CH 40: Asthma and COPD

A patient experiences persistent asthma that has not been well controlled. Which type of bronchodilator should the nurse expect to be prescribed? a) Methylxanthine b) Anticholinergic c) Short-acting beta2-adrenergic agonist d) Long-acting beta2-adrenergic agonist

methylxanthine **A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. Methylxanthines are used cautiously because of their narrow therapeutic index and interactions with multiple medications.

A patient taking montelukast (Singulair) is demonstrating symptoms of an overdose. Which treatment should the nurse anticipate? a) Supportive treatment b) Isoproterenol c) Epinephrine d) Gastric lavage

supportive treatment **Since there is no specific treatment for overdose, treatment for suspected montelukast overdose is supportive. Isoproterenol and epinephrine are not indicated for montelukast overdose. Gastric lavage is indicated for theophylline overdose.

The nurse instructs a patient about multiple inhaled medications for asthma. For which patient statement should the nurse provide additional teaching? a)"I should dry the inhaler and spacer with a hair dryer." b)"I may feel nervous after using my inhaler." c)"I will avoid caffeine when using my quick-acting inhaler." d)"I will rinse my mouth after using the inhalers."

"I should dry the inhaler and spacer with a hair dryer." **The patient should be instructed to permit the spacer and inhaler to air dry. Feeling nervous is a potential, yet not serious, adverse effect of inhaled medications. Caffeine should be avoided to help prevent nervousness, tremors, or palpitations. The patient should rinse the mouth after using inhalers, especially corticosteroids, to prevent fungal infections, localized reactions, and systemic absorption.

A patient asks if arformoterol (Brovana) can be used to terminate an acute asthma attack. Which response should the nurse provide? a)"No, because it takes longer to achieve maximum effects." b)"No, because the medication can cause rebound bronchoconstriction." c)"Yes, because the medication is the newest and safest on the market." d)"Yes, because the medication starts working in less than 30 seconds."

"No, because it takes longer to achieve maximum effects." **Arformoterol is a long-acting inhaled beta2-agonist (LABA) that should not be used to terminate acute asthma attacks because it has a relatively slow onset of action and will not abort an acute bronchospasm; an inhaled short-acting beta2-agonist should be used instead. Arformoterol has a black box warning that states asthma-related death is a risk. Risk for rebound bronchoconstriction is not why the medication is not used to terminate an acute asthma attack. The medication is not the newest LABA on the market, nor is it necessarily the safest. The medication takes longer to start acting.

A patient asks why it is important to rinse the mouth after using inhaled medications. Which should the nurse respond to this patient? a) "Rinsing helps prevent systemic absorption of the medications." b)"Rinsing decreases the risk of esophageal cancer." c) "Rinsing prevents all adverse medication effects from occurring." d) "Rinsing prevents the inhalers from interacting with other medications.

"Rinsing helps prevent systemic absorption of the medications." **The patient should be instructed to rinse the mouth after using inhaled medications to help prevent systemic absorption and localized reactions. Rinsing does not decrease esophageal cancer risk, nor does it necessarily prevent the inhaled medications from interacting with other medications. Although rinsing may help prevent some adverse medication effects from occurring, rinsing does not prevent all adverse medication effects.

A 65-year-old patient is prescribed ipratropium (Atrovent) for the treatment of asthma. Which condition should be reported to the healthcare provider before giving this patient the ipratropium? A) A reported allergy to peanuts B) A history of intolerance to albuterol (Proventil) C) A history of bronchospasms D) A reported allergy to chocolate

A reported allergy to peanuts

A patient with asthma asks how to avoid acute asthma attacks. Which response should the nurse make? a)"Avoid exposure to dust, pollen, and mold." b)"Use a cough suppressant to prevent attacks." c)"Use a steroid inhaler as soon as you start having symptoms." d)"Exposure to cold air will relax inflamed bronchioles."

Avoid exposure to dust, pollen, and mold **The patient should be instructed to avoid potential asthma triggers, such as cigarette smoke, dust, pollen, and mold. A cough suppressant will not prevent asthma attacks. A short-acting bronchodilator should be the first medication used during an acute asthma attack. In some patients, cold air can trigger an acute asthma attack.

