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Questions and Answers
A client with heart failure is prescribed furosemide. Which parameter should the nurse prioritize monitoring to prevent a potential adverse effect of this medication?
A client with heart failure is prescribed furosemide. Which parameter should the nurse prioritize monitoring to prevent a potential adverse effect of this medication?
- Blood glucose levels
- Serum potassium levels (correct)
- Intracranial pressure
- Uric acid levels
A patient with a history of asthma is prescribed albuterol. The nurse should educate the patient to recognize and report which potential adverse effect indicating excessive sympathetic stimulation?
A patient with a history of asthma is prescribed albuterol. The nurse should educate the patient to recognize and report which potential adverse effect indicating excessive sympathetic stimulation?
- Tremors and palpitations (correct)
- Muscle weakness and polyuria
- Bradycardia and hypotension
- Lethargy and constipation
A patient with COPD is prescribed ipratropium. Which assessment finding would warrant caution by the nurse before administering this medication?
A patient with COPD is prescribed ipratropium. Which assessment finding would warrant caution by the nurse before administering this medication?
- Presence of clear sputum production
- Reports of occasional dry mouth
- History of glaucoma (correct)
- Complaints of mild constipation
A client with asthma is prescribed budesonide via inhalation. What instruction should the nurse provide to minimize the risk of a common adverse effect?
A client with asthma is prescribed budesonide via inhalation. What instruction should the nurse provide to minimize the risk of a common adverse effect?
A patient is prescribed theophylline for chronic bronchitis. The nurse understands that which substance can significantly alter the drug's therapeutic level, potentially leading to toxicity?
A patient is prescribed theophylline for chronic bronchitis. The nurse understands that which substance can significantly alter the drug's therapeutic level, potentially leading to toxicity?
A patient taking spironolactone for heart failure should be educated to limit the intake of foods high in potassium to prevent which potential adverse effect?
A patient taking spironolactone for heart failure should be educated to limit the intake of foods high in potassium to prevent which potential adverse effect?
A patient with cerebral edema is prescribed mannitol. Which assessment finding would indicate a therapeutic effect of this medication?
A patient with cerebral edema is prescribed mannitol. Which assessment finding would indicate a therapeutic effect of this medication?
A patient with nasal congestion due to a cold is considering using pseudoephedrine. The nurse should advise caution in patients with which coexisting condition?
A patient with nasal congestion due to a cold is considering using pseudoephedrine. The nurse should advise caution in patients with which coexisting condition?
A patient with allergic rhinitis is prescribed diphenhydramine. The nurse should include which instruction in the patient's education to address a common adverse effect?
A patient with allergic rhinitis is prescribed diphenhydramine. The nurse should include which instruction in the patient's education to address a common adverse effect?
A patient with a persistent cough is prescribed guaifenesin. The nurse assesses the patient understands that guaifenesin helps with their cough by which mechanism?
A patient with a persistent cough is prescribed guaifenesin. The nurse assesses the patient understands that guaifenesin helps with their cough by which mechanism?
A nurse is teaching a client who is starting on hydrochlorothiazide for hypertension. What important dietary consideration should the nurse include in the teaching?
A nurse is teaching a client who is starting on hydrochlorothiazide for hypertension. What important dietary consideration should the nurse include in the teaching?
Which of the following assessment findings would be most concerning in a patient receiving mannitol?
Which of the following assessment findings would be most concerning in a patient receiving mannitol?
A patient with asthma is using albuterol inhaler. After administering the medication, the nurse assesses the patient and finds an increased heart rate and feelings of anxiety. What is the appropriate nursing intervention?
A patient with asthma is using albuterol inhaler. After administering the medication, the nurse assesses the patient and finds an increased heart rate and feelings of anxiety. What is the appropriate nursing intervention?
A female client taking spironolactone reports increased facial hair and breast tenderness. What is the nurse's best response?
A female client taking spironolactone reports increased facial hair and breast tenderness. What is the nurse's best response?
A patient is prescribed zafirlukast for asthma. What important instruction should the nurse provide regarding when to take this medication?
A patient is prescribed zafirlukast for asthma. What important instruction should the nurse provide regarding when to take this medication?
