ch55: lower resp drugs

A client is prescribed salmeterol as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time? 30 minutes before engaging in exercise Right before and after exercising Midway during the exercise routine Immediately after beginning to exercise

30 minutes before engaging in exercise To prevent an exercise-induced asthma attack, the client should take one inhalation of salmeterol 30 minutes before starting exercise. The options would not be effective in preventing an attack.

A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid? Orange juice Cranberry juice Bananas Chocolate

Chocolate Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.

Which of the following effects would result from the action of montelukast? Decreased capillary permeability Increased neutrophil aggregation Increased smooth muscle contraction Decreased eosinophil migration

Decreased eosinophil migration Montelukast selectively and competitively blocks receptors for the production of leukotrienes D4 and E4, which are components of slow-reacting substance of anaphylaxis. As a result, the drug blocks many of the signs and symptoms of asthma, such as neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction.

A nurse is required to educate a patient prescribed albuterol on the adverse effects associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the patient to report to the health care provider? Increased nighttime urination Fall in blood pressure Hearing impairment or deficit Headache and flushing

Headache and flushing The nurse should instruct the patient to contact the health care provider if palpitations, tachycardia, chest pain, muscle tremors, dizziness, headache, flushing, or difficulty with urination or breathing occur. Fall in blood pressure, increased nighttime urination, or hearing impairment are not adverse effects associated with a sympathomimetic bronchodilator.

The nurse is describing how aminophylline achieves its effect. Which would the nurse incorporate into the description? Stabilization of mast cell membranes Stimulation of the central nervous system Reduction of airway hyperresponsiveness Stimulation of beta-adrenergic receptors

Stimulation of the central nervous system Stimulation of the central nervous system is the mechanism of action for xanthine derivatives. Stimulation of beta-adrenergic receptors is the mechanism of action for beta-2 agonists. Reduction of airway hyperresponsiveness is the mechanism of action for inhaled corticosteroids. Stabilization of mast cell membranes is the mechanism of action for mast cell stabilizers.

A client has been prescribed medication therapy for the treatment of newly diagnosed asthma. During teaching, the nurse should alert the client to potential exacerbation of what concurrent medical condition? gastroesophageal reflux disease cataracts urinary retention dermatitis

gastroesophageal reflux disease Asthma may aggravate gastroesophageal reflux disease because antiasthma medications that dilate the airways also relax muscle tone in the gastroesophageal sphincter and may increase acid reflux. The relationship between asthma medications and the other options is not supported by research data.

The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which statement by the client indicates the need for further education? "This medication may also be used for allergy disorders." "I may experience wheezing with this medication." "I will use this medication when I am having an asthma attack." "This medication may cause my throat to become dry."

"I will use this medication when I am having an asthma attack." Cromolyn (Intal) is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders. Adverse reactions include drying of the throat and coughing or wheezing. It should not be used during an acute asthma attack because it may worsen the bronchospasm.

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

15 mcg/mL Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.

A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? Asthma Pneumonia Emphysema Chronic bronchitis

Asthma Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma. This class of medication is not typically associated with the long term management of any of the other options.

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? Cigarette smoking Alcohol intake Hyperthyroidism Gastrointestinal upset

Cigarette smoking Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary. Hyperthyroidism, gastrointestinal, upset or alcohol intake requires cautious use of the drug because these conditions may be exacerbated by the systemic effects of the drug. The drug dosage may need to be decreased in these situations.

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following? Increased pulse rate Increased prothrombin time Increased serum zileuton Increased serum theophylline

Increased serum theophylline When administering zileuton along with theophylline, the nurse should monitor for increased serum theophylline. Serum zileuton levels and pulse rate are not increased when zileuton is administered along with theophylline. Increased prothrombin time is seen when warfarin, and not theophylline, is given along with zileuton.

