Saunders-Pharmacology: Respiratory

A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which medication first?

A β2-agonist In treating an acute asthma attack, a short-acting β2-agonist such as albuterol will be given to produce bronchodilation.

The nurse has just been given a prescription to administer albuterol to a client. The nurse evaluates the effectiveness of the medication by checking which parameters before and during therapy?

Dyspnea and lung sounds Albuterol is an adrenergic bronchodilator. The nurse monitors respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The color, character, and amount of sputum also are noted. The medication is not given to affect the parameters listed in any of the other options.

A client has a new prescription to take guaifenesin every 4 hours as needed. Which medication instructions should the nurse reinforce?

Take the tablet with a full glass of water. Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. 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.

The nurse is checking a client who is taking theophylline for possible toxicity. Which signs and symptoms indicate theophylline toxicity? Select all that apply.

1.Flushing 2.Insomnia 3.Headache 5.Nausea and vomiting The normal therapeutic range for theophylline levels is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 19 mcg/mL places the client near the top of the therapeutic range. Theophylline relaxes the bronchial smooth muscle and causes bronchial dilation. Therapeutic response includes decreased dyspnea and clear lung fields bilaterally. Symptoms of toxicity include insomnia, flushing, nausea, vomiting, headache, tinnitus, delirium, seizures, tachycardia, cardiac arrhythmias, and blood pressure changes.

The nurse is reviewing the medication profile of a client taking theophylline. Which medications can increase the risk of theophylline toxicity? Select all that apply.

3.Cimetidine 4.Corticosteroids 5.Fluoroquinolones Theophylline has many medication interactions. Medications that increase the risk of theophylline toxicity include cimetidine, nonselective é-blockers, erythromycin, clarithromycin, oral contraceptives, corticosteroids, interferons, fluoroquinolones, disulfiram, mexiletine, fluvoxaMINE, high doses of allopurinol, influenza vaccines, interferon, and benzodiazepines. Medications that decrease the effectiveness of theophylline include nicotine products, adrenergics, barbiturates, phenytoin, ketoconazole, and rifampin.

The nurse has a prescription to give a client albuterol (two puffs) and beclomethasone dipropionate (two puffs) by metered-dose inhaler. How much time should the nurse place between administering the albuterol and then the beclomethasone dipropionate?

5 minutes Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Albuterol acts in 5 to 10 minutes and lasts for 3 to 4 hours. Since the medications are at the same time waiting 5 minutes allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

A client has a prescription to receive albuterol, two puffs and beclomethasone dipropionate, two puffs by metered-dose inhaler. Which should the nurse plan when administering these medications?

Administering the albuterol before the beclomethasone dipropionate Albuterol is an adrenergic type of bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are 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.

The nurse has observed a client self-administer a dose of metaproterenol sulfate via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. Which interpretation should the nurse make of this occurrence?

Bronchospasm, which must be reported to the primary health care provider The client taking a bronchodilator may experience bronchospasm, which is evident by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld, and the primary health care provider should be notified.

A client has begun therapy with theophylline. The nurse tells the client to limit the intake of which while taking this medication?

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

A client has been taking benzonatate as prescribed. The nurse determines that the medication is having the intended effect if the client experiences which response?

Decreased frequency and intensity of cough Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex.

The nurse reinforces client instructions about ethambutol. The nurse determines that the client understands the instructions if the client indicates to report which occurrence?

Difficulty discriminating the color red from green 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 driving a motor vehicle. The client is taught to report this symptom immediately. The client is also 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 is monitoring a client who is receiving a dose of an adrenergic bronchodilator. The nurse plans to monitor for which side effect of this medication?

Increased pulse and blood pressure Side effects of an adrenergic bronchodilator can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy.

A client with tuberculosis is being started on antitubercular therapy with isoniazid. The nurse reviews the client's health care record to be sure that which baseline studies have been completed before giving the client the first dose?

Liver enzymes Isoniazid therapy can cause an elevation of hepatic enzymes and drug-induced hepatitis. Therefore, liver enzymes 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 age 50 or abuses alcohol.

The nurse is collecting data on a client admitted to the hospital with a diagnosis of a respiratory infection unresponsive to oral antibiotics. The nurse discovers that the client has a history of bronchial asthma and has been taking zafirlukast. The nurse assists in developing a plan of care for the client and suggests monitoring of which data?

Liver function tests Zafirlukast is a leukotriene receptor antagonist that is used in the prophylaxis and chronic treatment of bronchial asthma. It is used with caution in clients with impaired hepatic function. Liver function laboratory values should be obtained as a baseline and should be monitored during administration of the medication.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesia, and tingling in the extremities. The nurse interprets that the client is experiencing which problem?

Peripheral neuritis A common adverse effect of isoniazid is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This adverse effect can be minimized by pyridoxine intake.

A licensed practical nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. Which action should the nurse take?

Report the client's symptoms to the registered nurse (RN). The client taking an adrenergic bronchodilator may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. If this occurs, further medication should be withheld, and the RN immediately notified.

