ch 55: Drugs Acting on the Lower Respiratory Tract

The nurse assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic?

15 mcg/mL

A client is prescribed salmeterol as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time?

30 min before exercise

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 is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.

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

Which of the following would a nurse identify as a surfactant?

Beractant Rationale: 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?

Beta-2 selective adrenergic agonist

The client's theophylline levels are increased when the lab results are added to the electronic health record. The nurse questions the client about his intake of which?

COFFEE

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?

Cigarette smoking

A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer?

Cromolyn

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?

Epinephrine

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 keep taking my medications until I'm not experiencing any more symptoms."

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 airway inflammation.

A neonate is receiving beractant. The nurse understands that this agent is administered by which route?

Intratracheal

An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?

Mix the drug with saline.

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?

SABA

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?

Salmeterol is contraindicated based on his wife's condition.

What is the most common first-line therapy for relief of an acute asthma attack?

beta2-adrenergic agonist Rationale: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist.

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

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 cig smoke allergens mold

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?

gastroesophageal reflux disease

A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient

has a high coffee intake

A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route?

inhalation

The nurse is providing care for a newborn who has received an instillation of surfactant. What assessment data indicates the infant is experiencing adequate oxygen perfusion? Select all that apply.

pink skin and warm to touch

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

rebound bronchoconstriction.

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."' 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.

An adolescent client is prescribed a leukotriene receptor antagonist as a part of a medication regime to manage his/her asthma. Which statement made by the client requires additional education on this classification of medications?

"I need to take the medication when I start to have problems breathing."

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

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 patient with asthma

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; 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.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem?

Adrenal insufficiency

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

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 relaxation of the bronchial smooth muscles.

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 first, wait five minutes and then follow with flunisolide Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.

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

Which of the following effects would result from the action of montelukast?

Decreased eosinophil migration Rationale: Montelukast selectively and competitively blocks receptors for the production of leukotrienes D4 and E4, which are components of slow-reacting substance of anaphylaxis. As a result, the drug blocks many of the signs and symptoms of asthma, such as neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction.

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 benefit primary benefit of administering the medication by inhaler?

Fewer systemic effects

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

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?

Have the resident rinse his or her mouth after each dose of the drug. Rationale: The client should be taught to rinse their mouth out with water after using oral inhalers to prevent a Candida oral infection. Candida is a yeast that can grow in the mouth, it is important that they have good oral hygiene, but rinsing the mouth is sufficient. ADVERTISEMENT

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following?

Increased serum theophylline

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?

Inform the health care provider that the client has toxic theophylline levels.

A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?

Relaxation of smooth muscle

In children, high doses of nebulized albuterol have been associated with what conditions? (Select all that apply.)

Tachycardia Hypokalemia Hyperglycemia

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators.

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

A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid?

chocolate

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