Karch Pharmacology CH55 - Lower Respiratory Drugs
A patient is receiving aminophylline orally. The nurse would expect this drug to begin acting within which time frame? 2 to 4 hours 6 to 8 hours 8 to 10 hours 1 to 6 hours
1 to 6 hours Explanation: Aminophylline has an onset of action of 1 to 6 hours.
A client who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert its full effects within which time frame? 10 minutes 20 minutes 5 minutes 15 minutes
20 minutes Explanation: When given intravenously, epinephrine peaks in approximately 20 minutes. It would be at this time that the drug is most effective.
A patient who is prescribed ipratropium administers the drug at 9:15 AM. The patient should begin to notice the drug beginning to act at which time? 9:30 AM 9:45 AM 10:15 AM 10:00 AM
9:30 AM Explanation: Inhaled ipratropium has an onset of action of 15 minutes, so the patient should begin to feel the effects of the drug at 9:30 AM.
A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem? Pituitary insufficiency Pancreatic insufficiency Adrenal insufficiency Renal insufficiency
Adrenal insufficiency Explanation: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.
A child prescribed an inhaled corticosteroid agent to decrease respiratory inflammation is now receiving high doses of the drug after only 2 days of treatment. What adverse reaction is the client at risk for developing? Edema Adrenal insufficiency Hypoglycemia Tachycardia
Adrenal insufficiency Explanation: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. The client is not at risk for tachycardia, edema, or hypoglycemia unless related to adrenal insufficiency.
After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)? Arformoterol Albuterol Salmeterol Formoterol
Albuterol Explanation: Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists
During the summer, a female client experiences increased periods of acute symptoms of her asthma. The health care provider increases the dose frequency of which of her medications? Albuterol Omalizumab Epinephrine Salmeterol
Albuterol Explanation: Albuterol is the initial drug of choice for acute bronchospasm.
After teaching a group of students about leukotriene receptor antagonists, the instructor determines a need for additional teaching when the students identify which agent as an example? Zileuton Montelukast Fluticasone Zafirlukast
Fluticasone Explanation: Fluticasone is an inhaled steroid. Montelukast is a leukotriene receptor antagonist. Zileuton is a leukotriene receptor antagonist. Zafirlukast is a leukotriene receptor antagonist.
A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following? Increased serum theophylline Increased prothrombin time Increased pulse rate Increased serum zileuton
Increased serum theophylline Explanation: When administering zileuton along with theophylline, the nurse should monitor for increased serum theophylline. Serum zileuton levels and pulse rate are not increased when zileuton is administered along with theophylline. Increased prothrombin time is seen when warfarin, and not theophylline, is given along with zileuton.
A client diagnosed with asthma is being prescribed a leukotriene receptor antagonist as part of their mediation therapy. The nurse should encourage the client to report incidence of what events as possible adverse effects of the new medication? Select all that apply. fever headache muscle aches ringing in the ears diarrhea
diarrhea headache fever muscle aches Explanation: Adverse effects associated with leukotriene receptor antagonists include headache, dizziness, nausea, diarrhea, abdominal pain, elevated liver enzyme concentrations, vomiting, generalized pain, fever, and myalgia. Tinnitus (ringing in the ears) is not associated with adverse effects of this classification of medications.
A client has been prescribed medication therapy for the treatment of newly diagnosed asthma. During teaching, the nurse should alert the client to potential exacerbation of what concurrent medical condition? urinary retention dermatitis cataracts gastroesophageal reflux disease
gastroesophageal reflux disease Explanation: Asthma may aggravate gastroesophageal reflux disease because antiasthma medications that dilate the airways also relax muscle tone in the gastroesophageal sphincter and may increase acid reflux. The relationship between asthma medications and the other options is not supported by research data.
The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy? fluticasone theophylline budesonide ipratropium
ipratropium Explanation: A client who is taking ipratropium should not take tiotropium because both drugs are anticholinergics. Theophylline and corticosteroids like budesonide and fluticasone are not necessarily contraindicated.
The nurse caring for a premature newborn receiving surfactant therapy should monitor for what adverse effects? Select all that apply. bronchoconstriction patent ductus arteriosus sepsis pneumothorax bradycardia
pneumothorax patent ductus arteriosus bradycardia sepsis Explanation: Adverse effects of surfactant therapy include pneumothorax, patent ductus arteriosus, bradycardia, and sepsis. Surfactant therapy is not associated with bronchoconstriction.
Which statement made by a nurse providing care to a newborn prescribed surfactant therapy indicates a need for additional instructions to ensure the medication's effectiveness? "The baby needs suctioning just prior to the instillation of the surfactant." "Suctioning should be avoided for at least 2 hours after the surfactant instillation." "The baby should be suctioned after the instillation of the surfactant only if clinically necessary." "The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant."
"The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant." Explanation: Suction the infant immediately before administration, but do not suction for 2 hours after administration unless clinically necessary, to allow the drug time to work.
