Chapter 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction

The nurse is performing a routine assessment of a client whose medical record indicates a history of asthma. What assessment findings would the nurse expect? Select all that apply. a. Airway inflammation b. Damaged airway mucosa c. Elevated temperature d. Bradycardia e. Confusion

a. Airway inflammation b. Damaged airway mucosa Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free. Elevated temperature and bradycardia are unrelated to the client's asthma. Confusion can occur during an acute attack, but it would not be expected otherwise.

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? a. Albuterol b. Azmacort c. Theophylline d. Omalizumab

a. Albuterol 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)? a. Albuterol b. Formoterol c. Salmeterol d. Arformoterol

a. Albuterol 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? a. Asthma b. Emphysema c. Chronic bronchitis d. Pneumonia

a. Asthma 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 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? a. Coffee b. Alcohol c. Salt d. Vitamin C

a. Coffee 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 pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present? (Select all that apply.) a. Cough b. Increased temperature c. Increased secretions d. Mucosal congestion

a. Cough c. Increased secretions d. Mucosal congestion Common signs and symptoms of respiratory disorders include cough, increased secretions, mucosal congestion, and bronchospasm. Increased temperature is not common among respiratory disorders unless infection is involved.

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? a. Cromolyn b. Montelukast c. Calfactant d. Triamcinolone

a. Cromolyn Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.

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. a. Exercise b. Allergens c. Mold d. Warm weather e. Cigarette smoke

a. Exercise b. Allergens c. Mold e. Cigarette smoke Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.

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? a. Fluticasone b. Montelukast c. Zileuton d. Zafirlukast

a. Fluticasone Fluticasone is an inhaled steroid. Montelukast is a leukotriene receptor antagonist. Zileuton is a leukotriene receptor antagonist. Zafirlukast is a leukotriene receptor antagonist.

Adverse effects of inhaled corticosteroids include which of the following? Select all that apply: a. Fungal infection b. Pharyngeal irritation c. Blurred vision d. Bradycardia e. Insomnia

a. Fungal infection b. Pharyngeal irritation Adverse effects of inhaled corticosteroids include oral, laryngeal, pharyngeal irritation, fungal infection, and suppression of HPA function.

Where should the nurse initially direct a client who is interested in learning more about the management of asthma? a. Global Initiative for Asthma (GINA) b. Journal of Allergy and Clinical Immunology c. Centers for Disease Control Education Center d. National Association of Educational Pulmonologists

a. Global Initiative for Asthma (GINA) Management of asthma involves prevention of airway inflammation and avoidance of triggers for better symptom control. Because of asthma's significance as a world health problem, the Global Initiative for Asthma (GINA) published asthma guidelines of diagnosis, management, and education. These guidelines emphasize the importance of classifying asthma severity and the assessment of asthma control. While the other options may provide information on asthma, the GINA is most inclusive.

A male client is experiencing dysphasia secondary to a mild stroke that he had 3 weeks ago. He states that his asthma medications are not working as well or as long as they did in the past. What does the nurse suspect is the reason for this? a. He is crushing the medication. b. He is administering the wrong medication. c. He is experiencing confusion. d. He is experiencing postural hypotension.

a. He is crushing the medication. The nurse needs to reinforce the importance of not exceeding the prescribed dose, not crushing long-acting formulations, reporting adverse effects, and keeping appointments for follow-up care

A 42-year-old male client has a history of smoking for 20 years. The client states he is feeling fine and asks why stopping smoking is necessary. What information might the nurse share with the client about smoking? a. Smoking decreases the size of the tubes leading to the lungs b. The chest becomes more elastic with increased time of smoking c. Carbon dioxide levels may decrease in the lungs d. Smoking causes the respiratory system to increase oxygen delivery to the lungs

a. Smoking decreases the size of the tubes leading to the lungs Smoking can decrease the efficiency of the respiratory system. Nicotine causes a decrease in bronchial diameter, constriction of blood vessels, a decrease in ciliary function (which assists in moving foreign particles out of the respiratory tract), and can destroy lung tissue over time. These factors can all result in a decrease in gas exchange. In addition, many tobacco products contain substances (e.g., tars) that can build up in the lungs. The chest does not become more elastic with increased time of smoking; instead, it loses elasticity and becomes stiffer. Thus, the lungs cannot expand, and the change in the ratio of pressure of oxygen and carbon dioxide in the lungs is the effect of aging on the respiratory system.