A postoperative client has received a dose of naloxone for respiratory depression. The nurse anticipates that the client will have which additional effect from the administration of this medication?

Sudden increase in pain Naloxone is an antidote to opioids; it also may be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may reverse the effects of analgesics. Therefore, the nurse must anticipate that the client may experience a sudden increase in the level of pain.

Which precautions should the nurse specifically take during the administration of ribavirin to a child with respiratory syncytial virus (RSV)?

Wearing goggles Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not necessary. A mask may be worn. Hand washing is to be performed before and after any child contact.

The nurse is giving discharge instructions to the client concerning theophylline. Which client statement indicates a need for further teaching?

"I need to drink plenty of fluids, so I will drink more coffee and tea." Theophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. The client needs to take the pulse since toxicity will increase the pulse. Smoking decreases drug blood levels and terminal half-life so the dosage may have to be changed. Theophylline should be with food or milk to decrease any GI effects. It should not be taken before bedtime because it may keep the client awake. The client should increase fluids to 2 L/day to decrease secretion viscosity; however, the client should not drink alcohol or caffeine products (tea, coffee, chocolate, colas).

Cycloserine is added to the medication regimen for a client with tuberculosis. Which instruction should the nurse suggest to include in the client teaching plan regarding this medication?

Return to the clinic weekly for serum drug levels. Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. A serum drug level less than 30 mg/mL reduces the incidence of neurotoxicity. The medication needs to be taken after meals to prevent gastrointestinal irritation. The client needs to be instructed to notify the primary health care provider if a skin rash or early signs of central nervous system toxicity are noted. Alcohol needs to be avoided because it increases the risk of seizure activity.

Cycloserine is added to the medication regimen for a client with tuberculosis. Which instruction should the nurse reinforce in the client-teaching plan regarding this medication?

To return to the clinic weekly for serum drug-level testing Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent GI irritation. The client must be instructed to notify the PHCP if a skin rash or signs of CNS toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.

A client is monitoring a client receiving theophylline to treat symptoms of chronic obstructive pulmonary disease (COPD). Which adverse effects require immediate consultation with the primary health care provider? Select all that apply.

3.Seizures 5.Irregular heartbeat Theophylline is a bronchodilator. Irregular heartbeats and seizures are signs of toxicity and require immediate primary health care provider notification. Anxiety and insomnia are common side effects and do not require immediate action. Diarrhea is not specifically associated with theophylline toxicity.

A client is taking cetirizine hydrochloride. The nurse should check for which side effect of this medication?

Drowsiness A frequent side effect of cetirizine hydrochloride, an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

A client is taking brompheniramine. The nurse reinforces instructions to the client to expect which side effect of this medication?

Drowsiness This medication is an antihistamine, and frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

A client diagnosed with pleurisy is being started on medication therapy with ibuprofen. Which statement by the nurse accurately describes the purpose of the medication for the client?

Ibuprofen is a nonsteroidal anti-inflammatory medication to enhance coughing and deep breathing. Ibuprofen is a nonsteroidal anti-inflammatory medication that has an analgesic effect and allows the client to cough and deep breathe more effectively.

A client is receiving acetylcysteine, 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for a possible adverse event after giving this medication?

Suction equipment Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

The nurse is providing instructions to a client taking ethambutol about the medication. The nurse instructs the client to contact the primary health care provider immediately if which occurs?

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

A primary health care provider has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse reinforces instructions given to the client about the medication and tells the client to monitor for which side effect?

Constipation A frequent side effect of codeine sulfate is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored.

A registered nurse has administered a dose of naloxone intravenously to a client with intravenous opioid overdose. The licensed practical nurse assigned to assist in monitoring the client ensures that which equipment is available in the immediate vicinity of the client?

Resuscitation equipment Naloxone is used to treat respiratory depression. The client who receives naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other items that may be needed include oxygen, a mechanical ventilator, and medications such as vasopressors.

A client with respiratory congestion is scheduled to receive acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer. The nurse checks the client's room to ensure that which equipment is available for use following administration of this medication?

Suction equipment Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

A child with respiratory syncytial virus (RSV) has been prescribed ribavirin. Which nursing actions should be implemented? Select all that apply.

1.Ribavirin is administered by fine aerosol mist via a mist tent. 2.Individuals who wear contact lenses caring for the child may develop conjunctivitis 5.Women who are of childbearing age, pregnant, or breastfeeding should not care for the child. Ribavirin is administered by fine aerosol mist through a mist tent. Caregivers and visitors who are of childbearing age, pregnant, or breastfeeding should not care for the child. Ribavirin has had teratogenic effects reported. The ribavirin mist can cause precipitation on the surface of plastics so individuals who wear contact lenses may develop conjunctivitis. The nurse should turn off the nebulizer and allow the mist to settle before opening the mist tent and providing care. Linens removed from the bed should be rolled slowly and carefully folded to avoid releasing ribavirin droplets into the air.

