Respiratory Drugs
What important instruction should be given to a patient who is taking guaifenesin (Mucinex)? A. "This medication is given to treat acetaminophen overdose." B. "This medication will thin your mucus and make it easier to cough up." C. "This medication can cause an oral infection called thrush." D. "This medication is used with a nebulizer facemask."
Answer: B
Which action by the nurse is most essential during intravenous administration of treprostinil (Orenitram) for a patient with pulmonary hypertension? A. Disconnect the intravenous line when assisting the patient to the bathroom. B. Utilize strict sterile technique when preparing and administering the drug. C. Connect intravenous antibiotic drugs to the same line to prevent needle pain. D. Monitor the patient's laboratory tests for signs of deteriorating kidney function.
Answer: B
Before administering an inhaled corticosteroid, it is important to take which action? A. Teach the patient how to use the inhaler or spacer. B. Teach the patient to expect nervousness after using. C. Prime a new canister of nedocromil (Tilade) once before use. D. Administer inhaled corticosteroid agents before bronchodilators.
Answer: A
The client who routinely takes sertraline presents to the emergency department reporting muscle rigidity and tremors. The client also states that they had a cough last week that was treated with dextromethorphan. What is the appropriate nursing intervention? A. administer intravenous diazepam B. administer ondansetron C. administer amitriptyline D. administer benztropine
Answer: A The combination of an anti-depressant and dextromethorphan can increase the serotonin level leading to serotonin syndrome. Diazepam or another benzodiazepine is administered to treat the seizures and anxiety that can result from this condition.
What are common side effects associated with inhaled anti-inflammatory drugs? (Select all that apply.) A. Bad taste B. Mouth dryness C. Seizures D. Leukopenia E. Oral infection
Answer: A, B, E
A child with asthma is having difficulty using a "rescue" aerosol inhaler effectively. What alteration in treatment should be discussed with the provider? A. Switching the route of administration to oral B. Using a nebulized form of the drug with a facemask C. Switching to a dry powder inhaler D. Changing to a long-acting inhaler
Answer: B
Symptom severity in a patient with asthma or chronic bronchitis is assessed by using which method? A. FEV1 B. PEFR C. PEEP D. CPAP
Answer: B
A patient has been given instructions on use of a dry-powder inhaler. Which patient action indicates the need for further instructions? A. The patient exhales deeply into the inhaler after the treatment. B. The patient stores the device in a dry place, at room temperature. C. The patient states she knows not to shake the inhaler prior to use. D. The patient removes the inhaler from her mouth as soon as she has inhaled.
Answer: A
A patient just took a short-acting inhaler drug. What symptoms of an adverse effect should be reported immediately to the prescriber?
Chest pain, severe tachycardia, rapid rise in blood pressure
A PEFR value that has dropped below 50% indicates what is occurring?
The patient has dangerously low airflow into and out of the airways.
If a patient is taking more than one type of inhaled drug, the ________________________ drug should be given at least 5 minutes before the other drug.
bronchodilator
Asthma medication that is used only during an acute episode is known as a(n) ________________________ drug.
rescue
The nurse must ensure that the patient using an oral inhaler knows the proper technique for using it, and for a(n) ________________________, if one is ordered.
spacer
After being hospitalized for status asthmaticus, a child is discharged with prednisone and other oral medications. Two weeks later, when the child comes to the clinic for a checkup, the nurse instructs the parent to gradually decrease the dosage of prednisone, which will be discontinued. The parent asks why prednisone must be discontinued. How should the nurse respond? A. "Steroids increase the appetite, leading to obesity with prolonged use." B. "Long-term steroid therapy may interfere with a child's growth." C. "The child may develop a hypersensitivity to steroids with continued use." D. "Prolonged steroid use may cause depression."
Answer: B Steroids suppress release of adrenocorticotropic hormone from the pituitary gland, stopping production of endogenous hormones by the adrenal cortex. Because prolonged adrenal suppression may cause growth restriction in a child, the duration and dosage of steroid therapy must be kept to a minimum. Steroids also may cause central nervous system effects, such as euphoria, insomnia, and mood swings. Although steroids increase the appetite, this effect isn't the reason for limiting their use in children. Steroids are present in the body, so hypersensitivity isn't a problem, and they're likely to cause euphoria, not depression.
