Pharm II Exam 2 (End of the chapter question with ATI)

A patient was prescribed fluticasone 2 sprays in each nostril 2 weeks ago. She calls the nurse to report that the drug has not helped. Which question should the nurse ask to identify a common cause of early treatment failures?

"Do you have nasal congestion?"

A patient is prescribed omalizumab for allergic rhinitis. Which statement, if made by the patient, suggests a need for further teaching about this drug therapy?

"I need to continue taking this drug during the winter to control my allergy to house dust."

A patient has received instructions regarding administration of benzonatate. Which statement made by the patient would indicate that the patient needs further teaching?

"I should crush the beads and mix them in a soft food such as applesauce."

A patient has received instructions regarding administration of a second-generation oral antihistamine for seasonal allergic rhinitis. Which of these statements made by the patient would indicate that the patient needs further teaching?

"I should only use the medication when i am experiencing symptoms."

A patient has received instructions from the nurse to administer two puffs of a B2-agonist drug via a MDI. Which statement by the patient would indicate a need for further teaching?

"I should start to inhale after activating the inhaler"

On admission, the nurse is reviewing all the drugs that a 78-year-old patient takes at home. The patient takes OTC diphenhydramine when she has a cold. That nurse explains the effect of first-generation histamine blockers on the body and on a cold. Which statement, if made by the patient after the teaching, suggests a need for additional teaching?

"diphenhydramine does not prevent colds but it can make my cold go away faster"

A healthcare professional is caring for a patient who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the healthcare professional expect to administer?

Acetylcysteine

A hospitalized patient has orders for budesonide and salmeterol, one inhalation every 12 hours and albuterol MDI, two puffs every 4 hours as needed. The patient has not requested albuterol for the last 24 hours. When preparing to administer the budesonide and salmeterol, the nurse notes audible wheezing and dyspnea. Which action by the nurse is correct?

Administer albuterol, wait 5 minutes, and then administer the salmeterol and then budesonide

What are current recommendations for use of inhaled glucocorticoids for persistent asthma?

Administer daily even on days where there are no symptoms

A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?

Administer the albuterol inhaler prior to using the beclomethasone inhaler

Zafirlukast is listed on the Medication Administration Record (MAR) to be administered at 7:00 am. Breakfast is served at 8:30 am. What should the nurse do?

Administer the drug as ordered

A child with moderate asthma is distressed because she has just learned that she is allergic to the family dog. Which intervention would most effectively address the physical and psychosocial needs of the child?

Advise the family to train the dog to stay out of bedrooms and off of furniture

The nurse would question the prescriber if which drug regimen is ordered for an asthmatic patient? (select all that apply)

Albuterol followed by budesonide suspension via ultrasonic nebulizer for a 6-year-old patient; Budesonide suspension followed by albuterol via jet nebulizer with a mask for a 4-year-old patient; salmeterol, one inhalation and budesonide every 12 hours for a 40-year-old patient

A healthcare professional is talking to a patient who is prescribed albuterol (proventil) via inhaler and fluticasone (advair) via inhaler for asthma management. The health care professional should tell the patient to use the albuterol inhaler before using the fluticasone inhaler for which of the following reasons?

Albuterol will increase the absorption of fluticasone

A patient is scheduled to receive a radiocontrast media for a computerized axial tomography (CAT) scan. The patient has never received any radiocontrast media. Why must the radiology nurse carefully assess for an allergic reaction?

Allergic reactions can occur even without prior exposure to radiocontrast media

A healthcare professional who is advising a patient about using intranasal glucocorticoids should include which of the following instructions?

Allow at least 2 weeks for the full therapeutic effect

Which statements are true about the common cold? (select all that apply)

Antibiotics are not effective, antihistamines do not help

The nurse administering albuterol via nebulizer when a patient with asthma experiences severe wheezing while trying to eat lunch. Several minutes after the treatment, the patient is resting quietly with his eyes closed. What should the nurse do?

Assess the patient's breathing and lung sounds

When advising a patient about taking prednisone for chronic asthma, a health care professional should include which of the following information?

Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDS)

Why is it important to teach patients to be prepared for possible allergic reactions every time they take a certain drug?

Because allergic reactions usually occur after previous exposure to a drug or its components

Despite instruction by the nurse to swallow the benzonatate whole, the patient proceeds to chew the capsule. What is a priority nursing concern until the effect of this drug has diminished?

Bronchospasms

Which of these assessment findings, if identified in a patient who is taking an oral decongestant, would be a priority to report to the prescriber?

Chest pain

Research suggests that codeine, dextromethorphan, and diphenhydramine are not effective in suppressing coughs induced by

Common cold

A healthcare professional should recognize that using pseudoephedrine (sudafed) to treat allergic rhinitis requires cautious use with patients who have which of the following

Coronary artery disease

A healthcare professional is advising a patient about the use of beclomethasone to treat asthma. The healthcare professional should explain that the drug treats asthma because it performs which of the following actions?

Decreases inflammation

Legal restrictions apply to the purchase of pseudoephedrine (sudafed) because of which of the following risks?

