# 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?

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> subject: Medical Emergencies  
> category: PA

## Question

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?

## Option

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

**Correct answer: 1**

## 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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