Karch's PrepU Ch. 55: Drugs Acting on the Lower Respiratory Tract

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

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

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements? "When I am short of breath, I will increase the use of my fluticasone." "I will wash my sheets weekly." "When I can do some, but not all of my usual activities, I am in the yellow zone." "I need to inhale my medication and hold my breath for 10 seconds."

"When I am short of breath, I will increase the use of my fluticasone." Explanation: Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.

A client with asthma has received two doses of theophylline. After analyzing the daily serum theophylline level, the nurse determines the client has achieved a therapeutic level with which result? 5 mcg/L 8 mcg/L 13 mcg/L 20 mcg/L

13 mcg/L Explanation: Therapeutic theophylline levels range from 10 to 20 mcg/L. The possibility of toxicity increases with levels over 15 mcg/L, with toxicity indicated with levels over 20 mcg/L.

The nurse assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic? 15 mcg/mL 5 mcg/mL 25 mcg/mL 30 mcg/mL

15 mcg/mL Explanation: Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.

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 9:45 AM 10:00 AM 10:15 AM

9:30 AM Explanation: Inhaled ipratropium has an onset of action of 15 minutes, so the patient should begin to feel the effects of the drug at 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 with asthma A 65-year-old female with hepatic disease An 83-year-old female with cardiac disease A 43-year-old male with hypertension

A 65-year-old male with asthma Explanation: The nurse can safely administer theophylline to the client who is 65 years of age. It needs to be administered cautiously in clients older 69 years or those with hepatic disease, cardiac disease, or hypertension.

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 The standard dose of aminophylline A drug other than aminophylline Phenytoin intravenously

A modified dose of aminophylline Explanation: 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? Pituitary insufficiency Pancreatic insufficiency Adrenal insufficiency Renal insufficiency

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

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.

A client with chronic asthma is prescribed albuterol. The nurse will prioritize which nursing diagnosis for this client? Anxiety Risk of impaired oral mucous membranes Ineffective tissue perfusion Risk of injury

Anxiety Explanation: The nurse would most likely identify a nursing diagnosis of anxiety related to the adverse reaction of albuterol. A nursing diagnosis of risk of impaired mucous membranes may be seen with the use of corticosteroids, which increase the risk of oral candidiasis. There is no increased risk of injury or ineffective tissue perfusion with the use of albuterol therapy.

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.

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.

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

Beta-2 selective adrenergic agonist Explanation: 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.

A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid? Chocolate Bananas Orange juice Cranberry juice

Chocolate Explanation: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.

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 nursing instructor is teaching a session explaining mast cell stabilizers. The instructor determines the session is successful when the students correctly choose which drug as an example? Beclomethasone Cromolyn Albuterol Montelukast

Cromolyn Explanation: Cromolyn is an example of a mast cell stabilizer. Beclomethasone is an inhaled corticosteroid. Albuterol is a short-acting beta2 agonist. Montelukast is an example of a leukotriene modifier.

When describing the action of xanthines, which would the nurse include? (Select all that apply.) Direct effect on the mobilization of calcium within the cell Stimulation of 2 prostaglandins leading to smooth muscle relaxation Inhibition of release of slow-reacting substance of anaphylaxis Selectively act at beta-2 receptor sites as agonists Block the action of acetylcholine at vagal mediated receptor sites

Direct effect on the mobilization of calcium within the cell Stimulation of 2 prostaglandins leading to smooth muscle relaxation Inhibition of release of slow-reacting substance of anaphylaxis Explanation: Although the exact action is unknown, it is thought that xanthines work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine.

Which of the following would be most important to assess before administering calfactant? (Select all that apply.) Endotracheal tube placement Bowel sounds Lung sounds Abdominal girth Oxygen saturation levels

Endotracheal tube placement Lung sounds Oxygen saturation levels Explanation: Before administering calfactant, it would be important to ensure proper endotracheal tube placement because the drug is instilled directly into the trachea. In addition, lung sounds and oxygen saturation levels would be important as a baseline to evaluate effectiveness of the drug.

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? Ipratropium bromide Epinephrine Cromolyn Pseudoephedrine

Epinephrine Explanation: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.

After teaching a group of students about antiasthmatic agents, the students demonstrate understanding of the information when they identify what as sympathomimetics? Select all that apply. Epinephrine Terbutaline Formoterol Budesonide Tiotropium Cromolyn

Epinephrine Terbutaline Formoterol Explanation: Epinephrine is a sympathomimetic. Terbutaline is a sympathomimetic. Formoterol is a sympathomimetic. Budesonide is an inhaled steroid. Tiotropium is an anticholinergic. Cromolyn is a mast cell stabilizer. Sympathomimetics are drugs that stimulate the sympathetic nervous system.

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

Isoproterenol is an anticholinergic agent. True False

False Explanation: Isoproterenol is a sympathomimetic agent.

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

Global Initiative for Asthma (GINA) Explanation: 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 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 kno

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 to

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.

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

Intratracheal Explanation: Beractant is administered intratracheally.

A nurse is teaching a client about the prescribed zileuton. The nurse determines the session is successful when the client correctly points out they will contact the health care provider if which reactions occur? Select all that apply. Jaundice Pruritus Fatigue Dizziness Restlessness

Jaundice Pruritus Fatigue Explanation: Zileuton may cause liver damage, which may present with the following symptoms: upper right quadrant pain, nausea, fatigue, lethargy, pruritus, and jaundice. Dizziness is a potential adverse reaction to albuterol, epinephrine, levalbuterol, terbutaline arformoterol, formoterol, ipratropium, and cromolyn. Restlessness is a potential adverse reaction to aminophylline, theophylline toxicity, xanthine derivative, and adrenergic bronchodilators.