A patient is prescribed albuterol (Proventil HFA, Ventolin HFA, VoSpire ER) for the treatment of asthma. Which type of medication should the nurse recall is contraindicated for use with albuterol? a)Beta blocker b)Corticosteroid c)Leukotriene modifier d)Mast cell stabilizer

Beta blocker **Concurrent use with beta blockers will inhibit the bronchodilation effect of albuterol. Albuterol is not contraindicated with a corticosteroid, leukotriene modifier, or mast cell stabilizer.

The nurse is reviewing the relationship between the respiratory and nervous systems. Which action should indicate the nervous system's control of ventilation? a)Changing the diameter of the airways b)Decreasing gas exchange in the alveoli c)Increasing the amount of mucus production d)Increasing the intrathoracic pressure

Changing the diameter of the airways **The nervous system, specifically the sympathetic and parasympathetic systems, controls ventilation by changing the diameter of the very small and abundant bronchioles. The nervous system does not play a role in decreasing gas exchange in the alveoli, increasing the amount of mucus production, or increasing intrathoracic pressure.

A patient experiencing an asthma attack is given a dose of albuterol. Which outcome should the nurse assess to determine effectiveness? a)Decreased adventitious breath sounds b)Heart rate of 130 beats/min c)Potassium level 2.8 mEq/L d)Constricted pupils

Decreased adventitious breath sounds **Albuterol is a bronchodilator that relieves asthma symptoms, such as wheezing. Decreased adventitious breath sounds indicate an improvement in asthma symptoms. A fast heart rate and low potassium level are adverse effects of the medication. The medication has no effect on pupil reaction.

A patient is prescribed an inhaled corticosteroid for long-term management of persistent asthma. Which therapeutic effect should the nurse expect? a)Decreased airway edema b)Bronchodilation c)Prevention of respiratory infections d)Expectoration of secretions

Decreased airway edema **Inhaled corticosteroids have an anti-inflammatory effect and decrease mucous production and edema in bronchial airways. An inhaled corticosteroid does not promote bronchodilation, prevent respiratory infections, or act as an expectorant.

A patient is prescribed multiple inhaled medications for asthma. Which patient statement should indicate to the nurse that teaching has been effective? a)"I will rinse my mouth after using the medications." b)"I will use the long-acting inhaler first when I have an asthma attack." c)"I will use the spacer if I'm not going to be able to take a deep breath." d)"I will use my inhalers once my symptoms are severe."

I will rinse my mouth after using the medications **The patient should be instructed to rinse the mouth after using inhaled medications to help prevent systemic absorption or localized reactions. A short-acting inhaler should be used for acute asthma symptoms. If available, a spacer should always be used because even when inhalers are used properly, most of the aerosolized medication never reaches the lungs. The patient should be instructed to use a quick-acting inhaler as soon as possible after symptoms appear.

The nurse teaches a patient about self-administration of multiple inhaled medications. Which statement should indicate to the nurse that teaching has been effective? a)"I will use the bronchodilator inhaler before using the corticosteroid inhaler." b)"I will use the bronchodilator and corticosteroid inhalers 30 seconds apart." c)"I will clean the inhalers at least monthly." d)"I will use the inhalers as often as needed."

I will use the bronchodilator inhaler before using the corticosteroid inhaler **The bronchodilator inhaler should be used before the corticosteroid inhaler. The corticosteroid inhaler should be used 5 to 10 minutes after the bronchodilator inhaler to ensure the medication reaches deep into the bronchial tree. The patient should clean the inhalers at least weekly. Inhalers, like all medications, have guidelines about frequency of use. The patient should be instructed to notify the healthcare provider if symptoms persist despite using the inhalers as directed.

A patient is prescribed ipratropium (Atrovent) for chronic obstructive pulmonary disease (COPD). Which teaching should the nurse provide? a)"Increase your fiber intake." b)"A bitter taste after taking the medication indicates an allergic reaction." c)"Difficulty urinating while taking the medication indicates renal failure." d)"Decrease your fluid intake."