A patient is receiving theophylline intravenously for severe bronchospasm. Which sign or symptom would indicate the patient is experiencing theophylline toxicity?
A patient is receiving theophylline intravenously for severe bronchospasm. Which sign or symptom would indicate the patient is experiencing theophylline toxicity?
Which diuretic is most likely to cause ototoxicity if administered at high doses or in conjunction with other ototoxic medications?
Which diuretic is most likely to cause ototoxicity if administered at high doses or in conjunction with other ototoxic medications?
A patient with a history of heart failure and renal dysfunction is prescribed a diuretic. Which diuretic would be contraindicated or require careful monitoring due to its potassium-sparing effect?
A patient with a history of heart failure and renal dysfunction is prescribed a diuretic. Which diuretic would be contraindicated or require careful monitoring due to its potassium-sparing effect?
A patient reports using an over-the-counter decongestant containing pseudoephedrine. Which pre-existing condition should prompt the nurse to advise the patient to discontinue using the medication?
A patient reports using an over-the-counter decongestant containing pseudoephedrine. Which pre-existing condition should prompt the nurse to advise the patient to discontinue using the medication?
A patient receiving mannitol reports headache and nausea. The nurse should assess the patient for other signs and symptoms of which potential complication?
A patient receiving mannitol reports headache and nausea. The nurse should assess the patient for other signs and symptoms of which potential complication?
A patient with chronic bronchitis is prescribed theophylline. What specific dietary instruction should the nurse provide to the patient to prevent potential complications?
A patient with chronic bronchitis is prescribed theophylline. What specific dietary instruction should the nurse provide to the patient to prevent potential complications?
A patient with asthma is prescribed both albuterol and budesonide inhalers. How should the nurse instruct the patient to use these medications?
A patient with asthma is prescribed both albuterol and budesonide inhalers. How should the nurse instruct the patient to use these medications?
A patient taking diphenhydramine for allergic rhinitis reports experiencing significant drowsiness. What safety measure should the nurse emphasize to this patient?
A patient taking diphenhydramine for allergic rhinitis reports experiencing significant drowsiness. What safety measure should the nurse emphasize to this patient?
A patient with a productive cough is prescribed guaifenesin. The nurse should emphasize which non-pharmacological measure to enhance the effectiveness of this medication?
A patient with a productive cough is prescribed guaifenesin. The nurse should emphasize which non-pharmacological measure to enhance the effectiveness of this medication?
The nurse is caring for a client who is administered mannitol. What is the primary mechanism by which mannitol reduces intracranial pressure?
The nurse is caring for a client who is administered mannitol. What is the primary mechanism by which mannitol reduces intracranial pressure?
Flashcards
Thiazide Diuretics Action
Thiazide Diuretics Action
Inhibits Na+ and Cl- reabsorption in distal tubules, increasing excretion of Na+, Cl-, and H2O.
Thiazide Diuretics Indications
Thiazide Diuretics Indications
Edema with HF, cirrhosis, hypertension, and renal dysfunction.
Thiazide Diuretics: Adverse Effects
Thiazide Diuretics: Adverse Effects
Dizziness, orthostatic hypotension, hypokalemia, dehydration, muscle cramps.
Loop Diuretics Action
Loop Diuretics Action
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Loop Diuretics Indications
Loop Diuretics Indications
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Loop Diuretics: Adverse Effects
Loop Diuretics: Adverse Effects
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Potassium-Sparing Diuretics Action
Potassium-Sparing Diuretics Action
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Potassium-Sparing Diuretics Indications
Potassium-Sparing Diuretics Indications
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Potassium-Sparing Diuretics: Adverse Effects
Potassium-Sparing Diuretics: Adverse Effects
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Osmotic Diuretics Action
Osmotic Diuretics Action
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Osmotic Diuretics Indications
Osmotic Diuretics Indications
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Osmotic Diuretics: Adverse Effects
Osmotic Diuretics: Adverse Effects
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Decongestants Action
Decongestants Action
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Decongestants Indications
Decongestants Indications
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Decongestants: Adverse Effects
Decongestants: Adverse Effects
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Antihistamines Action
Antihistamines Action
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Antihistamines Indications
Antihistamines Indications
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Antihistamines: Adverse Effects
Antihistamines: Adverse Effects
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Expectorants Action
Expectorants Action
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Expectorants Indications
Expectorants Indications
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Expectorants: Adverse Effects
Expectorants: Adverse Effects
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Xanthines Action
Xanthines Action
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Xanthines Indications
Xanthines Indications
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Xanthines: Adverse Effects
Xanthines: Adverse Effects
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Sympathomimetics Action
Sympathomimetics Action
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Study Notes
- Diuretics increase the excretion of water from the body
Thiazide/Thiazide-Like Diuretics (Hydrochlorothiazide)
- Inhibits sodium and chloride reabsorption in distal renal tubules.
