Respiratory Medications
A nurse is teaching a client with chronic asthma about long-term management. Which statement by the client indicates correct understanding of the prescribed therapy?
A. “Using the inhaled medication daily helps prevent inflammation in my airways.”
B. “The oral form is better because it acts faster.”
C. “If I feel fine, I can skip the inhaled medication.”
D. “The inhaled drug should stop an asthma attack immediately.”
Answer: A
Rationale: Long-term asthma control focuses on reducing airway inflammation and preventing exacerbations, not just treating acute symptoms. Inhaled corticosteroids (ICS) are the foundation of long-term asthma management and are most effective when taken daily, even when symptoms are not present. They work by reducing inflammation, swelling, and mucus production, making the airways less reactive to triggers and improving overall asthma control.
Options B and D confuse oral medications and rescue inhalers with maintenance therapy. While oral corticosteroids may act faster, they are typically reserved for acute exacerbations due to their systemic side effects. Option C reflects a misunderstanding, as skipping daily ICS can lead to poor asthma control and increased risk of attacks.
A new graduate nurse plans to verify IV medication compatibility by asking another new nurse on the unit. Which response by the preceptor is most appropriate?
A. “That’s fine if your coworker has used the drugs before.”
B. “You should always check with the hospital pharmacist or compatibility database.”
C. “Rely on your clinical judgment and observe the IV line.”
D. “Wait until the provider returns to the unit to ask.”
Answer: B
Rationale: Verifying IV medication compatibility is a critical safety step to prevent adverse drug interactions, precipitation, or reduced efficacy. Relying on another nurse’s experience or personal judgment is not a safe or evidence-based practice. The most reliable sources for compatibility information are hospital pharmacists and validated compatibility databases or charts, such as Lexicomp or Micromedex. Consulting these resources ensures accurate, up-to-date information and supports safe medication administration practices.
A nurse is educating a client recently diagnosed with influenza about oseltamivir therapy. For maximum effectiveness, when should the client begin taking oseltamivir?
A. Within 72 hours after the first cough
B. Within 7 days of exposure
C. Within 24 hours of fever resolution
D. Within 48 hours of symptom onset
Answer: D
Rationale: Oseltamivir (Tamiflu) is an antiviral medication used to treat influenza. It works by inhibiting the neuraminidase enzyme, which helps prevent the virus from spreading in the body. For optimal effectiveness, oseltamivir should be initiated within 48 hours of the onset of flu symptoms. Starting treatment within this window can reduce the duration and severity of symptoms and lower the risk of complications such as pneumonia or hospitalization. Delayed initiation beyond 48 hours significantly reduces the drug’s efficacy, especially in otherwise healthy individuals. [cdc.gov], [drugs.com], [salispharm.com]
Which instruction supports effectiveness of guaifenesin?
A. “Limit coughing to let the throat rest.”
B. “Avoid humidifiers.”
C. “Take with dairy products.”
D. “Drink plenty of fluids throughout the day.”
Answer:D
Rationale: Guaifenesin is an expectorant that helps loosen and thin mucus, making it easier to cough up. Adequate hydration is essential to enhance its effectiveness. The other options reflect incorrect or potentially harmful practices, as coughing helps clear mucus, humidifiers can aid breathing, and dairy may thicken secretions for some individuals.
A client with exercise-induced asthma is prescribed an inhaler for quick relief before physical activity. Which medication should the nurse anticipate administering?
A. Budesonide
B. Formoterol
C. Albuterol
D. Ipratropium
Answer: C
Rationale: Albuterol is a short-acting beta-agonist (SABA) used for quick relief of bronchospasm and is the preferred medication for preventing exercise-induced asthma symptoms. Budesonide is a corticosteroid used for long-term control, formoterol is a long-acting beta-agonist, and ipratropium is an anticholinergic not typically used for rapid relief in asthma.
The nurse is providing discharge teaching to a client newly prescribed tiotropium for long-term management of chronic obstructive pulmonary disease (COPD). Which statement by the client indicates correct understanding of the medication?
A. “This medication might slow down my heart rate.”
B. “If my cough gets worse, I’ll stop taking the inhaler.”
C. “I may get a dry mouth, so I’ll drink water throughout the day.”
D. “I’ll use this inhaler when I have sudden shortness of breath.”
Answer: C
Rationale: Tiotropium is a long-acting anticholinergic used for daily maintenance in COPD, not for acute symptom relief. A common side effect is dry mouth, so staying hydrated can help manage discomfort. It does not slow heart rate, and worsening symptoms should be reported rather than stopping the medication. It is not a rescue inhaler and should not be used for sudden breathing problems.
