Pharmacology: Chapter 55: Drugs Acting on the Lower Respiratory Tract
A 6-year-old child weighing 52 lb has had a loading dose of aminophylline. The nurse is ready to administer the regular prescribed dose of 4 mg/kg every 4 hours for three doses. How many milligrams should the client receive in 12 hours? Provide your answer to the nearest milligram. Provide your answer using numbers only - no units.
ANS: 284
A client has been diagnosed with asthma and prescribed inhaled steroids. What should the nurse teach the client about this treatment? a.Inhaled corticosteroids should not be used on an emergency basis. b.Effective levels are usually reached within 72 hours of starting treatment. c.Systemic adverse effects should be expected and can be serious. d.The drug will stimulate the sympathetic nervous system.
ANS: A
A client is prescribed salmeterol with dosage on a 4- to 6-hour schedule for treatment of exercise-induced asthma. What is the recommended dosing schedule of asthma experts regarding this drug? a.30 minutes before exercise to prevent dyspnea during exercise b.Immediately before and after exercise to prevent dyspnea c.As needed to treat or prevent dyspnea during exercise d.Every 1 to 2 hours to treat or prevent dyspnea during exercise
ANS: A
A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe? a.Ipratropium b.Isoetharine c.Cromolyn d.Aminophylline
ANS: A
A client with chronic bronchial asthma is prescribed montelukast. What will the nurse instruct the client to avoid taking? a.Aspirin b.Penicillin c.Sertraline d.Nifedipine
ANS: A
The client is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity? a.Avoiding beverages that contain caffeine b.Eating foods high in potassium c.Limiting fluid intake to 1,000 mL a day d.Taking the medication on an empty stomach
ANS: A
A client with asthma is going to begin taking an inhaled steroid. The nurse teaching the client that what adverse effects may occur when using this drug? Select all that apply. a. Headache b. Rebound congestion c. Sepsis d. Epistaxis e. Depression
ANS: A,B,D
The nurse is caring for a client with asthma who has been prescribed zafirlukast. The nurse would hold the medication and contact the provider if the client reported taking which medications at home? Select all that apply. a. Propranolol b. Warfarin c. Acetaminophen d. Ampicillin e. Terfenadine
ANS: A,B,E
The nurse provides care for numerous children with asthma. The nurse should expect to administer what drugs? Select all that apply. a. Long-acting inhaled steroids b. Xanthines c. Leukotriene-receptor antagonists d. Topical steroid nasal decongestants e. Beta-agonists
ANS: A,C,E
A 76-year-old man with COPD has been taking ipratropium. What change in the client's health status is most likely to require a change in the client's drug regimen? a.The client begins taking a diuretic for hypertension. b.The client is diagnosed with benign prostatic hypertrophy. c.The client loses 15 lb over 8 weeks. d.The client develops a venous ulcer.
ANS: B
A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to: a.keep an extra oxygen tank on hand for propelling the medication. b.sit in a fully upright position when administering the medication. c.take the exact number of puffs that have been prescribed. d.gargle with an alcohol-based mouthwash after each dose.
ANS: B
A client is in the clinic to have blood drawn to assess theophylline levels. The client appears to being responding well to the medication and is not experiencing any adverse effects. What serum level will the nurse expect the client to have? a.Between 0.5 and 5 mcg/mL b.Between 10 and 20 mcg/mL c.Between 25 and 35 mcg/mL d.Between 40 and 50 mcg/mL
ANS: B
The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response? a."It is an umbrella term for diseases like acute bronchitis." b."It means that the lungs have been damaged in such a way that airflow is limited in and out of the lungs." c."It means your lungs can't expand and contract like they are supposed to, which makes it hard for you to breathe." d."It is a term that covers so many lung diseases that all affect your breathing."
ANS: B
The nurse has provided health teaching for a 15-year-old boy newly diagnosed with asthma. What statement, made by the client, indicates that he has a good understanding of the teaching the nurse has done regarding inhalers? a."I should hold my breath when administering a puff." b."The aerosol canister should be shaken well before using." c."I need to take three short quick breaths when I administer the inhaler." d."I should insert the inhaler around 1 inch into my mouth."
ANS: B
The nurse is caring for a 38-year-old client with asthma who has been started on albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects? a.The client reports excessive thirst. b.The client's heart rate is 99 beats/minute. c.The client's oral temperature is 37.8°C (100°F). d.The client had diarrhea this morning.
ANS: B
The nurse is caring for a client experiencing acute bronchospasm. What drug is most likely to meet this client's needs? a.Ipratropium bromide b.Epinephrine c.Cromolyn d.Ephedrine
ANS: B
The nurse is caring for a client who has an acute attack of bronchoconstriction. What principle should guide the care team's choice of treatment? a.Short-acting bronchodilators are the drug of choice in this situation. b.Epinephrine is the drug of choice in this situation. c.Self-administered metered-dose inhalers (MDIs) are safest and most effective. d.Long-acting beta2-adrenergic agonists (LABAs) are the first-line treatment.
ANS: B
The nurse is caring for a client with chronic obstructive pulmonary disease. The plan of care will focus on what client problem? a.Risk for aspiration b.Lack of patent airway c.Activity intolerance d.Adverse effects of medication therapy
ANS: B
The nurse is reviewing the medication regimen of a newly admitted client. The nurse observes that the client takes sustained-release theophylline. When planning the client's care, the nurse should address what characteristic of this client's asthma? a.The client likely experiences several asthma exacerbations each day. b.The client likely has asthma symptoms once or twice a day. c.The client likely experiences asthma symptoms a few times each week, but not every day. d.The client was likely diagnosed with asthma several months ago.
