# A nurse instructs a COPD client on using nebulized ipratropium. Which precaution is most important to prevent a serious adverse effect?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391777&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse instructs a COPD client on using nebulized ipratropium. Which precaution is most important to prevent a serious adverse effect?

## Option

1. Use a tight-fitting mask or mouthpiece to prevent the mist from contacting the eyes **✔ Correct answer**
2. Rinse the mouth thoroughly with water after each nebulizer treatment to prevent thrush
3. Monitor heart rate before and after each treatment to detect tachycardia
4. Use a spacer device with the nebulizer to ensure proper delivery of the medication

**Correct answer: 1**

## Explanation

Correct (2): Ipratropium is an anticholinergic (SAMA); aerosol contact with the eyes can cause pupil dilation and acute angle-closure glaucoma in susceptible clients. A snug mask or mouthpiece prevents drug from reaching the eyes. (1) Food timing is not relevant for inhaled use. (3,4) Unrelated.

## In-depth explanation

Memory Tip Ipratropium = "Atrovent — Atro for atropine-like" anticholinergic. Avoid eye contact with mist; counsel about glaucoma symptoms (acute eye pain, halos, red eye).

## Clinical scenario

Scenario 67-year-old male with COPD using ipratropium 500 mcg nebulizer QID. History of narrow-angle glaucoma. Outpatient teaching session.

## Key concepts

- **Short-acting muscarinic antagonist (SAMA)** — Ipratropium bromide; quaternary anticholinergic with minimal systemic absorption used in COPD.
- **Narrow-angle glaucoma** — Acute angle closure risk with anticholinergic exposure; severe eye pain and vision loss.
- **Aerosol eye protection** — Mask or mouthpiece fit minimizes ocular drug exposure during nebulizer therapy.

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