REINFORCEMENT - CARDIORESPI PHARMA.docx

Text Description automatically generated **REINFORCEMENT EXAMINATION** **[PHARMACOLOGY: CARDIORESPIRATORY MEDICATIONS]** **NURSES LICENSURE EXAMINATION 2024** **Directions: Choose the LETTER of the best answer for each of the following questions.** 1. a. a beta blocker. b. a loop diuretic...

Text Description automatically generated **REINFORCEMENT EXAMINATION** **[PHARMACOLOGY: CARDIORESPIRATORY MEDICATIONS]** **NURSES LICENSURE EXAMINATION 2024** **Directions: Choose the LETTER of the best answer for each of the following questions.** 1. a. a beta blocker. b. a loop diuretic and spironolactone. c. a thiazide diuretic. d. counseling on lifestyle changes. **ANS: C** **This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective, but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy, but should also begin drug therapy because hypertension already exists.** 2. a. Notify the provider and ask about adding a beta blocker medication. b. Reassure the patient that the medications are working. c. Remind the patient to move slowly from sitting to standing. d. Request an order for an electrocardiogram. **ANS: A** **Beta blockers are often added to drug regimens to treat reflex tachycardia, which is a common side effect of lowering blood pressure, caused by the baroreceptor reflex. The patient's blood pressure is responding to the medications, but the tachycardia warrants treatment. Reminding the patient to move slowly from sitting to standing is appropriate with any blood pressure medication, but this patient has reflex tachycardia, which must be treated. An electrocardiogram is not indicated.** 3. a. "Beta blockers block the actions of angiotensin II." b. "Beta blockers decrease heart rate and contractility." c. "Beta blockers decrease peripheral vascular resistance." d. "Beta blockers decrease the release of renin." **ANS: A** **Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resistance, and decrease the release of renin.** 4. a. Beta blockers can reverse these side effects. b. Discontinue the medication immediately and notify the provider. c. Drink extra fluids and avoid driving when drowsy. d. Notify the provider if symptoms persist after several weeks. **ANS: C** **Clonidine can cause dry mouth and sedation; patients should be warned to drink extra fluids and avoid driving. Beta blockers do not reverse these drug side effects. Discontinuing clonidine abruptly can cause severe rebound hypertension. These are common side effects that do not abate over time.** 5. a. Controlling her blood pressure will decrease her risk of preeclampsia. b. Ask the provider about changing to an ARB during pregnancy. c. Continue taking the ACE inhibitor during her pregnancy. d. Discuss using methyldopa instead while she is pregnant. **ANS: D** **Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy.** 6. a. Hydrochlorothiazide and nadolol b. Hydralazine and minoxidil c. Spironolactone and amiloride d. Trichlormethiazide and hydrochlorothiazide **ANS: A** **When using two or more drugs to treat hypertension, each drug should come from a different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are both vasodilators. Spironolactone and amiloride are both potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics.** 7. a. "Multi-drug therapy often means that drugs may be given in lower doses." b. "Some agents are used to offset adverse effects of other agents." c. "Treatment of hypertension via different mechanisms increases success." d. "Two or more drugs will lower blood pressure more quickly." **ANS: D** **Multi-drug therapy does not lower blood pressure more quickly. Using more than one drug often means that doses can be decreased. Some agents can offset adverse effects of other agents. Treatment via different mechanisms increases the likelihood of success.** 8. a. Blocking aldosterone receptors b. Increasing diuresis c. Reducing venous pressure d. Reducing afterload **ANS: A** **Spironolactone prolongs survival in patients with HF primarily by blocking receptors for aldosterone. Spironolactone cause only minimal diuresis. Spironolactone does not reduce afterload, and it does not reduce venous pressure enough to prolong survival, because it causes only minimal diuresis.