Chapter 55 Drugs Acting on the Lower Respiratory Tract PrepU
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." Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching?
"I should see some results in about 3 to 4 days."
Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching? "I might notice some hoarseness with the drug." "I should see some results in about 3 to 4 days." "I should rinse my mouth after using the drug." "I can't use this drug if I have an acute attack."
"I should see some results in about 3 to 4 days." Inhaled steroids, such as triamcinolone, can take from 2 to 3 weeks to reach effective levels, so the client should be encouraged to take them to reach and then maintain the effective levels. The drug is not effective for acute attacks. It can cause hoarseness and sore throat. The client should rinse his mouth after using the inhaler to decrease the risk of systemic absorption and decrease gastrointestinal upset and nausea.
The nurse is teaching a client newly diagnosed with asthma about triggers. Which statement by the client indicates the client understands the teaching plan?
"I will use my air conditioner."
The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which statement by the client indicates the need for further education?
"I will use this medication when I am having an asthma attack."
Which statement made by a nurse providing care to a newborn prescribed surfactant therapy indicates a need for additional instructions to ensure the medication's effectiveness?
"The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant."
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 patient is receiving aminophylline orally. The nurse would expect this drug to begin acting within which time frame? 2 to 4 hours 8 to 10 hours 6 to 8 hours 1 to 6 hours
1 to 6 hours Aminophylline has an onset of action of 1 to 6 hours.
The nurse assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic?
15 mcg/mL
A client is using an inhaled bronchodilator as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time?
15 minutes before engaging in exercise
A patient who is prescribed ipratropium administers the drug at 9:15 AM. The patient should begin to notice the drug beginning to act at which time?
9:30 AM
a
A client recently began taking theophylline for treatment of asthma. Which changes in the client's lifestyle would suggest that the client understands proper use of the drug and management of the disease? a) Limiting fluid intake to one liter a day b) Avoiding caffeine c) Sleeping eight hours each night d) Increasing dietary intake of B vitamins
c
A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels? a) Corticosteroids b) Cimetidine c) Nicotine d) Allopurinol
b
A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the physician to give him? a) Asthmacort b) Albuterol c) Omalizumab d) Theophylline
d
A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route? a) Intramuscular b) Intravenous c) Oral d) Inhalation
A 5-year-old boy is brought to the ED with an asthma exacerbation, including wheezing (a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway). Those who have asthma chronically present with what signs, even when they may appear symptom free? (Select all that apply.)
Airway inflammation Damaged airway mucosa
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
Which of the following would a nurse identify as a surfactant?
Beractant
A client is experiencing an acute asthmatic attack. Which agent would be most effective?
Beta-2 selective adrenergic agonist
Which would the nurse include as possible adverse effects when teaching a patient about albuterol? (Select all that apply.)
Bronchospasm Nervousness Sweating
The nurse is developing an asthma plan for a young client and caregiver. The nurse determines they understand the plan when they correctly choose which actions to implement? Select all that apply.
Call health care provider is in yellow zone for more than 24 hours Quick-relief medications are not working The Asthma Care Plan utilizes the stop light approach with red, yellow, and green activities to guide the client in helping to maintain their control of asthma. Factors such as staying in the yellow zone for more than 24 hours and quick-relief medications not working are found in the red zone and necessitate an immediate call to the health care provider to advert a crisis. Waking up at night with wheezing, peak flow of 55% of personal best, and being able to only do some but not all usual activities are found in the yellow zone and should alert the client to take appropriate action to prevent the asthma from worsening..
The nurse should complete which of the following during acute breathing distress before initiation of a broncodilator? Select all that apply:
Check blood pressure. Check pulse. Check respiratory rate
A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid?
Chocolate
A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?
Cigarette smoking
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?
Contact the care provider and inform him or her that the client has toxic theophylline levels.
A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer?
Cromolyn
b
Cromolyn should not be used during an acute asthmatic attack. a) False b) True
Which of the following would be most important to assess before administering calfactant? (Select all that apply.)
Endotracheal tube placement Lung sounds Oxygen saturation levels
Isoproterenol is an anticholinergic agent.