A client, diagnosed with asthma, is prescribed a leukotriene receptorantagonist. The nurse will discuss the importance of which diagnostic lab tests to determine how effectively the medication is being metabolized and excreted? Select all that apply. Liver function Kidney function Complete blood count Thyroid function Glucose level

Liver function Kidney function Explanation: Evaluate liver and renal function tests to assess for impairments that could interfere with metabolism or excretion of the drugs. None of the other options are associated with the metabolism and excretion of this classification of medications.

A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective? Suctioning the infant every 30 minutes for 2 hours after the treatment has been initiated Monitoring respirations for bilateral chest movement Changing the newborn's position frequently to assure effective distribution of medication Supply supplemental oxygen as prescribed

Monitoring respirations for bilateral chest movement Explanation: Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug. Suctioning should be avoided for at least 2 hours after the surfactant is instilled into the newborn's endotracheal tube. Neither the delivery of supplemental oxygen nor position changes are related to the delivery of the medication into the infant's lungs.

The nurse teaches a client receiving an inhaled corticosteroid about the possibility of developing oral thrush. Which action(s) would the nurse include in the teaching plan as a way to reduce this risk? Select all that apply. Need to avoid eating after administration Performing strict oral hygiene Cleaning the inhaler per package instructions Using proper technique when administering dose Administering a dose only every other day

Performing strict oral hygiene Cleaning the inhaler per package instructions Using proper technique when administering dose Explanation: To decrease the likelihood of developing oral thrush, a client should use strict oral hygiene, cleanse the inhaler as directed in the package instructions, and use proper technique when administering a dose. There is no need to avoid eating after administration, and using the drug only every other day would not be effective.

A client receiving aminophylline reports heartburn on assessment to the nurse. What is the best response by the nurse? Eat small, frequent meals. Raise the head of the bed. Limit fluid intake with meals. Use strict oral hygiene.

Raise the head of the bed. Explanation: When a client receiving aminophylline reports heartburn, the nurse should instruct the client to remain upright with the head end of the bed raised. Eating small, frequent meals and limiting fluid intake with meals help alleviate the symptoms of nausea, and not of heartburn. Using strict oral hygiene helps prevent infection with Candida albicans seen with corticosteroid therapy.

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

Relaxation of smooth muscle Explanation: 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.

A premature newborn diagnosed with respiratory distress syndrome(RDS) has received surfactant therapy. The infant's nursing care plan should include which monitoring interventions to evaluate the effectiveness of the therapy? Select all that apply. Respirations Adventitious breath sounds Endotracheal tube placement Chest movement Heart rate

Respirations Adventitious breath sounds Endotracheal tube placement Chest movement Explanation: Monitor respirations, adventitious sounds, endotracheal tube placement and patency, and chest movements to evaluate the effectiveness of the drug and drug delivery. Heart rate is monitored to determine the infant's general health status.

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? LABA SABA Antiasthma Leukotriene modifier

SABA Explanation: Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.

A client with asthma should always carry a rescue inhaler or quick-relief medication with them at all times. Which of the following are considered quick-relief medications? Select all that apply: Salmeterol (Serevent) Metaproterenol (Alupent) Tiotropium (Spiriva) Albuterol (Proventil) Formoterol (Foradil)

Salmeterol (Serevent) Metaproterenol (Alupent) Albuterol (Proventil) Explanation: Short-acting beta agonists (SABAs) are used as rescue treatment for asthma. B and D are SABAs, A and E are long-acting beta agonists (LABAs). C is a cholinergic-blocking drug.

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? The husband made the correct decision in giving the extra doses. The extra doses facilitated bronchodilation and probably saved her life. Salmeterol is contraindicated based on his wife's condition. The health care provid

Salmeterol is contraindicated based on his wife's condition. Explanation: 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 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.

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 urinary retention dermatitis cataracts

gastroesophageal reflux disease Explanation: Asthma may aggravate gastroesophageal reflux disease because antiasthma medications that dilate the airways also relax muscle tone in the gastroesophageal sphincter and may increase acid reflux. The relationship between asthma medications and the other options is not supported by research data.

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 is a 56-year-old man. has a history of pneumonia. prefers a high-calorie diet. has a high coffe

has a high coffee intake. Explanation: 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.

The nurse is providing education to the parents of a child who has been newly diagnosed with asthma. During teaching, the nurse should explain that asthma attacks occur when mast cells release substances that cause what reaction? inflammation. smooth muscle dilation. decreased capillary permeability. Decreased fluid leakage.

inflammation. Explanation: When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation, increased capillary permeability and fluid leakage, and changes in the mucus-secreting properties of the airway epithelium.

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.

A nurse is teaching a newly diagnosed client with asthma how to manage the disease. What should the nurse encourage this client to do? begin using insulin taking anti-inflammatory drugs decrease exercising stop smoking cigarettes

stop smoking cigarettes Explanation: Since bronchoconstriction can be triggered by smoke, clients with asthma should be encouraged to quit smoking and to avoid secondhand smoke. Instead of instructing a client to abandon exercise, healthcare providers should consider prescribing bronchodilators as pre-exercise prophylaxis. nonsteroidal anti-inflammatory drugs can cause trigger an asthmatic attack in some clients; however, not all anti-inflammatory drugs cause this reaction.