Asthma Medications
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication? a. "I may notice mood changes in my child." b. "I should give this medication twice daily." c. "I will give my child one 4-mg chewable tablet daily." d. "This drug can alleviate symptoms during an acute attack."
A
A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation related to exposure to an animal. The patient's parent administers high doses of the therapy after 2 days of administration. What is the patient at risk for? A) Adrenal insufficiency B) Tachycardia C) Edema D) Hypoglycemia
A
A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent? a. Growth may be slowed, but eventual adult height will not be reduced. b. The growth rate is not impaired, but overall height will be reduced. c. The growth rate slows while the drug is used and only resumes when the drug is stopped. d. Long-term use of the drug results in a decrease in adult height.
A
A patient is being assessed by the home care nurse on the administration of the inhalers. Which of the following will assist in proper administration of the inhaler? A) Use of a spacer B) Administer corticosteroid first C) Provide 1000 mL of fluid D) Exhale after administration
A
A patient is given theophylline to treat acute asthma symptoms. Which of the following foods should the patient avoid? A) Chocolate B) Bananas C) Orange juice D) Cranberry juice
A
A patient is given theophylline to treat acute asthma symptoms. Which of the following foods should the patient avoid? A) Chocolate B) Bananas C) Orange juice D) Cranberry juice
A
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do? a. Ask whether the patient is rinsing the mouth after each dose. b. Request an order for an antifungal medication. c. Suggest that the patient be tested for a bronchial infection. d. Tell the patient to discontinue use of the glucocorticoid.
A
Which of the following drugs are agonists to beta receptors? a) salmeterol b) formoterol c) epinephrine d) metoprolol
A
18. A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss: a. adding roflumilast [Daliresp] once daily. b. changing to oral theophylline twice daily. c. prescribing oral steroids once daily. d. Using an ipratropium/albuterol combination twice daily.
ANS: A For patients with chronic, severe COPD, the risk of exacerbations may be reduced with roflumilast. Theophylline is used only when other bronchodilators are not effective. Oral steroids are not indicated for this use. Ipratropium is used to treat bronchospasm in COPD.
17. A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine
ANS: A LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in COPD, it is no longer recommended. It is used only if beta2 agonists are not available.
14. A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device? a. "You do not need good hand-lung coordination to use this device." b. "You will begin to inhale before activating the device." c. "You will need to use a spacer to help control the medication." d. "You will take 2 inhalations twice daily."
ANS: A The Advair Diskus is a dry powder inhaler and is activated by inhalation; therefore, hand-lung coordination is not required. There is no need for a spacer. Patients who use the Diskus take 1 inhalation twice daily.
15. A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV1) is 75% of predicted values. The nurse will expect this patient to be started on which regimen? a. Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed b. Daily low-dose inhaled glucocorticoid and a SABA as needed c. Daily medium-dose inhaled glucocorticoid/LABA combination d. No daily medications; just a SABA as needed
ANS: A This patient has moderate persistent asthma, which requires step 3 management for initial treatment. Step 3 includes daily inhalation of a low-dose glucocorticoid/LABA combination supplemented with a SABA as needed. A daily low-dose glucocorticoid with an as-needed SABA is used for step 2 management. A daily medium-dose glucocorticoid/LABA is used for step 4 management. Patients requiring step 1 management do not need daily medications.
Which drugs are used to treat COPD? (Select all that apply.) a. Anticholinergic medications b. Glucocorticoids c. Leukotriene modifiers d. Long-acting beta2 agonists e. Monoclonal antibodies
ANS: A, B, D Anticholinergic drugs, glucocorticoids, and LABAs are used to treat COPD. Leukotriene modifiers and monoclonal antibodies are used only to treat asthma.
