A nurse is caring for a client who had a right sided stroke and is exhibiting homonymous hemianopsia when eating. Which of the following actions should the nurse take?

Choice A reason: Administering the medication 2 hr before exercise is a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is a leukotriene modifier that helps to prevent asthma attacks and exercise induced bronchoconstriction. It is taken once a day in oral form and may cause side effects such as stomach pain, diarrhea, or mood changes. For children who have exercise induced asthma, an additional dose of montelukast may be taken 2 hr before exercise.

Choice B reason: Giving the medication at the onset of wheezing is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is not a fast acting rescue medicine for asthma attacks and needs to be taken daily. It does not work quickly enough to relieve the symptoms of an acute asthma attack, such as wheezing, coughing, or shortness of breath. For an asthma attack, the child should use a short acting beta agonist inhaler, such as albuterol, as prescribed by the provider.

Choice C reason: Administering the granules mixed with 20 oz of water is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast granules come in a sachet with 4 mg of granules inside (one dose). They can be placed directly on the child's tongue or mixed with a spoonful of cold or room temperature soft food, such as applesauce, mashed carrots, rice, or ice cream. They can also be mixed with 1 teaspoonful (5 mL) of cold or room temperature baby formula or breast milk. They should not be mixed with any other liquid drink other than baby formula or breast milk. The mixture should be taken within 15 minutes after opening the packet.

Choice D reason: Giving the medication in the morning daily is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast works best when taken in the evening, as it can improve the symptoms of asthma and allergic rhinitis that occur at night or early in the morning. Taking it at the same time every day can also help to maintain a steady level of the drug in the body and prevent missed doses.

Choice A reason: This is incorrect. Taking the albuterol before taking the cromolyn is not necessary. Albuterol and cromolyn are both used to treat asthma, but they have different mechanisms of action. Albuterol is a bronchodilator that relaxes the muscles around the airways and opens them up, making it easier to breathe. Cromolyn is a mast cell stabilizer that prevents the release of substances that cause inflammation and allergy symptoms in the airways. Albuterol is used to relieve acute asthma attacks, while cromolyn is used to prevent chronic asthma symptoms. The nurse should advise the client to use albuterol as needed for quick relief, and to use cromolyn regularly as prescribed to prevent asthma flareups.

Choice B reason: This is incorrect. Using both medications immediately after exercising is not recommended. Exercise can trigger asthma symptoms in some people, such as wheezing, coughing, or shortness of breath. This is called exercise induced bronchoconstriction (EIB) or exercise induced asthma (EIA). The nurse should advise the client to use albuterol 15 to 30 minutes before exercising to prevent EIB or EIA, and to avoid exercising in cold, dry, or polluted air. The nurse should also instruct the client to use cromolyn at least 15 minutes before exercising, as it takes time to work and does not provide immediate relief. The nurse should also tell the client to stop exercising and use albuterol if asthma symptoms occur during or after exercising.

Choice C reason: This is incorrect. Using cromolyn immediately if the breathing begins to feel tight is not effective. Cromolyn is not a rescue medication that can provide quick relief of asthma symptoms. It is a preventive medication that works by reducing the inflammation and sensitivity of the airways over time. The nurse should advise the client to use albuterol instead of cromolyn if the breathing begins to feel tight, as albuterol can rapidly open up the airways and ease the breathing. The nurse should also instruct the client to seek medical attention if the albuterol does not work or if the symptoms get worse.

Choice D reason: This is correct. Administering the medications 10 minutes apart is good practice. Cromolyn and albuterol can be used together to treat asthma, but they should not be mixed in the same nebulizer, as they may not be compatible and may lose their effectiveness. The nurse should instruct the client to use separate nebulizers for each medication, and to wait at least 10 minutes between each nebulization to allow the medication to reach the lungs and avoid irritation of the airways. The nurse should also teach the client how to use the nebulizer properly, and how to clean and store it after each use.