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.
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Related Questions
Correct Answer is D
Explanation
This is a dosage calculation problem. To solve it, we need to use the formula:A
Desired dose ÷ Available dose × Available quantity = Quantity to give
In this case, the desired dose is 30 mg, the available dose is 20 mg/mL, and the available quantity is 1 mL. Plugging these values into the formula, we get:
30 ÷ 20 × 1 = 1.5
Therefore, the nurse should administer **1.5 mL** of liquid oxycodone hydrochloride to the patient.
Correct Answer is A
Explanation
The IV infusion will be completed at 13:20.
This answer is correct because it is based on a simple division and addition calculation. The nurse can divide the total volume of the infusion by the infusion rate to get the duration of the infusion in hours, as follows:
1000 mL / 250 mL/hr = 4 hr
Therefore, the infusion will take 4 hours to complete. The nurse can add 4 hours to the start time of the infusion to get the end time, as follows:
09:20 + 4:00 = 13:20
Therefore, the IV infusion will be completed at 13:20.
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