A client is having a severe asthma attack lasting over 4 hours after exposure to animal dander.

 
On arrival, the pulse is 128/min, respirations are 36/min, pulse oximetry is 86% on room air, and
the client is using accessory muscles to breathe.  Lung sounds are diminished and high-pitched
wheezes are present on expiration.  Based on this assessment, the nurse anticipates the
administration of which of the following medications?  Select all that apply.

Clinical manifestations characteristic of moderate to severe asthma exacerbations include

tachycardia (>120/min), tachypnea (>30/min), saturation <90% on room air, use of accessory
muscles to breathe, and peak expiratory flow (PEF) <40% of predicted or best (<150 L/min).
Pharmacologic treatment modalities recommended by the Global initiative for Asthma (2014) to
correct hypoxemia, improve ventilation, and promote bronchodilation include the following:
1. Oxygen to maintain saturation >90%
2. High-dose inhaled short-acting beta agonist (SABA) (albuterol) and anticholinergic
agent (ipratropium) nebulizer treatments every 20 minutes
3. Systemic corticosteroids (Solu-Medrol)
(Option 4)  Montelukast (Singulair) is a leukotriene receptor blocker with both bronchodilator
and anti-inflammatory effects; it is used to prevent asthma attacks but is not recommended as an
emergency rescue drug in asthma.
(Option 5)  A long-acting beta agonist (Salmeterol) is administered with an inhaled
corticosteroid for long-term control of moderate to severe asthma; it is not used as an emergency
rescue drug in asthma.
Educational objective:
Clinical manifestations characteristic of moderate to severe asthma exacerbations include
tachycardia, tachypnea, saturation <90% on room air, use of accessory muscles of respiration,
and PEF <40% predicted.  Management includes the administration of high-dose inhaled SABA
and ipratropium nebulizer, systemic corticosteroids, and oxygen to maintain saturation >90%.
A client with a history of degenerative arthritis is being discharged home following an
exacerbation of chronic obstructive pulmonary disease.  After reviewing the discharge
medications, the nurse should educate the client about which topics?  Select all that apply. 
Click on the exhibit button for additional information.

A common side effect of tiotropium (Spiriva) and other anticholinergics (eg, ipratropium,

benztropine) is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the
salivary glands, which inhibits salivation.  Sugar-free candies or gum may be used to alleviate
dry mouth and throat (Option 1).
Tiotropium capsules should not be swallowed.  These capsules are placed inside the inhaler
device, and the capsule is pierced, allowing the client to inhale its contents (Option 5).
Glucocorticoids (eg, prednisone), when taken in combination with aspirin or nonsteroidal anti-
inflammatory drugs (NSAIDs) such as naproxen, can increase the risk of gastrointestinal
ulceration and bleeding.  The client should report black, tarry stools (ie, melena) to the health
care provider as they could indicate gastrointestinal bleeding (Option 4).
(Option 2)  Tinnitus (ie, ringing in the ears) is an uncommon side effect of NSAID (eg,
naproxen) use.  Tinnitus is commonly associated with toxicity related to salicylate-containing
NSAIDs (eg, aspirin) or aminoglycosides (eg, gentamicin, neomycin, tobramycin); its onset
should be reported by a client taking these medications.  The medication may need to be
discontinued to prevent permanent hearing loss.
(Option 3)  The albuterol canister should be shaken prior to inhalation to ensure appropriate
medication delivery.
Educational objective:
The nurse should teach the client taking glucocorticoids with aspirin or nonsteroidal anti-
inflammatory drugs about the risk for gastrointestinal bleeding or ulceration.  Xerostomia is a
common side effect of anticholinergic drugs that can be alleviated with sugar-free candies or
gum.  Tiotropium capsules should not be swallowed.