False
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 older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease (COPD). Which action should the nurse perform to reduce the client's risk for developing oral candidiasis?
Have the resident rinse his or her mouth after each dose of the drug.
When teaching a patient to use a dry powder inhaler, which of the following is true? Select all that apply: Hold inhaler 1 to 2 inches from mouth. Place device in water to clean. Inhale quickly. Swallow capsules provided. Hold breath for 10 seconds.
Hold breath for 10 seconds. Inhale quickly. To properly use a dry powder inhaler prepare the medication for inhalation, place mouthpiece to lips, inhale quickly, hold your breath for 10 seconds, do not swallow capsules provided, and do not place inhaler in water.
A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse?
I'll keep taking my medications until I'm not experiencing any more symptoms."
The triage nurse in the emergency department has a 42-year-old client with asthma present for treatment. The client's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this client?
Ineffective breathing pattern
How do inhaled corticosteroid agents assist in the treatment of asthma?
Inhaled corticosteroid agents will reduce airway inflammation. Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system or affect either bronchodilation or constriction.
Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use? It reduces the risk of sinusitis. It helps decrease the intrapulmonary delivery of the drug. It reduces the risk of tachycardia. It helps decrease systemic absorption.
It helps decrease systemic absorption. Spacers help decrease systemic absorption, because less flunisolide is swallowed. Spacers may also help alleviate dysphonia by filtering larger aerosol particles that ordinarily deposit in the oropharynx and extrathoracic airways (this precaution also reduces the risk for oropharyngeal candidiasis). The use of a spacer does not prevent intrapulmonary delivery of the drug; nor does it reduce the risk of tachycardia and sinusitis.
Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA? Leukotriene receptor antagonists Xanthines Mast cell stabilizers Anticholinergics
Leukotriene receptor antagonists Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.
a
Leukotriene receptor antagonists are administered orally. a) True b) False
A client, diagnosed with asthma, is prescribed a leukotriene receptor antagonist. The nurse will discuss the importance of which diagnostic lab tests to determine how effectively the medication is being metabolized and excreted? Select all that apply. Liver function Kidney function Complete blood count Thyroid function Glucose level
Liver function Kidney function Evaluate liver and renal function tests to assess for impairments that could interfere with metabolism or excretion of the drugs. None of the other options are associated with the metabolism and excretion of this classification of medications.
An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?
Mix the drug with saline.
The client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler?
Nervousness
A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels? Nicotine Corticosteroids Allopurinol Cimetidine
Nicotine
A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels?
Nicotine When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.
A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?
Relaxation of smooth muscle
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.
The nurse is providing care for a newborn who has received an instillation of surfactin. What assessment data indicates the infant is experiencing adequate oxygen perfusion? Select all that apply. Chest moves bilaterally with respirations Skin warm to the touch Breath sounds normal Skin is pink over entire body Infant temperature within normal limits
Skin is pink over entire body Skin warm to the touch Assess the skin temperature and color to evaluate perfusion of a newborn receiving surfactant. Breath sounds and chest movement would be monitored to determine effective ventilation. Temperature would be monitored for possible infection.
A history of an allergy to which would be a contraindication to the use of anticholinergics? (Select all that apply.)
Soy Peanuts The use of ipratropium and tiotropium, anticholinergics, is contraindicated in the presence of known allergy to soy products or peanuts.
The nurse is describing how aminophylline achieves its effect. Which would the nurse incorporate into the description?
Stimulation of the central nervous system Stimulation of the central nervous system is the mechanism of action for xanthine derivatives. Stimulation of beta-adrenergic receptors is the mechanism of action for beta-2 agonists. Reduction of airway hyperresponsiveness is the mechanism of action for inhaled corticosteroids. Stabilization of mast cell membranes is the mechanism of action for mast cell stabilizers.
Which teaching intervention is a priority for the client prescribed an albuterol inhaler experiencing shortness of breath related to the physiological constriction of airways?
Stop smoking due to the bronchoconstriction.
