Pharmacology CH. 53, 54, 55

What are the prevention and treatment measures for COPD?

-reduce environmental exposure to irritants -smoking cessation -filter allergens from the air -avoid exposure to known irritants and allergens -open the conducting airways through muscular bronchodilation -decrease the effects of inflammation on the airway lining

Diffusion of CO2 from the tissues into the capillary blood a. occurs if the tissue concentration of CO2 is greater than that in the blood. b. decreases as blood acidity increases. c. increases in the absence of carbonic anhydrase. d. is accompanied by a decrease in plasma bicarbonate.

A. Occurs if the tissue concentration of CO2 is greater than that in the blood.

A patient with COPD would be expected to have a. an acute viral infection of the respiratory tract. b. loss of protective respiratory mechanisms due to prolonged irritation or damage. c. localized swelling and inflammation within the lungs. d. inflammation or swelling of the sinus membranes over a prolonged period.

B. loss of protective respiratory mechanisms due to prolonged irritation or damage.

Which is most critical for respiration to occur? a. Low levels of oxygen b. Low levels of CO2 c. Functioning inspiratory muscles d. An actively functioning autonomic system

C. Functioning inspiratory muscles

The nurse emphasizes the need to take sinusitis seriously because a. it can cause a loss of sleep and exhaustion. b. it can lead to a painful otitis media. c. if it is left untreated, microorganisms can travel to brain tissue. d. drainage from infected sinus membranes often leads to pneumonia.

C. if it is left untreated, microorganisms can travel to brain tissue.

The type 2 cells of the walls of the alveoli function to a. replace mucus in the alveoli. b. produce serotonin. c. secrete surfactant. d. protect the lungs from bacterial invasion.

C. secrete surfactant

The barrel shaped chest is common with what respiratory disorder?

COPD

After teaching a community group about the common cold, the instructor determines that the teaching was successful when the group states which as the cause? a. Bacteria that grow best in the cold b. Allergens in the environment c. Irritation of the delicate mucous membrane d. A number of different viruses

D. A number of different viruses

A patient who coughs is experiencing a reflex caused by a. inflammation irritating the sinuses in the skull. b. irritants affecting receptor sites in the nasal cavity. c. pressure against the eustachian tube. d. irritation to receptors in the trachea and conducting airways.

D. irritation to receptors in the trachea and conducting airways.

True or False Inhaled steroids are used for emergency.

False: they are not used for emergency (they take 2-3 weeks to reach effective levels)

What is the only available expectorant?

Guaifenesin (Mucinex)

What is surfactant?

a lipoprotein that lowers the surface tension in the alveoli, allowing them to stay open to allow gas exchange

The pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present? (Select all that apply.) a. Increased secretions b. Mucosal congestion c. Cough d. Increased temperature

a, b, c

Common adverse effects associated with the use of topical nasal steroids would include which conditions? a. Local burning and stinging b. Dryness of the mucosa c. Headache d. Constipation and urinary retention e. Fungal infections f. Osteonecrosis

a, b, c, e

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. Using household measuring devices for dosage measurements d. Need to follow the directions for how often to give the drug e. Using adult formulation with smaller doses

a, b, d

Additional nursing interventions for clients receiving antihistamines would probably include which recommendations? a. Using a humidifier b. Advising the client to suck sugarless lozenges to help relieve the dry mouth c. Limiting fluid intake to decrease swelling d. Providing safety measures to prevent falls or injury e. Encouraging pushing fluids, if allowed f. Leaving bowls of water around the house to increase humidity

a, b, d, e, f

An antihistamine would be the drug of choice for treating which conditions? a. Itchy eyes b. Irritating cough c. Nasal congestion d. Runny nose e. Idiopathic urticaria f. Thick, tenacious secretions

a, c, d, e

A child with repeated asthma attacks may be treated with which drugs? a. A leukotriene receptor antagonist b. A beta-blocker c. An inhaled corticosteroid d. An inhaled beta-agonist e. A surfactant f. A mast cell stabilizer