Increase your fiber intake **Because an anticholinergic medication, such as ipratropium, can cause constipation, the patient should be instructed to increase fiber and fluid intake. The patient may experience a bitter taste after taking the medication, and although it is problematic for some patients, it does not indicate an allergic reaction. The patient should notify the healthcare provider if difficulty urinating occurs, because this is an adverse effect of anticholinergic medications (especially if the patient has an enlarged prostate); however, this does not indicate renal failure.

The nurse compares oral albuterol (VoSpire ER) with inhaled albuterol (Proventil HFA, Ventolin HFA). Which statement should the nurse make about this comparison? a)"Inhaled albuterol workin about 15 minutes." b)"Oral albuterol has a shorter onset of action." c)"Oral albuterol should be used for acute asthma attacks." d)"Inhaled albuterol is safe to use during pregnancy."

Inhaled albuterol workin about 15 minutes **Compared with oral albuterol, inhaled albuterol works in about 15 minutes. Oral albuterol has a longer onset of action and should not be used for acute asthma attacks. Inhaled albuterol is a pregnancy category C drug.

The nurse is asked why a peak expiratory flowmeter is important in asthma management. Which information should the nurse provide in response? a)"It helps evaluate medication effectiveness." b)"It determines whether chronic obstructive pulmonary disease (COPD) has been cured." c)"It determines whether the patient is a candidate for a lung transplant." d)"It determines the amount of mucus production."

It helps evaluate medication effectiveness **Peak expiratory flowmeter results help to evaluate medication effectiveness. COPD is a chronic disease that is not curable. Peak expiratory flowmeter results do not determine whether the patient is a candidate for a lung transplant, nor do they determine the amount of mucus production.

A patient is diagnosed with emphysema. Which should the nurse recall about the pathophysiology of this health problem? a)Loss of bronchiolar elasticity b)Total collapse of the airways on exhalation c)Increased perfusion and gas exchange at the alveolus d)Excess mucus production in the lower respiratory tract

Loss of bronchiolar elasticity **Emphysema, a chronic pulmonary condition, is characterized by a loss of bronchiolar elasticity and destruction of alveolar wall structures. Partial collapse of the airways occurs on exhalation. Emphysema results in decreased perfusion and gas exchange at the alveolus. Excess mucus production in the lower respiratory tract is a characteristic of chronic bronchitis.

A patient is diagnosed with chronic obstructive pulmonary disease (COPD). Which should the nurse recall about this disease process when planning care? a)Most patients with COPD are lifelong tobacco users. b)Strict medication management alters the progression of COPD. c)A patient with COPD is at low risk for pulmonary infections. d)Mucolytics are contraindicated with COPD

Most patients with COPD are lifelong tobacco users **Most patients with COPD are lifelong smokers, accounting for 85-90% of all nonasthmatic COPD cases. Strict medication management can relieve symptoms, but they do not alter COPD progression. The patient is high risk for pulmonary infections because microbes thrive in mucus-rich environments. Mucolytics loosen thick bronchial secretions and are important for COPD management.

A patient is newly diagnosed with intermittent asthma. Which type of inhaled medication should the nurse expect to be prescribed initially? a)Short-acting beta2-adrenergic agonist (SABA) b)Corticosteroid c)Long-acting beta2-adrenergic agonist (LABA) d)Leukotriene receptor antagonist (LTRA)

Short-acting beta2-adrenergic agonist (SABA) **Short-acting beta agonists (SABAs) have a rapid onset of action, usually several minutes. SABAs are the most frequently prescribed drugs for aborting or terminating an acute asthma attack. Their effects, however, last only 2 to 6 hours, so the use of SABAs is generally limited to as-needed (prn) management of acute episodes. Inhaled corticosteroids (ICS) are used for the long-term prevention of asthmatic attacks. Long-acting beta agonists (LABAs) have therapeutic effects that last up to 12 hours. These medications have a relatively slow onset of action and will not abort an acute bronchospasm. The leukotriene modifiers are second-line medications to reduce inflammation and ease bronchoconstriction and are used as alternative drugs in the management of asthma symptoms.