A client is experiencing an episode of status asthmaticus. What is the primary challenge facing the staff as they attempt to manage the client's respiratory crisis? a. The bronchospasm does not respond to usual treatment measures b. There is an unusually large amount of thick secretions in the airways c. The client's underlying medical condition complicates treatment d. The client's lungs are reacting to multiple allergens at once

a. The bronchospasm does not respond to usual treatment measures An extreme case of asthma is called status asthmaticus; this is a life- threatening bronchospasm that does not respond to usual treatment and occludes airflow into the lungs. Status asthmaticus is not associated with thick secretions or underlying medical conditions. While the crisis may have been initially triggered by exposure to allergens, it is the ineffectiveness of usual treatment that poses the greatest problem.

A client has been prescribed a inhaled steroid for the treatment of asthma. What information should the nurse include when providing medication education to the client? Select all that apply. a. The medication is not intended to treat an acute asthma attack b. Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency c. The medication can take up to 6 weeks to reach effective systemic levels d. Rebound nasal congestion is a adverse effect of this form of medication e. Promptly report a fever or any other indication of infection to your health provider

a. The medication is not intended to treat an acute asthma attack b. Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency d. Rebound nasal congestion is a adverse effect of this form of medication e. Promptly report a fever or any other indication of infection to your health provider Inhaled steroids are not intended to treat an acute asthma attack or status asthmaticus because these drugs will not provide the immediate relief that is needed. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenal insufficiency with sudden withdrawal. Monitor the patient for any sign of respiratory infection; continued use of steroids during an acute infection can lead to serious complications related to the depression of the inflammatory and immune responses. Instruct the patient to continue to take the drug to reach and then maintain effective levels since the drug can take 2 to 3 weeks to reach effective levels. Nasal rebound congestion is considered an adverse effect of this classification of medications.

Why are inhaled steroids used to treat asthma and COPD? a. They act locally to decrease release of inflammatory mediators b. They act locally to improve mobilization of edema c. They act locally to increase histamine release d. They act locally to decrease histamine release

a. They act locally to decrease release of inflammatory mediators 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.

Respiratory symptoms are treated with many types of drugs, including a. anti-inflammatory agents. b. analgesics. c. bronchoconstrictors. d. histamines.

a. anti-inflammatory agents. Major drug groups used to treat respiratory symptoms are bronchodilating and anti-inflammatory agents, antihistamines, and nasal decongestants, antitussives, and cold remedies.

What is considered a possible trigger for an asthma attack? Select all that apply. a. exercise b. allergens c. pollutants d. warm weather e. cigarette smoke

a. exercise b. allergens c. pollutants e. cigarette smoke Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.

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? a. "I'll try to make sure that I drink plenty of fluids each day." b. "I'll keep taking my medications until I'm not experiencing any more symptoms." c. "I'll make sure I don't take my inhalers more often than they've been prescribed." d. "I'm a heavy coffee drinker, but I know that I now know I need to cut down on this."

b. "I'll keep taking my medications until I'm not experiencing any more symptoms." 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 parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations? a. Theophylline b. Albuterol c. Beclomethasone d. Acetylcysteine

b. Albuterol Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing. Theophylline does not produce rapid symptom relief and beclomethasone is a maintenance drug. Acetylcysteine is not used in the treatment of asthma because it is used to manage secretions, which are not associated with asthma.

