NSG 322: Quiz Two (Chapter 55--PrepU)

The nurse has just finished teaching a 15-year-old patient how to use an inhaler to treat asthma. What statement, made by the patient, suggests that the patient understands the teaching?

"I need to shake the inhaler well before taking the medication." Explanation: Just before each use, the patient should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.

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." Explanation: 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.

With theophylline, the home care nurse needs to assess the client and the environment for certain products that can cause what to occur? (Select all that apply.)

-Affect metabolism of theophylline. -Decrease therapeutic effects. -Increased adverse effects. Explanation: With theophylline, the home care nurse needs to assess the client and the environment for substances that may affect metabolism of theophylline and decrease therapeutic effects or increase adverse effects. Issues with excretion of theophylline are rarely an issue.

A 5-year-old boy is brought to the ED with an asthma exacerbation, including wheezing (a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway). Those who have asthma chronically present with what signs, even when they may appear symptom free? (Select all that apply.)

-Airway inflammation -Damaged airway mucosa Explanation: Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free.

After teaching a group of students about antiasthmatic agents, the students demonstrate understanding of the information when they identify what as sympathomimetics? (Select all that apply.)

-Epinephrine -Terbutaline -Formoterol Explanation: Epinephrine is a sympathomimetic. Terbutaline is a sympathomimetic. Formoterol is a sympathomimetic. Budesonide is an inhaled steroid. Tiotropium is an anticholinergic. Cromolyn is a mast cell stabilizer.

A patient, diagnosed with asthma, has been prescribed tiotropium. What should the nurse know about tiotropium? (Mark all that apply.)

-It is an anticholinergic -You only need to take it once a day -It has a rapid onset of action and a long duration Explanation: Tiotropium is the first drug approved for once-daily maintenance treatment of bronchospasm associated with COPD. Patients who cannot tolerate the sympathetic effects of the sympathomimetics might respond to the anticholinergic drugs ipratropium (Atrovent) or tiotropium (Spiriva). Tiotropium has a rapid onset of action and a long duration, with a half-life of 5 to 6 days.

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

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

A 27-year-old athlete with newly diagnosed asthma presents for patient education regarding situations that could precipitate an asthma attack. The nurse teaches that acute episodes of asthma may last minutes to hours. In this teaching, which precipitants would the nurse state may cause the asthma? (Select all that apply.)

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

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 to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. Explanation: 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.

In children, high doses of nebulized albuterol have been associated with what conditions? (Select all that apply.)

-Tachycardia -Hypokalemia -Hyperglycemia Explanation: In children, high doses of nebulized albuterol have been associated with tachycardia, hypokalemia, and hyperglycemia. Lowered or elevated blood pressure is not a usual issue with high doses of nebulized albuterol in children.

Aerosols are often the drugs of choice to treat asthma because of what characteristics? (Select all that apply.)

-They produce fewer adverse effects than oral or parenteral drugs. -They act directly on the airways. -They relieve symptoms quickly. -They can usually be given in smaller doses. Explanation: 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.

The nurse assesses the serum theophylline of a patient. Which finding would the nurse identify as being therapeutic?

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

A client is using an inhaled bronchodilator as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time?

15 minutes before engaging in exercise

The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time?

15 minutes prior to exercising

A client who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert it full effects within which time frame?

20 minutes Explanation: When given intravenously, epinephrine peaks in approximately 20 minutes. It would be at this time that the drug is most effective.

A client is receiving theophylline intravenously. The nurse reviews the results of his serum drug levels and notifies the physician for which result?

25 mcg/mL Explanation: A serum theophylline level greater than 20 mcg/mL is considered toxic.

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?

9:30AM Explanation: 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 patient has been admitted to a health care facility with asthma. The nurse is advised to administer theophylline to the patient. To which patients can the nurse safely administer theophylline?

A 65-year-old male patient with asthma Explanation: The nurse can safely administer theophylline to the patient who is 65 years of age. It needs to be administered cautiously in patients above 69 years of age, or with hepatic disease, cardiac disease, and hypertension.