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? Inform the health care provider that the client has toxic theophylline levels. Administer the scheduled dose of theophylline with as needed (PRN) dose of a bronchodilator. Inform the health care provider that an increase in the client's dose of theophylline may be necessary. Withhold the scheduled dose of theophylline pending the next day's blood work results.

Inform the health care provider that the client has toxic theophylline levels. To determine theophylline dosage, prescribers should measure serum theophylline levels. Therapeutic range is 5 to 15 mcg/mL (27.75 to 83.25 µmol/L); toxic levels are 20 mcg/mL (111 µmol/L) or above. The health care provider must be informed of this elevated serum level.

A client with asthma should always carry a rescue inhaler or quick-relief medication with them at all times. Which of the following are considered quick-relief medications? Select all that apply: Metaproterenol (Alupent) Tiotropium (Spiriva) Albuterol (Proventil) Salmeterol (Serevent) Formoterol (Foradil)

Metaproterenol (Alupent) Albuterol (Proventil) Short-acting beta agonists (SABAs) are used as rescue treatment for asthma. B and D are SABAs, A and E are long-acting beta agonists (LABAs). C is a cholinergic-blocking drug.

An adult client with newly diagnosed asthma presents for client education regarding situations that could precipitate an asthma attack. In this teaching, which precipitants would the nurse state may trigger an attack? Select all that apply. Mold Cigarette smoke Warm weather Allergens Exercise

Mold Cigarette smoke Allergens Exercise Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.

A patient presents at the Emergency Department (ED) in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the patient may be allergic to what? Aspirin Ragweed pollen Penicillin Peanuts

Peanuts Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, or ragweed pollen are not associated with this drug.

A client with a diagnosis of asthma has been prescribed ipratropium 2 puffs QID. What is the most likely goal of this treatment? Promoting short-term relief of acute asthma symptoms Promoting long-term management of asthma symptoms Relieving acute bronchoconstriction Promoting blood flow in the alveolar capillaries

Promoting long-term management of asthma symptoms The anticholinergic bronchodilators are most useful in the long-term management of asthma and other conditions producing bronchoconstriction. These drugs are not used in the management of acute exacerbations of asthma. They do not promote alveolar blood flow.

After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state: The drugs action leads to suppression of beta adrenergic receptor activity. The drugs are slowly absorbed from the respiratory tract. The drugs are not for use during an acute attack. The drugs are systemically absorbed when inhaled.

The drugs are not for use during an acute attack. The drugs are not for emergency use or use during an acute attack because their onset of action is slow. Systemic absorption is not typical with inhalation unless the patient did not administer the drug properly or has lesions that allowed absorption of the drug. Inhalation decreases the effectiveness of the inflammatory cells leading to decreased swelling and promotion of beta adrenergic receptor activity. The drugs are rapidly absorbed, but take 2 to 3 weeks to reach effective levels.

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to severe anticholinergic effects. permanent liver damage. community-acquired pneumonia. rebound bronchoconstriction.

rebound bronchoconstriction. Patients who self-administer albuterol may use their MDIs more frequently than recommended. This practice can result in rebound bronchoconstriction, which may motivate the patient to increase MDI use, stimulating the cycle of rebound congestion. Overuse of albuterol is not linked to pneumonia or hepatotoxicity. Albuterol is not an anticholinergic drug.

An adolescent client is prescribed a leukotriene receptor antagonist as a part of a medication regime to manage his/her asthma. Which statement made by the client requires additional education on this classification of medications? "We need to let the health care provider know if the medicine gives me a headache or makes me dizzy." "This is a new kind of asthma medication." "This medication is safe for kids like me." "I need to take the medication when I start to have problems breathing."

"I need to take the medication when I start to have problems breathing." These drugs are not indicated for the treatment of acute asthmatic attacks because they do not provide any immediate effects on the airways. Patients need to be cautioned that they should not rely on these drugs for relief from an acute asthmatic attack. The remaining statements are all accurate information regarding this classification of medications.

Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching? "I can't use this drug if I have an acute attack." "I should rinse my mouth after using the drug." "I should see some results in about 3 to 4 days." "I might notice some hoarseness with the drug."

"I should see some results in about 3 to 4 days." Inhaled steroids, such as triamcinolone, can take from 2 to 3 weeks to reach effective levels, so the client should be encouraged to take them to reach and then maintain the effective levels. The drug is not effective for acute attacks. It can cause hoarseness and sore throat. The client should rinse his mouth after using the inhaler to decrease the risk of systemic absorption and decrease gastrointestinal upset and nausea.

A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client's concern? "It's best to take repeated doses of salmeterol every 5 minutes, until your symptoms subside." "It's important to take salmeterol as soon as you feel the first sensation of an asthma attack." "Unfortunately, Serevent (salmeterol) can take up to 15 minutes to relieve your difficulty breathing." "Remember that your salmeterol isn't effective when you take it at the time of an asthma attack."

"Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." Salmeterol is a long-acting beta2-adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short-acting drug. This information makes all the other options incorrect.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements? "When I am short of breath, I will increase the use of my fluticasone." "I will wash my sheets weekly." "I need to inhale my medication and hold my breath for 10 seconds." "When I can do some, but not all of my usual activities, I am in the yellow zone."

"When I am short of breath, I will increase the use of my fluticasone." Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.

A patient who is prescribed ipratropium administers the drug at 9:15 AM. The patient should begin to notice the drug beginning to act at which time? 10:15 AM 10:00 AM 9:30 AM 9:45 AM

9:30 AM Inhaled ipratropium has an onset of action of 15 minutes, so the patient should begin to feel the effects of the drug at 9:30 AM.

A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the health care provider to order? Phenytoin intravenously The standard dose of aminophylline A drug other than aminophylline A modified dose of aminophylline

A modified dose of aminophylline Cigarette smoking and drugs that stimulate drug-metabolizing enzymes in the liver (e.g., phenobarbital, phenytoin) increase the rate of metabolism and, therefore, the dosage requirements of aminophylline.

After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)? Salmeterol Albuterol Formoterol Arformoterol

Albuterol Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.

Which of the following would a nurse identify as a surfactant? Theophylline Beractant Cromolyn Zileuton

Beractant Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.

The nurse should complete which of the following during acute breathing distress before initiation of a bronchodilator? Select all that apply: Check blood glucose. Check peak flow Check respiratory rate Check blood pressure. Check pulse.

Check respiratory rate Check blood pressure. Check pulse. Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.

A nurse is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following? Salt Alcohol Vitamin C Coffee

Coffee The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol.

A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer? Calfactant Triamcinolone Cromolyn Montelukast

Cromolyn Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.

The nurse is performing a routine assessment of a client whose medical record indicates a history of asthma. What assessment findings would the nurse expect? Select all that apply. Damaged airway mucosa Bradycardia Elevated temperature Confusion Airway inflammation

Damaged airway mucosa Airway inflammation nflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free. Elevated temperature and bradycardia are unrelated to the client's asthma. Confusion can occur during an acute attack, but it would not be expected otherwise.

After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which as possible adverse effects? (Select all that apply.) Dizziness Constipation Vomiting Chills Myalgia

Dizziness Vomiting Myalgia Myalgia is a possible adverse effect of zafirlukast. Dizziness is a possible adverse effect of zafirlukast. Vomiting is a possible adverse effect of zafirlukast. Constipation is not associated with zafirlukast. Chills are not associated with zafirlukast.

Which of the following would be most important to assess before administering calfactant? (Select all that apply.) Endotracheal tube placement Bowel sounds Abdominal girth Lung sounds Oxygen saturation levels

Endotracheal tube placement Lung sounds Oxygen saturation levels Before administering calfactant, it would be important to ensure proper endotracheal tube placement because the drug is instilled directly into the trachea. In addition, lung sounds and oxygen saturation levels would be important as a baseline to evaluate effectiveness of the drug.