** 9. a. Withhold the drug for an hour and reassess the level. b. Withhold the drug and notify the prescriber immediately. c. Administer Digibind to counteract the toxicity. d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin. **ANS: D** **The optimum plasma digoxin range is 0.5 to 0.8 ng/mL. The patient's pulse should be checked before administration, as always, and the digoxin should be administered. The digoxin does not have to be withheld, nor does the prescriber need to be notified. If the digoxin level is demonstrating a trend of increasing, the issue should be discussed in rounds. Digibind is not indicated, because the digoxin level is therapeutic.** 10. a. It causes tachycardia and increases the cardiac workload. b. It does not correct the underlying pathology of heart failure. c. It has a wide therapeutic range that makes dosing difficult. d. It may actually shorten the patient's life expectancy. **ANS: B** **Digoxin improves cardiac output, alters electrical effects, and helps to decrease sympathetic outflow from the central nervous system (CNS) through its neurohormonal effects; however, it does not alter the underlying pathology of heart failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the cardiac workload by increasing contractility. It has a narrow therapeutic range and many adverse effects. Digoxin does not improve life expectancy; in women it may actually shorten life expectancy.** 11. a\. Contact the provider to request an increased dose of digoxin. b\. Give the dose of digoxin and notify the provider of the potassium level. c\. Request an order for a diuretic. d\. Withhold the dose and notify the provider of the heart rate. **ANS: B** **The patient's serum potassium level is above normal limits, but only slightly. An elevated potassium level can reduce the effects of digoxin, so there is no risk of toxicity. There is no indication that an increased dose of digoxin is needed. There is no indication for a diuretic. The heart rate is acceptable; doses should be withheld if the heart rate is less than 60 beats per minute.** 12. a\. "Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm." b\. "Atrial dysrhythmias can have life-threatening effects on ventricular function." c\. "Treating ventricular dysrhythmias helps prevent the likelihood of stroke." d\. "When ventricular contraction slows, atrial contraction is also slowed." **ANS: B** **Dysrhythmic activity in the atria does not significantly reduce cardiac output but can be dangerous when dysrhythmic impulses cross the AV node, causing ventricular dysrhythmias, which can be life threatening. Treating ventricular dysrhythmia helps improve ventricular pumping. These drugs do not restore normal sinus rhythm. To prevent stroke, an anticoagulant, such as warfarin, is used. Slowing ventricular contraction does not affect the rate of atrial contraction. Restoring normal sinus rhythm requires cardioversion, short-term treatment with amiodarone or sotalol, or RF ablation of the dysrhythmia source.** 13. a\. "Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones." b\. "Adverse effects of these drugs are mainly noncardiac in nature." c\. "For most antidysrhythmic drugs, there is evidence of reduced mortality." d\. "Use of these drugs may be necessary even if the benefits are unknown." **ANS: A** **Because antidysrhythmic drugs have prodysrhythmic actions, they can exacerbate existing dysrhythmias or generate new ones. Most adverse effects are cardiac related. There is evidence of increased mortality with many of these drugs. Use of these drugs should be limited to situations in which there is a clear benefit and only if that benefit outweighs any risks.** 14. a\. Asthma b\. Exercise-induced tachyarrhythmias c\. Hypertension d\. Paroxysmal atrial tachycardia associated with emotion **ANS: A** **Propranolol is contraindicated in patients with asthma, because it is a nonselective beta-adrenergic antagonist and can cause bronchoconstriction and exacerbate asthma. It is used to treat tachyarrhythmias and paroxysmal atrial tachycardia evoked by emotion, so it is not contraindicated for patients with these conditions. It lowers blood pressure, so it would be helpful in patients with hypertension.