressure
Severe liver disease – impaired metabolism can lead to drug accumulation and toxicity
D (generalized anxiety disorder) is not a contraindication; it is an indication for benzodiazepine therapy.
A nurse is providing discharge teaching to a client with COPD who has prescriptions for albuterol (a beta-2 adrenergic agonist) and ipratropium (an anticholinergic bronchodilator). Which of the following statements by the client indicate that the teaching has been effective? (Select all that apply.)
A. “If I start to feel short of breath suddenly, I should use my albuterol inhaler first.”
B. “Ipratropium helps prevent symptoms, not treat them during an acute attack.”
C. “I should rinse my mouth after using these inhalers to prevent irritation.”
D. “If I accidentally spray ipratropium in my eyes and notice blurred vision, I’ll call my healthcare provider.”
E. “If I feel shaky or my heart races after albuterol, I should stop taking it right away.”
F. “Both medications work together to keep my airways open and help me breathe easier.”
A. “If I start to feel short of breath suddenly, I should use my albuterol inhaler first.”
B. “Ipratropium helps prevent symptoms, not treat them during an acute attack.”
C. “I should rinse my mouth after using these inhalers to prevent irritation.”
D. “If I accidentally spray ipratropium in my eyes and notice blurred vision, I’ll call my healthcare provider.”
F. “Both medications work together to keep my airways open and help me breathe easier.”
Rationale:
A. ✅ Correct — Albuterol is a short-acting beta-2 agonist (SABA) used for acute bronchospasm or sudden shortness of breath (“rescue” inhaler).
B. ✅ Correct — Ipratropium is a maintenance (controller) medication used to prevent bronchospasms, not for acute attacks.
C. ✅ Correct — Rinsing the mouth helps prevent dryness and irritation, especially with repeated inhaler use.
D. ✅ Correct — Blurred vision or eye pain after ipratropium use may indicate the medication got into the eyes, which can increase intraocular pressure—important for patients with glaucoma.
E. ❌ Incorrect — Tremors or mild tachycardia are common side effects of albuterol and usually don’t require stopping the medication unless severe.
F. ✅ Correct — Both inhalers work synergistically to improve airway opening: albuterol relaxes smooth muscle (sympathetic action), while ipratropium blocks bronchoconstriction (parasympathetic inhibition).
Key NCLEX Takeaways:
Albuterol = Rescue → rapid relief of bronchospasm
Ipratropium = Controller → maintenance therapy to prevent symptoms
Side effects:
Albuterol: Tremor, tachycardia, nervousness
Ipratropium: Dry mouth, blurred vision (if eye contact)
Nursing priority: Evaluate effectiveness by improved breath sounds, decreased wheezing, and easier breathing
A nurse is teaching a client with asthma who is prescribed high-dose albuterol (a beta-2 adrenergic agonist). Which of the following symptoms should the nurse instruct the client to monitor and report to the healthcare provider? (Select all that apply.)
A. Tremors or shakiness
B. Palpitations or rapid heartbeat
C. Increased thirst and frequent urination
D. Unexplained fatigue or weakness
E. Dizziness and lightheadedness after standing
F. Persistent shortness of breath or worsening wheezing
A. Tremors or shakiness
B. Palpitations or rapid heartbeat
C. Increased thirst and frequent urination
D. Unexplained fatigue or weakness
F. Persistent shortness of breath or worsening wheezing
Rationale:
A & B. Tremors and palpitations are common sympathomimetic side effects from beta-2 stimulation. They should be monitored—especially if severe or persistent.
C & D. Increased thirst, frequent urination, and fatigue may indicate hyperglycemia, which can occur with high-dose or prolonged beta-2 agonist use, especially in clients with diabetes.
F. Persistent shortness of breath or worsening wheezing suggests the medication may not be effective or that bronchospasm is worsening—this requires provider evaluation.
E. Dizziness when standing (orthostatic hypotension) is not typically associated with beta-2 agonists.
A nurse is teaching a client who was prescribed codeine cough syrup for a persistent cough. Which of the following are common adverse effects of codeine? (Select all that apply.)
A. Constipation
B. Drowsiness
C. Respiratory depression
D. Increased urination
E. Nausea and vomiting
A. Constipation
B. Drowsiness
C. Respiratory depression
E. Nausea and vomiting
Rationale:
Codeine is an opioid used to suppress cough. Common adverse effects include:
Constipation – opioids slow gastrointestinal motility
Drowsiness and sedation – CNS depressant effects
Respiratory depression – dose-dependent and potentially life-threatening
Nausea and vomiting – common opioid side effect
D. Increased urination is not typical; in fact, opioids can sometimes cause urinary retention.
The biggest adverse effect to monitor for is respiratory suppression/sedation
A nurse is assessing a client who has been taking lorazepam for several weeks for anxiety. Which of the following findings should the nurse recognize as common adverse effects of benzodiazepines? (Select all that apply.)
A. Sedation
B. Dizziness
C. Respiratory suppression
D. Dry mouth
E. Impaired coordination
F. Confusion
A. Sedation
B. Dizziness
C. Respiratory suppression
E. Impaired coordination
F. Confusion
Rationale:
Benzodiazepines enhance GABA activity, leading to CNS depression. Common side effects include:
Drowsiness and fatigue
Dizziness
Impaired coordination, increasing fall risk
Respiratory depression, especially in high doses or with other CNS depressants
Hypotension
Dry mouth is not a common side effect of benzodiazepines; it is more associated with anticholinergic drugs such as TCAs or some antipsychotics.