A patient is receiving treatment for asthma with albuterol (Proventil). The nurse teaches the patient that while serious adverse effects are uncommon, the following may occur. (Select all that apply.) A) Tachycardia B) Sedation C) Temporary dyspnea D) Nervousness E) Headache

Tachycardia Nervousness Headache

A patient with exercise-induced bronchospasm is prescribed a leukotriene modifier. Which teaching should the nurse provide? a)"Take the medication 2 or more hours before you exercise." b)"The medication will terminate an acute asthma attack." c)"Take the medication with St. John's wort for best results." d)"Taking the medication with albuterol can cause overdose."

Take the medication 2 or more hours before you exercise **Montelukast (Singulair) is the only leukotriene modifier approved to prevent exercise-induced bronchospasm. The medication is effective if taken 2 or more hours before exercise. The medication will not terminate an acute asthma attack. There are no identified interactions with herbal preparations. If an acute asthma attack occurs, a short-acting beta2-agonist, such as albuterol (Proventil HFA, Ventolin HFA), should be used.

A patient who received a prescription for montelukast (Singulair) returns to his provider's office after 3 days, complaining that "the drug is not working." She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, albuterol (Proventil). What does the nurse suspect is the cause of the failure of the montelukast? A) The patient is not taking the drug correctly. B) The patient is not responding to the drug and will need to be switched to another formulation. C) The drug has not had sufficient time of use to have full effects. D) The albuterol inhaler is interacting with the montelukast.

The drug has not had sufficient time of use to have full effects.

A patient has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his healthcare provider's office complaining of a sore mouth. On inspection, the nurse notices white patches in the patient's mouth. What is a possible explanation for these findings? A) The patient has been consuming hot beverages after the use of the inhaler. B) The patient has limited his fluid intake, resulting in dry mouth. C) The residue of the inhaler propellant is coating the inside of the mouth. D) The patient has developed thrush as a result of the fluticasone.

The patient has developed thrush as a result of the fluticasone

A patient with persistent asthma is prescribed a methylxanthine bronchodilator. Which should the nurse suspect as the reason for this medication to be prescribed? a)The patient's asthma has been uncontrolled by other medications. b)The patient experiences exercise-induced bronchospasms. c)The patient has chronic obstructive pulmonary disease (COPD). d)The patient has been nonadherent with other medications.

The patient's asthma has been uncontrolled by other medications.

The nurse is asked about the role brainstem neurons have in the respiratory system. Which response should the nurse provide? a)"They determine the rate at which ventilation occurs." b)"They block gas exchange." c)"They cause bronchoconstriction." d)"They promote inflammation."

They determine the rate at which ventilation occurs. **The rate at which ventilation occurs is determined by brainstem neurons. Brainstem neurons do not block gas exchange, cause bronchoconstriction, or promote inflammation.

A patient taking ipratropium (Atrovent) receives a new prescription for tiotropium (Spiriva). Which teaching should the nurse provide about the new medication? a)Tiotropium is taken less frequently than ipratropium. b)Tiotropium is administered by metered-dose inhaler. c)Tiotropium, unlike ipratropium, is a corticosteroid. d)Tiotropium is more effective at treating acute asthma symptoms.

Tiotropium is taken less frequently than ipratropium **Tiotropium is taken once per day, whereas ipratropium is taken four or more times per day. The less frequent dosing decreases the chance of the patient missing a dose. Tiotropium is administered by dry powder inhaler, not metered-dose inhaler. Both medications are anticholinergics. The medications are closely related, but ipratropium is the only anticholinergic with a rapid onset that is suitable for treating acute asthma.

