Chapter 55: Drugs Acting on the Lower Respiratory Tract

The nurse is teaching a client newly diagnosed with asthma about triggers. Which statement by the client indicates the client understands the teaching plan? "I will spray my bed and carpeting with dust mite killer." "I will use my air conditioner." "I will move my pet out of my bed and onto the bedroom floor." "I will wash my bedding monthly."

"I will use my air conditioner." Rationale: It is important that the client use the air conditioner if triggers are allergens, because of molds and pollens. Animals should not be in the bedroom. Bedding should be washed weekly. Aerosols may be a trigger.

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

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

15 mcg/mL Rationale: Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.

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 Rationale: 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 child prescribed an inhaled corticosteroid agent to decrease respiratory inflammation is now receiving high doses of the drug after only 2 days of treatment. What adverse reaction is the client at risk for developing? Adrenal insufficiency Tachycardia Edema Hypoglycemia

Adrenal insufficiency Rationale: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. The client is not at risk for tachycardia, edema, or hypoglycemia unless related to adrenal insufficiency.

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 Rationale: Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing. Theophylline does not produce rapid symptom relief and beclomethasone is a maintenance drug. Acetylcysteine is not used in the treatment of asthma because it is used to manage secretions, which are not associated with asthma.

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? Asthma Emphysema Chronic bronchitis Pneumonia

Asthma Rationale: 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. This class of medication is not typically associated with the long term management of any of the other options.

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

Chocolate Rationale: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.

The nurse is providing education to a client who has been prescribed an antiasthmatic drug. The nurse should instruct the client to avoid excessive intake of what beverage? Coffee Grapefruit juice Green tea Acai juice

Coffee Rationale: 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. None of the other options contain sufficient amounts of caffeine to cause such an affect.

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

A patient tells you that a friend of theirs has recommended the use of caffeine to treat the patient's asthma. What would be the most important reason a nurse should counsel this patient not to delay prescribed treatment for the use of natural health products? Caffeine can aggravate the drugs used to treat asthma Most natural products are less toxic or more potent than traditional asthma medications Natural products decrease the adverse effects associated with adrenergic bronchodilators Delays in appropriate treatment can have serious, even fatal, consequences

Delays in appropriate treatment can have serious, even fatal, consequences Rationale: The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. These drugs were once the main treatment choices for asthma and bronchospasm. However, because they have a relatively narrow margin of safety, and they interact with many other drugs, they are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have an additive effect.

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 Rationale: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.

After teaching a group of students about antiasthmatic agents, the students demonstrate understanding of the information when they identify what as sympathomimetics? (Select all that apply.) Epinephrine Terbutaline Formoterol Budesonide Tiotropium Cromolyn

Epinephrine Terbutaline Formoterol Rationale: Epinephrine is a sympathomimetic. Terbutaline is a sympathomimetic. Formoterol is a sympathomimetic. Budesonide is an inhaled steroid. Tiotropium is an anticholinergic. Cromolyn is a mast cell stabilizer.

A client is prescribed a steroid to help decrease inflammation in their respiratory tract. When providing medication education to the client what should the nurse identify as the benefit primary benefit of administering the medication by inhaler? Fewer systemic effects Quicker response Ease of administration Allows for therapy during pregnancy

Fewer systemic effects Rationale: Steroids are used to decrease the inflammatory response in the airway. Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use. Steroids are not prescribed for the management of acute symptoms since they can take 2-3 weeks to reach effective levels. They should not be used during pregnancy or lactation. Ease of administration is not the primary benefit of this form of steroid therapy.

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. Rationale: 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 use of a spacer does not prevent intrapulmonary delivery of the drug; nor does it reduce the risk of tachycardia and sinusitis.

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? Fatigue Nervousness Bradycardia Hypotension

Nervousness Rationale: Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.

A patient presents at the Emergency Department (ED) in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the patient may be allergic to what? Aspirin Penicillin Peanuts Ragweed pollen

Peanuts Rationale: Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, or ragweed pollen are not associated with this drug.

An adult client with a diagnosis of asthma has been prescribed montelukast. The nurse should teach the client that this drug will help relieve symptoms by which mechanism? Reducing the muscle tone in the alveoli and facilitating gas exchange Relaxing smooth muscle in the bronchi and bronchioles Preventing the bronchoconstriction and inflammation that is caused by leukotrienes Preventing mast cells from releasing histamine

Preventing the bronchoconstriction and inflammation that is caused by leukotrienes Rationale: Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes. This information makes all the remaining options incorrect.

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

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

When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited? Epinephrine Intracellular calcium Prostaglandins Slow-reacting substance of anaphylaxis

Slow-reacting substance of anaphylaxis Rationale: Mast cell stabilizers work at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis. Epinephrine is not affected by mast cell stabilizers. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins.

Why are inhaled steroids used to treat asthma and COPD? They act locally to decrease release of inflammatory mediators They act locally to improve mobilization of edema They act locally to increase histamine release They act locally to decrease histamine release

They act locally to decrease release of inflammatory mediators Rationale: When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of beta-adrenergic receptor activity, that may promote smooth muscle relaxation and inhibit bronchoconstriction.