Respiratory and Lipid Levels
Decongestants elicit their effect by which of the following mechanisms? a. Non-selectively binding to central and peripheral H1 receptors b. Vasoconstriction of small blood vessels of the nasal membranes c. Selectively binding to peripheral H1 receptors d. Anesthetizing stretch receptors in the respiratory passages
B
A client is prescribed an antitussive medication. What is the most important thing for the nurse to teach the client? a. This medication may cause drowsiness and dizziness b. This may cause tremors and anxiety c. Watch out for diarrhea and abdominal cramping Headache and hypertension are common side effects
A
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? a. 9:30 AM b. 10:15 AM c. 10:00 AM d. 9:45 AM
A
As the nurse caring for a patient taking acetylcysteine, you are charged with the development of a nursing plan of care. What would be the most appropriate diagnosis for the patient with regards to potential side effects of the medication? a. Ineffective airway clearance related to drug effect or bronchospasm b. Alteration in urinary elimination related to drug effect or urinary retention c. Alteration in sensation related to the drug effect of neuropathy d. Alteration in cardiac output related to drug effect or hypotension
A
The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order? a. Albuterol first, wait five minutes and then follow with flunisolide b. Flunisolide first, wait five minutes and then follow with albuterol c. Albuterol followed immediately by flunisolide d. Flunisolide followed immediately by albuterol
A
The nurse would question an order for cholestyramine (Questran) if the client has which condition? a. Impaction b. Glaucoma c. Hepatic disease d. Renal disease
A
The pharmacology instructor is explaining the difference between bronchodilators and anti-inflammatory drugs. How does an anti-inflammatory drug reduce bronchoconstriction? a. By decreasing airway hyperreactivity to various stimuli b. Increases reactivity to medication c. Decreases formation of mucus secretions d. Increases ability to metabolize medication
A
When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what? a. Inhibits absorption of dietary cholesterol in the intestines. b. Binds with bile acids in the intestines to reduce LDL levels. c. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver. d. Forms insoluble complexes and reduces circulating cholesterol in blood.
A
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) A. Salmeterol (Serevent) inhaler B. Albuterol (Proventil) nebulizer solution C. Epinephrine D Montelukast (Singulair) E. Fluticasone (Flovent) Rotadisk inhaler
ANS: B, C Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.
A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse anticipates that which drug will be ordered to aid in the removal of mucus? A. benzonatate (Tessalon Perles) B. codeine C. guaifenesin (Humibid) D. dextromethorphan.
ANS: C. Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed are antitussives (cough suppressants).
The nurse knows that an antitussive drug would be most appropriate for the following patient? A. A patient with pneumonia who has a productive cough. B. A patient who has a tracheostomy and thick mucus secretions. C. A patient who has had a productive cough for 2 weeks. D. A patient who has developed bronchitis 2 days after a hernia repair surgery.
ANS: D Although most of the time coughing is beneficial, there are some occasions when it is not useful and may be harmful 9eg, after a surgical procedure such as hernia repair or in case of nonproductive or dry cough). Coughing would be beneficial in the other three situations.
When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? A. Fatigue and depression B. Anxiety and palpitations C. Headache and rapid heart rate D. Oral candidiasis and dry mouth
ANS: D Rationale: Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.
A nurse is teaching a patient about montelukast (Singulair). Which of these statements, if made by the patient, would indicate the nurse's teaching was effective? A. "I'll take a dose as soon as I feel short of breath and start to cough." B. "While taking this medicine, I may be able to reduce my steroid medication." C. "It is a priority medication to prevent exercise-induced asthma symptoms." D. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."
Ans. B. "While taking this medicine, I may be able to reduce my steroid medication." Rationale: Montelukast, an antileukotriene agent, when combined with an inhaled glucocorticoid medication, can improve asthma symptoms and thus may permit a reduction in glucocorticoid dosage. Its effects develop slowly, so it cannot be used as a quick-relief agent. Short-acting beta2 agonists are preferred for exercise-induced asthma. Montelukast does not affect coagulation, so bleeding and bruising do not occur.
