INTRO TO CLINICAL PHARM: Chapter 07: Drugs for Allergy and Respiratory Problems

A patient with allergies has been prescribed an antihistamine. Which response by the patient demonstrates understanding of the action of antihistamine drugs? a. "Antihistamines act by increasing the production of acetylcholine" b. Antihistamines act by blocking histamine receptors in tissues" c. "Antihistamines act by increasing dilation of blood vessels" d. "Antihistamines act by blocking the release of histamine"

"Antihistamines act by blocking histamine receptors in tissues" *Antihistamines do not block the release of histamine, but rather, block histamine receptors in target tissues which in turn limit the blood vessel vasodilation, capillary leak, swelling, and bronchoconstriction.

The nurse is educating a patient about adverse reactions to antitussive drug. Which statement is most important to include? A. "Monitor your blood pressure closely since you have a history of hypertension." B. "You may feel restless and unable to sleep if you take the drug at night." C. "You should plan to take drug to prevent diarrhea while on the antitussive." D. "Be aware of dizziness that may develop when you stand up suddenly."

"Be aware of dizziness that may develop when you stand up suddenly." *Dizziness when changing positions resulting from postural hypotension is an adverse reaction common with use of antitussives. Exacerbation of hypertension, restlessness and insomnia, and diarrhea are adverse reactions common with use of antihistamines.

The nurse is giving instructions to a patient about antihistamine use. Which statement indicates a need for further instruction? A. "I can still take my over-the-counter sleep aid if needed." B. "I cannot take this meds for more than 2 weeks." C. "I should not take any opioid pain meds while I am taking this med." D. "I will be careful driving because I could get drowsy."

"I can still take my over-the-counter sleep aid if needed." *Warn patients that many over-the-counter sleep aids contain first-generation antihistamines and taking these with an antihistamine could lead to overdose. Warn patients to not take these drugs with sedatives, opioids, anticholinergic drugs, or drugs that cause CNS depression because the CNS side effects will be more severe. Warn patients to take these drugs for two weeks or less to avoid tolerance and long-term side effects. Warn patients to not drive or operate hazardous equipment because these drugs usually cause drowsiness.

Which statement made by the patient demonstrates understanding of the use of oral mucolytics? a. "I will not use a humidifier while taking this drug." b. "This drug will stop me from coughing." c. "I will drink at least 2 quarts of water while taking this drug." d. "This drug will cause my urine to change color."

"I will drink at least 2 quarts of water while taking this drug." *Patient instructions should include the use of a humidifier and instruct the patient to drink at least 2 quarts of water daily while taking a mucolytic unless there is a medical reason for fluid restriction. These actions will help get the mucus out.

You are teaching a patient with newly diagnosed asthma about using the prescribed drugs to manage acute asthma symptoms. Which of the following statements made by the patient would indicate your teaching was effective? a. "I will keep my short-acting bronchodilating inhaler with me at all times." b. "I will take my cromolyn sodium 5 min after asthma symptoms begin." c. "I will take montelukast (Singulair) at the first sign of an asthma attack." d. "I will take my decongestant and corticosteroid nasal spray each day."

"I will keep my short-acting bronchodilating inhaler with me at all times." *Teach patients with asthma to always have their short-acting beta2-adrenergic agonists (SABAs) reliever drug with them at all times because an attack can occur anywhere and only a SABA can work fast enough to prevent a severe attack and death.

The LPN is giving instructions to a patient who has been prescribed a beclomethasone inhaler. Which statement indicates a need for further instruction? A. "I will rinse my mouth after I use my inhaler." B. "I will use my inhaler when I have an acute asthmatic attack." C. "I will use my inhaler just like I was shown." D. "I will call my healthcare provider if I notice white patches or redness in my mouth."

"I will use my inhaler when I have an acute asthmatic attack." *Warn patients that inhaled corticosteroids are not be used to treat an acute asthma attack because they are not bronchodilators. Teach patients to use these drugs daily as prescribed even when no symptoms are present because they are long-term controller drugs. Instruct patients to rinse their mouths after each use to minimize fungal infection of the mouth from immunosuppressive effects. Advise patients to notify their healthcare professional if white patches in mouth or throat, or soreness and redness in mouth or throat appear because these are indications of infection. Teach patients how to properly use the MDI and DPI inhalers because improper use reduces drug effectiveness.