The nurse is teaching a client with advanced chronic obstructive pulmonary disease who was
prescribed oral theophylline.  Which client statement indicates that additional teaching is
required?
Theophylline is a bronchodilator with a low therapeutic index and a narrow therapeutic range
(10-20 mcg/mL).  The serum level should be monitored frequently to avoid severe adverse
effects.  Toxicity is likely to occur at levels >20 mcg/mL.  Individual titration is based
on peak serum theophylline levels, so it is necessary to draw a blood level 30 minutes after
dosing.
Theophylline can cause seizures and life-threatening arrhythmias.  Toxicity is usually due to
intentional overdose or concurrent intake of medications that increase serum theophylline
levels.  Cimetidine and ciprofloxacin can dramatically increase serum theophylline levels
(>80%).  Therefore, they should not be used in these clients.
(Option 1)  Caffeinated products (eg, coffee, cola, chocolate) should be avoided as they would
intensify the adverse effects (eg, tachycardia, insomnia, restlessness) of theophylline.
(Option 2)  The best way to prevent toxicity is to monitor drug levels periodically and adjust
the dose.
(Option 3)  The signs of toxicity that should be reported are anorexia, nausea, vomiting,
restlessness, and insomnia.
Educational objective:
Theophylline can cause seizures and life-threatening arrhythmias due to its narrow therapeutic
range (10-20 mcg/mL).  The dose is adjusted based on peak drug levels, obtained 30 minutes
after the dose is given.  Clients should avoid caffeinated products and medications that increase
serum theophylline levels (eg, cimetidine, ciprofloxacin).

The nurse is preparing medication for 4 clients on a respiratory medical-surgical unit.  Which

situation would prompt the nurse to clarify the prescribed treatment with the health care
provider?

Acetylcysteine (Mucomyst) may be given via nebulizer to help loosen and liquefy respiratory

secretions to more easily clear them from the airway.  Inhaled acetylcysteine may be used for
clients with cystic fibrosis or other respiratory conditions with thick bronchial mucus. 
Acetylcysteine has no therapeutic effect on airway smooth muscle as it works primarily on
secretions and has been shown to cause and/or worsen bronchospasm.  Nurses caring for
clients with reactive airway diseases (eg, asthma) prescribed acetylcysteine should clarify the
prescription with the health care provider (Option 1).
(Option 2)  Chronic obstructive pulmonary disease (COPD) is a respiratory illness in which
excess mucus, inflamed bronchioles, and easily collapsible airways trap air within the alveoli. 
Oral corticosteroids (eg, prednisone) may be used to reduce airway inflammation and improve
ventilation in clients with acute COPD exacerbation.
(Option 3)  Cystic fibrosis is a genetic condition that causes dehydration and thickening of
mucus in the respiratory, gastrointestinal, and genitourinary systems.  Thick mucus within the
pancreas impairs the release of digestive enzymes (eg, lipase), requiring supplementation to
improve digestion and prevent malnutrition in clients with CF.
(Option 4)  Levofloxacin (Levaquin) is a broad-spectrum antibiotic that may be used to treat
respiratory tract infections, such as bacterial pneumonia.
Educational objective:
Acetylcysteine is a medication that can be inhaled to help loosen thick respiratory secretions. 
Nurses caring for clients with reactive airway diseases (eg, asthma) who are prescribed
acetylcysteine should clarify the prescription with the health care provider as it may cause and/or
worsen bronchospasm.

A nurse has received new medication prescriptions for a client admitted with hypertension and
an exacerbation of chronic obstructive pulmonary disease.  Which prescription should the nurse
question?

