Respiratory 35 & 36
The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? 1Monitor the patient for toxicity. 2Increase the intravenous (IV) drip rate. 3Continue to assess the patient's oxygenation. 4Stop the IV for an hour then restart at a lower rate
3Continue to assess the patient's oxygenation.
A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action?
Administering a beta2-adrenergic agonist
A patient reports to the nurse that after taking guaifenesin for 1 week, the productive cough still persists. What advice should the nurse give to the patient?
"Consult your primary health care provider."
The nurse is caring for a patient who is taking a traditional antihistamine. What is the most important information for the nurse to teach the patient?
"Do not drive after taking this medication."
Which instruction will the nurse include when teaching a patient about the proper use of metered-dose inhalers?
"Hold your breath for 10 seconds if you can after you inhale the medication."
The nurse is teaching a patient who has asthma about the frequency of inhalation of salmeterol. Which statement by the patient indicates effective learning?
"I will inhale it twice a day approximately 12 hours apart
The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching?
"Increase your fluid intake to decrease viscosity of secretions."
A nursing student is caring for a patient who is receiving ipratropium therapy. The student asks the nurse about the time required to reach the peak effect after the administration of the drug. What should the nurse tell the student?
"It takes about 1 to 2 hours.
A patient complains of worsening nasal congestion despite the use of oxymetazoline nasal spray every 2 hours. What is the nurse's most appropriate response?
"Overuse of nasal decongestants results in rebound congestion."
A patient is prescribed disulfiram for alcohol abuse. During the assessment, the nurse finds that the patient is also taking echinacea for wound healing. What should the nurse instruct the patient to do?
"Stop using echinacea."
A patient is prescribed ipratropium (Atrovent) and cromolyn sodium (Intal). What will the nurse teach the patient? Do not take these medications within 4 hours of each other." "Take the ipratropium (Atrovent) at least 5 minutes before the cromolyn (Intal)." "Administer both medications together in a metered-dose inhaler." "Take the ipratropium (Atrovent) only in the mornings."
"Take the ipratropium (Atrovent) at least 5 minutes before the cromolyn (Intal)." When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
A patient will begin taking diphenhydramine to treat motion sickness. What instruction will the nurse give to the patient to prevent gastrointestinal (GI) upset?
"Take the medication with food."
The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast in the patient teaching?
"This medication will prevent the inflammation that causes your asthma attack."
The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast (Accolate) in the patient teaching? Take the medication as soon as you begin wheezing." "It will take about 3 weeks before you notice a therapeutic effect." "This medication will prevent the inflammation that causes your asthma attack." "Increase fiber and fluid in your diet to prevent the side effect of constipation."
"This medication will prevent the inflammation that causes your asthma attack." Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.
What should the nurse tell a patient who reports feeling drowsy after beginning drug therapy with diphenhydramine?
"Use caution when driving."
The nurse is caring for a patient in the clinic who states being afraid of taking antihistamines because of being a truck driver. What is the best information for the nurse to give this patient?
"You may be able to safely take a nonsedating antihistamine."
What is the correct dose of montelukast for an adult?
10 mg
A patient is prescribed ipratropium metered-dose inhaler for the treatment of asthma. The nurse instructs the patient to take two puffs four times a day. The inhaler has a capacity of 200 inhalations. How many days will the inhaler deliver the prescribed dose? Record your answer using a whole number. ______ days
25
What is the elimination half-life of theophylline?
7 to 9 hours Theophylline is a xanthine derivative and is used for the treatment of asthma, chronic bronchitis, or emphysema. The elimination half-life of theophylline is 7 to 9 hours. The peak effect of theophylline occurs at 1 to 2 hours after administration. The elimination half-life of salmeterol is 5.5 hours. The duration of action of theophylline is 12 hours.
The nurse is caring for multiple patients on the pulmonary unit. The nurse should question the administration of prescribed epinephrine to which patient?
A patient with atrial fibrillation with a rate of 100 beats/min
A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action?
Administering a beta2 adrenergic agonist
14. A patient is brought to the emergency department and reports having taken "a lot" of acetaminophen extra-strength tablets 16 hours prior. The nurse will expect the provider to order a. acetylcysteine (Mucomyst). b. dornase alfa (Pulmozyme). c. gastric lavage. d. renal enzyme tests.
