Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 70-year-old patient is prescribed ipratropium bromide via inhaler for the management of asthma. During a follow-up visit, the patient reports difficulty urinating and blurred vision.
Which action should the nurse take first?
A. Reassure the patient these are expected effects of the medication.
Reassuring the patient these are expected effects dismisses potentially serious anticholinergic side effects associated with ipratropium, a muscarinic antagonist. Difficulty urinating (urinary retention) and blurred vision, especially in an elderly patient, could indicate significant systemic absorption, necessitating dosage adjustment or alternative therapy to prevent complications.
B. Encourage the patient to increase fluid intake to improve urination.
Increasing fluid intake is insufficient and potentially harmful if severe urinary retention is the cause of the difficulty, as it could exacerbate bladder distension. Ipratropium acts by blocking muscarinic receptors, relaxing detrusor muscle tone and potentially causing retention, which is a significant adverse effect requiring medical evaluation.
C. Notify the healthcare provider of the patient's symptoms.
Notifying the healthcare provider is the priority because these symptoms (urinary retention, blurred vision) are significant anticholinergic side effects of ipratropium, particularly concerning in a 70-year-old with potential prostatic hypertrophy or glaucoma. These adverse effects may require dose reduction or a change in medication to prevent serious harm.
D. Instruct the patient to use the inhaler only when experiencing wheezing.
While ipratropium is a maintenance treatment, not a rescue inhaler, instructing the patient to only use it when wheezing does not address the current adverse drug effects. Systemic side effects indicate the need for medical assessment and potential drug modification, not just a change in usage pattern.
This question is an excerpt from Nurse Dive's nursing test bank - Pathopharmacology Proctored Exam (Examplify Exam). Take the full exam now
Full Explanation
Choice A rationale
Reassuring the patient these are expected effects dismisses potentially serious anticholinergic side effects associated with ipratropium, a muscarinic antagonist. Difficulty urinating (urinary retention) and blurred vision, especially in an elderly patient, could indicate significant systemic absorption, necessitating dosage adjustment or alternative therapy to prevent complications.
Choice B rationale
Increasing fluid intake is insufficient and potentially harmful if severe urinary retention is the cause of the difficulty, as it could exacerbate bladder distension. Ipratropium acts by blocking muscarinic receptors, relaxing detrusor muscle tone and potentially causing retention, which is a significant adverse effect requiring medical evaluation.
Choice C rationale
Notifying the healthcare provider is the priority because these symptoms (urinary retention, blurred vision) are significant anticholinergic side effects of ipratropium, particularly concerning in a 70-year-old with potential prostatic hypertrophy or glaucoma. These adverse effects may require dose reduction or a change in medication to prevent serious harm.
Choice D rationale
While ipratropium is a maintenance treatment, not a rescue inhaler, instructing the patient to only use it when wheezing does not address the current adverse drug effects. Systemic side effects indicate the need for medical assessment and potential drug modification, not just a change in usage pattern.
Similar Questions
A nurse cares for a patient who is prescribed nasal fluticasone.
Which teaching is most appropriate for the patient?
A. Encourage gargling with saline after the medication is given.
Gargling with saline is typically recommended after using an inhaled corticosteroid like fluticasone delivered via a metered-dose inhaler (MDI) or dry powder inhaler (DPI) to prevent oral candidiasis (thrush), not for a nasal spray formulation. The primary concern with nasal use is local irritation.
B. Report persistent dryness of the nasal mucosa.
Reporting persistent dryness of the nasal mucosa is the most appropriate teaching because fluticasone is a nasal corticosteroid that can cause local side effects such as mucosal irritation, dryness, burning, and epistaxis (nosebleeds). These local effects warrant assessment by the provider, potentially requiring a dose change or a lubricant.
C. Advise the patient to be screened for diabetes monthly.
Advising monthly diabetes screening is not routine for nasal fluticasone, as the systemic absorption of inhaled or nasal corticosteroids is generally low. While high-dose or prolonged oral corticosteroids can increase blood glucose (normal fasting plasma glucose: 70–100 mg/dL), this is an unlikely effect for the nasal formulation.
D. Discontinue daily rights for the duration of treatment.
Discontinuing daily rights (presumably referring to daily activities or routine care) for the duration of treatment is irrelevant and incorrect. Nasal fluticasone is a maintenance medication for allergy or inflammation and should not interfere with daily life or necessitate limiting routine self-care.
