Chap 55 PrepU
Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching?
"I should see some results in about 3 to 4 days."
The nurse is teaching a client newly diagnosed with asthma about triggers. Which statement by the client indicates the teaching plan has been effective?
"I will use my air conditioner." It is important that the client use the air conditioner if triggers are allergens, because of molds and pollens.
The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which of the following statements by the client indicate the need for further education?
"I will use this medication when I am having an asthma attack."
When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements?
"When I am short of breath, I will increase the use of my fluticasone."
A patient has been admitted to a healthcare facility with asthma. The nurse is advised to administer theophylline to the patient. To which of the following patients can the nurse safely administer theophylline?
A 65-year-old male patient with asthma
Which of the following would a nurse identify as a surfactant?
Beractant
Your patient, an elderly woman, insists her asthma is exacerbated by her least favorite television show. While explaining that her dislike for the show's host may be a contributing factor, you explain that an asthma attack is caused by substances released from mast cells, which cause:
Bronchoconstriction and inflammation. When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation.
Your patient, an elderly woman, insists her asthma is exacerbated by her least favorite television show. While explaining that her dislike for the show's host may be a contributing factor, you explain that an asthma attack is caused by substances released from mast cells, which cause:
Bronchoconstriction and inflammation. When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation.
The client's theophylline levels are increased. The nurse questions the client about his intake of which of the following?
Coffee Xanthines are found in colas, coffee, chocolate, and charcoal prepared foods.
A client is experiencing an acute asthmatic attack. Which agent would be most effective?
Correct response: Beta-2 selective adrenergic agonist
A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer?
Cromolyn
A patient is admitted to the emergency room with inspiratory stridor and air hunger after a bee sting. Which of the following medications will the nurse prepare for administration?
Epinephrine (Adrenalin) Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction.
Isoproterenol is an anticholinergic agent.
False
The first step in treating obstructive pulmonary disorders involves medication therapy.
False
Michael, 8 years old, comes to see you complaining of shortness of breath, cough, and chest tightness when he participates in gym class. He is seen by the physician in the clinic and diagnosed with exercise-induced asthma. What inhaled drug therapy is the physician most likely to prescribe for him?
Formoterol (Foradil), a highly selective beta-2 agonist
Your patient recently began taking theophylline for treatment of asthma. Which of the following changes in the patient's lifestyle would suggest that he understands proper use of the drug and management of his disease?
He avoids caffeine. Some bronchodilating drugs, such as theophylline, can cause tachycardia, dysrhythmias, palpitations, agitation, and insomnia.
A nurse is required to educate a patient prescribed albuterol on the adverse effects associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the patient to report to the health care provider?
Headache and flushing
A client who smokes is receiving theophylline orally. Because of his history of smoking, the nurse expects the health care provider to do what with the theophylline dosing?
Increase
A patient with asthma is administered zileuton along with theophylline. Which of the following drug interactions should the nurse monitor the patient for?
Increased serum theophylline
You are acting as the triage nurse in the emergency department when a 42-year-old patient with asthma presents for treatment. The patient's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this patient?
Ineffective breathing pattern The correct nursing diagnosis is Ineffective Breathing Pattern related to impaired airway as manifested by tachypnea.
A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route?
Inhalation
A patient is prescribed salmeterol. The nurse would expect this drug to be administered by which route?
Inhalation
A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route?
Inhalation Levalbuterol is administered only as an inhalant by nebulizer.
A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma?
Inhaled corticosteroid agents will reduce airway inflammation. Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils.
A neonate is receiving beractant. The nurse understands that this agent is administered by which route?
Intratracheal
Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA?
Leukotriene receptor antagonists Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA.
A male client is prescribed montelukast and uses it successfully to manage his asthma. He develops hepatitis C. What would the nurse expect the physician to do?
Maintain the same dose of the montelukast Montelukast and zafirlukast produce higher blood levels and are eliminated more slowly in clients with hepatic impairment.
Which of the following is used to treat acute air flow obstruction? (Choose one)
Metaproterenol (Alupent)
The client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler?
Nervousness Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.
A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels?
Nicotine When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.
When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited?
Slow-reacting substance of anaphylaxis
You are teaching a patient newly diagnosed with asthma how to manage his disease. What should you encourage this patient to stop doing?
Smoking cigarettes
Xanthine derivatives elicit their effect by which of the following mechanisms? (Choose one)
Stimulation of the central nervous system Stimulation of the central nervous system is the mechanism of action for xanthine derivatives.
A patient is using an albuterol (Proventil) inhaler, which is a bronchodilator. Which of the following patient teaching interventions is important for the patient who is experiencing shortness of breath related to constriction of airways?