Codeine is a narcotic analgesic used for acute pain or as a cough suppressant.  Depressing the
cough reflex can cause an accumulation of secretions in the presence of chronic obstructive
pulmonary disease (COPD), leading to respiratory difficulty.  In general, sedatives (eg, narcotics,
benzodiazepines) can also depress the respiratory center and effort; therefore, they should not be
given to clients with respiratory diseases (eg, asthma, COPD).
(Option 1)  Calcium channel blockers (eg, amlodipine, nifedipine) are used to treat hypertension
and do not worsen bronchoconstriction, unlike beta blockers (eg, metoprolol, atenolol).
(Option 3)  Ipratropium (Atrovent) is a short-acting inhaled anticholinergic often used in
combination with a short-acting beta-agonist (eg, albuterol) to promote bronchodilation and
reduce bronchospasm.
(Option 4)  Methylprednisolone (Solu-Medrol) is a systemic glucocorticoid that improves
respiratory symptoms and overall lung function in clients experiencing an exacerbation of
COPD.
Educational objective:
Codeine is a narcotic medication with antitussive properties that can cause an accumulation of
secretions in clients with chronic obstructive pulmonary disease and lead to respiratory distress. 
Caution is advised when sedatives are prescribed for clients with respiratory diseases.

The nurse is caring for a client with asthma exacerbation.  Blood pressure is 146/86 mm Hg,
pulse is 110/min, and respirations are 32/min.  The respiratory therapist administers nebulized
albuterol as prescribed.  One hour after the treatment, the nurse assesses which finding that
indicates the drug is producing the therapeutic effect?

Albuterol (Proventil) is a short-acting inhaled beta-2 agonist used to control airway obstruction

caused by chronic obstructive pulmonary disease, asthma, or bronchitis.  It also is used to
prevent exercise-induced asthma.  The therapeutic effect is relaxation of the smooth muscles of
the airways, which results in immediate bronchodilation.  Bronchodilation decreases airway
resistance, facilitates mucus drainage (expectorates mucus plugs), decreases the work of
breathing, and increases oxygenation.  As a result of these actions, the respiratory
rate will decrease and peak flow will be increased (if tested).
However, short-acting beta-2 agonists are associated with the following side effects (not
therapeutic effects): tremor (most frequent), tachycardia and palpitations, restlessness, and
hypokalemia.
These side effects are due to the oral deposition of medication (subsequent systemic absorption)
and can be reduced with the use of a spacer or chamber device.
(Option 1)  The presence of constricted pupils is neither a side effect nor therapeutic effect of
the drug.  Constricted pupils are often seen with opioid medications (eg, morphine, oxycodone).
Educational objective:
Albuterol (Proventil) is a short-acting beta-2 agonist that produces immediate bronchodilation by
relaxing smooth muscles.  Bronchodilation decreases airway resistance, facilitates mucus
drainage, decreases the work of breathing, and increases oxygenation.  Peak flow will improve. 
The most frequent side effects are tremor, tachycardia, restlessness, and hypokalemia.

A pediatric client is diagnosed with an acute asthma attack.  Which immediate-acting

medications should the nurse prepare to administer to this client?  Select all that apply.

Asthma is an inflammatory condition in which the smaller airways constrict and become filled
with mucus.  Breathing, especially on expiration, becomes more difficult.  Pharmacologic
treatment for acute asthma includes the following:
1. Oxygen to maintain saturation >90%
2. High-dose inhaled short-acting beta agonist (albuterol or levalbuterol) and
anticholinergic agent (ipratropium) nebulizer treatments every 20 minutes
3. Systemic corticosteroids (Solu-Medrol) to control the underlying inflammation.  These
will take some time to show an effect.
(Option 2)  Nonsteroidal anti-inflammatory agents (eg, ibuprofen, naproxen, indomethacin) and
aspirin can worsen asthma symptoms in some clients and are not indicated unless necessary.
(Option 4)  Montelukast (Singulair) is a leukotriene (chemical mediator of inflammation)
inhibitor and is not used to treat acute episodes.  It is given orally in combination with beta
agonists and corticosteroid inhalers (eg, fluticasone, budesonide) to provide long-term asthma
control.
(Option 5)  Tobramycin is an aminoglycoside antibiotic.  It is used in aerosolized form to treat
cystic fibrosis exacerbation when Pseudomonas is the predominant organism causing lung
infection.
Educational objective:
Inhaled corticosteroids and leukotriene inhibitors are typically used to achieve and maintain
control of inflammation for long-term management of asthma.  Quick-relief medications (eg,
albuterol, ipratropium) are used to treat acute symptoms and exacerbations.
The nurse is providing discharge instructions on the proper use of prescribed short-acting beta
agonist and inhaled corticosteroid metered-dose inhalers to a client with newly diagnosed
asthma.  Which instructions should the nurse include?  Select all that apply.