** 15. a\. "I should not participate in aerobic exercise while taking this drug." b\. "I should take aspirin daily to reduce my need for nitroglycerin." c\. "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack." d\. "I take nitroglycerin to increase the amount of oxygen to my heart." **ANS: C** **Nitroglycerin can be taken before stressful events or exertion to reduce the chance of an attack of angina. Aerobic exercise is an important part of nondrug therapy to reduce the risk of heart attack. Aspirin therapy is an important adjunct to treatment to prevent coronary thrombus formation, but it does not reduce the need for nitroglycerin. Nitroglycerin reduces cardiac oxygen demand, but it does not increase the amount of oxygen available to the heart.** 16. a\. dilates coronary arteries to increase blood flow to the heart." b\. increases the oxygen supply to the cardiac muscle." c\. increases ventricular filling to improve cardiac output." d\. promotes vasodilation, which reduces preload and oxygen demand." **ANS: D** **Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or oxygen supply to the heart. An increase in ventricular filling would increase oxygen demand and result in increased anginal pain.** 17. a\. Apply a nitroglycerin transdermal patch. b\. Continue dosing at 10-minute intervals. c\. Give a second dose of nitroglycerin in 5 minutes. d\. Request an order for intravenous nitroglycerin. **ANS: C** **An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.** 18. a\. "Heparin has a longer half-life." b\. "Heparin has fewer adverse effects." c\. "The onset of warfarin is delayed." d\. "Warfarin prevents platelet aggregation." **ANS: C** **Warfarin is not useful for treating existing thromboses or for emergencies because the onset of action is delayed. Heparin has a shorter half life and has more side effects. Warfarin does not prevent platelet aggregation** 19. a\. a repeat aPTT to be drawn immediately. b\. analgesic medication. c\. changing heparin to aspirin. d\. protamine sulfate. **ANS: D** **Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.** 20. a\. administer the dose as ordered. b\. request an order to decrease the dose. c\. request an order to give vitamin K (phytonadione). d\. request an order to increase the dose. **ANS: A** **This patient has an INR in the appropriate range, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity.** 21. a\. vitamin K (phytonadione). b\. protamine sulfate. c\. a PTT. d\. a PT and an INR. **ANS: D** **This patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable, there are no hematomas or petechiae, and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy.** 22. a\. Administer the medications as ordered. b\. Ask the patient about the use of salt substitutes. c\. Contact the provider to report the laboratory values. d\. Request an order for furosemide (Lasix). **ANS: C** **Spironolactone should not be administered with ACE inhibitors, which can also elevate potassium levels. Because the potassium level is elevated, the nurse should not administer the medication and should obtain clarification of the order. There is no need to repeat the potassium level test that was just done this morning. Requesting an order for furosemide is appropriate only after the provider has been notified of the laboratory values.** 23. a\. Bumetanide (Bumex) b\. Chlorothiazide (Diuril) c\. Hydrochlorothiazide (HydroDIURIL) d\. Spironolactone (Aldactone) **ANS: D** **Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.** 24. a\. a chlorofluorocarbon (CFC) propellant is superior to a hydrofluoroalkane (HFA) propellant. b\. the patient should activate the device and then inhale. c\. the patient should store the MDI in the refrigerator between doses. d\. the patient should wait 1 minute between puffs. **ANS: D** **When 2 puffs are needed, an interval of at least 1 minute should separate the first puff from the second. CFC propellants will be discontinued because of damage to the environment. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.** 25. a\. Ask whether the patient is gargling after each dose of the glucocorticoid. b\. Request an order for an antifungal medication. c\. Suggest that the patient be tested for a bronchial infection. d\. Tell the patient to discontinue use of the glucocorticoid. **ANS: A** **The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid** 26. a\. Growth may be slowed, but eventual adult height will not be reduced. b\. The growth rate is not impaired, but overall height will be reduced. c\. The growth rate slows while the drug is used but resumes when the drug is stopped. d\. Long-term use of the drug results in a decrease in adult height. **ANS: A** **Glucocorticoids can slow growth in children and adolescents, but they do not reduce the eventual adult height. The growth rate will return to normal within a year, even when the drug is continued. Long-term use does not affect the eventual adult height.