Exam III: Respiratory Disorders

The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time? A. 15 minutes prior to exercising B. One hour before exercise C. Immediately on beginning to exercise D. In the morning of the day when exercise is planned

A. 15 minutes prior to exercising Rationale: Albuterol for exercise induced bronchospasm should be administered 15 minutes prior to exercising.

A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon? A. Antitussives suppress coughing while expectorants loosen bronchial secretions. B. Both drug types loosen bronchial secretions for ease of removal. C. Antitussives liquefy bronchial secretions while expectorants assist in the expectoration of those secretions. D. Antitussives kill cold viruses while expectorants liquefy bronchial secretions.

A. Antitussives suppress coughing while expectorants loosen bronchial secretions. Rationale: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

A client with chronic bronchial asthma is to take montelukast (Singulair). What will the nurse instruct the client to avoid taking? A. Aspirin B. Penicillin C. Sertraline (Zoloft) D. Nifedipine (Procardia)

A. Aspirin Rationale: The nurse would instruct the client to avoid aspirin, which might cause an increased montelukast level and toxicity.

A nurse is preparing a presentation for a local elementary school parent group about over-the-counter cold medications and their use in children. Which would be most appropriate to include? (Select all that apply.) A. Avoidance of use in children under age 2 B. Importance of reading the label for ingredients and dosage C. Need to follow the directions for how often to give the drug D. Using household measuring devices for dosage measurements E. Using adult formulation with smaller doses

A. Avoidance of use in children under age 2; B. Importance of reading the label for ingredients and dosage; C. Need to follow the directions for how often to give the drug Rationale: OTC cough and cold preparations should not be used in children under the age of 4 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.

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? A. Coffee B. Alcohol C. Salt D. Vitamin C

A. Coffee Rationale: The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol.

A patient's history reveals a genetic disorder involving the exocrine glands of the respiratory, gastrointestinal, and reproductive tracts. The nurse identifies this as most likely: A. Cystic fibrosis B. Asthma C. Respiratory distress syndrome D. Pneumonia

A. Cystic fibrosis Rationale: Cystic fibrosis is a hereditary disorder of the exocrine glands of the GI, respiratory, and reproductive tracts that results in the accumulation of copious thick secretions in the lungs.

A 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan? A. Dextromethorphan works in the medulla to suppress the cough reflex. B. Dextromethorphan works on the receptors in the throat to prevent a cough. C. Dextromethorphan works by inhibiting allergen response. D. Dextromethorphan works by relaxing the smooth muscles in the bronchioles.

A. Dextromethorphan works in the medulla to suppress the cough reflex. Rationale: Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.

The nurse is caring for a client with pneumonia. The nurse would expect to see which symptoms? Select all that apply. A. Difficulty breathing B. Urinary retention C. Rash D. Fever E. Oxygen saturation of 88%

A. Difficulty breathing; D. Fever; E. Oxygen saturation of 88% Rationale: Symptoms of clients with pneumonia include fever, difficulty breathing, fatigue, noisy breath sounds, and poor oxygenation.

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.) A. Exercise B. Allergens C. Pollutants D. Warm weather

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

After teaching a group of students about leukotriene receptor antagonists, the instructor determines a need for additional teaching when the students identify which agent as an example? A. Fluticasone B. Montelukast C. Zileuton D. Zafirkulast

A. Fluticasone Rationale: Fluticasone is an inhaled steroid.

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? A. Guaifenesin B. Acetylcysteine C. Dextromethorphan D. Benzonatate

A. Guaifenesin Rationale: Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.

A client has been using guaifenesin for a cough that accompanied a common cold. The client calls the nurse help line and states that she thinks she is having an adverse reaction to the medication. The nurse knows that which symptoms are adverse effects of this medication? Select all that apply. A. Nausea B. Rash C. Constipation D. Bleeding E. Headache

A. Nausea; B. Rash; E. Headache Rationale: Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash. Constipation and bleeding are not adverse effects of guaifenesin.

When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply. A. Suck on sugarless hard candy. B. Administer intravenous fluid bolus. C. Offer ice chips. D. Take frequent sips of water. E. Use a dehumidifier in the home.

A. Suck on sugarless hard candy; C. Offer ice chips; D. Take frequent sips of water. Rationale: Offering the client frequent sips of water or ice chips, and suggesting use of sugarless gum or candy are appropriate suggestions to relieve dry mouth. An intravenous fluid bolus is invasive and not a first-line suggestion to relieve dryness. The client should run a humidifier, not a dehumidifier, to add moisture to the air at home and help relieve dryness.