Drug abuse

A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhinitis. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication?

Dry mouth

Which adverse effect would the patient be most likely to experience when prescribed the anticholinergic bronchodilator drug tiotropium?

Dry mouth

A healthcare professional is advising a patient about the use of cromolyn sodium. Which of the following instructions should the health care professional include?

Expect a bitter aftertaste

A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcysteine. Which of the following information should the nurse include in the instructions?

Expect this medication to smell like rotten eggs

If flunisolide and formoteral are both ordered to be administered at 9:00 am, how should they be administered?

Formoteral first, using a spacer, then flunisolide 5 minutes later

Budesonide and beclomethasone MOA

Glucocorticoids that suppresses inflammation- leading to decreased synthesis and release of inflammatory mediators, decreased infiltration and activity of inflammation cells, and decreased edema of the airway mucosa

The classic antihistamines are drugs that block

H1 receptors

When advising a patient about using zileuton (zyflo), a health care professional should include which of the following instructions?

Have laboratory tests performed at regular intervals

The nurse is caring for several patients who receive b-agonist inhalation treatments for asthma. After treatments are administered, it is of greatest priority to reassess the patient who also has a history of which condition?

Heart failure

The school nurse notes that a child is receiving long-term therapy with intranasal glucocorticoids for seasonal rhinitis. The nurse must monitor the child's

Height

The nurse is caring for a patient who is prescribed zafirlukast for asthma and warfarin for atrial fibrillation. Which is a possible result of the interaction of these two drugs?

Hemorrhage

The nurse is teaching a patient who has a history of benign prostatic hyperplasia (BPH) and allergic rhinitis about taking desloratadine. What should teaching include? (select all that apply)

High doses are more likely to cause sedation, taking doses higher than recommended does not help the drug work better

Allergic rhinitis involves the release of (select all that apply)

Histamine, leukotrienes, prostaglandins

When advising a patient who is beginning fluticasone propionate/salmeterol (adviar) therapy, which of the following instructions should a healthcare professional include?

Increase weight-bearing activity

What are the most effective drugs for prevention and treatment of symptoms of seasonal and perennial rhinitis?

Intranasal glucocorticoids

A nurse is teaching a client about the use of fluticasone to treat perennial rhinitis. Which of the following statements by the client indicates an understanding of the teaching?

It can take as long as 3 weeks before the medication takes a maximum effect

Why does the FDA recommend that patients with asthma who use an inhaled long-acting B-adrenergic agonist (LABA) bronchodilator only be prescribed a combination product with a glucocorticoid rather than the two drugs as separate inhalers?

It decreases the risk that the patient will take the LABA and not the glucocorticoid

What is an advantage of intranasal cromolyn in allergic rhinitis?

It has fewer adverse reactions

A patient who recently saw a commercial for montelukast asks the office nurse why the prescriber will not order this for her allergic symptoms. The nurse knows that prescribers may not readily prescribe this drug for allergic rhinitis for what reason?

It has many adverse effects

Cromolyn MOA

Mast cell stabilizer that suppresses inflammation by stabilizing the cytoplasmic membrane of mast cells, preventing release of histamine and other mediators

Umeclidinium may cause hypersensitivity reactions in people with which allergy

Milk

A patient who has asthma has had peak expiratory flow rates at approximately 70% of his personal best despite regular and as-needed use of drugs. What are current treatment recommendations for this patient?

Monitor PEF more frequently and consult the prescriber for possible treatment changes

A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication?

Nasal congestion

The nurse teaches a patient with allergic rhinitis that oral antihistamines are not effective in reducing which symptom?

Nasal congestion

The parent of a 3-year-old child who was recently diagnosed with asthma calls during phone hour at the pediatrician's office. The child has a cold, which often triggers an asthma attack. The parent has forgotten which drug the child should be given when he starts wheezing. Which drug would be safe and effective?

No antihistamines are safe and effective for wheezing of asthma

A health care professional should tell a patient who is taking albuterol (proventil) to report which of the following possible indications of a serious adverse effect?

Palpitations

A patient exhibits watery nasal discharge and sneezing every winter when the house is closed and the forced-air furnace is running. How is this classified?

Perennial rhinitis

In an emergency department, the nurse is caring for a patient who has asthma and takes omalizumab in an emergency department. Which symptom would warrant immediate, priority care?

Perioral edema

Before prescribing dextromethorphan (robitussin) to a patient, the primary care provider should know that, when given with an opioid, the drug can result in which of the following?

Potentiation of the analgesic effect of the opioid

It is of greatest priority to teach strategies to maintain adequate bone mass if an asthmatic patient is prescribed which drug?

Prednisolone oral tablets

Which outcome would be of greatest priority for most asthma patients?

Preventing airway inflammation

A healthcare professional who is advising a patient about the use of antihistamines to treat allergic rhinitis should explain that these drugs are effective because they perform which of the following actions?

Prevents histamine from binding to receptors

The nurse is administering 6:00 am medications, including chlorpheniramine 4 mg every 6 hours for urticaria. The patient complains of nausea associated with the medication. What should the nurse do?