- Increases excretion of sodium, chloride, and water.
- Treats edema with heart failure, cirrhosis, hypertension, and renal dysfunction.
- Be cautious with allergies to thiazide or sulfa medications, hypovolemia, severe renal disease, lupus, glucose abnormalities, and gout.
- Adverse effects: dizziness, orthostatic hypotension, hypokalemia, nausea, vomiting, diarrhea, dehydration, polyuria/nocturia, muscle cramps/spasms.
- Drug interaction: increases digoxin toxicity due to potassium loss.
Loop Diuretics (Furosemide)
- Acts on the loop of Henle.
- Inhibits sodium and chloride reabsorption in distal renal tubules and the loop of Henle, resulting in sodium-rich diuresis.
- Treats edema with heart failure and acute pulmonary edema.
- Use cautiously in patients with electrolyte depletion and anuria.
- Adverse effects: orthostatic hypotension, hypokalemia, hyperuricemia, dehydration, ototoxicity.
Potassium-Sparing Diuretics (Spironolactone)
- Blocks aldosterone effects in the renal tubule, causing sodium and water loss while retaining potassium.
- Treats edema in heart failure, nephrotic syndrome, and ascites with cirrhosis.
- Be cautious with severe renal disease, anuria, and hyperkalemia.
- Adverse effects: hyperkalemia, hirsutism/gynecomastia.
- Avoid foods high in potassium.
- High potassium foods include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, orange, peaches, potatoes, prunes, decaffeinated coffee, spinach, sunflower seeds, tomatoes, watermelon, and rhubarb.
Osmotic Diuretics (Mannitol)
- Elevates the similarity of the glomerular filtration, leading to loss of sodium, water, and chloride.
- Treats the oliguria phase in renal failure, reduces intracranial pressure, and treats cerebral edema.
- Be cautious with allergies, severe renal disease, anuria, pulmonary congestion, intracranial bleeding, dehydration, and heart failure.
- Adverse effects: hypotension, fluid and electrolyte imbalances, acute heart failure, acute pulmonary edema.
- Administer via IV infusion only, using a filter.
- Keep vials warm to prevent crystallization.
Nursing Management and Implications for Diuretics
- Obtain thorough patient history and conduct a physical exam.
- Monitor baseline fluid status daily, including input/output.
- Monitor baseline chemistry and electrolyte values regularly during treatment.
- Administer diuretics in the morning.
- Patients may need to increase protein intake, except with potassium-sparing diuretics.
- Monitor for digitalis toxicity if the patient is also taking digitalis for heart disease.
- Teach patients to change positions slowly to avoid orthostatic hypotension.
- Encourage patients to keep a log of their daily weights every morning.
- Remind patients to attend follow-up visits and lab work.
- Instruct patients to notify their healthcare provider if they experience nausea, vomiting, or diarrhea due to the risk of fluid and electrolyte imbalances.
- Signs and symptoms of hypokalemia include muscle weakness, constipation, irregular pulse rate, and lethargy.
- Instruct patients to notify their healthcare provider immediately if they experience a rapid heart rate.
Decongestants (Pseudoephedrine)
- Has sympathomimetic effects, causing vasoconstriction in the mucous membranes of the nasal passages to improve drainage and ventilation.
- Treats nasal congestion, sinusitis, colds, hay fever, and eustachian tube congestion.
- Be cautious with conditions exacerbated by sympathetic activity (hypertension/cardiac disease).
- Adverse effects: seizures, hypertension, arrhythmias, urinary retention, respiratory difficulty.
