A nurse is caring for a client with many different medications who is newly prescribed acetazolamide.

What medications can interact with acetazolamide?

 High-dose aspirin (metabolic acidosis)

 Quinidine (can increase risk of toxic effects)

o Instruct client to notify provider of concurrent use and to watch for indications of toxicity,

such as decreased heart rate

 Lithium (decrease blood levels)

o Teach clients to watch for increased indications of mania. Monitor lithium levels regularly

 Phenytoin (increase osteomalacia)

o Teach clients to watch for bone pain or weakness and report symptoms to provider

 Sodium bicarbonate (increases risk of kidney stones)

o Question clients about use of sodium bicarbonate and other OTC antacids

A nurse is preparing to administer ipratropium by metered dose inhaler. What adverse effects should the

nurse instruct the client to monitor for?

 Local anticholinergic effects (dry mouth, hoarseness)

o Advise client to sip fluids and suck on sugar-free hard candies to control dry mouth

A client has a new prescription for salmeterol. The nurse is teaching the client about adverse effects of the

medication. What instructions should the nurse include in thus education?

 Tachycardia, angina

o Advise client to observe for chest, jaw or arm pain/palpitations and to notify provider if

they occur

o Instruct to check pulse and to report an increase of greater than 20-30/bpm

o Advise to avoid caffeine

o Dosage might need to be reduced

 Tremors

o Usually resolve with continued medication use

o Dosage might need to be reduced

A nurse is caring for a client prescribed the inhaled glucocorticoid beclomethasone (QVAR) for the

treatment of asthma. What is a potential adverse effect of this medication and what are two (2) teaching

points to discuss to address these adverse effects?

 Difficulty speaking, hoarseness, candidiasis

o Advise client to rinse mouth or gargle with water after use

o Advise client to monitor for redness, sores, or white patches and to report to provider if

they occur. Treat candidiasis with nystatin oral suspension

A client has a new prescription for an albuterol inhaler and a beclomethasone inhaler. What instructions

should the nurse include concerning use of these inhalers?

 Advise client to inhale the beta2-agonist (albuterol) BEFORE inhaling the glucocorticoid

(beclomethasone). The beta2-agonist promotes bronchodilation and enhances absorption of the

glucocorticoid

A nurse is administering gemfibrozil to a client with elevated cholesterol. Identify two (2) adverse effects

related to this medication.

 GI distress

 Gallstones

o Advise to observe for indications of gallbladder disease ( RUQ aches, pain, fat intolerance,

bloating)