A nurse is preparing to educate the parents of a child prescribed amoxicillin/clavulanate for acute sinusitis. Which statements reflect accurate information about this medication’s drug class and administration? (Select all that apply.)
A. This medication is a combination antibiotic that includes a beta-lactam and a beta-lactamase inhibitor
B. It belongs to the macrolide class and may cause hearing loss
C. It should be administered with food to reduce gastrointestinal side effects
D. The suspension should be shaken well before each dose to ensure proper mixing
E. It is safe to measure doses using a kitchen teaspoon for convenience
Answer: A, C, D
Rationale: Amoxicillin/clavulanate is a combination antibiotic that includes a beta-lactam (amoxicillin) and a beta-lactamase inhibitor (clavulanate), designed to overcome bacterial resistance. It should be taken with food to reduce gastrointestinal side effects, and the liquid suspension must be shaken well before each dose to ensure proper mixing. Accurate dosing is essential, so parents should use a pharmacy-provided syringe or cup rather than household utensils. While some antibiotics may cause mild side effects, a rash with this medication could signal an allergic reaction and should be reported.
The nurse is providing discharge education to a client prescribed ciprofloxacin. Which statement should be included in the teaching?
A. “Report any tendon pain or swelling.”
B. “Limit water intake while taking this medication.”
C. “Expect blurred vision as a common side effect.”
D. “Take with calcium-rich foods to improve absorption.”
Answer: A
Rationale: Ciprofloxacin is a fluoroquinolone antibiotic that carries a black box warning for tendon inflammation and rupture, particularly in older adults, those on corticosteroids, and individuals with kidney, heart, or lung transplants. Clients should be instructed to report any tendon pain, swelling, or inflammation immediately, as these symptoms may indicate early signs of tendon injury.
A nurse is preparing to administer a bronchodilator to a client with asthma. Under which circumstance is a nebulized breathing treatment preferred over a metered-dose inhaler (MDI)?
A. When the client is able to coordinate inhalation with device activation
B. When aerosolization of pathogens must be minimized
C. When the client requires supplemental oxygen during medication administration
D. When rapid medication delivery is needed in a busy clinical setting
Answer: C
Rationale: Nebulized breathing treatments are preferred in certain clinical situations, especially when a client is hypoxic and requires supplemental oxygen. Nebulizers can deliver medication simultaneously with oxygen, which is not possible with standard MDIs. They are also beneficial for clients who have difficulty coordinating inhalation, such as young children or those in respiratory distress.
A nurse is reviewing new prescriptions for a client with a documented history of severe penicillin allergy. Which medication order should the nurse question?
A. Cephalexin
B. Azithromycin
C. Doxycycline
D. Clindamycin
Answer: A
Rationale: Cephalexin is a first-generation cephalosporin, which shares a similar beta-lactam ring structure with penicillins. Although cross-reactivity between penicillins and cephalosporins is relatively low (especially with later generations), first-generation cephalosporins like cephalexin have a higher risk of cross-reactivity, particularly in clients with a Type I hypersensitivity reaction (e.g., anaphylaxis) to penicillin. In such cases, it is safest to avoid cephalosporins unless allergy testing confirms tolerance. Azithromycin, doxycycline, and clindamycin are non-beta-lactam antibiotics and are generally considered safe alternatives for clients with severe penicillin allergies.
The nurse is reviewing influenza vaccination options with several clients. Which client should not receive the live-attenuated intranasal influenza vaccine (LAIV)?
A. A healthy 22-year-old college student
B. A 28-year-old with no health problems
C. A 40-year-old teacher
D. A 3-year-old diagnosed with leukemia
Answer: D
Rationale: The live-attenuated influenza vaccine (LAIV), administered as a nasal spray, is approved for use in healthy, non-pregnant individuals aged 2 through 49 years. However, immunocompromised individuals, such as those with leukemia, should not receive LAIV due to the risk of infection from the live virus. These clients should instead receive an inactivated influenza vaccine. Other contraindications include pregnancy, children under 2 years, and individuals with certain chronic conditions like asthma or recent wheezing episodes in young children.
The nurse is reviewing medications with a group of clients. Which client should avoid using codeine cough syrup?
