Chapter 37 Respiratory adaptive quizzing

Which medication is a mast cell stabilizer? 1. Zileuton 2.Cromolyn 3. Montelukast 4.Arformoterol

Cromolyn Cromolyn is a mast cell stabilizer drug. It is used for the treatment of exercise-induced asthma. It works by stabilizing the cell membranes of mast cells to prevent the release of inflammatory mediators such as histamine. Zileuton and montelukast are leukotriene receptor antagonists. Arformoterol is a long-acting beta agonist. These are not used to treat exercise asthma. These drugs are effective in asthma, chronic bronchitis, and emphysema.

The nurse is teaching a patient who has asthma about the frequency of inhalation of salmeterol. Which statement by the patient indicates effective learning?

"I will inhale it twice a day approximately 12 hours apart

A nursing student is caring for a patient who is receiving ipratropium therapy. The student asks the nurse about the time required to reach the peak effect after the administration of the drug. What should the nurse tell the student?

"It takes about 1 to 2 hours.

What is the correct dose of montelukast for an adult?

10 mg

A patient with asthma has been prescribed albuterol. The patient reports dizziness after taking the medication. What will the nurse assess in the patient?

Blood pressure

Which condition is characterized by enlargement of air spaces caused by the destruction of the alveolar walls?

Emphysema

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. What is the nurse's best action?

Hold the next dose of theophylline and assess the patient.

A patient is prescribed albuterol. The nurse is explaining the most common route of administration of albuterol to the patient. Which route should the nurse discuss?

Inhalation

A patient who is taking ipratropium for asthma is complaining of a dry cough. Which action should the nurse implement first?

Listen to the patient's lungs.

A patient is prescribed zileuton to treat asthma. Which will be closely monitored in the patient to ensure safe drug administration?

Liver enzyme levels The nurse should assess the patient's liver enzyme levels, because administration of zileuton may lead to liver dysfunction. Zileuton has no effect on creatinine level, blood cells, or uric acid level. Therefore, testing of creatinine clearance, complete blood count, and uric acid baseline level are not required after administering zileuton.

A patient has taken metaproterenol. What is the nurse's priority action?

Monitoring for heart rate (100 beats/min)

Which antiasthmatic, available only for oral use, is approved for use in children 2 years of age and older?

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.

A patient is prescribed ipratropium for the treatment of chronic obstructive pulmonary disease. For what should the nurse assess to ensure safe administration of ipratropium?

Peanut allergy

A patient is prescribed ipratropium and cromolyn sodium. What should the nurse teach the patient?

Take the ipratropium 5 minutes before the cromolyn. When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 2 to 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.

A patient is prescribed oral albuterol to treat bronchitis. What instruction should the nurse give to the patient to prevent gastrointestinal (GI) upset?

Take the prescribed medication with food."

The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What should the nurse do?

Teach the child to use a spacer.

A patient reports nausea, shortness of breath, joint pain, weakness, and fatigue. On review of the patient's history, the nurse finds that the patient is prescribed prednisone to treat asthma. The nurse also learns that the patent has abruptly discontinued the medicine shortly after getting some relief from asthma. What should the nurse interpret from the assessment?

The patient has Addisonian crisis. Prednisone is a systemic corticosteroid. If a systemic corticosteroid is abruptly discontinued, Addisonian crisis ensues. Nausea, shortness of breath, joint pain, weakness, and fatigue are symptoms of Addisonian crisis. Coronary ischemia causes shortness of breath, fatigue, and weakness but is not associated with discontinuation of steroid therapy. Rheumatoid arthritis is an autoimmune disease, which is not caused by abrupt cessation of corticosteroid therapy. Nausea, shortness of breath, joint pain, weakness, and fatigue do not indicate Cushing's syndrome. Therefore, the patient does not have Cushing's syndrome. Moon face, acne, an increase in fat pads, and swelling are symptoms of Cushing's syndrome.

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. What will the nurse infer from the assessment?

The patient has Cushing's syndrome

What interaction can occur when an asthmatic patient consumes rifampin along with xanthine derivatives?

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.

A patient is prescribed inhaled corticosteroids. Why should the nurse ask the patient to rinse the mouth after each dose?

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.

What are adverse effects of albuterol? Select all that apply.

Tremors Palpitations Tachy

The nurse is assessing a patient with asthma. Which symptoms should the nurse expect to find in the patient?

Wheezing Chest Tightness Shortness of breath

What are the adverse effects of ipratropium and tiotropium therapy? Select all that apply.

headache dry mouth nasal congestion

A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action?

Administering a beta2-adrenergic agonist

The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? 1Monitor the patient for toxicity. 2Increase the intravenous (IV) drip rate. 3Continue to assess the patient's oxygenation. 4Stop the IV for an hour then restart at a lower rate

3Continue to assess the patient's oxygenation.

What is the elimination half-life of theophylline?

7 to 9 hours Theophylline is a xanthine derivative and is used for the treatment of asthma, chronic bronchitis, or emphysema. The elimination half-life of theophylline is 7 to 9 hours. The peak effect of theophylline occurs at 1 to 2 hours after administration. The elimination half-life of salmeterol is 5.5 hours. The duration of action of theophylline is 12 hours.

The nurse is caring for multiple patients on the pulmonary unit. The nurse should question the administration of prescribed epinephrine to which patient?

A patient with atrial fibrillation with a rate of 100 beats/min

A patient is in the emergency department to treat a xanthine overdose. What will the health care provider prescribe to treat this patient?

Activated charcoal

The health care provider prescribes albuterol and beclomethasone inhalers for a patient. What is the nurse's best action?

Administer the albuterol, wait 5 minutes, and then administer beclomethasone.

The nurse should instruct a patient to avoid caffeine and stimulants when the individual is using which medication?

Albuterol

Which medication should be administered to a patient who has an acute asthmatic attack?

Albuterol

A patient is prescribed tiotropium for the treatment of chronic obstructive pulmonary disease (COPD). How can the absorption of tiotropium be improved?

By waiting for 1 to 2 minutes before inhaling the second dose The nurse should 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.

Which antiasthmatic drugs work by preventing the inflammation commonly provoked by the substances released from mast cells?

Corticosteroids Corticosteroids prevent the inflammation commonly provoked by the substances released from mast cells. Anticholinergics prevent the binding of cholinergic substances that cause bronchoconstriction and increase secretions. Mast cell stabilizers (cromolyn and nedocromil) stabilize the cell membranes of the mast cells in which antigen-antibody reactions take place, thereby preventing the release of substances such as histamine that cause constriction. Xanthine derivatives raise intracellular levels of cyclic adenosine monophosphate.

A patient receiving inhaled ipratropium therapy visits the clinic for a follow-up. Which complaint should the nurse anticipate from the patient?

Dry mouth

Which medication given for asthma can suppress bone growth in children?

Corticosteroids have antiinflammatory action 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 is prescribed ipratropium metered-dose inhaler for the treatment of asthma. The nurse instructs the patient to take two puffs four times a day. The inhaler has a capacity of 200 inhalations. How many days will the inhaler deliver the prescribed dose? Record your answer using a whole number. ______ days

25

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?

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.