The nurse is caring for a child who has been newly diagnosed with asthma. What environmental modifications should the nurse encourage the parents to make to help their child avoid future attacks? Select all that apply. a. Make sure the child begins herbal therapy as soon as possible. b. Avoid crowded areas as much as possible. c. Keep the child away from any known allergens. d. Encourage the child to maximize physical activity. e. Keep the child away from areas that are filled with cigarette smoke.

b. Avoid crowded areas as much as possible. c. Keep the child away from any known allergens. e. Keep the child away from areas that are filled with cigarette smoke. Parents need to be encouraged to take measures to prevent acute attacks, including avoidance of known allergens, smoke-filled rooms, and crowded or dusty areas. OTC drugs and herbal remedies should be avoided if possible. The child should perform physical activity within his or her limits, but it is not necessary to perform it to maximum limits, which could exacerbate symptoms.

Shane, a 25-year-old man, is diagnosed with asthma. He began an albuterol MDI 2 weeks ago. He reports that his symptoms persist in spite of using albuterol MDI as prescribed. What advice should the nurse give the client? a. Contact the health care provider to obtain an increased dosage of albuterol. b. Contact the health care provider to obtain adjunctive medications. c. Use the MDI more often. d. Clean the MDI thoroughly on a regular basis.

b. Contact the health care provider to obtain adjunctive medications. Explain to the client the importance of administering the drug as prescribed and encourage consultation with the health care provider if the symptoms do not abate with the recommended therapy. Using the MDI more frequently than recommended can result in rebound bronchoconstriction, which may motivate the client to increase MDI use, stimulating the cycle of rebound. This practice is not recommended.

Which would the nurse identify as being involved with asthma? a. Acute infection b. Hyperactive airways c. Alveolar collapse d. Progressive loss of lung compliance

b. Hyperactive airways Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. Sometimes an infection may be a trigger, but it is not always associated with asthma. Alveolar collapse refers to atelectasis, which might occur with asthma if the airways become blocked with secretions. Progressive loss of lung compliance is associated with acute respiratory distress syndrome.

What action by the client would indicate that the client understands how to use an inhaler? a. The client inhales as soon as the inhaler enters his or her mouth. b. The client holds his or her breath for several seconds after compressing the canister. c. The client uses a spacer to administer a powdered medication. d. The client exhales as soon as he or she compresses the inhaler.

b. The client holds his or her breath for several seconds after compressing the canister. Holding the breath prevents exhalation of medication still remaining in the mouth. The client should inhale when the canister is compressed, not as soon as the inhaler enters his or her mouth. The client should only administer one dose of medication at a time, and the client should wait to exhale until after the breath has been held as long as possible. Spacers are not used with powdered medications.

The nurse is caring for a 38-year-old client with asthma who has been started on albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects? a. The client reports excessive thirst. b. The client's heart rate is 99 beats/min. c. The client's oral temperature is 37.8°C (100°F). d. The client had diarrhea this morning.

b. The client's heart rate is 99 beats/min. Adrenergic agents stimulate beta1-adrenergic receptors in the heart as well as beta2-adrenergic receptors in the lungs. Adrenergic agents do not cause polydipsia, fever, or diarrhea.

A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to: a. keep an extra oxygen tank on hand for propelling the medication. b. sit in a fully upright position when administering the medication. c. take the exact number of puffs that have been prescribed. d. gargle with an alcohol-based mouthwash after each dose.

b. sit in a fully upright position when administering the medication. Clients should sit in the Fowler position when inhaling nebulized medications. Compressed air (not oxygen) is used. Inhalers require a prescribed number of "puffs," not nebulizers. The client should rinse his or her mouth after administration, but an alcohol-based solution is not necessary.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem? a. Pituitary insufficiency b. Pancreatic insufficiency c. Adrenal insufficiency d. Renal insufficiency

c. Adrenal insufficiency Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.

A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe? a. Ipratropium b. Isoetharine c. Cromolyn d. Aminophylline

c. Cromolyn Cromolyn is the only mast cell stabilizer used in the treatment of asthma. Aminophylline is a xanthine. Ipratropium is an anticholinergic drug. Isoetharine is a sympathomimetic drug.

A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route? a. Oral b. Intravenous c. Inhalation d. Intramuscular

c. Inhalation Levalbuterol is administered only as an inhalant by nebulizer.

