Pharm- Chapter 29 & 30 Test Bank & Evolve questions PLUS PRACTICE QUESTIONS

How long does it take for a patient to achieve the maximal effect of intranasal corticosteroids after beginning therapy?

2 weeks

The nurse is obtaining a history of respiratory symptoms on a patient with the diagnosis of COPD. The patient reports smoking one pack of cigarettes per day for the past 20 years. The nurse calculates the pack years as

20

CALCULATE THE FLOW RATE FOR 250ML NS TO INFUSE BY INFUSION PUMP OVER 90 MINUTES. ROUND TO THE NEAREST WHOLE NUMBER IF NECESSARY. FLOW RATE______ ML/H

250ML /1.5=166.666 ANS: 167ML/H

Which patient(s) would be able to take an alpha-adrenergic decongestant safely? (Select all that apply.)

a. 24-year-old woman with allergic rhinitis b. 18-year-old man with cold symptoms

Which topically active aerosol steroids are highly effective for reducing sneezing, nasal itching, stuffiness, and rhinorrhea? (Select all that apply.)

a. Beclomethasone (Beconase AQ) c. Fluticasone (Flonase) d. Flunisolide (Nasarel) e. Budesonide (Rhinocort Aqua)

The nurse is preparing education for a patient who has developed rebound nasal congestion resulting from use of topical decongestants. What information will the nurse include? (Select all that apply.)

a. For future topical decongestant use, follow the dosage directions daily. Do not overuse. b. Stop the topical decongestant at once. d. Nasal steroid solutions can be used but may take several days to reduce inflammation and congestion. e. Use nasal saline spray to moisturize irritated mucosa.

Which principle(s) would be when teaching a patient to use a steroid inhaler? (Select all that apply.)

a. Frequent oral hygiene is necessary. c. Rinse and spit after inhalation of the medication. d. When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first. e. Hold the breath for 10 seconds during inhalation of the medication.

Which statement(s) about ipratropium bromide (Atrovent) is/are true? (Select all that apply.)

a. It is administered by aerosol inhalation. d. It has minimal effect on ciliary activity. f. It may cause tachycardia or urinary retention.

Which statement(s) about acetylcysteine is/are true? (Select all that apply.)

a. It reduces viscosity of secretions. b. It treats acetaminophen toxicity. d. It is given to improve airway flow f. It is administered by inhalation

Which physical assessment(s) would be pertinent to the patient with asthma? (Select all that apply.)

a. Lung sounds b. Patient color c. Respiratory rate and effort d. Peak expiratory flow e. Pulse oximetry reading

When does allergic rhinitis occur? (Select all that apply.)

a. Nasal mucosa become inflamed. b. Exposure as a result of an allergen produces inflammation. c. Histamine is released following allergen exposure.

Which action(s) is/are true of antihistamines? (Select all that apply.)

a. Reduce inflammation locally b. Antagonize H1 receptors c. May be administered orally d. Are systemically distributed

The nurse is providing counseling to a patient on cromolyn sodium (Nasalcrom) nasal spray. Information relayed to the patient will include that (Select all that apply.)

b. the patient should blow the nose before nasal instillation. e. the maximum is six sprays in each nostril daily.

The nurse is teaching a patient with chronic obstructive pulmonary disease about the drug ipratropium (Atrovent). Which statement by the patient indicates a need for further instruction?

"If I suddenly have difficulty getting my breath I will use this medicine immediately."

A patient has questions regarding a recently prescribed antitussive agent. Which response by the nurse is the best?

"It will reduce the frequency of your cough."

What structures in the respiratory tract assist in removing foreign bodies such as smoke and bacteria?

. Ciliary hairs

Which patient must be observed closely when taking acetylcysteine (Mucomyst)?

A 30 year old with quadriplegia

Which patient must avoid taking alpha-adrenergic decongestants?

A 45 year old with hyperthyroidism

A PATIENT REPORTS A HARSH, NONPRODUCTIVE COUGH AND MUSCLE ACHES THAT HAVE LASTED FOR 5 DAYS. THERE IS NO SORE THROAT, TEMPERATURE ELEVATION, OR SWOLLEN LYMPH NODES, BUT THE PATIENT IS COUGHING SO MUCH THAT SLEEPING AT NIGHT IS DIFFICULT. WHICH TYPE OF MEDICATION WILL LIKELY BE PRESCRIBED FOR THIS PATIENT?