A. An adolescent with seasonal allergies
B. A post-operative client recovering from surgery
C. A client diagnosed with chronic obstructive pulmonary disease (COPD)
D. A client experiencing a mild headache
Answer: C
Rationale: Codeine is an opioid cough suppressant that can cause respiratory depression, making it potentially dangerous for clients with COPD or other chronic respiratory conditions. These individuals are at increased risk for breathing difficulties, and codeine may worsen respiratory function. While other clients may experience side effects, they are not at the same level of risk as those with compromised lung function.
The nurse is teaching a client about a new prescription for formoterol. Which statement by the client indicates correct understanding of this medication?
A. “I’ll use this medication only when I’m short of breath.”
B. “This inhaler helps prevent symptoms, but it’s not for sudden attacks.”
C. “I’ll take this instead of my rescue inhaler.”
D. “If I feel fine, I don’t need to use it daily.”
Answer: B
Rationale: Formoterol is a long-acting beta-agonist (LABA) used for maintenance therapy in asthma and COPD. It helps prevent symptoms but is not appropriate for acute relief. It should be used consistently, even when symptoms are controlled, and not replaced with a rescue inhaler during sudden episodes of shortness of breath.
A hospitalized client is receiving IV methylprednisolone for a severe COPD exacerbation. Which finding indicates the medication is having a therapeutic effect?
A. Persistent productive cough with thick sputum
B. Decreased wheezing and improved oxygen saturation
C. Elevated blood glucose level
D. Development of oral candidiasis
Answer: B
Rationale: Methylprednisolone is a corticosteroid used to reduce airway inflammation during COPD exacerbations. A decrease in wheezing and improvement in oxygen saturation are signs of effective treatment. Elevated blood glucose and oral candidiasis are side effects, while a persistent productive cough may still occur and does not necessarily reflect therapeutic improvement.
A client with cystic fibrosis develops a Pseudomonas aeruginosa lung infection and is prescribed aztreonam (Azactam). Which statement about this medication is accurate?
A. “Aztreonam is taken by mouth with meals.”
B. “Aztreonam is a monobactam antibiotic often used in people allergic to penicillin.”
C. “Aztreonam causes cross-reactivity in all beta-lactam allergic individuals.”
D. “Aztreonam is mainly used to treat fungal infections.”
Answer: B
Rationale: Aztreonam is a monobactam antibiotic used to treat gram-negative bacterial infections, including Pseudomonas aeruginosa. It is often chosen for clients with penicillin allergies because it has minimal cross-reactivity with other beta-lactam antibiotics. It is not administered orally, does not treat fungal infections, and does not cause cross-reactivity in all beta-lactam allergic individuals.
A nurse is reviewing a new antibiotic order for a client with suspected pneumonia. The provider has prescribed empiric therapy. Which statement best describes this approach?
A. Antibiotics used only for resistant infections
B. Medications given to prevent infection
C. Treatment started before the specific pathogen is identified
D. Therapy initiated after culture results are available
Answer: C
Rationale: Empiric therapy refers to the initiation of treatment (often with antibiotics) based on the most likely pathogens and clinical presentation, before the exact causative organism has been identified through cultures or diagnostic testing. This approach is common in urgent or serious infections where waiting for lab results could delay necessary care.
The nurse is evaluating a client’s response to prescribed medications for chronic obstructive pulmonary disease (COPD). Which outcome best indicates effective medication management?
A. Lung tissue regeneration
B. Absence of chronic cough
C. Reports less dyspnea with exertion
D. Oxygen saturation consistently 100%
Answer: C
Rationale: COPD is a progressive, irreversible respiratory condition characterized by airflow limitation and chronic symptoms such as dyspnea, cough, and sputum production. The primary goal of medication management is to reduce symptoms, improve exercise tolerance, and prevent exacerbations, not to cure the disease or regenerate lung tissue. Reporting less dyspnea with exertion reflects improved functional status and effective symptom control, aligning with evidence-based goals for COPD care.
The nurse is monitoring a client receiving gentamicin therapy. Which finding is most concerning and suggests possible drug toxicity?