** 27. a\. LABAs are safer than short-acting beta2 agonists. b\. LABAs can be used on an as-needed basis to treat symptoms. c\. LABAs reduce the risk of asthma-related deaths. d\. LABAs should be combined with an inhaled glucocorticoid. **ANS: D** **LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.** 28. a\. Combination inhaled glucocorticoids/long-acting beta2 agonists b\. Inhaled low-dose glucocorticoids c\. Long-acting beta2 agonists d\. Short-acting beta2 agonists **ANS: D** **Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs, along with inhaled glucocorticoids, are used for step 3 management.** 29. a\. Asking the patient to demonstrate use of the inhaler b\. Assessing the patient's exposure to tobacco smoke c\. Auscultating lung sounds and obtaining vital signs d\. Suggesting that the patient use one puff to reduce side effects **ANS: D** **It is not within the nurse's scope of practice to change the dose of a medication without an order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate the patient's ability to administer the medication properly and is part of the nurse's evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessment helps the nurse evaluate the patient's response to the medication.** 30. a\. A 30-year-old man with kidney disease b\. A 75-year-old woman with cystitis c\. A 50-year-old man with an upper respiratory tract infection d\. A 9-year-old boy with an ear infection **ANS: A** **The individual with impaired kidney function would be at risk of having the drug accumulate to a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder and not usually the cause of excretion problems that might lead to an adverse reaction from a medication. A respiratory tract infection would not predispose a patient to an adverse reaction, because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have the greatest predisposition to an adverse reaction simply because he is a child; nor does an ear infection put him at greater risk.** **31. A patient with atrial fibrillation is prescribed warfarin. Which laboratory value should the nurse monitor to evaluate the effectiveness of the medication?** a\) Hemoglobin\ b) Potassium\ c) International Normalized Ratio (INR)\ d) Activated partial thromboplastin time (aPTT) **Correct Answer:** c) International Normalized Ratio (INR)\ **Rationale:** INR is the standard measure used to monitor the therapeutic effects of warfarin and ensure it is within the desired range (usually 2.0-3.0 for most indications). Hemoglobin and potassium levels are not directly related to warfarin therapy, and aPTT is used to monitor heparin, not warfarin. **32. A patient on digoxin presents with symptoms of nausea, vomiting, and visual disturbances. What is the most appropriate initial nursing action?** a\) Administer an antiemetic\ b) Check the patient\'s digoxin level\ c) Increase the dose of digoxin\ d) Administer atropine **Correct Answer:** b) Check the patient\'s digoxin level\ **Rationale:** Nausea, vomiting, and visual disturbances are classic signs of digoxin toxicity. The nurse should first assess the digoxin level to confirm toxicity before taking further action. **33. A patient taking furosemide is at risk for which electrolyte imbalance?** a\) Hyperkalemia\ b) Hypernatremia\ c) Hypokalemia\ d) Hypercalcemia **Correct Answer:** c) Hypokalemia\ **Rationale:** Furosemide is a loop diuretic that promotes potassium excretion, leading to a risk of hypokalemia. Monitoring potassium levels is critical in patients on furosemide to prevent complications. **34. A patient with chronic heart failure is prescribed spironolactone. Which of the following serum electrolyte levels should be monitored closely?** a\) Sodium\ b) Potassium\ c) Calcium\ d) Chloride **Correct Answer:** b) Potassium\ **Rationale:** Spironolactone is a potassium-sparing diuretic, and it can lead to hyperkalemia. Monitoring serum potassium levels is essential to prevent hyperkalemia, which can lead to life-threatening cardiac dysrhythmias. **35. Which of the following medications is most likely to cause a first-dose hypotension effect?