A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest? Take it on an empty stomach, 1 hour before or 2 hours after meals Take it with a meal Increase the drug dosage up to 50% Take it with foods containing xanthines, such as caffeine
Take it on an empty stomach, 1 hour before or 2 hours after meals Sustained-release preparations of theophylline should be taken on an empty stomach, 1 hour before or 2 hours after meals. Immediate-release preparations should be administered with meals to alleviate gastrointestinal distress. Foods containing xanthines, in particular caffeine, increase the effects of theophylline, but they do not help minimize the adverse effects of theophylline. Patients who smoke may require an increase in theophylline dosage of up to 50%, but increasing the dosage is not a nursing responsibility.
c
The client's theophylline levels are increased. The nurse questions the client about his intake of which of the following? a) Cheese b) Tea c) Coffee d) Carrots
b
The first step in treating obstructive pulmonary disorders involves medication therapy. a) True b) False
Why are inhaled steroids used to treat asthma and COPD?
They act locally to decrease release of inflammatory mediators
What is the most common first-line therapy for relief of an acute asthma attack?
beta2-adrenergic agonist
A client diagnosed with asthma is being prescribed a leukotriene receptor antagonist as part of their mediation therapy. The nurse should encourage the client to report incidence of what events as possible adverse effects of the new medication? Select all that apply.
diarrhea headache fever muscle aches
What is considered a possible trigger for an asthma attack? Select all that apply.
exercise allergens pollutants cigarette smoke
What medical condition is likely to be exacerbated by the medication therapy associated with asthma?
gastroesophageal reflux disease (GERD)
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.
The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy?
ipratropium
An adult client with a diagnosis of asthma has been prescribed montelukast. The nurse should teach the client that this drug will help relieve symptoms by which mechanism? relaxing smooth muscle in the bronchi and bronchioles preventing the bronchoconstriction and inflammation that is caused by leukotrienes preventing mast cells from releasing histamine reducing the muscle tone in the alveoli and facilitating gas exchange
preventing the bronchoconstriction and inflammation that is caused by leukotrienes Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes. This information makes all the remaining options incorrect.
A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to
rebound bronchoconstriction.
A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family provider. What effect will the client's smoking status have on the therapeutic use of theophylline?
stop smoking cigarettes
Which statement made by a nurse providing care to a newborn prescribed surfactin therapy indicates a need for additional instructions to ensure the medication's effectiveness? "The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant." "The baby needs suctioning just prior to the instillation of the surfactin." "The baby should be suctioned after the instillation of the surfactant only if clinically necessary." "Suctioning should be avoided for at least 2 hours after the surfactant instillation."
"The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant." Suction the infant immediately before administration, but do not suction for 2 hours after administration unless clinically necessary, to allow the drug time to work.
A client has been prescribed a inhaled steroid for the treatment of asthma. What information should the nurse include when providing medication education to the client? Select all that apply.
-The medication is not intended to treat an acute asthma attack -Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency -Rebound nasal congestion is a adverse effect of this form of medication -Promptly report a fever or any other indication of infection to your health provider
A patient is receiving aminophylline orally. The nurse would expect this drug to begin acting within which time frame?
1 to 6 hours
A client has been admitted to a health care facility with asthma. The nurse is to administer theophylline to the client. To which clients can the nurse safely administer theophylline?
A 65-year-old male with asthma The nurse can safely administer theophylline to the client who is 65 years of age. It needs to be administered cautiously in clients older 69 years of age or those with hepatic disease, cardiac disease, or hypertension.
b
A therapeutic theophylline level ranges from 10 to 20 mcg/mL. a) False b) True
A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem?
Adrenal insufficiency
Tom, age 42, is prescribed ipratropium bromide as an anticholinergic agent for treating asthma. The nurse caring for Tom needs to develop a plan of care. What must be included in the plan? Select all that apply.
Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma.
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 nurse should complete which of the following during acute breathing distress before initiation of a broncodilator? Select all that apply: Check blood pressure. Check peak flow Check pulse. Check blood glucose. Check respiratory rate
Check blood pressure. Check pulse. Check respiratory rate Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.
a, c, d
Choice Multiple question - Select all answer choices that apply. After teaching a group of students about antiasthmatic agents, the students demonstrate understanding of the information when they identify which of the following as sympathomimetics? Select all that apply. a) Terbutaline b) Budesonide c) Epinephrine d) Formoterol e) Tiotropium f) Cromolyn
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 was using a nicotine patch to stop smoking when he was started on theophylline for emphysema. He has successfully stopped smoking and has stopped using his nicotine patch. Which of following would the nurse anticipate about the prescribed theophylline?
