Pharm - Chapter 37 - Respiratory Drugs

Which medication should be administered to a patient who has an acute asthmatic attack? 1 Albuterol 2 Fluticasone 3 Ipratropium 4 Montelukast

1 Albuterol Beta-adrenergic agonists are used to treat acute asthma attacks. Therefore albuterol should be administered to a patient who has an acute asthmatic attack. Fluticasone, ipratropium, and montelukast are drugs used to treat chronic asthma.

Which are the adverse effects of ipratropium and tiotropium therapy? Select all that apply. 1 Headache 2 Dry mouth 3 Nasal congestion 4 Increased urinary frequency 5 Decreased intraocular pressure

1 Headache 2 Dry mouth 3 Nasal congestion Ipratropium and tiotropium are the anticholinergic drugs that relieve bronchial spasms. The most common adverse effects of ipratropium and tiotropium therapy are anticholinergic effects like headache, dry mouth, nasal congestion, urinary retention, and increased intraocular pressure. Increased urinary frequency and decreased intraocular pressure are not adverse effects of ipratropium and tiotropium therapy.

A patient is prescribed albuterol. The nurse is explaining the most common route of administration of albuterol to the patient. Which route would the nurse discuss? 1 Inhalation 2 Intravenous 3 Subcutaneous 4 Intramuscular

1 Inhalation The most preferred route of administration of albuterol is inhalation. Oral routes also are sometimes used. Intravenous, subcutaneous, and intramuscular routes are not suitable for administering albuterol.

While investigating the cause of sudden death in a patient with asthma, the nurse finds that the patient's medications were changed from systemic corticosteroids to inhaled corticosteroids. Which intervention, if followed, might have saved the patient from dying? 1 Tapering the dose of systemic corticosteroid 2 Providing an initial high dose of inhaled corticosteroid 3 Administering the same dose of systemic corticosteroid 4 Reducing the dose frequency of the inhaled corticosteroid

1 Tapering the dose of systemic corticosteroid When a patient's medications are suddenly switched from systemic corticosteroids to an inhaled corticosteroid, adrenal suppression takes place. This leads to adrenal failure, which can be fatal. Death can be prevented by gradually reducing the dose of systemic corticosteroids because this prevents the withdrawal symptoms. An initial high-loading dose of inhaled corticosteroids may cause localized irritation and other adverse effects. However, the initial loading dose is usually preferred for the systemic administration of medications. By continuing the administration of same dose of systemic corticosteroids, the patient would have severe adverse effects from the synergistic effects of systemic and inhaled corticosteroids. Gradual reduction of dosage frequency may not help, because an initially large amount of drug might have been accumulated in the body and would have caused an adverse reaction in the patient.

The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. Which intervention would the nurse implement? 1 Teach the child to use a spacer. 2 Tell the parent to hold the inhaler for the child. 3 Ask the health care provider to switch to oral medications. 4 Tell the parent that young children should not use inhalers.

1 Teach the child to use a spacer. If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.

Which interaction can occur when an asthmatic patient consumes rifampin along with xanthine derivatives? 1 Theophylline levels are decreased. 2 Theophylline metabolism is decreased. 3 Additive cardiac stimulation is produced. 4 Additive central nervous system stimulation is produced.

1 Theophylline levels are decreased. Xanthine derivatives are used as bronchodilators in asthmatic patients. Administration of rifampin along with xanthine derivatives causes increased metabolism of theophylline, which results in decreased levels of theophylline. Additive cardiac and central nervous system stimulation is produced when caffeine is administered along with theophylline.

The nurse is assessing a patient with asthma. Which symptoms would the nurse expect to find in the patient? Select all that apply. 1 Wheezing 2 Rhinorrhea 3 Chest tightness 4 Shortness of breath 5 Conjunctival swelling

1 Wheezing 3 Chest tightness 4 Shortness of breath Asthma refers to recurrent and reversible shortness of breath resulting from narrowing of the bronchi and bronchioles. Wheezing, chest tightness, and shortness of breath are symptoms of asthma. Rhinorrhea (excess nasal secretion) and conjunctival swelling are symptoms of hay fever. Rhinorrhea and conjunctival swelling are not associated with asthma.

