Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Ceftriaxone, with a white blood cell count of 16,000 u/L.

Zafirlukast, with an AST of 30 units/L and ALT of 20 units/L.

Theophylline, with a theophylline level of 21 mg/dL.

Prednisone, with a glucose level of 110 mg/dL.

Answer and Explanation

The Correct Answer is C

Choice A Reason
Ceftriaxone is an antibiotic that may be prescribed during COPD exacerbations to treat or prevent infection. A white blood cell count of 16,000 u/L indicates an elevated level, which could be a response to infection. Therefore, ceftriaxone would be appropriate, and there is no need to question this medication based on the white blood cell count.

Choice B Reason
Zafirlukast is a leukotriene receptor antagonist used for the prophylactic treatment of asthma, and it may be used off-label for COPD. AST and ALT levels are liver enzymes, and the values provided (AST of 30 units/L and ALT of 20 units/L) are within normal ranges. Thus, there is no immediate concern regarding liver function that would prompt the nurse to question the use of zafirlukast.

Choice C Reason
Theophylline is a bronchodilator used in the treatment of COPD. However, a theophylline level of 21 mg/dL is above the therapeutic range, which is generally considered to be 5-15 mg/dL. Levels above 20 mg/dL are associated with toxicity and can lead to serious side effects such as seizures or arrhythmias. Therefore, the nurse should question this medication due to the high theophylline level.

Choice D Reason
Prednisone is a corticosteroid that may be used to reduce inflammation during COPD exacerbations. A glucose level of 110 mg/dL is slightly elevated but may be expected as corticosteroids can increase blood sugar levels. This would not typically be a reason to question the use of prednisone unless the patient has poorly controlled diabetes or other specific contraindications.

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Correct Answer is C

Explanation

Choice A Reason
Metoprolol, a beta-blocker, can cause fluid retention, which may lead to swelling in the ankles. However, this is not a common side effect and is not typically included as a standard warning for patients starting on metoprolol. Patients should be aware of this potential side effect but also understand that it may not occur.

Choice B Reason
Patients should not stop taking metoprolol abruptly, especially if they experience fatigue, which can be a common side effect. Abrupt cessation can lead to rebound hypertension or angina. Instead, patients should consult their healthcare provider if they experience significant fatigue that impacts their daily activities.

Choice C Reason
Checking the pulse is an important self-monitoring measure for patients on metoprolol. This medication can slow the heart rate, and patients should be instructed on how to check their pulse and what to do if it falls below a certain rate, as advised by their healthcare provider.

Choice D Reason
While staying hydrated is generally good advice, there is no specific need to drink plenty of fluids related to the use of metoprolol for angina pectoris. Patients should follow normal hydration guidelines unless otherwise directed by their healthcare provider.

A. Use an antiemetic one hour following administration. B. Drink 2-3 liters of water per day. C. Rinse mouth twice per day with an alcohol-based mouthwash. D. Take the medication with an NSAID.

Correct Answer is D

Explanation

Choice A Reason
Using an antiemetic one hour after administration of methotrexate is not a standard recommendation. Antiemetics are typically used to prevent nausea and vomiting associated with chemotherapy and are taken before or at the time of methotrexate administration, not afterward.

Choice B Reason
Drinking 2-3 liters of water per day is important for patients taking methotrexate to prevent kidney damage by ensuring adequate hydration and facilitating the excretion of the drug¹. Methotrexate can be nephrotoxic, and proper hydration helps to mitigate this risk.

Choice C Reason
Rinsing the mouth with an alcohol-based mouthwash is not recommended for patients taking methotrexate. Alcohol can cause drying and irritation, which might exacerbate any mouth sores caused by methotrexate. Instead, patients should use a gentle, non-alcoholic mouthwash to maintain oral hygiene.

Choice D Reason
Taking methotrexate with an NSAID is not advised without specific medical guidance. NSAIDs can increase the toxicity of methotrexate by displacing it from protein-binding sites and reducing its renal clearance, potentially leading to increased side effects.

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Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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