Dose should be decreased.
Isoproterenol is an anticholinergic agent. True False
False Isoproterenol is a sympathomimetic agent.
In children, high doses of nebulized albuterol have been associated with what conditions? (Select all that apply.)
Hypokalemia Hyperglycemia Tachycardia
A client who smokes is receiving theophylline orally. Because of his history of smoking, the nurse expects the health care provider to do what with the theophylline dosing?
Increase
A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following?
Increased serum theophylline
The triage nurse in the emergency department has a 42-year-old client with asthma present for treatment. The client's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this client? Ineffective airway clearance Impaired gas exchange Ineffective breathing pattern Activity intolerance
Ineffective breathing pattern The correct nursing diagnosis is Ineffective Breathing Pattern related to impaired airway as manifested by tachypnea. The other options may be applicable, but they do not take priority over the ineffective breathing pattern.
A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route?
Inhalation
The nurse is providing education to a client with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action?
Inhaled corticosteroid agents reduce airway inflammation.
A neonate is receiving beractant. The nurse understands that this agent is administered by which route?
Intratracheal
Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use?
It helps decrease systemic absorption.
Which medication is used to treat acute airflow obstruction? Metaproterenol Azelastine Montelukast Beclomethasone
Metaproterenol Metaproterenol is a short-acting beta-2 agonist used as a quick-relief medication. Beclomethasone is an inhaled corticosteroid used as a long-term control medication. Montelukast is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Azelastine is a second-generation antihistamine.
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
When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited? Intracellular calcium Prostaglandins Epinephrine Slow-reacting substance of anaphylaxis
Slow-reacting substance of anaphylaxis Mast cell stabilizers work at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis. Epinephrine is not affected by mast cell stabilizers. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins.
A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest?
Take it on an empty stomach, 1 hour before or 2 hours after meals
Leukotriene receptor antagonists are administered orally.
True
A client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning which intervention will assist a client in the proper use of the device?
Using a spacer
d
When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited? a) Epinephrine b) Prostaglandins c) Intracellular calcium d) Slow-reacting substance of anaphylaxis
A client prescribed antiasthmatic drugs should be encouraged to avoid excessive intake of what beverage?
coffee
c
A patient is given theophylline to treat acute asthma symptoms. Which of the following foods should the patient avoid? a) Orange juice b) Bananas c) Chocolate d) Cranberry juice
After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)?
Albuterol Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.
The nurse should complete which of the following during acute breathing distress before initiation of a broncodilator? Select all that apply: Check pulse. Check blood pressure. Check respiratory rate Check blood glucose. Check peak flow
Check blood pressure. Check pulse. Check respiratory rate Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.
The first step in treating obstructive pulmonary disorders involves medication therapy.
False
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 (Foradil), a highly selective beta-2 agonist
While reviewing a client's history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?
Peanuts
The nurse caring for a premature newborn receiving surfactin therapy should monitor for what adverse effects? Select all that apply.
Pneumothorax Patent ductus arteriosus bradycardia
A child prescribed an inhaled corticosteroid agent to decrease respiratory inflammation is now receiving high doses of the drug after only 2 days of treatment. What adverse reaction is the client at risk for developing?
adrenal insufficiency
A client has been prescribed theophylline intravenously and began the therapy three days ago. The nurse suspects that the serum drug level is above therapeutic levels when the client makes what statement? Select all that apply. "It feels like my heart is beating faster than usual." "I need to tell you that I vomited a few minutes ago." "I'm so tired; I haven't been sleeping well." "I don't want lunch; I'm feeling nauseous." "Please look at this rash I have on my chest and neck."
"I don't want lunch; I'm feeling nauseous." "I'm so tired; I haven't been sleeping well." "It feels like my heart is beating faster than usual." "I need to tell you that I vomited a few minutes ago." Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other dysrhythmias, and tonic-clonic convulsions. A rash is not associated with toxic levels of theophylline.
