Question 1

A client has been prescribed acetaminophen and has been instructed by the nurse not to take any over-the-counter (OTC) cough or cold medications without first checking with the health care provider or pharmacist. What is the rationale for this instruction?

A) There could be an increased risk for bleeding in the stomach and within other organs of the body.
B) Cough medications and other OTC drugs could contain acetaminophen, so inadvertent overdose could occur.
C) There is an increased risk for Reye's syndrome.
D) No one should be taking more than one medication for pain.

Cough medications and other OTC drugs could contain acetaminophen, so inadvertent overdose could occur.

Accepted Answer

Rationale 1: Acetaminophen is not implicated in bleeding.
Rationale 2: Many over-the-counter medications contain acetaminophen that could cause the client to inadvertently overdose. Acetaminophen is a primary alternative to NSAIDs when patients have a contraindication to taking aspirin or ibuprofen. It is frequently combined with other OTC cold and flu preparations and with opioid analgesics. Patients taking acetaminophen routinely should be careful to avoid overdose.
Rationale 3: Reye's syndrome occurs when children under the age of 18 are administered aspirin or other salicylates due to flu-like symptoms.
Rationale 4: Many clients require multiple medications for pain; however, they should be closely monitored by their health care provider.

Question 2

The client has been ordered Prednisone for a severe inflammatory condition. What teaching will the nurse provide the client about this drug?&#10;A) Do not discontinue this medication without consulting physician.&#10;B) Take medication on an empty stomach.&#10;C) Use Ibuprofen if needed for treatment of pain.&#10;D) Weigh daily, and check for ankle swelling.&#10;E) May take senna if you become constipated.&#10;

Accepted Answer

Rationale 1: Corticosteroid therapy should not be stopped abruptly, as the body may be used to higher levels, and this may cause an acute lack of adrenal functioning.
Rationale 2: Prednisone must be taken with food in order to prevent gastric upset.
Rationale 3: Prednisone can be irritating to the stomach and should not be taken with other drugs that have similar adverse effects.
Rationale 4: Prednisone can cause sodium and water retention, clients should weigh themselves daily and monitor for signs of fluid overload.
Rationale 5. Senna should not be taken with prednisone which may promote potassium loss.

Question 3

Last week, a client was advised to drink fluids, rest, and take aspirin to minimize symptoms of a head cold. Today the client calls the clinic and reports dizziness, nausea, and "a strange buzzing sound in my head." How should the nurse respond?

A) "Are you having difficulty hearing?"
B) "You should increase your fluid intake."
C) "Come to the clinic today."
D) "Take an additional aspirin with each dose."
E) "Are you allergic to aspirin?"

"Are you having difficulty hearing?"
"Come to the clinic today."

Accepted Answer

Rationale 1: Aspirin may be ototoxic and cause hearing loss.
Rationale 2: Dehydration may be occurring and might cause dizziness but is not a likely cause of the buzzing sound or nausea.
Rationale 3: Buzzing or ringing in the ears, nausea, and dizziness are all associated with aspirin toxicity. This client should be evaluated in the clinic.
Rationale 4: This client is likely taking too much aspirin already.
Rationale 5: Aspirin allergy does not manifest as buzzing in the ears.

Question 4

The nurse is instructing the parents of a young child on appropriate dosing of acetaminophen. Which instruction should the nurse include?&#10;A) &#34;Use the dosage cup that comes with the acetaminophen to measure the dosage.&#34;&#10;B) &#34;If you use an eyedropper to draw up the dose out of the bottle, it is not so sticky and messy.&#34;&#10;C) &#34;If you already have acetaminophen pills at home, you can crush one up and put it in juice.&#34;&#10;D) &#34;If you lose this medication cup, use a cereal spoonful to measure the dose.&#34;&#10;E) &#34;Your pharmacist may be able to supply a calibrated dosing spoon you can use for this medication.&#34;&#10;

Accepted Answer

Rationale 1: Acetaminophen should be dosed with the dosage cup included with the medication.
Rationale 2: The medication should be dosed with the medication cup that is included.
Rationale 3: Acetaminophen is enterically coated and should not be crushed. The adult formulation may not be the correct dosage for the child.
Rationale 4: Not all household spoons measure the same amount. Only a calibrated measure should be used.
Rationale 5: Calibrated dosing spoons are an acceptable alternative to the medication cup included with the drug.

Question 5

An older woman is seen in the travel clinic to receive immunization before travelling to Africa. She tells the nurse she is going to take Benadryl on the plane to help her sleep over the long flight. What conditions of the client would cause the nurse to caution her about using Benadryl?

A) Atrial fibrillation
B) Cholelithiasis
C) COPD
D) Hemolytic anemia

Accepted Answer

Rationale 1. The use of Benadryl is not contraindicated for patients who have atrial fibrillation.
Rationale 2. Cholelithiasis is not a contraindication for clients taking Benadryl.
Rationale 3. Antihistamines should be used cautiously in patients with COPD due to its anticholinergic effects which may cause bronchospasm.
Rationale 4. Hemolytic Anemia is not a contraindication for taking Benadryl.

Question 6

A pediatric nurse is educating a 6-year-old and the mother on the use of a metered-dose inhaler (MDI) with a spacer. The mother asks what the spacer is for. The nurse responds:&#10;A) &#34;Without the spacer, most of the medication does not get into the lungs because the heavier particles fall out into the throat.&#34;&#10;B) &#34;It can be difficult to properly coordinate pressing the canister and inhaling so the medication falls into the mouth instead of getting to the lungs.&#34;&#10;C) &#34;The spacer holds the medication during inhalation, so your child will not have to worry about coordination.&#34;&#10;D) &#34;The spacer is automatically activated when your child inhales, making it a lot easier to get the medication into the lungs.&#34;&#10;E) &#34;The spacer vaporizes the medication so your child can inhale it. More medication gets directly into the lungs.&#34;&#10;

Accepted Answer

Rationale 1: Even when MDIs are properly used, the majority of the aerosolized drug never reaches the lungs because the heavier particles fall out by gravity and are deposited in the throat.
Rationale 2: Because the spacer holds the medication, the client does not have to precisely coordinate inhalation with activation.
Rationale 3: The spacer holds drops that fall out of the aerosol so that less medication is deposited in the mouth and throat.
Rationale 4: A dry powder inhaler (DPI), not an MDI with spacer, is automatically activated by inhalation.
Rationale 5: A nebulizer vaporizes medication for inhalation, not a spacer.

Question 7

The nurse is providing discharge instruction to a client newly diagnosed with asthma. The client has been prescribed Salbutamol (Ventolin) for bronchospasm. Which side effects should the nurse explain to the client?

A) Restlessness
B) Tremor
C) Nervousness
D) Abnormal EKG
E) Hypertensive crisis

Accepted Answer

Rationale 1: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause restlessness.
Rationale 2: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause tremors.
Rationale 3: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause nervousness.
Rationale 4: Albuterol would be used cautiously in any client with a history of prolonged QT interval, coronary artery disease, or high blood pressure. However, this is not a side effect the client would be warned to expect.
Rationale 5: Hypertensive crisis would only occur if the client is taking monoamine oxidase inhibitors (MAOIs) at the same time as albuterol.

Deck 16: Pharmacotherapy of Inflammation, Fever and Allergies