ATI Pharmacology Made Easy 4.0 ~ The Respiratory System

A nurse is teaching a client who is taking prednisone for an acute asthma exacerbation. Which of the following instructions should the nurse include? A. "Avoid taking nonsteroidal anti-inflammatory drugs." B. "Rinse your mouth after taking the medication to prevent a yeast infection." C. "Stop taking the medication if you become nauseous." D. "Change position slowly when standing up."

A. "Avoid taking nonsteroidal anti-inflammatory drugs." Rationale: A. 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. B. Inhaled, not oral, glucocorticoids can cause oral candidiasis. C. To prevent acute adrenal insufficiency, clients should not stop taking the drug abruptly. Taking the drug with food can help minimize GI effects. D. Prednisone, an oral glucocorticoid, does not cause postural hypotension. It can, however, cause hyperglycemia.

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone via inhaler for asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler? A. Albuterol will increase the absorption of fluticasone. B. Albuterol will decrease inflammation. C. Albuterol will reduce nasal secretions. D. Fluticasone will reduce the adverse effects of albuterol.

A. Albuterol will increase the absorption of fluticasone. Rationale: A. Albuterol, an inhaled, short-acting beta2 agonist, causes bronchodilation, which will increase the absorption of fluticasone, an inhaled glucocorticoid. B. Fluticasone, an inhaled glucocorticoid, will reduce inflammation. Albuterol relaxes the smooth muscles of the airways. C. Although albuterol, an inhaled, short-acting beta2​ agonist, can reduce nasal secretions, this is not the reason it should be used first. D. Fluticasone, an inhaled glucocorticoid, will not reduce the adverse effects of albuterol, which are typically minimal but can include cardiac stimulation and tremors, especially with systemic administration.

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? A. Headache B. Sleepiness C. Hypotension D. Constipation

A. Headache Rationale: A. Oral sympathomimetics stimulate the adrenergic receptors, causing blood vessel constriction, which can cause nervousness, headache, blurred vision, and tremors. B. The nurse should recognize that phenylephrine has the potential adverse effect of insomnia. C. The nurse should recognize that hypertension is an adverse effect of phenylephrine. D. The nurse should recognize that nausea, vomiting, and epigastric pain are the gastrointestinal adverse effects of this drug.

For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over-the-counter cold products? A. Over-the-counter cold products can also contain guaifenesin. B. Blood glucose levels are increased. C. Rebound congestion is likely. D. Drug tolerance is likely.

A. Over-the-counter cold products can also contain guaifenesin. Rationale: A. Many combination over-the-counter cold products contain guaifenesin. A client taking both might be taking excessive amounts of the drug. Combination products also contain multiple drugs to treat different manifestations, some of which the client might not have. All drugs have potential adverse effects, so the client should use only those drugs required to treat existing symptoms and only in the recommended amounts. B. Guaifenesin and over-the-counter cold products do not affect blood glucose levels. Extended therapy with oral glucocorticoids can increase the risk of hyperglycemia (increased blood glucose levels). C. Rebound congestion, a recurrent nasal stuffiness that develops from the overuse of decongestant sprays, does not occur due to the concurrent use of combination cold remedies and guaifenesin. D. Drug tolerance, a reduced physiological response to a drug with repeated use over time, does not occur due to the concurrent use of combination cold remedies and guaifenesin.

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include? (Select all that apply.) A. Restlessness B. Bradycardia C. Insomnia D. Muscle pain E. Anxiety

A. Restlessness C. Insomnia E. Anxiety Rationale: A. Restlessness is an adverse effect of pseudoephedrine, an oral sympathomimetic. B. Pseudoephedrine is more likely to cause tachycardia, not bradycardia. C. Insomnia is an adverse effect of pseudoephedrine. D. Muscle pain is not an adverse effect of pseudoephedrine. The drug is more likely to cause numbness of the extremities. E. Anxiety is an adverse effect of pseudoephedrine.