A client is admitted to the emergency department with inspiratory stridor and air hunger. When anticipating treatment, the nurse will prepare which medication for administration? Pseudoephedrine Epinephrine Ipratropium bromide Cromolyn

Epinephrine Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.

Where should the nurse initially direct a client who is interested in learning more about the management of asthma? National Association of Educational Pulmonologists Global Initiative for Asthma (GINA) Centers for Disease Control Education Center Journal of Allergy and Clinical Immunology

Global Initiative for Asthma (GINA) Management of asthma involves prevention of airway inflammation and avoidance of triggers for better symptom control. Because of asthma's significance as a world health problem, the Global Initiative for Asthma (GINA) published asthma guidelines of diagnosis, management, and education. These guidelines emphasize the importance of classifying asthma severity and the assessment of asthma control. While the other options may provide information on asthma, the GINA is most inclusive.

A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route? Subcutaneous Intravenous Oral Inhalation

Inhalation Salmeterol is administered via inhalation.

An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate? Mix the drug with saline. Turn the device off when the mist slows. Have the child lie flat. Encourage rapid shallow breaths.

Mix the drug with saline. Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.

The nurse is writing a plan of care for a patient newly admitted to the floor with asthma. What would be an appropriate intervention for this patient? Try to prevent or reduce panic, which may initiate bronchospasm. Assist patients with moderate to severe asthma in obtaining a home nebulizer unit. Monitor peak flow rates, especially in children. Prophylaxis by prior inhalation of bronchodilating agents is better than avoiding exercise.

Prophylaxis by prior inhalation of bronchodilating agents is better than avoiding exercise. Teach patient who use one of these drugs for exercise-induced asthma to use it 30 to 60 minutes before exercising to ensure peak therapeutic effects when they are needed. The most important intervention would be to use a bronchodilator as prophylaxis for a patient with exercise induced asthma. It would not be monitoring peak flow rates, trying to prevent or reduce panic, or assisting in obtaining a home nebulizer unit.

The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching? Diarrhea Polydipsia Tachycardia Hypotension

Tachycardia The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.

A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which common adverse effects of the drug? Headache Throat irritation

Throat irritation The most common adverse effects of inhaled albuterol include throat irritation, palpitations, sinus tachycardia, anxiety tremor, and increased blood pressure. Serious adverse effects such as bronchospasm, urticaria, and angiedema rarely occur. Headache, dyspepsia, and muscle cramps are frequent adverse effects of oral albuterol only.

A patient tells you that a friend of theirs has recommended the use of caffeine to treat the patient's asthma. What would be the most important reason a nurse should counsel this patient not to delay prescribed treatment for the use of natural health products? Natural products decrease the adverse effects associated with adrenergic bronchodilators Most natural products are less toxic or more potent than traditional asthma medications Caffeine can aggravate the drugs used to treat asthma Delays in appropriate treatment can have serious, even fatal, consequences

Delays in appropriate treatment can have serious, even fatal, consequences The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. These drugs were once the main treatment choices for asthma and bronchospasm. However, because they have a relatively narrow margin of safety, and they interact with many other drugs, they are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have an additive effect.

An 8-year-old client reports shortness of breath, cough, and chest tightness when participating in gym class. The client is diagnosed with exercise-induced asthma. What inhaled drug therapy is the health care provider most likely to prescribe? Theophylline, a xanthine derivative Formoterol, a highly selective beta-2 agonist Terbutaline, a beta-2 selective adrenergic agonist Epinephrine, a nonselective adrenergic agonist

Formoterol, a highly selective beta-2 agonist Formoterol is used primarily to prevent exercise-induced asthma, although it may also be used in clients with emphysema or chronic bronchitis. Epinephrine induces multiple adverse reactions, while terbutaline's main pharmacotherapeutic effect is the prevention of bronchospasm, and it is also clinically used to abort premature labor. Theophylline is administered orally or intravenously.

