NUR333 Ch.55 PrepU
Which of the following would a nurse identify as a surfactant? Cromolyn Beractant Zileuton Theophylline
Beractant Explanation: Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.
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? Fluticasone Montelukast Zileuton 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.
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? Eggs Dairy 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.
Why are inhaled steroids used to treat asthma and COPD? They act locally to decrease release of inflammatory mediators They act locally to improve mobilization of edema They act locally to increase histamine release They act locally to decrease histamine release
They act locally to decrease release of inflammatory mediators Explanation: When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of beta-adrenergic receptor activity, that may promote smooth muscle relaxation and inhibit bronchoconstriction.
A nurse is providing health teaching to a newly diagnosed asthmatic client. The client has been prescribed theophylline. The nurse should encourage this client to stop: using insulin. taking anti-inflammatory drugs. exercising. smoking cigarettes.
smoking cigarettes. Explanation: Nicotine increases the metabolism of xanthines in the liver and the xanthine dosage must be increased in clients who continue to smoke while using xanthines. In addition, extreme caution must be used if the client decides to decrease or discontinue smoking because severe xanthine toxicity can occur. Bronchoconstriction is not caused by using insulin and anti-inflammatory drugs do not cause bronchoconstriction.
A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the health care provider to give the client? Albuterol Azmacort Theophylline Omalizumab
Albuterol Explanation: A selective, short-acting, inhaled beta2-adrenergic agonist (e.g., albuterol) is the initial rescue drug of choice for acute bronchospasm; subcutaneous epinephrine may also be considered.
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)? Albuterol Formoterol Salmeterol Arformoterol
Albuterol Explanation: Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.
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 blocks the stimulation of the beta-2 receptors. Albuterol decreases vital capacity. Albuterol causes relaxation of the bronchial smooth muscles.
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.
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? Flunisolide first, wait five minutes and then follow with albuterol Albuterol first, wait five minutes and then follow with flunisolide Flunisolide followed immediately by albuterol Albuterol followed immediately by flunisolide
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.
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 Emphysema Chronic bronchitis 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.
A client recently began taking theophylline for treatment of asthma. Which changes in the client's lifestyle would suggest that the client understands proper use of the drug and management of the disease? Avoiding caffeine Increasing dietary intake of B vitamins Limiting fluid intake to one liter a day Sleeping eight hours each night
Avoiding caffeine Explanation: Some bronchodilating drugs, such as theophylline, can cause tachycardia, arrhythmias, palpitations, agitation, and insomnia. Since caffeine, a mild bronchodilator, can add to these effects, clients should avoid excessive amounts while taking bronchodilating drugs. Clients with asthma and other bronchoconstrictive disorders should be encouraged to drink ample amounts of fluids each day to help thin secretions in the throat and lungs.
A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? Hyperthyroidism Cigarette smoking Gastrointestinal upset Alcohol intake
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.
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? Coffee Alcohol Salt Vitamin C
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.
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? Coffee Grapefruit juice Green tea Acai juice
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.
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. Exercise Allergens Mold Warm weather Cigarette smoke
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.
The client has mild, persistent asthma. The nurse anticipates the healthcare provider prescribing which daily medications? Albuterol Levalbuterol Terbutaline 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.
Administer prophylactic antifungal medications. Have the resident rinse his or her mouth after each dose of the drug. 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. 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.
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'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." "I'll make sure I don't take my inhalers more often than they've been prescribed." "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." 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.
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? Inhalation Oral Subcutaneous Intravenous
Inhalation Explanation: Salmeterol is administered via inhalation.
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 will depress the central nervous system. Inhaled corticosteroid agents reduce respiratory rate. Inhaled corticosteroid agents reduce bronchodilation. Inhaled corticosteroid agents reduce airway inflammation.
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.
The nurse is describing how aminophylline achieves its effect. Which would the nurse incorporate into the description? Stimulation of the central nervous system Stimulation of beta-adrenergic receptors Reduction of airway hyperresponsiveness Stabilization of mast cell membranes
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.
The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching? Polydipsia Tachycardia Hypotension Diarrhea
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.
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? Using a spacer Administrating corticosteroid first Pushing fluids Exhaling immediately after administration
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. Reference:
A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to permanent liver damage. rebound bronchoconstriction. community-acquired pneumonia. severe anticholinergic effects.
rebound bronchoconstriction. Explanation: Patients who self-administer albuterol may use their MDIs more frequently than recommended. This practice can result in rebound bronchoconstriction, which may motivate the patient to increase MDI use, stimulating the cycle of rebound congestion. Overuse of albuterol is not linked to pneumonia or hepatotoxicity. Albuterol is not an anticholinergic drug.