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 physician to order?

A modified dose of aminophylline Explanation: 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.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem?

Adrenal insufficiency Explanation: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.

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?

Adrenal insufficiency Explanation: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. The patient is not at risk for tachycardia, edema, or hypoglycemia unless related to adrenal insufficiency.

A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the physician to give him?

Albuterol Explanation: A selective, short-acting, inhaled beta2-adrenergic agonist (e.g., albuterol) is the initial rescue drug of choice for acute bronchospasm; subcutaneous epinephrine may also be considered.

The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son's medication regimen by the nurse. The nurse is currently teaching the parent's about the appropriate use of a "rescue drug" for acute exacerbations of their son's asthma. What drug should the nurse suggests the parents to use in these situations?

Albuterol Explanation: Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing. Theophylline does not produce rapid symptom relief and beclomethasone is a maintenance drug. Acetylcysteine is not used in the treatment of asthma because it is used to manage secretions, which are not associated with asthma.

During the summer, a female client experiences increased periods of acute symptoms of her asthma. The physician increases the dose frequency of which of her medications?

Albuterol Explanation: Albuterol is the initial drug of choice for acute bronchospasm.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication?

Albuterol causes relaxation of the bronchial smooth muscles Explanation: The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.

The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?

Albuterol first, wait five minutes and then follow with flunisolide Explanation: Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.

A client recently began taking theophylline for treatment of asthma. Which changes in the client's lifestyle would suggest that the client understands proper use of the drug and management of the disease?

Avoiding caffeine Explanation: Some bronchodilating drugs, such as theophylline, can cause tachycardia, dysrhythmias, palpitations, agitation, and insomnia. Since caffeine, a mild bronchodilator, can add to these effects, clients should avoid excessive amounts while taking bronchodilating drugs. Clients with asthma and other bronchoconstrictive disorders should be encouraged to drink ample amounts of fluids each day to help thin secretions in the throat and lungs.

Which of the following would a nurse identify as a surfactant?

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

A patient is experiencing an acute asthma attack. What is the first-line therapy for relief of an acute asthma attack?

Beta2-adrenergic agonist Explanation: A patient experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The patient can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

A patient is given theophylline to treat acute asthma symptoms. Which of the following foods should the patient avoid?

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

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?

Cigarette smoking Explanation: 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 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?

Coffee Explanation: 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.

The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline?

Coffee Explanation: Theophylline is a xanthine, which has properties that are close to caffeine; therefore, the nurse will ensure that the client doesn't have anything on the tray that has caffeine in it.

The client's theophylline levels are increased. The nurse questions the client about his intake of:

Coffee Explanation: Xanthines are found in colas, coffee, chocolate, and charcoal-prepared foods. This could cause the client's theophylline levels to increase. Neither tea, carrots, nor cheese affect theophylline levels.

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?

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

A patient is experiencing an acute asthma attack. Which of the following medications are contraindicated for the treatment of acute asthma?

Cromolyn (Intal) Explanation: Cromolyn stabilizes mast cells and is not used in acute bronchospasm. Aminophylline is used in limited cases, but is administered for acute asthma attack. Albuterol is used for acute asthma attack. Corticosteroids are administered for acute asthma attack to decrease inflammation.

Which of the following effects would result from the action of montelukast?

Decreased eosinophil migration Explanation: 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 patient is admitted to the emergency room with inspiratory stridor and air hunger after a bee sting. Which medication will the nurse prepare for administration?

Epinephrine (Adrenalin) Explanation: 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.

True or False: Isoproterenol is an anticholinergic agent.

False Explanation: Isoproterenol is a sympathomimetic agent.

After teaching a group of students about leukotriene receptor antagonists, the instructor determines a need for additional teaching when the students identify which agent as an example?

Fluticasone Explanation: Fluticasone is an inhaled steroid. Montelukast is a leukotriene receptor antagonist. Zileuton is a leukotriene receptor antagonist. Zafirkulast is a leukotriene receptor antagonist.