ANS: A Acetylcysteine is used as an antidote for acetaminophen overdose if given within 12 to 24 hours of ingestion. Dornase alfa is used to treat cystic fibrosis. Gastric lavage is no longer used as treatment. Liver enzyme tests are indicated since acetaminophen is hepatotoxic. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 597 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
1. The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen? a. "I should use albuterol when my symptoms worsen." b. "I will need to take oral prednisone on a daily basis." c. "My provider will prescribe prophylactic antibiotics." d. "My symptoms are reversible with proper medications."
ANS: A Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 587 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
15. A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report experiencing cough and a bad taste. The nurse will instruct the patient to perform which action? a. Drink water before and after using the inhaler. b. Schedule an appointment to discuss these effects with the provider. c. Stop taking the medication immediately. d. Use the inhaler only as needed for acute bronchospasms.
ANS: A Cough and a bad taste are the most common side effects associated with cromolyn sodium, and these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 597 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take? a. Ask the patient if herbal medications are used. b. Notify the provider to report theophylline toxicity. c. Recommend that the patient increase fluid intake. d. Request an order for renal function studies.
ANS: A Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 593 TOP: NURSING PROCESS: Assessment/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol a. has a more immediate onset than the oral form. b. may cause more side effects than the oral preparation. c. requires an increased dose in order to have therapeutic effects. d. will not lead to tolerance with increased doses.
ANS: A Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects, since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 586 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order? a. Albuterol, ipratropium bromide, steroid b. Albuterol, steroid, ipratropium bromide c. Ipratropium bromide, albuterol, steroid d. Steroid, ipratropium bromide, albuterol
ANS: A Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 588 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is caring for a patient who is receiving intravenous theophylline. The patient complains of headache and nausea. The nurse will contact the provider to a. change the medication to an oral theophylline. b. obtain an order for a serum theophylline level. c. request an order for an analgesic medication. d. suggest an alternative methylxanthine medication.
ANS: B Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 590 TOP: NURSING PROCESS: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to a. decrease the dose of theophylline. b. increase the dose of theophylline. c. keep the theophylline dose as ordered. d. discontinue the theophylline.
ANS: B Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 589 TOP: NURSING PROCESS: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug? a. An extra dose should be taken when symptoms worsen. b. Anorexia and gastrointestinal upset are unexpected side effects. c. Avoid caffeine while taking this medication. d. Food will decrease the amount of drug absorbed.
ANS: C Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 590 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason? a. To be more convenient for patients who require both medications b. To improve compliance in patients who may forget to take both drugs c. To increase forced expiratory volume, an indicator of symptom improvement d. To minimize the side effects that would occur if the drugs are given separately
ANS: C Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the FEV1. While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter drug side effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 588 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
13. The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests? a. Cardiac enzymes and serum calcium b. Electrolytes and a complete blood count c. Liver function tests and serum glucose d. Urinalysis and serum magnesium
ANS: C The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 591 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication? a. Failure to respond to the medication indicates a need for a higher dose. b. Monitor for hypoglycemia symptoms when using this medication. c. Palpitations are common with this drug even at normal, therapeutic doses. d. Overuse of this medication can result in airway narrowing and bronchospasm.
ANS: D Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 586 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action? Calling a code Asking the patient to describe the symptoms Administering a beta2 adrenergic agonist Administering a long-acting glucocorticoid
Administering a beta2 adrenergic agonist In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense. A beta2-adrenergic agonist will provide immediate relief, while a glucocorticoid will not; there is no need to call a code.
10. The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching? a. "I will need to have periodic laboratory tests while taking this medication." b. "I will not take ibuprofen for pain or fever while taking this drug." c. "I will take one tablet daily at bedtime." d. "I will use this as needed for acute symptoms."
ANS: D Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have an aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 594 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer isoproterenol (Isuprel) to a patient who is experiencing an acute bronchospasm. The nurse understands that, because isoproterenol is a nonselective beta-adrenergic agonist, the patient will experience which effects? a. Alpha- and beta-adrenergic agonist effects b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects
ANS: D Non-selective beta-adrenergic agonists affect both beta1 and beta2 receptors, causing both tachycardia and bronchodilation. Alpha receptors are not affected. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 586 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patient's tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action? a. Avoid using a spacer with the inhaled glucocorticoid medication. b. Clean the inhaler with hot, soapy water after each use. c. Consume yogurt daily while using this medication. d. Rinse the mouth thoroughly with water after each use.