A. Flushed skin
B. Tinnitus
C. Elevated temperature
D. Muscle cramps
Answer: B
Rationale: Gentamicin is an aminoglycoside antibiotic known for its potential ototoxic and nephrotoxic effects. Tinnitus (ringing in the ears) is an early sign of ototoxicity, which may progress to irreversible hearing loss if not addressed promptly. Other signs of ototoxicity include dizziness, vertigo, and balance disturbances. Nephrotoxicity may present as decreased urine output, elevated creatinine, or swelling in the lower extremities. Flushed skin, fever, and muscle cramps are not typical indicators of gentamicin toxicity and may be related to other conditions or side effects. Prompt recognition of tinnitus is essential to prevent permanent auditory damage.
The nurse is planning a community flu vaccination clinic. Which group should receive priority for annual influenza vaccination?
A. Individuals with a history of egg allergy
B. Postoperative orthopedic patients
C. Clients with chronic pulmonary disease
D. Healthy adults under age 30
Answer: C
Rationale: While annual influenza vaccination is recommended for everyone aged 6 months and older, certain populations are prioritized due to their higher risk of severe complications from the flu. These include older adults, young children, pregnant individuals, and those with chronic medical conditions such as chronic pulmonary disease (e.g., asthma, COPD). These individuals are more likely to experience serious outcomes like pneumonia, hospitalization, or death if infected with influenza. Although people with egg allergies can still receive the flu vaccine, they are not considered a priority group unless they also have other risk factors.
During an antibiotic infusion, a client suddenly develops stridor and hypotension. What is the nurse’s priority action?
A. Stop the infusion immediately
B. Recheck the client’s blood pressure
C. Administer an antipyretic
D. Document the findings
Answer: A
Rationale: Stridor and hypotension during an antibiotic infusion may indicate a severe allergic reaction or anaphylaxis, which is a medical emergency. The nurse’s first and most critical action is to stop the infusion immediately to prevent further exposure to the offending agent. Rechecking vital signs and documenting are important but should follow after the infusion is stopped. Administering an antipyretic is not appropriate in this situation.
A child is prescribed budesonide, an inhaled corticosteroid, for long-term management of chronic asthma. Which teaching point is most important for the nurse to include during discharge education?
A. “Rinse your mouth after each use.”
B. “Use this medication for quick relief during an asthma attack.”
C. “Skip doses when you feel well.”
D. “You can stop the drug once your symptoms improve.”
Answer: A
Rationale: Budesonide is an inhaled corticosteroid used for daily maintenance of asthma symptoms. Rinsing the mouth after each use is essential to prevent oral thrush, a common side effect. It is not intended for acute symptom relief, and should be used consistently, even when the child feels well. Stopping the medication without medical advice can lead to worsening asthma control.
A nurse is reviewing discharge instructions with a client prescribed roflumilast for chronic obstructive pulmonary disease (COPD). Which statement by the client indicates a need for further teaching?
A. “This medication helps decrease the number of flare-ups I have.”
B. “If I get diarrhea or lose weight, I should tell my provider.”
C. “I’ll take this only when I feel short of breath.”
D. “I might have mild headache or nausea.”
Answer: C
Rationale: Roflumilast is a daily oral medication used to reduce inflammation and prevent COPD exacerbations, not to treat acute symptoms like shortness of breath. It should be taken regularly as prescribed, regardless of symptom presence. The other statements reflect accurate understanding of the medication’s purpose and potential side effects, such as diarrhea, weight loss, headache, and nausea.
The nurse is preparing to administer a dose of vancomycin to a hospitalized client. Which action is most appropriate to perform before giving the medication?
A. Obtain a serum trough level before the next dose.
B. Administer the dose as a rapid IV bolus.
C. Mix vancomycin with other antibiotics in the same IV line.
D. Stop the infusion if the client develops mild flushing.
Answer: A
Rationale: Vancomycin requires serum trough level monitoring before the next dose to ensure therapeutic effectiveness and prevent toxicity, particularly nephrotoxicity and ototoxicity. It should be administered slowly via IV infusion, not as a bolus, to avoid infusion-related reactions like red man syndrome. Mild flushing may occur but does not require stopping the infusion; instead, slowing the rate is recommended. Vancomycin should not be mixed with other antibiotics in the same IV line due to potential incompatibilities.
After administering an intramuscular dose of penicillin, which nursing action is most important to ensure client safety?
