NCLEX PN: Respiratory questions 7th edition

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. The nurse determines that the client needs further teaching about the medication if the client makes which statement? 1."I will take the daily dose at bedtime." 2."I will drink at least 2 L of fluid per day." 3."I will avoid over-the-counter (OTC) cough and cold medications unless approved by the PHCP." 4."I will avoid changing brands of the medication without primary health care provider (PHCP) approval."

1."I will take the daily dose at bedtime." Rationale:The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the PHCP before changing brands of the medication. The client also checks with the PHCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects increasing the side effects of theophylline and causing dysrhythmias.

Levalbuterol via inhalation is prescribed for a client with a diagnosis of emphysema. The nurse reinforces instructions to the client regarding the medication and teaches the client about the dietary restrictions that must be implemented while taking this medication. The nurse determines that the client understands the dietary instructions when the client states he will avoid which food choice? 1.Cocoa 2.Bananas 3.Orange juice 4.Baked potatoes

1.Cocoa Rationale:Levalbuterol is a bronchodilator. This medication stimulates the beta receptors in the lungs, relaxes bronchial smooth muscle, increases vital capacity, and decreases airway resistance. Central nervous system (CNS) stimulation can occur with the use of this medication. The client is instructed to avoid caffeine-containing products such as coffee, tea, colas, and chocolate because these products can cause further CNS stimulation. Options 2, 3, and 4 are food items that are high in potassium.

A client is receiving acetylcysteine, 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for a possible adverse event after giving this medication?' 1.Ambu bag 2.Intubation tray 3.Nasogastric tube 4.Suction equipment

4.Suction equipment Rationale:Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

The nurse is monitoring a client who is receiving a dose of an adrenergic bronchodilator. The nurse plans to monitor for which side effect of this medication? 1.Drowsiness 2.Hypokalemia 3.Hyperglycemia 4.Increased pulse and blood pressure

4.Increased pulse and blood pressure Rationale:Side effects of an adrenergic bronchodilator can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. Options 1, 2, and 3 are not side effects.

A client has a prescription to take guaifenesin every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client makes which statement? 1."I will watch for irritability as a side effect." 2."I will take the tablet with a full glass of water." 3."I will take an extra dose if the cough is accompanied by fever." 4."I will crush the sustained-release tablet if immediate relief is needed."

"I will take the tablet with a full glass of water." Rationale: Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness. The client should contact the PHCP if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

A primary health care provider has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse reinforces instructions given to the client about the medication and tells the client to monitor for which side effect? 1.Constipation 2.Increased urination 3.Difficulty coughing 4.Difficulty swallowing

1.Constipation Rationale:A frequent side effect of codeine sulfate is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Options 3 and 4 are unrelated to the administration of this medication.

The nurse is checking a client who is taking theophylline for possible toxicity. Which signs and symptoms indicate theophylline toxicity? Select all that apply. 1.Flushing 2.Insomnia 3.Headache 4.Decreased wheezing 5.Nausea and vomiting 6.Serum theophylline level of 22 mcg/mL

1.Flushing 2.Insomnia 3.Headache 5.Nausea and vomiting 6.Serum theophylline level of 22 mcg/mL Rationale:The normal therapeutic range for theophylline levels is 5 to 15 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 22 mcg/mL places the client near the top of the therapeutic range. Theophylline relaxes the bronchial smooth muscle and causes bronchial dilation. Therapeutic response includes decreased dyspnea and clear lung fields bilaterally. Symptoms of toxicity include insomnia, flushing, nausea, vomiting, headache, tinnitus, delirium, seizures, tachycardia, cardiac arrhythmias, and blood pressure changes.

The nurse has a prescription to give a client albuterol (two puffs) and beclomethasone dipropionate (two puffs) by metered-dose inhaler. How much time should the nurse place between administering the albuterol and then the beclomethasone dipropionate? 1. 1 minute 2. 2 minutes 3. 5 minutes 4. Administer immediately

3. 5 minutes Rationale:Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Albuterol acts in 5 to 10 minutes and lasts for 3 to 4 hours. Since the medications are at the same time waiting 5 minutes allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

A client has been taking benzonatate as prescribed. The nurse determines that the medication is having the intended effect if the client experiences which response? 1.Decreased anxiety level 2.Increased comfort level 3.Reduction in nausea and vomiting 4.Decreased frequency and intensity of cough

4.Decreased frequency and intensity of cough Rationale:Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex. Options 1, 2, and 3 are not associated with the effects of this medication.