Vilanterol and fluticasone (Breo Ellipta) has been ordered for a patient with COPD. Because of the combination of drugs, what adverse effects may be expected? (Select all that apply). A) Sedation and drowsiness B )Tremor and nervousness C) Hypotension D) Dry mouth and hoarseness E) Oropharyngeal cadidiasis and increased risk of infections

Tremor and nervousness Dry mouth and hoarseness Oropharyngeal cadidiasis and increased risk of infections

A patient with asthma has a prescription for two inhalers, albuterol (Proventil) and beclomethasone (Qvar). How should the nurse instruct this patient on the proper use of the inhalers? A) Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved. B) Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. C) Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. D) Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler.

Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler.

A patient is prescribed cromolyn for chronic obstructive pulmonary disease (COPD). Which should the nurse expect to see documented in the medical record? a)Allergy to corticosteroids b)Diagnosis of intermittent asthma c)Diagnosis of end-stage COPD d)Report of coughing for over a week

allergy to corticosteroids **Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Cromolyn is not effective for acute attacks. Diagnoses of intermittent asthma and end-stage COPD alone do not indicate a need for cromolyn. Cromolyn reduces inflammation and is not prescribed as an antitussive

A patient's airways have suddenly become hyperresponsive to stimuli. Which health problem should the nurse suspect? a)Asthma attack b)Chronic obstructive pulmonary disease (COPD) exacerbation c)Bacterial pneumonia d)Acute respiratory distress syndrome (ARDS)

asthma attack **The airway smooth muscles of a patient with asthma are hyperresponsive to stimuli, which results in bronchospasm. The patient is most likely experiencing an asthma attack and not a COPD exacerbation, bacterial pneumonia, or ARDS.

A patient with chronic obstructive pulmonary disease (COPD) is at risk for osteoporosis. Which long-term medication prescription should the nurse question for this patient? a)Beclomethasone (Qvar) b)Levalbuterol (Xopenex) c)Formoterol (Foradil, Perforomist) d)Ipratropium (Atrovent)

beclomethasone

A patient with chronic obstructive pulmonary disease (COPD) is allergic to corticosteroid medications. Which medication should the nurse expect to be prescribed? a)Cromolyn b)Flunisolide c)Budesonide (Pulmicort) d)Mometasone (Asmanex)

cromolyn **Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Like corticosteroids, cromolyn is not effective for acute attacks. Flunisolide, budesonide (Pulmicort), and mometasone (Asmanex) are all corticosteroids.

An older patient is prescribed long-term beclomethasone (Qvar). Which should the nurse consider before administering the medication? a)Recent diagnosis of osteoporosis b)History of peanut allergy c)Current prescription for an antihyperlipidemic medication d)Recent completion of antibiotic therapy

recent diagnosis of osteoporosis **When taken long term, oral and inhaled corticosteroids such as beclomethasone can affect bone physiology in adults and children. At-risk patients, including those with osteoporosis, should have periodic bone mineral density tests, and the healthcare provider may prescribe a bisphosphonate medication to prevent fractures. There are no known food or medications that interact significantly with beclomethasone. A recent completion of antibiotic therapy is not of concern, although an active infection is a contraindication for the medication's use.

The nurse is teaching a patient about the pathogenesis of asthma. Which information should the nurse include about the action of the smooth muscles within the airway? a)They are hyperresponsive to stimuli. b)They block histamine release. c)They block prostaglandin release. d)They activate beta2-adrenergic receptors.

they are hyperresponsive to stimuli **The smooth muscles located in the airway are hyperresponsive to stimuli, which results in bronchospasm and inflammation in the patient with asthma. During an asthma attack, histamines and prostaglandins are released. Activation of beta2-adrenergic receptors would result in bronchodilation.

A patient is prescribed theophylline for asthma. Which should the nurse suspect as the reason this medication was prescribed? a)treatment with a beta agonist was unreasonsive. b)It is the preferred treatment for asthma. c)Asthma was recently diagnosed. d)It has a wide margin of safety.

treatment with a beta agonist was unreasonsive. **Theophylline is currently used primarily for the long-term oral prophylaxis of asthma that is unresponsive to beta agonists or inhaled corticosteroids. It is not the preferred treatment for asthma. Asthma was not recently diagnosed because other medications have to have been attempted. It has a narrow margin of safety.