Module 3

What statements best indicate to the nurse that the client understood instructions about self-administration of salmeterol (Serevent, a B- agonist). Select all that apply.

"Although it will remain regular, this medicine may increase my heart rate." "This drug is supposed to prevent an asthma attack, but is not good for treating one."

A client receiving theophylline (Theo-Dur) asks the nurse why a specific item was removed from the food tray. Which of the following is the best response?

"Coffee contains caffeine, which can increase the drug level more quickly." Rationale: The actions of theophylline are similar to the sympathetic response., which results in increased heart rate. Food items, such as coffee or tea, contain stimulants like caffeine that can have an additive effect with theophylline.

A nurse knows teaching was effective if client using an ipratropium inhaler (Atrovent), states:

"This inhaler should not be used alone to treat an acute asthma attack." Rationale: Although ipratropium works to prevent broncho-constriction and thus secondarily leads to bronchodilation, a direct-action bronchodilator is needed to treat an acute asthma attack.

Client teaching regarding the use of leukotriene inhibitor agents such as zafirlukast (Accolate) should include which statement?

"This medication works by preventing the inflammation that causes your asthma." Rationale: 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.

A client is receiving a theophylline infusion at a rate of 50 mL/hr. The solution has 250 mg of theophylline in 500 mL of solution. How many mg of theophylline infuse in an hour?

25 mg/hr Rationale: Each mL of solution has 0.5 mg of theophylline (250 mg/500 mL). 50 mL/hr infusion rate x 0.5 mg of medication in each mL = 25 mg/hr is infusing

A child with repeated asthma attacks maybe treated with which of the following drugs? (SELECT ALL THAT APPLY)

A leukotriene receptor antagonist An inhaled corticosteroid An inhaled beta agonist

The nurse is teaching a client about administering beta2-adrenergic agonists and glucocorticoid inhalers. How should the nurse instruct the client to administer the inhalers?

Administer the beta2-adrenergic agonist inhaler first, followed by the glucocorticoid inhaler

A physician prescribes ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for your client. The nurse should:

Administer the bronchodilator first; wait 5 minutes; administer the anticholinergic, wait 5 minutes; administer the corticosteroid. Rationale: Administering the bronchodilator first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics also help bronchodilate but to a lesser extent. Steroid do not dilate and are therefore given last.

A client with asthma begins experiencing wheezing and demonstrates signs of an acute asthmatic attack. Which inhaler can the nurse anticipate would be most effective in relieving her acute symptoms?

Albuterol (Proventil)

Because a client on the inpatient unit is having an acute asthma attack, the nurse is most likely to administer which of the following medications with an appropriate order?

Albuterol (Proventil)

A person with hypertension and known heart disease has frequent bronchospasms and asthma attacks that are most responsive to sympathomimetic drugs. This patient might be best treated with:

An inhaled sympathomimetic, to decrease systemic effects

Leukotriene receptor antagonists act to block production of a component of SRSA. They are most beneficial in treating:

Asthma

Nonselective adrenergic agonist bronchodilators should be used cautiously in clients with:

Coronary Artery Disease Rationale: Nonselective adrenergic agonist bronchodilators stimulate Beta 1 receptors in the heart and Beta 2 receptors in the lungs. Stimulation of Beta 1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patient with coronary artery disease.

The nurse should question an order for epinephrine (Primatene) for the treatment of acute bronchitis when the client has which of the following health problems?

Coronary Artery disease Rationale: Because adrenergic agents such as Primatene increase oxygen consumption as well as increase the workload on the myocardium, they are contraindicated in clients with cardiovascular disease.

Which of the following goals is most likely to be included by a nurse in the care plan for a client who is ingesting Singular?

Client will manage headaches commonly associated with the drug.

Teaching for clients receiving expectorants should include which information?

Increase fluid intake to decrease viscosity of secretions Rationale: Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.

Corticosteroids are useful in the treatment of acute respiratory disorders secondary to their ability to:

Decrease inflammation Rationale: Corticosteroids suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

A client who is taking theophylline reports that she is continuing to smoke. What effect will smoking have on serum theophylline levels?

Decreased theophylline levels

After assessing a client with chronic obstructive pulmonary disease (COPD) who is being tested with beclomethasone dipropionate (Beclovent) via oral steroid inhaler, which clinical manifestations would the nurse conclude are side effects of this medication? Select all that apply:

Delayed healing Oral fungal infection Weight Gain

A patient with many adverse reactions to drugs is tried on an inhaled steroid for treatment of bronchospasm. For the first 3 days, the patient does not notice any improvement, you should:

Encourage the patient to continue the drug for 2 to 3 weeks; if no response is noted by then, try another inhaled steroid.

Use of which substance while taking theophylline can decrease theophylline's therapeutic effects?

tobacco Rationale: Use of tobacco has been shown to decrease serum theophylline levels

Which statment would be included when teaching a child about the proper use of a metered dose inhaler?

Hold your breath for 10 seconds if you after you inhale the medication. Rationale: Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.

An antihistamine would be the drug of choice for treating which of the following? (SELECT ALL THAT APPLY)

Itchy eyes Nasal congestion Drippy nose

When assessing for a therapeutic effect of acetylcysteine (Mucomyst), which finding would the nurse expect?

Liquefying and loosening of bronchial secretions Rationale: Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions to enhance their expectoration.

An advantage of salmeterol (Severent) over other Beta 2- agonists such as albuterol (Proventil) is:

Longer duration of action Rationale: Salmeterol has a longer duration of action requiring the patient to use it only twice a day instead of four times a day with albuterol.

Because the symptoms have worsened, the mother of a 6-year-old child with asthma informs the nurse that the child is using metaproterenol (Alupent, a Beta-agonist) more frequently. The nurse is most likely to caution the parent about which of the following adverse effects?

Nervousness and Tachycardia

The most frequent adverse effect with the use of glucocorticoid inhaler is: *select all that apply.

Oral candida species infection Glucose intolerance Osteoporosis

Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, non-productive coughing. Antitussives are best used with:

Patients with a dry, irritating cough

After the nurse administers albuterol (Proventil, a beta 2 agonist) to a 24-year-old client with symptoms of an acute asthma attack, which of the following outcomes is best?

Relief of Wheezing Rationale: The symptoms of an acute asthma attack are related to constriction of the airway, which leads to dyspnea, wheezing, increased respiratory rate, and declining oxygenation saturation. Albuterol is a beta-adrenergic agent or sympathomimetic that relaxes the smooth-muscles of the bronchial tree, resulting in bronchodilation and relief of wheezing.

Clients who are using inhalers require careful teaching about which of the following. (Select all that apply)

Storage of the drug Administration techniques to promote therapeutic effects and avoid adverse effects Timing of administration The difference between rescue treatment and prophylaxis

Discharge teaching for a client receiving a Beta- agonist bronchodilator should emphasize reporting with which adverse effect?

Tachycardia Rationale: a Beta Agonist bronchodilator stimulates the Beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation hyperglycemia (if severe) and alertness.

A patient with sinus pressure and pain related to a seasonal rhinitis would benefit from taking:

a decongestant

Which respiratory medication is an leukotriene inhibitor agent?

montelukast (Singulair) Rationale: Montelukast is an antileukotriene agent. Epinepherine and isoproterenol are adrenergic agonists. Cromolyn is a mast cell stabilizer.