ASTHMA and COPD medication and interventions

Why are long-acting beta-adrenergic agonists not useful during an actual acute asthma attack? a. They are likely to cause allergies. b. They need time to build up an effect. c. They take too long to be absorbed by the intestinal tract. d. They reduce inflammation rather than relax bronchial smooth muscle.

b. They need time to build up an effect.

Which type of asthma problem is helped most directly by anti-inflammatory drugs? a. Thick mucus b. Mucosal swelling c. Bronchoconstriction d. Large, flabby alveoli

b. Mucosal swelling

Which type of asthma problem is helped most by bronchodilator drugs? a. Thick mucus b. Mucosal swelling c. Bronchoconstriction d. Large, flabby alveoli

c. Bronchoconstriction

How do mucolytics help asthma and chronic obstructive lung disease (COPD)? a. Reducing inflammation b. Inducing bronchodilation c. Reducing mucus thickness d. Enhancing respiratory rate

c. Reducing mucus thickness

What is a common side effect of inhaled anti-inflammatory drugs for asthma? a. Anemia b. Bronchoconstriction c. Cutaneous itching d. Dry mouth

d. Dry mouth

A patient has been medicated during an asthma attack. Which assessment finding indicates that the therapy is ineffective? a. Trachea is at the midline. b. Oxygen saturation is 96%. c. Respiratory rate is 22 breaths/min. d. Peak expiratory flow is 40% below expected value.

d. Peak expiratory flow is 40% below expected value.

Asthma exacerbations at home are managed by the patient by: 1. Increasing frequency of beta-2-agonists and contacting their provider 2. Doubling inhaled corticosteroid doses 3. Increasing frequency of beta-2-agonists 4. Starting montelukast (Singulair)

1. Increasing frequency of beta-2-agonists and contacting their provider

Which of the following statements is true regarding asthma? 1. It has both inflammatory and bronchoconstriction components. 2. Asthma is caused by a virus. 3. Asthma cannot be treated. 4. Symptoms most often occur with rest.

1. It has both inflammatory and bronchoconstriction components.

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur: 1. At nighttime one to two times a month 2. At nighttime three to four times a month 3. Less than twice a week 4. Daily

2. At nighttime three to four times a month

James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin's diet for weight loss. The appropriate response would be: 1. Congratulate him on making a positive change in his life. 2. Recommend he try stopping smoking instead of the Atkin's diet. 3. Schedule him for regular testing of serum theophylline levels during his diet due to increased excretion of theophylline. 4. Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels.

2. Recommend he try stopping smoking instead of the Atkin's diet.

Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? 1. Betamethasone, an inhaled corticosteroid 2. Salmeterol, an inhaled long-acting beta-agonist 3. Albuterol, a short-acting beta-agonist 4. Montelukast, a leukotriene modifier

2. Salmeterol, an inhaled long-acting beta-agonist

Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to: 1. Reassure him this is probably a viral infection and should be better soon 2. Have him seen the same day for an assessment and theophylline level 3. Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better 4. Order a theophylline level at the laboratory for him

3 Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better

Pregnant patients with asthma may safely use ________ throughout their pregnancy. 1. Oral terbutaline 2. Prednisone 3. Inhaled corticosteroids (budesonide) 4. Montelukast (Singulair)

3. Inhaled corticosteroids (budesonide)

The first-line therapy for mild-persistent asthma is: 1. High-dose montelukast 2. Theophylline 3. Low-dose inhaled corticosteroids 4. Long-acting beta-2-agonists

3. Low-dose inhaled corticosteroids

Monitoring a patient with persistent asthma includes: 1. Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment 2. Monthly in-office spirometry testing 3. Determining if the patient has increased use of his or her long-acting beta-2-agonist due to exacerbations 4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan by the nurse include? 1. This medication is indicated for acute asthma attacks. 2. This medication can affect blood glucose levels. 3. This medication will help prevent asthma attacks. 4. This medication can result in hypertension.

3. This medication will help prevent asthma attacks. Rationale 3: By reducing inflammation, cromolyn (Intal) is able to prevent asthma attacks.