A client is receiving ipratropium as maintenance therapy for chronic obstructive pulmonary disease. The nurse would caution the client that up to how many inhalations may be used in 24 hours if needed? 16 12 8 4
12 Explanation: With ipratropium, the usual dosage is 2 inhalations four times/day for a total of 8 inhalations. However, the client can use up to 12 inhalations if needed in 1 day.
A client has been admitted to a health care facility with asthma. The nurse is to administer theophylline to the client. To which clients can the nurse safely administer theophylline? A 65-year-old male with asthma A 43-year-old male with hypertension A 65-year-old female with hepatic disease An 83-year-old female with cardiac disease
A 65-year-old male with asthma Explanation: The nurse can safely administer theophylline to the client who is 65 years of age. It needs to be administered cautiously in clients older 69 years of age or those with hepatic disease, cardiac disease, or hypertension.
A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the health care provider to order? A modified dose of aminophylline The standard dose of aminophylline A drug other than aminophylline Phenytoin intravenously
A modified dose of aminophylline Explanation: Cigarette smoking and drugs that stimulate drug-metabolizing enzymes in the liver (e.g., phenobarbital, phenytoin) increase the rate of metabolism and, therefore, the dosage requirements of aminophylline.
The nurse is performing a routine assessment of a client whose medical record indicates a history of asthma. What assessment findings would the nurse expect? Select all that apply. Confusion Airway inflammation Damaged airway mucosa Elevated temperature Bradycardia
Airway inflammation Damaged airway mucosa Explanation: Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free. Elevated temperature and bradycardia are unrelated to the client's asthma. Confusion can occur during an acute attack, but it would not be expected otherwise.
The client has been diagnosed with asthma and is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order? Albuterol followed immediately by flunisolide Flunisolide followed immediately by albuterol Albuterol first, wait five minutes and then follow with flunisolide Flunisolide first, wait five minutes and then follow with albuterol
Albuterol first, wait five minutes and then follow with flunisolide Explanation: Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.
When describing the events of an asthma attack to a client, the nurse incorporates understanding that stimulation of alpha-adrenergic receptors results in which of the following? Bronchodilation Sputum production Bronchoconstriction Cough
Bronchoconstriction Explanation: Stimulation of alpha-adrenergic receptors results in bronchoconstriction. When leukotriene production is inhibited, bronchodilation is facilitated. Cough is a physiologic mechanism that causes the central airways to be cleared of foreign materials and excess secretions, usually results from stimulation of sensory nerves in the airways. Inflammation of the mucosa is responsible for sputum production from increased mucus.
A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid? Cranberry juice Orange juice Bananas Chocolate
Chocolate Explanation: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.
A male client is prescribed montelukast and uses it successfully to manage his asthma. He develops hepatitis C. What would the nurse expect the health care provider to do? Discontinue the medication and prescribe another Maintain the same dose of the montelukast Lower the dose of the montelukast Increase the dose of the montelukast
Maintain the same dose of the montelukast Explanation: Montelukast and zafirlukast produce higher blood levels and are eliminated more slowly in clients with hepatic impairment. However, no dosage adjustment is recommended for clients with mild to moderate hepatic impairment.
Which medication is used to treat acute airflow obstruction? Metaproterenol Beclomethasone Azelastine Montelukast
Metaproterenol Explanation: Metaproterenol is a short-acting beta-2 agonist used as a quick-relief medication. Beclomethasone is an inhaled corticosteroid used as a long-term control medication. Montelukast is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Azelastine is a second-generation antihistamine.
A client with asthma should always carry a rescue inhaler or quick-relief medication with them at all times. Which of the following are considered quick-relief medications? Select all that apply: Albuterol Salmeterol Metaproterenol Montelukast Fluticasone
Metaproterenol (Alupent) Albuterol (Proventil) Explanation: Short-acting beta agonists (SABAs) are used as rescue treatment for asthma.
The nurse is evaluating the education of a client that uses albuterol for an acute asthma attack. The nurse knows that the lesson has been effective when the client states that albuterol is which of the following types of medication? LABA SABA Antiasthma Leukotriene modifier
SABA Explanation: Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.
A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation? The health care provider will most likely order continuation of the salmeterol with increased dosage. The extra doses facilitated bronchodilation and probably saved her life. The husband made the correct decision in giving the extra doses. Salmeterol is contraindicated based on his wife's condition.
Salmeterol is contraindicated based on his wife's condition. Explanation: The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.
A client has been prescribed theophylline intravenously and began the therapy three days ago. The nurse suspects that the serum drug level is above therapeutic levels when the client makes what statement(s)? Select all that apply. "It feels like my heart is beating faster than usual." "The headache I mentioned yesterday still hasn't gone away." "I need to tell you that I vomited a few minutes ago." "I don't want lunch; I'm feeling nauseated." "Last night, I slept soundly all night."