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? A. Seizures B. Constipation C. Normal sinus rhythm D. Somnolence

A. Seizures Rationale: A. Seizures are likely when plasma drug levels of theophylline, a methylxanthine, are higher than 30 mcg/mL, which indicates toxicity. B. Plasma drug levels of theophylline, a methylxanthine, that exceed the therapeutic level of 5 to 15 mcg/mL are more likely to cause diarrhea than constipation. C. Plasma drug levels of theophylline, a methylxanthine, that exceed the therapeutic level of 5 to 15 mcg/mL are likely to cause severe dysrhythmias. D. Plasma drug levels of theophylline, a methylxanthine, that exceed the therapeutic level of 5 to 15 mcg/mL are likely to cause restlessness and insomnia.

For which of the following reasons should a client attach a spacer to a metered dose inhaler? A. ​To increase the amount of drug delivered to the lungs B. To increase the amount of drug delivered to the oropharynx C. To increase the amount of drug delivered on exhalation D. To increase the speed of drug delivery into the mouth

A. ​To increase the amount of drug delivered to the lungs Rationale: A. A spacer increases the amount of drug that reaches the lungs. B. A spacer reduces the amount of drug that reaches the mouth and oropharynx. C. A spacer ensures that the drug enters the oropharynx at the beginning of inhalation. D. A spacer slows the delivery of the drug into the 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? A. Muscle tremors B. Drowsiness C. Excitation D. Insomnia

B. Drowsiness Rationale: A. Diphenhydramine, a first-generation antihistamine, does not cause muscle tremors. B. The most common adverse effect of diphenhydramine, a first-generation antihistamine, is drowsiness. C. Diphenhydramine, a first-generation antihistamine, can cause uncommon paradoxical effects in children, such as excitation. D. Diphenhydramine, a first-generation antihistamine, does not cause insomnia.

Legal restrictions apply to the purchase of pseudoephedrine because of which of the following risks? A. Respiratory depression B. Drug abuse C. Drug tolerance D. Rebound congestion

B. Drug abuse Rationale: A. Pseudoephedrine is more likely to cause generalized stimulation, not respiratory depression. B. Because it is possible to alter pseudoephedrine and epinephrine into methamphetamine, a commonly abused drug, the law restricts the drugs' purchase. C. The legal restriction of pseudoephedrine is unrelated to drug tolerance, which is a reduced physiological response to a drug with repeated use over time. D. The legal restriction of pseudoephedrine is unrelated to rebound congestion, which is a recurrent nasal stuffiness that develops from the overuse of decongestant sprays.

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine? A. Reduced antitussive effect of dextromethorphan B. Potentiation of depression of CNS actions C. Increased renal reabsorption of the dextromethorphan D. Delayed analgesic effect of the opioid

B. Potentiation of depression of CNS actions Rationale: A. Opioids, such as morphine, do not reduce the antitussive effect of dextromethorphan. B. Combining dextromethorphan with an opioid, such as morphine, increases the risk for decreased respirations and other depressed CNS responses. C. Renal reabsorption is not altered by the administration of an opioid, such as morphine. D. The onset of the analgesic effect of an opioid, such as morphine, is not altered by dextromethorphan administration.

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects? A. Suppresses the cough stimulus B. Reduces surface tension C. Reduces inflammation D. Dries mucous membranes

B. Reduces surface tension Rationale: A. An expectorant does not suppress the cough stimulus. Antitussives, such as dextromethorphan, have this therapeutic effect. B. Expectorants act by reducing the surface tension and viscosity 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. C. An expectorant does not reduce inflammation. Glucocorticoids have this therapeutic effect. D. An expectorant does not dry mucous membranes. Anticholinergic drugs have this therapeutic effect.

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects? (Select all that apply.) A. Muscle tremors B. Urinary retention C. Dry mouth D. Insomnia E. Tachycardia

B. Urinary retention C. Dry mouth Rationale: A. Muscle tremors can occur with beta2 agonists, not with inhaled anticholinergics such as ipratropium. B. Urinary retention can occur with ipratropium, an inhaled anticholinergic. C. Ipratropium can dry oral secretions. D. Methylxanthines, not inhaled anticholinergics such as ipratropium, can cause insomnia. E. Tachycardia can occur with beta2 agonists, not with inhaled anticholinergics such as ipratropium.