A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy? a. Reduction of the inflammatory response b. Decrease in the production of leukotrienes D4 and E4 c. Relaxation of smooth muscle d. Enhancement of alveolar expansion

c. Relaxation of smooth muscle Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation. None of the other options describe the bronchial dilation affected of the anticholinergic classification of medications.

The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions? a. Clean spacer with alcohol twice a day. b. Do not use a spacer because it promotes infections. c. Rinse mouth with water after each use. d. Brush teeth thoroughly after each puff.

c. Rinse mouth with water after each use. The client should be taught to rinse his 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. The client would not brush teeth between puffs, nor would they clean a spacer with alcohol. A spacer allows for better usage of the drug especially in children.

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? a. The husband made the correct decision in giving the extra doses. b. The extra doses facilitated bronchodilation and probably saved her life. c. Salmeterol is contraindicated based on his wife's condition. d. The health care provider will most likely order continuation of the salmeterol with increased dosage.

c. Salmeterol is contraindicated based on his wife's condition. The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.

A male client is concerned because ever since he began his antiasthma medication, his GERD symptoms are worse. The nurse explains that his symptoms are worse because his asthma medications have what effect? a. They cause acid indigestion. b. They tighten the gastresophageal sphincter. c. They relax the gastresophageal sphincter. d. They stimulate peristalsis.

c. They relax the gastresophageal sphincter. Asthma may aggravate GERD, because antiasthma medications that dilate the airways also relax muscle tone in the gastresophageal sphincter and may increase acid reflux.

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? a. "This medication is safe for kids like me." b. "We need to let the health care provider know if the medicine gives me a headache or makes me dizzy." c. "This is a new kind of asthma medication." d. "I need to take the medication when I start to have problems breathing."

d. "I need to take the medication when I start to have problems breathing." These drugs are not indicated for the treatment of acute asthmatic attacks because they do not provide any immediate effects on the airways. Patients need to be cautioned that they should not rely on these drugs for relief from an acute asthmatic attack. The remaining statements are all accurate information regarding this classification of medications.

A patient tells you that her friend has recommended using caffeine to treat her asthma. How would you appropriately respond to this patient? a. "Caffeine is a bronchodilator, so it might help to use it along with your prescription medications." b. "Your friend doesn't know what he's talking about. Caffeine doesn't treat any symptoms of asthma." c. "You could try replacing your medications with caffeine for a while, but you should switch back if it doesn't seem to work as well." d. "Prescription drugs have been proven effective in treating asthma, and caffeine hasn't been. Since uncontrolled asthma can be deadly, I wouldn't recommend that you switch from your medications to caffeine."

d. "Prescription drugs have been proven effective in treating asthma, and caffeine hasn't been. Since uncontrolled asthma can be deadly, I wouldn't recommend that you switch from your medications to caffeine." Since, in general, herbal and dietary therapies in asthma have not been studied in controlled clinical trials, they are unproven and should be avoided. Because asthma can result in death in a matter of minutes, patients should be counseled not to use dietary or herbal supplements in place of prescribed bronchodilating and anti-inflammatory medications. Although caffeine is a mild bronchodilator, combining it with bronchodilating drugs can increase the adverse effects of those drugs.

A client who has been newly diagnosed with chronic obstructive pulmonary disease (COPD) calls the clinic and asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse? a. "The medications that have been ordered for you are what the physician thinks will help your breathing the most." b. "The medications that have been ordered for you are to help you breathe with less resistance from your diaphragm." c. "The medications that have been ordered for you are designed to work together to reduce your oxygen requirements." d. "The medications that have been ordered for you are to help relieve the inflammation and to open your airways."

d. "The medications that have been ordered for you are to help relieve the inflammation and to open your airways." Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation. Drugs affecting the lower airway do not normally affect the diaphragm. They do not reduce the body's oxygen demand. Stating that the physician thinks they are best is not a sufficient or helpful response.

