Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Ceftriaxone, with a white blood cell count of 16,000 u/L.

Zafirlukast, with an AST of 30 units/L and ALT of 20 units/L.

Theophylline, with a theophylline level of 21 mg/dL.

Prednisone, with a glucose level of 110 mg/dL.

Answer and Explanation

The Correct Answer is C

Choice A Reason
Ceftriaxone is an antibiotic that may be prescribed during COPD exacerbations to treat or prevent infection. A white blood cell count of 16,000 u/L indicates an elevated level, which could be a response to infection. Therefore, ceftriaxone would be appropriate, and there is no need to question this medication based on the white blood cell count.

Choice B Reason
Zafirlukast is a leukotriene receptor antagonist used for the prophylactic treatment of asthma, and it may be used off-label for COPD. AST and ALT levels are liver enzymes, and the values provided (AST of 30 units/L and ALT of 20 units/L) are within normal ranges. Thus, there is no immediate concern regarding liver function that would prompt the nurse to question the use of zafirlukast.

Choice C Reason
Theophylline is a bronchodilator used in the treatment of COPD. However, a theophylline level of 21 mg/dL is above the therapeutic range, which is generally considered to be 5-15 mg/dL. Levels above 20 mg/dL are associated with toxicity and can lead to serious side effects such as seizures or arrhythmias. Therefore, the nurse should question this medication due to the high theophylline level.

Choice D Reason
Prednisone is a corticosteroid that may be used to reduce inflammation during COPD exacerbations. A glucose level of 110 mg/dL is slightly elevated but may be expected as corticosteroids can increase blood sugar levels. This would not typically be a reason to question the use of prednisone unless the patient has poorly controlled diabetes or other specific contraindications.

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Correct Answer is B

Explanation

Choice A Reason
A blood pressure of 120/80 mmHg is considered within the normal range and is an ideal target for most individuals being treated for hypertension. This finding would not typically alert the nurse to a side effect of lisinopril.

Choice B Reason
Serum potassium of 5.5 mEq/L is higher than the normal range, which is typically between 3.5 and 5.0 mEq/L. Lisinopril can cause hyperkalemia, which is an elevated level of potassium in the blood. This is a known side effect of lisinopril, especially in clients with renal impairment, as it inhibits the renin-angiotensin-aldosterone system and reduces potassium excretion.

Choice C Reason
A heart rate of 80 beats per minute is within the normal range for adults, which is typically 60-100 beats per minute at rest. This finding would not alert the nurse to a side effect of lisinopril.

Choice D Reason
A respiration rate of 16 breaths per minute is within the normal range for adults, which is typically 12-20 breaths per minute at rest. This finding would not alert the nurse to a side effect of lisinopril.

A. Switched to heparin. B. Given as prescribed. C. Increased. D. Held.

Correct Answer is A

Explanation

Choice A Reason:
Switching to heparin is not the standard response for a high INR. Heparin may be used in conjunction with warfarin when starting anticoagulation therapy, but it is not typically used as a substitute in response to an elevated INR.

Choice B Reason:
Giving the dose as prescribed would not be appropriate when the INR is significantly above the therapeutic range. Continuing the same dose could increase the risk of bleeding complications.

Choice C Reason:
Increasing the dose would be contraindicated as the INR is already too high. Increasing the warfarin dose would further elevate the INR and increase the risk of bleeding.

Choice D Reason:
Holding the dose is the correct action when the INR is significantly above the therapeutic range, which is generally between 2.0 to 3.0 for most indications. The healthcare provider should be notified, and the warfarin dose should be held until the INR returns to the therapeutic range. Vitamin K may also be administered to help lower the INR more quickly if necessary.

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Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is prescribed lisinopril 20 mg PO daily for the treatment of hypertension. Which finding would alert the nurse that a side effect of the medication has occurred?

Correct Answer is B

Explanation

The nurse has administered warfarin 2.5 mg orally daily for three days to a client who has deep vein thrombosis. The client's International Normalized Ratio (INR) today is 5.0. The nurse notifies the healthcare provider because today's dose of the medication should be:

Correct Answer is A

Explanation

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