Chapter 40: Drugs for asthma and pulmonary disorders

The nurse teaches a client about chronic obstruction pulmonary disease​ (COPD). Which risk factor should the nurse include in this​ explanation? (Select all that​ apply.)

B. Breathing air pollutants D. Smoking cigarettes

A patient with asthma asks how to avoid acute asthma attacks. Which response should the nurse make? "Use a cough suppressant to prevent attacks." "Use a steroid inhaler as soon as you start having symptoms." "Avoid exposure to dust, pollen, and mold." "Exposure to cold air will relax inflamed bronchioles."

"Avoid exposure to dust, pollen, and mold." WHAT YOU NEED TO KNOW The patient should be instructed to avoid potential asthma triggers, such as cigarette smoke, dust, pollen, and mold. A cough suppressant will not prevent asthma attacks. A short-acting bronchodilator should be the first medication used during an acute asthma attack. In some patients, cold air can trigger an acute asthma attack.

The nurse instructs a patient about multiple inhaled medications for asthma. For which patient statement should the nurse provide additional teaching? "I should dry the inhaler and spacer with a hair dryer." "I may feel nervous after using my inhaler." "I will avoid caffeine when using my quick-acting inhaler." "I will rinse my mouth after using the inhalers."

"I should dry the inhaler and spacer with a hair dryer." WHAT YOU NEED TO KNOW The patient should be instructed to permit the spacer and inhaler to air dry. Feeling nervous is a potential, yet not serious, adverse effect of inhaled medications. Caffeine should be avoided to help prevent nervousness, tremors, or palpitations. The patient should rinse the mouth after using inhalers, especially corticosteroids, to prevent fungal infections, localized reactions, and systemic absorption.

A patient is prescribed multiple inhaled medications for asthma. Which patient statement should indicate to the nurse that teaching has been effective? "I will rinse my mouth after using the medications." "I will use the long-acting inhaler first when I have an asthma attack." "I will use the spacer if I'm not going to be able to take a deep breath." "I will use my inhalers once my symptoms are severe."

"I will rinse my mouth after using the medications." WHAT YOU NEED TO KNOW The patient should be instructed to rinse the mouth after using inhaled medications to help prevent systemic absorption or localized reactions. A short-acting inhaler should be used for acute asthma symptoms. If available, a spacer should always be used because even when inhalers are used properly, most of the aerosolized medication never reaches the lungs. The patient should be instructed to use a quick-acting inhaler as soon as possible after symptoms appear. previous

The nurse teaches a patient about self-administration of multiple inhaled medications. Which statement should indicate to the nurse that teaching has been effective? "I will use the bronchodilator and corticosteroid inhalers 30 seconds apart." "I will use the bronchodilator inhaler before using the corticosteroid inhaler." "I will clean the inhalers at least monthly." "I will use the inhalers as often as needed."

"I will use the bronchodilator inhaler before using the corticosteroid inhaler." WHAT YOU NEED TO KNOW The bronchodilator inhaler should be used before the corticosteroid inhaler. The corticosteroid inhaler should be used 5 to 10 minutes after the bronchodilator inhaler to ensure the medication reaches deep into the bronchial tree. The patient should clean the inhalers at least weekly. Inhalers, like all medications, have guidelines about frequency of use. The patient should be instructed to notify the healthcare provider if symptoms persist despite using the inhalers as directed.

A patient is prescribed ipratropium (Atrovent) for chronic obstructive pulmonary disease (COPD). Which teaching should the nurse provide? "A bitter taste after taking the medication indicates an allergic reaction." "Difficulty urinating while taking the medication indicates renal failure." "Decrease your fluid intake." "Increase your fiber intake."

"Increase your fiber intake." WHAT YOU NEED TO KNOW Because an anticholinergic medication, such as ipratropium, can cause constipation, the patient should be instructed to increase fiber and fluid intake. The patient may experience a bitter taste after taking the medication, and although it is problematic for some patients, it does not indicate an allergic reaction. The patient should notify the healthcare provider if difficulty urinating occurs, because this is an adverse effect of anticholinergic medications (especially if the patient has an enlarged prostate); however, this does not indicate renal failure.