E. Use the nasal spray for acute relief of asthma symptoms.
Fluticasone is a corticosteroid used for the maintenance control of allergic rhinitis or inflammation, and it is not effective for the acute relief of asthma or allergy symptoms. Short-acting bronchodilators are used for acute relief, as corticosteroids require time to reduce inflammation.
Full Explanation
Choice A rationale
Gargling with saline is typically recommended after using an inhaled corticosteroid like fluticasone delivered via a metered-dose inhaler (MDI) or dry powder inhaler (DPI) to prevent oral candidiasis (thrush), not for a nasal spray formulation. The primary concern with nasal use is local irritation.
Choice B rationale
Reporting persistent dryness of the nasal mucosa is the most appropriate teaching because fluticasone is a nasal corticosteroid that can cause local side effects such as mucosal irritation, dryness, burning, and epistaxis (nosebleeds). These local effects warrant assessment by the provider, potentially requiring a dose change or a lubricant.
Choice C rationale
Advising monthly diabetes screening is not routine for nasal fluticasone, as the systemic absorption of inhaled or nasal corticosteroids is generally low. While high-dose or prolonged oral corticosteroids can increase blood glucose (normal fasting plasma glucose: 70–100 mg/dL), this is an unlikely effect for the nasal formulation.
Choice D rationale
Discontinuing daily rights (presumably referring to daily activities or routine care) for the duration of treatment is irrelevant and incorrect. Nasal fluticasone is a maintenance medication for allergy or inflammation and should not interfere with daily life or necessitate limiting routine self-care.
Choice E rationale
Fluticasone is a corticosteroid used for the maintenance control of allergic rhinitis or inflammation, and it is not effective for the acute relief of asthma or allergy symptoms. Short-acting bronchodilators are used for acute relief, as corticosteroids require time to reduce inflammation.
Choice F rationale
Vigorously shaking the canister for two minutes is excessive and incorrect. While many MDI inhalers require a brief shake, a nasal spray typically only requires a gentle shake, if any, before use. Over-shaking is unnecessary and does not improve drug delivery or efficacy.
Choice G rationale
Limiting intake of vitamin C while taking this medication is unnecessary and incorrect. There is no significant scientific interaction between nasal fluticasone, a glucocorticoid, and vitamin C (ascorbic acid). Dietary limitations are not generally required for nasal corticosteroid use.
A patient will be discharged home with albuterol to use for asthma.
Which information will the nurse include when teaching this patient about this medication?
A. Failure to respond to the medication indicates a need for a higher dose.
Albuterol is a short-acting beta-2 adrenergic agonist (SABA) used as a rescue inhaler. Failure to respond to the usual dose or increasing frequency of use (normal use is 2 puffs every 4-6 hours as needed) indicates worsening asthma control, potentially requiring oral corticosteroids or a change in controller medication, not simply a need for a higher dose of the rescue inhaler.
B. Overuse of this medication can result in airway narrowing and bronchospasm.
Overuse of albuterol can lead to tolerance (tachyphylaxis) of the β_2-receptors in the bronchial smooth muscle, making the drug less effective. Paradoxically, frequent, high-dose use can sometimes exacerbate airway hyperresponsiveness and potentially cause bronchospasm or a "rebound" effect, indicating poor asthma control and the need for urgent medical reassessment and management escalation.
C. Dysarthria is common with this drug even at normal, therapeutic doses.
Dysarthria, which is difficulty with speech articulation, is not a recognized common or expected side effect of albuterol at therapeutic doses. Common side effects are related to beta-adrenergic stimulation, such as tachycardia (palpitations), tremor, and nervousness, due to non-selective receptor activation in skeletal muscle and the heart.
D. Monitor for hypoglycemia symptoms when using this medication.
Albuterol, a β_2-agonist, is known to cause a shift of potassium into the cells, which can lead to hypokalemia (normal range 3.5-5.0 mEq/L), particularly at high doses. Although it can transiently elevate blood glucose, it is not associated with causing hypoglycemia (low blood sugar), and monitoring for symptoms of hyperglycemia would be more appropriate, though less common than hypokalemia.