Provide a snack with each dose of medication

A healthcare professional is advising a patient about the use of cromolyn sodium to prevent bronchospasm. The healthcare professional should explain that the drug prevents bronchospasm because it performs which of the following actions?

Reduces inflammation

A healthcare professional who is advising a patient about the use of an expectorant to treat a cough should explain that this type of drug is effective because it performs which of the following actions?

Reduces surface tension

A health care professional is caring for a patient who is taking codeine. Which of the following is the most important assessment following administration of the drug?

Respirations

Which of these assessment findings, if identified by the delivery room nurse in a full-term neonate whose mother has taken diphenhydramine just before going into labor, would be a priority to immediately report to the pediatrician?

Respirations 25 breaths/min

A healthcare professional is advising a patient about the adverse effects of pseudoephedrine (sudafed). Which of the following should the healthcare professional include?

Restlessness, Insomnia, Anxiety

The nurse is explaining therapy with cromolyn to a patient who has asthma. Which statement should not be included in the teaching?

Rinse the mouth immediately after administration to remove the unpleasant taste.

A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include?

Rinse your mouth after each use of this medication

A healthcare professional should explain to a patient who is prescribed diphenhydramine that the most common side effect associated with the drug is

Sedation

A nurse is teaching a client who has a new prescription for dextromethorphan to suppress a cough. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication?

Sedation

A healthcare professional is monitoring plasma drug levels in a patient who is taking theophylline (theo-24). Which of the following adverse effects should the healthcare professional expect to see if the patient's levels indicates toxicity?

Seizures

An adolescent patient with asthma has controlled her asthma using a drug regimen that includes theophylline. Which new behavior would be of greatest priority to report to the prescriber?

Smoking marijuana

Which of the following should a healthcare professional include when advising a patient about the use of montelukast (singulair)?

Take the drug once a day in the evening

A 42-year-old patient with asthma is admitted for a surgery. Which information would be of greatest priority for the nurse to share with the anesthesiologist?

The patient was recently changed from long-term oral methylprednisolone to inhaled beclomethasone

The nurse would be most concerned about drug interactions if a patient who has asthma is prescribed zileuton and

Theophylline

A healthcare professional cautions a patient who is taking guaifenesin (mucinex) about using combination over-the-counter cold products because

They can also contain guaifenesin

Why do second-generation H1 blockers cause less sedation than first-generation H1 blockers?

They cross the blood-brain barrier poorly

A healthcare professional who is advising a patient about the use of a mucolytic to treat a cough should explain that this type of drug is effective because it performs which of the following actions?

Thins and loosens mucus

For which of the following reasons should a patient attach a spacer to a metered-dose inhaler

To increase the amount of drug delivered to the lungs

The nurse is providing instructions to a client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include?

Tremors are an adverse effect of this medication

Which assessment finding in a patient who is prescribed a B2-adrenergic agonist would be a reason for the nurse to consult the prescriber?

Unexplained fainting

A healthcare professional is caring for a patient who is taking ipratropium (atroven). The healthcare professional should explain which of the following adverse effects to the patient?

Urinary retention, Dry mouth

When explaining how a patient should use ipratropium (atrovent), a healthcare professional should include which of the following instructions?

Wait 5 min between using the drug and another inhaled drug

A nurse is teaching a client who has prescription for long-term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication?

Weight gain

Which symptom suggests that a child with asthma is not rinsing his or her mouth after using a glucocorticoid inhaler?

White patches in mouth

Ipratropium MOA

anticholinergic that relieves bronchospasm by blocking muscarinic cholinergic receptors in the bronchi (muscarinic antagonist)

Albuterol MOA

beta 2 adrenergic agonist that works as a sympathomimetic, activating beta 2-adrenergic receptors in the smooth muscle of the lungs to promote bronchodilation and thus relieve bronchospasm

Montelukast MOA

high affinity for leukotriene receptors in the airway and on proinflammatory cells such as eosinophils. By occupying these receptors, the drug blocks receptor activation by the body's leukotrienes. Leukotrienes are compounds that promoted smooth muscle constriction, blood vessel permeability, and inflammatory responses through direct action as well as through recruitment of eosinophils and other inflammatory cells

Tiotropium MOA

long acting, anticholinergic that relieves bronchospasm by blocking muscarinic cholinergic receptors in the bronchi (muscarinic antagonist)

Salmeterol MOA

long-acting beta2 adrenergic agonist that works as a sympathomimetic, activating beta2-adrenergic receptors in the smooth muscle of the lungs to promote bronchodilation and thus relieve bronchospasm

Theophylline MOA

methylxanthine that produces bronchodilation by relaxing smooth muscle of the bronchi through blockade of receptors for adenosine

Azelatine MOA

second-generation antihistamine that blocks histamine-1 receptors and thereby decreases itching, sneezing, and rhinorrhea; but does not reduce congestion

Roflumilast MOA

selective inhibitor of phosphodiesterase, an enzyme that inactivates cyclic adenosine monophosphate (cAMP). This drug reduces inflammation, cough, and excessive mucus production by raising levels of cAMP in lung cells