Asthma is a disorder of the lungs characterized by reversible airway hyper-reactivity and chronic
inflammation of the airways.  Albuterol (Proventil) is a short-acting beta agonist (SABA)
administered as a quick-relief, rescue drug to relieve symptoms (eg, wheezing, breathlessness,
chest tightness) associated with intermittent or persistent asthma.  Beclomethasone (Beconase) is
an inhaled corticosteroid (ICS) normally used as a long-term, first-line drug to control chronic
airway inflammation.
When using an ICS metered-dose inhaler (MDI), small particles of the medication are deposited
and can impact the tongue and mouth.  Rinsing the mouth and throat well after using the MDI
and not swallowing the water are recommended to help prevent a Candida infection
(thrush) (white spots on tongue, buccal mucosa, and throat), a common side effect of ICSs. 
The use of a spacer with the inhaler can also decrease the risk of developing thrush (Option 2).
When both MDIs are to be taken at the same time, clients are instructed to take the SABA first to
open the airways and then the ICS to provide better delivery of the medication.  It is important
for the nurse to clarify indications and sequencing as the SABA is a rescue drug taken on an as-
needed basis and is not always taken with the ICS (Options 4 and 5).
(Option 1)  Inhaled corticosteroids (eg, fluticasone, beclomethasone) are not rescue drugs.  They
are prescribed to be taken on a regular schedule (eg, morning, bedtime) on a long-term basis to
prevent exacerbations and should not be omitted even if the SABA is effective.
(Option 3)  Taking the albuterol (Proventil) inhaler apart, washing the mouthpiece (not
canister) under warm running water, and letting it air dry at least 1–2 times a week is
recommended.  Medication particles can deposit in the mouthpiece and prevent a full dose of
medication from being dispensed.  Taking the ICS inhaler apart and cleaning it every day is
recommended.
Educational objective:
Proper use of the short-acting beta agonist (SABA) inhaler includes taking it apart and rinsing
the mouthpiece with warm water 1–2 times a week.  Proper use of the inhaled corticosteroid
(ICS) inhaler includes taking it apart and rinsing the mouthpiece with warm water daily and
rinsing the mouth and throat after each use to prevent a Candida infection (thrush).  When these
medications are administered together, the sequence is SABA first to open the airways and ICS
second.
Candida infection (thrush)

The community health nurse prepares a teaching plan for a client with latent tuberculosis who is
prescribed oral isoniazid (INH).  Which instructions should the nurse include?  Select all that
apply.
Isoniazid (INH) is a first-line antitubercular drug prescribed as monotherapy to treat latent
tuberculosis infection.  Combined with other drugs, INH is also used for active tuberculosis
treatment.  Two serious adverse effects of INH use are hepatotoxicity and peripheral
neuropathy.
A teaching plan for a client prescribed INH includes the following:
 Avoid intake of alcohol and limit use of other hepatotoxic agents (eg, acetaminophen) to
reduce risk of hepatotoxicity (Option 1)
 Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy
 Avoid aluminum-containing antacids (eg, aluminum hydroxide (Maalox)) within 1
hour of taking INH
 Report changes in vision (eg, blurred vision, vision loss)
 Report signs/symptoms of severe adverse effects such as:
o Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine,
fatigue) (Option 3)
o Peripheral neuropathy (eg, numbness, tingling of extremities) (Options 4)
(Option 2)  Rifampin, another antitubercular drug, often causes a red-orange discoloration of
body fluids (ie, urine, sweat, saliva, tears).  However, this effect is not associated with INH use.
(Option 5)  Concurrent use of antacids containing aluminum decreases INH absorption.  The
medication may be taken with food if gastric irritation is a concern.
Educational objective:
Common potential side effects of INH include hepatotoxicity (eg, jaundice, vomiting, dark
urine, fatigue) and peripheral neuropathy (eg, numbness, tingling of extremities).  Clients
should avoid alcohol use and aluminum-containing antacids, and report any experienced side
effects to the health care provider immediately.