The nurse is giving discharge instructions to the client concerning theophylline. Which client statement indicates a need for further teaching?

"I can keep on being the charcoal grill king and eat a lot of beef steak." Client instructions concerning theophylline include not to drink alcohol or caffeine products (tea, coffee, chocolate, colas) and to avoid large amounts of charcoal-grilled beef. The client needs to avoid hazardous activities because of possible dizziness. The client needs to notify primary health care provider about changes in smoking habits because a change in dose may be required.

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. The nurse determines that the client needs further teaching about the medication if the client makes which statement?

"I will take the daily dose at bedtime." The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the PHCP before changing brands of the medication. The client also checks with the PHCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects increasing the side effects of theophylline and causing dysrhythmias.

A client has a prescription to take guaifenesin every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client makes which statement?

"I will take the tablet with a full glass of water." Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness. The client should contact the PHCP if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

Albuterol, two puffs and fluticasone propionate, two puffs by metered-dose inhaler have been prescribed for a client with chronic obstructive pulmonary disease. The nurse caring for the client provides instructions regarding administration of the medication. Which statement by the client indicates an understanding of how to take these medications?

"I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate." Albuterol is an adrenergic type of bronchodilator. Fluticasone propionate 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.

Isoniazid is prescribed for a 2-year-old child with a positive tuberculin skin test. The mother of the child asks the nurse how long the child will need to take the medication. Which time frame is the appropriate response to the mother?

9 months Isoniazid is given to prevent TB infection from progressing to active disease. A chest x-ray film is obtained before the initiation of preventive therapy. In infants and children, the recommended duration of isoniazid therapy is 9 months. For children with human immunodeficiency virus infection, a minimum of 12 months is recommended.

A hospitalized client with allergic asthma has been started on cromolyn sodium inhaler. The nurse assists in preparing a plan of care and includes monitoring for undesirable side effects associated with the use of this medication. The nurse places the highest priority on monitoring for which side effect?

Bronchospasm The most common undesired clinical responses 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.

A client has been started on long-term therapy with rifampin. Which information about this medication should the nurse provide to the client?

Causes red-orange discoloration of sweat, tears, urine, and feces 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 PHCP. The medication should be administered on an empty stomach unless it causes GI upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes red-orange discoloration of body secretions and will permanently stain soft contact lenses.

Levalbuterol via inhalation is prescribed for a client with a diagnosis of emphysema. The nurse reinforces instructions to the client regarding the medication and teaches the client about the dietary restrictions that must be implemented while taking this medication. The nurse determines that the client understands the dietary instructions when the client states he will avoid which food choice?

Cocoa Levalbuterol is a bronchodilator. This medication stimulates the beta receptors in the lungs, relaxes bronchial smooth muscle, increases vital capacity, and decreases airway resistance. Central nervous system (CNS) stimulation can occur with the use of this medication. The client is instructed to avoid caffeine-containing products such as coffee, tea, colas, and chocolate because these products can cause further CNS stimulation.

A client with tuberculosis (TB) will be treated with isoniazid and rifampin. The nurse is reinforcing instructions for the client regarding these medications. Which statement should the nurse plan to provide to the client?

"The entire prescribed course of the medication needs to be completed." The client needs to be instructed that the entire prescribed course (9 months to 1 year) of the medication needs to be completed. It is preferable to take the medication 1 hour before or 2 hours after meals. If GI irritation occurs, the medication should not be discontinued, and in this situation, a small amount of food may be taken to reduce the irritation. It is not necessary to increase fluids during this medication therapy.

A newborn infant receives naloxone hydrochloride to reverse opiate-induced respiratory depression that occurred following labor and delivery. For which reason would the nurse continue to monitor the respiratory status of a newborn infant following the administration of this medication?

The newborn infant may demonstrate a reappearance of respiratory depression. reverses the respiratory depression that can be exhibited in newborn infants whose mothers have been treated with opiates for the pain of labor and delivery. Because it is short acting and the newborn's liver is immature, respiratory depression may recur after the duration of effects of naloxone.

Ribavirin is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which route?

Via face mask Ribavirin is an antiviral respiratory medication that may be used in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if administered within the first 3 days of the infection.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse ensures that which baseline study has been completed?

Liver enzyme levels 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 greater than age 50 or abuses alcohol.

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 to report which occurrence immediately?

Problems with visual acuity 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 is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Red-orange discoloration of secretions occurs with rifampin.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to provide which information to the client?

Report yellow eyes or skin immediately. Isoniazid is hepatotoxic, and therefore the client is taught to report signs/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 light-headedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine during the course of isoniazid therapy.

A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse should check the client for which sign/symptom?

Sudden increase in pain Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse should monitor for which side/adverse effects of the medication? Select all that apply.

1.Signs of hepatitis 2.Flu-like syndrome 3.Low neutrophil count 5.Ocular pain or blurred vision 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 effects include rash, GI disturbances, neutropenia (low neutrophil count), red-orange 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. Ethambutol also causes peripheral neuritis.