A
What is the first step of the nursing process with patients who are receiving drug therapy?
Assessment
What are important considerations when giving a decongestant such as Phenylephrine or Pseudoephedrine?
Rebound congestion
abuse possible
A patient receives epinephrine for anaphylaxis. Which assessment indicates the medication is having a dangerous effect, not a therapeutic one?
a. Improved air movement
b. Resolving hives
c. Ventricular tachycardia on the monitor
d. Increased blood pressure
c. Ventricular tachycardia on the monitor
Which assessment finding in a patient taking prednisone for an asthma flare is MOST life-threatening?
a. Increased appetite
b. Blood glucose 350 mg/dL
c. Mild mood swings
d. Facial swelling
b. Blood glucose 350 mg/dL
High-dose steroids cause hyperglycemia that can progress to DKA or hyperosmolar crisis.
A patient prescribed zafirlukast (Accolate) presents with nausea, jaundice, and right upper quadrant pain. What complication does the nurse suspect?
a. Pancreatitis
b. Liver toxicity
c. Viral infection
d. Allergic reaction
b. Liver toxicity
Zafirlukast is hepatotoxic; jaundice + RUQ pain are signs of liver injury.
Name a 1st generation antihistamine
diphenhydramine (Benadryl)
What are important considerations when giving steroids?
must be tapered
rare: can slow linear pediatric growth
A patient taking benzonatate (Tessalon Pearls) reports numbness of the mouth after chewing the capsule. What is the nurse’s PRIORITY?
a. Give warm fluids
b. Assess airway immediately
c. Hold the next dose
d. Notify the provider during rounds
b. Assess airway immediately
A patient using an inhaled corticosteroid reports painful white patches in the mouth and throat. What complication is the nurse concerned about?
a. Oral candidiasis
b. Viral stomatitis
c. Dehydration
d. Chemical irritation
a. Oral candidiasis
This fungal infection can spread down the throat and impair swallowing/breathing.
A patient receiving montelukast (Singulair) reports new-onset suicidal thoughts. What is the nurse’s PRIORITY?
a. Recommend meditation
b. Document the finding and continue
c. Discontinue medication and notify provider STAT
d. Suggest taking it at bedtime
c. Discontinue medication and notify provider STAT
Montelukast carries a black box warning for neuropsychiatric effects including suicidal ideation.
A patient asks what medication would be most effective in the treatment of seasonal hay fever. The nurse will teach the patient about the use of:
A. azelastine (Astelin).
B. chlorpheniramine (Chlor-Trimeton).
C. fluticasone (Flonase).
D. pseudoephedrine (Sudafed).
C. fluticasone (Flonase).
What would you watch for if a patient was administered opioid antitussives?
Respiratory depression
A patient taking dextromethorphan presents with slurred speech, hallucinations, and decreased respirations. What complication is occurring?
a. Anaphylaxis
b. CNS depression from overdose
c. Serotonin withdrawal
d. Hypoglycemia
b. CNS depression from overdose
Which statement by the client indicates that more patient education is needed?
a) I gargle with water after I use my inhalers.
b) I use my Flovent inhaler everyday on a schedule and I use my albuterol when I am having an acute asthma attack, or before I exercise.
c) I have trouble with my hand lung coordination so I stopped using the spacer with my inhaler
d) I am taking Claritin for my hay fever which often triggers my asthma.
c) I have trouble with my hand lung coordination so I stopped using the spacer with my inhaler
A patient has been using diphenhydramine daily for sleep. Which finding is MOST dangerous?
a. Dry mouth
b. Drowsiness
c. Urinary retention
d. Respiratory depression with slowed breathing
d. Respiratory depression with slowed breathing
Diphenhydramine is a CNS depressant → high doses + long-term use can suppress breathing.
A child rushes into the camp nurse office wheezing and gasping “asthma attack”. Which inhaler does the nurse grab?
A. the one marked expired
B. the one containing a steroid such as Flovent (fluconasone)
C. the combination containing both a steroid and rescue ingredient such as Advair (fluconasone and salmeterol)
D. the one containing (albuterol) Ventolin
D. the one containing (albuterol) Ventolin
When administering benzonatate (Tessalon Pearls), what do you have to be sure to tell the patient?
Swallow whole
Do not crush or chew
Can cause spasm or numbness
A patient using oxymetazoline (Afrin) nasal spray for 10 days reports worsening congestion and headaches. What action is MOST important?
a. Encourage continued use
b. Discontinue the medication immediately
c. Switch to diphenhydramine
d. Take the spray with food
b. Discontinue the medication immediately
Extended use causes rebound congestion (rhinitis medicamentosa). The drug must be stopped.
A patient with a history of coronary artery disease is prescribed isoproterenol (bronchodilator) for bronchospasm. Which symptom requires IMMEDIATE intervention?
a. Heart rate 110
b. Lightheadedness
c. Chest pain
d. Dry mouth
c. Chest pain
Isoproterenol increases oxygen demand and can trigger MI in patients with coronary disease
Which symptom in a patient receiving epinephrine indicates the medication should be STOPPED?
a. BP increases from 90/60 to 110/70
b. Heart rate 118
c. New onset chest pain
d. Skin pallor
c. New onset chest pain
Chest pain = possible myocardial ischemia from excessive beta-1 stimulation.
What oral medication is given if a patient is experiencing anaphylaxis?
50mg diphenhydramine (Benadryl)
A patient with a severe asthma attack receives repeated albuterol nebulizers. Which assessment finding is MOST concerning?
a. Heart rate 128
b. Tremors
c. Oxygen saturation 89%
d. Complaints of nervousness
c. Oxygen saturation 89%
Which of the following statements concerning antihistamines by the patient is accurate?
A. “I shouldn’t take loratadine (Alavert) before driving.”
B. “Loratadine (Claritin) should help with my allergy symptoms like sneezing and running eyes.”
C. “I should first take loratadine (Alavert) for my peanut allergy instead of the diphenhydramine (Benadryl)”
D. “It is OK for me to take diphenhydramine (Benadryl) before drinking alcohol (ETOH).”
B. “Loratadine (Claritin) should help with my allergy symptoms like sneezing and running eyes.”
A patient taking metaproterenol (bronchodilator) develops palpitations and irregular heartbeats. What is the nurse’s PRIORITY?
a. Increase fluid intake
b. Assess cardiac rhythm
c. Administer another dose
d. Teach to take medication with food
b. Assess cardiac rhythm
Beta-agonists can cause life-threatening dysrhythmias; assess rhythm before deciding next steps.
A patient using albuterol inhaler every 2–3 hours reports worsening wheezing and fatigue. What is the nurse’s FIRST priority?
a. Teach proper inhaler technique
b. Administer another albuterol dose
c. Notify the provider of possible impending respiratory failure
d. Encourage slow deep breathing
c. Notify the provider of possible impending respiratory failure
Overuse of albuterol signals severe uncontrolled asthma → risk for status asthmaticus.