An older adult with a history of asthma, rhinitis, and no known drug allergies has been admitted to receive IV antimicrobial therapy for bronchitis. The patient has received the oral form of the antimicrobial agent in the past. Which factors increase the risk for an allergic reaction? (Select all that apply.) a. Medical history of asthma b. The patient's age c. IV antimicrobial therapy d. Medical history of rhinitis e. Subsequent use of the same antimicrobial therapy

ANS: A, D, E Patients with a history of asthma, allergies, or rhinitis should be closely monitored for possible allergic reaction. Subsequent use of the same antimicrobial therapy may only pose a risk if a reaction occurred with the first administration of the drug; in this case, repeat exposures to a previously sensitized substance can be fatal. Older adults, because of physiologic changes of aging, require close observation for therapeutic response and drug toxicity, but not necessarily for allergic reaction. The route of administration does not increase the risk of an allergic reaction.

A child has been diagnosed with asthma and the nurse is providing education to the family. Which statement by the mother indicates a need for further teaching? a. "I will place the stuffed animals in the freezer overnight." b. "We will confine our dog to the kitchen area." c. "I should wash bedding in hot water." d. "A damp cloth should be used when I dust."

ANS: B Pets should be removed from the home or kept outside if at all possible.

The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after administration, the nurse finds the patient agitated and stating that "everyone is out to get me." What is the term for this unusual reaction? a. Desired action b. Adverse effect c. Idiosyncratic reaction d. Allergic reaction

ANS: C Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first administered. Patients typically exhibit an overresponsiveness to a medication related to diminished metabolism. These reactions are believed to be related to genetic enzyme deficiencies. Desired actions are expected responses to a medication. Adverse effects are reactions that occur in another system of the body; they are usually predictable. Allergic reactions appear after repeated medication dosages.

Which drug group for glaucoma can worsen asthma? a. Adrenergic agonists b. Beta blockers c. Cholinergics d. Prostaglandin agonists

B. Beta blockers

Which of the following is a sympathomimetic? A) Itropium B) Theophylline C) Migitol D) Albuterol

D, albuterol. Look for the -terol ending

A client with asthma is using ipratropium (Atrovent). What is the most appropriate teaching point for this client? 1. Limit outside activity. 2. Monitor serum glucose. 3. Increase outside activity. 4. Decrease fluid intake.

Rationale 1: Instruction to limit outside activity should be given to the client because ipratropium (Atrovent) is an anticholinergic, and can therefore inhibit sweat gland secretions due to direct blockade of the muscarinic receptors on the sweat glands. By limiting outside activity, especially when the weather is hot, the client avoids possible heatstroke. Sweating is necessary for clients to cool down, so this inhibition of sweating can increase their risk for hypothermia.

The client with asthma has just been placed on a beta blocker for a dysrhythmia. What symptom should the nurse assessment this client for due to the beta blocker? 1. Elevated blood pressure. 2. Dizziness and fainting. 3. Increased asthma attacks. 4. Bradycardia.

Correct Answer: 3 Rationale 1: Elevated blood pressure is incorrect because only three beta blockers have been approved for dysrhythmias because of their side effects, which include hypotension; bradycardia, leading to dizziness; and fainting. The client with asthma, however, will be more prone to bronchospasm, since the beta blockers will affect the lungs. Rationale 2: Dizziness and fainting is incorrect because only three beta blockers have been approved for dysrhythmias because of their side effects, which include hypotension; bradycardia, leading to dizziness; and fainting. The client with asthma, however, will be more prone to bronchospasm, since the beta blockers will affect the lungs. Rationale 3: Only three beta blockers have been approved for dysrhythmias because of their side effects, which include hypotension; bradycardia, leading to dizziness; and fainting. The client with asthma, however, will be more prone to bronchospasm, since the beta blockers will affect the lungs. Rationale 4: Bradycardia is incorrect because only three beta blockers have been approved for dysrhythmias because of their side effects, which include hypotension; bradycardia, leading to dizziness; and fainting. The client with asthma, however, will be more prone to bronchospasm, since the beta blockers will affect the lungs.