** a\) Atenolol\ b) Losartan\ c) Doxazosin\ d) Metoprolol **Correct Answer:** c) Doxazosin\ **Rationale:** Doxazosin, an alpha-1 adrenergic blocker, is known for causing a significant drop in blood pressure after the first dose, known as first-dose hypotension. Patients should be advised to take the first dose at bedtime to avoid dizziness or fainting. **36. A patient is prescribed nitroglycerin for angina. Which statement indicates the patient understands the side effects of this medication?** a\) \"I can take this medication before meals to avoid nausea.\"\ b) \"I should call my doctor if I experience a headache after taking this medication.\"\ c) \"I need to store this medication in a cool, dark place.\"\ d) \"I can take up to five tablets in 15 minutes if I don\'t feel relief.\" **Correct Answer:** c) \"I need to store this medication in a cool, dark place.\"\ **Rationale:** Nitroglycerin should be stored in a cool, dark place to prevent degradation. Headaches are a common side effect of nitroglycerin due to vasodilation, so they do not necessarily require medical attention unless they are severe. The patient should take a maximum of three tablets within 15 minutes and seek emergency medical attention if angina persists. **37. Which drug is contraindicated for a patient receiving enalapril?** a\) Potassium supplements\ b) Thiazide diuretics\ c) Calcium channel blockers\ d) Beta-blockers **Correct Answer:** a) Potassium supplements\ **Rationale:** Enalapril is an ACE inhibitor that can increase potassium levels in the blood. Taking potassium supplements concurrently can lead to hyperkalemia, which is dangerous. Monitoring potassium levels is crucial when a patient is on an ACE inhibitor. **38. A patient with coronary artery disease is started on atorvastatin. What is the primary goal of this medication?** a\) Lowering blood pressure\ b) Increasing HDL cholesterol\ c) Reducing LDL cholesterol\ d) Preventing arrhythmias **Correct Answer:** c) Reducing LDL cholesterol\ **Rationale:** Atorvastatin is a statin medication primarily used to reduce LDL cholesterol levels, which is a major risk factor for coronary artery disease. While it may have modest effects on HDL levels, its primary purpose is LDL reduction. **39. Which of the following symptoms should be closely monitored in a patient receiving amiodarone therapy?** a\) Shortness of breath and fatigue\ b) Dry mouth and constipation\ c) Weight loss and tremors\ d) Urinary retention and headache **Correct Answer:** a) Shortness of breath and fatigue\ **Rationale:** Amiodarone can cause pulmonary toxicity, leading to symptoms such as shortness of breath, cough, and fatigue. It's critical to monitor these symptoms as they can indicate serious lung complications. **40. A patient with hypertension is prescribed a non-dihydropyridine calcium channel blocker, verapamil. What is a potential adverse effect of this medication?** a\) Reflex tachycardia\ b) Constipation\ c) Hyperglycemia\ d) Hypokalemia **Correct Answer:** b) Constipation\ **Rationale:** Verapamil, a non-dihydropyridine calcium channel blocker, is commonly associated with constipation as a side effect. It also has negative inotropic effects, which can reduce heart rate, making reflex tachycardia unlikely. **41. A patient with asthma is prescribed salmeterol. What is the primary purpose of this medication?** a\) To provide immediate relief during an acute asthma attack\ b) To act as a rescue inhaler\ c) To provide long-term control of asthma symptoms\ d) To treat underlying infection in asthma **Correct Answer:** c) To provide long-term control of asthma symptoms\ **Rationale:** Salmeterol is a long-acting beta-2 agonist (LABA) used for long-term control of asthma symptoms and prevention of bronchospasm. It is not used as a rescue inhaler because it does not provide immediate relief. **42. A patient with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium. What is the most important side effect to monitor in this patient?