What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.) a. Reduced bronchial hyperreactivity b. Reduced edema of the airway c. Reduced number of bronchial beta2 receptors d. Increased responsiveness to beta2-adrenergic agonists e. Increased synthesis of inflammatory mediators
ANS: A, B, D Glucocorticoids act by reducing bronchial hyperreactivity and airway edema and increasing airway responsiveness to beta2-adrenergic agonists. They do not reduce the number of beta2-adrenergic agonist receptors. They help reduce the synthesis of inflammatory mediators.
11. A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication? a. "After the loading dose has been given, the patient will receive 6 mg/kg/hr." b. "Dosing is titrated based on the serum theophylline levels." c. "If the patient's serum theophylline level is less than 15 mcg/mL, the rate should be reduced." d. "The patient will receive a loading dose of 180 mg over 5 minutes."
ANS: B Dosing for aminophylline is based on each patient's serum theophylline levels. The loading dose usually is 6 mg/kg; after that, the maintenance infusion is titrated according to the theophylline levels. A serum theophylline level of 15 mcg/mL is within the therapeutic range, so dosing would not need to change. The patient's total loading dose will be 180 mg, but infusions should never be given at a rate faster than 25 mg/min.
10. A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss: a. changing to a different antibiotic. b. reducing the theophylline dose. c. giving theophylline once daily. d. switching from theophylline to a LABA.
ANS: B Fluoroquinolone antibiotics increase theophylline levels, so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.
13. A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient? a. LABAs are safer than short-acting beta2 agonists. b. LABAs can be used on an as-needed basis to treat symptoms. c. LABAs reduce the risk of asthma-related deaths. d. LABAs should be combined with an inhaled glucocorticoid.
ANS: D LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.
16. Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonists d. Short-acting beta2 agonists
ANS: D Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs, along with inhaled glucocorticoids, are used for step 3 management.
12. A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do? a. Contact the provider to report systemic anticholinergic side effects. b. Discontinue the aerosol treatment immediately. c. Notify the provider of a possible allergic reaction. d. Reassure the patient that these are expected side effects.
ANS: D The most common adverse effects of this combination drug are dry mouth and irritation of the pharynx. The patient should be reassured that these are common and minor effects. Systemic anticholinergic side effects are rare. It is not necessary to discontinue the medication. Patients with peanut allergy may have severe anaphylactic reactions, but the patient's symptoms are not those associated with anaphylaxis.
19. A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? a. "You may have another dose in 4 hours." b. "You may need to take two inhalations instead of one." c. "You should have peak effects in about 6 hours." d. "You should see improved effects within the next week."
ANS: D Tiotropium shows therapeutic effects in about 30 minutes, with improved bronchodilation occurring with subsequent doses, up to 8 days. The medication is given once daily, with inhalation of one capsule. Peak effects occur in 3 hours.
9. A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do? a. Contact the provider to request a systemic glucocorticoid. b. Contact the provider to suggest using a long-acting beta2 agonist. c. Evaluate the need for teaching about MDI use. d. Question the patient about how much albuterol has been used.
ANS: D To determine the next course of action, it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used, that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results, evaluating the MDI technique may be warranted.
A patient has been diagnosed with asthma. Which of the following patient teaching interventions are most important? A) Do not become fatigued. It will trigger asthma. B) Exposure to cold temperatures can trigger asthma. C) Do not consume foods high in sodium. D) The exposure to direct sunlight will trigger asthma.
B
A patient has been taking ibuprofen (Advil) twice daily for 2 weeks after an ankle injury. The patient calls her health care provider and states she is bothered by shortness of breath and rapid breathing. What will the patient's health care provider suspect? A) The patient is having an anxiety attack. B) The patient is having a hypersensitivity reaction. C) The patient is experiencing hypoglycemia. D) The patient is suffering from a myocardial infarction.
