The nurse is caring for a client with chronic bronchitis and a ...

[Jramos095]

The nurse is caring for a client with chronic bronchitis and a history of glaucoma. The nurse recognizes that which drug would not be an appropriate choice for the control of the client's bronchospasm?
 
  1. Cromolyn (Intal)
  2. Dyphylline (Lufyllin)
  3. Formoterol (Foradil)
  4. Ipratropium (Atrovent)

Question 2

A client with moderate and persistent asthma has obtained control with a formoterol inhaler qid for bronchospasm for several years.
 
  In the past couple of weeks, however, the client has been reporting more chest tightness and wheezing during the day. The nurse recognizes that the most likely problem is that the client:
  1. is not taking the medication as directed.
  2. needs to have the dose reduced and work back up to the full dose.
  3. has developed a tolerance to the medication.
  4. needs an inhaled steroid.

[Cheesycrackers]

Answer to Question 1

Correct Answer: 4
Rationale 1: Mast cell stabilizers do not affect intraocular pressure and therefore could be an appropriate choice.
Rationale 2: Xanthines do not affect intraocular pressure and therefore could be an appropriate choice.
Rationale 3: Long-acting beta blockers do not affect intraocular pressure and therefore could be an appropriate choice.
Rationale 4: Ipratropium is an anticholinergic that can elevate intraocular pressure. It is not a good choice for the client with glaucoma.
Global Rationale: Because it is not readily absorbed from the lungs, ipratropium produces few systemic adverse effects. Though rare, it can worsen glaucoma with sufficient systemic absorption. Mast stabilizers, xanthines, and long-acting beta blockers do not affect intraocular pressure and could be an appropriate choice.

Answer to Question 2

Correct Answer: 3
Rationale 1: Clients sometimes develop tolerance to the beta-adrenergic binding effects of inhaled bronchodilators even when taking medication as directed.
Rationale 2: Clients sometimes develop tolerance to the beta-adrenergic binding effects of inhaled bronchodilators. Decreasing the dose may cause an exacerbation of symptoms.
Rationale 3: Clients sometimes develop tolerance to the beta-adrenergic binding effects of inhaled bronchodilators.
Rationale 4: The client may need an inhaled steroid but this would not account for why the current medication is not working.
Global Rationale: Drug tolerance is possible with the beta agonists and sympathomimetics. Decreasing the dose may cause an exacerbation of symptoms. The client may need an inhaled steroid but this would not account for why the current medication is not working.

[Jramos095]

Excellent

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TYSM