A patient weighing 60 kg reports shortness of breath, wheezing, and chest discomfort. The patient is prescribed 5 mg/kg ipratropium every 12 hours. In a recall visit, the patient reports taking 300 mg/day ipratropium.
What instruction should be given to the patient for the effective management of asthma?
Continue the same dose of medication.
Change to alternative medication.
Double the dose of medication.
Halve the dose of medication.
The Correct Answer is D
This instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.
The other options are not appropriate instructions because:
a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.
b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.
c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
To calculate the rate (in mL/hr) at which the IV pump should be programmed to deliver the dose of esmolol, we can use the following formula:
Rate (mL/hr) = (Dose × Patient weight × 60) / (Concentration × Time)
Given:
Dose = 2.5 grams Patient weight = 110 lb Concentration = 250 mL
Time = 1 hour (since the dose is given per hour)
Converting the patient's weight from pounds to kilograms:
Patient weight = 110 lb ÷ 2.2046 = 49.9 kg
Substituting the values into the formula:
Rate (mL/hr) = (2.5 g × 49.9 kg × 60) / (250 mL × 1)
Simplifying the equation:
Rate (mL/hr) = (2.5 × 49.9 × 60) / 250
Rate (mL/hr) = 74.85
Rounding to the nearest whole number, the nurse should program the IV pump to deliver 75 mL/hr.
Therefore, the correct answer is c. 75 mL/hr.
Correct Answer is D
Explanation
The nurse should administer 2 tablets per dose to this patient.
This answer is correct because it is based on a simple unit conversion and ratio and proportion calculation. The nurse can convert 0.1 mg to 100 mcg by multiplying by 1000, since there are 1000 mcg in 1 mg. Then, the nurse can set up a proportion as follows:
50 mcg / 1 tablet = 100 mcg / x tablets
Cross-multiplying and solving for x gives:
x = 2 tablets
Therefore, the nurse should administer 2 tablets of Synthroid to deliver 0.1 mg or 100 mcg of the medication to the patient.
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