What information should be included in the teaching plan for a patient who is prescribed an antitussive agent? a. "This drug can cause drowsiness." b. "This drug can be taken for long periods of time." c. "This drug contains codeine, but is not habit forming." d. "Do not give this drug to adults, as this drug is for children's use only."

"This drug can cause drowsiness." *Side effects of antitussives include drowsiness and dizziness. Antitussives should be used only for short periods of time because they can be addictive. They are prescribed for adults.

You are teaching an older adult patient about the antihistamine that was prescribed for the treatment of allergies. Which instructions would be appropriate to include? (Select all that apply.) a. Antihistamines can cause drowsiness. b. Avoid alcohol while taking antihistamines. c. Drink additional fluids when taking antihistamines. d. Antihistamines can lower blood pressure in older patients. e. Take antihistamines around the clock to stabilize drug blood levels. f. Older patients can develop memory problems when using antihistamines.

1. Antihistamines can cause drowsiness. 2. Avoid alcohol while taking antihistamines. 3. Drink additional fluids when taking antihistamines. 4. Older patients can develop memory problems when using antihistamines. *Most antihistamines cause drowsiness, so additional sedatives and alcohol should be avoided. If not contraindicated, additional fluids counteract the dryness of mucus membranes experienced with antihistamines. These drugs should only be taken when needed, and can raise the blood pressure in older adults. Older adults can develop memory problems due to antihistamine use.

Cholinergic anatagonists (select all that apply) A. Are orally inhaled controller drugs B. Relax the muscles around the airways C. Allow more of the body's own adrenalin to activate beta 2 receptors D. May cause constipation

1. Are orally inhaled controller drugs 2. Relax the muscles around the airways 3. Allow more of the body's own adrenalin to activate beta 2 receptors

Which responses are possible side effects of inhaled beta2 adrenergic agonists? (Select all that apply.) a. Bad taste in the mouth b. Increased salivation c. Difficulty sleeping d. Rapid heart rate e. Hypotension f. Diarrhea

1. Bad taste in the mouth 2. Difficulty sleeping 3. Rapid heart rate *Beta2 adrenergic agonists have actions similar to the sympathetic division of the autonomic nervous system. When these drugs are used heavily, they can have systemic effects, which include rapid heart rate, increased blood pressure, a feeling of nervousness, and difficulty sleeping. The inhaled drugs can dry the mouth and throat and also may leave a bad taste in the mouth. These drugs, even when absorbed systemically, do not cause diarrhea.

Antihistamines (select all that apply) A. Could cause blindness B. Increase airflow through the bronchial tubes C. Reduce symptoms of sneezing, itching, and runny nose D. Could cause increased blood pressure E. Could cause slight nosebleed F. Drowsiness is an expected side effect

1. Could cause blindness 2. Reduce symptoms of sneezing, itching, and runny nose 3. Could cause increased blood pressure 4. Drowsiness is an expected side effect

Which drugs are contraindications with administration of xanthine derivatives? (Select all that apply.) A. Anticoagulant therapy B. Diuretics C. Digitalis glycosides D. Vitamins

1. Diuretics 2. Digitalis glycosides *Drug interactions may occur with MAO (monoamine oxidase) inhibitors, tricyclic antidepressants, beta blockers (beta-adrenergic antagonists), other antihypertensive agents, digoxin, potassium-losing diuretics, and caffeine-containing herbs. The combination of two or more of these agents may produce an additive effect.

Which manifestations may be the result of an adverse reaction to antihistamines? (Select all that apply.) A. Hypertension B. Bradycardia C. Dizziness D. Binge eating E. Nervousness F. Hyperreflexia G. Rectal bleeding

1. Hypertension 2. Dizziness 3. Nervousness 4. Hyperreflexia *Most adverse effects are related to severe anticholinergic symptoms, such as cardiac dysrhythmias or dangerously high blood pressure. A rising intraocular pressure (pressure inside the eye) in patients with glaucoma can worsen the disease and could cause blindness. Symptoms of overdosage include nervousness, anxiety, fear, agitation, restlessness, weakness, irritability, talkativeness, and insomnia. These symptoms may progress to dizziness, light-headedness, tremor, and hyperreflexia, with progression to confusion, delirium, hallucinations, and euphoria.

