Chapter 55: Drugs Acting on the Lower Respiratory Tract

A client who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert its full effects within which time frame? -5 minutes -10 minutes -15 minutes -20 minutes

20 minutes *When given intravenously, epinephrine peaks in approximately 20 minutes. It would be at this time that the drug is most effective.

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 -9:45 AM -10:00 AM -10:15 AM

9:30 AM *Inhaled ipratropium has an onset of action of 15 minutes, so the patient should begin to feel the effects of the drug at 9:30 AM.

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following? -Increased pulse rate -Increased serum zileuton -Increased serum theophylline -Increased prothrombin time

Increased serum theophylline *When administering zileuton along with theophylline, the nurse should monitor for increased serum theophylline.

A client prescribed albuterol should be educated on identifying and managing which adverse reaction? -polydipsia -tachycardia -hypotension -diarrhea

tachycardia *The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol.

A client has been prescribed a inhaled steroid for the treatment of asthma. What information should the nurse include when providing medication education to the client? Select all that apply. -Promptly report a fever or any other indication of infection to your health provider -The medication can take up to 6 weeks to reach effective systemic levels -Rebound nasal congestion is a adverse effect of this form of medication -The medication is not intended to treat an acute asthma attack -Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency

-The medication is not intended to treat an acute asthma attack -Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency -Rebound nasal congestion is a adverse effect of this form of medication -Promptly report a fever or any other indication of infection to your health provider

A client has been admitted to a health care facility with asthma. The nurse is to administer theophylline to the client. To which clients can the nurse safely administer theophylline? -A 65-year-old male with asthma -A 65-year-old female with hepatic disease -An 83-year-old female with cardiac disease -A 43-year-old male with hypertension

A 65-year-old male with asthma *The nurse can safely administer theophylline to the client who is 65 years of age. It needs to be administered cautiously in clients older 69 years of age or those with hepatic disease, cardiac disease, or hypertension.

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 -One hour before exercise -Immediately on beginning to exercise -In the morning of the day when exercise is planned

15 minutes prior to exercising *Albuterol for exercise induced bronchospasm should be administered 15 minutes prior to exercising

Which statement made by a nurse providing care to a newborn prescribed surfactin therapy indicates a need for additional instructions to ensure the medication's effectiveness? -"The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant." -"The baby needs suctioning just prior to the instillation of the surfactin." -"Suctioning should be avoided for at least 2 hours after the surfactant instillation." -"The baby should be suctioned after the instillation of the surfactant only if clinically necessary."

"The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant." *Suction the infant immediately before administration, but do not suction for 2 hours after administration unless clinically necessary, to allow the drug time to work.

During the summer, a female client experiences increased periods of acute symptoms of her asthma. The health care provider increases the dose frequency of which of her medications? -Epinephrine -Omalizumab -Salmeterol -Albuterol

Albuterol *Albuterol is the initial drug of choice for acute bronchospasm.

A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid? -Bananas -Orange juice -Chocolate -Cranberry juice

Chocolate *Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline.

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? -Hyperthyroidism -Cigarette smoking -Gastrointestinal upset -Alcohol intake

Cigarette smoking *Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary.

An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate? -Encourage rapid shallow breaths. -Turn the device off when the mist slows. -Mix the drug with saline. -Have the child lie flat.

Mix the drug with saline. *Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.

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? -LABA -Leukotriene modifier -SABA -Antiasthma

SABA *Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.

What is the most common first-line therapy for relief of an acute asthma attack? -beta2-adrenergic agonist -xanthine -leukotriene modifier -inhaled steroid

beta2-adrenergic agonist *A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

A client prescribed antiasthmatic drugs should be encouraged to avoid excessive intake of what beverage? -coffee -grapefruit juice -green tea -acai juice

coffee *Clients taking antiasthmatic drugs should generally avoid excessive intake of caffeine-containing fluids such as coffee, tea, and cola drinks. These beverages may increase bronchodilation but also may increase heart rate and cause palpitations, nervousness, and insomnia with bronchodilating drugs.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem? -Pituitary insufficiency -Renal insufficiency -Adrenal insufficiency -Pancreatic insufficiency

Adrenal insufficiency *Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.

A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family provider. What effect will the client's smoking status have on the therapeutic use of theophylline? -Theophylline may be contraindicated due to the risk of an anaphylactoid reaction -The client may require administration of an inhaled bronchodilator before each dose of theophylline -The client will require serial blood testing to ensure a safe serum level of theophylline -The client may require higher doses of theophylline than a nonsmoker

The client may require higher doses of theophylline than a nonsmoker *Smoking cigarettes may decrease serum theophylline levels. In fact, some clients who smoke require an increase in theophylline dosage of up to 50%.