The nurse is caring for several clients on the respiratory unit who are receiving the β-adrenergic agonist bronchodilator albuterol in the prescribed nebulizer treatments. Which side effects would the nurse expect to assess following administration? Select all that apply. A. increased tachypnea B. irritability and nervousness C. tachycardia D. increased somnolence E. insomnia F. anxiety
Answer: B, C, E, F Albuterol is prescribed to prevent and treat wheezing, difficulty breathing, and chest tightness caused by lung diseases such as asthma and chronic obstructive lung disease (COPD). Irritability, nervousness, tachycardia, insomnia, and anxiety are common side effects of β-adrenergic agonist bronchodilators that result from sympathetic nervous system stimulation. The expected therapeutic effect of a bronchodilator is decreased dyspnea and slower (not increased) breathing. Increased somnolence does not occur with sympathetic nervous system stimulation.
A patient has just taken a short-acting inhaler drug to treat asthma symptoms. Which best indicates the medication has been effective? A. An increase in the respiratory rate B. A pulse oximetry value of 85% C. An increase of 15% in the peak flow D. Wheezing within 2 hours of use
Answer: C
A patient is using an aerosol inhaler without a spacer. Two puffs are prescribed. How far apart should the puffs be administered? A. 10 seconds B. 30 seconds C. 60 seconds D. 120 seconds
Answer: C
Which important point should be included when teaching patients about the use of long-acting beta2-adrenergic agonists? A. "Use this medication whenever you have new symptoms of wheezing." B. "Take an extra dose of this medication if your symptoms worsen." C. "Take this medication even when symptoms are not present." D. "Omit your daily dose of this medication if you are wheezing."
Answer: C
A client reports having a dry, hacking cough that disturbs sleep at night. Which antitussive agent and intervention are most appropriate for this client? A. decreasing the room temperature and administering a benzonatate B. increasing fluids to liquefy secretions and administering codeine C. using a cooling mist humidifier and administering dextromethorphan D. providing a heat vaporizer and administering hydrocodone
Answer: C Dextromethorphan is the most widely used antitussive in Canada because it produces few adverse reactions while effectively suppressing a cough. A cool mist humidifier will help open nasal passages. Benzonatate is used for cough associated with respiratory conditions and chronic pulmonary diseases. Opioid antitussives, such as codeine and hydrocodone, are reserved for treating unruly coughs usually associated with lung cancer.
A client, stung by a bee, is rushed to the emergency room. The client is experiencing hives and redness at the site. Upon arrival, the client states, "I feel a lump in my throat and I am sweating. I can't breathe! I think I am going to die!" The nurse anticipates which emergency treatment next? A. Administer oxygen 4 liters via nasal cannula. B. Administer albuterol 2 puffs stat. C. Administer an injection of epinephrine stat. D. Have the client in high Fowler's position in the bed.
Answer: C. Symptoms of hives and redness at the bee sting site coupled with a progression of symptoms including respiratory difficulty and an impending feeling of doom indicate anaphylaxis. Emergency treatment of anaphylaxis is an injection of epinephrine. Bronchodilators may help but are not the primary treatment. β-adrenergic blockers are not indicated in the management of anaphylaxis because they may cause bronchospasm. Having the client in high Fowler's position is appropriate but not emergency treatment.
A patient is taking ipratropium (Atrovent), and reports having difficulty emptying his bladder. What should be the nurse's action? A. Report symptoms of kidney disease to the prescriber. B. Encourage the patient to drink more fluids. C. Ask the prescriber for an order for an indwelling catheter. D. Discuss the patient's symptoms with the prescriber.
Answer: D
Which is the most important point to include in patient teaching for a female patient with pulmonary hypertension who will have bosentan (Tracleer) prescribed? A. "We can electronically transfer this prescription to your retail pharmacist." B. "A yellowish tinge to your skin is common while taking this medication." C. "If you have any difficulty swallowing the tablet, cut it in half." D. "Your pregnancy test must be negative before this drug can be given."
Answer: D
A client takes prednisone for an acute exacerbation of rheumatoid arthritis. The nurse determines the client understands how to take the prednisone when the client says: A. "I can stop taking the prednisone as soon as my joints feel better." B. "It is important for me to increase my sodium intake while I am taking this medication." C. "I should not be concerned if I lose a little weight while I take the prednisone." D. "It is best if I take this medication with some food."
Answer: D Prednisone is a gastrointestinal irritant that is best taken with food. The client should not abruptly stop taking the prednisone when her joints feel better. Rather, the drug must be tapered slowly. Abrupt withdrawal can precipitate a return of the symptoms. Sodium intake should be reduced, not increased. The client will most likely retain fluids and demonstrate some weight gain.