ANS: D When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 595 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient is in the emergency department to treat a xanthine overdose. What will the health care provider prescribe to treat this patient?
Activated charcoal
The patient tells the nurse that she has a cold, is coughing, and feels like she has fluid in her lungs. What action will the nurse anticipate performing next? Administer dextromethorphan. Administer guaifenesin. Encourage the patient to drink fluids hourly. Administer fluticasone (Flonase).
Administer guaifenesin. The patient needs an expectorant. This medication will help the patient cough the fluid out of her lungs. Dextromethorphan and fluticasone will not help the patient expectorate. There is no information about the patient's fluid intake, so hourly fluids may be too much.
The health care provider orders ipratropium bromide, albuterol, and beclomethasone inhalers for a patient. What is the nurse's best action?
Administer the albuterol, wait 5 min, administer ipratropium bromide, then beclomethasone several minutes later.
The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a patient. What is the nurse's best action? Question the order; three inhalers should not be given at one time. Administer the albuterol, wait 5 minutes, administer ipratropium bromide, then beclomethasone several minutes later. Administer each inhaler at 30-minute intervals. Administer beclomethasone, wait 2 minutes, administer ipratropium bromide, then albuterol several minutes later.
Administer the albuterol, wait 5 minutes, administer ipratropium bromide, then beclomethasone several minutes later Administering the bronchodilator albuterol (Proventil) first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide (Atrovent) also help bronchodilate, but to a lesser extent. Corticosteroids such as beclomethasone (Vanceril) do not dilate and are therefore given last.
The health care provider prescribes albuterol and beclomethasone inhalers for a patient. What is the nurse's best action?
Administer the albuterol, wait 5 minutes, and then administer beclomethasone.
The nurse should instruct a patient to avoid caffeine and stimulants when the individual is using which medication?
Albuterol
Which medication should be administered to a patient who has an acute asthmatic attack?
Albuterol
A patient comes to the emergency department with urticaria after contact with shrubs. Which type of drug should the nurse expect to be included in the treatment plan?
Antihistamine
Which medication can cause paradoxical reactions in children?
Antihistamine
The nurse observes a mild cough in a patient after hernia repair. Which medication should the nurse expect the provider to prescribe for this patient?
Antitussive
A patient with chronic obstructive pulmonary disease has an acute bronchospasm. The nurse anticipates that the health care provider will prescribe which medication?
Epinephrine
The health care provider indicates that a patient will be prescribed an opioid antitussive. Which medication should the nurse anticipate the provider will order?
Benzonatate
A patient with asthma has been prescribed albuterol. The patient reports dizziness after taking the medication. What will the nurse assess in the patient?
Blood pressure
A patient is prescribed tiotropium for the treatment of chronic obstructive pulmonary disease (COPD). How can the absorption of tiotropium be improved?
By waiting for 1 to 2 minutes before inhaling the second dose The nurse should instruct the patient to wait for 1 to 2 minutes before inhaling the second dose of tiotropium to allow for maximal lung penetration. This helps to increase the absorption of tiotropium. The nurse instructs the patient not to take a higher dose of tiotropium for inhalation, because this will result in severe adverse effects. The patient should not inhale the tiotropium continuously for some time, because this increases the concentration of the drug in the body and causes adverse effects. Tiotropium is an anticholinergic drug and therefore reduces secretions and causes mucosal irritation and dryness of the mouth. Therefore, the patient should rinse the mouth with water immediately after using tiotropium to prevent mucosal irritation and dryness of the mouth.
In discharge teaching, the nurse will emphasize to a patient receiving a beta-agonist bronchodilator the importance of reporting which side effect?
Tachycardia
A patient presenting with cough is prescribed diphenhydramine. The nurse instructs the patient to avoid consuming alcohol. Which consequence of drug interaction with alcohol would be prevented if the patient follows the nurse's instructions?
Central nervous system (CNS) depression
Which is the most effective antitussive?
Codeine
The health care provider indicates that the patient will be ordered an opioid antitussive. Which medication does the nurse anticipate the provider will order? Promethazine with dextromethorphan Benzonatate (Tessalon Perles) Codeine CSS II Levocetirizine (Xyzal)
Codeine CSS II Codeine CSS II is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate (Tessalon Perles) are both nonopioid antitussives. Levocetirizine (Xyzal) is an antihistamine.