The hospice nurse is caring for an actively dying client who is unresponsive and has developed a
loud rattling sound with breathing ("death rattle") that distresses family members.  Which
prescription would be most appropriate to treat this symptom?
The "death rattle" is a loud rattling sound with breathing that occurs in a client who is actively
dying.  When the client cannot manage airway secretions, the movement of these
secretions during breathing causes a noisy rattling sound.  This can distress family and friends at
the bedside of the dying client.  The "death rattle" can be treated using anticholinergic
medications to dry the client's secretions.  Medications include atropine drops administered
sublingually or a transdermal scopolamine patch.
(Option 2)  Lorazepam is a benzodiazepine that is used to treat anxiety and restlessness in
terminally ill clients.  It can be effective for alleviating dyspnea exacerbated by anxiety, but it is
ineffective for controlling secretions (the cause of the "death rattle").
(Option 3)  Morphine is an opioid analgesic that is effective for pain treatment as well as
terminal dyspnea.  The client is not exhibiting these symptoms, so morphine would be
inappropriate.
(Option 4)  Ondansetron will help the nausea and vomiting but is not very effective for treating
the "death rattle."
Educational objective:
The "death rattle" is a noisy rattling sound with breathing commonly seen in a dying client who
is unresponsive and no longer able to manage airway secretions.  Anticholinergic medications
such as transdermal scopolamine or atropine sublingual drops effectively treat this symptom by
drying up the excess secretions.

A client with bronchial asthma and sinusitis has increased wheezing and decreased peak flow
readings.  During the admission interview, the nurse reconciles the medications and notes that
which of the following over-the-counter medications taken by the client could be contributing to
increased asthma symptoms?
Two groups of commonly used drugs, nonsteroidal anti-inflammatory drugs and beta-
adrenergic antagonists (beta blockers), have the potential to cause problems for clients
with asthma.
Ibuprofen (Motrin) and aspirin are common over-the-counter anti-inflammatory drugs that are
effective in relieving pain, discomfort, and fever.  About 10%-20% of asthmatics are sensitive to
these medications and can experience severe bronchospasm after ingestion.  This is prevalent in
clients with nasal polyposis.
(Option 1)  Guaifenesin (Mucinex) is an expectorant used to facilitate mobilization of mucus
and should not have the potential to exacerbate asthma or cause an attack.
(Option 3)  Loratadine (Claritin) is an antihistamine and should not have the potential to
exacerbate asthma or cause an attack.
(Option 4)  Vitamin D is used to help maintain bone density and should not have the potential to
exacerbate asthma or cause an attack.
Educational objective:
Ibuprofen and aspirin are common over-the-counter anti-inflammatory drugs that can cause
bronchospasm in some clients with asthma.

A client with an asthma exacerbation has been using her albuterol rescue inhaler 10-12 times a

day because she cannot take a full breath.  What possible side effects of albuterol does the nurse
anticipate the client will report?  Select all that apply.
Albuterol is a short-term beta-adrenergic agonist used as a rescue inhaler  to treat reversible
airway obstruction associated with asthma.  Dosing in an acute asthma exacerbation should not
exceed 2-4 puffs every 20 minutes x 3.  If albuterol is not effective, an inhaled corticosteroid is
indicated to treat the inflammatory component of the disease.  Albuterol is
a sympathomimetic drug.  Expected side effects mimic manifestations related to stimulation of
the sympathetic nervous system, and commonly include insomnia, nausea and
vomiting, palpitations (from tachycardia), and mild tremor.  
(Option 1)  Constipation is not a common side effect of inhaled beta-agonist drugs.
(Option 3)  Hives can occur as a sign of an allergic reaction and are not a common anticipated
side effect of an inhaled beta-agonist drug.
Educational objective:
Albuterol is a short-term beta-agonist rescue drug used to control symptoms of airway
obstruction and promote bronchodilation.  It is a sympathomimetic drug; common expected side
effects include insomnia, nausea and vomiting, palpitations (tachycardia), and mild tremor.

An elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse,
and cirrhosis has a serum theophylline level of 25.8 mcg/mL (143 µmol/L).  Which clinical
manifestation associated with theophylline toxicity should worry the nurse most?
Theophylline has narrow therapeutic index and plasma concentrations >20 mcg/mL (111
µmol/L) are associated with theophylline drug toxicity.  Toxicity can be acute or chronic. 
Conditions associated with chronic toxicity include advanced age (>60), drug interactions (eg,
alcohol, macrolide and quinolone antibiotics), and liver disease.  Acute toxicity is associated
with intentional or accidental overdose.
Symptoms of toxicity usually manifest as central nervous system stimulation (eg, headache,
insomnia, seizures), gastrointestinal disturbances (eg, nausea, vomiting), and cardiac
toxicity (eg, arrhythmia).
(Option 1)  Alteration in color perception and visual changes are commonly seen with digoxin
toxicity.
(Option 2)  Gum hypertrophy is seen with phenytoin toxicity.
(Option 3)  Hyperthermia and tinnitus are often seen with aspirin overdose.
Educational objective:
Theophylline plasma concentrations >20 mcg/mL (111 µmol/L) are associated with theophylline
drug toxicity.  Seizures (central nervous system stimulation) and cardiac arrhythmias are the
most serious and lethal consequences.

Which medication prescriptions should the nurse question?  Select all that apply.

Cephalexin is a cephalosporin, which is chemically similar to penicillin.  If a client has had a

severe allergic reaction to penicillin, there is a 1%-4% chance of an allergic reaction (cross-
sensitivity) to a cephalosporin (Option 1).
Clients with nasal polyps often have sensitivity to nonsteroidal anti-inflammatory drugs
(NSAIDS), including aspirin.  In addition, NSAIDs can exacerbate asthma symptoms. 
Therefore, acetaminophen may be a better choice for these clients (Option 3).
The selective beta blockers (eg, metoprolol, atenolol, bisoprolol) are generally given for heart
failure and hypertension control due to their beta 1-blocking effect.  The nonselective beta
blockers (eg, propranolol, nadolol), in addition, have a beta2-blocking effect that results in
bronchial smooth muscle constriction.  Therefore, nonselective beta blockers are generally
contraindicated in clients with asthma (Option 5).
(Option 2)  H1 receptor antagonists (eg, fexofenadine, cetirizine, levocetirizine, loratadine)
decrease the inflammatory response by blocking histamine receptors.  Histamine is released from
mast cells during a type I (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic
conjunctivitis, and hives).
(Option 4)  Angiotensin-converting (ACE) inhibitors (ending in "pril") are the drugs of choice in
diabetic clients with hypertension or proteinuria.  This would be an appropriate administration.
Educational objective:
Clients with asthma and nasal polyps can have sensitivity to NSAIDs; those with an allergy to
penicillin can have a cross-sensitivity to cephalosporins.  Nonselective beta blockers are
contraindicated in clients with asthma.  H1 receptor antagonists block histamine in an allergic
reaction.  ACE inhibitors are protective for diabetic nephropathy.

An elderly client is prescribed codeine for a severe cough.  The home health nurse teaches the
client how to prevent the common adverse effects associated with codeine.  Which client
statements indicate an understanding of how to prevent them?  Select all that apply.

