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A client with a history of chronic obstructive pulmonary disease (COPD) receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

A.

Stores the medication at room temperature.

B.

Attaches spacer device to the inhaler.

C.

Rinses the mouth after each use.

D.

Primes the inhaler with 7 pumps.

Answer and Explanation

The Correct Answer is D

Choice A rationale

 

Storing the medication at room temperature is appropriate for ipratropium inhalers. This ensures the medication remains effective and safe for use.

 

Choice B rationale

 

Attaching a spacer device to the inhaler is recommended for patients using ipratropium inhalers. A spacer helps deliver the medication more effectively to the lungs and reduces the risk of side effects.

 

Choice C rationale

 

Rinsing the mouth after each use of the inhaler is a good practice to prevent oral thrush and other side effects. It is a recommended step in the proper use of inhalers.

 

Choice D rationale

 

Priming the inhaler with 7 pumps is excessive. Typically, inhalers need to be primed with 2-4 pumps before first use or if they haven’t been used for a while. Over-priming can waste medication and indicate a need for additional teaching.


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Correct Answer is D

Explanation

Choice A rationale

Flatulence is not a specific indicator of a serious complication related to a gallstone lodged in the common bile duct.

Choice B rationale

Amber urine is normal and does not indicate a serious complication.

Choice C rationale

Belching is not a specific indicator of a serious complication related to a gallstone lodged in the common bile duct.

Choice D rationale

Yellow sclera indicates jaundice, which is a sign of bile duct obstruction and requires immediate medical attention.

Correct Answer is A

Explanation

Choice A rationale

Lactulose is a synthetic sugar used to treat hepatic encephalopathy by reducing the absorption of ammonia in the intestines. Ammonia is a neurotoxin that can impair mental status in patients with liver dysfunction. By decreasing ammonia levels, lactulose helps improve cognitive function and mental status in patients with hepatic encephalopathy.

Choice B rationale

While lactulose can cause diarrhea as a side effect, the therapeutic goal in hepatic encephalopathy is not to reduce the number of liquid stools but to lower ammonia levels in the blood. The reduction in ammonia levels leads to improved mental status, not necessarily a reduction in liquid stools.

Choice C rationale

The ability to ambulate independently is not a direct therapeutic response to lactulose. The primary goal of lactulose therapy in hepatic encephalopathy is to improve mental status by reducing ammonia levels, not to enhance physical mobility.

Choice D rationale

Lactulose does not have a direct effect on urine output. Its primary mechanism of action is to reduce ammonia absorption in the intestines, thereby improving mental status in patients with hepatic encephalopathy.

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