The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention?
Continue to assess the patient's oxygenation.
The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? Increase the IV drip rate. Monitor the patient for toxicity. Continue to assess the patient's oxygenation. Stop the IV for an hour then restart at lower rate.
Continue to assess the patient's oxygenation. The therapeutic theopylline level is 10 to 20 mcg/mL. The nurse should continue interventions and monitor oxygenation.
Which antiasthmatic drugs work by preventing the inflammation commonly provoked by the substances released from mast cells?
Corticosteroids Corticosteroids prevent the inflammation commonly provoked by the substances released from mast cells. Anticholinergics prevent the binding of cholinergic substances that cause bronchoconstriction and increase secretions. Mast cell stabilizers (cromolyn and nedocromil) stabilize the cell membranes of the mast cells in which antigen-antibody reactions take place, thereby preventing the release of substances such as histamine that cause constriction. Xanthine derivatives raise intracellular levels of cyclic adenosine monophosphate.
Which medication given for asthma can suppress bone growth in children?
Corticosteroids have antiinflammatory action and are used for the treatment of asthma. Administration of corticosteroids may lead to bone growth suppression in children and adolescents. Beta agonists, anticholinergics, and xanthine derivatives do not affect bone growth. Therefore, bone growth suppression is not observed when beta agonists, anticholinergics, or xanthine derivatives are administered.
Which medication is a mast cell stabilizer? 1. Zileuton 2.Cromolyn 3. Montelukast 4.Arformoterol
Cromolyn Cromolyn is a mast cell stabilizer drug. It is used for the treatment of exercise-induced asthma. It works by stabilizing the cell membranes of mast cells to prevent the release of inflammatory mediators such as histamine. Zileuton and montelukast are leukotriene receptor antagonists. Arformoterol is a long-acting beta agonist. These are not used to treat exercise asthma. These drugs are effective in asthma, chronic bronchitis, and emphysema.
Which drug will the primary health care provider prescribe for a patient who has nighttime insomnia and motion sickness?
Diphenhydramine
An older adult who presents with a cough is instructed not to use diphenhydramine. What is the possible reason for this?
Diphenhydramine causes a "hangover" effect.
What are the adverse effects of echinacea? Select all that apply.
Dizziness, Headache, Dermatitis
The nurse is caring for a patient who is taking a first-generation antihistamine. What is the most important information for the nurse to teach the patient? Do not drive after taking this medication." "Make sure you drink a lot of liquids while on this medication." "Take this medication on an empty stomach." "Do not take this medication for more than 2 days."
Do not drive after taking this medication. First-generation antihistamines cause drowsiness. There is no evidence to indicate that the patient should force fluids, take the medication on an empty stomach, or place the medication on hold for any period of time
Which anticholinergic effect is seen in a patient who takes brompheniramine?
Dry Mouth
A patient receiving inhaled ipratropium therapy visits the clinic for a follow-up. Which complaint should the nurse anticipate from the patient?
Dry mouth
Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis?
Dryness
Which condition is characterized by enlargement of air spaces caused by the destruction of the alveolar walls?
Emphysema
A patient who is a taxi driver is diagnosed with allergic rhinitis. Which antihistamine should the nurse expect to be included in the treatment plan?
Fexofenadine
The nurse observes that a patient who is taking phenylephrine and vitamin C tablets has developed rebound congestion. What is the probable reason for rebound congestion?
Frequent use of phenylephrine
A patient is prescribed aminophylline-theophylline. For what adverse effect should the nurse monitor the patient?
Increased heart rate
The health care provider indicates that the patient will be prescribed an expectorant. Which medication does the nurse anticipate the provider will prescribe?
Guaifenesin
The health care provider indicates that the patient will be ordered an expectorant. Which medication does the nurse anticipate the provider will order? Brompheniramine maleate (DeCongest) Chlorpheniramine maleate (Chlor-Trimeton) Dexchlorpheniramine maleate (Polaramine) Guaifenesin (Robitussin)
Guaifenesin (Robitussin) Guaifenesin (Robitussin) is classified as an expectorant. The other drugs listed are classified as first-generation antihistamines.