Which medication given for asthma can suppress bone growth in children? 1 A beta agonist 2 A corticosteroid 3 An anticholinergic 4 A xanthine derivative

2 A corticosteroid Corticosteroids have antiinflammatory effects and are used for the treatment of asthma. Administration of corticosteroids may lead to bone growth suppression in children and adolescents. Beta agonists, anticholinergics, and xanthine derivatives do not affect bone growth. Therefore bone growth suppression is not observed when beta agonists, anticholinergics, or xanthine derivatives are administered.

A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." Which is the nurse's highest priority action? 1 Calling a code 2 Administering a beta2-adrenergic agonist 3 Administering a long-acting glucocorticoid 4 Asking the patient to describe the symptoms

2 Administering a beta2-adrenergic agonist In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense. A beta2-adrenergic agonist will provide immediate relief, whereas a glucocorticoid will not; there is no need to call a code. Asking the patient to describe the symptoms is not the highest priority action.

A patient receiving inhaled ipratropium therapy visits the clinic for a follow-up. Which complaint would the nurse anticipate from the patient? 1 Insomnia 2 Dry mouth 3 Anginal pain 4 Vascular headache

2 Dry mouth The most commonly reported adverse effects of ipratropium therapy are caused by the anticholinergic effects of the drug and include dry mouth or throat, nasal congestion, heart palpitations, gastrointestinal distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety. Insomnia, anginal pain, and vascular headache are the adverse effects of alpha-adrenergic agonists.

Which condition is characterized by enlargement of air spaces caused by the destruction of the alveolar walls? 1 Rhinitis 2 Emphysema 3 Bronchial asthma 4 Chronic bronchitis

2 Emphysema In emphysema, the air spaces enlarge because of the destruction of the alveolar walls as a result of the effect of proteolytic enzymes released from leukocytes in response to alveolar inflammation. Therefore the alveolar walls are partially destroyed, and the surface area available for oxygen and carbon dioxide exchange is reduced. This leads to impaired oxygenation. Rhinitis is irritation and inflammation of the mucous membrane inside the nose. Bronchial asthma is a recurrent and reversible shortness of breath resulting from narrowing of the bronchi and bronchioles. Chronic bronchitis is a continuous inflammation and low-grade infection of the bronchi.

A patient has taken metaproterenol. Which is the nurse's priority action? 1 Monitoring for sedation 2 Monitoring for heart rate (100 beats/min) 3 Telling the patient not to drive for 2 hours 4 Assessing for decreased blood glucose levels

2 Monitoring for heart rate (100 beats/min) The beta1 properties of this drug can cause increased heart rate and palpitations. The drug should not cause sedation or hypoglycemia. It is not necessary to tell the patient not to drive for 2 hours.

A patient is prescribed tiotropium for the treatment of chronic obstructive pulmonary disease (COPD). How can the absorption of tiotropium be improved? 1 By taking a higher dose of tiotropium for inhalation 2 By inhaling the tiotropium continuously for some time 3 By waiting for 1 to 2 minutes before inhaling the second dose 4 By avoiding rinsing the mouth with water after inhaling the medicine

3 By waiting for 1 to 2 minutes before inhaling the second dose The nurse would instruct the patient to wait for 1 to 2 minutes before inhaling the second dose of tiotropium to allow for maximal lung penetration. This helps to increase the absorption of tiotropium. The nurse instructs the patient not to take a higher dose of tiotropium for inhalation because this will result in severe adverse effects. The patient should not inhale the tiotropium continuously for some time because this increases the concentration of the drug in the body and causes adverse effects. Tiotropium is an anticholinergic drug and therefore reduces secretions and causes mucosal irritation and dryness of the mouth. Therefore the patient should rinse the mouth with water immediately after using tiotropium to prevent mucosal irritation and dryness of the mouth.

A patient taking an oral theophylline drug is due for the next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 beats/min. The patient is irritable. Which is the nurse's best action? 1 Administer oxygen at 2 L per minute via nasal cannula. 2 Continue to monitor the patient and give the medication. 3 Hold the next dose of theophylline and assess the patient. 4 Call the health care provider to request an increased dose.

3 Hold the next dose of theophylline and assess the patient. The patient is displaying possible adverse reactions to theophylline such as tachycardia and irritability, and the blood level should be assessed before another dose of the medication is given. These symptoms may also be related to hypoxia. The nurse would assess for hypoxia before administering oxygen. The nurse would hold the medication and evaluate the cause for these symptoms. Until the serum theophylline level is known, an increased dose is not indicated.