a, c, d, f

What would a nurse expect to assess if a patient has inflammation of the upper respiratory tract (Select all that apply) a. A runny nose b. Laryngitis c. Sneezing d. Hypoxia e. Rales f. Wheezing

a. a runny nose b. laryngitis c. sneezing

A person with hypertension and known heart disease has frequent bronchospasms and asthma attacks that are most responsive to sympathomimetic drugs. This patient might be best treated with a. an inhaled sympathomimetic to decrease systemic effects. b. a xanthine. c. no sympathomimetics because they would be contraindicated. d. an anticholinergic.

a. an inhaled sympathomimetic to decrease systemic effects

With which condition are the bronchial epithelial cells replaced by a fibrous scar tissue? a. Bronchiectasis b. Pneumonia c. Bronchitis d. Asthma

a. bronchiectasis

Antihistamines should be used cautiously in patients with a. histories of arrhythmias or prolonged QT intervals. b. COPD or bronchitis. c. asthma or seasonal rhinitis. d. angioedema or low blood pressure.

a. histories of arrhythmias or prolonged QT intervals

Treatment of obstructive pulmonary disorders is aimed at a. opening the conducting airways or decreasing the effects of inflammation. b. blocking the autonomic reflexes that alter respirations. c. blocking the effects of the immune and inflammatory systems. d. altering the respiratory membrane to increase the flow of oxygen and carbon dioxide.

a. opening the conducting airways or decreasing the effects of inflammation

The nose performs which functions in the respiratory system? (Select all that apply) a. Serves as a passageway for air movement b. Warms and humidifies the air c. Cleanses the air using hair fibers d. Stimulates surfactant release from the alveoli e. Initiates the cough reflex f. Initiates the sneeze reflex

a. serves as a passageway for air movement b. warms and humidifies the air c. cleanses the air using hair fibers f. initiates the sneeze reflex

Sympathomimetics are used for what?

acute asthma attacks

What is a pneumothorax?

air in the pleural space exerting high pressure against the alveoli

Gas exchange occurs in the

alveoli

What selectively blocks the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response?

antihistamines

Clients who are using inhalers require careful teaching about which information? a. Avoiding food 1 hour before and 2 hours after dosing b. Storage of the drug c. Administration techniques to promote therapeutic effects and avoid adverse effects d. Lying flat for as long as 2 hours after dosing e. Timing of administration f. The difference between rescue treatment and prophylaxis

b, c, e, f

A nurse is teaching a 55-year-old client about fexofenadine prescribed to treat allergic symptoms. Which client statement suggests an understanding of this teaching? a. "It's safe to take this medication with the nighttime sinus medication that I've been using." b. "I should avoid driving after taking this medication." c. "Taking this medication shouldn't stop me from having my after-dinner drink." d. "This medication has no serious side effects."

b. "I should avoid driving after taking this medication."

A client with asthma has been prescribed an albuterol inhaler. What recommendation should the nurse include in client teaching? a. "Immediately stop using the inhaler if you experience hand shaking." b. "Stop smoking to reduce bronchoconstriction." c. "Take ibuprofen to decrease inflammation associated with the condition." d. "Limit exercise to one session per week."

b. "Stop smoking to reduce bronchoconstriction."

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

b. 15 mcg/mL

While providing a medication history, the client reports taking a nebulized drug to liquefy respiratory secretions but cannot recall the name. The nurse suspects the client is taking which medication? a. guaifenesin b. acetylcysteine c. prednisone d. pseudoephedrine

b. acetylcysteine

A patient with many adverse reactions to drugs is tried on an inhaled steroid for treatment of bronchospasm. For the first 3 days, the patient does not notice any improvement. You should a. switch the patient to a xanthine. b. encourage the patient to continue the drug for 2 to 3 weeks. c. switch the patient to a sympathomimetic. d. try the patient on surfactant.

b. encourage the patient to continue the drug for 2 to 3 weeks.