A patient taking an oral theophylline drug is due for the next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 beats/min. The patient is irritable. What is the nurse's best action?
Hold the next dose of theophylline and assess the patient.
A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse's best action?
Hold the next dose of theophylline.
A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse's best action? Continue to monitor the patient. Call the health care provider. Hold the next dose of theophylline. Administer oxygen 2 L per minute via nasal cannula.
Hold the next dose of theophylline. The patient is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.
Which instruction will the nurse include when teaching a patient about the proper use of metered-dose inhalers? "After you inhale the medication once, repeat until you obtain relief." "Make sure that you puff out air repeatedly after you inhale the medication." "Hold your breath for 10 seconds if you can after you inhale the medication." "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
Hold your breath for 10 seconds if you can after you inhale the medication Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.
Which drug is contraindicated in a patient who has Addison's disease?
Hydrocodone
The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? "Restrict your fluids in order to decrease mucus production." "Take the medication once a day only, at bedtime." "Increase your fluid intake in order to decrease viscosity of secretions." "Increase your fiber and fluid intake to prevent constipation."
Increase your fluid intake in order to decrease viscosity of secretions. Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.
A patient is prescribed albuterol. The nurse is explaining the most common route of administration of albuterol to the patient. Which route should the nurse discuss?
Inhalation
A patient complains that symptoms of allergic rhinitis are persistent even after taking fexofenadine. After checking the patient's history, the nurse finds that the patient is taking phenytoin for the treatment of seizures. What should the nurse interpret from this information?
It indicates drug-drug interaction.
During the assessment of a patient, the nurse finds symptoms of dizziness, confusion, sedation, and hypotension. After reviewing the patient's medical history, the nurse finds that the patient is taking diphenhydramine for treatment of nighttime insomnia. What should the nurse interpret from the assessment?
It is a paradoxical reaction.
Fluticasone propionate and salmeterol combination inhalation is ordered for a patient with chronic obstructive pulmonary disease. What does the nurse know about this medication? (Select all that apply.)
It is delivered as a dry-powder inhaler It is taken as one puff two times a day It promotes bronchodilation
What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine?
Liquefying and loosening of bronchial secretions
What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)? Decreased cough reflex Decreased nasal secretions Liquefying and loosening of bronchial secretions Relief of bronchospasms
Liquefying and loosening of bronchial secretions Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.
A patient who is taking ipratropium for asthma is complaining of a dry cough. Which action should the nurse implement first?
Listen to the patient's lungs.
A patient is prescribed zileuton to treat asthma. Which will be closely monitored in the patient to ensure safe drug administration?
Liver enzyme levels The nurse should assess the patient's liver enzyme levels, because administration of zileuton may lead to liver dysfunction. Zileuton has no effect on creatinine level, blood cells, or uric acid level. Therefore, testing of creatinine clearance, complete blood count, and uric acid baseline level are not required after administering zileuton.
What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)? Loratadine can potentially cause dysrhythmias. Loratadine has fewer sedative effects. Loratadine has increased bronchodilating effects. Loratadine causes less gastrointestinal upset.
Loratadine has fewer sedative effects Loratadine (Claritin) does not affect the central nervous system and therefore is nonsedating. There is insufficient evidence to indicate that loratadine (Claritin) can cause dysrhythmias, can act as a bronchodilator, or cause gastrointestinal upset than other comparable medications.
What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine to loratadine?
Loratadine has fewer sedative effects.
A patient with chronic obstructive pulmonary disease is taking the leukotriene antagonist montelukast. The nurse is aware that this medication is given for which purpose?
Maintenance treatment of asthma
A patient has taken metaproterenol. What is the nurse's priority action?
Monitoring for heart rate (100 beats/min)
A patient has taken metaproterenol. What is the nurse's priority action?
Monitoring for heart rate >100 beats/min
A patient has taken metaproterenol (Alupent). What is the nurse's priority action? Monitoring for heart rate >100 beats/min Telling the patient not to drive for 2 hours Monitoring for sedation Assessing for elevated blood pressure
Monitoring for heart rate >100 beats/min The beta1 properties of this drug can cause increased heart rate and palpitations. The drug should not cause sedation or elevated blood pressure.
The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention?
