Pharmacology Ch 55 (2)

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

Adrenal insufficiency Rationale: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids.

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

Beta-2 selective adrenergic agonist Rationale: A beta-2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after injection and rapidly absorbed after inhalation. An inhaled steroid would require 2 to 3 weeks to reach effective levels. Leukotriene receptor antagonists and mast cell stabilizers do not have immediate effects.

A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid?

Chocolate Rationale: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline.

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

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 Rationale: Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.

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." Rationale: Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.

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 Rationale: *Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following?

Increased serum theophylline Rationale: When administering zileuton along with theophylline, the nurse should monitor for increased serum theophylline.

A neonate is receiving beractant. The nurse understands that this agent is administered by which route?

Intratracheal Rationale: Beractant is administered intratracheally.

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

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

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 Rationale: Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.

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 Rationale: Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.

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?

The client may require higher doses of theophylline than a nonsmoker Rationale: Smoking cigarettes may decrease serum theophylline levels. In fact, some clients who smoke require an increase in theophylline dosage of up to 50%.

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. Rationale: Administer drug on an empty stomach, 1 hour before or 2 hours after meals; the bioavailability of these drugs is decreased markedly by the presence of food.

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 Rationale: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

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 Rationale: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction.

What medical condition is likely to be exacerbated by the medication therapy associated with asthma?

gastroesophageal reflux disease (GERD)