** a\) Bradycardia\ b) Dry mouth\ c) Hyperkalemia\ d) Hypoglycemia **Correct Answer:** b) Dry mouth\ **Rationale:** Ipratropium is an anticholinergic bronchodilator, and one of its common side effects is dry mouth. While other side effects may occur, dry mouth is the most commonly reported and should be monitored. **43. A patient on theophylline presents with nausea, vomiting, and seizures. What should the nurse do first?** a\) Administer an antiemetic\ b) Check the patient\'s serum theophylline level\ c) Increase the theophylline dose\ d) Administer activated charcoal **Correct Answer:** b) Check the patient\'s serum theophylline level\ **Rationale:** Nausea, vomiting, and seizures are signs of theophylline toxicity. The nurse should first check the patient\'s serum theophylline level to confirm toxicity before taking further action, such as adjusting the dose or administering treatment for overdose. **44. Which of the following respiratory medications can cause paradoxical bronchospasm?** a\) Albuterol\ b) Montelukast\ c) Fluticasone\ d) Tiotropium **Correct Answer:** a) Albuterol\ **Rationale:** Albuterol, a short-acting beta-2 agonist, can rarely cause paradoxical bronchospasm, which is a worsening of bronchospasm after using the inhaler. Patients should be advised to discontinue use and seek immediate medical attention if this occurs. **45. A patient with pulmonary fibrosis is being treated with nintedanib. What is the primary concern for this patient?** a\) Hepatotoxicity\ b) Renal failure\ c) Hypoglycemia\ d) Hyperkalemia **Correct Answer:** a) Hepatotoxicity\ **Rationale:** Nintedanib, an anti-fibrotic agent used in pulmonary fibrosis, carries a risk of hepatotoxicity. Liver function tests should be monitored regularly to detect any signs of liver damage. **46. A patient with a history of tuberculosis is started on rifampin. What is the nurse\'s priority teaching point?** a\) \"Avoid consuming dairy products while on this medication.\"\ b) \"This medication may cause your urine and other body fluids to turn orange-red.\"\ c) \"You should take this medication with food to prevent stomach upset.\"\ d) \"This medication may cause constipation, so increase fiber intake.\" **Correct Answer:** b) \"This medication may cause your urine and other body fluids to turn orange-red.\"\ **Rationale:** Rifampin is known to cause a harmless orange-red discoloration of urine, sweat, and tears, which can alarm patients if they are not warned. This side effect is benign but important to communicate to the patient. **47. A patient is prescribed omalizumab for severe asthma. Which of the following is the most serious adverse effect the nurse should monitor for?** a\) Injection site reaction\ b) Hypertension\ c) Anaphylaxis\ d) Hypokalemia **Correct Answer:** c) Anaphylaxis\ **Rationale:** Omalizumab, a monoclonal antibody used in the treatment of severe asthma, has a risk of causing anaphylaxis. Patients should be closely monitored after administration, especially during the initial doses. **48. A patient with severe COPD is prescribed roflumilast. What is the nurse\'s priority assessment related to this medication?** a\) Monitoring liver function\ b) Assessing mental health status\ c) Checking for signs of hyperkalemia\ d) Monitoring blood glucose levels **Correct Answer:** b) Assessing mental health status\ **Rationale:** Roflumilast, a phosphodiesterase-4 inhibitor used in COPD, has been associated with psychiatric side effects, including depression and suicidal thoughts. Mental health assessment is a priority in patients taking this medication. **49. A patient on high-dose corticosteroids for asthma exacerbation is at risk for which of the following complications?** a\) Hypoglycemia\ b) Osteoporosis\ c) Hyperkalemia\ d) Hyponatremia **Correct Answer:** b) Osteoporosis\ **Rationale:** Long-term or high-dose corticosteroid use can lead to osteoporosis due to decreased bone mineral density. Patients on chronic corticosteroid therapy should be monitored for bone health and may require calcium and vitamin D supplementation. **50. Which respiratory medication requires the patient to rinse their mouth after use to prevent an oral fungal infection?** a\) Albuterol\ b) Ipratropium\ c) Budesonide\ d) Montelukast **Correct Answer:** c) Budesonide\ **Rationale:** Budesonide is an inhaled corticosteroid, and it can increase the risk of oral thrush (candidiasis) if residue remains in the mouth. Patients should be instructed to rinse their mouth after each use to reduce this risk. END OF MATERIAL