During the summer, a female client experiences increased periods of acute symptoms of her asthma. The health care provider increases the dose frequency of which of her medications? a. Epinephrine b. Omalizumab c. Salmeterol d. Albuterol

d. Albuterol Albuterol is the initial drug of choice for acute bronchospasm.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? a. Albuterol causes stimulation of the bronchial tissue. b. Albuterol blocks the stimulation of the beta-2 receptors. c. Albuterol decreases vital capacity. d. Albuterol causes relaxation of the bronchial smooth muscles.

d. Albuterol causes relaxation of the bronchial smooth muscles. 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.

A client is experiencing an acute asthmatic attack. Which agent would be most effective? a. Inhaled steroid b. Leukotriene receptor antagonist c. Mast cell stabilizer d. Beta-2 selective adrenergic agonist

d. Beta-2 selective adrenergic agonist A beta-2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after injection and rapidly absorbed after inhalation. An inhaled steroid would require 2 to 3 weeks to reach effective levels. Leukotriene receptor antagonists and mast cell stabilizers do not have immediate effects.

The nursing instructor is discussing common respiratory disorders with the nursing class. Which of the following might the instructor identify as a common sign or symptom? a. Oxygen saturation of 95% b. Drowsiness c. Hallucinations d. Bronchospasm

d. Bronchospasm Common signs and symptoms of respiratory disorders include cough, increased secretions, mucosal congestion, and bronchospasm.

A client with asthma has been prescribed an anti-inflammatory medication. How does an anti-inflammatory drug reduce this client's bronchoconstriction? a. Increasing ability to metabolize medication b. Decreases formation of mucus secretions c. Increasing uptake of corticosteroids to medication d. Decreasing airway hyperreactivity to stimuli

d. Decreasing airway hyperreactivity to stimuli Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that decreases mucosal edema and formation of mucus secretions that narrow airways. Anti-inflammatory drugs do not increase the ability to metabolize medication or increase uptake of steroids.

A patient tells you that a friend of theirs has recommended the use of caffeine to treat the patient's asthma. What would be the most important reason a nurse should counsel this patient not to delay prescribed treatment for the use of natural health products? a. Caffeine can aggravate the drugs used to treat asthma b. Most natural products are less toxic or more potent than traditional asthma medications c. Natural products decrease the adverse effects associated with adrenergic bronchodilators d. Delays in appropriate treatment can have serious, even fatal, consequences

d. Delays in appropriate treatment can have serious, even fatal, consequences The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. These drugs were once the main treatment choices for asthma and bronchospasm. However, because they have a relatively narrow margin of safety, and they interact with many other drugs, they are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have an additive effect.

A client presents to the emergency department (ED) having an acute asthma attack and has been prescribed epinephrine. The nurse should assess what therapeutic effect of this drug? a. Decreased inflammatory response in the airways b. Reduced surface tension within the alveoli allowing for gas exchange c. Inhibition of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the allergic asthmatic response d. Dilation of the bronchi with increased rate and depth of respiration

d. Dilation of the bronchi with increased rate and depth of respiration Epinephrine will cause the bronchi to dilate and also cause the rate and depth of respiration to increase. Inhaled steroids decrease the inflammatory response, and lung surfactants reduce the surface tension within the alveoli. Mast cell stabilizers inhibit the release of histamine and SRSA to prevent the allergic response.

A client has been admitted to the emergency department (ED) in status asthmaticus. The ED nurse should anticipate administering which medication? a. inhaled corticosteroids b. intravenous theophylline c. high doses of montelukast d. beta2 agonists in high doses

d. beta2 agonists in high doses Management of status asthmaticus entails beta2 agonists in high doses and as often as every 20 minutes for 1 to 2 hours. While montelukast, a leukotriene modifier, is prescribed in the management of asthma, it is not the drug of choice for status asthmaticus. Corticosteroids are used after the respiratory crisis has been stabilized. Theophylline is given in oral not intravenous form to promote bronchial dilatation.

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 a. is a 56-year-old man. b. has a history of pneumonia. c. prefers a high-calorie diet. d. has a high coffee intake.

d. has a high coffee intake. Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy.