Respiratory Ques

Legal restrictions apply to the purchase of pseudoephedrine because of which of the following risks? a. respiratory depression b. drug abuse c. drug tolerance d. rebound congestion

b. drug abuse Rational: because it is possible to alter pseudoephedrine and epinephrine, the law restricts the drug's purchase

A health care professional is caring for a patient who is taking codeine. Which of the following is the most important assessment following administration of the drug? a. blood pressure b. apical heart rate c. respirations d. level of consciousness

c. respirations Rational: Codeine, an opioid agonist, is a severe respiratory depression.

1. A client with asthma has a prescription for two inhalers, albuterol (Proventil, VoSpire) and beclomethasone (Qvar). How should the nurse instruct this client on the proper use of the inhalers? 1. Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved. 2. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. 3. Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. 4. Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler.

ANS: 3 Rationale: Using a bronchodilating inhaler such as albuterol (Proventil, VoSpire) first, then waiting 5-10 minutes before using an ICS inhaler such as beclomethasone (Qvar), will allow the corticosteroid to reach deeper into the lungs following bronchodilation. Options 1, 2, and 4 are incorrect. The two inhalers have been prescribed together to maximize therapeutic effects. Using the beclomethasone before the albuterol may not allow the drug to reach deeply into the lungs for best effects.

A client has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his health care provider's office complaining of a sore mouth. On inspection, the nurse notices white patches in the client's mouth. What is a possible explanation for these findings? 1. The client has been consuming hot beverages after the use of the inhaler. 2. The client has limited his fluid intake, resulting in dry mouth. 3. The residue of the inhaler propellant is coating the inside of the mouth. 4. The client has developed thrush as a result of the fluticasone.

ANS: 4 Rationale: The client likely has developed a thrush (Candida) infection of the mouth secondary to the use of the corticosteroid inhaler. After the use of ICS inhalers such as fluticasone (Flovent), clients should be taught to rinse the mouth and spit out the residue. Drinking fluids will also prevent irritation, ulcerations, and thrush infections of the throat. Options 1, 2, and 3 are incorrect. Drinking hot liquids should be managed carefully but will not increase the incidence of adverse effects due to the inhaler. Fluids in general should be increased but dry mouth should not result in white patches. The propellant should not be remaining in the client's mouth after rinsing, eating, or drinking.

1. A male, age 67, reports taking diphenhydramine (Benadryl) for "hay fever." Considering this client's age, the nurse assesses for which of the following findings? a. A history of prostate or urinary conditions b. Any recent weight gain c. A history of allergic reactions d. A history of peptic ulcer disease

ANS: A Rationale: Diphenhydramine (Benadryl) and other antihistamines are contraindicated in clients with prostate or lower urinary tract obstruction because anticholinergic effects may worsen these conditions. Options 2, 3, and 4 are incorrect. Diphenhydramine (Benadryl) is a common treatment for allergic conditions and has no effects on weight gain or peptic ulcer disease. Cognitive Level: Analyzing. Nursing Process: Assessment.

1. A 65-year-old client is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this client the ipratropium? a. A reported allergy to peanuts b. A history of intolerance to albuterol (Proventil, VoSpire) c. A history of bronchospasms d. A reported allergy to chocolat

ANS: A Rationale: Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soya lecithin or related food products such as soybean and peanut. Options 2, 3, and 4 are incorrect. A history of intolerance to albuterol or bronchospasms are indications for the ipratropium. A history of allergy to chocolate is not a contraindication for this drug.

1. The client has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? a. Limit use of this spray to 5 days or less. b. The drug may be sedating so be cautious with activities requiring alertness. c. This drug should not be used in conjunction with antihistamines. d. This is an OTC drug and may be used as needed for congestion.