Antihistamines (Diphenhydramine)
- Competitively blocks histamine effects at H1 receptor sites.
- Treats rhinitis, urticaria, angioedema, and parkinsonism.
- Use cautiously in renal/hepatic impairment, history of arrhythmias, and prolonged QT intervals.
- Adverse effects: sedation, thick bronchial secretions, urinary retention, bradycardia.
- Administer IV for angioedema and IM.
- Assess the condition or reaction and drug allergies.
- Contraindicated in acute asthma attacks or lower respiratory diseases like pneumonia.
- Use cautiously in cardiac/hypertension, renal disease, COPD, or pregnancy.
- Assess and educate about excessive sedation.
- Avoid driving, alcohol, and CNS depressants.
- Best taken with meals.
- Frequent mouth care is needed due to dry mouth.
Expectorants (Guaifenesin)
- Enhances respiratory tract fluid output by reducing the adhesiveness of the fluid, which removes viscous mucus.
- Provides relief from respiratory conditions by thinning mucous secretions, allowing them to be cleared.
- Use cautiously in older adults and patients with asthma and respiratory insufficiency.
- Caution for allergy, persistent cough.
- Adverse effects: nausea, vomiting, dizziness.
- Patients taking expectorants should increase fluid intake to help liquefy secretions.
- Report fever, cough, or other symptoms lasting longer than one week.
- Monitor for the intended therapeutic effect.
Xanthines (Theophylline)
- Relaxes bronchial smooth muscle, causing bronchodilation.
- Provides relief and prevention of bronchospasm in asthma, chronic bronchitis, and emphysema (COPD).
- Be cautious with GI problems, coronary disease, and alcoholism.
- Adverse effects: palpitations, life-threatening arrhythmias, proteinuria, respiratory arrest.
- Toxicity can lead to life-threatening arrhythmias, seizures, and hypotension.
- Drug interaction: cigarette smoking reduces levels of theophylline.
- Administered acutely via IV.
- Therapeutic levels: 10-20 mcg/mL.
Sympathomimetics (Albuterol)
- Acts as an agonist at beta-receptor sites in the SNS, causing bronchodilation and increased heart rate, respiratory rate, and blood pressure.
- Treats bronchospasm and prevents exercise-induced bronchospasm.
- Cautious use depends on the severity of underlying conditions aggravated by sympathetic stimulation.
- Adverse effects: fear, anxiety, restlessness, headache, sore throat, paradoxical bronchospasm, arrhythmias, hypertension, angina.
- Administered via inhalation.
Anticholinergics (Ipratropium)
- Blocks acetylcholine action, causing smooth muscle relaxation and bronchodilation.
- Provides maintenance for bronchospasm in COPD.
- Be cautious with conditions aggravated by anticholinergic or atropine-like effects, such as bladder obstruction and glaucoma.
- Adverse effects: dizziness, palpitations, ocular changes, urinary changes, urinary retention, paradoxical bronchospasm, dry mouth.
Inhaled Steroids (Budesonide)
- Decreases the inflammatory response in the airway.
- Used for the prevention and treatment of asthma.
- NOT for emergency use; avoid in active infections of the respiratory system.
- Adverse effects: fungal infections (pharyngeal and laryngeal), so patients need to rinse their mouth after use.
Leukotriene Receptor Antagonist (Zafirlukast)
- Blocks receptors for leukotrienes, preventing airways edema.
- Used for the prevention and treatment of asthma.
- NOT for emergency use; use cautiously in hepatic/renal impairment.
- Adverse effects: headache, dizziness, nausea, fever/pain, infection, hepatotoxicity, rash, kidney and liver issues, neuropsychiatric events.
Nursing Management for Respiratory Medications
- Assess for improved air movement, medication or environmental allergies (triggers), and contraindications (cardiac concerns).
- Assess for cough symptoms and knowledge of the underlying issue and medications being used.
- Implement monitoring, such as pulse oximetry.
- Teach patients about avoiding triggers, the treatment plan, and medication information.
- Provide patient teaching on the proper use of inhalers, spacers, or nebulizers.
- Collaborate with respiratory therapy colleagues.
- Avoid caffeine.
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