Which antiasthmatic, available only for oral use, is approved for use in children 2 years of age and older? 1 Albuterol 2 Terbutaline 3 Montelukast 4 Systemic corticosteroid

3 Montelukast Montelukast is a leukotriene receptor antagonist that is approved for use in adults and children 2 years of age and older. It is available only for oral use. Albuterol and terbutaline are available in oral and inhalation forms. Systemic corticosteroids are not approved for children.

Which statement about glucocorticoids is accurate? 1 They decrease serum sodium and glucose concentrations. 2 They stimulate defense mechanisms to produce immunity. 3 They influence carbohydrate, lipid, and protein metabolism. 4 They are produced in decreased amounts during times of stress.

3 They influence carbohydrate, lipid, and protein metabolism. Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They increase sodium and glucose concentrations, suppress the immune system, and are produced in increasing amounts during stress.

The nurse is teaching a patient who has asthma about the frequency of inhalation of salmeterol. Which statement by the patient indicates effective learning? 1 "I will inhale it once a day upon waking." 2 "I will inhale it once a day before bedtime." 3 "I will inhale it twice a day at my convenience." 4 "I will inhale it twice a day approximately 12 hours apart."

4 "I will inhale it twice a day approximately 12 hours apart." The action of salmeterol starts in a patient with asthma within 30 to 48 minutes after inhalation; the peak effect occurs in 3 to 4 hours, and the duration of action is 12 hours. Thus the bronchodilator inhalation dose for adults and children older than 12 years is one puff twice daily, morning and evening, approximately 12 hours apart. The drug will not exhibit the correct therapeutic effect if used once a day or at the convenience of the patient.

The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? 1 A patient who is 16 years old 2 A patient with a history of emphysema 3 A patient with a history of type 2 diabetes 4 A patient with atrial fibrillation with a rate of 100 beats/min

4 A patient with atrial fibrillation with a rate of 100 beats/min The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. A patient with atrial fibrillation and a rate of 100 beats/min therefore should not receive epinephrine. There is no contraindication for giving epinephrine to adolescents or to patients with a history of emphysema or type 2 diabetes.

The care provider prescribes albuterol and beclomethasone inhalers for a patient. Which is the nurse's best action? 1 Administer each inhaler at 30-minute intervals. 2 Question the prescription; two inhalers should not be given at one time. 3 Administer beclomethasone, wait 2 minutes, and then administer albuterol. 4 Administer the albuterol, wait 5 minutes, and then administer beclomethasone.

4 Administer the albuterol, wait 5 minutes, and then administer beclomethasone. Administering the bronchodilator albuterol first allows the beclomethasone to reach deeper into the lungs as the bronchioles dilate. Corticosteroids such as beclomethasone do not cause dilation and are therefore given last. They are not given at 30-minute intervals. There is no need to change this prescription. The bronchodilator albuterol should be given first, then after 5 minutes, the beclomethasone may be administered.

The nurse observes that a patient has moon face, acne, an increase in fat pads, and swelling. After checking the patient history, the nurse finds that the patient is taking methylprednisolone for bronchospastic disorder. Which condition will the nurse infer from the assessment? 1 The patient has thyrotoxicosis. 2 The patient has hypothyroidism. 3 The patient is in Addisonian crisis. 4 The patient has Cushing's syndrome.

4 The patient has Cushing's syndrome. Methylprednisolone is a systemic corticosteroid. Sometimes excess levels of systemic corticosteroids may lead to Cushing's syndrome. Moon face, acne, an increase in fat pads, and swelling are symptoms of Cushing's syndrome. Corticosteroids do not interact with thyroid activity. Therefore the symptoms would not indicate that the patient has thyrotoxicosis or hypothyroidism. If a systemic corticosteroid is abruptly discontinued, Addisonian crisis may occur. Nausea, shortness of breath, joint pain, weakness, and fatigue are symptoms of Addisonian crisis.

A patient is prescribed inhaled corticosteroids. Why does the nurse ask the patient to rinse the mouth after each dose? 1 To relieve the patient's dry mouth 2 To minimize the chance of nasal congestion 3 To reduce the risk of sore throat and infection 4 To prevent the development of oral candidiasis

4 To prevent the development of oral candidiasis It is recommended that patients rinse their mouth immediately after use of the inhaler or nebulizer dosage forms of corticosteroids. It helps to prevent overgrowth of oral fungi and subsequent development of oral candidiasis (thrush). Dry mouth, nasal congestion, and sore throat are not side effects of corticosteroid inhaler use.