Monitoring patient for potential chest pain
The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention? Monitoring patient for potential chest pain Monitoring blood pressure continuously Assessing daily for hyperkalemia Assessing 12-lead ECG each shift
Monitoring patient for potential chest pain Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patient with coronary artery disease. Cautious use of these agents is indicated if the patient has coronary artery disease.
Which antiasthmatic, available only for oral use, is approved for use in children 2 years of age and older?
Montelukast Montelukast is a leukotriene receptor antagonist that is approved for use in adults and children 2 years of age and older. It is available only for oral use. Albuterol and terbutaline are available in oral and inhalation forms. Systemic corticosteroids are not approved for children.
Which symptom of allergic rhinitis is treated with fluticasone?
Nasal congestion
A patient is receiving intravenous aminophylline. The nurse checks the patient's lab values and sees the serum theophylline level is 32 mcg/mL. What action should the nurse take?
Notify the health care provider of the level
A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 hours. What is the nurse's most appropriate response? "Oxymetazoline is not an effective nasal decongestant." "Overuse of nasal decongestants results in rebound congestion." "Oxymetazoline should be administered every hour for severe congestion." "You are probably displaying an unexpected reaction to oxymetazoline."
Overuse of nasal decongestants results in rebound congestion Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3 to 5 days.
The primary health care provider prescribes oxymetazoline to a patient with sinusitis who complains of nasal congestion and difficulty in breathing. About which possible adverse effect should the nurse teach to the patient?
Palpitations
Which patients are the best candidates to receive antitussive cough medication?
Patients who have undergone hernia surgery
A patient is prescribed ipratropium for the treatment of chronic obstructive pulmonary disease. For what should the nurse assess to ensure safe administration of ipratropium?
Peanut allergy
In discharge teaching, the nurse will emphasize to a patient receiving a beta-agonist bronchodilator the importance of reporting which side effect? Hypoglycemia Nonproductive cough Sedation Tachycardia
Tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.
The use of fexofenadine is contraindicated in patients with which conditions?
Renal Impairment
A patient is prescribed naphazoline for the treatment of hay fever. During an assessment, the nurse finds that the patient has hypertension. Which action by the nurse is correct?
Report this finding to the primary health care provider.
What over-the-counter product will the nurse instruct the patient to avoid when taking montelukast?
St. John's wort
What over-the-counter product will the nurse instruct the patient to avoid when taking montelukast (Singulair)? Acetaminophen (Tylenol) Echinacea Diphenhydramine (Benadryl) St. John's wort
St. John's wort St. John's wort has been shown to decrease serum montelukast (Singulair) levels. The other substances do not interact with montelukast.
A patient is prescribed ipratropium and cromolyn sodium. What should the nurse teach the patient?
Take the ipratropium 5 minutes before the cromolyn. When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 2 to 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
A patient is prescribed ipratropium and cromolyn sodium. What will the nurse teach the patient?
Take the ipratropium at least 5 min before the cromolyn.
A patient is prescribed oral albuterol to treat bronchitis. What instruction should the nurse give to the patient to prevent gastrointestinal (GI) upset?
Take the prescribed medication with food."
While investigating the cause of sudden death in a patient with asthma, the nurse finds that the patient's medications were changed from systemic corticosteroids to inhaled corticosteroids. Which intervention, if followed, might have saved the patient from dying?
Tapering the dose of systemic corticosteroid When a patient's medications are suddenly switched from systemic corticosteroids to an inhaled corticosteroid, adrenal suppression takes place. This leads to adrenal failure, which can be fatal. Death can be prevented by gradually reducing the dose of systemic corticosteroids, because this prevents the withdrawal symptoms. An initial high loading dose of inhaled corticosteroids may cause localized irritation and other adverse effects. However, the initial loading dose is usually preferred for the systemic administration of medications. By continuing the administration of same dose of systemic corticosteroids, the patient would have severe adverse effects from the synergistic effects of systemic and inhaled corticosteroids. Gradual reduction of dosage frequency may not help, because an initially large amount of drug might have been accumulated in the body and would have caused an adverse reaction in the patient.
The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What should the nurse do?
Teach the child to use a spacer.
The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What will the nurse do?
Teach the child to use a spacer.
The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What will the nurse do? Tell the parent to hold the inhaler for the child. Ask the health care provider to switch to oral medications. Tell the parent that young children should not use inhalers. Teach the child to use a spacer.