Leukotriene inhibitors (select all that apply) A. Block histamines to prevent inflammation B. Decrease the thickness of respiratory secretions and aid in their removal C. Long-term use could lead to liver dysfunction D. Used to reduce symptoms of allergies and asthma

1. Long-term use could lead to liver dysfunction 2. Used to reduce symptoms of allergies and asthma

Which side effects are expected when taking a narcotic antitussive drug? (Select all that apply.) A. Drug tolerance B. Nausea C. Addiction D. Lightheadedness E. Constipation

1. Nausea 2. Lightheadedness 3. Constipation *Expected side effects when taking a narcotic antitussive drug include nausea, lightheadedness, and constipation. Drug tolerance is not an expected side effect but an effect of taking a drug for a certain length of time. Narcotic antitussive drugs should not be taken for a long period. Addiction is not an expected side effect.

Cromolyn is effective in which situations? (Select all that apply.) a. Prophylaxis for asthma b. Management of allergies c. Prophylaxis for pneumonia d. Management of allergic rhinitis e. Management of postexercise bronchospasm f. Management of an acute exacerbation of asthma

1. Prophylaxis for asthma 2. Management of allergies 3. Management of allergic rhinitis 4. Management of postexercise bronchospasm *Cromolyn is effective for asthma prophylaxis; in patients with food allergies to prevent GI reactions; in patients with allergic rhinitis; and in asthma patients with postexercise bronchospasm. This drug should not be used to manage acute attacks of asthma, or pneumonia.

Decongestants (select all that apply) A. Reduce the swelling of nasal passages B. Used to relieve or suppress coughing C. Overuse can cause insomnia D. Can be used daily for extended periods of time

1. Reduce the swelling of nasal passages 2. Overuse can cause insomnia

Short-Acting beta2-adrenergic agonists (SABAs) (select all that apply) A. Relax smooth muscles almost immediately B. Effects wear off quickly C. Common side effects include depression D. May cause tremors

1. Relax smooth muscles almost immediately 2. Effects wear off quickly 3. May cause tremors

Antitussives (select all that apply) A. Relieve or suppress coughing B. Can work by peripherally anesthetizing stretch receptors in the respiratory tract C. Capsules that are not swallowed whole can anesthetize the throat D. Prevent mast and white blood cells from releasing mediators of inflammation

1. Relieve or suppress coughing 2. Can work by peripherally anesthetizing stretch receptors in the respiratory tract 3. Capsules that are not swallowed whole can anesthetize the throat

Which side effects should you monitor for after a patient receives ipratropium (Atrovent)? (Select all that apply.) a. Eye pain b. Sore throat c. Stuffy nose d. Constipation e. Decreased heart rate f. Increased urine output

1. Sore throat 2. Stuffy nose 3. Constipation *Ipratropium (Atrovent) is a cholinergic antagonist drug. Cholinergic antagonists are associated with sore throat, stuffy nose and constipation. Patients should be educated to expect these common side-effects.

Long acting beta2 adrenergic agonists (select all that apply) A. May cause rising intraocular pressure B. Taken daily to prevent bronchospasms C. Are orally inhaled and bind to beta2-adrenergic receptors D. Dry mouth and bad taste are common side effects

1. Taken daily to prevent bronchospasms 2. Are orally inhaled and bind to beta2-adrenergic receptors 3. Dry mouth and bad taste are common side effects

Which drugs are most effective for an acute asthma attack? (Select all that apply.) A. beclomethasone (QVAR) B. albuterol (Ventolin) C. salmeterol (Servent) D. levalbuterol (Xopenex) E. Pirbuterol (Maxair) F. Cromolyn sodium (Intal)

