NURS 351 Exam 3

Which intervention would the nurse offer the client to help relieve the symptoms of sinusitis?

saline irrigation

What are the adrenergic bronchodilators?

short acting beta2-adrenergic long acting beta- adrenergic

What do platelet activating factor do?

smooth muscle contraction, bronchoconstriction, platelet aggregation and serontonin and histamine release

What are the xanthines medications?

theophylline (Theo-24, Elixophyllin)

What are the clinical manifestations of anaphylactic (type 1) hypersensitivity?

tissue edema - larnyx - angioedema

Which intervention would the nurse implement to help prevent atelectasis in a client with fractured ribs as a result of chest trauma?

encourage coughing and deep breathing

Which would the nurse include when teaching a client about the use of an incentive spirometer?

exhale completely; take a slow, deep breath; hold it as long as possible, and slowly exhale.

What are the primary chemical mediators?

histamine, eosinophil chemotactic factor, platelet activating factor and prostaglandins.

what chemical mediators cause bronchoconstriction?

histamine, platelet activating factors, prostaglandins, leukotrienes, bradykinin, serotonin.

What are the anticholinergic medications?

ipratropium bromide (Atrovent) u tiotropium (Spiriva)

What are the secondary chemical mediators?

leukotrienes, bradykinin, serotonin

Why is drug inhalation so important?

Goes directly to the source of bronchi constriction. ABC - Airway, Breathing and Circulation

What is the xanthines therapeutic index?

Has narrow therapeutic index

When a client has difficulty swallowing after a stroke, which action by the nurse would be most important in preventing pneumonia?

Having suction available during meals

True or False: asthma and COPD are chronic diseases?

True

What are the Beta(2) adrenergic agonist routes of administration?

Inhalation: MDI, Nebulizer

What are the types of hypersensitivity reactions?

- Anaphylactic: Type I - Cytotoxic: Type II - Immune complex: Type III - Delayed-type: Type IV

What are the xanthines nursing implications?

- Caution in patient with impaired liver function - Contraindicated in patients with acute gastritis and peptic ulcer disease, seizure disorder and CV disorders - Monitor serum drug levels - Narrow therapeutic index (10-20 mcg/mL) - Multiple drug/drug interactions - Cytochrome P450 enzyme system

What are anticholinergic adverse effects?

- Dry mouth - GI upset - HA - Throat irritation

What are the nursing implications for the anticholinergic drugs ipratropium bromide (Atrovent) and tiotropium (Spiriva)

- Effective against allergen-induced asthma and exercise- induced asthma - Errors in inhalation technique result in ineffectiveness - Cautious use with prostatic hypertrophy, bladder neck obstruction, narrow angle glaucoma

Which assessment finding indicates that a client has had a stroke?

- FAST (acronym)

What are the (Anticholinergic) ipratropium bromide (Atrovent) and tiotropium (Spiriva) routes of drug administration?

- MDI, Nebulizer

What are the adverse effects of Beta(2) adrenergic agonist - short acting drugs?

- Muscle tremor - Tachycardia - Palpitations - Anxiety - Hypokalemia

What are the nursing implications for Beta2 Adrenergic Agonists - Long acting (LABA)

- NEVER use a LABA in a rescue situation and never double up on a dose if the med is ineffective. - Use the bronchodilator first then the inhaled steroid if both drugs are given via the inhaled route - Wait 5 minutes between different inhalers

Define the characteristics of emphysema

- Overdistention of alveolar walls - Loss of elastic recoil

What is the route of administration for (Xanthines) theophylline (Theo-24, Elixophyllin)?

- PO and infusion

What are the nursing implications for Beta(2) adrenergic agonist short acting drugs?

- Use before other inhalers - Caffeine-containing products can increase adverse effects - Beta-adrenergic blockers inhibit can induce bronchospasm/inhibit bronchodilation

Which instruction will the nurse include when teaching a client with Parkinson's disease who is prescribed cardiopa-levodopa?

- You may experience dizziness when moving from sitting to standing

Which factor is unique to vascular dementia when comparing assessment findings in clients with vascular dementia and dementia of the Alzheimer type?

- abrupt onset of symptoms

What Beta(2) Adrenergic agonist - short acting medications relax airway smooth muscle by stimulating B(2) adrenergic receptors in bronchi and bronchioles?

- albuterol (proventil HFA, ventolin HFA) - Levalbuterol (Xopenex)

What are the Beta2 Adrenergic Agonists- Long acting (LABA) medications?

- almeterol (Serevent) - formoterol (Foradil)

What is the use (Xanthines) theophylline (Theo-24, Elixophyllin)?

- bronchodilation

The nurse teaches a client's family about the administration of donepezil for treatment of dementia of the Alzheimer type. Which side effect identified by the caregiver indicates to the nurse that further teaching is needed?

- constipation

What chemical mediators cause smooth muscle contraction?

- histamine, platelet activating factor, leukotrienes, bradykinin, serotonin

Routes of administration for Prophylaxis of acute Beta2 Adrenergic Agonists- Long acting (LABA) medications?

- inhalation dry powder (salmeterol) - nebulizer (formoterol)

Which factors are unique to delirium when distinguishing between dementia and delirium?

- slurred speech, visual or tactile hallucinations and a fluctuating level of consciousness

Which description of symptoms is consistent with dementia of the Alzheimer type?

