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?
Reassure the patient these are expected effects of the medication.
Encourage the patient to increase fluid intake to improve urination.
Notify the healthcare provider of the patient's symptoms.
Instruct the patient to use the inhaler only when experiencing wheezing.
The Correct Answer is C
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
There is no established direct causal link between long-term, routine therapeutic use of Ibuprofen (a non-selective NSAID) at standard doses and the development of dementia or significant cognitive decline. The primary risks of prolonged NSAID use center on the cardiovascular and gastrointestinal systems, not typically on neurodegenerative disorders.
Choice B rationale
Extrapyramidal symptoms (EPS), such as tardive dyskinesia, akathisia, and dystonia, are motor side effects most commonly associated with dopamine receptor blocking agents, such as typical antipsychotics. Ibuprofen does not act on the dopamine system and is therefore not associated with the development of EPS.
Choice C rationale
Long-term use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs), including ibuprofen, is associated with an increased risk of cardiovascular events, such as stroke and myocardial infarction. NSAIDs can promote sodium and water retention, increase blood pressure, and potentially shift the hemostatic balance toward thrombosis, especially with prolonged use in vulnerable patients.
Choice D rationale
Urinary tract infections (UTIs) are generally caused by bacterial colonization of the urinary tract, most commonly E. coli. There is no direct pharmacological mechanism by which ibuprofen would increase the susceptibility to bacterial growth or recurrent UTIs; renal effects are primarily related to acute kidney injury.
Correct Answer is C
Explanation
Choice A rationale
The kinin system, primarily involving bradykinin, is responsible for mediating inflammation by promoting vasodilation, increased capillary permeability, and pain. It does not function directly to tag pathogens for destruction; its role is more focused on the vascular changes and sensory signals of the inflammatory process.
Choice B rationale
The fibrin system is not a formally recognized component of the plasma protein systems involved in immunity or inflammation. Fibrin is the final product of the clotting cascade, forming the insoluble meshwork necessary for blood clot formation, which traps platelets and blood cells at a site of injury.
Choice C rationale
The complement cascade is a critical part of the innate immune system, consisting of multiple plasma proteins. A key function is opsonization, where complement proteins (specifically C3b) coat the surface of pathogenic microorganisms. This coating acts as a molecular tag, enhancing their recognition and subsequent engulfment and destruction by phagocytes like macrophages.
Choice D rationale
The clotting cascade (also called the coagulation cascade) is a series of enzymatic reactions leading to the formation of a fibrin clot, which prevents blood loss and localizes the inflammatory process. While intertwined with inflammation, its primary role is hemostasis, not the specific tagging of pathogens via opsonization.
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