Which statements made about theophylline by a patient with asthma would alert the nurse that further intervention is warranted? (Select all that apply)

I should avoid smoking and being around smoke while I am taking the drug.

I should take an extra dose during an asthma attack.

If I accidentally miss a dose, I can double up on my next dose.

I should avoid caffeine as much as possible while receiving theophylline.

I will routinely follow up with my health care provider to have my drug levels determined.

Answer and Explanation

Correct Answer : B,C

Choice A reason: Avoiding smoking is appropriate, as it can exacerbate asthma and reduce theophylline efficacy by inducing hepatic CYP450 enzymes, increasing drug clearance. This statement reflects correct understanding, as smoke exposure worsens airway inflammation, and theophylline’s narrow therapeutic index requires stable metabolism.

Choice B reason: Taking an extra dose of theophylline during an asthma attack is dangerous. Theophylline, a methylxanthine, is used for maintenance, not acute relief, due to its slow onset and narrow therapeutic index. Extra doses risk toxicity (e.g., seizures, arrhythmias), requiring immediate nurse intervention to correct this misconception.

Choice C reason: Doubling a missed theophylline dose is unsafe due to its narrow therapeutic index. Theophylline’s metabolism varies, and doubling doses can lead to toxic levels, causing nausea, tachycardia, or seizures. The nurse must intervene to educate the patient on adhering to the prescribed schedule without adjustments.

Choice D reason: Avoiding caffeine is correct, as it is a methylxanthine like theophylline, potentially increasing plasma levels and toxicity by competing for metabolism. Caffeine can exacerbate theophylline’s side effects like nervousness or tachycardia, so this statement reflects appropriate patient understanding and does not require intervention.

Choice E reason: Routine follow-up to monitor theophylline levels is appropriate due to its narrow therapeutic index (10-20 mcg/mL). Regular blood tests ensure therapeutic efficacy and prevent toxicity, as metabolism varies. This statement indicates correct understanding, supporting safe use without needing nurse intervention.

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Correct Answer is B

Explanation

Choice A reason: Inhaled corticosteroids, such as fluticasone, are not specifically timed for bedtime to minimize side effects. Their primary effect is local anti-inflammatory action in the airways, with minimal systemic absorption. Timing does not significantly reduce side effects like oral thrush, which is managed by rinsing the mouth. Administration is typically twice daily for consistent asthma control, independent of bedtime.

Choice B reason: Rinsing the mouth after using inhaled corticosteroids is essential to prevent oral candidiasis (thrush). Residual corticosteroid in the oral cavity can disrupt the local microbial balance, promoting fungal overgrowth. Rinsing removes excess drug, reducing infection risk while maintaining the drug’s anti-inflammatory effect in the airways, ensuring safe and effective therapy.

Choice C reason: Weight gain of 5 pounds in a week is not a typical side effect of inhaled corticosteroids due to their minimal systemic absorption. Stopping the medication abruptly could exacerbate asthma symptoms. Significant weight gain is more associated with systemic corticosteroids, which affect metabolism and fluid retention, unlike inhaled formulations.

Choice D reason: Inhaled corticosteroids do not require an empty stomach for effectiveness, as they are delivered directly to the lungs via inhalation. Their local action on airway inflammation is independent of gastrointestinal absorption. Food intake does not influence their pharmacokinetics or therapeutic efficacy, making this instruction irrelevant for inhaled corticosteroid use.

A. Definitive B. Empiric C. Supportive D. Prophylactic

Correct Answer is D

Explanation

Choice A reason: Definitive therapy targets a confirmed infection with antibiotics chosen based on culture results. Prescribing antibiotics before a dental procedure for a heart condition aims to prevent infection, not treat an existing one, making this incorrect for endocarditis prophylaxis.

Choice B reason: Empiric therapy involves antibiotics for suspected infections without confirmed pathogens. Antibiotics before dental procedures in heart patients prevent endocarditis, not treat suspected infections. This is a preventive measure based on risk, not empiric treatment, making this incorrect.

Choice C reason: Supportive therapy addresses symptoms or supports other treatments, not infection prevention. Antibiotics before dental procedures in patients with heart conditions (e.g., valvular disease) prevent bacterial endocarditis, a specific prophylactic measure, not supportive care, making this an incorrect classification.

Choice D reason: Prophylactic antibiotic therapy prevents infections in high-risk patients, such as those with heart conditions (e.g., mitral valve prolapse) before dental procedures. It reduces the risk of bacterial endocarditis from transient bacteremia, aligning with guidelines for prophylaxis in susceptible individuals, making this correct.

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Which statements made about theophylline by a patient with asthma would alert the nurse that further intervention is warranted? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is educating a client about an inhaled corticosteroid. What statement will the nurse include?

Correct Answer is B

Explanation

A patient with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered?

Correct Answer is D

Explanation

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