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." Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
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."
Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching? "I can't use this drug if I have an acute attack." "I should rinse my mouth after using the drug." "I might notice some hoarseness with the drug." "I should see some results in about 3 to 4 days."
"I should see some results in about 3 to 4 days." Inhaled steroids, such as triamcinolone, can take from 2 to 3 weeks to reach effective levels, so the client should be encouraged to take them to reach and then maintain the effective levels. The drug is not effective for acute attacks. It can cause hoarseness and sore throat. The client should rinse his mouth after using the inhaler to decrease the risk of systemic absorption and decrease gastrointestinal upset and nausea.
The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which statement by the client indicates the need for further education? "I may experience wheezing with this medication." "I will use this medication when I am having an asthma attack." "This medication may also be used for allergy disorders." "This medication may cause my throat to become dry."
"I will use this medication when I am having an asthma attack." Cromolyn (Intal) is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders. Adverse reactions include drying of the throat and coughing or wheezing. It should not be used during an acute asthma attack because it may worsen the bronchospasm.
A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client's concern? "It's important to take salmeterol as soon as you feel the first sensation of an asthma attack." "Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." "Unfortunately, Sereventsalmeterol can take up to 15 minutes to relieve your difficulty breathing." "It's best to take repeated doses of salmeterol every 5 minutes, until your symptoms subside."
"Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." Salmeterol is a long-acting beta2-adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short-acting drug. This information makes all the other options incorrect.
A patient is receiving aminophylline orally. The nurse would expect this drug to begin acting within which time frame? 6 to 8 hours 2 to 4 hours 1 to 6 hours 8 to 10 hours
1 to 6 hours Aminophylline has an onset of action of 1 to 6 hours.
A client is receiving ipratropium as maintenance therapy for chronic obstructive pulmonary disease. The nurse would caution the client that up to how many inhalations may be used in 24 hours if needed? 12 8 16 4
12 With ipratropium, the usual dosage is 2 inhalations four times/day for a total of 8 inhalations. However, the client can use up to 12 inhalations if needed in 1 day.
The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time?
15 minutes prior to exercising
A client has been admitted to a health care facility with asthma. The nurse is to administer theophylline to the client. To which clients can the nurse safely administer theophylline?
A 65-year-old male with asthma
A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the health care provider to order?
A modified dose of aminophylline
c
A patient has been admitted to a healthcare facility with asthma. The nurse is advised to administer theophylline to the patient. To which of the following patients can the nurse safely administer theophylline? a) An 83-year-old female patient with cardiac disease b) A 65-year-old female patient with hepatic disease c) A 65-year-old male patient with asthma d) A 43-year-old male patient with hypertension
d
A patient is being assessed by the home care nurse on the administration of the inhalers. Which of the following will assist in proper administration of the inhaler? a) Provide 1000 mL of fluid b) Exhale after administration c) Administer corticosteroid first d) Use of a spacer
b
A patient is started on albuterol (Proventil). What reaction should the patient be instructed on? a) Hypotension will occur. b) Tachycardia will occur. c) Diarrhea will occur. d) Polydipsia will occur.
The parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations?
Albuterol
A 27-year-old athlete with newly diagnosed asthma presents for patient education regarding situations that could precipitate an asthma attack. The nurse teaches that acute episodes of asthma may last minutes to hours. In this teaching, which precipitants would the nurse state may cause the asthma? (Select all that apply.)
Allergens Exercise Pollutants
b
An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate? a) Turn the device off when the mist slows. b) Mix the drug with saline. c) Have the child lie flat. d) Encourage rapid shallow breaths.
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, c, e
Choice Multiple question - Select all answer choices that apply. When describing the action of xanthines, which of the following would the nurse include? Select all that apply. a) Inhibition of release of slow-reacting substance of anaphylaxis b) Block the action of acetylcholine at vagal mediated receptor sites c) Direct effect on the mobilization of calcium within the cell d) Selectively act at beta-2 receptor sites as agonists e) Stimulation of 2 prostaglandins leading to smooth muscle relaxation
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 which of the following?
Coffee
The client's theophylline levels are increased when the lab results are added to the electronic health record. The nurse questions the client about his intake of which?