ANTITUSSIVE

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client?

Acetylcysteine

A patient is admitted to the emergency department after overdosing on acetaminophen (Tylenol). The nurse anticipates that the physician will order which medication to treat this patient?

Acetylcysteine (Mucomyst)

What is albuterol (Proventil) used to treat?

Acute bronchospasm

A nurse is teaching a client who has prescription for albuterol via inhaler and fluticasone via inhaler for asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler?

Albuterol will increase the absorption of fluticasone

A nurse is teaching a client about using intranasal glucocorticoids. Which of the following instructions should the nurse give?

Allow at least 2 weeks for the full therapeutic effect

A patient at sports camp is complaining of itchy and watery eyes, coughing, and sneezing when outdoors. The patient's chart states that he has an allergy to grasses. Which medication will the nurse administer?

Antihistamine

A drug from which class will most likely help a patient reporting insomnia as a result of a persistent cough?

Antitussive

Which medication taken, if taken with zafirlukast (Accolate), may cause toxic levels of zafirlukast?

Aspirin

The nurse is teaching a patient with a history of COPD to self-administer tiotropium (Spiriva) by dry powder inhalation. Which information provided by the nurse is accurate?

Avoid breathing into the mouthpiece.

A patient is prescribed promethazine hydrochloride (Phenergan). For which anticholinergic effect does the nurse monitor the patient?

Blurred Vision

The nurse is providing nutrition information to a patient diagnosed with a lower respiratory tract disease. What is the rationale for limiting caffeine?

Caffeine can result in thicker lung secretions.

A nurse should recognize that using pseudeophedrine to treat allergic rhinitis requires cautious use with clients who have which of the following conditions?

Coronary artery disease

Which medication may be given to patients with allergic seasonal rhinitis who do not respond to antihistamines and sympathomimetics?

Corticosteroids

A patient is taking cromolyn sodium (Nasalcrom) for prophylactic management of asthma. Which adverse effect does the nurse instruct the patient to report to the healthcare provider immediately?

Coughing

A PATIENT IS EXPERIENCING A SEVERE HEADACHE AND PRESSURE OVER THE EYES. THE PATIENT FEELS CONGESTED BUT HAS NO TEMPERATURE ELEVATION, AND THERE IS A HISTORY OF SINUS INFECTION. WHICH AGENT DOES THE NURSE ANTICIPATE THE HEALTH CARE PROVIDER MIGHT ORDER?

DECONGESTANT

An adult patient is admitted for an asthma attack. Which assessment obtained by the nurse would support that albuterol (Proventil) was effective?

Decrease in wheezing present on auscultation

What is the action of zafirlukast (Accolate), a leukotriene receptor antagonist?

Decreases leukotriene release

A nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects?

Decrese inflammation

Which antitussive has a combination of antihistamine and antitussive properties?

Diphenhydramine (Diphen)

A nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug?

Drowsiness

Which is a serious adverse effect of decongestants?

Hypertension

What antibody level must be evaluated before beginning omalizumab (Xolair)?

IgE

A nurse is teaching a client who is beginning fluticasone propionate/salmaterol therapy. Which of the following instructions should the nurse include?

Increase weight bearing

What initiates the sneeze reflex?

Irritation of the nasal mucosa by foreign particulate matter

The health care provider in an outpatient clinic has prescribed omalizumab (Xolair) to a patient. Which primary outcome will the nurse teach the patient to expect?

Less frequent asthma exacerbations

A PATIENT HAS A HISTORY OF EMPHYSEMA AND HAS BEEN COUGHING FOR A PROLONGED PERIOD AFTER WAKING IN THE MORNING. THE PATIENT IS HAVING DIFFICULTY CLEARING THE THICKENED MUCUS FROM THE LUNGS. WHICH TYPE OF MEDICATION DOES THE NURSE ANTICIPATE WILL BE ORDERED FOR THIS PATIENT?

MUCOLYTIC

A patient is prescribed ephedrine (Adrenalin) for nasal congestion. The nurse questions the order after finding that the patient is also taking which medication?

Methldopa (Aldomet)

A PATIENT IS BEING TREATED WITH AN INTRANASAL CORTICOSTEROID. WHICH SEVERE ADVERSE EFFECT DOES THE NURSE TEACH THE PATIENT ABOUT?