The nurse compares oral albuterol (VoSpire ER) with inhaled albuterol (Proventil HFA, Ventolin HFA). Which statement should the nurse make about this comparison? "Oral albuterol has a shorter onset of action." "Oral albuterol should be used for acute asthma attacks." "Inhaled albuterol workin about 15 minutes." "Inhaled albuterol is safe to use during pregnancy."

"Inhaled albuterol workin about 15 minutes." WHAT YOU NEED TO KNOW Compared with oral albuterol, inhaled albuterol works in about 15 minutes. Oral albuterol has a longer onset of action and should not be used for acute asthma attacks. Inhaled albuterol is a pregnancy category C drug. Additional Learning Potential adverse effects of albuterol (Proventil HFA, Ventolin HFA, VoSpire ER) include: Palpitations. Headaches. Throat irritation. Tremor. Nervousness. Restlessness. Tachycardia. Insomnia. Dry mouth. Chest pain (uncommon). Paradoxical bronchospasm (uncommon). Allergic reactions (uncommon).

The nurse is asked why a peak expiratory flowmeter is important in asthma management. Which information should the nurse provide in response? "It determines whether chronic obstructive pulmonary disease (COPD) has been cured." "It determines whether the patient is a candidate for a lung transplant." "It determines the amount of mucus production." "It helps evaluate medication effectiveness."

"It helps evaluate medication effectiveness." WHAT YOU NEED TO KNOW Peak expiratory flowmeter results help to evaluate medication effectiveness. COPD is a chronic disease that is not curable. Peak expiratory flowmeter results do not determine whether the patient is a candidate for a lung transplant, nor do they determine the amount of mucus production.

A patient asks if arformoterol (Brovana) can be used to terminate an acute asthma attack. Which response should the nurse provide? "No, because the medication can cause rebound bronchoconstriction." "Yes, because the medication is the newest and safest on the market." "Yes, because the medication starts working in less than 30 seconds." "No, because it takes longer to achieve maximum effects."

"No, because it takes longer to achieve maximum effects." WHAT YOU NEED TO KNOW Arformoterol is a long-acting inhaled beta2-agonist (LABA) that should not be used to terminate acute asthma attacks because it has a relatively slow onset of action and will not abort an acute bronchospasm; an inhaled short-acting beta2-agonist should be used instead. Arformoterol has a black box warning that states asthma-related death is a risk. Risk for rebound bronchoconstriction is not why the medication is not used to terminate an acute asthma attack. The medication is not the newest LABA on the market, nor is it necessarily the safest. The medication takes longer to start acting. Additional Learning Additional examples of LABAs include: Arformoterol. Albuterol (VoSpire ER). Formoterol. Olodaterol. Salmeterol.

A patient asks why it is important to rinse the mouth after using inhaled medications. Which should the nurse respond to this patient? "Rinsing decreases the risk of esophageal cancer." "Rinsing helps prevent systemic absorption of the medications." "Rinsing prevents all adverse medication effects from occurring." "Rinsing prevents the inhalers from interacting with other medications."

"Rinsing helps prevent systemic absorption of the medications." WHAT YOU NEED TO KNOW The patient should be instructed to rinse the mouth after using inhaled medications to help prevent systemic absorption and localized reactions. Rinsing does not decrease esophageal cancer risk, nor does it necessarily prevent the inhaled medications from interacting with other medications. Although rinsing may help prevent some adverse medication effects from occurring, rinsing does not prevent all adverse medication effects.

A patient with exercise-induced bronchospasm is prescribed a leukotriene modifier. Which teaching should the nurse provide? "Take the medication 2 or more hours before you exercise." "The medication will terminate an acute asthma attack." "Take the medication with St. John's wort for best results." "Taking the medication with albuterol can cause overdose."

"Take the medication 2 or more hours before you exercise." WHAT YOU NEED TO KNOW Montelukast (Singulair) is the only leukotriene modifier approved to prevent exercise-induced bronchospasm. The medication is effective if taken 2 or more hours before exercise. The medication will not terminate an acute asthma attack. There are no identified interactions with herbal preparations. If an acute asthma attack occurs, a short-acting beta2-agonist, such as albuterol (Proventil HFA, Ventolin HFA), should be used

The nurse is asked about the role brainstem neurons have in the respiratory system. Which response should the nurse provide? "They determine the rate at which ventilation occurs." "They block gas exchange." "They cause bronchoconstriction." "They promote inflammation."

