Chapter 55 Lower Resp. Tract Drugs
A patient 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) Every 15 minutes during 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
A
A patient with chronic bronchial asthma is prescribed montelukast (Singulair). What will the nurse instruct the patient to avoid taking? A) Aspirin B) Penicillin C) Sertraline (Zoloft) D) Nifedipine (Procardia)
A
The patient 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 caffeine B) Eating foods high in potassium C) Limiting fluid intake to 1,000 mL a day D) Taking the medicine on an empty stomach
A
Why are inhaled steroids used to treat asthma and chronic obstructive pulmonary disease (COPD)? A) They act locally to decrease release of inflammatory mediators. B) They act locally to improve mobilization of edema. C) They act locally to increase histamine release. D) They act locally to decrease histamine release.
A
A patient with asthma is going to begin taking an inhaled steroid. The nurse teaching the patient 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
A,B,D
The nurse has just admitted a patient with asthma and the emergency department doctor has ordered the patient to begin taking zafirlukast (Accolate). The nurse would hold the medication and contact the physician if the patient reported taking which medication at home? (Select all that apply.) A) Propranolol B) Warfarin C) Acetaminophen D) Ampicillin E) Terfenadine
A,B,E
The nursing instructor is talking to a group of nursing students about the treatment regimen for children with asthma. The students indicate they understand the information when they identify which class of drugs that comprise this regimen? (Select all that apply.) A) Long-acting inhaled steroids B) Xanthines C) Leukotriene-receptor antagonists D) Topical steroid nasal decongestants E) Beta-agonists
A,C,E
A 76-year-old man with asthma is being treated with an anticholinergic. What will the nurse be careful to assess for? A) Cardiac arrhythmias B) Prostatic hypertrophy C) Thyroid conditions D) Parkinsonism
B
A patient has an acute asthma attack. A bronchodilator is used to bring the exacerbation under control. What drug would be used to prevent acute bronchoconstriction? A) Salbutamol (Ventolin) B) Salmeterol (Serevent) C) Fenoterol (Berotec) D) Terbutaline (Bricanyl)
B
A patient is in the clinic to have blood drawn to assess his or her theophylline level. The patient is taking theophylline (Theo-Dur) and appears to being doing well on the drug. He or she reports no problems. What serum level will the nurse expect the patient to have? A) Between 0.5 to 5 mcg/mL B) Between 10 to 20 mcg/mL C) Between 25 to 35 mcg/mL D) Between 40 to 50 mcg/mL
B
Epinephrine, formerly the drug of choice for acute attacks of bronchoconstriction, has been replaced by what? A) Short-acting bronchodilators are the drug of choice in this situation. B) Nothing has replaced epinephrine as drug of choice in this situation. C) Self-administered metered-dose inhalers (MDIs) D) Long-acting beta2-adrenergic agonists (LABAs)
B
The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient 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 there 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 I can't list them all."
B
The nurse caring for a 38-year-old patient started on albuterol (Proventil) should advise the patient that he or she may experience what adverse effect? A) Polydipsia B) Tachycardia C) Hypotension D) Diarrhea
B
The nurse has admitted a patient (who takes ipratropium) to the respiratory unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). While writing a plan of care for this patient, what would be the most appropriate nursing diagnosis to use? A) Deficient knowledge regarding alternative therapy B) Imbalanced nutrition: Less than body requirements C) Acute pain related to renal effects of the drug D) Disturbed thought processes related to central nervous system (CNS) effects
B
The nurse has provided health teaching for a 15-year-old boy newly diagnosed with asthma. What statement, made by the patient, 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) "A second aerosol medication cannot be administered until 30 minutes after the first aerosol medication."
B
The nurse is caring for a patient with chronic obstructive pulmonary disease. The plan of care will focus on what patient problem? A) Pain B) Obstructed airway C) Activity intolerance D) Adverse effects of medication therapy
B
The nursing instructor is discussing bronchodilators with a group of nursing students. The students understand the instruction when they identify what drug is most effective in treating acute bronchospasm? A) Ipratropium bromide (Atrovent) B) Epinephrine (Adrenalin) C) Cromolyn (Intal) D) Ephedrine
B
What action by the patient would indicate that the patient understands how to use an inhaler? A) The patient inhales as soon as the inhaler enters his or her mouth. B) The patient holds his or her breath for several seconds after releasing the medication. C) The patient administers three doses of medication within a 1-minute time frame. D) The patient exhales as soon as he or she compresses the inhaler.