ANS: B
What action by the client would indicate that the client understands how to use an inhaler? a.The client inhales as soon as the inhaler enters his or her mouth. b.The client holds his or her breath as long as possible after compressing the canister. c.The client uses a spacer to administer a powdered medication. d.The client exhales as soon as he or she compresses the inhaler.
ANS: B
The nurse is caring for a child who has been newly diagnosed with asthma. What environmental modifications should the nurse encourage the parents to make to help their child avoid future attacks? Select all that apply. a. Make sure the child begins herbal therapy as soon as possible. b. Avoid crowded areas as much as possible. c. Keep the child away from any known allergens. d. Encourage the child to maximize physical activity. e. Keep the child away from areas that are filled with cigarette smoke.
ANS: B,C,E
The use of a sympathomimetic would be contraindicated or only used with great caution in clients with what disorders? Select all that apply. a. Hypothyroidism b. Cardiac disease c. Kidney disease d. Diabetes mellitus e. Peripheral vascular disease
ANS: B,D,E
A client presents to the emergency department in acute respiratory distress. A quick assessment by the triage nurse indicates that the client has experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the client may be allergic to what? a.Aspirin b.Penicillin c.Peanuts d.Ragweed pollen
ANS: C
An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the client be instructed to do? a.Use the inhaler every day at the same time each day. b.Use the inhaler as soon as the symptoms start. c.Use the inhaler 30 to 60 minutes before exercising. d.Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness.
ANS: C
A client, diagnosed with asthma, has been prescribed tiotropium. What should the nurse teach the client about this drug? Select all that apply. a. "It will likely make you fatigued." b. "You need to stay out of direct sunlight." c. "It is an anticholinergic." d. "You only need to take it once a day." e. "It has a rapid onset of action and a long duration."
ANS: C,D,E
A 70-year-old man is being treated for chronic obstructive pulmonary disease (COPD) with theophylline (Theo-Dur). What will be a priority assessment by the nurse? a.Intake of fatty foods b.Weight c.Activity level d.Use of nicotine
ANS: D
A client presents to the emergency department (ED) having an acute asthma attack and has been prescribed epinephrine. The nurse should assess what therapeutic effect of this drug? a.Decreased inflammatory response in the airways b.Reduced surface tension within the alveoli, allowing for gas exchange c.Inhibition of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the allergic asthmatic response d.Dilation of the bronchi with increased rate and depth of respiration
ANS: D
A client tells the nurse that a friend has recommended the use of herbs to treat the client's asthma. The client wants to "give this a try before taking drugs." The nurse counsels the client to begin treatment immediately with the prescribed medications for what reason? a.Herbs and supplements counteract the drugs used to treat asthma. b.Most natural products are less potent than traditional asthma medications. c.Many natural products reduce the effectiveness of adrenergic bronchodilators, even months later. d.Delays in appropriate treatment can have serious, even fatal, consequences.
ANS: D
A client with asthma has been prescribed an anti-inflammatory medication. How does an anti-inflammatory drug reduce this client's bronchoconstriction? a.Increasing ability to metabolize medication b.Decreasing formation of mucus secretions c.Increasing uptake of corticosteroids to medication d.Decreasing airway hyperreactivity to stimuli
ANS: D
A client with chronic obstructive pulmonary disease (COPD) presents to the emergency department in acute respiratory distress. The client's family tells the nurse that the client's problems began right after the client took her first dose of ipratropium. The nurse should prioritize assessment for what potential cause? a.An allergy to milk b.Overexertion by the client c.Incorrect administration technique d.An allergy to soy products
ANS: D
A client, newly diagnosed with chronic obstructive pulmonary disease (COPD), calls the clinic and asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse? a."The medications that have been ordered for you are what the physician thinks will help your breathing the most." b."The medications that have been ordered for you are to help you breathe with less resistance from your diaphragm." c."The medications that have been ordered for you are designed to work together to reduce your oxygen requirements." d."The medications that have been ordered for you are to help relieve the inflammation and to open your airways."
ANS: D
A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for asthma-related death? a.An Asian American client with a history of cigarette smoking b.A 17-year-old client who experiences exercise-induced asthma c.A 76-year-old client who takes theophylline d.An African American client taking salmeterol
ANS: D
A premature newborn is being treated for respiratory distress syndrome. What action should the nurse perform in anticipation of beractant administration? a.Establish reliable intravenous access b.Temporarily discontinue the client's oxygen therapy c.Review the client's bilirubin and AST and ALT levels, if available d.Position the client for intratracheal administration
ANS: D
The nurse is caring for a client who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously? a.Liver failure b.Renal failure c.Respiratory failure d.Heart failure
ANS: D
The nurse provides care for a client who presents to the outpatient clinic once per week to receive a dose of Zemaira. When planning the client's assessments, what guideline should the nurse follow? a.The client has a genetic predisposition to severe asthma. b.The client is a lung transplant recipient. c.The client has chronic obstructive pulmonary disease that has not responded to conventional therapies. d.The client has a high risk of emphysema.
ANS: D