1. albuterol (Ventolin) 2. levalbuterol (Xopenex) 3. Pirbuterol (Maxair

Which drugs are considered long-acting beta agonists (LABAS)? (Select all that apply.) A. arformoterol (Brovana) B. cromolyn Sodium (Intal) C. formoterol (Foradil, Oxeze, Performomist) D. levalbuterol (Xopenex) E. salmeterol (Servent) F. Aabuterol (Ventolin)

1. arformoterol (Brovana) 2. formoterol (Foradil, Oxeze, Performomist) 3. salmeterol (Servent)

Which symptoms can be expected when using a cholinergic antagonist like Tiotropium (Spiriva)? (Select all that apply.) A. constipation B. dry mouth C. diarrhea D. watery eyes E. dry eyes

1. constipation 2. dry mouth 3. dry eyes

Which of the following patients is most at risk for overdose from the oral mucolytic drug guaifenesin? a. A 38-year-old patient who had surgery 4 days ago b. A 60-year-old with a history of COPD c. An adolescent with a history of asthma d. A 1-year-old child with a cold and cough

A 1-year-old child with a cold and cough *Because of cases of overdosage, the FDA recommends that these products not be given to children under 2 years old and some products not to children under 6 years old.

Which patient would not be an appropriate candidate to be treated with antihistamine drugs? A. A 45-year-old female with a history of overactive cough B. A 58-year-old male with a history of COPD C. A 35-year-female with a history of postural hypotension D. A 72-year-old male with a history of mental confusion

A 72-year-old male with a history of mental confusion *The 72-year-old male with mental confusion should not be treated with an antihistamine since confusion is an adverse effect of antihistamines. A 45-year-old female with a history of overactive cough would be a candidate for an antitussive. The 58-year-old male with COPD and the 35-year-old female with postural hypotension should not be given antitussives.

Which drug can be used as an asthmatic rescue agent? A. Albuterol B. Beclomethasone C. Guaifenesin D. Salmeterol

Albuterol *Albuterol is a short-acting beta agonist which is used as an asthmatic rescue agent. Beclomethasone is an inhaled corticosteroid which reduces bronchial inflammation. Guaifenesin is a mucolytic which reduces the stickiness of respiratory secretions. Salmeterol is a long-acting beta agonist which does smooth bronchial tissue over time.

A patient with asthma is struggling to breathe and displays wheezes and pursed-lip breathing. Which drug should be given immediately? A. Cromolyn sodium (Cromolyn) B. Nedocromil sodium C. Albuterol (Proventil) D. Salmeterol (Serevent)

Albuterol (Proventil) *Albuterol is a sympathomimetic drug that relaxes smooth muscle cells of the bronchi by stimulating beta2-adrenergic receptors. Albuterol also stimulates alpha receptors producing a vasoconstriction response throughout the body that contracts the blood vessels in the bronchial mucosa. Albuterol is used during an acute asthmatic attack. Cromolyn sodium, a mast cell stabilizer, helps slow the destruction of sensitized mast cells in patients with asthma. This drug has no antihistaminic, anti-inflammatory, or bronchodilator activity and is therefore not used for an acute attack. Nedocromil sodium, a mast cell stabilizer, is used for asthma management. This drug has no antihistaminic, anti-inflammatory, or bronchodilator activity and is therefore not used for an acute attack. Salmeterol is a long-acting beta agonist used to prevent asthmatic attacks. It is not used during an acute attack.

The LPN is planning a discharge teaching session for a patient who has received treatment with cromolyn. Which information is most important to include? A. Always plan to give the cromolyn before giving a bronchodilator. B. Always rinse the mouth and gargle after using the nebulizer. C. Always take the drug, even if you feel that you are having an asthma attack. D. Prime the inhalation canister by pressing it three times before the first use.

Always rinse the mouth and gargle after using the nebulizer. *Patients must rinse the mouth and gargle after using the nebulizer to minimize dry mouth or throat, throat irritation, and hoarseness. The bronchodilator should be given first, then the cromolyn. The drug should not be taken if the patient feels that he is having an asthma attack. Priming the inhalation canister by pressing three times is an intervention that applies to nedocromil.