Coffee Xanthines are found in colas, coffee, chocolate, and charcoal-prepared foods. This could cause the client's theophylline levels to increase. Neither tea, carrots, nor cheese affect theophylline levels.
The client's theophylline levels are increased when the lab results are added to the electronic health record. The nurse questions the client about his intake of which?
Coffee Xanthines are found in colas, coffee, chocolate, and charcoal-prepared foods. This could cause the client's theophylline levels to increase. Neither tea, carrots, nor cheese affect theophylline levels.
A client was using a nicotine patch to stop smoking when he was started on theophylline for emphysema. He has successfully stopped smoking and has stopped using his nicotine patch. Which of following would the nurse anticipate about the prescribed theophylline? Dose should be increased. Dose should be decreased. The drug should be discontinued. The client will receive the same amount.
Dose should be decreased. Nicotine decreases theophylline levels. If a client is no longer using nicotine, his theophylline levels will increase, warranting a decrease in theophylline dose. The drug should not be discontinued as the client may develop exacerbation of the emphysema. The dose should not be increased because the nicotine patch decreases the theophylline levels. Adjustment should be made to keep the client's theophylline levels in the desired range.
A client was using a nicotine patch to stop smoking when he was started on theophylline for emphysema. He has successfully stopped smoking and has stopped using his nicotine patch. Which of following would the nurse anticipate about the prescribed theophylline?
Dose should be decreased. Nicotine decreases theophylline levels. If a client is no longer using nicotine, his theophylline levels will increase, warranting a decrease in theophylline dose. The drug should not be discontinued as the client may develop exacerbation of the emphysema. The dose should not be increased because the nicotine patch decreases the theophylline levels. Adjustment should be made to keep the client's theophylline levels in the desired range.
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
Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA? Leukotriene receptor antagonists Anticholinergics Xanthines Mast cell stabilizers
Leukotriene receptor antagonists Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.
When teaching a client about his prescribed asthma therapy, the nurse understands that which medications may increase the risk of asthma-related death? Inhaled corticosteroids (ICSs) Short-acting beta agonists (SABAs) Long-acting beta-2 agonists Mast cell stabilizers
Long-acting beta-2 agonists Long-acting beta-2 agonists may increase the risk of asthma-related death. ICSs are contraindicated in clients with hypersensitivity to the corticosteroids, acute bronchospasm, status asthmaticus, or other acute episodes of asthma and can cause throat irritation, hoarseness, upper respiratory tract infection, and fungal infections of the mouth and throat. SABA bronchodilators are drugs used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema but can cause tachycardia, palpations, arrhythmias, hypertension, nervousness, anxiety, and insomnia. The mast cell stabilizer is contraindicated in clients with known hypersensitivity to the drugs and during attacks of acute asthma, because they may worsen bronchospasm during the acute asthma attack. A mast cell stabilizer is used cautiously during pregnancy (pregnancy category B) and lactation and in clients with impaired renal or hepatic function.
A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels? Nicotine Corticosteroids Allopurinol Cimetidine
Nicotine When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.
A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels?
Nicotine When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.
a
One method of reducing bronchoconstriction is removing excessive secretions from the respiratory tract. Patients can take several actions on their own to help manage secretions. Which of the following will not help manage secretions? a) Asking the physician to prescribe inhaled corticosteroids b) Consuming at least two quarts of fluids each day c) Practicing deep breathing d) The patient can take all the above actions to manage secretions in the respiratory tract.
A patient presents at the Emergency Department (ED) in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the patient may be allergic to what?
Peanuts
A premature newborn diagnosed with respiratory distress syndrome(RDS) has received surfactant therapy. The infant's nursing care plan should include which monitoring interventions to evaluate the effectiveness of the therapy? Select all that apply.
Respirations Adventitious breath sounds Endotracheal tube placement Chest movement
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
The client is 73 years of age and has a history of coronary artery disease and COPD. She is being started on formoterol (Foradil). The nurse would assess the client for which of the following conditions? Select all that apply. Tachycardia Hypertension Hypotension Bradycardia Lethargy
Tachycardia Hypertension Older adults taking adrenergic bronchodilators are at increased risk for adverse reactions related to the cardiovascular system, such as tachycardia (not bradycardia), arrhythmias, palpitations, and hypertension (not hypotension). Lethargy is not related to taking adrenergic bronchodilators.