Codeine is an opioid drug prescribed as an analgesic to treat mild to moderate pain and as an

antitussive to suppress the cough reflex.  Although the antitussive dose (10-20 mg orally every 4-
6 hours) is lower than the analgesic dose, clients can still experience the common adverse effects
(eg, constipation, nausea, vomiting, orthostatic hypotension, dizziness) associated with the drug.
Codeine decreases gastric motility, resulting in constipation.  Increasing fluid intake and fiber in
the diet and taking laxatives are effective measures to prevent constipation (Option 2).
Changing position slowly is effective in preventing the orthostatic hypotension associated with
codeine, especially in the elderly (Option 4).
Taking the medication with food is effective in preventing the gastrointestinal irritation
(eg, nausea, vomiting) associated with codeine (Option 5).
(Options 1 and 3)  These statements are inaccurate as photosensitivity, insomnia, palpitations,
and anxiety are not adverse effects associated with codeine.
Educational objective:
The common adverse effects of codeine, an opioid drug, include constipation, nausea, vomiting,
orthostatic hypotension, and dizziness.  Interventions to help prevent them include increasing
fluid intake and bulk in the diet, laxatives, taking the medication with food, and changing
position slowly.

The nurse is assessing a client diagnosed with tuberculosis who started taking rifapentine a week
ago.  Which statement by the client warrants further assessment and intervention by the
nurse?

Rifapentine (Priftin), a derivative of rifampin, is an antitubercular agent used with other drugs

(eg, isoniazid) as a combination therapy in active and latent tuberculosis infections.  Both
rifampin and rifapentine reduce the efficacy of oral contraceptives by increasing their
metabolism; therefore, this client will need an alternate birth control plan (non-hormonal) to
prevent pregnancy during treatment (Option 1).
(Option 2)  Rifapentine should be taken with meals for best absorption and to prevent stomach
upset.
(Option 3)  Hepatotoxicity may occur; therefore, liver function tests are required at least every
month.  Signs and symptoms of hepatitis include jaundice of the eyes and skin, fatigue,
weakness, nausea, and anorexia.
(Option 4)  Rifapentine may cause red-orange-colored body secretions, which is an expected
finding.  Dentures and contact lenses may be permanently stained.
Educational objective:
Clients taking rifampin or rifapentine (Priftin) as part of antitubercular combination therapy
should be taught to prevent pregnancy with non-hormonal contraceptives, notify the health care
provider of any signs or symptoms of hepatotoxicity (eg, jaundice, fatigue, weakness, nausea,
anorexia), and expect red-orange-colored body secretions.

A client with asthma was recently prescribed fluticasone/salmeterol.  After the client has
received instructions about this medication, which statement would require further teaching by
the nurse?

Fluticasone/salmeterol (Advair) is a combination drug containing a corticosteroid (fluticasone)

and a bronchodilator (salmeterol).  Salmeterol is a long-acting inhaled β2-adrenergic agonist
that promotes relaxation of the bronchial smooth muscles over 12 hours.  Fluticasone decreases
inflammation.  This medication is used as part of the treatment plan for prevention and long-term
control of asthma.
Client instructions include:
 After inhalation, rinse the mouth with water without swallowing to reduce the risk of
oral/esophageal candidiasis
 Avoid smoking and using tobacco products
 Receive the pneumococcal and influenza vaccines if there is a risk for infection
(Option 2)  Fluticasone/salmeterol is not a rescue inhaler and does not treat acute exacerbations
of asthma.  The client should always have a rescue inhaler (eg, albuterol [short-acting β2-
adrenergic agonist] or ipratropium [Atrovent]) for sudden changes in breathing and call 911 if
the rescue inhaler does not relieve the breathing problem.
Educational objective:
Fluticasone/salmeterol (Advair) is a long-acting inhaled β2-adrenergic agonist combination drug
containing a corticosteroid (fluticasone) and a bronchodilator (salmeterol).  It is used for long-
term control of asthma but not for acute attacks.