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 use a broom to sweep the bedroom every day. E) Keep the child away from areas that are filled with cigarette smoke.
B,C,E
The nursing instructor is discussing the use of sympathomimetics in patients who have acute bronchospasm. The instructor shares with the students that this classification of drugs is contraindicated or only used with great caution in patients with what disorders? (Select all that apply.) A) Hypothyroidism B) Cardiac disease C) Kidney disease D) Diabetes mellitus E) Peripheral vascular disease
B,D,E
A 6-year-old child weighing 52 pounds has had a loading dose of aminophylline (Truphylline). The nurse is ready to administer the regular prescribed dose of 4 mg/kg every 4 hours for three doses. How many milligram will the patient receive in 12 hours? A) 44 mg B) 94 mg C) 284 mg D) 344 mg
C
A patient presents at the emergency department 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? A) Aspirin B) Penicillin C) Peanuts D) Ragweed pollen
C
A patient who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the physician prescribe? A) Ipratropium or budesonide B) Isoetharine or montelukast C) Nedocromil or cromolyn D) Aminophylline or caffeine
C
An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the patient 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 to ensure peak therapeutic levels when needed. D) Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness.
C
The nurse is writing a plan of care for a patient newly admitted to the floor with an asthma attack that occurred while exercising. What would be the most appropriate intervention for this patient? A) Assist patients with moderate to severe asthma in obtaining a home nebulizer unit B) Try to prevent or reduce panic, which may initiate bronchospasm C) Teach patient to use an inhaler before exercising D) Monitor peak flow rates, especially in children
C
A patient, diagnosed with asthma, has been prescribed tiotropium (Spiriva). What should the nurse teach the patient about this drug? (Select all that apply.) A) It makes 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.
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) Ingestion of fatty foods B) Weight C) Activity level D) Use of nicotine
D
A patient presents to the emergency department (ED) having an acute asthma attack. An ED physician has ordered a sympathomimetic (epinephrine). The nurse expects what as the therapeutic effect of this drug? A) Decrease the inflammatory response in the airways B) Reduce the surface tension within the alveoli allowing for gas exchange C) Inhibit the release of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the allergic asthmatic response D) Cause dilation of the bronchi with increased rate and depth of respiration
D
A patient tells the nurse that a friend has recommended the use of caffeine to treat the patient's asthma. The nurse counsels the patient to begin treatment immediately with the prescribed medication for what reason? A) Caffeine can aggravate the drugs used to treat asthma. B) Most natural products are less toxic or more potent than traditional asthma medications. C) Natural products decrease the adverse effects associated with adrenergic bronchodilators. D) Delays in appropriate treatment can have serious, even fatal, consequences.
D
A patient with chronic obstructive pulmonary disease (COPD) presents at the emergency department in acute respiratory distress. The patient's family tells the nurse that the patient's problems began right after the patient took his or her first dose of ipratropium (Atrovent). What would the nurse suspect is the problem? A) An allergy to milk B) Overexertion by the patient C) Patient not taking the medications correctly D) An allergy to soy products
D
A patient, 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 you the most." B) "The medications that have been ordered for you are to help you breathe easier." C) "The medications that have been ordered for you are designed to work together to help you feel better." D) "The medications that have been ordered for you are to help relieve the inflammation and promote dilation of the bronchi."
D
A premature newborn is being treated for respiratory distress syndrome. The nurse teaches the parents about what adverse effect that can occur with the use of lung surfactants? A) Kidney dysfunction B) Cardiac arrhythmias C) High fever D) Collapsed lung
D
The nurse is caring for a patient 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
D
The nurse is providing health teaching to a newly diagnosed asthmatic patient. The patient has been prescribed theophylline. What is contraindicated with the use of this drug? A) Using insulin B) Taking anti-inflammatory drugs C) Exercising D) Smoking cigarettes
D
The pharmacology instructor is explaining the difference between bronchodilators and anti-inflammatory drugs. How does an anti-inflammatory drug reduce bronchoconstriction? A) Increases ability to metabolize medication B) Decreases formation of mucus secretions C) Increases reactivity to medication D) By decreasing airway hyperreactivity to various stimuli
D