"I don't want lunch; I'm feeling nauseated." "It feels like my heart is beating faster than usual." "The headache I mentioned yesterday still hasn't gone away." "I need to tell you that I vomited a few minutes ago." Explanation: Theophylline has a narrow range of safety, with potentially significant side effects occurring at serum levels above the therapeutic range. Signs and symptoms of theophylline toxicity include anorexia, nausea, vomiting, headache, agitation, nervousness, and insomnia. If serum levels continue to increase, the client can experience tachycardia and other arrhythmias, tonic-clonic convulsions, and other serious adverse effects. A report of restful sleep would not suggest theophylline toxicity.
The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching? "I need to shake the inhaler well before taking the medication." "I should take a deep breath, hold it while I administer the medication, and then exhale." "I need to take three short, quick breaths to inhale the medication." "I need to wait at least 30 minutes after the first inhalation before taking a second."
"I need to shake the inhaler well before taking the medication." Explanation: Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which statement by the client indicates the need for further education? "I will use this medication when I am having an asthma attack." "This medication may cause my throat to become dry." "This medication may also be used for allergy disorders." "I may experience wheezing with this medication."
"I will use this medication when I am having an asthma attack." Explanation: Cromolyn (Intal) is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders. Adverse reactions include drying of the throat and coughing or wheezing. It should not be used during an acute asthma attack because it may worsen the bronchospasm.
The nurse assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic? 25 mcg/mL 15 mcg/mL 5 mcg/mL 30 mcg/mL
15 mcg/mL Explanation: Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.
A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for asthma-related death? A 17-year-old client who experiences exercise-induced asthma An African American client taking salmeterol An Asian American client with a history of cigarette smoking a 76-year-old client who takes theophylline
An African American client taking salmeterol Explanation: Salmeterol has a black box warning addressing a small but significant increase in the risk of life-threatening asthma episodes in patients using salmeterol. This is based on a study that showed African American clients had a greater risk of asthma-related deaths than did other groups. For this reason, an African American client taking salmeterol likely has a higher risk than the other listed clients.
A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? Asthma Chronic bronchitis Emphysema Pneumonia
Asthma Explanation: Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma. This class of medication is not typically associated with the long term management of any of the other options
Which of the following would a nurse identify as a surfactant? Zileuton Cromolyn Theophylline Beractant
Beractant Explanation: Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.
A client is experiencing an acute asthmatic attack. Which agent would be most effective? Leukotriene receptor antagonist Mast cell stabilizer Beta-2 selective adrenergic agonist Inhaled steroid
Beta-2 selective adrenergic agonist Explanation: A beta-2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after injection and rapidly absorbed after inhalation. An inhaled steroid would require 2 to 3 weeks to reach effective levels. Leukotriene receptor antagonists and mast cell stabilizers do not have immediate effects.
The nurse should complete which of the following during acute breathing distress before initiation of a bronchodilator? Select all that apply: Check respiratory rate Check pulse. Check peak flow Check blood pressure. Check blood glucose.
Check blood pressure. Check pulse. Check respiratory rate Explanation: Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.
A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? Cigarette smoking Hyperthyroidism Alcohol intake Gastrointestinal upset
Cigarette smoking Explanation: Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary. Hyperthyroidism, gastrointestinal, upset or alcohol intake requires cautious use of the drug because these conditions may be exacerbated by the systemic effects of the drug. The drug dosage may need to be decreased in these situations.
Which of the following would be most important to assess before administering calfactant? (Select all that apply.) Oxygen saturation levels Endotracheal tube placement Bowel sounds Lung sounds Abdominal girth
Endotracheal tube placement Lung sounds Oxygen saturation levels Explanation: Before administering calfactant, it would be important to ensure proper endotracheal tube placement because the drug is instilled directly into the trachea. In addition, lung sounds and oxygen saturation levels would be important as a baseline to evaluate effectiveness of the drug.
After teaching a group of students about antiasthmatic agents, the students demonstrate understanding of the information when they identify what as sympathomimetics? (Select all that apply.) Cromolyn Tiotropium Terbutaline Epinephrine Budesonide Formoterol
Epinephrine Terbutaline Formoterol Explanation: Epinephrine is a sympathomimetic. Terbutaline is a sympathomimetic. Formoterol is a sympathomimetic. Budesonide is an inhaled steroid. Tiotropium is an anticholinergic. Cromolyn is a mast cell stabilizer.
The client has mild, persistent asthma. The nurse anticipates the healthcare provider prescribing which daily medications? Albuterol Terbutaline Levalbuterol Fluticasone
Fluticasone Explanation: Terbutaline, albuterol, and levalbuterol are all short-acting beta-2 agonists that are used for acute symptom relief. Fluticasone is a daily inhaled corticosteroid.
Where should the nurse initially direct a client who is interested in learning more about the management of asthma? National Association of Educational Pulmonologists Global Initiative for Asthma (GINA) Centers for Disease Control Education Center Journal of Allergy and Clinical Immunology
Global Initiative for Asthma (GINA) Explanation: Management of asthma involves prevention of airway inflammation and avoidance of triggers for better symptom control. Because of asthma's significance as a world health problem, the Global Initiative for Asthma (GINA) published asthma guidelines of diagnosis, management, and education. These guidelines emphasize the importance of classifying asthma severity and the assessment of asthma control. While the other options may provide information on asthma, the GINA is most inclusive.
A nurse is required to educate a patient prescribed albuterol on the adverse effects associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the patient to report to the health care provider? Headache and flushing Fall in blood pressure Hearing impairment or deficit Increased nighttime urination
Headache and flushing Explanation: The nurse should instruct the patient to contact the health care provider if palpitations, tachycardia, chest pain, muscle tremors, dizziness, headache, flushing, or difficulty with urination or breathing occur. Fall in blood pressure, increased nighttime urination, or hearing impairment are not adverse effects associated with a sympathomimetic bronchodilator.
A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse? "I'm a heavy coffee drinker, but I know that I now know I need to cut down on this." I'll keep taking my medications until I'm not experiencing any more symptoms." "I'll make sure I don't take my inhalers more often than they've been prescribed." "I'll try to make sure that I drink plenty of fluids each day."
I'll keep taking my medications until I'm not experiencing any more symptoms." Explanation: Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.
A client who smokes is receiving theophylline orally. Because of his history of smoking, the nurse expects the health care provider to do what with the theophylline dosing? Decrease Monitor closely Increase Discontinue
Increase Explanation: Nicotine from smoking interferes with the ability of the body to metabolize theophylline. Due to decreased metabolism, the dosage of theophylline would be increased.
The triage nurse in the emergency department has a 42-year-old client with asthma present for treatment. The client's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this client? Impaired gas exchange Activity intolerance Ineffective breathing pattern Ineffective airway clearance
Ineffective breathing pattern Explanation: The correct nursing diagnosis is Ineffective Breathing Pattern related to impaired airway as manifested by tachypnea. The other options may be applicable, but they do not take priority over the ineffective breathing pattern.
The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take? Withhold the scheduled dose of theophylline pending the next day's blood work results. Administer the scheduled dose of theophylline with as needed (PRN) dose of a bronchodilator. Inform the health care provider that an increase in the client's dose of theophylline may be necessary. Inform the health care provider that the client has toxic theophylline levels.
Inform the health care provider that the client has toxic theophylline levels. Explanation: To determine theophylline dosage, prescribers should measure serum theophylline levels. Therapeutic range is 5 to 15 mcg/mL (27.75 to 83.25 µmol/L); toxic levels are 20 mcg/mL (111 µmol/L) or above. The health care provider must be informed of this elevated serum level.
A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route? Oral Intravenous Inhalation Subcutaneous
Inhalation Explanation: Salmeterol is administered via inhalation
An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate? Have the child lie flat. Mix the drug with saline. Encourage rapid shallow breaths. Turn the device off when the mist slows.
Mix the drug with saline. Explanation: Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.
A history of an allergy to which would be a contraindication to the use of anticholinergics? (Select all that apply.) Soy Eggs Peanuts Shellfish Iodine
Soy Peanuts Explanation: The use of ipratropium and tiotropium, anticholinergics, is contraindicated in the presence of known allergy to soy products or peanuts.
The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching? Diarrhea Tachycardia Polydipsia Hypotension
Tachycardia Explanation: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.
The client is 73 years of age and has a history of coronary artery disease and COPD. She is being started on formoterol (Foradil). The nurse would assess the client for which of the following conditions? Select all that apply. Lethargy Hypotension Tachycardia Bradycardia Hypertension
Tachycardia Hypertension Explanation: Older adults taking adrenergic bronchodilators are at increased risk for adverse reactions related to the cardiovascular system, such as tachycardia (not bradycardia), arrhythmias, palpitations, and hypertension (not hypotension). Lethargy is not related to taking adrenergic bronchodilators.
In children, high doses of nebulized albuterol have been associated with what conditions? (Select all that apply.) Hypotension Hypokalemia Tachycardia Hyperkalemia Hyperglycemia
Tachycardia Hypokalemia Hyperglycemia Explanation: In children, high doses of nebulized albuterol have been associated with tachycardia, hypokalemia, and hyperglycemia. Lowered or elevated blood pressure is not a usual issue with high doses of nebulized albuterol in children.
A client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussion medication instructions with this client? The medication is most effective when taken at breakfast The medication should be taken 30 minutes before a meal The effectiveness of the medication is enhanced when taken with food The medication should be taken on an empty stomach.
The medication should be taken on an empty stomach. Explanation: Administer drug on an empty stomach, 1 hour before or 2 hours after meals; the bioavailability of these drugs is decreased markedly by the presence of food. None of the other options present accurate information regarding the administration of this class of medications.
When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements? "I need to inhale my medication and hold my breath for 10 seconds." "When I am short of breath, I will increase the use of my fluticasone." "When I can do some, but not all of my usual activities, I am in the yellow zone." "I will wash my sheets weekly."
has a high coffee intake. Explanation: Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy.