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

A. 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.

Expectorants elicit their effect by which mechanism? A. Thinning respiratory secretions B. Breaking down thick mucus in the lower lungs C. Depressing the cough center in the brain D. Anesthetizing stretch receptors in the respiratory passages

A. Thinning respiratory secretions Rationale: Thinning respiratory secretions is the mechanism of action for expectorants. Breaking down thick mucus in the lower lungs is the mechanism of action of mucolytics. Depressing the cough center in the brain is the mechanism of action for centrally acting antitussives. Anesthetizing stretch receptors in the respiratory passages is the mechanism of action for peripherally acting antitussives.

A client is being assessed by the home care nurse on the appropriate use of her metered-dose inhalers. Instructions concerning which intervention will assist a client in the proper administration of the metered-dose inhaler? A. using a spacer B. administrating corticosteroid first C. pushing fluids D. exhaling immediately after administration

A. using a spacer Rationale: The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI).

The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching? A. "I should take a deep breath, hold it while I administer the medication, and then exhale." B. "I need to shake the inhaler well before taking the medication." C. "I need to take three short, quick breaths to inhale the medication." D. "I need to wait at least 30 minutes after the first inhalation before taking a second."

B. "I need to shake the inhaler well before taking the medication." Rationale: Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.

Which client is most likely to benefit from the administration of a nasal steroid. A. A client with an acute sinus infection. B. A client who has chronic allergic rhinitis C. A client who is recovering from a tonsillectomy D. A client who has a deviated nasal septum

B. A client who has chronic allergic rhinitis Rationale: Because nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections. The most common reason they are prescribed is for the treatment of allergic rhinitis or to relieve inflammation after the removal of nasal polyps.

A patient is taking low-dose corticosteroids on a long-term basis for COPD. What does prolonged use of corticosteroids put the patient at risk for? A. Adrenal storm B. Adrenal atrophy C. Stunted growth D. Hypothalamic insufficiency

B. Adrenal atrophy Rationale: Prolonged use of corticosteroids suppresses the normal hypothalamic-pituitary axis and leads to adrenal atrophy from lack of stimulation.

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? A. Flunisolide first, wait five minutes and then follow with albuterol B. Albuterol first, wait five minutes and then follow with flunisolide C. Flunisolide followed immediately by albuterol D. Albuterol followed immediately by flunisolide

B. Albuterol first, wait five minutes and then follow with flunisolide Rationale: Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.

The nursing instructor is discussing cystic fibrosis with his clinical group. What would the instructor cite as the hallmark pathology of CF? A. Alveolar mucous plugging, infection, and eventual bronchiectasis B. Bronchial mucous plugging, inflammation, and tissue damage C. Atelectasis, infection, and eventual COPD D. Bronchial mucous plugging, infection, and eventual COPD

B. Bronchial mucous plugging, inflammation, and tissue damage Rationale: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue.

Carbon dioxide combines with which cell types for elimination from the body? A. Leukocytes B. Erythrocytes C. Macrophages D. Platelets

B. Erythrocytes Rationale: Oxygen combines with hemoglobin in red blood cells (erythrocytes) for transport to body cells. Carbon dioxide combines with hemoglobin in the cells for return to the lungs and elimination from the body.

Which cholinergic-blocking drugs are used in the treatment of chronic obstructive pulmonary disease (COPD)? (Select all that apply.) A. Darifenacin (Enablex) B. Ipratropium (Atrovent) C. Benztropine (Cogentin) D. Biperiden (Akineton) E. Tiotropium (Spiriva)

B. Ipratropium (Atrovent); E. Tiotropium (Spiriva) Rationale: Ipratropium (Atrovent) and tiotropium (Spiriva) are inhaled cholinergic-blocking drugs used in the treatment of chronic obstructive pulmonary disease (COPD).

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? A. Fatigue B. Nervousness C. Bradycardia D. Hypotension

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

Asthma is characterized by which clinical manifestations? (Select all that apply.) A. Thick sputum B. Reversible bronchospasm C. Inflammation D. Hyperactive airways E. Destruction of lung tissue

B. Reversible bronchospasm; C. Inflammation; D. Hyperactive airways Rationale: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. Triggers for the hyperactivity are allergens, non-allergic inhaled irritants, or factors such as exercise or emotions.

What action by the client would indicate that the client is obtaining maximum benefit from their inhaler? A. The client inhales as soon as the inhaler enters the mouth. B. The client holds breath for several seconds after releasing the medication. C. The client administers 3 doses of medication within a 1-minute time frame. D. The client exhales as soon as the client compresses the inhaler.

B. The client holds breath for several seconds after releasing the medication. Rationale: Holding the breath prevents exhalation of medication still remaining in the mouth.