A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which medication first? 1.A β2-agonist 2.Oral corticosteroids 3.A leukotriene modifier 4.A nonsteroidal anti-inflammatory

1.A β2-agonist Rationale:In treating an acute asthma attack, a short-acting β2-agonist such as albuterol will be given to produce bronchodilation. Options 2, 3, and 4 are long-term control (preventive) medications.

A hospitalized client with allergic asthma has been started on cromolyn sodium inhaler. The nurse assists in preparing a plan of care and includes monitoring for undesirable side effects associated with the use of this medication. The nurse places the highest priority on monitoring for which side effect? 1.Cough 2.Bronchospasm 3.Throat irritation 4.Nasal congestio

2.Bronchospasm Rationale:The most common undesired clinical responses associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

A client is taking brompheniramine. The nurse reinforces instructions to the client to expect which side effect of this medication? 1.Diarrhea 2.Excitability 3.Drowsiness 4.Excess salivation

3.Drowsiness Rationale:This medication is an antihistamine, and frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating. The other options are incorrect.

A client has begun therapy with theophylline. The nurse tells the client to limit the intake of which while taking this medication? 1.Oranges and pineapple 2.Coffee, cola, and chocolate 3.Oysters, lobster, and shrimp 4.Cottage cheese, cream cheese, and dairy creamers

2.Coffee, cola, and chocolate Rationale:Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

A client is taking cetirizine hydrochloride. The nurse should check for which side effect of this medication? 1.Diarrhea 2.Excitability 3.Drowsiness 4.Excess salivation

3.Drowsiness Rationale:A frequent side effect of cetirizine hydrochloride, an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

The nurse has observed a client self-administer a dose of metaproterenol sulfate via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. Which interpretation should the nurse make of this occurrence? 1.Bronchospasm, which must be reported to the primary health care provider 2.Insufficient dosage of the medication, which needs to be increased 3.Probable interaction of this medication with an over-the-counter cold remedy 4.Tolerance to the medication indicating a need for a stronger type of bronchodilator

1.Bronchospasm, which must be reported to the primary health care provider Rationale:The client taking a bronchodilator may experience bronchospasm, which is evident by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld, and the primary health care provider should be notified. Options 2, 3, and 4 are incorrect interpretations.

The nurse has just been given a prescription to administer albuterol to a client. The nurse evaluates the effectiveness of the medication by checking which parameters before and during therapy? 1.Nausea and vomiting 2.Dyspnea and lung sounds 3.Headache and level of consciousness 4.Urine output and blood urea nitrogen

2.Dyspnea and lung sounds Rationale:Albuterol is an adrenergic bronchodilator. The nurse monitors respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The color, character, and amount of sputum also are noted. The medication is not given to affect the parameters listed in any of the other options.

A licensed practical nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. Which action should the nurse take? 1.Tell the RN that a stronger medication is needed. 2.Report the client's symptoms to the registered nurse (RN). 3.Tell the client to administer a second dose of the medication. 4.Ask the client about any over-the-counter medications taken recently.

2.Report the client's symptoms to the registered nurse (RN). Rationale:The client taking an adrenergic bronchodilator may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. If this occurs, further medication should be withheld, and the RN immediately notified.

A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse should check the client for which sign/symptom? 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

3. Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

The nurse is reviewing the medication profile of a client taking theophylline. Which medications can increase the risk of theophylline toxicity? Select all that apply. 1.Rifampin 2.Phenytoin 3.Cimetidine 4.Corticosteroids 5.Fluoroquinolones

3.Cimetidine 4.Corticosteroids 5.Fluoroquinolones Rationale:Theophylline has many medication interactions. Medications that increase the risk of theophylline toxicity include cimetidine, nonselective é-blockers, erythromycin, clarithromycin, oral contraceptives, corticosteroids, interferons, fluoroquinolones, disulfiram, mexiletine, fluvoxaMINE, high doses of allopurinol, influenza vaccines, interferon, and benzodiazepines. Medications that decrease the effectiveness of theophylline include nicotine products, adrenergics, barbiturates, phenytoin, ketoconazole, and rifampin.