According to the National Asthma Education and Prevention Program (NAEPP) Expert Panel Guidelines, a client prescribed a short-acting beta2 agonist may take this medication how often during an acute exacerbation of asthmatic symptoms? every 30 seconds until symptoms subside hourly, with no more than six doses in a 24-hour period up to three treatments at 20-minute intervals every 5 minutes to a maximum of three doses
up to three treatments at 20-minute intervals Explanation: For acute exacerbations, the NAEPP Guidelines suggest a short-acting, inhaled, beta2 agonist, two to four puffs as needed. If symptoms are severe, clients may need up to three treatments at 20-minute intervals or a nebulizer treatment.
Isoproterenol is an anticholinergic agent: True False
False Explanation: Isoproterenol is a sympathomimetic agent.
A client is prescribed a steroid to help decrease inflammation in their respiratory tract. When providing medication education to the client what should the nurse identify as the primary benefit of administering the medication by inhaler? Fewer systemic effects Allows for therapy during pregnancy Quicker response Ease of administration
Fewer systemic effects Explanation: Steroids are used to decrease the inflammatory response in the airway. Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use. Steroids are not prescribed for the management of acute symptoms since they can take 2-3 weeks to reach effective levels. They should not be used during pregnancy or lactation. Ease of administration is not the primary benefit of this form of steroid therapy.
When teaching a patient to use a dry powder inhaler, which of the following is true? Select all that apply: Hold inhaler 1 to 2 inches from mouth. Place device in water to clean. Inhale quickly. Swallow capsules provided. Hold breath for 10 seconds.
Hold breath for 10 seconds. Inhale quickly. Explanation: To properly use a dry powder inhaler prepare the medication for inhalation, place mouthpiece to lips, inhale quickly, hold your breath for 10 seconds, do not swallow capsules provided, and do not place inhaler in water.
A client, diagnosed with asthma, is prescribed a leukotriene receptor antagonist. The nurse will discuss the importance of which diagnostic lab tests to determine how effectively the medication is being metabolized and excreted? Select all that apply. Liver function Kidney function Thyroid function Glucose level Complete blood count
Liver function Kidney function Explanation: Evaluate liver and renal function tests to assess for impairments that could interfere with metabolism or excretion of the drugs. None of the other options are associated with the metabolism and excretion of this classification of medications.
The client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler? Fatigue Bradycardia Nervousness Hypotension
Nervousness Explanation: Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.
While reviewing a client's history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium? Dairy Eggs Peanuts Shellfish
Peanuts Explanation: The use of ipratropium is contraindicated in the presence of known allergy to the drug or to peanuts or soy products because the vehicle used to make ipratropium, an aerosol, contains a protein associated with peanut allergies.
When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited? Epinephrine Prostaglandins Intracellular calcium Slow-reacting substance of anaphylaxis
Slow-reacting substance of anaphylaxis Explanation: Mast cell stabilizers work at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis. Epinephrine is not affected by mast cell stabilizers. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins.
A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest? Take it with foods containing xanthines, such as caffeine Take it on an empty stomach, 1 hour before or 2 hours after meals Take it with a meal Increase the drug dosage up to 50%
Take it on an empty stomach, 1 hour before or 2 hours after meals Explanation: Sustained-release preparations of theophylline should be taken on an empty stomach, 1 hour before or 2 hours after meals. Immediate-release preparations should be administered with meals to alleviate gastrointestinal distress. Foods containing xanthines, in particular caffeine, increase the effects of theophylline, but they do not help minimize the adverse effects of theophylline. Patients who smoke may require an increase in theophylline dosage of up to 50%, but increasing the dosage is not a nursing responsibility.
A hospital client's medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, the nurse should base the intervention on which fact? The two drugs can be mixed in the nebulizer immediately before administration. The two drugs should be administered at least 30 minutes apart, with albuterol administered first. The nurse should contact the prescriber due to the increased risk of adverse effects when these drugs are administered concurrently. The two drugs should be administered at least 30 minutes apart, with ipratropium administered first.
The two drugs can be mixed in the nebulizer immediately before administration. Explanation: It is appropriate to mix ipratropium bromide inhalation solution in the nebulizer with albuterol or metaproterenol if the mixture is used within 1 hour. These drugs have a synergistic effect.
A client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning which intervention will assist a client in the proper use of the device? Pushing fluids Using a spacer Exhaling immediately after administration Administrating corticosteroid first
Using a spacer Explanation: The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI). The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The client should hold the breath for several seconds after administration of the inhaler.
After teaching a group of students about drugs as bronchodilators, the instructor determines that the teaching has been successful when the students identify which group of drugs as once being first-line agents? Xanthines Sympathomimetics Mast cell stabilizers Leukotriene receptor antagonists
Xanthines
Adrenergics are a category of bronchodilators used in the treatment of asthma and chronic obstructive pulmonary disease. In what conditions is cautious use of these drugs recommended? Select all that apply. hypertension hypothyroidism seizure disorders renal failure diabetes mellitus
hypertension seizure disorders diabetes mellitus Explanation: Adrenergic drugs are contraindicated in severe coronary artery disease; they should be used cautiously in clients with hypertension, hyperthyroidism, diabetes mellitus, and seizure disorders.