Stop smoking due to the bronchoconstriction
A patient is started on albuterol (Proventil). What reaction should the patient be instructed on?
Tachycardia will occur. The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The patient will not experience polydipsia, hypotension, or diarrhea.
After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state which of the following?
The drugs are not for use during an acute attack.
A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family doctor. What effect will the patient's smoking status have on the therapeutic use of theophylline?
The patient may require higher doses of theophylline than a nonsmoker Smoking cigarettes may decrease serum theophylline levels. In fact, some patients who smoke require an increase in theophylline dosage of up to 50%.
A client was using nicotine patch to stop smoking when he was started on theophylline for emphysema. He has successfully stop smoking and has stopped using his nicotine patch. Which of following would be warranted? (Choose one)
Theophylline dose should be decreased
A client was using nicotine patch to stop smoking when he was started on theophylline for emphysema. He has successfully stop smoking and has stopped using his nicotine patch. Which of following would be warranted? (Choose one)
Theophylline dose should be decreased Nicotine decreases theophylline levels. If a client is no longer using nicotine his/her theophylline levels will increase warranting a decrease in theophylline dose.
A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which of the following common adverse effects of the drug?
Throat irritation
A therapeutic theophylline level ranges from 10 to 20 mcg/mL.
True
Cromolyn should not be used during an acute asthmatic attack.
True
Leukotriene receptor antagonists are administered orally.
True
A patient is being assessed by the home care nurse on the administration of the inhalers. Which of the following will assist in proper administration of the inhaler?
Use of a spacer
A patient is being assessed by the home care nurse on theadministration of the inhalers. Which of the following will assist in proper administration of the inhaler?
Use of a spacer
A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient
has a high coffee intake. Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol.
A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to
rebound bronchoconstriction. Patients who self-administer albuterol may use their MDIs more frequently than recommended.
A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to
rebound bronchoconstriction. Patients who self-administer albuterol may use their MDIs morefrequently than recommended. This practice can result in rebound bronchoconstriction,
Tom, age 42, is prescribed ipratropium bromide as an anticholinergic agent for treating asthma. As the nurse caring for Tom, you need to develop a plan of care. What must be included in the plan? (Choose all that apply.)
• Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. • Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma.
With theophylline, the home care nurse needs to assess the client and the environment for certain products that can cause what to occur? (Select all that apply.)
• Affect metabolism of theophylline • Decrease therapeutic effects • Increase adverse effects
A 5-year-old boy is brought to the ED with an asthma exacerbation, including wheezing (a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway). Those who have asthma chronically present with what signs, even when they may appear symptom free? Select all that apply.
• Airway inflammation • Damaged airway mucosa
Which of the following would the nurse include as possible adverse effects when teaching a patient about albuterol? Select all that apply.
• Bronchospasm • Nervousness • Sweating
A patient, diagnosed with asthma, has been prescribed tiotropium. What should the nurse know about tiotropium? (Mark all that apply.)
• It is an anticholinergic • You only need to take it once a day • It has a rapid onset of action and a long duration
You have just finished teaching your 15-year-old patient how to use his inhaler to treat his asthma. What statement, made by your patient, suggests that he understands what you've taught him?
"I need to shake the inhaler well before taking the medication."
You have just finished teaching your 15-year-old patient how to use his inhaler to treat his asthma. What statement, made by your patient, suggests that he understands what you've taught him?
"I need to shake the inhaler well before taking the medication."
The nurse instructs a patient who is using albuterol for exercise induced bronchospasm to use the inhaler at which time?
15 minutes prior to exercising Albuterol for exercise induced bronchospasm should be administered 15 minutes prior to exercising.
A client who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert it full effects within which time frame?
20 minutes
A client is receiving theophylline intravenously. The nurse reviews the results of his serum drug levels and notifies the physician for which result?
25 mcg/mL
A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the physician to order?
A modified dose of aminophylline
A patient with acute respiratory symptoms is receiving a loading dose of theophylline. Which of the following signs of toxicity should alert the nurse to notify the primary health care provider immediately?
Abdominal cramps
The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son's medication regimen by the nurse. The nurse is currently teaching the parent's about the appropriate use of a "rescue drug" for acute exacerbations of their son's asthma. What drug should the nurse suggests the parents to use in these situations?
Albuterol Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing.
The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son's medication regimen by the nurse. The nurse is currently teaching the parent's about the appropriate use of a "rescue drug" for acute exacerbations of their son's asthma. What drug should the nurse suggests the parents to use in these situations?
Albuterol Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing.