"They determine the rate at which ventilation occurs." WHAT YOU NEED TO KNOW The rate at which ventilation occurs is determined by brainstem neurons. Brainstem neurons do not block gas exchange, cause bronchoconstriction, or promote inflammation. Additional Learning The normal adult respiratory rate is 12-18 breaths/min. This rate may be modified by factors such as emotions, fever, stress, blood pH, and other medications.

A client taking medication for chronic obstructive pulmonary disease​ (COPD) asks what else can be done to manage the disease. Which instruction should the nurse​ provide?

A client with COPD should rest between eating and activities. The​ client's appetite, ability to​ eat, and performance of activities of daily living will be directly affected if the client with COPD does not adequately rest. The client should increase fluid intake to liquefy secretions. Increasing room temperature at night will not protect against infections. To prevent fatigue and​ malnutrition, the client should eat​ small, frequent meals of​ calorie-rich, nutrient-dense foods. OK

A client is prescribed a leukotriene modifier. Which information should the nurse include when teaching about this​ medication?

A leukotriene modifier may be prescribed as an alternative when inhaled corticosteroids and​ short-acting beta2-adrenergic agonists​ (SABAs) are ineffective. SABAs are most likely to be prescribed for treatment of acute asthma attacks. The onset of action for leukotriene modifiers is 1 week. The mechanism of action for corticosteroids is different than the mechanism of action for leukotriene modifiers. Next question

The nurse is reviewing the two branches of the autonomic nervous system. Which action should indicate to the nurse that the sympathetic branch has been​ activated?

Airway diameter increases as the sympathetic branch activates beta2​-adrenergic receptors. The parasympathetic branch causes bronchoconstriction to occur. Airway clearance is likely to increase as a result of bronchodilation. Mucus production is not directly impacted. Next question

Examples of SABAs include:

Albuterol (Proventil HFA, Ventolin HFA, VoSpire ER). Metaproterenol. Levalbuterol (Xopenex). Subcutaneous terbutaline.

A patient is prescribed cromolyn for chronic obstructive pulmonary disease (COPD). Which should the nurse expect to see documented in the medical record? Diagnosis of intermittent asthma Diagnosis of end-stage COPD Report of coughing for over a week Allergy to corticosteroids

Allergy to corticosteroids WHAT YOU NEED TO KNOW Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Cromolyn is not effective for acute attacks. Diagnoses of intermittent asthma and end-stage COPD alone do not indicate a need for cromolyn. Cromolyn reduces inflammation and is not prescribed as an antitussive.

A client reports not using a steroid inhaler as prescribed but plans to use it for acute asthma attacks. Which information about inhaled steroids should the nurse​ provide?

Are used to prevent acute asthma attacks but are ineffective at terminating an acute asthma attack An inhaled corticosteroid is a​ first-line medication for the​ long-term management of persistent acute​ asthma, but it is not effective in terminating an acute asthma attack. A bronchodilator is needed during an acute asthma attack. Inhaled corticosteroids are generally taken 1 to 3 times per​ day, depending on the individual medication. Next question

A patient with chronic obstructive pulmonary disease (COPD) is at risk for osteoporosis. Which long-term medication prescription should the nurse question for this patient? Beclomethasone (Qvar) Levalbuterol (Xopenex) Formoterol (Foradil, Perforomist) Ipratropium (Atrovent)

Beclomethasone (Qvar) When taken long term, oral and inhaled corticosteroids such as beclomethasone can affect bone physiology in adults and children. At-risk patients, including those with osteoporosis, should have periodic bone density tests, and the healthcare provider may prescribe a bisphosphonate medication to prevent fractures. Levalbuterol (Xopenex), formoterol (Foradil, Perforomist), and ipratropium (Atrovent) are medications commonly prescribed to treat COPD that do not affect bone physiology. Additional Learning Additional adverse effects of inhaled corticosteroids include: Hoarseness. Dry mouth. Change in taste. Cataract development. Growth inhibition in children. Oropharyngeal candidiasis.

A client taking inhaled beclomethasone​ (Qvar) for 3 days wants to stop the medication because it is not working. Which information should the nurse​ provide?

Beclomethasone is an inhaled corticosteroid used for the​ long-term management of persistent asthma. The​ medication's onset of action is 1 to 4 weeks. The client should not take the medication more frequently than directed. There are no clinically significant medication interactions with beclomethasone because very little of the medication is absorbed systemically. There are also no known food interactions with beclomethasone​ (Qvar).