The triage nurse in the emergency department has a 42-year-old client with asthma present for treatment. The client's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this client? Activity intolerance Ineffective breathing pattern Ineffective airway clearance Impaired gas exchange

Ineffective breathing pattern The correct nursing diagnosis is Ineffective Breathing Pattern related to impaired airway as manifested by tachypnea. The other options may be applicable, but they do not take priority over the ineffective breathing pattern.

Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use? It reduces the risk of tachycardia. It helps decrease systemic absorption. It reduces the risk of sinusitis. It helps decrease the intrapulmonary delivery of the drug.

It helps decrease systemic absorption. Spacers help decrease systemic absorption, because less flunisolide is swallowed. Spacers may also help alleviate dysphonia by filtering larger aerosol particles that ordinarily deposit in the oropharynx and extrathoracic airways (this precaution also reduces the risk for oropharyngeal candidiasis). The use of a spacer does not prevent intrapulmonary delivery of the drug; nor does it reduce the risk of tachycardia and sinusitis.

Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA? Mast cell stabilizers Xanthines Anticholinergics Leukotriene receptor antagonists

Leukotriene receptor antagonists Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.

When teaching a client about their prescribed asthma therapy, the nurse understands that which medications may increase the risk of asthma-related death? Mast cell stabilizers Long-acting beta-2 agonists Inhaled corticosteroids (ICSs) Short-acting beta agonists (SABAs)

Long-acting beta-2 agonists Long-acting beta-2 agonists may increase the risk of asthma-related death. ICSs are contraindicated in clients with hypersensitivity to the corticosteroids, acute bronchospasm, status asthmaticus, or other acute episodes of asthma and can cause throat irritation, hoarseness, upper respiratory tract infection, and fungal infections of the mouth and throat. SABA bronchodilators are drugs used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema but can cause tachycardia, palpations, arrhythmias, hypertension, nervousness, anxiety, and insomnia. The mast cell stabilizer is contraindicated in clients with known hypersensitivity to the drugs and during attacks of acute asthma, because they may worsen bronchospasm during the acute asthma attack. A mast cell stabilizer is used cautiously during pregnancy (pregnancy category B) and lactation and in clients with impaired renal or hepatic function.

A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective? Suctioning the infant every 30 minutes for 2 hours after the treatment has been initiated Supply supplemental oxygen as prescribed Changing the newborn's position frequently to assure effective distribution of medication Monitoring respirations for bilateral chest movement

Monitoring respirations for bilateral chest movement Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug. Suctioning should be avoided for at least 2 hours after the surfactant is instilled into the newborn's endotracheal tube. Neither the delivery of supplemental oxygen nor position changes are related to the delivery of the medication into the infant's lungs.

A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy? Enhancement of alveolar expansion Reduction of the inflammatory response Relaxation of smooth muscle Decrease in the production of leukotrienes D4 and E4

Relaxation of smooth muscle Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation. None of the other options describe the bronchial dilation affected of the anticholinergic classification of medications.

Tom, age 42, is prescribed ipratropium bromide as an anticholinergic agent for treating asthma. The nurse caring for Tom needs to develop a plan of care. What must be included in the plan? Select all that apply. Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma. Advise the patient that ipratropium is used to abort an asthma attack in progress. Inform the patient that repeated doses may be administered until relief is experienced. Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin.

Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma. Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. It is important to caution the patient to avoid taking ipratropium if allergic to soybeans, legumes, or soya lecithin, because it may cause serious adverse effects. It is also important to remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma. The patient should be informed that ipratropium is used prophylactically to reduce the frequency and severity of future asthma attacks, and it will not abort an asthma attack in progress. Overuse of ipratropium may induce adverse effects and therefore should be avoided.

A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation? The husband made the correct decision in giving the extra doses. The extra doses facilitated bronchodilation and probably saved her life. The health care provider will most likely order continuation of the salmeterol with increased dosage. Salmeterol is contraindicated based on his wife's condition.