A client is diagnosed with chronic bronchiectasis. What assessment should the nurse provide regularly to monitor for a common complication of this disorder? a. Bronchospasms b. Fever c. Difficult expiration d. Difficult inspiration

b. fever

A patient taking a behind-the-counter cold medication and a behind-the-counter allergy medicine is found to be taking double doses of pseudoephedrine. As a result, the patient might exhibit a. ear pain and eye redness. b. restlessness and palpitations. c. sinus pressure and ear pain. d. an irritating cough and nasal drainage.

b. restlessness and palpitations

For gas exchange to occur in the lungs, oxygen must pass through which structures? (Select all that apply) a. The conducting airways b. The alveolar epithelium c. The pleural fluid d. The interstitial alveolar wall e. The capillary basement membrane f. The interstitial space

b. the alveolar epithelium, e. the capillary basement membrane f. the interstitial space

An adult client has reported experiencing a dry mouth and urinary retention after several nights of taking an over-the-counter (OTC) sleep aid. The nurse should suspect that this medication contains what antihistamine? a. Olopatadine b. Promethazine c. Diphenhydramine d. Loratadine

c. Diphenhydramine

An older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease. When administering the drug, what action should the nurse perform to reduce the client's risk for developing oral candidiasis? a. Have the client gargle with normal saline prior to administering the drug. b. Administer prophylactic antifungal medications. c. Have the resident rinse his or her mouth after each dose of the drug. d. Encourage the resident not to deeply inhale the medication.

c. Have the resident rinse his or her mouth after each dose of the drug.

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

c. They act locally to decrease release of inflammatory mediators

Which mechanism is involved in the movement of oxygen and carbon dioxide at the alveolar level? a. Facilitated diffusion b. Active transport c. Diffusion d. Osmosis

c. diffusion

The xanthines a. block the sympathetic nervous system. b. stimulate the sympathetic nervous system. c. directly affect the smooth muscles of the respiratory tract. d. act in the CNS to cause bronchodilation.

c. directly affect the smooth muscles of the respiratory tract.

Your patient has been maintained on theophylline for many years and has recently taken up smoking. The theophylline levels in this patient would be expected to a. rise because nicotine prevents the breakdown of theophylline. b. stay the same because smoking has no effect on theophylline. c. fall because substances in cigarettes stimulate liver metabolism of theophylline. d. rapidly reach toxic levels.

c. fall because substances in cigarettes stimulate liver metabolism of theophylline

Sympathetic stimulation of the respiratory system leads to what? a. decreased respiratory rate b. decreased depth of respirations c. increased respiratory rate d. increased perfusion of the lungs

c. increased respiratory rate

Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with a. postoperative patients. b. asthma patients. c. patients with a dry, irritating cough. d. COPD patients who tire easily.

c. patients with a dry, irritating cough

Respiratory distress syndrome occurs in a. babies with frequent colds. b. babies with genetic allergies. c. premature and low-birth-weight babies. d. babies stressed during the pregnancy.

c. premature and low-birth-weight babies.

A patient is not getting a response to the antihistamine that was prescribed. Appropriate action might include a. switching to a decongestant. b. stopping the drug and increasing fluids. c. trying a different antihistamine. d. switching to a corticosteroid

c. trying a different antihistamine

The bronchial tubes are composed of what three layers?

cartilage, muscle, and epithelial cells

What are some second generation antihistamines? ---these cause less side effects

cetirizine, fexofenadine, levocetirizine, and loratadine (doesn't cause drowsiness)

What is atelectasis?

collapse of once-expanded alveoli

Which neurological patient is most likely to have abnormalities in breathing regulation? a. A 23-year-old male who has an injury to his frontal lobe following a sports injury b. A 66-year-old male with temporal lobe infarcts secondary to a stroke c. A 45-year-old female with a spinal cord injury at C4 following a motor vehicle accident d. A 34-year-old male with damage to his pons and medulla oblongata following a blow to the back of the head

d. A 34-year-old male with damage to his pons and medulla oblongata following a blow to the back of the head

The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take? a. Withhold the scheduled dose of theophylline pending the next day's blood work results. b. Administer the scheduled dose of theophylline with as needed (PRN) dose of a bronchodilator. c. Inform the health care provider that an increase in the client's dose of theophylline may be necessary. d. Inform the health care provider that the client has toxic theophylline levels.

d. Inform the health care provider that the client has toxic theophylline levels.