A patient is prescribed albuterol (Proventil HFA, Ventolin HFA, VoSpire ER) for the treatment of asthma. Which type of medication should the nurse recall is contraindicated for use with albuterol? Corticosteroid Beta blocker Leukotriene modifier Mast cell stabilizer

Beta blocker WHAT YOU NEED TO KNOW Concurrent use with beta blockers will inhibit the bronchodilation effect of albuterol. Albuterol is not contraindicated with a corticosteroid, leukotriene modifier, or mast cell stabilizer. Additional Learning Patients should avoid monoamine oxidase inhibitors within 14 days of beginning albuterol therapy because of the risk for hypertensive crisis.

Leukotriene Modifiers

Blocks inflammatory response -COPD and asthma **singulair Teach pts to take daily, maintenance drug

Cholinergic Antagonists

Causes bronchodilation by inhibiting the PNS allowing the SNS to dominate cant see, cant spit, can pee, cant shit -Carry it at all times, report blurred vision- DANGER, observe for dry mouth, eye pain, tremor, cant sleep *Know correct technique for MDI

The nurse is reviewing the relationship between the respiratory and nervous systems. Which action should indicate the nervous system's control of ventilation? Decreasing gas exchange in the alveoli Changing the diameter of the airways Increasing the amount of mucus production Increasing the intrathoracic pressure

Changing the diameter of the airways WHAT YOU NEED TO KNOW The nervous system, specifically the sympathetic and parasympathetic systems, controls ventilation by changing the diameter of the very small and abundant bronchioles. The nervous system does not play a role in decreasing gas exchange in the alveoli, increasing the amount of mucus production, or increasing intrathoracic pressure.

Additional adverse effects of ipratropium include:

Cough. Drying of the nasal mucosa. Hoarseness. Bitter taste. Epistaxis.

A client reports a​ cough, shortness of​ breath, wheezing, and chest tightness after cutting grass. Which health problem should the nurse​ suspect?

Cough​ (including an evening​ cough), shortness of​ breath, wheezing, and chest tightness are classic symptoms of asthma. Pollen from​ trees, grasses, and weeds are common asthma triggers. Because the symptoms occurred after cutting​ grass, emphysema, chronic​ bronchitis, and ARDS are not suspected. Next question

A patient with chronic obstructive pulmonary disease (COPD) is allergic to corticosteroid medications. Which medication should the nurse expect to be prescribed? Flunisolide Cromolyn Budesonide (Pulmicort) Mometasone (Asmanex)

Cromolyn WHAT YOU NEED TO KNOW Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Like corticosteroids, cromolyn is not effective for acute attacks. Flunisolide, budesonide (Pulmicort), and mometasone (Asmanex) are all corticosteroids

A patient experiencing an asthma attack is given a dose of albuterol. Which outcome should the nurse assess to determine effectiveness? Decreased adventitious breath sounds Heart rate of 130 beats/min Potassium level 2.8 mEq/L Constricted pupils

Decreased adventitious breath sounds WHAT YOU NEED TO KNOW Albuterol is a bronchodilator that relieves asthma symptoms, such as wheezing. Decreased adventitious breath sounds indicate an improvement in asthma symptoms. A fast heart rate and low potassium level are adverse effects of the medication. The medication has no effect on pupil reaction.

A patient is prescribed an inhaled corticosteroid for long-term management of persistent asthma. Which therapeutic effect should the nurse expect? Decreased airway edema Bronchodilation Prevention of respiratory infections Expectoration of secretions

Decreased airway edema WHAT YOU NEED TO KNOW Inhaled corticosteroids have an anti-inflammatory effect and decrease mucous production and edema in bronchial airways. An inhaled corticosteroid does not promote bronchodilation, prevent respiratory infections, or act as an expectorant.

A client is receiving a mast cell stabilizer. Which therapeutic effect should the nurse​ expect?

Decreased inflammation Mast cell stabilizers decrease inflammation in clients with asthma or chronic obstructive pulmonary disease. They do not provide​ long-term bronchodilation, decrease mucus​ production, or terminate a bronchospasm. Next question

A client with asthma asks why theophylline has not been prescribed. Which should the nurse consider about theophylline when​ responding? (Select all that​ apply.)