ANS: A Rationale: Prolonged use of oxymetazoline (Afrin) causes hypersecretion of mucus and worsening nasal congestion, resulting in increased daily use. Options 2, 3, and 4 are incorrect. This medication should not be used for longer than 5 days unless otherwise directed. It may be used with antihistamines for symptomatic relief and it is not sedating. Cognitive Level: Applying. Nursing Process: Implementation. Client Need: Physiological Integrity.

1. A client is receiving treatment for asthma with albuterol (Proventil, VoSpire). The nurse teaches the client that while serious adverse effects are uncommon, the following may occur. (Select all that apply.) a. 1. Tachycardia b. 2. Sedation c. 3. Temporary dyspnea d. 4. Nervousness e. 5. Headache

ANS: A, D, E Rationale: Tachycardia, nervousness, and headache may occur with the use of albuterol (Proventil, VoSpire) inhalers. Options 2 and 3 are incorrect. Sedation and dyspnea are not adverse effects of albuterol.

A client has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the client be taught to use these drugs? a. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes. b. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes. c. The drugs may be used in either order. d. The fluticasone should be used only if the oxymetazoline fails to relieve the nasal congestion.

ANS: B Rationale: The oxymetazoline (Afrin) should be used first, followed by the fluticasone (Flonase) in 5 to 10 minutes. When a decongestant and corticosteroid nasal spray are used together, the decongestant spray should be used first to allow time for the nasal passages to open, allowing the corticosteroid to reach deeper into the nasal passages. Options 1, 3, and 4 are incorrect. The drugs are ordered in combination for better control of nasal rhinitis. The oxymetazoline should not be used for over 5 days unless otherwise directed.

Which of the following is the best advice that the nurse can give a client with viral rhinitis who intends to purchase an OTC combination cold remedy? a. "Dosages in these remedies provide precise dosing for each symptom that you are experiencing." b. "These drugs are best used in conjunction with an antibiotic." c. "It is safer to use a single-drug preparation if you are experiencing only one symptom." d. "Since these drugs are available over the counter, it is safe to use any of them as long as needed."

ANS: C Rationale: Single-symptom OTC preparations are preferred over multiuse preparations to avoid additional drugs that are not needed for symptom relief and to decrease risk of additional adverse effects. Options 1, 2, and 4 are incorrect. Dosing of any OTC preparation is carefully calculated to provide precise dosing for age and symptoms. Antibiotics may be required for serious infections, but for common symptoms OTC remedies are recognized as safe and effective; however, they should not be used indefinitely without consultation with a health care provider.

1. The nurse is teaching a client about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the client's teaching? a. "Lie supine for 30 minutes after taking the liquid." b. "Drink minimal fluids to avoid stimulating the cough reflex." c. "Take the drug with food for best results." d. "Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day."

ANS: D Rationale: The syrup base of dextromethorphan will help to soothe throat irritation and fluids should be avoided immediately following administration. Overall fluid intake should be increased throughout the day. Options 1, 2, and 3 are incorrect. The client does not need to remain supine after taking this drug, take the drug with food, or avoid fluid intake.

A health care professional is talking to a patient who is prescribed albuterol via inhaler and fluticasone (Advair) via inhaler for asthma management. The health care professional should tell the patient to use the albuterol inhaler before using the fluticasone inhaler for which of the following reasons? a. albuterol will increase the absorption of fluticasone b. albuterol will decrease inflammation c. albuterol will reduce nasal secretions d. fluticasone will reduce the adverse effects of albuterol

a. albuterol will increase the absorption of fluticasone Rational: Albuterol, an inhaled, short-acting beta2-agonist, causes broncholdilation, which will increase the absorption of fluticasone, an inhaled glucocorticoid, when the patient uses it before the glucocorticoid

When advising a patient about taking prednisone for chronic asthma, a health care professional should include which of the following information? a. avoid taking NSAIDs b. rinse your mouth after taking the drug to prevent a yeast infection c. stop taking the drug if you become nauseated d. change position slowly when standing up

a. avoid taking NSAIDs Rational: gastric protective measures are essential for patients who are taking oral glucocorticoids. Anti-inflammatory drugs can cause GI bleeding, so patients should not take them concurrently with prednisone.

