PHARMACOLOGY TEST 3 QUESTIONS AND ANSWERS

PHARMACOLOGY TEST 3 QUESTIONS AND ANSWERS • Question 1 2 out of 2 points The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to Answer s: a. decrease the dose of theophylline. b. discontinue the theophylline. c. keep the theophylline dose as ordered. d. increase the dose of theophylline. Response Feedback: Answer D. Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects. • Question 2 2 out of 2 points A client is in the clinic to have blood drawn to assess theophylline levels. The client appears to being responding well to the medication and is not experiencing any adverse effects. What serum level will the nurse expect the client to have? Answer s: A. Between 10 and 20 mcg/mL B. Between 25 and 35 mcg/mL C. Between 0.5 and 5 mcg/mL D. Between 40 and 50 mcg/mL Response Feedback: Answer A. Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5 mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL would be too high and could cause serious adverse effects. • Question 3 The nurse is caring for a patient who is receiving intravenous 2 out of 2 points theophylline. The patient complains of headache and nausea. The nurse will contact the provider to Answer s: Response Feedback : a. change the medication to an oral theophylline. b. suggest an alternative methylxanthine medication. c. obtain an order for a serum theophylline level. d. request an order for an analgesic medication. Answer C. Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism. • Question 4 2 out of 2 points The client is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity? Answer s: A. Taking the medication on an empty stomach B. Avoiding beverages that contain caffeine C. Eating foods high in potassium Response Feedback : D. Limiting fluid intake to 1,000 mL a day Answer B. Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach is not an indication that the client has understood the nurse's teaching. • Question 5 The nurse is teaching a patient who will begin taking oral theophylline (Theo- Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug? Answers : a. Avoid caffeine while taking this medication. b. Food will decrease the amount of drug absorbed. c. Anorexia and gastrointestinal upset are unexpected side effects. d. An extra dose should be taken when symptoms worsen. Response Feedback: Answer A. Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed. • Question 6 A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take? Answers : a. Request an order for renal function studies. b. Notify the provider to report theophylline toxicity. c. Ask the patient if herbal medications are used. d. Recommend that the patient increase fluid intake. Response Feedback: Answer C. Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated. • Question 7 A client is in the clinic to have blood drawn to assess theophylline levels. The client appears to being responding well to the medication and is not experiencing any adverse effects. What serum level will the nurse expect the client to have? A. Between 25 and 35 mcg/mL B. Between 0.5 and 5 mcg/mL C. Between 40 and 50 mcg/mL D. Between 10 and 20 mcg/mL Answer D. Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5 mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL would be too high and could cause serious adverse effects. Question 8 A 70-year-old man is being treated for chronic obstructive pulmonary disease (COPD) with theophylline (Theo-Dur). What will be a priority assessment by the nurse? Answers : A. Weight B. Use of nicotine C. Intake of fatty foods D. Activity level Response Answer B. Nutritional status, weight, and activity level would be important Feedback: for a nurse to know about a COPD client. However, it would be most important for the nurse to know whether the client smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect. Question 9 The nurse is reviewing the medication regimen of a newly admitted client. The nurse observes that the client takes sustained-release theophylline. When planning the client's care, the nurse should address what characteristic of this client's asthma? Answer s: A. The client likely has asthma symptoms once or twice a day. B. The client likely experiences asthma symptoms a few times each week, but not every day. C. The client likely experiences several asthma exacerbations each day. D. The client was likely diagnosed with asthma several months ago. Response Feedback: Answer A. Sustained-release theophylline is used for mild persistent asthma, in which the client has symptoms at least once per week but not every day. There is no way of knowing when the client was first diagnosed. • Question 10 A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe? 2 out of 2 points Answer s: A. Aminophylli ne B. Ipratropium C. Isoetharine D. Cromolyn Response Feedback: Answer D. Cromolyn is the only mast cell stabilizer used in the treatment of asthma. Aminophylline is a xanthine. Ipratropium is an anticholinergic drug. Isoetharine is a sympathomimetic drug. Question 11 • A client with asthma has been prescribed an anti-inflammatory medication. How does an anti-inflammatory drug reduce this client's bronchoconstriction? Answers: A. Increasing uptake of corticosteroids to medication B. Decreasing formation of mucus secretions C. Increasing ability to metabolize medication D. Decreasing airway hyper-reactivity to stimuli Response Feedback: Answer D. Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that decreases mucosal edema and formation of mucus secretions that narrow airways. Anti- inflammatory drugs do not increase the ability to metabolize medication or increase uptake of steroids.