A 27-year-old athlete with newly diagnosed asthma presents for patient education regarding situations that could precipitate an asthma attack. The nurse teaches that acute episodes of asthma may last minutes to hours. In this teaching, which precipitants would the nurse state may cause the asthma? (Select all that apply.) -Pollutants -Warm weather -Exercise -Allergens

Exercise Allergens Pollutants *Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.

A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route? -Inhalation -Oral -Subcutaneous -Intravenous

Inhalation *Salmeterol is administered via inhalation.

How do inhaled corticosteroid agents assist in the treatment of asthma? -Inhaled corticosteroid agents will depress the central nervous system. -Inhaled corticosteroid agents will reduce respiratory rate. -Inhaled corticosteroid agents will reduce bronchodilation. -Inhaled corticosteroid agents will reduce airway inflammation.

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. Inhaled corticosteroid agents do not depress the central nervous system or affect either bronchodilation or constriction.

Which of the following would be most important to assess before administering calfactant? (Select all that apply.) -Abdominal girth -Lung sounds -Endotracheal tube placement -Bowel sounds -Oxygen saturation levels

Lung sounds Endotracheal tube placement Oxygen saturation levels *Before administering calfactant, it would be important to ensure proper endotracheal tube placement because the drug is instilled directly into the trachea. In addition, lung sounds and oxygen saturation levels would be important as a baseline to evaluate effectiveness of the drug

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? -Eggs -Dairy -Peanuts -Shellfish

Peanuts *The use of ipratropium is contraindicated in the presence of known allergy to the drug or to peanuts or soy products because the vehicle used to make ipratropium, an aerosol, contains a protein associated with peanut allergies.

A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse? "I'm a heavy coffee drinker, but I know that I now know I need to cut down on this." I'll keep taking my medications until I'm not experiencing any more symptoms." "I'll make sure I don't take my inhalers more often than they've been prescribed." "I'll try to make sure that I drink plenty of fluids each day."

"I'll keep taking my medications until I'm not experiencing any more symptoms." *Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms.

A premature newborn diagnosed with respiratory distress syndrome(RDS) has received surfactant therapy. The infant's nursing care plan should include which monitoring interventions to evaluate the effectiveness of the therapy? Select all that apply. -Respirations -Adventitious breath sounds -Endotracheal tube placement -Chest movement -Heart rate

-Respirations -Adventitious breath sounds -Endotracheal tube placement -Chest movement *Monitor respirations, adventitious sounds, endotracheal tube placement and patency, and chest movements to evaluate the effectiveness of the drug and drug delivery.

The nurse assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic? -30 mcg/mL -15 mcg/mL -5 mcg/mL -25 mcg/mL

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? -Immediately after beginning to exercise -15 minutes before engaging in exercise -Right before and after exercising -Midway during the exercise routine

15 minutes before engaging in exercise *The client should use the inhaler approximately 15 minutes before exercising to achieve the maximum therapeutic effects.

The parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations? -Theophylline -Albuterol -Beclomethasone -Acetylcysteine

Albuterol *Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing.

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 stimulation of the bronchial tissue. - Albuterol blocks the stimulation of the beta-2 receptors. -Albuterol decreases vital capacity. -Albuterol causes relaxation of the bronchial smooth muscles.

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. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.

The client has been diagnosed with asthma and 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 followed immediately by flunisolide -Flunisolide first, wait five minutes and then follow with albuterol -Flunisolide followed immediately by albuterol

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 client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? -Pneumonia -Asthma -Chronic bronchitis -Emphysema

Asthma *Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma.

Which of the following would a nurse identify as a surfactant? -Beractant -Zileuton -Cromolyn -Theophylline

Beractant *Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.

The client's theophylline levels are increased when the lab results are added to the electronic health record. The nurse questions the client about his intake of which? -Coffee -Tea -Carrots -Cheese

Coffee *Xanthines are found in colas, coffee, chocolate, and charcoal-prepared foods. This could cause the client's theophylline levels to increase. Neither tea, carrots, nor cheese affect theophylline levels.

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 -Montelukast -Calfactant -Triamcinolone

Cromolyn *Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.

Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use? -It helps decrease the intrapulmonary delivery of the drug. -It reduces the risk of tachycardia. -It helps decrease systemic absorption. -It reduces the risk of sinusitis.

It helps decrease systemic absorption. *Spacers help decrease systemic absorption, because less flunisolide is swallowed. Spacers may also help alleviate dysphonia by filtering larger aerosol particles that ordinarily deposit in the oropharynx and extrathoracic airways (this precaution also reduces the risk for oropharyngeal candidiasis).

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? -Hypotension -Fatigue -Nervousness -Bradycardia

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 -Allopurinol -Cimetidine -Corticosteroids

Nicotine *When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.

A client is admitted to the emergency department with inspiratory stridor and air hunger. When anticipating treatment, the nurse will prepare which medication for administration? -ipratropium bromide -epinephrine -cromolyn -pseudoephedrine

epinephrine *Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction.

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 history of pneumonia. -prefers a high-calorie diet. -has a high coffee intake. -is a 56-year-old man.

has a high coffee intake. *Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate.

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? -"I will wash my sheets weekly." -"When I can do some, but not all of my usual activities, I am in the yellow zone." -"When I am short of breath, I will increase the use of my fluticasone." -"I need to inhale my medication and hold my breath for 10 seconds."

"When I am short of breath, I will increase the use of my fluticasone." *Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.

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.) -Damaged airway mucosa -Bradycardia -Elevated temperature -Airway inflammation

Airway inflammation Damaged airway mucosa *Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free.

After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)? -Albuterol -Formoterol -Salmeterol -Arformoterol

Albuterol *Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.

A client is experiencing an acute asthmatic attack. Which agent would be most effective? -Mast cell stabilizer -Beta-2 selective adrenergic agonist -Leukotriene receptor antagonist -Inhaled steroid

Beta-2 selective adrenergic agonist *A beta-2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after injection and rapidly absorbed after inhalation.

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 blood glucose. -Check pulse. -Check respiratory rate -Check peak flow

Check blood pressure. Check pulse. Check respiratory rate *Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.

The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take? -Withhold the scheduled dose of theophylline pending the next day's blood work results. -Administer the scheduled dose of theophylline with as needed (PRN) dose of a bronchodilator. -Inform the care provider that an increase in the client's dose of theophylline may be necessary. -Contact the care provider and inform him or her that the client has toxic theophylline levels.

Contact the care provider and inform him or her that the client has toxic theophylline levels. *To determine theophylline dosage, prescribers should measure serum theophylline levels. Therapeutic range is 5 to 15 mcg/mL (27.75 to 83.25 µmol/L); toxic levels are 20 mcg/mL (111 µmol/L) or above. The care provider must be informed of this elevated serum level.

A neonate is receiving beractant. The nurse understands that this agent is administered by which route? -Intratracheal -Subcutaneous -Intramuscular -Intravenous

Intratracheal *Beractant is administered intratracheally.

A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy? -Reduction of the inflammatory response -Enhancement of alveolar expansion -Decrease in the production of leukotrienes D4 and E4 -Relaxation of smooth muscle

Relaxation of smooth muscle *Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation.

The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions? -Clean spacer with alcohol twice a day. -Do not use a spacer because it promotes infections. -Rinse mouth with water after each use. -Brush teeth thoroughly after each puff.

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. Candida is a yeast that can grow in the mouth, it is important that they have good oral hygiene but rinsing the mouth is sufficient.

A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation? -The health care provider will most likely order continuation of the salmeterol with increased dosage. -The extra doses facilitated bronchodilation and probably saved her life. -The husband made the correct decision in giving the extra doses. -Salmeterol is contraindicated based on his wife's condition.

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.

After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state: -The drugs are not for use during an acute attack. -The drugs are systemically absorbed when inhaled. -The drugs action leads to suppression of beta adrenergic receptor activity. - The drugs are slowly absorbed from the respiratory tract.

The drugs are not for use during an acute attack. *The drugs are not for emergency use or use during an acute attack because their onset of action is slow. Systemic absorption is not typical with inhalation unless the patient did not administer the drug properly or has lesions that allowed absorption of the drug. Inhalation decreases the effectiveness of the inflammatory cells leading to decreased swelling and promotion of beta adrenergic receptor activity. The drugs are rapidly absorbed, but take 2 to 3 weeks to reach effective levels.

What is considered a possible trigger for an asthma attack? Select all that apply. -exercise -allergens -pollutants -warm weather -cigarette smoke

exercise allergens pollutants cigarette smoke *Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.