Full Explanation
Choice A rationale
Albuterol is a short-acting beta-2 adrenergic agonist (SABA) used as a rescue inhaler. Failure to respond to the usual dose or increasing frequency of use (normal use is 2 puffs every 4-6 hours as needed) indicates worsening asthma control, potentially requiring oral corticosteroids or a change in controller medication, not simply a need for a higher dose of the rescue inhaler.
Choice B rationale
Overuse of albuterol can lead to tolerance (tachyphylaxis) of the β_2-receptors in the bronchial smooth muscle, making the drug less effective. Paradoxically, frequent, high-dose use can sometimes exacerbate airway hyperresponsiveness and potentially cause bronchospasm or a "rebound" effect, indicating poor asthma control and the need for urgent medical reassessment and management escalation.
Choice C rationale
Dysarthria, which is difficulty with speech articulation, is not a recognized common or expected side effect of albuterol at therapeutic doses. Common side effects are related to beta-adrenergic stimulation, such as tachycardia (palpitations), tremor, and nervousness, due to non-selective receptor activation in skeletal muscle and the heart.
Choice D rationale
Albuterol, a β_2-agonist, is known to cause a shift of potassium into the cells, which can lead to hypokalemia (normal range 3.5-5.0 mEq/L), particularly at high doses. Although it can transiently elevate blood glucose, it is not associated with causing hypoglycemia (low blood sugar), and monitoring for symptoms of hyperglycemia would be more appropriate, though less common than hypokalemia.
A patient with a common cold asks for a medication that will "cure" their illness.
How should the nurse explain the purpose of medications used for a common cold?
A. Strengthen the immune system.
Medications for the common cold, such as decongestants (e.g., pseudoephedrine) and antihistamines (e.g., chlorpheniramine), primarily act on the symptoms by reducing mucosal swelling or blocking histamine release, respectively. They do not contain components that actively stimulate or strengthen the innate or adaptive immune system's response to the rhinovirus or other causative pathogens; they are purely for symptomatic relief.
B. Relieve or control symptoms.
The common cold is a self-limiting viral illness, typically caused by the rhinovirus, for which there is no current cure. Medications used, such as antitussives for cough and analgesics (e.g., acetaminophen) for fever/sore throat, are designed to alleviate or manage the uncomfortable symptoms (like rhinorrhea, nasal congestion, cough) until the patient's immune system naturally clears the viral infection.
C. Stop transmission of the virus.
Cold medications, which are mostly symptom relievers, do not have a direct mechanism to prevent the shedding or transmission of the viral particles from the infected person to others. Transmission is primarily interrupted by non-pharmacological interventions like hand hygiene and respiratory etiquette, as these drugs only mitigate the patient's discomfort and do not affect viral load or infectivity.
D. Eliminate the rhinovirus.
Currently, there are no clinically available antiviral drugs approved or highly effective for eliminating the rhinovirus or other common cold viruses (like coronaviruses or adenoviruses). The common cold medications focus on symptom palliation (relief) to improve the patient's comfort while the body's immune response works to naturally clear the viral infection over time.
Full Explanation
Choice A rationale
Medications for the common cold, such as decongestants (e.g., pseudoephedrine) and antihistamines (e.g., chlorpheniramine), primarily act on the symptoms by reducing mucosal swelling or blocking histamine release, respectively. They do not contain components that actively stimulate or strengthen the innate or adaptive immune system's response to the rhinovirus or other causative pathogens; they are purely for symptomatic relief.
Choice B rationale
The common cold is a self-limiting viral illness, typically caused by the rhinovirus, for which there is no current cure. Medications used, such as antitussives for cough and analgesics (e.g., acetaminophen) for fever/sore throat, are designed to alleviate or manage the uncomfortable symptoms (like rhinorrhea, nasal congestion, cough) until the patient's immune system naturally clears the viral infection.
Choice C rationale
Cold medications, which are mostly symptom relievers, do not have a direct mechanism to prevent the shedding or transmission of the viral particles from the infected person to others. Transmission is primarily interrupted by non-pharmacological interventions like hand hygiene and respiratory etiquette, as these drugs only mitigate the patient's discomfort and do not affect viral load or infectivity.
Choice D rationale
Currently, there are no clinically available antiviral drugs approved or highly effective for eliminating the rhinovirus or other common cold viruses (like coronaviruses or adenoviruses). The common cold medications focus on symptom palliation (relief) to improve the patient's comfort while the body's immune response works to naturally clear the viral infection over time.