The nurse is giving discharge instructions to the client concerning theophylline. Which client statement indicates a need for further teaching? 1."I need to learn how to take my pulse." 2."I will start a smoking cessation program." 3."I will take my pill in the morning at breakfast." 4."I need to drink plenty of fluids, so I will drink more coffee and tea."

4."I need to drink plenty of fluids, so I will drink more coffee and tea." Rationale:Theophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. The client needs to take the pulse since toxicity will increase the pulse. Smoking decreases drug blood levels and terminal half-life so the dosage may have to be changed. Theophylline should be with food or milk to decrease any GI effects. It should not be taken before bedtime because it may keep the client awake. The client should increase fluids to 2 L/day to decrease secretion viscosity; however, the client should not drink alcohol or caffeine products (tea, coffee, chocolate, colas).

Albuterol, two puffs and fluticasone propionate, two puffs by metered-dose inhaler have been prescribed for a client with chronic obstructive pulmonary disease. The nurse caring for the client provides instructions regarding administration of the medication. Which statement by the client indicates an understanding of how to take these medications? 1."I will alternate a single puff of each, beginning with the albuterol." 2."I will alternate a single puff of each, beginning with the fluticasone propionate." 3."I will take the two puffs of the fluticasone propionate first and then the two puffs of the albuterol." 4."I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate."

4."I will take the two puffs of the albuterol first and then the two puffs of the fluticasone propionate." Rationale:Albuterol is an adrenergic type of bronchodilator. Fluticasone propionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective. Options 1, 2, and 3 are incorrect.

The nurse is collecting data on a client admitted to the hospital with a diagnosis of a respiratory infection unresponsive to oral antibiotics. The nurse discovers that the client has a history of bronchial asthma and has been taking zafirlukast. The nurse assists in developing a plan of care for the client and suggests monitoring of which data? 1.Gastric pH 2.Platelet counts 3.Urinary output 4.Liver function tests

4.Liver function tests Rationale:Zafirlukast is a leukotriene receptor antagonist that is used in the prophylaxis and chronic treatment of bronchial asthma. It is used with caution in clients with impaired hepatic function. Liver function laboratory values should be obtained as a baseline and should be monitored during administration of the medication. Options 1, 2, and 3 are not specifically related to the use of this medication.

A registered nurse has administered a dose of naloxone intravenously to a client with intravenous opioid overdose. The licensed practical nurse assigned to assist in monitoring the client ensures that which equipment is available in the immediate vicinity of the client? 1.Nasogastric tube 2.Thoracentesis tray 3.Central line insertion kit 4.Resuscitation equipment

4.Resuscitation equipment Rationale:Naloxone is used to treat respiratory depression. The client who receives naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other items that may be needed include oxygen, a mechanical ventilator, and medications such as vasopressors.

A client has a new prescription to take guaifenesin every 4 hours as needed. Which medication instructions should the nurse reinforce? 1.Be aware of irritability as a side effect. 2.Take the tablet with a full glass of water. 3.Take an extra dose if the cough is accompanied by fever. 4.Crush the sustained-release tablet if immediate relief is needed.

2.Take the tablet with a full glass of water. Rationale:Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

A newborn infant receives naloxone hydrochloride to reverse opiate-induced respiratory depression that occurred following labor and delivery. For which reason would the nurse continue to monitor the respiratory status of a newborn infant following the administration of this medication? 1.The effects of naloxone are long lasting. 2.The use of naloxone in newborn infants is toxic. 3.The newborn infant may have an underlying respiratory disorder. 4.The newborn infant may demonstrate a reappearance of respiratory depression.

4.The newborn infant may demonstrate a reappearance of respiratory depression. Rationale:Naloxone is a short-term opiate antagonist. It reverses the respiratory depression that can be exhibited in newborn infants whose mothers have been treated with opiates for the pain of labor and delivery. Because it is short acting and the newborn's liver is immature, respiratory depression may recur after the duration of effects of naloxone.