A patient with sinus pressure and pain related to seasonal rhinitis would benefit from taking a. an antitussive. b. an expectorant. c. a mucolytic. d. a decongestant.

d. a decongestant

Leukotriene receptor antagonists act to block production of a component of slow-reacting substance of anaphylaxis. They are most beneficial in treating a. seasonal rhinitis. b. pneumonia. c. COPD. d. asthma.

d. asthma

When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage? a. Once-weekly dosing b. Absence of adverse effects c. Lower cost d. Decreased sedation

d. decreased sedation

Lung surfactants used therapeutically are a. injected into a developed muscle. b. instilled via a nasogastric tube. c. injected into the umbilical artery. d. instilled into an endotracheal tube properly placed in the baby's lungs.

d. instilled into an endotracheal tube properly placed in the baby's lungs.

Dornase alfa (Pulmozyme), because of its mechanism of action, is reserved for use in a. clearing secretions before diagnostic tests. b. facilitating the removal of secretions postoperatively. c. protecting the liver from acetaminophen toxicity. d. relieving the buildup of secretions in cystic fibrosis.

d. relieving the buildup of secretions in cystic fibrosis

Patients with seasonal rhinitis experience irritation and inflammation of the nasal passages and passages of the upper airways. Treatment for these patients might include a. systemic corticosteroids. b. mucolytic agents. c. an expectorant. d. topical nasal steroids

d. topical nasal steroids

What is a mast cell stabilizer?

drug that works at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis

What are sympathomimetics?

drugs that mimic the effects of the sympathetic nervous system

What are leukotriene receptor antagonists?

drugs that selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of slow-reacting substance of anaphylaxis

The sympathetic system is responsible for

fight or flight

Adverse effects associated with levels of theophylline; level of > 30-35

hyperglycemia, hypotension, cardiac arrhythmias, tachycardia, seizures, brain damage, death

Antitussives must be used in caution for people who are...

hypersensitive & have a history of narcotic addiction

The cough center is located where?

in the brain

What is Cheyne-Stokes respiration?

it is an abnormal rhythm of breathing with alternation periods of hyperventilation and apnea--may reflect delayed blood flow through the brain

What respiratory drug is to be used in an emergency?

lung surfactant

What is a bronchodilator?

medication that dilates the airways; helpful in symptomatic relief or prevention of bronchial asthma & bronchospasm associated with COPD

What are xanthines?

naturally occurring substances, including caffeine and theophylline, that have a direct effect on the smooth muscle of the resp. tract, both in the bronchi and in the blood vessels

Adverse effects associated with levels of theophylline; level of < or equal to 20-25

nausea, vomiting, diarrhea, insomnia, headache, irritability

If nasal medications such as nasal spray and nasal aerosol are over used what can happen?

rebound congestion (constant nasal stuffiness)

What is asthma?

recurrent & reversible episodes of bronchospasm

The parasympathetic system is responsible for

rest and digest

COPD patients have trouble with inspiration or expiration?

they have trouble with expiration- because air is trapped

What is cilia?

tiny hairlike structures of the upper respiratory tract, which are constantly moving & directing the mucus and any trapped substance toward the throat

Benzonatate, codeine, dextromethorphan, and hydrocodone are medications used to treat what?

treatment of a nonproductive cough

Adverse effects associated with levels of theophylline; level of < or equal to 20

uncommon

Topical nasal decongestants cause what?

vasodilation