Interacts with multiple medications Has a narrow therapeutic index

A patient reports increasing dietary fiber because of a prescribed medication for chronic obstructive pulmonary disease (COPD). Which medication should the nurse expect was prescribed for this patient? Theophylline Fluticasone (Flovent) Ipratropium (Atrovent) Cromolyn

Ipratropium (Atrovent) WHAT YOU NEED TO KNOW Ipratropium, an anticholinergic medication, can cause constipation. The patient should increase fiber and fluid intake. The patient would not have to increase fiber intake for theophylline, fluticasone (Flovent), or cromolyn. Additional Learning Additional adverse effects of ipratropium include: Cough. Drying of the nasal mucosa. Hoarseness. Bitter taste. Epistaxis.

A client is prescribed ipratropium​ (Atrovent). Which mechanism of action should the nurse include when teaching about this​ medication?

Ipratropium is an anticholinergic medication that works by blocking cholinergic receptors and leads to bronchial smooth muscle dilation. Cromolyn is a mast cell stabilizer that prevents the inflammatory response. Montelukast​ (Singulair) is a leukotriene modifier that prevents airway edema and inflammation. Albuterol​ (Proventil HFA, Ventolin​ HFA, VoSpire​ ER) binds to beta2​-adrenergic receptors and results in bronchodilation. Next question

A client is prescribed ipratropium​ (Atrovent). Which adverse effect should the nurse instruct the client to​ report?

Ipratropium produces few systemic adverse effects. Irritation of the upper respiratory tract may result in​ cough, drying of the nasal​ mucosa, or hoarseness.​ Tremors, tachycardia, and nervousness are potential adverse effects of beta​ agonists, such as albuterol​ (Proventil HFA, Ventolin​ HFA, VoSpire​ ER). Next question

A patient is diagnosed with emphysema. Which should the nurse recall about the pathophysiology of this health problem? Loss of bronchiolar elasticity Total collapse of the airways on exhalation Increased perfusion and gas exchange at the alveolus Excess mucus production in the lower respiratory tract

Loss of bronchiolar elasticity WHAT YOU NEED TO KNOW Emphysema, a chronic pulmonary condition, is characterized by a loss of bronchiolar elasticity and destruction of alveolar wall structures. Partial collapse of the airways occurs on exhalation. Emphysema results in decreased perfusion and gas exchange at the alveolus. Excess mucus production in the lower respiratory tract is a characteristic of chronic bronchitis.

A patient experiences persistent asthma that has not been well controlled. Which type of bronchodilator should the nurse expect to be prescribed? Methylxanthine Anticholinergic Short-acting beta2-adrenergic agonist Long-acting beta2-adrenergic agonist

Methylxanthine WHAT YOU NEED TO KNOW A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. Methylxanthines are used cautiously because of their narrow therapeutic index and interactions with multiple medications. previous

A patient is diagnosed with chronic obstructive pulmonary disease (COPD). Which should the nurse recall about this disease process when planning care? Most patients with COPD are lifelong tobacco users. Strict medication management alters the progression of COPD. A patient with COPD is at low risk for pulmonary infections. Mucolytics are contraindicated with COPD.

Most patients with COPD are lifelong tobacco users. WHAT YOU NEED TO KNOW Most patients with COPD are lifelong smokers, accounting for 85-90% of all nonasthmatic COPD cases. Strict medication management can relieve symptoms, but they do not alter COPD progression. The patient is high risk for pulmonary infections because microbes thrive in mucus-rich environments. Mucolytics loosen thick bronchial secretions and are important for COPD management.

The nurse is teaching a client how to use a​ metered-dose inhaler​ (MDI). Which action should the nurse prioritize at the conclusion of client​ teaching?

Observing a return demonstration after teaching verifies that the client can​ self-administer the medication correctly. Although the client must be able to recognize known asthma triggers and symptoms that require MDI​ use, this is not the most important action after client teaching. Assessing the​ client's lung sounds is important but is not relevant to determine effectiveness of teaching. Next question

A client is prescribed albuterol​ (Proventil HFA, Ventolin​ HFA, VoSpire​ ER). For which adverse effect should the nurse monitor this​ client? hypoglycemia hyperkalemia bradycardia palpitations

Palpitations are a potential adverse effect of albuterol​ (Proventil HFA, Ventolin​ HFA, VoSpire​ ER). Bradycardia,​ hyperkalemia, and hypoglycemia are not potential adverse effects of this medication. OK

A client is prescribed inhaled albuterol​ (Proventil HFA, Ventolin​ HFA). For which therapeutic effect should the nurse monitor the​ client?

