MOD 11 EVOLVE PRACTICE QUESTIONS: Chapter 36 Lower Respiratory Disorders

A patient has taken metaproterenol. What is the nurse's priority action? A) monitoring for heart rate >100 beats/min B) telling the patient not to drive for 2 h C) monitoring for sedation D) assessing for elevated blood pressure

A) monitoring for heart rate >100 beats/min Side effects of metaproterenol include: headache, tremor, tachycardia, palpitations, and nausea.

A patient has just received a nebulizer treatment of metaproterenol. It is most important for the nurse to assess the patient for the development of which side effect/adverse effect? A) tremors B) bradycardia C) hypotension D) hypoglycemia

A) tremors Other side effects/adverse effects of metaproterenol include tachycardia, hypertension, and hyperglycemia.

The health care provider orders ipratropium bromide, albuterol, and beclomethasone inhalers for a patient. What is the nurse's best action? A) question the order; three inhalers should not be given at one time B) administer the albuterol, wait 5 min, administer ipratropium bromide, then beclomethasone several minutes later C) administer each inhaler at 30-min intervals D) administer beclomethasone, wait 2 min, administer ipratropium bromide, then albuterol several minutes later

B) administer the albuterol, wait 5 min, administer ipratropium bromide, then beclomethasone several minutes later Administering the bronchodilator albuterol first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide also help the bronchodilator, but to a lesser extent. Corticosteroids such as beclomethasone do not dilate and are therefore given last.

The nurse is preparing class for patients with asthma. The nurse will inform the patients that leukotriene modifiers are used in the treatment of asthma to: A) assist in opening narrowed airways B) suppress the release of histamine and other mediators from the mast cells C) loosen mucus from the airways D) prevent serious complications from bacterial infections

B) suppress the release of histamine and other mediators from the mast cells

A patient is prescribed ipratropium and cromolyn sodium. What will the nurse teach the patient? A) do not take these medications within 4 h of each other B) take the ipratropium at least 5 min before the cromolyn C) administer both medications together in a metered-dose inhaler D) take the ipratropium only in the mornings

B) take the ipratropium at least 5 min before the cromolyn When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 min before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.

Which instruction will the nurse include when teaching a patient about the proper use of metered-dose inhalers? A) "after you inhale the medication once, repeat until you obtain relief" B) "make sure that you puff out air repeatedly after you inhale the medication" C) "hold your breath for 10 seconds if you can after you inhale the medication" D) "hold the inhaler in your mouth, take a deep breath, and then compress the inhaler"

C) "hold your breath for 10 seconds if you can after you inhale the medication" Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.

The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast in the patient teaching? A) "take the medication as soon as you begin wheezing" B) "it will take about 3 weeks before you notice a therapeutic effect" C) "this medication will prevent the inflammation that causes your asthma attack" D) "increase fiber and fluid in your diet to prevent the side effect of constipation"

C) "this medication will prevent the inflammation that causes your asthma attack" Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.

What over-the-counter product will the nurse instruct the patient to avoid when taking montelukast? A) acetaminophen B) echinacea C) St. John's wort

C) St. John's wort St. John's wort has been shown to decrease serum montelukast levels, therefore decreasing the therapeutic effects of the medication. The other substances do not interact with montelukast.

A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action? A) calling a code B) asking the patient to describe the symptoms C) administering a beta2 adrenergic agonist D) administering a long-acting glucocorticoid

C) administering a beta2 adrenergic agonist In an acute asthmatic attack, the short-acting sympathomimetics (beta2 adrenergic agonists) are the first line of defense.

The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? A) increase the IV drip rate B) monitor the patient for toxicity C) continue to assess the patient's oxygenation D) stop the IV for an hour, then restart at lower rate

C) continue to assess the patient's oxygenation The therapeutic theophylline level is 10-20 mcg/mL. The nurse should continue interventions and monitor oxygenation.

A patient is using a glucocorticoid inhaler. The patient asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. The nurse should inform the patient that rinsing the mouth is done to: A) avoid mucous membrane breakdown B) increase hydration of the oral mucosa C) decrease risk of infection D) slow the development of cavities

C) decrease risk of infection The most common superinfection that can result from the use of a glucocorticoid inhaler is thrush (Candida or yeast infection of the mouth). Rinsing the mouth after each use of the inhaler can help to prevent a superinfection from developing.

A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse's best action? A) continue to monitor the patient B) call the health care provider C) hold the next dose of theophylline D) administer oxygen 2 L/min via nasal cannula

C) hold the next dose of theophylline The patient is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.

What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine? A) decreased cough reflex B) decreased nasal secretions C) liquefying and loosening of bronchial secretions D) relief of bronchospasms

C) liquefying and loosening of bronchial secretions Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.

A home care nurse is visiting a patient with asthma who suddenly experiences an acute asthma attack. Which drug should the nurse prepare to administer? A) zafirlukast B) cromolyn C) metaproterenol D) zileuton

C) metaproterenol Metaproterenol is a bronchodilator that works in a similar manner as albuterol. The other drugs listed are used for the prevention of asthma.

A patient with chronic obstructive pulmonary disease asks the nurse what the albuterol he is taking does. The nurse should inform the patient that albuterol is used to: A) mobilize respiratory secretions B) decrease the cough response C) increase the work of breathing D) dilate the larger airways

D) dilate the larger airways One important thing to keep in mind is that if a patient is ordered albuterol and a glucocorticoid (corticosteroid), the nurse should always administer albuterol before the glucocorticoid. This is because albuterol opens up the airways so that the glucocorticoid can go further into the lungs and carry out its effects.

In discharge teaching, the nurse will emphasize to a patient receiving a beta-agonist bronchodilator the importance of reporting which side effect? A) hypoglycemia B) nonproductive cough C) sedation D) tachycardia

D) tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.

The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What will the nurse do? A) tell the parent to hold the inhaler for the child B) ask the health care provider to switch to oral medications C) tell the parent that young children should not use inhalers D) teach the child to use a spacer

D) teach the child to use a spacer If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.

The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? A) the patient with a history of emphysema B) the patient with a history of type 2 diabetes C) the patient who is 16 years old D) the patient with atrial fibrillation with a rate of 100

D) the patient with atrial fibrillation with a rate of 100 The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This patient should not receive epinephrine.

A patient with chronic bronchitis is admitted to the health care facility for treatment of a bacterial respiratory infection. Which antimicrobial will most likely be ordered for the patient? A) terfenadine B) amphotericin B C) acyclovir D) trimethoprim-sulfamethoxazole

D) trimethoprim-sulfamethoxazole Terfenadine is an antihistamine not longer available on the U.S. market. Amphotericin B is used to treat fungal infections. Acyclovir is an antiviral drug used to treat herpes virus infections.