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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This statement is correct because the abdomen has a large surface area and a good blood supply, which allows for a consistent and predictable absorption of insulin. Insulin is a hormone that regulates blood glucose levels and needs to be delivered in precise doses to avoid complications such as hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose).
The abdomen is also easy to access and has less variation in fat thickness, which reduces the risk of injecting into the muscle or the skin instead of the subcutaneous tissue. The subcutaneous tissue is the layer of fat and connective tissue below the skin and above the muscle, where insulin injections are given.
The other statements are not correct because they do not explain why the abdomen is the preferred site for subcutaneous insulin injections or they contain false information.
a.It is the least painful location for this injection. This statement is false because pain is subjective and depends on many factors, such as the type and size of the needle, the technique and speed of injection, the temperature and viscosity of the insulin, and the individual's pain tolerance and sensitivity. The abdomen may not be the least painful location for everyone, and some people may prefer other sites, such as the arms, thighs, or butocks.
b.There are fewer insulin side effects when given in this site. This statement is false because insulin side effects are not related to the site of injection, but to the dose, type, and timing of insulin, as well as the individual's response to insulin and other factors, such as diet, exercise, stress, illness, and medications. Insulin side effects may include hypoglycemia, weight gain, allergic reactions, lipodystrophy (changes in fat tissue), or edema (swelling).
c.It causes less bruising at the site. This statement is false because bruising is caused by bleeding under the skin due to damage to blood vessels during injection. Bruising can occur at any site of injection and depends on many factors, such as the type and size of the needle, the technique and speed of injection, the pressure applied after injection, the individual's clotting ability and blood thinning medications, and the presence of any underlying conditions that affect blood vessels or circulation.
Correct Answer is B
Explanation
To find the rate in mL/hr, you need to use the formula for infusion rate:
Infusion rate (mL/h) = Total volume (mL) / Time (h)
Since the total volume is 500 mL and the time is 2 hours, plug in these values into the formula:
Infusion rate (mL/h) = 500 mL / 2 h
Simplify and solve for the infusion rate:
Infusion rate (mL/h) = 250 mL/h
Therefore, the nurse should set the IV pump to deliver **250 mL/h** to infuse LR 500 mL over 2 hours.
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