A nurse is teaching a newly diagnosed client with asthma how to manage the disease. What should the nurse encourage this client to do? decrease exercising taking anti-inflammatory drugs stop smoking cigarettes begin using insulin
stop smoking cigarettes Explanation: Since bronchoconstriction can be triggered by smoke, clients with asthma should be encouraged to quit smoking and to avoid secondhand smoke. Instead of instructing a client to abandon exercise, healthcare providers should consider prescribing bronchodilators as pre-exercise prophylaxis. nonsteroidal anti-inflammatory drugs can cause trigger an asthmatic attack in some clients; however, not all anti-inflammatory drugs cause this reaction.
A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client's concern? "It's important to take salmeterol as soon as you feel the first sensation of an asthma attack." "It's best to take repeated doses of salmeterol every 5 minutes, until your symptoms subside." "Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." "Unfortunately, Serevent (salmeterol) can take up to 15 minutes to relieve your difficulty breathing."
"Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." Explanation: Salmeterol is a long-acting beta2-adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short-acting drug. This information makes all the other options incorrect.
The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time? Immediately on beginning to exercise In the morning of the day when exercise is planned One hour before exercise 15 minutes prior to exercising
15 minutes prior to exercising Explanation: Albuterol for exercise induced bronchospasm should be administered 15 minutes prior to exercising.
A patient with acute respiratory symptoms is receiving a loading dose of theophylline. Which of the following signs of toxicity should alert the nurse to notify the primary health care provider immediately? Mental depression Constipation Abdominal cramps Bradycardia
Abdominal cramps Explanation: It is important for the nurse to closely monitor the patient for signs of theophylline toxicity. The nurse should notify the primary health care provider immediately if any of the following signs of theophylline toxicity develop: anorexia, nausea, vomiting, diarrhea, confusion, abdominal cramping, headache, restlessness, insomnia, tachycardia, arrhythmias, or seizures. Constipation, bradycardia, or mental depression are not signs of theophylline toxicity.
Tom, age 42, is prescribed ipratropium bromide as an anticholinergic agent for treating asthma. The nurse caring for Tom needs to develop a plan of care. What must be included in the plan? Select all that apply. Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma. Advise the patient that ipratropium is used to abort an asthma attack in progress. Inform the patient that repeated doses may be administered until relief is experienced.
Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma. Explanation: It is important to caution the patient to avoid taking ipratropium if allergic to soybeans, legumes, or soya lecithin, because it may cause serious adverse effects. It is also important to remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma. The patient should be informed that ipratropium is used prophylactically to reduce the frequency and severity of future asthma attacks, and it will not abort an asthma attack in progress. Overuse of ipratropium may induce adverse effects and therefore should be avoided.
Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? Albuterol causes stimulation of the bronchial tissue. Albuterol causes relaxation of the bronchial smooth muscles. Albuterol blocks the stimulation of the beta-2 receptors. Albuterol decreases vital capacity.
Albuterol causes relaxation of the bronchial smooth muscles. Explanation: The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.
What is the most common first-line therapy for relief of an acute asthma attack? Beta2-adrenergic agonist Inhaled steroid Leukotriene modifier Xanthine
Beta2-adrenergic agonist Explanation: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.
Which would the nurse include as possible adverse effects when teaching a patient about albuterol? (Select all that apply.) Chills Hypotension Bronchospasm Sweating Nervousness
Bronchospasm Nervousness Sweating Explanation: Adverse effects associated with albuterol, a sympathomimetic, include CNS stimulation, GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing.
The nurse is providing education to a client who has been prescribed an antiasthmatic drug. The nurse should instruct the client to avoid excessive intake of what beverage? Grapefruit juice Acai juice Coffee Green tea
Coffee Explanation: Clients taking antiasthmatic drugs should generally avoid excessive intake of caffeine-containing fluids such as coffee, tea, and cola drinks. These beverages may increase bronchodilation but also may increase heart rate and cause palpitations, nervousness, and insomnia with bronchodilating drugs. None of the other options contain sufficient amounts of caffeine to cause such an affect.
A nurse is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following? Alcohol Salt Vitamin C Coffee
Coffee Explanation: The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol.
When describing the action of xanthines, which would the nurse include? (Select all that apply.) Stimulation of 2 prostaglandins leading to smooth muscle relaxation Direct effect on the mobilization of calcium within the cell Inhibition of release of slow-reacting substance of anaphylaxis Selectively act at beta-2 receptor sites as agonists Block the action of acetylcholine at vagal mediated receptor sites
Direct effect on the mobilization of calcium within the cell Stimulation of 2 prostaglandins leading to smooth muscle relaxation Inhibition of release of slow-reacting substance of anaphylaxis Explanation: Although the exact action is unknown, it is thought that xanthines work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine.
