NU141- Chapter 55 Drugs Acting on the Lower Respiratory Tract
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."
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."
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."
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?
"Remember that your salmeterol isn't effective when you take it at the time of an asthma attack."
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."
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 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
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
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 who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert its full effects within which time frame?
20 minutes
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 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
A patient with acute respiratory symptoms is receiving a loading dose of theophylline. Which of the following signs of toxicity should alert the nurse to notify the primary health care provider immediately?
Abdominal cramps
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
Which of the following effects would result from the action of montelukast?
Decreased eosinophil migration
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
A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the health care provider to give the client?
Albuterol
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
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
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
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
A patient with COPD presents at the Emergency Department (ED) in acute respiratory distress. The patient's family tells the nurse that the patient takes Atrovent and started having problems right after tasting soy milk. What would the nurse suspect is the problem?
An allergy to soy products
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
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
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.)
Exercise Allergens Pollutants
Isoproterenol is an anticholinergic agent.
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 (Foradil), 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)
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.
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
When teaching a patient to use a dry powder inhaler, which of the following is true? Select all that apply:
Hold breath for 10 seconds. Inhale quickly.
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."
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
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
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
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
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 breathing pattern
A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route?
Inhalation
A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route?
Inhalation
How do inhaled corticosteroid agents assist in the treatment of asthma?
Inhaled corticosteroid agents will 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 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
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 male client is prescribed montelukast and uses it successfully to manage his asthma. He develops hepatitis C. What would the nurse expect the health care provider to do?
Maintain the same dose of the montelukast
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.
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
After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which as possible adverse effects? (Select all that apply.)
Myalgia Dizziness Vomiting
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 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
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
A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?
Relaxation of smooth muscle
The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions?
Rinse mouth with water after each use.
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
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 history of an allergy to which would be a contraindication to the use of anticholinergics? (Select all that apply.)
Soy Peanuts
The nurse is describing how aminophylline achieves its effect. Which would the nurse incorporate into the description?
Stimulation of the central nervous system
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.
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
After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state:
The drugs are not for use during an acute attack.
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.
A hospital client's medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, the nurse should base the intervention on which fact?
The two drugs can be mixed in the nebulizer immediately before administration.
Aerosols are often the drugs of choice to treat asthma because of what characteristics? (Select all that apply.)
They act directly on the airways. They can usually be given in smaller doses. They produce fewer adverse effects than oral or parenteral drugs. They relieve symptoms quickly.
Why are inhaled steroids used to treat asthma and COPD?
They act locally to decrease release of inflammatory mediators
A child with repeated asthma attacks may be treated with which drugs? a. A leukotriene receptor antagonist b. A beta-blocker c. An inhaled corticosteroid d. An inhaled beta-agonist e. A surfactant f. A mast cell stabilizer
a. A leukotriene receptor antagonist c. An inhaled corticosteroid d. An inhaled beta-agonist f. A mast cell stabilizer
A person with hypertension and known heart disease has frequent bronchospasms and asthma attacks that are most responsive to sympathomimetic drugs. This patient might be best treated with a. an inhaled sympathomimetic to decrease systemic effects. b. a xanthine. c. no sympathomimetics because they would be contraindicated. d. an anticholinergic.
a. an inhaled sympathomimetic to decrease systemic effects
Treatment of obstructive pulmonary disorders is aimed at a. opening the conducting airways or decreasing the effects of inflammation. b. blocking the autonomic reflexes that alter respirations. c. blocking the effects of the immune and inflammatory systems. d. altering the respiratory membrane to increase the flow of oxygen and carbon dioxide.