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? A. Decrease viscosity of nasal secretions B. Block H2 receptors C. Prevent histamine from binding to receptors D. Reduce nasal congestion

C. Prevent histamine from binding to receptors Rationale: A. Expectorants, not antihistamines, decrease the viscosity of nasal secretions. B. H2 receptor antagonists block H2 receptors to treat peptic ulcer disease. C. Antihistamines treat allergic rhinitis and reduce swelling by blocking histamine from binding to the receptor sites. D. Decongestants, not antihistamines, reduce nasal congestion.

A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include? A. Do not drink anything for 30 min after using the drug. B. Wait 5 min between using the drug and another inhaled drug. C. This drug is used to thin respiratory secretions. D. Check pulse rate after inhaling the drug.

B. Wait 5 min between using the drug and another inhaled drug. Rationale: A. Ipratropium, an inhaled anticholinergic, does not require fluid restriction after use. Drinking water after use can help minimize the drug's unpleasant taste. B. 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. C. Ipratropium reduces nasal secretions but does not thin respiratory secretions. D. Ipratropium, an inhaled anticholinergic, does not alter heart rate. Tachycardia can occur with beta2 agonists.

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client? A. Ipratropium B. Beclomethasone C. Acetylcysteine D. Azelastine

C. Acetylcysteine Rationale: A. Ipratropium reduces nasal secretions and is used to treat allergic and nonallergic rhinorrhea. B. Beclomethasone is a glucocorticoid that reduces inflammation. C. Acetylcysteine is a mucolytic that loosens thick respiratory secretions. D. Azelastine is an intranasal antihistamine that treats allergic rhinitis.

A nurse is teaching a client about using intranasal glucocorticoids. Which of the following instructions should the nurse give? A. Start at a low dose and gradually increase it. B. Take the drug as needed for nasal congestion. C. Allow at least 2 weeks for the full therapeutic effect. D. Use the drug prior to exercise.

C. Allow at least 2 weeks for the full therapeutic effect. Rationale: A. Providers prescribe higher doses of intranasal glucocorticoids initially and then reduce them over time. B. Clients use intranasal glucocorticoids prophylactically to control allergic rhinitis, not nasal congestion. C. It can take 2 or 3 weeks to see the full therapeutic effect of intranasal glucocorticoids. D. Intranasal glucocorticoids do not prevent exercise-induced bronchospasm. Better choices for this purpose are inhaled cromolyn sodium and albuterol.

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? A. Thins mucus B. Relaxes bronchial smooth muscle C. Decreases inflammation D. Increases the cough threshold

C. Decreases inflammation Rationale: A. Mucolytics thin mucus to increase expectoration. B. Beta2 agonists and methylxanthines cause bronchodilation by relaxing bronchial smooth muscle. C. Beclomethasone, an intranasal glucocorticoid, treats asthma by reducing inflammation. D. Opioid antitussives relieve a cough by increasing the cough threshold in the CNS.

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? A. Blood pressure B. Apical heart rate C. Respirations D. Level of consciousness

C. Respirations Rationale: A. Although it is important to check the client's blood pressure because codeine can cause hypotension, it is not the priority assessment. B. Although it is important to check the client's apical heart rate because codeine can slow the heart rate, it is not the priority assessment. C. The greatest risk to clients who are taking codeine, an opioid agonist, is severe respiratory depression. Therefore, the respiratory rate is the priority assessment. D. Although it is important to check the client's level of consciousness because codeine can cause sedation, it is not the priority assessment.

A nurse is teaching a client about the use of a mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects? A. Suppresses the cough stimulus B. Reduces inflammation C. Thins and loosens mucus D. Dries secretions

C. Thins and loosens mucus Rationale: A. A mucolytic does not suppress the cough stimulus. Antitussives, such as dextromethorphan, have this therapeutic effect. B. A mucolytic does not reduce inflammation. Glucocorticoids have this therapeutic effect. C. Mucolytics make mucus less viscous to increase a cough's productivity. D. A mucolytic does not dry secretions. Anticholinergic drugs have this therapeutic effect.

A nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious use with clients who have which of the following conditions? A. Peptic ulcer disease B. A seizure disorder C. Anemia D. Coronary artery disease

D. Coronary artery disease Rationale: A. Peptic ulcer disease is not a contraindication for taking pseudoephedrine. Clients who have hyperthyroidism or prostatic hypertrophy, however, should not take the drug. B. A seizure disorder is not a contraindication for taking pseudoephedrine. Clients who have hyperthyroidism or prostatic hypertrophy, however, should not take the drug. C. Anemia is not a contraindication for taking pseudoephedrine. Clients who have hyperthyroidism or prostatic hypertrophy, however, should not take the drug. D. 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 who has a prescription for zileuton. Which of the following instructions should the nurse include? A. Check apical pulse before taking the drug. B. Take the drug only as needed before exercising. C. Rinse mouth after using the drug. D. Have laboratory tests performed at regular intervals.

D. Have laboratory tests performed at regular intervals. Rationale: A. Zileuton, a leukotriene modifier, should not affect heart rate, but it can cause chest pain. B. Clients should take zileuton, a leukotriene modifier, on a regular schedule throughout the day to decrease bronchoconstriction and inflammation. C. Clients should take zileuton, a leukotriene modifier, orally. It is not necessary to rinse the mouth after taking the drug, which is a precaution necessary with inhaled glucocorticoids. D. Zileuton, a leukotriene modifier, can cause liver injury. The nurse should monitor liver function once a month for 3 months, then every 2 to 3 months during the first year of treatment.

A nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. Which of the following instructions should the nurse include? A. Take the drug as needed for acute asthma. B. Follow a low-sodium diet. C. Use an alternate-day dosing schedule. D. Increase weight-bearing activity.

D. Increase weight-bearing activity. Rationale: A. Clients should use fluticasone propionate/salmeterol on a regular schedule to treat chronic asthma. B. It is not necessary to follow a low-sodium diet when taking fluticasone propionate/salmeterol, an inhaled glucocorticoid. C. Clients may take prednisone, an oral glucocorticoid, on an alternate-day dosing schedule to reduce adrenal suppression. D. Weight-bearing activity can help minimize bone loss, which is an adverse effect of fluticasone propionate/salmeterol, an inhaled glucocorticoid and inhaled long-acting beta2 agonist (LABA) combination medication.

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? A. Fever B. Bruising C. Polyuria D. Palpitations

D. Palpitations Rationale: A. Fever is not an adverse effect of albuterol, a beta2 agonist. However, the drug can cause headache. B. Bruising is not an adverse effect of albuterol, a beta2 agonist. However, the drug can cause muscle cramps. C. Polyuria is not an adverse effect of albuterol, a beta2 agonist. However, the drug can cause nausea and vomiting. D. Although not common at therapeutic doses, beta2 agonists can cause cardiac stimulation, resulting in chest pain, palpitations, hypertension, and arrhythmias.

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? A. Increases leukocyte activity B. Blocks muscarinic receptors C. Causes bronchodilation D. Reduces inflammation

D. Reduces inflammation Rationale: A. Cromolyn sodium decreases activity of leukocytes and eosinophils. B. Anticholinergic drugs block muscarinic receptors to cause bronchial dilation. C. Cromolyn sodium, a mast cell stabilizer, does not cause bronchodilation. Beta2 agonists achieve this therapeutic effect. D. Cromolyn sodium, a mast cell stabilizer, reduces inflammation by inhibiting the inflammatory response.

A nurse is teaching a client about montelukast. Which of the following instructions should the nurse include? A. Use a spacer to improve inhalation. B. Take the drug at the onset of bronchospasm. C. Rinse mouth to prevent an oral fungal infection. D. Take the drug once a day in the evening.

D. Take the drug once a day in the evening. Rationale: A. Clients should take montelukast, a leukotriene modifier, orally. B. Montelukast, a leukotriene modifier, manages asthma prophylactically. C. Oral candidiasis can occur with inhaled glucocorticoids. However, it is not likely with montelukast, a leukotriene modifier. D. Montelukast, a leukotriene modifier, is most effective when taken once per day in the evening.