A client is admitted to the emergency department with inspiratory stridor and air hunger. When anticipating treatment, the nurse will prepare which medication for administration? Ipratropium bromide Pseudoephedrine Epinephrine Cromolyn
Epinephrine Explanation: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.
An adult client with newly diagnosed asthma presents for client education regarding situations that could precipitate an asthma attack. In this teaching, which precipitants would the nurse state may trigger an attack? Select all that apply. Mold Exercise Warm weather Cigarette smoke Allergens
Exercise Allergens Mold Cigarette smoke Explanation: Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.
An older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease. When administering the drug, what action should the nurse perform to reduce the client's risk for developing oral candidiasis? Encourage the resident not to deeply inhale the medication. Have the client gargle with normal saline prior to administering the drug. Have the resident rinse his or her mouth after each dose of the drug. Administer prophylactic antifungal medications.
Have the resident rinse his or her mouth after each dose of the drug. Explanation: Rinsing may reduce a person's risk of developing oral candidiasis during treatment with inhaled corticosteroids. It would be incorrect to discourage deep inhalation of the medication. Gargling prior to administration is ineffective, and prophylactic medications are not used.
The nurse is providing education to a client with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action? Inhaled corticosteroid agents reduce respiratory rate. Inhaled corticosteroid agents will depress the central nervous system. Inhaled corticosteroid agents reduce airway inflammation. Inhaled corticosteroid agents reduce bronchodilation.
Inhaled corticosteroid agents reduce airway inflammation. Explanation: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system or reduce bronchodilation or respiratory rate.
Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use? It reduces the risk of sinusitis. It reduces the risk of tachycardia. It helps decrease the intrapulmonary delivery of the drug. It helps decrease systemic absorption.
It helps decrease systemic absorption. Explanation: Spacers help decrease systemic absorption, because less flunisolide is swallowed. Spacers may also help alleviate dysphonia by filtering larger aerosol particles that ordinarily deposit in the oropharynx and extrathoracic airways (this precaution also reduces the risk for oropharyngeal candidiasis). The use of a spacer does not prevent intrapulmonary delivery of the drug; nor does it reduce the risk of tachycardia and sinusitis.
Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA? Xanthines Anticholinergics Mast cell stabilizers Leukotriene receptor antagonists
Leukotriene receptor antagonists Explanation: Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.
When teaching a client about his prescribed asthma therapy, the nurse understands that which medications may increase the risk of asthma-related death? Mast cell stabilizers Short-acting beta agonists (SABAs) Inhaled corticosteroids (ICSs) Long-acting beta-2 agonists
Long-acting beta-2 agonists Explanation: Long-acting beta-2 agonists may increase the risk of asthma-related death. ICSs are contraindicated in clients with hypersensitivity to the corticosteroids, acute bronchospasm, status asthmaticus, or other acute episodes of asthma and can cause throat irritation, hoarseness, upper respiratory tract infection, and fungal infections of the mouth and throat. SABA bronchodilators are drugs used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema but can cause tachycardia, palpations, arrhythmias, hypertension, nervousness, anxiety, and insomnia. The mast cell stabilizer is contraindicated in clients with known hypersensitivity to the drugs and during attacks of acute asthma, because they may worsen bronchospasm during the acute asthma attack. A mast cell stabilizer is used cautiously during pregnancy (pregnancy category B) and lactation and in clients with impaired renal or hepatic function.
A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective? Supply supplemental oxygen as prescribed Suctioning the infant every 30 minutes for 2 hours after the treatment has been initiated Changing the newborn's position frequently to assure effective distribution of medication Monitoring respirations for bilateral chest movement
Monitoring respirations for bilateral chest movement Explanation: Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug. Suctioning should be avoided for at least 2 hours after the surfactant is instilled into the newborn's endotracheal tube. Neither the delivery of supplemental oxygen nor position changes are related to the delivery of the medication into the infant's lungs.
An adult client with a diagnosis of asthma has been prescribed montelukast. The nurse should teach the client that this drug will help relieve symptoms by which mechanism? Reducing the muscle tone in the alveoli and facilitating gas exchange Preventing mast cells from releasing histamine Preventing the bronchoconstriction and inflammation that is caused by leukotrienes Relaxing smooth muscle in the bronchi and bronchioles
Preventing the bronchoconstriction and inflammation that is caused by leukotrienes Explanation: Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes. This information makes all the remaining options incorrect.
A client with a diagnosis of asthma has been prescribed ipratropium 2 puffs QID. What is the most likely goal of this treatment? Promoting short-term relief of acute asthma symptoms Promoting blood flow in the alveolar capillaries Relieving acute bronchoconstriction Promoting long-term management of asthma symptoms
Promoting long-term management of asthma symptoms Explanation: The anticholinergic bronchodilators are most useful in the long-term management of asthma and other conditions producing bronchoconstriction. These drugs are not used in the management of acute exacerbations of asthma. They do not promote alveolar blood flow.