Which of the following should a patient be advised to do to lessen the likelihood of developing oral thrush with the use of an inhaled corticosteroid or mast cell aerosol? Select all that apply: A. Avoid eating after administration. B. Use strict oral hygiene. C. Cleanse inhaler per package instructions. D. Use proper technique when administering dose. E. Only administer a dose every other day.

B. Use strict oral hygiene; C. Cleanse inhaler per package instructions; D. Use proper technique when administering dose. Rationale: To decrease the likelihood of developing oral thrush, a client should use strict oral hygiene, cleanse inhaler as directed in the package instructions, and use proper technique when administering a dose.

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 A. permanent liver damage. B. rebound bronchoconstriction. C. community-acquired pneumonia. D. severe anticholinergic effects.

B. rebound bronchoconstriction. Rationale: Patients who self-administer albuterol may use their MDIs more frequently than recommended. This practice can result in rebound bronchoconstriction, which may motivate the patient to increase MDI use, stimulating the cycle of rebound congestion.

A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to: A. keep an extra oxygen tank on hand for propelling the medication. B. sit in a fully upright position when administering the medication. C. take the exact number of puffs that have been prescribed. D. gargle with an alcohol-based mouthwash after each dose.

B. sit in a fully upright position when administering the medication. Rationale: Clients should sit in the Fowler's position when inhaling nebulized medications.

The nurse is preparing to administer 80 mg of Solu-medrol intravenously (IV) to a client with pneumonia. The vial states that it has 120 mg per 2 mL. The nurse would correctly draw up which amount? A. 0.3 mL B. 0.6 mL C. 1.3 mL D. 1.6 mL

C. 1.3 mL Rationale: The ordered amount is 80 mg and is supplied in 120mg/2 mL. In order to calculate you can divide what is needed (80mg) by what you have (120 mg) times the concentration of 2 mL. The nurse would administer 1.3 mL of Solu-medrol to the client.

A patient with a history of chronic cough is suspected of having pulmonary tuberculosis. Which vaccination is used to prevent the condition? A. MMR vaccine B. DPT vaccine C. BCG vaccine D. IPV vaccine

C. BCG vaccine Rationale: For the prevention of pulmonary tuberculosis (TB) in high-risk populations such as health care workers, infants, and children in endemic areas, a BCG vaccination is given. The MMR vaccine is used for preventing measles, mumps, and rubella. The DPT vaccine is used for the prevention of diphtheria, pertussis, and tetanus. IPV is an inactivated polio virus used to prevent polio.

A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the health care provider prescribe? A. Ipratropium or budesonide B. Isoetharine or montelukast C. Cromolyn D. Aminophylline or caffeine

C. Cromolyn Rationale: Cromolyn is the only available mast cell stabilizer.

Second-generation antihistamines were developed to remove the sedation of first generation drugs. Which of the following antihistamines is a second-generation drug? A. Dexchlorpheniramine B. Chlorpheniramine C. Fexofenadine D. Diphenhydramine

C. Fexofenadine Rationale: Fexofenadine is a second-generation antihistamine.

The nurse caring for a client taking acetylcysteine is charged with the development of a nursing plan of care. What would be the most appropriate diagnosis for the client with regards to potential side effects of the medication? A. Alteration in sensation related to the drug effect of neuropathy B. Alteration in cardiac output related to drug effect or hypotension C. Ineffective airway clearance related to drug effect or bronchospasm D. Alteration in urinary elimination related to drug effect or urinary retention

C. Ineffective airway clearance related to drug effect or bronchospasm Rationale: Inhaled acetylcysteine may induce bronchospasm, bronchoconstriction, chest tightness, a burning feeling in the upper airway, and rhinorrhea. Some patients report stomatitis as well. Less common adverse effects are fever, chills, drowsiness, and clammy skin.

The nurse is teaching a group of clients with allergic rhinitis about the use of their medications. What would be the most essential information to give these clients about preventing possible drug interactions? A. OTC medications are safe to use. B. Use only one pharmacy so the pharmacist can check drug interactions for you. C. Read drug labels before taking OTC medications. D. Ask the pharmacy tech to assist you in selecting an OTC medication.

C. Read drug labels before taking OTC medications. Rationale: Teach clients to read the OTC labels to avoid inadvertent overdose.

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition? A. Drink ample water before taking the tablet. B. Take an antacid before the tablet. C. Take the tablet with food. D. Take the tablet one hour before food.

C. Take the tablet with food. Rationale: If the client has gastric irritation following ingestion of the antihistamine, the nurse should instruct the client to take the tablet with food and not before food. Taking an antacid before the tablet may reduce the absorption of the antihistamine. Drinking ample water before taking the tablet will not help to alleviate the patient's condition.

