PHARM - Respiratory Practice Questions

You are instructing a patient about using cromolyn via inhalation to treat exercise-induced asthma. You should should advise the patient to take the drug:

15 minutes before exercising

You should instruct a patient who is taking zileuton to report which of the following possible indications of a serious adverse effect of the drug?

Abdominal pain This medication may cause liver damage and hepatitis.

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 Acetylcysteine is a mucolytic that loosens thick respiratory secretions.

You are instructing a patient who is taking cetirizine (Zyrtec) how to treat allergic rhinitis. Which of the following information should the provider include?

Administer the drug prophylactically during allergy seasons.

A nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious use with clients who have which of the following conditions?

CAD Because pseudoephedrine, an oral sympathomimetic, can cause systemic vasoconstriction, it requires cautious use with clients who have severe hypertension or coronary artery disease.

A nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects?

Decreases inflammation Beclomethasone, an intranasal glucocorticoid, treats asthma by reducing inflammation.

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

Drug abuse

You should monitor a patient taking dextromethorphan (Robitussin DM and others) due to the potential for which of the following?

Drug abuse

You should recognize that codeine is contraindicated for patients who have which of the following?

Emphysema Codeine is contraindicated for patients who have decreased respiratory reserve

When advising a patient about using zileuton (Zyflo), a healthcare professional should include which of the following instructions?

Have lab tests performed at regular intervals (liver function) Zileuton, a leukotriene modifier, can cause liver injury. The health care professional should monitor liver function once a month for 3 months, then every 2 to 3 months during the first year of treatment.

Which of the following information should you include when teaching a patient about using an albuterol (Proventil) inhaler for asthma?

Use it periodically to prevent exercise-induced asthma

A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include?

Wait 5 minutes between using the drug and another inhaled drug Ipratropium, an inhaled anticholinergic, requires a 5-min wait between its administration and that of another inhaled drug to allow for bronchodilation to take effect.

You should advise a patient who is taking beclomethasone (QVAR) to monitor for which of the following possible indications of an adverse effect of the drug?

White coating in the mouth

You are obtaining a health history from a patient who is to start using a new ipratropium (Atrovent) inhaler. Which of the following information from the patient's history should alert you to take further action? (select all that apply)

- urinary retention - glaucoma

A nurse is teaching a client who is taking prednisone for chronic asthma. Which of the following instructions should the nurse include?

"Avoid taking nonsteroidal anti-inflammatory drugs" Gastric protective measures are essential for clients who are taking oral glucocorticoids. Anti-inflammatory drugs can cause GI bleeding, so clients should not take them concurrently with prednisone.

Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)?

"I will rinse my mouth with water after each use." Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.

The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful?

"This inhaler is not to be used alone to treat an acute asthma attack." Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.

Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse?

"This medication works by preventing the inflammation that causes your asthma attack." LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast.

Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers?

"Wait 1 to 2 minutes before you take a second puff of the same drug." If a second puff of the same drug is ordered, instruct the client to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the client to wait 2 to 5 minutes between the medications or to take as prescribed.

Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply)

- Lactose - Cellulose - Povidone Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs.

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include?

- Restlessness - Insomnia - Anxiety

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone/salmeterol via inhaler who asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler?

Albuterol will increase the absorption of fluticasone Albuterol, an inhaled, short-acting beta2 agonist, causes bronchodilation, which will increase the absorption of fluticasone, an inhaled glucocorticoid.

You are advising a patient about using intranasal glucocorticoids. What instructions should you include?

Allow at least 2 weeks for the full therapeutic effect It can take 2 or 3 weeks to see the full effect from intranasal glucocorticoids.

The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription?

Coronary artery disease Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease.

A nurse is preparing to administer phenylephrine to a client. The nurse should identify that which of the following manifestations is an adverse effect of this drug?

Headache Oral sympathomimetics stimulate the adrenergic receptors, causing blood vessel constriction, which can cause nervousness, headache, blurred vision, and tremors.

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

Increase weight-bearing activity Weight-bearing activity can help minimize bone loss, which is a side effect of fluticasone propionate/salmeterol, an inhaled glucocorticoid.

You should instruct a patient using phenylephrine (Neo-Synephrine) spray for nasal congestion to do which of the following to avoid rebound congestion? (Select all that apply)

Limit the drug's use to 3-5 days

Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client

Liver enzymes Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.

A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)?

Longer duration of action Salmeterol has a longer duration of action, requiring the client to use it only twice a day instead of three or four times a day with albuterol.

For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over-the-counter cold products?

OTC cold products can also contain guaifenesin

A nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug?

Palpitations Although not common at therapeutic doses, beta2 agonists can cause cardiac stimulation, resulting in chest pain, palpitations, hypertension, and arrhythmias.

Which of the following indicates to you that a patient who is taking theophylline needs further instruction?

Patient drinks 2 cups of coffee each morning

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine?

Potentiation of depression of CNS actions Combining dextromethorphan with an opioid, such as morphine, increases the risk for decreased respirations and other depressed CNS responses.

A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions?

Prevent histamine from binding to receptors Antihistamines treat allergic rhinitis and reduce swelling by blocking histamine from binding to the receptor sites.

A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects?

Reduces inflammation Cromolyn sodium, a mast cell stabilizer, reduces inflammation by inhibiting the inflammatory response.

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 Expectorants act by reducing the surface tension of respiratory secretions. This results in thinning thick mucus, making it easier to cough out of the lungs and drain out of the nose and sinuses.

A nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make?

Respirations The greatest risk to clients who are taking codeine, an opioid agonist, is severe respiratory depression. Therefore, the respiratory rate is the priority assessment.

A nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity?

Seizures Seizures are likely when plasma drug levels of theophylline, a methylxanthine, are higher than 30 mcg/mL, which indicates toxicity.

Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels?

St. John's wort St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.

Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect?

Tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.

A nurse is teaching a client about montelukast. Which of the following instructions should the nurse include?

Take the drug once a day in the evening Montelukast, a leukotriene modifier, is most effective when taken once per day in the evening.

The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level?

Therapeutic The therapeutic theophylline level is 10 to 20 mcg/mL.

What is the role of corticosteroids in the treatment of acute respiratory disorders?

They decrease inflammation. Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

A nurse is teaching a client about the use of mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects?

Thins and loosens mucus Mucolytics make mucus less viscous to increase a cough's productivity.

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 A spacer increases the amount of drug that reaches the lungs.

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects?

- Urinary retention - Dry mouth

A nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug?

Drowsiness The most common adverse effect of diphenhydramine, a first-generation antihistamine, is drowsiness.