After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state: The drugs action leads to suppression of beta adrenergic receptor activity. The drugs are slowly absorbed from the respiratory tract. The drugs are systemically absorbed when inhaled. The drugs are not for use during an acute attack.
The drugs are not for use during an acute attack. The drugs are not for emergency use or use during an acute attack because their onset of action is slow. Systemic absorption is not typical with inhalation unless the patient did not administer the drug properly or has lesions that allowed absorption of the drug. Inhalation decreases the effectiveness of the inflammatory cells leading to decreased swelling and promotion of beta adrenergic receptor activity. The drugs are rapidly absorbed, but take 2 to 3 weeks to reach effective levels.
After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state: The drugs are slowly absorbed from the respiratory tract. The drugs are systemically absorbed when inhaled. The drugs are not for use during an acute attack. The drugs action leads to suppression of beta adrenergic receptor activity.
The drugs are not for use during an acute attack. The drugs are not for emergency use or use during an acute attack because their onset of action is slow. Systemic absorption is not typical with inhalation unless the patient did not administer the drug properly or has lesions that allowed absorption of the drug. Inhalation decreases the effectiveness of the inflammatory cells leading to decreased swelling and promotion of beta adrenergic receptor activity. The drugs are rapidly absorbed, but take 2 to 3 weeks to reach effective levels.
a
The nurse has just finished teaching a 15-year-old patient how to use an inhaler to treat asthma. What statement, made by the patient, suggests that the patient understands the teaching? a) "I need to shake the inhaler well before taking the medication." b) "I need to take three short, quick breaths to inhale the medication." c) "I need to wait at least 30 minutes after the first inhalation before taking a second." d) "I should take a deep breath, hold it while I administer the medication, and then exhale."
c
The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline? a) Eggs b) Green leafy vegetables c) Coffee d) Milk
c
Which of the following effects would result from the action of montelukast? a) Decreased capillary permeability b) Increased smooth muscle contraction c) Decreased eosinophil migration d) Increased neutrophil aggregation
b
Which of the following is an example of a short acting Beta 2 Agonist (SABA)? (Choose one) a) Formoterol b) Albuterol c) Arformoterol d) Salmeterol
c
Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching? a) "I can't use this drug if I have an acute attack." b) "I should rinse my mouth after using the drug." c) "I should see some results in about 3 to 4 days." d) "I might notice some hoarseness with the drug."
a
Xanthine derivatives elicit their effect by which of the following mechanisms? (Choose one) a) Stimulation of the central nervous system b) Reduction of airway hyper-responsiveness c) Stabilization of mast cell membranes d) Stimulation of beta-adrenergic receptors
b
You are acting as the triage nurse in the emergency department when a 42-year-old patient with asthma presents for treatment. The patient's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this patient? a) Ineffective airway clearance b) Ineffective breathing pattern c) Impaired gas exchange d) Activity intolerance
A child prescribed an inhaled corticosteroid agent to decrease respiratory inflammation is now receiving high doses of the drug after only 2 days of treatment. What adverse reaction is the client at risk for developing? adrenal insufficiency edema hypoglycemia tachycardia
adrenal insufficiency Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. The client is not at risk for tachycardia, edema, or hypoglycemia unless related to adrenal insufficiency.
An adult client with a diagnosis of asthma has been prescribed montelukast. The nurse should teach the client that this drug will help relieve symptoms by which mechanism? preventing the bronchoconstriction and inflammation that is caused by leukotrienes relaxing smooth muscle in the bronchi and bronchioles preventing mast cells from releasing histamine reducing the muscle tone in the alveoli and facilitating gas exchange
preventing the bronchoconstriction and inflammation that is caused by leukotrienes Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes. This information makes all the remaining options incorrect.
A client prescribed albuterol should be educated on identifying and managing which adverse reaction?
tachycardia The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.
A client prescribed albuterol should be educated on identifying and managing which adverse reaction?
tachycardia The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.