Antihistamines should be used with caution in clients with asthma or COPD. What is the rationale for this caution?1. Anticholinergic effects of antihistamines can trigger angioedema. 2. Most people with asthma are allergic to antihistamines. 3. Antihistamines cause severe headache when given to clients with COPD or asthma. 4. Anticholinergic effects of antihistamines can trigger bronchospasm.

Correct Answer: 4 Rationale 1: Anticholinergic effects of antihistamines may trigger angioedema is incorrect. Antihistamines can trigger bronchospasm. Rationale 2: Most people with asthma are allergic to antihistamines is incorrect. Antihistamines can trigger bronchospasm. Rationale 3: Antihistamines cause severe headache when given to clients with COPD or asthma is incorrect. Antihistamines can trigger bronchospasm. Rationale 4: Use with extreme caution in patients with asthma or COPD. Keep resuscitative equipment accessible. Anticholinergic effects of antihistamines can trigger bronchospasm.

The nurse is caring for a client with asthma. The client asks the nurse what structures make up the upper respiratory tract. Which response by the nurse is the most appropriate? 1. The nose, nasal cavity, pharynx, and paranasal sinuses 2. The lungs and associated structures 3. The nose and nasal cavity only 4. The nose, nasal cavity, pharynx, paranasal sinuses, and the lungs

Rationale 1: The URT consists of the nose, nasal cavity, pharynx, and paranasal sinuses. These passageways warm, humidify, and clean the air before it enters the lungs. The URT traps and removes particulate matter and many pathogens before they reach the lower portions of the lungs, where they would be able to access the capillaries of the systemic circulation.

The client receives zafirlukast (Accolate) as treatment for asthma. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. "This medication activates my fight-or-flight response." 2. "This medication is good when I have an acute attack of asthma." 3. "This medication dilates my airways so I can breathe better." 4. "This medication decreases the inflammation in my lungs."

Rationale 4: Zafirlukast (Accolate) prevents airway edema and inflammation by blocking leukotriene receptors in the airways.

A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon wakening in the morning. The nurse should suggest that the client: a. Use a humidifier in the bedroom b. Sleep with two or more pillows c. Cough regularly even if the cough does not produce sputum d. Cough and deep breathe each night before going to sleep

a A humidifier will help liquefy secretions and promote their expectoration. Sleeping on pillows facilitates breathing; it does not relieve chest congestion. Nonproductive coughing should be avoided because it is irritating and exhausting. Deep breathing and coughing at night will not help relieve early morning congestion.

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? a. Pulse rate of 72/minute b. Temperature of 98.4° F c. Oxygen saturation 96% d. Respiratory rate of 18/minute

a Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 indicates that the patient did not experience tachycardia as an adverse effect.

A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? a. Irregular heartbeat. b. Constipation. c. Pedal edema. d. Decreased pulse rate.

a Irregular heartbeats should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders.

"The client with chronic obstructive pulmonary disease (COPD) is taking theophylline. The nurse should instruct the client to report which of the following signs of theophylline toxicity? Select all that apply. a. Nausea. b. Vomiting. c. Seizures. d. Insomnia. e. Vision changes.

a, b, c, d The therapeutic range for serum theophylline is 10 to 20 mcg/mL (55.5 to 111 μmol/L). At higher levels, the client will experience signs of toxicity such as nausea, vomiting, seizure, and insomnia.

A plan of care for the patient with COPD could include (select all that apply) a. exercise such as walking. b. high flow rate of O2 administration. c. low-dose chronic oral corticosteroid therapy. d. use of peak flow meter to monitor the progression of COPD. e. breathing exercises such as pursed-lip breathing that focus on exhalation.

a, e Breathing exercises may assist the patient during rest and activity (e.g., lifting, walking, stair climbing) by decreasing dyspnea, improving oxygenation, and slowing the respiratory rate. The main type of breathing exercise commonly taught is pursed-lip breathing. Walking or other endurance exercises (e.g., cycling) combined with strength training is probably the best intervention to strengthen muscles and improve the endurance of a patient with chronic obstructive pulmonary disease (COPD).