A. Observe the client for at least 30 minutes for signs of allergic reaction
B. Leave immediately after injection to reduce anxiety
C. Encourage the client to ambulate and exercise the muscle
D. Instruct the client to take an oral antihistamine afterward
Answer: A
Rationale: Penicillin is associated with a risk of serious allergic reactions, including anaphylaxis, which can occur shortly after administration. Standard nursing protocol requires observing the client for at least 30 minutes post-injection to monitor for signs such as rash, itching, swelling, respiratory distress, or hypotension. This allows for prompt intervention if a reaction occurs.
The nurse is teaching a client about the use of mucolytic medications. Which statement by the client indicates correct understanding?
A. “It causes bronchodilation.”
B. “It helps loosen thick mucus so it can be coughed up.”
C. “It suppresses the cough reflex.”
D. “It is used to prevent asthma attacks.”
Answer: B
Rationale: Mucolytics, such as acetylcysteine, work by breaking down the chemical structure of mucus, making it thinner and easier to clear from the airways. This helps improve airway clearance, especially in conditions like COPD, cystic fibrosis, or bronchitis. They do not cause bronchodilation (Option A), do not suppress the cough reflex (Option C), and are not used to prevent asthma attacks (Option D). Instead, they support respiratory function by facilitating mucus removal.
The nurse is preparing to administer vancomycin IV to a hospitalized client. Which nursing action best helps prevent an infusion-related reaction?
A. Mix with other antibiotics
B. Increase flow rate for quick completion
C. Infuse over at least 1 hour
D. Flush line rapidly after infusion
Answer: C
Rationale: Vancomycin is associated with a common infusion-related reaction known as Vancomycin Infusion Reaction (VIR), previously referred to as "Red Man Syndrome." This reaction is not a true allergic response, but rather a rate-dependent pseudo-allergic reaction caused by histamine release due to rapid infusion. Symptoms include flushing, pruritus, rash, and hypotension, typically affecting the face, neck, and upper torso.
To prevent VIR, vancomycin should be infused slowly- typically over at least 60 minutes for doses ≤1 gram. Larger doses may require even longer infusion times (e.g., 90-120 minutes). Mixing vancomycin with other antibiotics or flushing the line rapidly does not prevent this reaction and may increase risk. Increasing the flow rate is contraindicated, as it directly contributes to the development of VIR.
A nurse is teaching a group of clients about influenza prevention. Which statement indicates correct understanding of the flu vaccine?
A. “I’ll wait to get vaccinated until I feel sick.”
B. “The vaccine cannot cause the flu.”
C. “It replaces good hand hygiene.”
D. “I don’t need it every year.”
Answer: B
Rationale: Flu vaccines administered by injection contain inactivated (killed) viruses or recombinant proteins, which cannot cause influenza. The nasal spray version contains a live-attenuated virus, but it is weakened and also does not cause the flu in healthy individuals. Statements A, C, and D reflect common misconceptions. Vaccination should be done before symptoms appear, not after. Hand hygiene remains essential even with vaccination, as it helps prevent the spread of many respiratory viruses. Finally, annual vaccination is necessary because flu strains change each year and immunity wanes over time.
A client’s anaphylaxis symptoms persist 10 minutes after epinephrine. What’s next?
A. Apply cold compresses
B. Reassess in one hour
C. Administer IV corticosteroid
D. Repeat IM epinephrine
Answer: D
Rationale: In cases of persistent anaphylaxis, a repeat dose of intramuscular epinephrine is the priority intervention if symptoms continue after the initial dose. Epinephrine is the first-line treatment for anaphylaxis and may need to be repeated every 5-15 minutes. Cold compresses and corticosteroids may be supportive but are not immediate interventions. Delaying reassessment for an hour is inappropriate in an emergency situation.
The nurse is teaching a client about proper use and side effects of an ipratropium inhaler. Which statement by the client indicates correct understanding?
A. “It quickly opens my airways during an asthma attack.”
B. “It works by relaxing my airways through beta receptors.”
C. “It might cause a dry mouth, so I’ll keep water nearby.”
D. “I should use this before my rescue inhaler.”
Answer: C
Rationale: Ipratropium is a short-acting anticholinergic bronchodilator used for maintenance therapy in conditions like COPD and sometimes as an adjunct in asthma. A common side effect is dry mouth, so staying hydrated can help manage discomfort. It does not act on beta receptors and is not a fast-acting rescue medication for acute asthma symptoms. It should be used as prescribed, typically after a rescue inhaler if both are ordered.
A client with seasonal allergies is prescribed diphenhydramine. Which statement by the client indicates correct understanding of the medication?