Relief of bronchospasm Inhaled albuterol is used to prevent and treat bronchospasm. The medication causes​ bronchodilation, and respiratory rate will likely decrease as bronchodilation occurs. Although the medication does not decrease mucus​ production, it helps facilitate mucus drainage. OK

A patient is newly diagnosed with intermittent asthma. Which type of inhaled medication should the nurse expect to be prescribed initially? Short-acting beta2-adrenergic agonist (SABA) Corticosteroid Long-acting beta2-adrenergic agonist (LABA) Leukotriene receptor antagonist (LTRA)

SABA WHAT YOU NEED TO KNOW Short-acting beta agonists (SABAs) have a rapid onset of action, usually several minutes. SABAs are the most frequently prescribed drugs for aborting or terminating an acute asthma attack. Their effects, however, last only 2 to 6 hours, so the use of SABAs is generally limited to as-needed (prn) management of acute episodes. Inhaled corticosteroids (ICS) are used for the long-term prevention of asthmatic attacks. Long-acting beta agonists (LABAs) have therapeutic effects that last up to 12 hours. These medications have a relatively slow onset of action and will not abort an acute bronchospasm. The leukotriene modifiers are second-line medications to reduce inflammation and ease bronchoconstriction and are used as alternative drugs in the management of asthma symptoms.

Bronchodilator

SABA- such as albuterol for immediate relief, opens up the airway, FAST ACTING, RESCUE INHALER ...teach pt to monitor airway and to carry it at all times. *Use at least 5 minutes before other drugs (nclex), basically saba opens up airway and increases abosopton for other drugs

A client with coughing and wheezing reports chest tightness and shortness of breath. Which type of medication should the nurse expect to give​ first?

SABAs​ (e.g., albuterol​ [Proventil HFA, Ventolin​ HFA]) have a rapid onset of action and are preferred to relieve the symptoms of acute​ asthma, which include​ cough, wheezing, chest​ tightness, and shortness of breath. Mast cell​ stabilizers, leukotriene​ modifiers, and LABAs have a longer onset of​ action, and they are not effective in relieving the symptoms of acute asthma. Next question

The nurse has provided teaching to a client with asthma. Which client statement should indicate to the nurse that teaching has been​ effective?

Secondhand cigarette smoke is a potential asthma​ trigger, so the client should avoid all exposure to cigarette smoke. Caffeine should be avoided while using a​ short-acting bronchodilator, as this combination may cause​ nervousness, tremors, or palpitations. The client should wear medication identification jewelry in the event of an emergency that indicates the presence of​ asthma, use of inhaler​ therapy, and any significant allergies or anaphylaxis. A​ short-acting bronchodilator should be used at the onset of acute asthma symptoms. OK

A client is prescribed roflumilast​ (Daliresp). For which health problem should the nurse assess this​ client?

Severe chronic obstructive pulmonary disease​ (COPD) Roflumilast is a medication that is only prescribed for severe COPD. The medication inhibits the enzyme phosphodiesterase 4 and results in​ anti-inflammatory effects on the airway. The medication is not used to treat moderate or severe persistent asthma or ARDS. OK

cromone

Stabilizes the membranes of mast cells and prevents the release of inflammatory mediators. Purpose is to prevent asthma attack triggered by inflammation or allergens.

A patient taking montelukast (Singulair) is demonstrating symptoms of an overdose. Which treatment should the nurse anticipate? Supportive treatment Isoproterenol Epinephrine Gastric lavage

Supportive treatment WHAT YOU NEED TO KNOW Since there is no specific treatment for overdose, treatment for suspected montelukast overdose is supportive. Isoproterenol and epinephrine are not indicated for montelukast overdose. Gastric lavage is indicated for theophylline overdose.

A patient with persistent asthma is prescribed a methylxanthine bronchodilator. Which should the nurse suspect as the reason for this medication to be prescribed? The patient experiences exercise-induced bronchospasms. The patient's asthma has been uncontrolled by other medications. The patient has chronic obstructive pulmonary disease (COPD). The patient has been nonadherent with other medications.

