Respiratory Medications

Which leukotriene modifier's absorption is decreased by food, requiring that the drug be given 1 hour before or 2 hours after meals? A. Zileuton B. Montelukast C. Zafirlukast D. Nedocromil

C. Absorption of zafirlukast is decreased by food, and it must be given 1 hour before or 2 hours after meals.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse should monitor for which side and adverse effects of rifabutin? Select all that apply. 1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

Answer: 1, 2, 3, 5 Rationale: Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication? 1. "I feel like my heart is racing." 2. "I feel more bloated than usual." 3. "My eyes have been watering lately." 4. "I haven't had a bowel movement in 4 days."

Answer: 1 Rationale: Albuterol/ipratropium is a combination agent—one is a β2-adrenergic agonist and the other is an anticholinergic medication, and in combination they produce an overall bronchodilation effect. Common side and adverse effects include headache, dizziness, dry mouth, tremors, nervousness, and tachycardia. Therefore, option 1 is correct. Options 2, 3, and 4 are not specifically associated with this medication.

The nurse is teaching a client who is beginning antiviral therapy for influenza. Which statement by the client indicates an understanding of the instructions? 1. "I must take the medication exactly as prescribed." 2. "Once I start the medication, I will no longer be contagious." 3. "I will not get any colds or infections while taking this medication." 4. "This medication has minimal side effects and I can return to normal activities."

Answer: 1 Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza, and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1. "I will take the medication on an empty stomach." 2. "I won't drink alcohol while taking this medication." 3. "I won't do activities that require mental alertness while taking this medication." 4. "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

Answer: 1 Rationale: Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster, and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese, and dairy creamers

Answer: 1 Rationale: Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

Answer: 2 Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

Answer: 2 Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine, because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? 1. Beclomethasone first and then the salmeterol 2. Salmeterol first and then the beclomethasone 3. Alternating a single puff of each, beginning with the salmeterol 4. Alternating a single puff of each, beginning with the beclomethasone

Answer: 2 Rationale: Salmeterol is an adrenergic type of bronchodilator, and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that she or he will perform which action? 1. Take an extra dose if fever develops 2. Take the medication with meals only 3. Take the tablet with a full glass of water 4. Decrease the amount of daily fluid intake

Answer: 3 Rationale: Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.

A client with tuberculosis is starting antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

Answer: 3 Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if 1 dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

Answer: 3 Rationale: Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.

Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's medical history requires caution by the nurse? 1. Osteoarthritis 2. Hypothyroidism 3. Diabetes mellitus 4. Polycystic disease

Answer: 3 Rationale: Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside? 1. Nasogastric tube 2. Paracentesis tray 3. Resuscitation equipment 4. Central line insertion tray

Answer: 3 Rationale: The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors.

Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1. Platelet count 2. Neutrophil count 3. Liver function tests 4. Complete blood count

Answer: 3 Rationale: Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? 1. Insomnia 2. Constipation 3. Hypotension 4. Bronchospasm

Answer: 4 Rationale: Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green

Answer: 4 Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client alerts the nurse of a life-threatening effect? 1. "I have a severe headache." 2. "My feet are quite swollen." 3. "I am nauseated and may vomit." 4. "My lips and tongue are swollen."

Answer: 4 Rationale: Omalizumab is an antiinflammatory and monoclonal antibody used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an anaphylaxis. The client statements in options 1, 2, and 3 are not indicative of an adverse reaction.

You're instructing a patient with asthma about the use of bronchodilators. You should teach the patient: A. to take the medication 4 hours before exercise to prevent exercise-induced bronchospasm. B. to take only the specific drugs prescribed for acute bronchospasm, usually a short-acting beta2-adrenergic agonist such as albuterol. C. to double the dose of the medication in the event of a missed dose. D. that long-acting beta2-adrenergic agonists, such as salmeterol, are effective in the treatment of acute asthma attacks.

B. Short-acting beta2-adrenergic agonists are used in the treatment of acute bronchospasm. Long-acting agents aren't effective in acute attacks. To prevent exercise-induced asthmas, medication should be taken 30-60 minutes before exercise.

A client with bronchitis is administered a dose of ipratropium inhalation. The client complains of a dry mouth and throat. The nurse knows that which of the following is a reason for this? A. This drug is a beta 2 agonist and this is a common side effect B. This drug is inhaled, which leads to decreased secretions C. This drug is an anticholinergic medication and this is an expected side effect D. This drug causes vasoconstriction which leads to a dry mouth and throat

C. This drug is an anticholinergic drug, which decreases secretions and can cause a dry mouth, throat, and mucus membranes.

Which anticholinergic agent is used to treat patients with COPD? A. Atropine B. Guaifenesin C. Budesonide D. Ipratropium bromide

D. Inhaled ipratropium bromide is an anthicholinergic agent used as a bronchodilator in patients with COPD.

The nurse is caring for a client with bronchitis who requires respiratory treatments. The nurse reviews the client's medication list and notes an order for metaproterenol. Which of the following conditions in the client's health history would cause concern for a client prescribed this medication? A. History of Addison's disease B. History of anxiety C. History of delirium D. History of stroke

D. Metaproterenol is a non-selective beta-2 agonist. This drug dilates the smooth muscle in the lungs, but also causes vasoconstriction of small blood vessels throughout the body. If a client has a high risk of stroke, this medication is contraindicated.