Unit 2: Chap. 33--Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction

The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching?

"I need to shake the inhaler well before taking the medication."

An adolescent client is prescribed a leukotriene receptor antagonist as a part of a medication regime to manage his/her asthma. Which statement made by the client requires additional education on this classification of medications?

"I need to take the medication when I start to have problems breathing."

The nurse is providing education to a client who has been prescribed theophylline. The nurse interprets what client statement as a sign of successful teaching?

"I should avoid beverages that contain caffeine."

A client who has been 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?

"The medications that have been ordered for you are to help relieve the inflammation and to open your airways."

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."

A nurse should question chronic asthma clients concerning which of the following at each office visit?

> Allergies > Frequency of attacks > Severity of attacks > Anti-asthma drugs currently taken > Anti-asthma drugs taken in the past

Chronic obstructive pulmonary disease (COPD) encompasses...

> Asthma > Chronic bronchitis

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?

> Avoid crowded areas as much as possible. > Keep the child away from any known allergens. > Keep the child away from areas that are filled with cigarette smoke.

A client is given a prescription for fluticasone/salmeterol (Advair) 250/50 to inhale one puff twice a day, before leaving the hospital after an acute asthma attack. The nurse completing the client's discharge counseling should tell the client which of the following?

> Continue to carry a rescue inhaler. > Check peak flow daily. > Rinse mouth after each use.

A client comes to the clinic because of an exacerbation of his asthma. When obtaining the client's history, the nurse would anticipate hearing the client report an increase in which of the following? Select all that apply.

> Cough > Dyspnea > Chest tightness

A nurse is assessing a client who comes to the emergency department with acute respiratory distress. The nurse suspects that the client is experiencing an asthma attack based on what symptoms?

> Cough with or without mucus > Generalized chest tightness > Prolongation of expiration

Adverse effects of inhaled corticosteroids include...

> Fungal infection > Pharyngeal irritation

When describing the mast cells to a group of students, an instructor would include what as being released by these cells?

> Histamine > Serotonin > Adenosine triphosphate

The pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present?

> Increased secretions > Mucosal congestion > Cough

After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which as possible adverse effects?

> Myalgia > Dizziness > Vomiting

What are some possible triggers for an asthma attack?

> exercise > allergens > pollutants > cigarette smoke > mold

Adrenergics are a category of bronchodilators used in the treatment of asthma and chronic obstructive pulmonary disease. In what conditions is cautious use of these drugs recommended?

> hypertension > seizure disorders > diabetes mellitus

An older adult client, diagnosed with chronic obstructive pulmonary disease (COPD), is being considered for corticosteroid therapy. The nurse should anticipate that these drugs may be administered by what routes? Select all that apply.

> oral > parenteral

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

Adrenal insufficiency

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

Albuterol

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.

The client has been diagnosed with asthma and 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

The goals of pharmacotherapy for asthma management are to reduce acute asthma episodes and maintain long-term control of persistent asthma. Two major groups of medications are used, one with a directly positive effect on the other's efficacy. Which medication group affects both pathophysiologies?

Anti-inflammatory drugs

A patient is prescribed Ventolin (albuterol) for bronchospasm in chronic bronchial asthma. Which of the following nursing diagnoses would the nurse expect to see on the care plan as a result of the adverse effect of albuterol?

Anxiety

A client with chronic bronchial asthma is prescribed montelukast. What will the nurse instruct the client to avoid taking?

Aspirin

A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition?

Asthma

A school-age client with a history of asthma presents to the primary care office with an elevated temperature, bilateral ear pain, and irritability. What instruction should the nurse convey to the parents regarding the use of antipyretics and analgesics?

Avoid administering acetaminophen for fever and discomfort.

A client is experiencing an acute asthmatic attack. Which agent would be most effective?

Beta-2 selective adrenergic agonist

The nursing instructor is discussing common respiratory disorders with the nursing class. Which of the following might the instructor identify as a common sign or symptom?

Bronchospasm

With bronchitis, proteins leak into the area due to:

Changes in capillary permeability

A client arrives in the emergency room with an attack of acute bronchiectasis. What is the principal pathologic finding in the diagnosis of bronchiectasis?

Chronic, irreversible dilation of the bronchi and bronchioles

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

Cigarette smoking

The nurse is monitoring a premature infant diagnosed with respiratory distress syndrome (RDS). Which assessment finding will serve to demonstrate that the instillation of surfactant as a treatment has been effective?

Clear breath sounds

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 what?

Coffee

Shane, a 25-year-old man, is diagnosed with asthma. He began an albuterol MDI 2 weeks ago. He reports that his symptoms persist in spite of using albuterol MDI as prescribed. What advice should the nurse give the client?

Contact the health care provider to obtain adjunctive medications.

Ventricular dysrhythmias or _______________ may be the first sign of theophylline toxicity.

Convulsions

A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe?

Cromolyn

A client with asthma has been prescribed an anti-inflammatory medication. How does an anti-inflammatory drug reduce this client's bronchoconstriction?