NASAL IRRITATION

What occurs in the nasal structures when cholinergic fibers are stimulated?

Production of serous and mucous secretions in the nostrils

When evaluating the effectiveness of zafirlukast (Accolate), which factor of acute asthma attacks does the nurse determine?

Number

WHAT IS THE ACTION OF ANTIHISTAMINES?

OCCUPY THE RECEPTOR SITES FOR HISTAMINE

Which beta-adrenergic agonist is used for the treatment of emphysema?

Olodaterol (Striverdi Respimat)

For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over the counter cold products?

Over-the-counter cold products can also contain guaifenesin

A nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug?

Palpations

A nurse should identify that dextromethorphen can have which of the following effects when combines with morphine?

Potentiation of depression of CNS actions

A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis . The nurse should explain that these drugs are effective because they perform which of the following actions?

Prevents histamine from binding to receptors

WHEN A PERSON USES A TOPICAL DECONGESTANT FREQUENTLY, THEN STOPS TAKING THE DRUG AND NOTICES EVEN MORE CONGESTION OCCURRING, WHAT IS THIS PHENOMENON CALLED?

REBOUND EFFECT

What is the primary reason for instructing patients to avoid overuse of nasal decongestant sprays?

Rebound swelling of the nasal passages can occur

A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects?

Reduces inflammation

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects?

Reduces suface tension

What process in the antigen-antibody reaction causes the symptoms of allergies?

Release of histamine

A nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make?

Respirations

What can result if a patient overuses topical decongestants?

Secondary congestion

A patient is seen in the emergency department. The patient had been maintained on theophylline (Theo Dur), and a blood sample reveals the serum theophylline level is subtherapeutic. Which may cause a subtherapeutic serum level?

Smoking

From where do the fluids of the respiratory tract originate?

Specialized mucous glands called goblet cells

Within minutes of the initiation of a nebulizer treatment with a sympathomimetic bronchodilator, the patient turns on his call light and states that he feels "panicky" and his heart is racing. Which action will the nurse take?

Stop treatment and notify the health care provider.

HUMAN LUNGS CONTAIN MILLIONS OF ALVEOLAR SACS SURROUNDED BY CAPILLARIES. IF THESE WERE SPREAD OUT ON A FLAT SURFACE, WHAT WOULD THE SIZE OF THAT SURFACE COMPARE TO?

TENNIS COURT

When evaluating the effectiveness of cromolyn sodium (Intal) therapy, what must the nurse consider?

The desired outcome of therapy is decreased frequency of allergic rhinitis and asthma attacks.

A nurse is teaching a client about the use of mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects?

Thins and loosens mucus

What is the reason for administering sodium chloride to a patient with emphysema?

To decrease mucus viscosity

For which of the following reasons should a client attach a spacer to a metered dose inhaler?

To increase the amount of drug delivered to the lungs.

THE HEALTH CARE PROVIDER HAS ORDERED THE USE OF AN INHALER FOR AN 8-YEAR-OLD PATIENT NEWLY DIAGNOSED WITH ASTHMA. TO USE THE INHALER CORRECTLY, WHAT DOES THE NURSE INSTRUCT THE PATIENT TO DO?

USE A SPACER BETWEEN THE INHALER AND LIPS TO CONTROL THE MEDICATION.

50ML NS WITH ANTIBIOTIC IV TO INFUSE OVER 20 MINS. ROUND TO THE WHOLE NUMBER IF NECESSARY. THE DROP FACTOR IS 20GTTS/ML

V/T X D= R 50/20 MIN X 20GTT/ML= 50GTT/MIN

A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include?

Wait 5 min between using the drug and another inhaled drug.

The nurse is completing the admission of an older adult patient with a history of COPD whose diagnosis is pneumonia. Which assessments would be most important to include in obtaining the history? (Select all that apply.)

a. Smoking history and exposure to secondhand smoke b. Current medications c. Chief complaint and onset of symptoms d. Support system e. Home oxygen use

What is true about arterial blood gases (ABGs)? (Select all that apply.)

a. They are measured from an arterial sample. b. They measure partial pressures of carbon dioxide. c. They measure blood pH. e. They measure partial pressures of oxygen.