The patient's asthma has been uncontrolled by other medications. WHAT YOU NEED TO KNOW A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. There is not enough information to conclude that the patient experiences exercise-induced bronchospasms, has COPD, or has been nonadherent with other medications.

The nurse is teaching a patient about the pathogenesis of asthma. Which information should the nurse include about the action of the smooth muscles within the airway? They block histamine release. They are hyperresponsive to stimuli. They block prostaglandin release. They activate beta2-adrenergic receptors.

They are hyperresponsive to stimuli. The smooth muscles located in the airway are hyperresponsive to stimuli, which results in bronchospasm and inflammation in the patient with asthma. During an asthma attack, histamines and prostaglandins are released. Activation of beta2-adrenergic receptors would result in bronchodilation.

A patient taking ipratropium (Atrovent) receives a new prescription for tiotropium (Spiriva). Which teaching should the nurse provide about the new medication? Tiotropium is administered by metered-dose inhaler. Tiotropium is taken less frequently than ipratropium. Tiotropium, unlike ipratropium, is a corticosteroid. Tiotropium is more effective at treating acute asthma symptoms.

Tiotropium is taken less frequently than ipratropium. WHAT YOU NEED TO KNOW Tiotropium is taken once per day, whereas ipratropium is taken four or more times per day. The less frequent dosing decreases the chance of the patient missing a dose. Tiotropium is administered by dry powder inhaler, not metered-dose inhaler. Both medications are anticholinergics. The medications are closely related, but ipratropium is the only anticholinergic with a rapid onset that is suitable for treating acute asthma. previous

A patient is prescribed theophylline for asthma. Which should the nurse suspect as the reason this medication was prescribed? It is the preferred treatment for asthma. Treatment with a beta agonist was unreasonsive. Asthma was recently diagnosed. It has a wide margin of safety.

Treatment with a beta agonist was unreasonsive. WHAT YOU NEED TO KNOW Theophylline is currently used primarily for the long-term oral prophylaxis of asthma that is unresponsive to beta agonists or inhaled corticosteroids. It is not the preferred treatment for asthma. Asthma was not recently diagnosed because other medications have to have been attempted. It has a narrow margin of safety.

The nurse is reviewing the mechanical process of ventilation. Which factor should the nurse recognize that influences the rate at which ventilation​ occurs? (Select all that​ apply.) A. Blood pH B. Stress C. Emotional upset D. Fever E. Adequate oxygenation

a-d

LABAS

another beta 2 agonist, but not immediate -Not good for ongoing asthma, it PREVENTS ...Teach pts that if they have symptoms dont take this but instead the SABAS ...Teach pts correct technique for MDI

Antiflammatories decrease

inflammation

Review steps for mdi or dpi

nclex

corticosteroids (predniZONE)

prevent asthma attack caused by inflammation ...teach pts to use daily, even when no symptoms are present, teach about good mouth care and to check mouth for lesions and drainage ...steroids mask the signs of infection so TEACH PTS TO STAY AWAY FROM THOSE WITH AN URI ...increase risk for stomach ulcers so teach them to take it with FOOD ...Teach them to not stop taking for any reason (addisons disease- stopped exogenous source, adrenal crisis occurs from abrupt stop)

which drug for acute symtpoms

sabas

A client asks why a spacer is needed with an inhaler. Which information should the nurse​ provide?

​"It holds medication so that more is deposited in your​ lungs." The spacer holds medication drops that fall out of the​ aerosol, so more ends up being deposited in the lungs instead of in the mouth. Less coordination is required when using a spacer because the client does not have to coordinate inhalation with activation of the device. Special enzymes do not line the spacer to provide faster symptom relief. OK

The nurse is teaching a client with chronic bronchitis about the reason for recurrent pulmonary infections. Which explanation should the nurse​ provide?

​"Microbes thrive in​ mucus-rich environments." Chronic bronchitis is characterized by excess mucus production in the lower respiratory tract due to irritation from cigarette smoking or pollutants. Microbes thrive in​ mucus-rich environments, leading to recurrent pulmonary infections. The recurrence of pulmonary infections does not directly relate to the functioning status of the immune system. White blood cell count will be elevated when infections are present. Finishing prescribed antibiotics is​ important, but a client with chronic bronchitis will always be at risk for recurrent pulmonary infections because the body will always be producing excess mucus in the lower respiratory tract. Next question