a nurse is teaching a client who has a new prescription for ipratropium which of the following instructions should the nurse include

ATI RN

ATI Pharmacology Test Bank

1. When teaching a client with a new prescription for Ipratropium, which of the following instructions should the nurse include?

A. This medication can be used as a rescue inhaler.
B. This medication should be taken before albuterol.
C. Wait 5 minutes between medications if two inhaled medications are prescribed.
D. Ipratropium can be used before exercise.

Correct answer: C

Rationale: When two inhaled medications are prescribed, waiting 5 minutes between medications allows for optimal absorption and effectiveness of each medication. This ensures that each medication can work properly without interference from the other, improving the client's respiratory condition.

2. A client has a new prescription for nitroglycerin transdermal patches. Which of the following instructions should the nurse include?

A. Apply the patch to a different location each day.
B. Remove the patch every night before bedtime.
C. Massage the patch area gently after application.
D. Shave the area before applying the patch.

Correct answer: B

Rationale: The correct instruction for a client using nitroglycerin transdermal patches is to remove the patch every night before bedtime. This practice helps prevent tolerance to the medication's effects. Continuous exposure to nitroglycerin can result in the body becoming less responsive to its therapeutic effects over time, reducing its efficacy in managing the prescribed condition. Choices A, C, and D are incorrect. Applying the patch to a different location each day does not address the issue of tolerance. Massaging the patch area gently after application is not recommended as it may alter drug absorption. Shaving the area before applying the patch is unnecessary and may increase the risk of skin irritation.

3. Which drug undergoes extensive first-pass hepatic metabolism?

A. Heparin
B. Insulin
C. Propranolol
D. Nitroglycerin

Correct answer: C

Rationale: Propranolol undergoes extensive first-pass hepatic metabolism in the liver. When administered orally, propranolol is extensively metabolized by the liver before reaching systemic circulation, leading to reduced bioavailability. This process is known as first-pass hepatic metabolism, which significantly affects the drug's effectiveness and necessitates higher oral doses compared to other routes of administration. Heparin (Choice A) is not metabolized by the liver but excreted unchanged by the kidneys. Insulin (Choice B) is a peptide hormone that is not subject to significant first-pass metabolism. Nitroglycerin (Choice D) is primarily metabolized in the blood and tissues, bypassing significant first-pass metabolism in the liver.

4. Which of the following is not a side effect of Sympathoplegics (Clonidine)?

A. Hypertension
B. Difficulty breathing
C. Dry oral cavity
D. Lethargic behavior

Correct answer: A

Rationale: The correct answer is A. Clonidine, a Sympathoplegic, typically causes hypotension rather than hypertension. The other side effects associated with Clonidine include dry oral cavity, lethargic behavior, and difficulty breathing, making them incorrect choices in this context.

5. A client receiving chemotherapy with Methotrexate asks why Leucovorin is being given. Which of the following responses should the nurse use?

A. Leucovorin reduces the risk of a transfusion reaction from Methotrexate.
B. Leucovorin increases platelet production and prevents bleeding.
C. Leucovorin potentiates the cytotoxic effects of Methotrexate.
D. Leucovorin protects healthy cells from Methotrexate's toxic effects.

Correct answer: D

Rationale: Leucovorin, a folic acid derivative and an antagonist to Methotrexate, is given within 12 hours of high doses of Methotrexate to protect healthy cells from the toxic effects of Methotrexate. It helps to reduce the bone marrow suppression and gastrointestinal side effects caused by Methotrexate, supporting the client's overall well-being during chemotherapy treatment. Choices A, B, and C are incorrect because Leucovorin does not reduce the risk of a transfusion reaction from Methotrexate, increase platelet production, prevent bleeding, or potentiate the cytotoxic effects of Methotrexate. Instead, Leucovorin works by rescuing healthy cells from the toxic effects of Methotrexate.