a. opening the conducting airways or decreasing the effects of inflammation
Cheyne-Stokes respiration
abnormal pattern of breathing characterized by apneic periods followed by periods of tachypnea; may reflect delayed blood flow through the brain
Clients who are using inhalers require careful teaching about which information? a. Avoiding food 1 hour before and 2 hours after dosing b. Storage of the drug c. Administration techniques to promote therapeutic effects and avoid adverse effects d. Lying flat for as long as 2 hours after dosing e. Timing of administration f. The difference between rescue treatment and prophylaxis
b. Storage of the drug c. Administration techniques to promote therapeutic effects and avoid adverse effects e. Timing of administration f. The difference between rescue treatment and prophylaxis
A patient with many adverse reactions to drugs is tried on an inhaled steroid for treatment of bronchospasm. For the first 3 days, the patient does not notice any improvement. You should a. switch the patient to a xanthine. b. encourage the patient to continue the drug for 2 to 3 weeks. c. switch the patient to a sympathomimetic. d. try the patient on surfactant.
b. encourage the patient to continue the drug for 2 to 3 weeks
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
What is the most common first-line therapy for relief of an acute asthma attack?
beta2-adrenergic agonist
An elderly female client insists her asthma is exacerbated by her least favorite television show. While explaining that her dislike for the show's host may be a contributing factor, the nurse relates that an asthma attack is caused by substances released from mast cells, which cause:
bronchoconstriction and inflammation.
The xanthines a. block the sympathetic nervous system. b. stimulate the sympathetic nervous system. c. directly affect the smooth muscles of the respiratory tract. d. act in the CNS to cause bronchodilation.
c. directly affect the smooth muscles of the respiratory tract
Your patient has been maintained on theophylline for many years and has recently taken up smoking. The theophylline levels in this patient would be expected to a. rise because nicotine prevents the breakdown of theophylline. b. stay the same because smoking has no effect on theophylline. c. fall because substances in cigarettes stimulate liver metabolism of theophylline. d. rapidly reach toxic levels.
c. fall because substances in cigarettes stimulate liver metabolism of theophylline
Respiratory distress syndrome occurs in a. babies with frequent colds. b. babies with genetic allergies. c. premature and low-birth-weight babies. d. babies stressed during the pregnancy.
c. premature and low-birth-weight babies
Which medication is contraindicated for the treatment of acute bronchospasm?
cromolyn
Leukotriene receptor antagonists act to block production of a component of slow-reacting substance of anaphylaxis. They are most beneficial in treating a. seasonal rhinitis. b. pneumonia. c. COPD. d. asthma.
d. asthma
Lung surfactants used therapeutically are a. injected into a developed muscle. b. instilled via a nasogastric tube. c. injected into the umbilical artery. d. instilled into an endotracheal tube properly placed in the baby's lungs.
d. instilled into an endotracheal tube properly placed in the baby's lungs
Mast cell stabilizer
drug that works at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and the release of slow-reacting substance of anaphylaxis (SRSA)
Sympathomimetics
drugs that mimic the effects of the sympathetic nervous system
Leukotriene receptor antagonists
drugs that selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of slow-reacting substance of anaphylaxis (SRSA)
A client is admitted to the emergency department with inspiratory stridor and air hunger. When anticipating treatment, the nurse will prepare which medication for administration?
epinephrine
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
Bronchodilator
medication used to facilitate respirations by dilating the airways; helpful in symptomatic relief or prevention of bronchial asthma and bronchospasm associated with chronic obstructive pulmonary disease
Xanthines
naturally occurring substances, including caffeine and theophylline, that have a direct effect on the smooth muscle of the respiratory tract, both in the bronchi and in the blood vessels
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
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
A client with a diagnosis of asthma has been prescribed ipratropium 2 puffs QID. What is the most likely goal of this treatment?
promoting long-term management of asthma symptoms
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 nurse is teaching a newly diagnosed client with asthma how to manage the disease. What should the nurse encourage this client to do?
stop smoking cigarettes
A client prescribed albuterol should be educated on identifying and managing which adverse reaction?
tachycardia
According to the National Asthma Education and Prevention Program (NAEPP) Expert Panel Guidelines, a client prescribed a short-acting beta2 agonist may take this medication how often during an acute exacerbation of asthmatic symptoms?
up to three treatments at 20-minute intervals
A client is being assessed by the home care nurse on the appropriate use of her metered-dose inhalers. Instructions concerning which intervention will assist a client in the proper administration of the metered-dose inhaler?
using a spacer