A health care professional is advising a patient about the adverse effects of pseudoephedrine. Which of the following should the health care professional include? (select all that apply) a. restlessness b. bradycardia c. insomnia d. muscle pain e. anxiety

a. restlessness c. insomnia e. anxiety

A health care professional is monitoring plasma drug levels in a patient who is taking the theophylline. Which of the following adverse effects should the health care professional expect to see if the patient's level indicates toxicity? a. seizures b. constipation c. vomiting d. restlessness

a. seizures Rational: seizures are likely when plasma drug levels of theophylline, a methylxanthine, a higher than 30 mcg/mL, which indicates toxicity

A health care professional cautions a patient who is taking guaifenesin about using combination OTC cold products because: a. they can also contain guaifenesin b. serious interactions are possible c. rebound congestion is likely d. drug tolerance is likely

a. they can also contain guaifenesin Rational: many combination OTC cold products contain guaifenesin; a patient taking both might be taking excessive amounts of the drug.

For which of the following reasons should a patient attach a spacer to a metered-dose inhaler? a. to increase the amount of drug delivered to the lungs b. to increased the amount of drug delivered to the oropharynx c. to increase the amount of drug delivered on exhalation d. to increase the speed of drug delivery

a. to increase the amount of drug delivered to the lungs Rational: a spacer increases the amount of drug that reaches the lungs

Before prescribing dextromethorphan to a patient, the primary care provider should know that, when given with an opioid, the drug can result in which of the following? a. reduced antitussive effect of dextromethorphan b. potentiation of the analgesic effect of the opioid c. increased renal reabsorption of the dextromethorphan d. delayed analgesic effect of the opioid

b. potentiation of the analgesic effect of the opioid Rational: combining dextromethorphan with an opioid, such as morphine, increases the analgesic effect of the opioid

A health care professional who is advising a patient about the use of an expectorant to treat a cough should explain that this type of drug is effective because it performs which of the following actions? a. suppresses the cough stimulus b. reduces surface tension c. reduces inflammation d. dries mucous membranes

b. reduces surface tension Rational: Expectorants act by reducing the surface tension of respiratory secretions. This results in thinning thick mucus, making it easier to cough out of the lungs and drain out of the nose and sinuses

A health care professional should explain to a patient who is prescribed diphenydramine that the most common side effect associated with the drug is: a. muscle tremors b. sedation c. anxiety d. insomnia

b. sedation Rational: the most common adverse effect of diphendydramine, a first-generation antihistamine, is sedation

A health care professional is caring for a patient who is taking ipratropium (Atrovent). The health care professional should explain which of the following adverse effects to the patient? (Select all that apply.) a. muscle tremors b. urinary retention c. dry mouth d. insomnia e. tachycardia

b. urinary retention c. dry mouth

When explaining how a patient should use ipratropium (Atrovent), a health care professional should include which of the following instructions? a. do not drink anything for 30 min after using the drug b. wait 5 min between using the drug and another inhaled drug c. use the drug to abort acute bronchoconstriction d. check pulse rate after inhaling the drug

b. wait 5 min between using the drug and another inhaled drug Rational: Ipratropium, an inhaled anticholinergic, requires a 5-min wait between its administration and that of another inhaled drug to allow for its bronchodilating effects

A health care professional is caring for a patient who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the health professional expect to administer? a. Ipratropium b. beclomethasone c. acetylcysteine d. azelastine

c. acetylcysteine Rational: Acetylcysteine is a mucolytic that loosens thick respiratory secretions

A health care professional who is advising a patient about using intranasal glucocorticoids should include which of the following instructions? a. starts at a low dose and gradually increase it b. take the drug as needed for nasal congestion c. allow at least 2 weeks for the full therapeutic effect d. use the drug prior to exercise

c. allow at least 2 weeks for the full therapeutic effect Rational: it can take 2 or 3 weeks to see the full effect from intranasal glucocorticoids