Which patient would not be a candidate for a leukotriene inhibitor as part of the treatment plan for mild asthma? a. An adult patient with a history of liver disease b. An older patient with cognitive impairment c. An adolescent with allergic rhinitis d. A patient with depression

An adult patient with a history of liver disease *Liver dysfunction is possible with long-term use. The leukotriene inhibitors interact with drugs that stimulate liver metabolism such as phenytoin, phenobarbital, and carbamazepine, and rifampin.

A patient with a history of congestive heart failure has been prescribed furosemide and theophylline, a xanthine-derivative bronchodilator. The nurse is aware that if taken together, these drugs can cause which interaction? A. Central nervous system stimulation B. An antagonized effect of the xanthine derivative C. An increase in the serum level of theophylline D. Insomnia

An increase in the serum level of theophylline *Furosemide given in conjunction with theophylline increases the serum levels of theophylline and may cause toxicity. Central nervous system stimulation is an adverse reaction caused by xanthine derivatives. Beta-blocking agents may antagonize the effect of xanthine. Insomnia is an adverse reaction associated with xanthine derivatives.

How do nonopioid antitussives reduce the cough reflex? A. Anesthetizing stretch receptors in respiratory passages, lungs, and pleura B. Acting directly on the cough center in the medulla of the brain C. Thinning the secretions to promote ciliary action D. Relaxing the muscles around the airway

Anesthetizing stretch receptors in respiratory passages, lungs, and pleura

Which drug classification can cause the rebound effect? A. Antihistamines B. Antitussives C. Bronchodilators D. Mucolytics

Antihistamines *Antihistamines especially nasal agents can cause a rebound effect or increase in symptoms. Antitussives are used to stop or decrease coughing. Bronchodilators are used to dilate the bronchi. Mucolytics are used to liquify mucoid secretions.

Which statement would be true in teaching a patient with hypertension about taking antihistamines? a. Antihistamines need to be taken 2 h apart. b. Antihistamines can cause the blood pressure to rise. c. Antihistamines can cause a slowing of the pulse rate. d. Antihistamines must be taken at the same time as antihypertensives.

Antihistamines can cause the blood pressure to rise *A rise in blood pressure is an adverse action of antihistamines.

When assessing patients before giving antihistamines, what specific information should you obtain? A. Determine whether the patient is actually allergic to the substance B. Examine tge patient's ears and throat to determine how badly they are affected from the allergic reaction C. Ask whether the patient has objections due to religious reasons for taking any kind of drug D. Ask whether the patient suffers from thyroid disease of migraine headaches

Ask whether the patient suffers from thyroid disease of migraine headaches

Drug therapy for both asthma and COPD includes two types of agents. One agent is an anti-inflammatory. What is the other type of agent required for treatment? A. Bronchodilating B. Sympathomimetic C. Corticosteroid D. Mast cell stabilizer

Bronchodilating

How can an individual procure first generation antihistamines? A. With a prescription from an allergy specialist B. Can be purchased over-the-counter C. Are available over the internet from Canada or India D. These drugs are no longer produced

Can be purchased over-the-counter

A patient received an albuterol (Ventolin) small volume nebulizer treatment 15 min ago. Which symptom warrants a call to the provider? A. Increase in heart rate from 72 to 90 B. Increase in oxygen saturation from 88% to 94% C. An increase in hand tremors D. Chest discomfort

Chest discomfort

What symptom should you alert a patient taking a codeine-based antitussive to be aware of? a. Diarrhea b. Insomnia c. Paresthesia d. Constipation

Constipation *Codeine-containing antitussives may cause severe constipation.

An adolescent with a history of asthma needs a drug to prevent exercise-induced asthma while playing high school sports. Which drug would be appropriate for this use? a. Cromolyn sodium b. Theochron c. Sus-Phrine d. Proventil

Cromolyn sodium *Cromolyn sodium is used for prophylaxis in treating asthma. It works by slowing down the destruction of sensitized mast cells and inhaled specific antigens.

Which statement regarding the action of decongestants is true? a. Decongestants act by decreasing inflammation within the respiratory tract. b. Decongestants must be used cautiously as they can induce asthma attacks. c. Decongestants act primarily to reduce symptoms associated with allergy. d. Decongestants act by reducing the immune response of lymphocytes.

