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 B
Explanation
The dose of the medicine per day is 1.8 mcg.
This answer is correct because it is based on a simple multiplication calculation. The nurse should follow these steps to calculate the dose of the medicine per day:
1) Divide 24 hours by the frequency of the dose to get the number of doses per day, as follows:
24 / 4 = 6
Therefore, the client will receive 6 doses of the medicine per day.
2) Multiply the number of doses per day by the amount of each dose to get the total dose per day, as follows:
6 x 0.3 mcg = 1.8 mcg
Therefore, the dose of the medicine per day is 1.8 mcg.
Correct Answer is B
Explanation
The correct angle for giving an intradermal injection is **10 to 15 degrees**. This angle allows the needle to enter the dermis, which is the layer of skin just below the epidermis. The needle should be inserted almost flat against the patient's skin, with the bevel side up. A small blister or bleb should form under the skin after injecting the medication.
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