The client has mild, persistent asthma. The nurse anticipates the health care provider prescribing which of the following daily medications?

Fluticasone Explanation: Terbutaline, albuterol, and levalbuterol are all short-acting beta-2 agonists that are used for acute symptom relief. Fluticasone is a daily inhaled corticosteroid.

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

Has a high coffee intake Explanation: 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.

A patient is prescribed salmeterol. The nurse would expect this drug to be administered by which route?

Inhalation

A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route?

Inhalation Explanation: Levalbuterol is administered only as an inhalant by nebulizer.

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?

Inhales corticosteriod agents will reduce airway inflammation Explanation: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system. Inhaled corticosteroid agents do not affect bronchodilation or constriction.

A neonate is receiving beractant. The nurse understands that this agent is administered by which route?

Intratracheal

A male client is prescribed montelukast and uses it successfully to manage his asthma. He develops hepatitis C. What would the nurse expect the physician to do?

Maintain the same dose of the montelukast Explanation: Montelukast and zafirlukast produce higher blood levels and are eliminated more slowly in clients with hepatic impairment. However, no dosage adjustment is recommended for clients with mild to moderate hepatic impairment.

What is used to treat acute air flow obstruction?

Metaproterenol (Alupent) Explanation: Metaproterenol (Alupent) is a short-acting beta-2 agonist used as a quick relief medication. Qvar is an inhaled corticosteroid used as a long-term control medication. Singulair is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Astelin is a second-generation antihistamine.

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. Explanation: 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 client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler?

Nervousness Explanation: Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.

A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels?

Nicotine Explanation: When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.

While reviewing a client's history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?

Peanuts Explanation: The use of ipratropium is contraindicated in the presence of known allergy to the drug or to peanuts or soy products because the vehicle used to make ipratropium, an aerosol, contains a protein associated with peanut allergies.

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...

Rebound bronchoconstriction Explanation: 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.

The nurse is evaluating the education of a client that uses albuterol for an acute asthma attack. The nurse knows that the lesson has been effective when the client states that albuterol is which of the following types of medication?

SABA Explanation: Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.

A nurse is teaching a client newly diagnosed with asthma how to manage the disease. What should the nurse encourage this client to stop doing?

Smoking cigarettes Explanation: Since bronchoconstriction can be triggered by smoke, patients with asthma should be encouraged to quit smoking and to avoid secondhand smoke. Instead of instructing a patient to abandon exercise, health care providers should consider prescribing bronchodilators as pre-exercise prophylaxis. Non-steroidal anti-inflammatory drugs can cause trigger an asthmatic attack in some patients; however, not all anti-inflammatory drugs cause this reaction.

A patient is started on albuterol (Proventil). What reaction should the patient be instructed on?

Tachycardia will occur Explanation: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The patient will not experience polydipsia, hypotension, or diarrhea.

A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest?

Take it on an empty stomach, 1 hour before or 2 hours after meals Explanation: Sustained-release preparations of theophylline should be taken on an empty stomach, 1 hour before or 2 hours after meals. Immediate-release preparations should be administered with meals to alleviate gastrointestinal distress. Foods containing xanthines, in particular caffeine, increase the effects of theophylline, but they do not help minimize the adverse effects of theophylline. Patients who smoke may require an increase in theophylline dosage of up to 50%, but increasing the dosage is not a nursing responsibility.

A male client was using nicotine patch to stop smoking when he was started on theophylline for emphysema. He has successfully stop smoking and has stopped using his nicotine patch. Which would be warranted?

Theophylline dose should be decreased Explanation: Nicotine decreases theophylline levels. If a client is no longer using nicotine his/her theophylline levels will increase warranting a decrease in theophylline dose.

True or False: Leukotriene receptor antagonists are administered orally.

True

True or False: Cromolyn should not be used during an acute asthmatic attack.

True Explanation: Cromolyn is the only mast cell stabilizer still available and is available only in an OTC form. It is no longer considered part of the treatment standards because of the availability of more specific and safer drugs.