For which asthma patient is a beta2-adrenergic agonist best delivered by nebulizer? a. 3-year-old child who has a broken leg b. 16-year-old boy who has a broken nose c. 25-year-old woman who is 8 months pregnant d. 60-year-old man who has an enlarged prostate gland

a. 3-year-old child who has a broken leg

Which statement about the pathology of asthma is true? a. Breath sounds are normal between attacks. b. Mucous plugs are the major cause of airway obstruction. c. Eventually the alveoli are destroyed and gas exchange is limited. d. During an attack, arterial oxygen levels and carbon dioxide levels are decreased.

a. Breath sounds are normal between attacks.

A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is your best instruction to the patient? a. Use the albuterol (Proventil) inhaler instead. b. Wait at least one full minute between puffs. c. Attach the spacer to the inhaler before using it. d. Take a deep breath, hold it for 15 seconds, and then exhale before using the inhaler.

a. Use the albuterol (Proventil) inhaler instead.

A client with bronchial asthma (reactive airway disease) can be expected to be relieved by the administration of a drug that stimulates which of the following receptors? a. beta-2 c. alpha-2 b. beta-1 d. alpha-1

a. beta-2 A Correct: Beta-2 receptors are located primarily in bronchial smooth muscle and will cause bronchial dilation when stimulated. B Incorrect: Beta-1 receptors are located primarily in the heart. C Incorrect: These receptors are the synaptic neurotransmitter controllers. D Incorrect: If these receptors are stimulated, they will increase blood pressure.

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters? a. Apical pulse b. Daily weight c. Bowel sounds d. Deep tendon reflexes

b Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.

The nurse teaches a 33-year-old male patient with asthma how to administer fluticasone (Flovent HFA) by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions? a. "I should not use a spacer device with this inhaler." b. "I will rinse my mouth each time after I use this inhaler." c. "I will feel my breathing improve over the next 2 to 3 hours." d. "I should use this inhaler immediately if I have trouble breathing."

b Fluticasone (Flovent HFA) may cause oral candidiasis (thrush). The patient should rinse the mouth with water or mouthwash after use or use a spacer device to prevent oral fungal infections. Fluticasone is an inhaled corticosteroid, and it may take 2 weeks of regular use for effects to be evident. This medication is not recommended for an acute asthma attack.

Which precaution about zanamivir (Relenza) therapy do you teach a patient who also uses a bronchodilator for asthma control? a. "Drink at least 3 L of water daily while using this drug." b. "Use the bronchodilator 15 minutes before taking the zanamivir." c. "Avoid taking the zanamivir within 2 hours of using the bronchodilator." d. "Take your pulse daily while on this drug because when taken with a bronchodilator heart rhythm problems are common."

b. "Use the bronchodilator 15 minutes before taking the zanamivir."

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent)

b. A short-acting beta2 agonist such as albuterol (Proventil)

Which part of the respiratory system is most affected by asthma? a. Alveoli b. Airway c. Trachea d. Cartilage

b. Airway

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) a. Salmeterol (Serevent) inhaler b. Albuterol (Proventil) nebulizer solution c. Epinephrine d. Montelukast (Singulair) e. Fluticasone (Flovent) Rotadisk inhaler

b. Albuterol (Proventil) nebulizer solution c. Epinephrine

A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during teaching sessions with the patient? a. Repeat subsequent puffs, if ordered, after 5 minutes. b. Inhale slowly while pressing down to release the medication. c. Inhale quickly while pressing down to release the medication. d. Administer the inhaler while holding it 3 to 4 inches away from the mouth.

b. Inhale slowly while pressing down to release the medication.