A health care professional is advising a patient about the use of beclomethasone to treat asthma. The health care professional should explain that the drug treats asthma because it performs which of the following actions? a. thins mucus b. relaxes bronchial smooth muscle c. decreases inflammation d. increases the cough threshold

c. decreases inflammation Rational: Beclomethasone, an intranasal glucocorticoid, treats asthma by reducing inflammation

A health care professional is advising a patient about the use of cromolyn sodium. Which of the following instructions should the health care professional instruction should the health care professional include? a. report signs of jaundice b. anticipate difficulty sleeping c. expect a bitter aftertaste d. increase calcium and vitamin D intake

c. expect a bitter aftertaste Rational: Cromolyn sodium, a mast cell stabilizer, leaves a bitter aftertaste. Taking sips of water or sucking on hard candy after use of the drug can minimize this effect

A health care professional who is advising a patient about the use of antihistamines to treat allergic rhinitis should explain that these drugs are effective because they perform which of the following actions? a. decreases viscosity of nasal secretions b. Blocks H2 receptors c. prevents histamine from binding to receptors d. reduces nasal congestion

c. prevents histamine from binding to receptors Rational: antihistamines treat allergic rhinitis and reduce swelling by blocking histamine from binding to the receptor sites

A health care professional who is advising a patient about the use of a mucolytic to treat a cough should explain that this type of drug is effective because it performs which of the following actions? a. suppresses the cough stimulus b. reduces inflammation c. thins and loosen mucus d. dries secretions

c. thins and loosen mucous Rational: Mycolytics make mucus less viscous to increase a cough's productivity

A health care professional should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious use with patients who have which of the following? a. peptic ulcer disease b. a seizure disorder c. anemia d. coronary artery disease

d. coronary artery disease Rational: because pseudoephedrine, an oral sympathomimetic, can cause systemic vasoconstriction, it requires cautions use with patients who have severe hypertension or CAD

When advising a patient about using zileuton, a health care professional should include which of the following instructions? a. check the apical pulse before taking the drug b. take the drug prior to exercising c. rinse the mouth after using the drug d. have laboratory tests performed at regular intervals

d. have laboratory tests performed at regular intervals Rational: Zileuton, a leukotriene modifier, can cause liver injury. The health care professional should monitor liver function once a month for 3 months, then every 2 to 3 months during the first year of treatment

When advising a patient who is beginning fluticasone propionate/salmeterol (Advair) therapy, which of the following instructions should a health care professional include? a. take the drug as needed for acute asthma b. follow a low-sodium diet c. use an alternate-day dosing schedule d. increase weight-bearing activity

d. increase weight-bearing activity Rational: weight-bearing activity can help minimize bone loss, which is a side effect of fluticasone propionate/salmeterol, an inhaled glucocorticoid

A health care professional should tell a patient who is taking albuterol to report which of the following possible indications of a serious adverse effects? a. fever b. bruising c. polyuria d. palpitations

d. palpitations Rational: Beta2 agonists can cause cardiac stimulation, resulting in chest pain, tachycardia, and hypertension.

A health care professional is advising a patient about the use of cromolyn sodium to prevent bronchospasm. The health care professional should explain that the drug prevents bronchospasm because it performs which of the following actions? a. increases leukocyte activity b. blocks muscarinic receptors c. causes bronchodilation d. reduces inflammation

d. reduces inflammation Rational: cromolyn sodium, a mast cell stabilizer, reduces inflammation by inhibiting the inflammatory response

Which of the following should a health care professional include when advising a patient about the use of montelukast? a. use a spacer to improve inhalation b. take the drug at the onset of bronchospasm c. rinse the mouth to prevent an oral fungal infection d. take the drug once a day in the evening

d. take the drug once a day in the evening Rational: Montelukast, a leukotriene modifier, is most effective when taken once per day in the evening