A. “I’ll take this before bed since it might make me sleepy.”
B. “This drug will shrink swollen nasal passages.”
C. “It will thin my mucus and make coughing easier.”
D. “I can take this right before getting my flu shot to prevent side effects.”
Answer: A
Rationale: Diphenhydramine is a first-generation antihistamine commonly used to treat allergic symptoms such as sneezing, itching, and runny nose. It often causes drowsiness, so taking it at bedtime is appropriate. It does not shrink nasal passages (like decongestants), thin mucus, or prevent side effects from vaccines. The other statements reflect misunderstandings of the drug’s purpose and effects.
A client with seasonal allergic rhinitis is prescribed fexofenadine. The nurse is reviewing the expected therapeutic effects of the medication. Which symptom is least likely to improve with fexofenadine treatment?
A. Itchy eyes and nose
B. Runny nose
C. Nasal congestion
D. Sneezing
Answer: C
Rationale: Fexofenadine is a second-generation antihistamine that effectively treats symptoms like itching, sneezing, and runny nose by blocking histamine receptors. However, nasal congestion is primarily caused by vascular swelling and inflammation, which may not respond well to antihistamines alone. Decongestants or intranasal corticosteroids are often needed to relieve congestion.
A nurse is educating a group of adults about the different types of influenza vaccines available in the United States. Which statements are accurate regarding influenza vaccines? (Select all that apply.)
A. The inactivated influenza vaccine (IIV) contains a killed virus and is administered intramuscularly.
B. The recombinant influenza vaccine (RIV) contains live virus and is given as a nasal spray.
C. The live attenuated influenza vaccine (LAIV) is recommended for healthy, non-pregnant individuals aged 2–49 years.
D. The recombinant influenza vaccine (RIV) is suitable for individuals with egg allergies.
E. Cell-based (ccIIV) and adjuvanted (aIIV) vaccines are considered distinct categories separate from inactivated vaccines.
Answers: A, C, D
Rationale:
A. Correct. The inactivated influenza vaccine (IIV) contains killed virus and is typically administered intramuscularly. It is safe for most populations, including those with chronic conditions.
B. Incorrect. The recombinant influenza vaccine (RIV) does not contain live virus and is not given as a nasal spray. It is administered intramuscularly and is produced without eggs, making it suitable for individuals with egg allergies.
C. Correct. The live attenuated influenza vaccine (LAIV) is given as a nasal spray and is recommended only for healthy, non-pregnant individuals aged 2-49 years.
D. Correct. The RIV is made using recombinant technology and does not use eggs, making it a good option for clients with egg allergies.
E. Incorrect. Both cell-based (ccIIV) and adjuvanted (aIIV) vaccines are types of inactivated influenza vaccines, not separate categories.
A client using an albuterol inhaler reports using it approximately 12 times per day and experiencing insomnia and palpitations. What should the nurse suspect?
A. Normal medication response
B. Systemic beta-adrenergic stimulation
C. Allergic reaction
D. Anticholinergic side effect
Answer: B
Rationale: Albuterol is a short-acting beta-2 adrenergic agonist (SABA) used for quick relief of bronchospasm in conditions like asthma and COPD. Frequent use (such as 12 times daily) can lead to systemic absorption, resulting in beta-adrenergic side effects like tachycardia, palpitations, tremors, and insomnia. These symptoms indicate overuse and possible poor asthma control, warranting reassessment of the treatment plan.
The nurse is preparing to administer IV erythromycin and ondansetron to a hospitalized client. Which action is most appropriate?
A. Administer both medications together in the same IV line
B. Request an alternative antiemetic from the provider
C. Crush tablets before mixing in IV solution
D. Administer additional IV fluids to dilute the medications
Answer: B
Rationale: Erythromycin and ondansetron both carry a risk of QT interval prolongation, which can lead to serious and potentially life-threatening arrhythmias such as torsades de pointes. Administering them together may result in additive effects on cardiac conduction, especially in clients with underlying heart conditions or electrolyte imbalances. Therefore, the nurse should question the concurrent use and advocate for an alternative antiemetic that does not pose the same cardiac risk. Mixing tablets in IV solutions (Option C) is inappropriate and unsafe, and administering extra fluids (Option D) does not mitigate the risk of drug interaction. Administering both drugs together (Option A) could increase the risk of adverse cardiac events.