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)? a. Relaxing bronchial smooth muscle, leading to wider airways b. Reducing mucosal swelling in the lumens, leading to wider airways c. Triggering the sympathetic nervous system, leading to deeper respirations d. Controlling anxiety, leading to an increased ability to focus on respiratory effort

b. Reducing mucosal swelling in the lumens, leading to wider airways

A client with asthma is being taught how to use a peak flow meter to monitor how well the asthma is being controlled. What should the nurse instruct the client to do? a. Perform the procedure once in the morning and once at night b. Move the trunk to an upright position and then exhale while bending over c. Inhale completely and then blow out as hard and as fast as possible through the mouthpiece d. Place the mouthpiece between the lips and in front of the teeth before starting the procedure

c A peak flow meter measures the peak expiratory flow rate, the maximum flow of air that can be forcefully exhaled in one second; this monitors the pulmonary status of a client with asthma. The peak flow measurement should be done daily in the morning before the administration of medication or when experiencing dyspnea. The client should be standing or sitting upright. Placing the mouthpiece between the lips and in front of the teeth before starting the procedure will interfere with an accurate test; the mouthpiece should be in the mouth between the teeth with the lips creating a seal around the mouthpiece.

A patient is being discharged with plans for home O2 therapy provided by an O2 concentrator with an O2-conserving portable unit. In preparing the patient to use the equipment, what should the nurse teach the patient? a. The portable unit will last about 6 to 8 hours. b. The unit is strictly for portable and emergency use. c. The unit concentrates O2 from the air, providing a continuous O2 supply. d. Weekly delivery of one large cylinder of O2 will be necessary for a 7- to 10-day supply of O2.

c Oxygen concentrators or extractors continuously supply O2 concentrated from the air. O2-conserving units will last for up to 20 hours. Portable liquid O2 units will hold about 6 to 8 hours of O2 but because of the expense they are only used for portable and emergency use. Compressed O2 comes in various tank sizes but generally it requires weekly deliveries of four to five large tanks to meet a 7- to 10-day suppl

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma? a. Epoprostenol (Flolan) b. Warfarin (Coumadin) c. Guaifenesin (Organidin) d. Salmeterol (Serevent)

c. Guaifenesin (Organidin)

Which medication is a dry powder inhaler (DPI) that is used only for COPD? a. Roflumilast (Daliresp) b. Salmeterol (Serevent) c. Ipratropium (Atrovent HFA) d. Indacterol (Arcapta Neohaler)

d Indacterol (Arcapta Neohaler) is a DPI that is used only for COPD. Roflumilast (Daliresp) is an oral medication used for COPD. Salmeterol (Serevent) is a DPI but it is also used in asthma with inhaled corticosteroids. Ipratropium (Atrovent HFA) is used for COPD but it is delivered via metered-dose inhaler or nebulizer.

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? a. "Long-term home oxygen therapy should be used to prevent respiratory failure." b. "Oxygen will not be needed until or unless you are in the terminal stages of this disease." c. "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." d. "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

d Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered.

When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which statement by the patient shows the nurse that the patient needs more teaching? a. "I do not need to use the spacer like I used to." b. "I will hold my breath for 10 seconds or longer if I can." c. "I will not shake this inhaler like I did with my old inhaler." d. "I will store it in the bathroom so I will be able to clean it when I need to."

d Storing the dry powder inhaler (DPI) in the bathroom will expose it to moisture, which could cause clumping of the medication and an altered dose. The other statements show patient understanding.

During an acute exacerbation of mild COPD, the patient is severely short of breath and the nurse identifies a nursing diagnosis of ineffective breathing pattern related to obstruction of airflow and anxiety. What is the best action by the nurse? a. Prepare and administer routine bronchodilator medications. b. Perform chest physiotherapy to promote removal of secretions. c. Administer oxygen at 5 L/min until the shortness of breath is relieved. d. Position the patient upright with the elbows resting on the over-the-bed table

d The tripod position with an elevated backrest and supported upper extremities to fix the shoulder girdle maximizes respiratory excursion and an effective breathing pattern. Staying with the patient and encouraging pursed lip breathing also helps. Bronchodilators may help but can also increase nervousness and anxiety; rescue inhalers would be used before routine bronchodilators. Postural drainage is not tolerated by a patient in acute respiratory distress and oxygen is titrated to an effective rate based on ABGs because of the possibility of carbon dioxide narcosis.

Why are xanthines seldom used to treat asthma now? a. They increase bronchial secretions at the same time that they induce bronchial dilation. b. They have no role in preventing bronchoconstriction or inflammation. c. They are all administered intravenously. d. They have severe systemic side effects.

d. They have severe systemic side effects