B
A patient is admitted to the emergency room with inspiratory stridor and air hunger after a bee sting. Which of the following medications will the nurse prepare for administration? A) Ipratropium bromide (Atrovent) B) Epinephrine (Adrenalin) C) Cromolyn (Intal) D) Pseudoephedrine
B
A patient is experiencing an acute asthma attack. Which of the following medications are contraindicated for the treatment of acute asthma? A) Aminophylline B) Cromolyn (Intal) C) Albuterol (Proventil) D) Corticosteroids
B
A patient is started on albuterol (Proventil). What reaction should the patient be instructed on? A) Polydipsia will occur. B) Tachycardia will occur. C) Hypotension will occur. D) Diarrhea will occur.
B
A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a. Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c. Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy
B
Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes: A) Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day B) Beclomethasone needs to be used every day to treat her asthma C) Report any systemic side effects she is experiencing, such as weight gain D) Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation
B
Montelukast (Singulair) may be prescribed for: A) A 6-year-old child with exercise-induced asthma B) A 2-year-old child with moderate persistent asthma C) An 18-month-old child with seasonal allergic rhinitis D) None of the above; montelukast is not approved for use in children
B
A patient is experiencing an acute asthma attack. What is the first-line therapy for relief of an acute asthma attack? A) Inhaled steroid B) Leukotriene modifier C) Beta2-adrenergic agonist D) Xanthine
C
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug? a. Four puffs of albuterol, oxygen, and intravenous theophylline b. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
C
Albuterol (Proventil) is administered for bronchodilation. What is stimulated to be increased in production with the administration of this beta2-adrenergic agonist? A) Leukotrienes B) Cortisol C) Cyclic AMP D) Glucagon
C
Long-acting beta-agonists (LABAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the: A) Risk of life-threatening dermatological reactions B) Increased incidence of cardiac events when LTBAs are used C) Increased risk of asthma-related deaths when LTBAs are used D) Risk for life-threatening alterations in electrolytes
C
A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching? a. "Beta2-adrenergic agonists provide quick relief via any formulation." b. "Long-acting beta2 agonists may be used alone to prevent attacks." c. "Short-acting beta2 agonists are usually given by nebulizer." d. "Oral beta2 agonists are not useful for short-term treatment."
D
A patient is admitted to the intensive care unit with status asthmaticus. The patient is administered high doses of nebulized albuterol (Proventil). What electrolyte imbalance should the nurse expect with this patient? A) Hyperkalemia B) Hypermagnesemia C) Hypocalcemia D) Hypokalemia
D
A patient is admitted to the intensive care unit with status asthmaticus. The patient is administered high doses of nebulized albuterol (Proventil). What electrolyte imbalance should the nurse expect with this patient? A) Hyperkalemia B) Hypermagnesemia C) Hypocalcemia D) Hypokalemia
D
A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks? A) Xanthines B) Beta2-adrenergic agonists C) Anticholinergics D) Leukotriene modifiers
D
A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma? A) Inhaled corticosteroid agents will depress the central nervous system. B) Inhaled corticosteroid agents will reduce respiratory rate. C) Inhaled corticosteroid agents will reduce bronchodilation. D) Inhaled corticosteroid agents will reduce airway inflammation.
D
A patient is prescribed an adrenergic bronchodilator for airway constriction. Which of the following conditions will require it to be administered cautiously? A) Liver failure B) Renal failure C) Respiratory constriction D) Seizure disorder
D
A patient is using an albuterol (Proventil) inhaler, which is a bronchodilator. Which of the following patient teaching interventions is important for the patient who is experiencing shortness of breath related to constriction of airways? A) Administer insulin to decrease hand shaking B) Administer ibuprofen (Advil) to decrease inflammation C) Exercise should be limited to one time per week D) Stop smoking due to the bronchoconstriction
D
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that: a. the patient should inhale suddenly to receive the maximum dose. b. the patient should activate the device and then inhale. c. the patient should store the MDI in the refrigerator between doses. d. the patient should wait 1 minute between puffs.
D
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a. "I should use the glucocorticoid as needed when symptoms flare." b. "I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."
D
The bronchodilator of choice for patients taking propranolol is: A) Albuterol B) Pirbuterol C) Formoterol D) Ipratropium
D