Decongestants act primarily to reduce symptoms associated with allergy. *Decongestants are a class of drugs that are used to control the symptoms associated with allergy. They have no anti-inflammatory action.

Mucolytics A. Shrink swollen nasal membranes B. May cause fungal infections in the nose or throat C. Prevent bronchoconstriction in asthma D. Decrease the thickness of respiratory secretions and aids in their removal

Decrease the thickness of respiratory secretions and aids in their removal

The nurse is preparing to teach a patient who has been prescribed nasal steroids for seasonal allergies. Which information is most important to include in the teaching plan? A. Do not exceed the prescribed dosage and frequency so that the drug is not absorbed into the general circulation. B. Do not use this drug if you develop an infection. C. Do not use this drug if you experience temporary dryness and irritation of the nose. D. When stopping this drug, tapering is not necessary.

Do not use this drug if you develop an infection. *Patients should not use nasal steroids if they have an infection because it can depress the immune system. Patients should notify a healthcare provider if an infection develops while taking this drug. Patients should be informed to use this drug as prescribed and not increase the frequency because the drug may be absorbed into the general circulation. Temporary dryness and irritation of the nose are common side effects that should resolve. When stopping this drug, the dosage must be tapered slowly and not suddenly stopped especially if the drug has been used for long periods.

What is a common side effect of inhaled anti-inflammatory drugs for asthma? a. Anemia b. Bronchoconstriction c. Cutaneous itching d. Dry mouth

Dry mouth *Anti-inflammatory drugs reduce inflammation and dry all mucous membranes including those in the mouth and throat. They would reduce any cutaneous (skin) itching. They do not work on bronchial smooth muscles or the bone marrow (which produces red blood cells).

When should leukotriene inhibitors NOT be given? A. If the patient is having an acute asthma attack B. When the patient is not having an acute asthma attack C. If a paitent has never had asthma D. If adults with asthma weigh over 100 pounds

If the patient is having an acute asthma attack

Which antibody is produced in response to an allergen? A. IgE B. IgG C. IgA D. IgM

IgE

An older adult patient with glaucoma reports taking an antihistamine for allergy symptoms. What adverse effect of antihistamines would you alert this patient about? a. Ototoxicity b. Ocular "floaters" c. Excessive tearing d. Increased intraocular pressure

Increased intraocular pressure *A rising intraocular pressure (pressure inside the eye) in patients with glaucoma can worsen the disease and could cause blindness.

How do mucolytic drugs decrease the thickness of respiratory secretions? A. Enabling patients to cough up large quantities of thick mucus B. Increasing the amount of fluid in the respiratory tract C. Increasing the size of nasal passages to allow for more productive cough D. Enabling patients to drain sinuses more efficiently

Increasing the amount of fluid in the respiratory tract

Why do patients with asthma usually require more than one type of drug to manage the symptoms? A. Many drugs become ineffective after long term usage B. Inflammation narrows airways from the inside, and bronchoconstriction narrows airways from the outside C. Asthma attacks are initiated by allergens, and multiple drugs are necessary to focus on specific allergic reactions D. Asthma has multiple symptoms (e.g., shortness of breathm wheezing, cough)

Inflammation narrows airways from the inside, and bronchoconstriction narrows airways from the outside

What is the most common route used to deliver short-acting beta-adrenergic agonists? a. Oral b. Intravenous c. Transdermal d. Inhalation

Inhalation *Short-acting beta-adrenergic agonists work directly on the airways. They are delivered by oral inhalation so that their effects are exerted almost exclusively on the airway tissues.

A patient presents at an outpatient clinic complaining of frequent episodes of sneezing. The LPN recognizes that which drug would be the most appropriate choice for the patient's symptoms? A. Promethazine (Phenergan) B. Loratadine (Claritin) C. Diphenhydramine (Benadryl) D. Hydroxyzine (Atarax)

Loratadine (Claritin) *The student is experiencing symptoms of seasonal rhinitis. She should avoid sedative drugs if possible. Loratadine is an over-the-counter drug with a low incidence of side effects. Promethazine would be contraindicated. This drug requires a healthcare provider's order and has strong central nervous system side effects. Diphenhydramine can be purchased over the counter but has sedating effects. Hydroxyzine is used for pruritus, analgesia, and sedation. This drug would not be appropriate for the patient's symptoms and requires a healthcare provider's prescription.