The nurse is describing how aminophylline achieves its effect. Which would the nurse incorporate into the description? Reduction of airway hyperresponsiveness Stimulation of the central nervous system Stabilization of mast cell membranes Stimulation of beta-adrenergic receptors
Stimulation of the central nervous system Explanation: Stimulation of the central nervous system is the mechanism of action for xanthine derivatives. Stimulation of beta-adrenergic receptors is the mechanism of action for beta-2 agonists. Reduction of airway hyperresponsiveness is the mechanism of action for inhaled corticosteroids. Stabilization of mast cell membranes is the mechanism of action for mast cell stabilizers.
A client has been prescribed a inhaled steroid for the treatment of asthma. What information should the nurse include when providing medication education to the client? Select all that apply. Promptly report a fever or any other indication of infection to your health provider The medication is not intended to treat an acute asthma attack The medication can take up to 6 weeks to reach effective systemic levels Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency Rebound nasal congestion is a adverse effect of this form of medication
The medication is not intended to treat an acute asthma attack Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency Rebound nasal congestion is a adverse effect of this form of medication Promptly report a fever or any other indication of infection to your health provider Explanation: Inhaled steroids are not intended to treat an acute asthma attack or status asthmaticus because these drugs will not provide the immediate relief that is needed. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenal insufficiency with sudden withdrawal. Monitor the patient for any sign of respiratory infection; continued use of steroids during an acute infection can lead to serious complications related to the depression of the inflammatory and immune responses. Instruct the patient to continue to take the drug to reach and then maintain effective levels since the drug can take 2 to 3 weeks to reach effective levels. Nasal rebound congestion is considered an adverse effect of this classification of medications.
Aerosols are often the drugs of choice to treat asthma because of what characteristics? (Select all that apply.) They may be given less frequently. They relieve symptoms quickly. They can usually be given in smaller doses. They act directly on the airways. They produce fewer adverse effects than oral or parenteral drugs.
They act directly on the airways. They can usually be given in smaller doses. They produce fewer adverse effects than oral or parenteral drugs. They relieve symptoms quickly. Explanation: Because aerosol products act directly on the airways, drugs given by inhalation can usually be given in smaller doses and produce fewer adverse effects than oral or parenteral drugs. Aerosol products also produce a relief of asthma symptoms in a quick fashion.
A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which common adverse effects of the drug? Headache Dyspepsia Throat irritation Muscle cramps
Throat irritation Explanation: The most common adverse effects of inhaled albuterol include throat irritation, palpitations, sinus tachycardia, anxiety tremor, and increased blood pressure. Serious adverse effects such as bronchospasm, urticaria, and angiedema rarely occur. Headache, dyspepsia, and muscle cramps are frequent adverse effects of oral albuterol only.
The nurse teaching a client about theophylline will include the identification of which possible symptoms of toxicity? agitation and arrhythmias Chest pain and shortness of breath Polyuria and polyphagia Confusion and decreased level of consciousness
agitation and arrhythmias Explanation: Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other arrhythmias, and tonic-clonic convulsions. Ventricular arrhythmias or convulsions may be the first sign of toxicity. Chest pain, shortness of breath, polyuria, polyphagia, and decreased level of consciousness do not accompany theophylline overdose.
What pathology is present in a client diagnosed with chronic asthma even when they may appear symptom free? Select all that apply. damaged airway mucosa hypogastric secretions bradycardia airway inflammation elevated temperature
damaged airway mucosa airway inflammation Explanation: Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free. None of the other options are associated with chronic asthma.
The nurse is providing education to the parents of a child who has been newly diagnosed with asthma. During teaching, the nurse should explain that asthma attacks occur when mast cells release substances that cause what reaction? decreased capillary permeability. smooth muscle dilation. Decreased fluid leakage. inflammation.
inflammation. Explanation: When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation, increased capillary permeability and fluid leakage, and changes in the mucus-secreting properties of the airway epithelium.
A client with asthma that has not been successfully controlled with other medications is prescribed theophylline. When providing education to the client about the medication, what adverse effect would the nurse mention? bronchoconstriction bradycardia relaxation of smooth muscle insomnia
insomnia Explanation: Adverse effects of theophylline are associated with blood levels of the drug. At normal therapeutic levels, adverse effects are uncommon. At slightly higher levels, however, GI effects (e.g., nausea, diarrhea, vomiting) and central nervous system effects (e.g., irritability, headache, insomnia) can occur. As levels increase, potentially life-threatening effects can occur, including tachycardia, arrhythmias, hypotension, seizures, and brain damage. Theophylline achieves bronchodilation (not bronchoconstriction) through relaxation of smooth muscle; therefore, relaxation of smooth muscle is a therapeutic effect, not an adverse effect. At high serum levels, the drug can cause tachycardia, not bradycardia.