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 A
Explanation
The nurse should administer 0.35 mcg of medication to the infant.
This answer is correct because it is based on a simple multiplication calculation. The nurse should multiply the prescribed dose per kilogram by the infant's weight in kilograms to get the total dose in micrograms, as follows:
0.05 mcg/kg x 7 kg = 0.35 mcg
Therefore, the nurse should administer 0.35 mcg of medication to the infant.
Correct Answer is A
Explanation
Insulin is a hormone that helps regulate blood sugar levels. It is usually injected into the fat layer just under the skin (subcutaneous or SubQ) using a syringe and needle or a pen-like device². Insulin syringes are marked in units of insulin, not milliliters or cubic centimeters. The most common insulin syringe holds 1 mL of fluid and has markings for 100 units of insulin². A U-100 syringe means that for every 1 mL of fluid, there are 100 units of insulin³.
To administer 14 units of insulin, you would need to draw up 0.14 mL of fluid in a U-100 syringe. You would inject the insulin into your abdomen, upper arm, butocks, hip, or the front or side of the thigh¹. You would use a different area within the site each time you inject insulin to prevent lumps, swelling, or thickened skin¹.
The other options are incorrect because:
b) There is no need to divide the dose into two injections. This would increase the risk of infection and pain.
c) A tuberculin syringe is not designed for insulin administration. It is marked in milliliters or cubic centimeters, not units of insulin. Using a tuberculin syringe could result in an incorrect dose of insulin.
d) The timing of insulin administration depends on the type and duration of insulin. Some insulins are taken before meals, some are taken after meals, and some are taken once or twice a day. The primary healthcare provider should specify when to take the insulin.
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