What is the function of sympathomimetic drugs? A. Mimic stimulation of sympathetic nervous system and shrink blood vessels so the nose can drain more efficiently B. Block the body's adrenalin to reduce inflammation in the nasal passages C. Slow the production of histamine and leukotriene D. Reduce discomfort of skin allergies

Mimic stimulation of sympathetic nervous system and shrink blood vessels so the nose can drain more efficiently

Which type of asthma problem is helped most directly by anti-inflammatory drugs? a. Thick mucus b. Mucosal swelling c. Bronchoconstriction d. Large, flabby alveoli

Mucosal swelling *Anti-inflammatory drugs reduce inflammation and do not help bronchoconstriction. They directly inhibit mucosal swelling and, thus indirectly, reduce mucosal production of mucus. They do not affect mucous that has already formed. Flabby alveoli are not caused by inflammation.

Which of the following conditions does NOT prohibit use of oral sympathomimetic drugs? A. High blood pressure B. HIV C. Sinus infection D. Nasal inflammation

Nasal inflammation

The nurse is caring for a newly admitted patient who has an order for a bronchodilator. The patient has a history of an irregular heartbeat, and her home drugs include digitalis and an antidepressant. What action should the nurse take first? A. Notify the healthcare provider of the information. B. Document the drugs and conditions. C. Monitor the patient's vital signs closely. D. Instruct the patient to notify his healthcare provider.

Notify the healthcare provider of the information. *Use of digitalis and antidepressants are contraindications to use of a bronchodilator. Although documentation of information and vital sign assessments are important, the healthcare provider should be notified first so that drugs may be adjusted. The nurse should speak with the healthcare provider, not the patient.

A patient asks the nurse why he must use the bronchodilator inhaler before his corticosteroid inhaler. What is the nurse's best response? A. There is no risk of an allergic reaction occurring if the bronchodilator is used first. B. If the bronchodilator is not given first a fungal infection of the mouth is likely to occur. C. Opening up the bronchioles with the bronchodilator first helps the corticosteroid inhaler be more effective. D. The side effects of the bronchodilator are reduced if it is given first.

Opening up the bronchioles with the bronchodilator first helps the corticosteroid inhaler be more effective.

How do cromones reduce symptoms of patients with allergies or asthma? A. Block leukotriene response B. Activate mast cells that control the immune system C. Prevent mast cells from opening D. Prevent allergic responses to dander

Prevent mast cells from opening

Minutes after receiving a dose of Albuterol (Proventil) for the first time, the patient complains that "my heart is pounding, and I think I'm having a heart attack." Which response is most appropriate? A. Call for medical assistance and supplies. B. Page the attending healthcare provider immediately. C. Initiate the cardiopulmonary resuscitation protocol. D. Reassure the patient and continue to assess.

Reassure the patient and continue to assess. *Adverse reactions to sympathetic bronchodilators include dysrhythmias, hypotension, increased heart rate, anxiety, anorexia, headache, insomnia, nausea, pallor, perspiration, polyuria, restlessness, vomiting, weakness, urinary hesitancy, and urinary retention. These reactions are frightening to patients and teaching is essential when the drug is given. Even though the symptoms the patient is experiencing are common with this drug, the nurse should always continue to assess. The nurse does not require medical assistance or supplies at this point in time. Continuing to manage this patient's care is within the realm of nursing. Continued reassurance of the patient and assessment are warranted. The patient does not require initiation of the cardiopulmonary resuscitation protocol.

There are two types of histamines, H1 and H2, Antihistamines that block H1 receptors limit bronchoconstriction. What do antihistmaines block when focused on H2 receptors? A. Skin irritation B. Lymph nodes C. Stomach acid production D. Nasal passage swelling

Stomach acid production

The LPN is caring for a patient who is receiving an expectorant. Which drug effect should the nurse expect? A. The patient's mucus is likely to be liquefied before receiving the drug. B. The patient's mucus is likely to be blood-tinged after receiving the drug. C. The patient's mucus is likely to be thick in consistency before receiving the drug. D. The patient's mucus is likely to be green in color before receiving the drug.

