A nurse is providing teaching to an adolescent who has a prescription for cromolyn for the management of asthma.
Which of the following statements by the adolescent indicates an understanding of the teaching?
"I use this medication every day, even when I have no symptoms.”.
"I should use this medication as soon as I feel like I am going to start to wheeze.”.
"I will be sure to call the doctor if I don't feel better in a week.”.
"When I know I am going to play softball, I use the medication 2 hours before I start.”.
The Correct Answer is A
Choice A rationale
Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators like histamine from mast cells. This prophylactic action requires consistent, daily use to build up therapeutic levels and prevent the initiation of the asthmatic response, rather than acting as a rescue medication during an acute attack.
Choice B rationale
Using cromolyn as soon as one feels like wheezing is incorrect because cromolyn is not a bronchodilator and does not provide immediate relief for acute bronchospasm. Its mechanism of action involves stabilizing mast cells, which prevents the degranulation and release of inflammatory mediators, thus preventing symptoms from occurring.
Choice C rationale
Expecting to feel better in a week is an inappropriate timeframe for assessing cromolyn's efficacy. The full prophylactic benefits of cromolyn may take several weeks of consistent use to become apparent. Patients should be educated on the preventative nature and delayed onset of action.
Choice D rationale
While cromolyn can be used prophylactically before exercise, using it 2 hours before playing softball is not the recommended timing. For exercise-induced bronchospasm, cromolyn is typically administered 15 to 30 minutes prior to the activity to allow for adequate absorption and mast cell stabilization before exertion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Disulfiram is an aldehyde dehydrogenase inhibitor used in the treatment of chronic alcoholism, causing an unpleasant reaction when alcohol is consumed. It has no pharmacological antagonism to opioids and would not be effective in reversing the effects of hydromorphone toxicity.
Choice B rationale
Epinephrine is a potent vasoconstrictor and bronchodilator, primarily used in anaphylaxis and cardiac arrest. While it stimulates adrenergic receptors, it does not counteract the central nervous system depression caused by opioid toxicity and is not a specific antidote for hydromorphone.
Choice C rationale
Naloxone is an opioid antagonist that competitively binds to opioid receptors, displacing opioid agonists like hydromorphone. This action rapidly reverses the central nervous system and respiratory depression characteristic of opioid toxicity, restoring ventilation and consciousness.
Choice D rationale
Flumazenil is a benzodiazepine receptor antagonist, used to reverse the effects of benzodiazepine overdose. It has no affinity for opioid receptors and therefore would be ineffective in treating hydromorphone toxicity, which is mediated by opioid receptor activation.
Correct Answer is C
Explanation
Choice A rationale
Administering diclofenac at bedtime does not specifically mitigate its gastrointestinal side effects. NSAIDs like diclofenac can cause gastric irritation and ulceration by inhibiting cyclooxygenase-1 (COX-1), which produces prostaglandins essential for gastric mucosal protection. Time of administration is less critical than co-administration with food or protective agents.
Choice B rationale
Antacids can interfere with the absorption of some medications, but specifically for diclofenac, avoiding concomitant administration is not a standard recommendation to mitigate adverse effects. In fact, antacids can sometimes be used to alleviate gastric distress associated with NSAIDs, although they do not prevent direct mucosal damage.
Choice C rationale
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric mucosa, potentially causing dyspepsia, nausea, and ulceration. Administering the medication with food or milk helps to buffer the gastric acid and physically protect the stomach lining, thereby reducing the direct irritant effect on the gastrointestinal tract and enhancing tolerability.
Choice D rationale
Diclofenac is typically formulated as an enteric-coated tablet or delayed-release capsule to protect the stomach from irritation and ensure targeted drug release in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach, increasing gastric irritation, and potentially reducing therapeutic efficacy.
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