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

C. beta2-adrenergic agonist Rationale: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist.

The client reports cough, low-grade fever, anorexia, and night sweats. The client has also been coughing up blood at times. What disease does this client most likely have? A. pneumonia caused by influenza B. Kaposi sarcoma C. tuberculosis D. Pneumonitis interstitial infection

C. tuberculosis Rationale: Symptoms of active TB include night sweats, cough, low-grade fever, fatigue, weight loss, and anorexia.

A client, newly diagnosed with COPD, calls the clinic and asks the nurse why the client has to take the medication if their lungs don't work right. What would be an appropriate response by the nurse? A. "The medication that has been ordered for you is what the health care provider thinks will help you the most." B. "The medication that has been ordered for you is to help you breathe easier." C. "The medication that has been ordered for you is designed to work together to make it easier for you to breathe." D. "The medication that has been ordered for you is to help relieve the inflammation and promote dilation of the bronchi."

D. "The medication that has been ordered for you is to help relieve the inflammation and promote dilation of the bronchi." Rationale: Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation.

What statement by a 61-year-old client who is to take an antitussive with codeine indicates that the teaching has been effective? A. "I will take this medication anytime I start to cough." B. "This medication may make me anxious and nervous." C. "I should call the health care provider if I develop nausea, diarrhea, or stomach cramps while taking this medication." D. "This medication can cause drowsiness, so I will avoid driving while I use it."

D. "This medication can cause drowsiness, so I will avoid driving while I use it." Rationale: Codeine is a CNS depressant and should not be combined with driving or heavy machinery activities.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? A. Albuterol causes stimulation of the bronchial tissue. B. Albuterol blocks the stimulation of the beta-2 receptors. C. Albuterol decreases vital capacity. D. Albuterol causes relaxation of the bronchial smooth muscles.

D. Albuterol causes relaxation of the bronchial smooth muscles. Rationale: 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.

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is: A. Antihistamines are not used for this issue. B. Antihistamines are recommended for extended use, as long as you monitor for adverse effects. C. Antihistamines are not recommended for this issue; only antibiotics are useful. D. Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.

D. Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough. Rationale: Many cold remedies are over-the-counter formulations. Although antihistamines are popular over-the-counter drugs because they dry nasal secretions, they are not recommended because they can also dry lower respiratory secretions and worsen secretion retention and cough.

The nurse is caring for a client who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously? A. Liver failure B. Renal failure C. Respiratory failure D. Heart failure

D. Heart failure Rationale: Adrenergic drugs cause cardiac stimulation.

A 36-year-old client is prescribed inhaled corticosteroid (ICS) for daily use. Which adverse effects should the nurse closely monitor for in this client? A. Delayed growth B. Suppression of the hypothalamic-pituitary-adrenal axis C. Hypotension D. Oropharyngeal Candida albicans infection

D. Oropharyngeal Candida albicans infection Rationale: Dysphonia and oropharyngeal Candida albicans infections are common adverse effects associated with daily use of ICS.

A patient is prescribed an inhalational corticosteroid therapy along with bronchodilator therapy. Which of the following points should the nurse include in the patient teaching plan? A. Stop corticosteroid therapy immediately if you notice any adverse effects. B. Before each dose of corticosteroid, rinse the mouth thoroughly with water. C. The corticosteroid drug provides rapid relief during an asthma attack. D. Take the corticosteroid several minutes after the bronchodilator dose.

D. Take the corticosteroid several minutes after the bronchodilator dose. Rationale: The nurse should instruct the patient to take the corticosteroid several minutes after the bronchodilator dose. This helps in enhancing the application of the steroid into the bronchial tract.

A 25-year-old woman comes to the clinic because of a chronic, nonproductive cough. Assessment reveals that she has a history of asthma, and dextromethorphan (Robitussin) is prescribed for her. The nurse will question this order because A. serotonin syndrome may result. B. persistent coughing may develop. C. respiratory secretions may be thickened. D. secretions may be retained.

D. secretions may be retained. Rationale: Dextromethorphan is contraindicated in patients with asthma. If coughing were to be suppressed, these patients may retain secretions, and this would exacerbate the disease.

Second generation antihistamines are associated with a higher risk of sedation than first generation antihistamines. True/False

False Rationale: The risk for sedation is higher with first generation antihistamines than with second generation antihistamines.

Leukotriene receptor antagonists are administered orally. True/False

True

Cromolyn should not be used during an acute asthmatic attack. True/False

True Rationale: Cromolyn is the only mast cell stabilizer still available and is available only in an OTC form. It is no longer considered part of the treatment standards because of the availability of more specific and safer drugs.

Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis. True/False

True Rationale: Mucolytics increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. Patients may be suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis.