Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,QUESTION 1 (MCQ)
Clinical Scenario:
A 68-year-old male patient with a 45-pack-year smoking history
and diagnosis of moderate persistent COPD is admitted to the
medical-surgical unit with increased shortness of breath,
productive cough with green sputum, and wheezing. The
patient's current home medications include tiotropium bromide
(Spiriva) 18 mcg once daily, albuterol sulfate (Proventil) 2 puffs
every 4-6 hours PRN, and fluticasone/salmeterol (Advair Diskus)
250/50 mcg one inhalation twice daily. The patient reports
using his albuterol inhaler "about 6-8 times a day" for the past
week.
Question Stem:
The nurse is preparing to administer the patient's scheduled
morning medications. Which assessment finding would indicate
the need to contact the healthcare provider before
administering fluticasone/salmeterol (Advair Diskus)?
Answer Options:
A. Blood pressure 148/92 mmHg
B. Respiratory rate 24 breaths/min with accessory muscle use
C. Heart rate 112 bpm and patient reports palpitations
D. Fasting blood glucose 162 mg/dL
,Correct Answer: C. Heart rate 112 bpm and patient reports
palpitations
Comprehensive Rationale:
The correct answer is C because salmeterol, a long-acting beta-
2 adrenergic agonist (LABA) component of Advair Diskus, can
cause significant cardiovascular effects including tachycardia,
palpitations, and cardiac arrhythmias. The patient's heart rate
of 112 bpm with palpitations suggests excessive beta-2
stimulation that may be exacerbated by the patient's overuse of
albuterol (6-8 times daily), indicating possible beta-agonist
toxicity. Salmeterol has a slower onset and longer duration of
action (12 hours) compared to albuterol, and its cardiovascular
effects can be more prolonged. The nurse should assess the
patient's ECG, evaluate for other signs of beta-agonist toxicity
(tremor, nervousness, hypokalemia, hyperglycemia), and notify
the healthcare provider before administering another dose of a
LABA-containing product.
Pharmacologic Principles:
• Mechanism of Action: Salmeterol selectively stimulates
beta-2 adrenergic receptors in bronchial smooth muscle,
causing bronchodilation via increased intracellular cAMP.
However, at higher doses or in susceptible patients, beta-1
cardiac receptors may also be stimulated.
, • Pharmacokinetics: Salmeterol has a duration of action of
approximately 12 hours, making it suitable for twice-daily
dosing. Fluticasone is a potent corticosteroid that reduces
airway inflammation.
• Adverse Effects: Beta-2 agonists can cause tachycardia,
palpitations, tremor, nervousness, hypokalemia, and
hyperglycemia. Fluticasone may cause oral thrush and
hoarseness.
Distractor Analysis:
• A. Blood pressure 148/92 mmHg: While hypertension is a
concern, this finding alone does not contraindicate Advair
Diskus administration. Beta-agonists can increase blood
pressure, but this level is not an absolute contraindication.
The nurse should monitor BP but can administer the
medication with ongoing monitoring.
• B. Respiratory rate 24 breaths/min with accessory muscle
use: This indicates respiratory distress and suggests the
patient needs bronchodilation. This finding supports the
need for bronchodilator therapy, not a contraindication.
The nurse should administer the medication and monitor
for response.
• D. Fasting blood glucose 162 mg/dL: Beta-agonists can
cause hyperglycemia through glycogenolysis, but this level
does not contraindicate Advair Diskus. The nurse should
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,QUESTION 1 (MCQ)
Clinical Scenario:
A 68-year-old male patient with a 45-pack-year smoking history
and diagnosis of moderate persistent COPD is admitted to the
medical-surgical unit with increased shortness of breath,
productive cough with green sputum, and wheezing. The
patient's current home medications include tiotropium bromide
(Spiriva) 18 mcg once daily, albuterol sulfate (Proventil) 2 puffs
every 4-6 hours PRN, and fluticasone/salmeterol (Advair Diskus)
250/50 mcg one inhalation twice daily. The patient reports
using his albuterol inhaler "about 6-8 times a day" for the past
week.
Question Stem:
The nurse is preparing to administer the patient's scheduled
morning medications. Which assessment finding would indicate
the need to contact the healthcare provider before
administering fluticasone/salmeterol (Advair Diskus)?
Answer Options:
A. Blood pressure 148/92 mmHg
B. Respiratory rate 24 breaths/min with accessory muscle use
C. Heart rate 112 bpm and patient reports palpitations
D. Fasting blood glucose 162 mg/dL
,Correct Answer: C. Heart rate 112 bpm and patient reports
palpitations
Comprehensive Rationale:
The correct answer is C because salmeterol, a long-acting beta-
2 adrenergic agonist (LABA) component of Advair Diskus, can
cause significant cardiovascular effects including tachycardia,
palpitations, and cardiac arrhythmias. The patient's heart rate
of 112 bpm with palpitations suggests excessive beta-2
stimulation that may be exacerbated by the patient's overuse of
albuterol (6-8 times daily), indicating possible beta-agonist
toxicity. Salmeterol has a slower onset and longer duration of
action (12 hours) compared to albuterol, and its cardiovascular
effects can be more prolonged. The nurse should assess the
patient's ECG, evaluate for other signs of beta-agonist toxicity
(tremor, nervousness, hypokalemia, hyperglycemia), and notify
the healthcare provider before administering another dose of a
LABA-containing product.
Pharmacologic Principles:
• Mechanism of Action: Salmeterol selectively stimulates
beta-2 adrenergic receptors in bronchial smooth muscle,
causing bronchodilation via increased intracellular cAMP.
However, at higher doses or in susceptible patients, beta-1
cardiac receptors may also be stimulated.
, • Pharmacokinetics: Salmeterol has a duration of action of
approximately 12 hours, making it suitable for twice-daily
dosing. Fluticasone is a potent corticosteroid that reduces
airway inflammation.
• Adverse Effects: Beta-2 agonists can cause tachycardia,
palpitations, tremor, nervousness, hypokalemia, and
hyperglycemia. Fluticasone may cause oral thrush and
hoarseness.
Distractor Analysis:
• A. Blood pressure 148/92 mmHg: While hypertension is a
concern, this finding alone does not contraindicate Advair
Diskus administration. Beta-agonists can increase blood
pressure, but this level is not an absolute contraindication.
The nurse should monitor BP but can administer the
medication with ongoing monitoring.
• B. Respiratory rate 24 breaths/min with accessory muscle
use: This indicates respiratory distress and suggests the
patient needs bronchodilation. This finding supports the
need for bronchodilator therapy, not a contraindication.
The nurse should administer the medication and monitor
for response.
• D. Fasting blood glucose 162 mg/dL: Beta-agonists can
cause hyperglycemia through glycogenolysis, but this level
does not contraindicate Advair Diskus. The nurse should