Which statement(s) is/are true regarding the nursing assessment of a patient with a respiratory disorder? (Select all that apply.)

b. Clubbing of the fingernails is a sign of hypoxia. c. As oxygen levels diminish, mental alertness will progressively deteriorate. e. Episodes of apnea are present in Cheyne-Stokes.

Which principle(s) will the nurse include in a teaching plan for antihistamine therapy? (Select all that apply.)

b. Dietary fiber and fluids should be increased. c. Do not take with prescription medications unless approved by a physician. d. Blurred vision is an expected adverse effect.

A college student is being seen at an outpatient clinic with reports of allergic rhinitis and conjunctivitis. The health care provider orders fexofenadine. When providing information regarding this medication, the nurse will include statements indicating that

fexofenadine is one of the least sedating antihistamines.

A nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity?

seizures

A PATIENT PRESENTS WITH A RUNNY NOSE, SNEEZING, CONGESTED THROAT, CHILLS, AND FEVER. WHAT CHEMICAL IN THE BODY IS RESPONSIBLE FOR THESE SYMPTOMS?

HISTAMINE

A nurse is teaching a client who has a prescription for zileuton. Which of the following instructions should the nurse include?

Have laboratory test performed at regular intervals

A nurse is preparing to administer phenylephrine to a client. The nurse should identify that that which of the following manifestations is an adverse effect of this drug

Headache

Which information does the nurse include in the teaching plan for a patient starting on antihistamine therapy for seasonal allergies?

"Take medication 45 to 60 minutes before going outdoors during pollen season."

Which instruction will the nurse include when teaching a patient with seasonal rhinitis and blocked nasal passages about intranasal corticosteroid therapy?

"Use a decongestant prior to administration."

Which instruction does the nurse give to a patient who is prescribed both tiotropium bromide (Spiriva) and fluticasone-salmeterol (Advair Diskus)?

"Use the Spiriva, wait several minutes and then use the Advair."

The nurse is teaching a patient about the administration of antihistamines. The nurse will instruct the patient to take the medication at what time of day?

45 minutes before exposure to an allergen

Legal restrictions apply to the purchase of pseudoephedrine because of which of the following risks?

Drug Abuse

The nurse is providing instruction about ipratropium (Atrovent) to a patient with chronic obstructive pulmonary disease (COPD). Which is a common adverse effect that tends to resolve with therapy?

Dry mouth

The clinic nurse is assessing a patient being seen for a severe allergic reaction to environmental allergens. Which symptom should the nurse prioritize as the most important?

Dyspnea

A patient has just been prescribed diphenhydramine hydrochloride (Benadryl) for a dermatologic reaction. The nurse questions the order after finding that the patient currently has which condition?

Glaucoma

Premedication assessments before the use of anticholinergic bronchodilating agents should verify that the patient has no history of which condition?

Glaucoma

Which is a common expectorant in over-the-counter medications?

Guaifenesin

A nurse is teaching a client about montelukast. Which of the following instructions should the nurse include?

Take the drug once a day in the evening

The nurse is preparing to administer two inhalations of ipratropium bromide (Atrovent). When providing this medication, the nurse will instruct the patient to (Select all that apply.)

b. keep the eyes closed. d. wait 15 seconds before the second inhalation. e. shake the canister thoroughly prior to use.

A child has been diagnosed with asthma and the nurse is providing education to the family. Which statement by the mother indicates a need for further teaching?

"We will confine our dog to the kitchen area."

Which information does the nurse include when teaching a patient with asthma how to administer cromolyn sodium (Nasalcrom)? (Select all that apply.)

- A maximum of six sprays in each nostril may be used daily -Continue therapy even if symptom-free

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects? Select all that apply.

- Urinary retention - Dry Mouth

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include? Select all that apply

-Restlessness -Insomnia -Anxiety

A resident in a long-term care facility diagnosed with COPD has a new medication order for indacaterol. When the nurse is providing education to the resident regarding this medication, information will include that

. onset of action is within 5 minutes

A PERSON WHO HAS SMOKED 1½ PACKS OF CIGARETTES FOR 30 YEARS HAS A PACK-YEAR HISTORY OF HOW MANY YEARS?

30

A nurse is teaching a client who is taking prednisone for an acute asthma exacerbation. Which of the following instructions should the nurse include?

Avoid taking nonsteroidal anti-inflammatory drugs