A patient is given theophylline to treat acute asthma symptoms. Which of the following foods should the patient avoid?
Chocolate Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the patient is taking theophylline.
A nurse is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following?
Coffee
The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline?
Coffee
The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline?
Coffee
While reviewing a client's history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?
Peanuts
The nurse is teaching a client how to prevent Candida infections. Which of the following would the nurse include in the instructions?
Rinse mouth with water after each use.
The nurse is evaluating the education of a client that uses albuterol for an acute asthma attack. The nurse knows that the lesson has been effective when the client states that albuterol is which of the following types of medication?
SABA
After teaching a group of students about drugs as bronchodilators, the instructor determines that the teaching has been successful when the students identify which group of drugs as once being first-line agents?
Xanthines
A patient is experiencing an acute asthma attack. What is the first-line therapy for relief of an acute asthma attack?
You selected: Beta2-adrenergic agonist
A patient who is prescribed ipratropium administers the drug at 9:15 AM. The patient should begin to notice the drug beginning to act at which time?
9:30 AM
Which of the following would be most important to assess before administering calfactant? (Select all that apply.)
• Lung sounds • Oxygen saturation levels • Endotracheal tube placement
A patient is receiving aminophylline orally. The nurse would expect this drug to begin acting within which time frame?
1 to 6 hours
A client is receiving ipratropium as maintenance therapy for chronic obstructive pulmonary disease. The nurse would caution the client that up to how many inhalations may be used in 24 hours if needed?
12 With ipratropium, the usual dosage is 2 inhalations four times/day for a total of 8 inhalations. However, the client can use up to 12 inhalations if needed in 1 day.
The nurse assesses the serum theophylline of a patient. Which finding would the nurse identify as being therapeutic?
15 mcg/mL Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.
A client is using an inhaled bronchodilator as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time?
15 minutes before engaging in exercise
A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem?
Adrenal insufficiency Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.
A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the physician to give him?
Albuterol
A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the physician to give him?
Albuterol
Which of the following is an example of a short acting Beta 2 Agonist (SABA)? (Choose one)
Albuterol Albuterol is a SABA. Formoterol, Salmeterol, and Arformoterol are long acting Beta 2 Agonists (LABA)
During the summer, a female client experiences increased periods of acute symptoms of her asthma. The physician increases the dose frequency of which of her medications?
Albuterol Albuterol is the initial drug of choice for acute bronchospasm.
Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication?
Albuterol causes relaxation of the bronchial smooth muscles. The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles.
The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?
Albuterol first, wait five minutes and then follow with flunisolide
The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?
Albuterol first, wait five minutes and then follow with flunisolide Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.
A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?
Cigarette smoking Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary.
A patient is experiencing an acute asthma attack. Which of the following medications are contraindicated for the treatment of acute asthma?
Cromolyn (Intal)
An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?
Mix the drug with saline. Metaproterenol is mixed with saline in the nebulizer chamber for administration.
The nurse is teaching a client how to prevent Candida infections. Which of the following would the nurse include in the instructions?
Rinse mouth with water after each use. The client should be taught to rinse his mouth out with water after using oral inhalers to prevent a Candida oral infection.
A female client presents to the emergency department with acutely deteriorating asthma. Her husband shows the nurse salmeterol when the nurse asks what medications his wife takes at home. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation?
Salmeterol is contraindicated based on his wife's condition. The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.
When educating a group of students on the mechanism of action of various anti-asthma drugs, the nurse identifies which of the following drugs as inhibiting the formation of leukotriene?
Zileuton Zileuton acts by inhibiting the formation of leukotriene.
The nurse should complete which of the following during acute breathing distress before initiation of a broncodilator? Select all that apply:
• Check blood pressure. • Check respiratory rate • Check pulse.
Your patient, a 27-year-old athlete with newly diagnosed asthma, presents at your office for patient education regarding situations that could precipitate an asthma attack. Your teaching includes that acute episodes of asthma may last minutes to hours. In your teaching, which of the following precipitants do you state may cause the asthma? Select all that apply.
• Exercise • Allergens • Pollutants
After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which of the following as possible adverse effects? Select all that apply.
• Myalgia • Dizziness • Vomiting
A history of an allergy to which of the following would be a contraindication to the use of anticholinergics? Select all that apply.
• Soy • Peanuts
The client is 73 years of age and has a history of coronary artery disease and COPD. She is being started on formoterol (Foradil). The nurse would assess the client for which of the following conditions? Select all that apply.
• Tachycardia • Hypertension
In children, high doses of nebulized albuterol have been associated with what conditions? (Select all that apply.)
• Tachycardia • Hypokalemia • Hyperglycemia