The patient's mucus is likely to be thick in consistency before receiving the drug. *Expectorants are given for mucus that is thick in consistency. Mucus will be liquefied after receiving the drug. Expectorants do not cause mucus to be blood-tinged or green in color.

Why are xanthine agents seldom used to treat asthma now? a. They increase bronchial secretions at the same time that they induce bronchial dilation. b. They have no role in preventing bronchoconstriction or inflammation. c. They are all given intravenously. d. They have severe systemic side effects.

They have severe systemic side effects. *The xanthines are powerful systemic drugs that have a narrow therapeutic range. They have many dangerous and systemic side effects, especially for the cardiovascular and neurologic systems.

Which statement accurately describes how expectorants work? A. They increase the amount of fluid in the respiratory tract. B. They decrease the movement of the ciliary body in the respiratory tract. C. They decrease the amount of sputum produced by the respiratory tract. D. They increase the amount of coughing by the patient.

They increase the amount of fluid in the respiratory tract. *Expectorants are agents that thin respiratory secretions and aid in their removal. They are believed to work by increasing the amount of fluid in the respiratory tract. Increased liquid secretions prompt ciliary action, cause an increase in the amount of sputum produced, and cause a decrease in the amount of patient coughing.

Why are long-acting beta-adrenergic agonists not useful during an actual acute asthma attack? a. They are likely to cause allergies. b. They need time to build up an effect. c. They take too long to be absorbed by the intestinal tract. d. They reduce inflammation rather than relax bronchial smooth muscle.

They need time to build up an effect. *Long-acting beta2-adrenergic agonists (LABAs) work in the same way as SABAs but need time to build up an effect. Therefore LABAs are used to prevent an asthma attack because their effects last longer but have no value during an acute attack.

Why should guafenesin (Mucinex) be given with a full glass of water? A. To prevent the side effect of nausea and vomiting. B. To assist in liquefying secretions. C. To prevent the side effect of constipation. D. To prevent increased stomach acid from causing an ulcer.

To assist in liquefying secretions.

Allergic reactions usually occur at the point of contact with the allergen. If the skin reacts to an allergen and becomes red and/or swollen, what is one common method of drug administration that can be used to lessen the reaction? A. Nasal spray B. Lung inhalation C. Topical cream D. Suppository

Topical cream

According to the Food and Drug Administration (FDA), mucolytic drugs should not be given to which of the following patients? A. Immunocompromised patients B. Elderly patients C. Young children D. Pregnant of breast-feeding women

Young children

The LPN is designing a teaching plan for a patient who has been placed on zafirlukast. Which information should the nurse include in the teaching plan? A. Zafirlukast may cause pink-tinged saliva. B. Zafirlukast should be taken on an empty stomach. C. Zafirlukast is a xanthine bronchodilator. D. Zafirlukast should only be given with grapefruit juice.

Zafirlukast should be taken on an empty stomach. *Zafirlukast is an oral tablet that should be stored at 68 to 77 degrees Fahrenheit and protected from light and moisture. Teach patients to take zafirlukast one hour before or 2 h after a meal because the drug is best absorbed on an empty stomach. It does not have to be taken with grapefruit juice. Zafirlukast should not cause pink-tinged saliva. Zafirlukast is a leukotriene receptor inhibitor.

Which antihistamine should be used only when necessary in the geriatric population? A. levocetirizine (Xyzal) B. diphenhydramine (Benedryl) C. fexofenadine (Allegra) D. loratadine (Claritin)

diphenhydramine (Benedryl)

Which of the following are considered harmless substances that can cause allergic reactions to people who are overly sensitive to them? A. Sand and dirt B. Dust mites C. Concrete parking lots D. Iron fences

dust mites

Which drug mimics the effect of the sympathetic nervous system? A. fluticasone furoate (Flonase Sensimist) B. nedocromil sodium (Tildade) C. phenylephrine (Sudafed PE) D. Ipratropium (Atrovent)

phenylephrine (Sudafed PE)