A patient who has been taking oral glucocorticoids for a month ...

[rayancarla1]

A patient who has been taking oral glucocorticoids for a month comes to the clinic for a follow-up appointment.
 
  After assessment and review of the patient's medications, the prescriber plans to convert the glucocorticoids from an oral route to an inhaler. When providing education, the nurse should inform the patient that
  a. the oral glucocorticoids will be tapered gradually.
  b. oral glucocorticoids should be discontinued immediately.
  c. the mouth should be rinsed prior to use of the inhaler.
  d. an oral agent and an inhaler should never be used simultaneously.

Question 2

A nurse evaluates an asthmatic patient who has developed tachycardia and dysrhythmias. The laboratory result that would suggest that these signs are the result of theophylline toxicity is a serum theophylline level _______ mcg/mL.
 
  a. below 10
  b. above 30
  c. between 20 and 25
  d. above 2.5

[kjo;oj]

Answer to Question 1

ANS: A
Patients who are switched from oral glucocorticoids to inhaled glucocorticoids must be given supplemental oral glucocorticoids to allow the adrenocortical function to recover.
The medication should not be discontinued abruptly, especially if given in a high dose, because the patient will not be able to produce enough endogenous glucocorticoids as a result of adrenal suppression.
The mouth should be rinsed after an inhaler is used, not before.
An oral agent and an inhaler may be used simultaneously, especially in situations of high stress.

Answer to Question 2

ANS: B
The laboratory result that would confirm severe toxicity, which would lead to tachycardia and dysrhythmias, is a serum theophylline level above 30 mcg/mL.
A serum theophylline level of 5 to 15 mcg/mL is appropriate for most patients. This level falls within that range and does not demonstrate toxicity.
At serum theophylline level of 20 to 25 mcg/mL, the patient may experience relatively mild reactions, such as nausea, vomiting, diarrhea, insomnia, and restlessness.
A serum theophylline level below 2.5 is most probably subtherapeutic, not toxic.

[rayancarla1]

Excellent

[bdobbins]

Gracias!