Teach the child to use a spacer. If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.
A patient reports nausea, shortness of breath, joint pain, weakness, and fatigue. On review of the patient's history, the nurse finds that the patient is prescribed prednisone to treat asthma. The nurse also learns that the patent has abruptly discontinued the medicine shortly after getting some relief from asthma. What should the nurse interpret from the assessment?
The patient has Addisonian crisis. Prednisone is a systemic corticosteroid. If a systemic corticosteroid is abruptly discontinued, Addisonian crisis ensues. Nausea, shortness of breath, joint pain, weakness, and fatigue are symptoms of Addisonian crisis. Coronary ischemia causes shortness of breath, fatigue, and weakness but is not associated with discontinuation of steroid therapy. Rheumatoid arthritis is an autoimmune disease, which is not caused by abrupt cessation of corticosteroid therapy. Nausea, shortness of breath, joint pain, weakness, and fatigue do not indicate Cushing's syndrome. Therefore, the patient does not have Cushing's syndrome. Moon face, acne, an increase in fat pads, and swelling are symptoms of Cushing's syndrome.
The nurse observes that a patient has moon face, acne, an increase in fat pads, and swelling. After checking the patient history, the nurse finds that the patient is taking methylprednisolone for bronchospastic disorder. What will the nurse infer from the assessment?
The patient has Cushing's syndrome
A patient who has allergic rhinitis comes to the clinic for a scheduled allergy test. After performing a health history, the nurse informs the patient that the allergy test will have to be rescheduled. What may be the reason for this?
The patient is being treated with antihistamine drugs.
The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient?
The patient with atrial fibrillation with a rate of 100
The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? The patient with a history of emphysema The patient with a history of type 2 diabetes The patient who is 16 years old The patient with atrial fibrillation with a rate of 100
The patient with atrial fibrillation with a rate of 100 The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This patient should not receive epinephrine.
What interaction can occur when an asthmatic patient consumes rifampin along with xanthine derivatives?
Theophylline levels are decreased Xanthine derivatives are used as bronchodilators in asthmatic patients. Administration of rifampin along with xanthine derivatives causes increased metabolism of theophylline, which results in decreased levels of theophylline. Additive cardiac and central nervous system stimulation is produced when caffeine is administered along with theophylline.
A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? "This medication may cause drowsiness and dizziness." "Watch for diarrhea and abdominal cramping." "This medication may cause tremors and anxiety." "Headache and hypertension are common side effects."
This medication may cause drowsiness and dizziness. Antitussive medications also affect the central nervous system, thus causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension.
The nurse is teaching the patient on the use of beclomethasone diproprionate (Beconase). Which statement by the patient indicates an understanding of the teaching? I will need to taper off the medication to prevent acute adrenal crisis." "This medication will help prevent the inflammatory response of my allergies." "I will need to monitor my blood sugar more closely because it may increase." "I need to take this medication only when my symptoms get bad."
This medication will help prevent the inflammatory response of my allergies. Beclomethasone diproprionate (Beconase) is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.
A patient is prescribed inhaled corticosteroids. Why should the nurse ask the patient to rinse the mouth after each dose?
To prevent the development of oral candidiasis It is recommended that patients rinse their mouth immediately after use of the inhaler or nebulizer dosage forms of corticosteroids. It helps to prevent overgrowth of oral fungi and subsequent development of oral candidiasis (thrush). Dry mouth, nasal congestion, and sore throat are not side effects of corticosteroid inhaler use.
What are adverse effects of albuterol? Select all that apply.
Tremors Palpitations Tachy
For which adverse drug effect is the nurse alert in an older adult patient taking diphenhydramine?
Urinary retention
The nurse is assessing a patient with asthma. Which symptoms should the nurse expect to find in the patient?
Wheezing Chest Tightness Shortness of breath
The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient? "Take the medication only when you are not driving." "Take a lower dose than normal when you have to drive." "You are correct; you should not take antihistamines." "You may be able to safely take a second-generation antihistamine."
You may be able to safely take a second-generation antihistamine. Second-generation antihistamines are often called non-sedating antihistamines. These may be safer for the patient to take, but the patient should still monitor for signs of excessive sedation.
What are the adverse effects of ipratropium and tiotropium therapy? Select all that apply.
headache dry mouth nasal congestion