Oseltamivir is prescribed for a client with flu-like symptoms. The nurse understands this medication is most effective in managing illness caused by which viruses? (Select all that apply.)
A. Influenza type A
B. Influenza type B
C. Human papillomavirus (HPV)
D. Epstein–Barr virus (EBV)
Answers: A, B
Rationale: Oseltamivir (Tamiflu) is an antiviral medication used to treat and prevent influenza A and B. It works by inhibiting the neuraminidase enzyme, which helps stop the virus from spreading in the body. It is not effective against viruses like HPV or EBV, which are unrelated to influenza and require different treatment approaches.
The nurse is caring for a client prescribed cromolyn sodium via inhalation for the management of allergic asthma. Which finding requires immediate intervention?
A. Mild cough and throat irritation after inhalation
B. Drowsiness reported after medication use
C. Bronchospasm occurring shortly after drug administration
D. Increased nasal discharge and sneezing
Answer: C
Rationale: Cromolyn sodium is a mast cell stabilizer used prophylactically to prevent asthma symptoms and allergic reactions. It is not a rescue medication and does not treat acute asthma attacks. While mild side effects such as cough, throat irritation, drowsiness, and nasal symptoms are relatively common and typically self-limiting, bronchospasm following inhalation is a serious and potentially life-threatening adverse reaction. It may indicate hypersensitivity or paradoxical worsening of asthma symptoms and requires immediate medical evaluation and possible discontinuation of the drug.
A client with chronic asthma is prescribed salmeterol for long-term symptom control. Which nursing statement best explains the purpose of this medication?
A. “It quickly opens your airways during sudden shortness of breath.”
B. “It reduces inflammation by suppressing your immune system.”
C. “It provides long-acting bronchodilation to help prevent asthma symptoms.”
D. “It dries up mucus to make breathing easier.”
Answer: C
Rationale: Salmeterol is a long-acting beta-agonist (LABA) used for maintenance therapy in asthma. It works by providing prolonged bronchodilation, helping to prevent symptoms and reduce the frequency of asthma attacks. It is not intended for quick relief during acute episodes, and it does not reduce inflammation or dry secretions. For sudden symptoms, a short-acting beta-agonist (SABA) like albuterol is preferred.
A client asks the nurse how pseudoephedrine (Sudafed) helps relieve nasal congestion. Which explanation by the nurse is accurate?
A. “It causes the blood vessels in your nasal passages to shrink.”
B. “It blocks histamine from binding to nasal receptors.”
C. “It acts as an expectorant to thin mucus.”
D. “It increases mucus production to clear your airway.”
Answer: A
Rationale: Pseudoephedrine is a decongestant that works by vasoconstricting blood vessels in the nasal passages, which reduces swelling and congestion. It does not block histamine receptors like antihistamines, nor does it act as an expectorant or increase mucus production. Its primary action is to relieve nasal congestion by decreasing blood flow to swollen nasal tissues.
The nurse is teaching a client who has been prescribed clindamycin. Which adverse effect should the client be instructed to report immediately?
A. Blurred vision
B. Hearing loss
C. Profuse watery diarrhea
D. Oral thrush
Answer: C
Rationale: Clindamycin is an antibiotic that carries a risk of Clostridioides difficile (C. diff) infection, which can cause severe, watery diarrhea. This is a serious adverse effect that requires prompt medical attention. Blurred vision and hearing loss are not typical side effects of clindamycin, and while oral thrush can occur, it is less urgent and not as potentially life-threatening as C. diff-associated diarrhea.
A client with a severe infection and circulatory collapse is receiving IV corticosteroids and antibiotics. The nurse notes new onset of confusion and nausea. Which assessment finding is the highest priority to report to the provider?
A. Blood glucose 285 mg/dL (15.8 mmol/L)
B. White blood cell count 15,800/mm³ (15.8 × 10⁹/L)
C. Generalized pitting edema in the lower extremities
D. Irregular heart rate with a pulse of 56 beats/min
Answer:D
Rationale: While elevated blood glucose and WBC count are expected findings in clients receiving corticosteroids and being treated for severe infection, an irregular heart rate with bradycardia (pulse of 56 bpm) is most concerning in the context of circulatory collapse and new confusion. This could indicate worsening hemodynamic instability, electrolyte imbalance, or cardiac involvement, all of which require immediate provider notification. Changes in vital signs and mental status are red flags in critically ill patients and must be prioritized for prompt intervention.