A nurse reviews a serum theophylline level of 22 mcg/mL in a client receiving long-term theophylline for COPD. Which set of findings would the nurse expect to assess?

1 Nausea, vomiting, tremor, tachycardia, and possible seizure activity ✓ Correct answer
2 Bradycardia, hypotension, and somnolence
3 Hyperreflexia, hypertonia, and clonus
4 Pinpoint pupils and respiratory depression

Explanation

Correct (2): Therapeutic theophylline = 10-20 mcg/mL. Toxicity (>20): nausea, vomiting, tremor, tachycardia, agitation; >30: seizures, arrhythmias. (1) Opposite of stimulant theophylline. (3) Serotonin syndrome. (4) Opioid toxicity.

In-depth explanation

Memory Tip Theophylline = "Tea + Coffee" stimulant; toxicity mimics caffeine overdose (jittery, vomiting, tachy, seizures). CPG Narrow therapeutic index; check level at steady state and after dose change or interacting drug.

Clinical scenario

Scenario 65-year-old male on theophylline 300 mg PO BID for COPD × 1 year. Trough level today: 22 mcg/mL (therapeutic 10-20). Reports new nausea and tremor.

Key concepts

Theophylline therapeutic range — 10-20 mcg/mL serum target; some references prefer 5-15 to minimize toxicity.
Theophylline toxicity — GI symptoms first, then CNS (tremor, agitation, seizures) and cardiovascular (tachycardia, arrhythmias).
Methylxanthine — Drug class including theophylline, aminophylline, caffeine; phosphodiesterase inhibitor with bronchodilator effect.

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A nurse reviews a serum theophylline level of 22 mcg/mL in a client receiving long-term theophylline for COPD. Which set of findings would the nurse expect to assess?

In-depth explanation

Clinical scenario

Key concepts

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