Decreasing airway hyperreactivity to stimuli

A patient tells you that a friend of theirs has recommended the use of caffeine to treat the patient's asthma. What would be the most important reason a nurse should counsel this patient not to delay prescribed treatment for the use of natural health products?

Delays in appropriate treatment can have serious, even fatal, consequences

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?

Dilation of the bronchi with increased rate and depth of respiration

The nurse is caring for a client experiencing acute bronchospasm. What drug is most likely to meet this client's needs?

Epinephrine

________________ may be injected subcutaneously in an acute attack of bronchoconstriction.

Epinephrine

T or F: Adrenal insufficiency is most likely to occur with local or low doses of inhaled corticosteroids.

False

T or F: In early stages of COPD, clients likely need corticosteroid therapy.

False

T or F: Theophylline can usually be given without adjustments in clients with impaired renal function.

False

A client is prescribed a steroid to help decrease inflammation in their respiratory tract. When providing medication education to the client what should the nurse identify as the benefit primary benefit of administering the medication by inhaler?

Fewer systemic effects

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

An 8-year-old client reports shortness of breath, cough, and chest tightness when participating in gym class. The client is diagnosed with exercise-induced asthma. What inhaled drug therapy is the health care provider most likely to prescribe?

Formoterol, a highly selective beta-2 agonist

Where should the nurse initially direct a client who is interested in learning more about the management of asthma?

Global Initiative for Asthma (GINA)

A nurse is required to educate a patient prescribed albuterol on the adverse effects associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the patient to report to the health care provider?

Headache and flushing

What would the nurse identify as being involved with asthma?

Hyperactive airways

The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take?

Inform the health care provider that the client has toxic theophylline levels.

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

Inhalation

A client has been diagnosed with asthma and prescribed inhaled steroids. What should the nurse teach the client about this treatment?

Inhaled corticosteroids should not be used on an emergency basis.

When teaching a client about his prescribed asthma therapy, the nurse understands that which medications may increase the risk of asthma-related death?

Long-acting beta-2 agonists

A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective?

Monitoring respirations for bilateral chest movement

What is the most effective method used to monitor clients with asthma that they can use at home?

Peak-flow monitor

A nurse is caring for a client with chronic bronchiectasis. The nurse should assess the patient for which clinical manifestation?

Purulent cough

A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?

Relaxation of smooth muscle

A client is being evaluated for a possible diagnosis of emphysema. What client characteristic should the nurse monitor to provide evidence of the disorder?

Respiratory expiration

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 (short-acting beta agonist)

A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation?

Salmeterol is contraindicated based on his wife's condition.

A 42-year-old male client has a history of smoking for 20 years. The client states he is feeling fine and asks why stopping smoking is necessary. What information might the nurse share with the client about smoking?

Smoking decreases the size of the tubes leading to the lungs

A client has been admitted to a health care facility with acute bronchospasm. The health care provider prescribes the drug epinephrine. Through which route should the nurse administer the drug?

Subcutaneous

The nurse is caring for a 38-year-old client who is beginning treatment with albuterol. Which should the nurse identify as a potential adverse effect of the drug?

Tachycardia

Your patient, a 73-year-old Hispanic man, has a 40 pack/year history of cigarette smoking and was admitted with an exacerbation of COPD. As his nurse, you understand the efficacy of his respiratory system depends on:

The ability of the lungs to expand and contract.

A client is experiencing an episode of status asthmaticus. What is the primary challenge facing the staff as they attempt to manage the client's respiratory crisis?

The bronchospasm does not respond to usual treatment measures

A client has experienced an atelectasis in the left lung. What explanation should the nurse provide the family regarding the cause of this condition?

The collapse of some of the alveoli in the left lung occurred as a result of outside pressure pushing against them.

A client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussion medication instructions with this client?

The medication should be taken on an empty stomach.

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators

A male client is concerned because ever since he began his antiasthma medication, his GERD symptoms are worse. The nurse explains that his symptoms are worse because his asthma medications have what effect?

They relax the gastresophageal sphincter.

T or F: Caffeine is considered a xanthine, which has bronchodilating effects similar to those of theophylline.

True

T or F: IV aminophylline is no longer used to treat acute asthma attacks.

True

A 70-year-old client is being treated for chronic obstructive pulmonary disease (COPD) with theophylline. What will be a priority assessment by the nurse?

Use of nicotine

_____________ is a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway.

Wheezing

The two major groups of medications used to treat chronic bronchitis and emphysema are bronchodilators and __________________ drugs.

anti-inflammatory

Respiratory symptoms are treated with many types of drugs, including

anti-inflammatory agents.

A client has been admitted to the emergency department (ED) in status asthmaticus. The ED nurse should anticipate administering which medication?

beta2 agonists in high doses

In lung cells, cyclic AMP inhibits release of _________________ substances, and this indirectly promotes bronchodilation.

bronchoconstrictive

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.

A client who is 6 feet (1.83 m) tall and weighs 300 pounds (136 kg) has been prescribed a combination of an antiasthmatic and theophylline. When reviewing the prescribed dose of theophylline, the nurse should verify that it is based on what factor?

ideal weight

The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy?

ipratropium

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:

sit in a fully upright position when administering the medication.