Salmeterol is contraindicated based on his wife's condition. The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.

A client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussion medication instructions with this client? The medication should be taken on an empty stomach. The medication should be taken 30 minutes before a meal The effectiveness of the medication is enhanced when taken with food The medication is most effective when taken at breakfast

The medication should be taken on an empty stomach. Administer drug on an empty stomach, 1 hour before or 2 hours after meals; the bioavailability of these drugs is decreased markedly by the presence of food. None of the other options present accurate information regarding the administration of this class of medications.

Aerosols are often the drugs of choice to treat asthma because of what characteristics? (Select all that apply.) They can usually be given in smaller doses. They relieve symptoms quickly. They may be given less frequently. They produce fewer adverse effects than oral or parenteral drugs. They act directly on the airways.

They can usually be given in smaller doses. They relieve symptoms quickly. They produce fewer adverse effects than oral or parenteral drugs. They act directly on the airways. Because aerosol products act directly on the airways, drugs given by inhalation can usually be given in smaller doses and produce fewer adverse effects than oral or parenteral drugs. Aerosol products also produce a relief of asthma symptoms in a quick fashion.

A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient is a 56-year-old man. has a high coffee intake. prefers a high-calorie diet. has a history of pneumonia.

has a high coffee intake. Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy.

Adrenergics are a category of bronchodilators used in the treatment of asthma and chronic obstructive pulmonary disease. In what conditions is cautious use of these drugs recommended? Select all that apply. hypertension hypothyroidism seizure disorders renal failure diabetes mellitus

hypertension seizure disorders diabetes mellitus Adrenergic drugs are contraindicated in severe coronary artery disease; they should be used cautiously in clients with hypertension, hyperthyroidism, diabetes mellitus, and seizure disorders.

A client with asthma that has not been successfully controlled with other medications is prescribed theophylline. When providing education to the client about the medication, what adverse effect would the nurse mention? bradycardia relaxation of smooth muscle insomnia bronchoconstriction

insomnia Adverse effects of theophylline are associated with blood levels of the drug. At normal therapeutic levels, adverse effects are uncommon. At slightly higher levels, however, GI effects (e.g., nausea, diarrhea, vomiting) and central nervous system effects (e.g., irritability, headache, insomnia) can occur. As levels increase, potentially life-threatening effects can occur, including tachycardia, arrhythmias, hypotension, seizures, and brain damage. Theophylline achieves bronchodilation (not bronchoconstriction) through relaxation of smooth muscle; therefore, relaxation of smooth muscle is a therapeutic effect, not an adverse effect. At high serum levels, the drug can cause tachycardia, not bradycardia.

A client has been admitted to the emergency department (ED) in status asthmaticus. The ED nurse should anticipate administering which medication? high doses of montelukast inhaled corticosteroids beta2 agonists in high doses intravenous theophylline

intravenous theophylline Management of status asthmaticus entails beta2 agonists in high doses and as often as every 20 minutes for 1 to 2 hours. While montelukast, a leukotriene modifier, is prescribed in the management of asthma, it is not the drug of choice for status asthmaticus. Corticosteroids are used after the respiratory crisis has been stabilized. Theophylline is given in oral not intravenous form to promote bronchial dilatation.

According to the National Asthma Education and Prevention Program (NAEPP) Expert Panel Guidelines, a client prescribed a short-acting beta2 agonist may take this medication how often during an acute exacerbation of asthmatic symptoms? hourly, with no more than six doses in a 24-hour period every 30 seconds until symptoms subside up to three treatments at 20-minute intervals every 5 minutes to a maximum of three doses

up to three treatments at 20-minute intervals For acute exacerbations, the NAEPP Guidelines suggest a short-acting, inhaled, beta2 agonist, two to four puffs as needed. If symptoms are severe, clients may need up to three treatments at 20-minute intervals or a nebulizer treatment.