- symptoms reflect progressive disintegration

Which side effect will the nurse monitor for when carbidopa-levodopa is prescribed for a client with Parkinson's disease?

- vomiting - involuntary movements - changes in mood

What are the adverse effects for (Xanthines) theophylline (Theo-24, Elixophyllin)?

Adverse Effects: u CNS hyperstimulation u Overdose symptoms: u Anorexia u N/V u Nervousness u Insomnia u Tachycardia u Ventricular dysrhythmias u Seizures

Which cell produces IgE antibodies?

B cells

What are the adverse effects of Beta2 Adrenergic Agonists- Long acting (LABA) medications salmeterol (Serevent) u formoterol (Foradil)?

Black Box Warning: Initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening. - Muscle Tremor - Tachycardia - Palpitations - Anxiety - Hypokalemia

What are the MOA for ipratropium bromide (Atrovent) and tiotropium (Spiriva) anticholinergic medication?

Blocks muscarinic acetylcholine receptors in the smooth muscles of the bronchi in the lungs. Inhibits bronchoconstriction and mucus secretion.

What should be monitored with corticosteroids?

Blood sugar. Corticosteroids can cause hyperglycemia

What cells are killer T cells?

CD8 positive T lymphocytes are toxic or killer t cells

What are the characteristics of Asthma?

Chronic Inflammatory Disease - Reversible, diffuse, airway inflammation

What are the characteristics of COPD?

Chronic, slowly progressive disease - Not fully reversible - Airflow obstruction

What is the purpose of the respiratory system?

Deliver oxygen to and expel carbon dioxide from the body. warms and filters the air as its traveling through the nose and mucous membrane and is our major site of gas exchange.

Which action would the nurse take to prevent aspiration recurrence in a client with aspiration pneumonia who is NPO status with a nasogastric tube and a prescription for antibiotics?

Elevating the head of the bed to 30 degrees

What are the antibodies of allergic responses to protect the body?

IgE, IGg, IgM and IgA

What is the use for the anticholinergic medication ipratropium bromide (Atrovent) and tiotropium (Spiriva) ?

Long-term management of bronchoconstriction

When preparing to assess a client with active tuberculosis, which piece of personal protective equipment would the nurse put on before entering the clients room?

N95 respiratory mask

Which client would the nurse categorize as urgent level level according to the 3-tiered triage system based on condition?

Pneunmonia

Use of Beta2 Adrenergic Agonists- Long acting (LABA) medications?

Prophylaxis of acute bronchoconstriction

MOA: Beta2 Adrenergic Agonists- Long acting (LABA) medications?

Relax airway smooth muscle by stimulating β2- adrenergic receptors

What are the MOA for (Xanthines) theophylline (Theo-24, Elixophyllin)?

Relaxes bronchial smooth muscle and suppresses airway responsiveness to stimuli

The nurse is caring for a client on bed rest. Which nursing intervention would prevent a pulmonary embolus?

Teach the client how to exercise the legs

What does the Beta (2) adrenergic agonist - short acting drugs do?

Treat bronchi spasms & prevent exercise induce bronchospasm

What do IgE molecules bind to?

allergen and trigger mast cells or basophils

What are IgE antibodies involved in?

allergic reactions

What are the type 1 hyper sensitivities?

allergic rhinitis and anaphylaxis

What is the most severe hypersensitivity reaction?

anaphylactic (type 1) hypersensitivity

What is needed to determine oxygen administration for a client with chronic obstructive pulmonary disease (COPD) and an oxygen saturation of 87%

arterial blood gases

What do esinophil chemotactic factors do?

attracts eosinophils

Which secondary chemical mediator causes increased mucus production?

bradykinin

When is immune complex (type iii) hypersensitivity caused?

caused when immune complexes are formed when antigens bind to antibodies.

What does the Cytotoxic Type II (hypersensitivity) do?

causes opsonization and lysis of cells

What do IgE cells release?

chemical mediators such as histamine, serotonin, kinins, SRS-A, and neutrophil factor

How often should metered dose inhalers be cleaned and how long between usage should you inhale the next dose?

clean once per week and wait 5 mins

The nurse teaches a client's family about the administration of donepezil for treatment of dementia of the Alzheimer type. Which side effect identified by the caregiver indicates to the nurse further teaching is needed?

constipation

What do anti-inflammatory drugs do?

decrease edema

What population are spacers recommended for?

older adults, children and COPD patients

What do bronchodilators do?

open narrowed airways

An older client with shortness of breath is admitted to the hospital. The medical history reveals and a diagnosis of pneumonia 3 days ago. Which vital sign assessment would be seen as a sign that the client needs immediate medical attention?

oxygen saturation 89%

A client with chronic obstructive pulmonary disease is breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheeze. Which action would the nurse take?

raise the head of the head to a high-fowler position and administer 2 L/min oxygen per nasal cannula

Which client would the nurse categorize as urgent level according to the 3-tiered triage system based on condition?

triage stage 3

What do prostaglandins do?

vasodilation and can cause bronchoconstriction or bronchodilation depending on type

What do histamines cause?

vasodilation, smooth concraction, bronchoconstriction, increase vascular permeability, increased mucus secretion, h(1) and h(2)