. After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? A. "This is an expected adverse effect. Let me take your pulse." B. "The next scheduled nebulizer treatment will be skipped." C. "I will notify the physician about this adverse effect." D. "We will hold the treatment for 24 hours."
Ans: A Rationale: Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.
Which of the following statements indicates that the client has understood the teaching for diphenhydramine? A. "I should wear sunscreen and protective clothing when going out in the sunlight" B. "I should drink alcohol when taking diphenhydramine" C. "It is okay to take other OTC diphenhydramine medications and products containing diphenhydramine" D. "It is okay to drive a car after taking this medication"
Ans: A Rationale: because the medication causes photosensitivity it is important to wear sunscreen and protective clothing
The client is receiving an antitussive with codeine for treatment of a cough. Nursing intervention is required if the client makes which of the following statements? A."I will avoid driving." B."I will take my medicine with red wine to help me sleep." C."I will notify my doctor if my breathing changes." D."I will keep this medication away from my children."
Ans: B Rationale: The codeine antitussive medications should not be combined with alcohol, which can cause increased CNS depression.
The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? A. Toxic B. Therapeutic C. Subtherapeutic D. Life threatening
Ans: B. Therapeutic Rationale: NARROW THERAPEUTIC WINDOW (10-20). >20 GI upset and CNS stime . >30 Tachy, AA, HTN, Seizure, coma (VERY DANGEROUS
A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium (Combivent). Upon reviewing the medical history of the patient, the nurse questions the prescription if which of the following is noted? A. History of smoking. B. History of allergy to egg. C. History of allergy to peanut. D. History of a previous infection.
Ans: C. History of allergy to peanut. Rationale: Contraindications Soy and peanut allergy, Pregnancy category B, conditions sensitive to anticholinergic effects
Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? A. Platelet count B. Neutrophil count C. Liver function tests D. Complete blood count
Ans: C. Liver function tests Rationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.
Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI (Proventil) at which of these times? A. Twice daily combined with an inhaled glucocorticoid B. Only with a long-acting beta2 agonist (LABA) C. Whenever needed (PRN) as a quick relief agent D. If night time awakenings are more than 2 days per week
Ans: C. Whenever needed (PRN) as a quick relief agent Rationale: For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasm. For patients at step 1, no long-term control medications are taken. A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more than 2 days per week. For patients at steps 2 and above, albuterol is considered a quick-relief medication taken PRN.
The client presents to the clinic with a serum cholesterol of 275 mg/dl and is placed on rosuvastatin (Crestor). Which instruction should be given to the client? A. Report muscle weakness to the physician B. Allow 6 months for the drug to take effect C. Take the medication with fruit juice D. Ask the doctor to perform a complete blood count prior to starting the medication
Answer A is correct. The client taking antilipidemics should be encouraged to report muscle weakness because this is a sign of rhabdomyositis. The medication takes effect within 1 month of beginning therapy, so answer B is incorrect. The medication should be taken with water. Fruit juice, particularly grapefruit juice, can decrease the drug's effectiveness, so answer C is incorrect. Liver function studies, not a CBC, should be checked prior to beginning the medication, so answer D is incorrect.
The client is instructed regarding foods that are low in fat and cholesterol. Which diet selection is lowest in saturated fats? A. Macaroni & cheese B. Shrimp with rice C. Turkey breast D. Spaghetti & meatballs
Answer C is correct. Turkey contains the least amount of fat and cholesterol. Cheese, shrimp, and beef should be avoided by the client on a low cholesterol, low fat diet
The nurse taking care of a neonate with RDS is preparing to administer a medication that is used to replace the surfactant that is missing in the lungs. Which medication will the nurse be expected to administer? a. Beractant b. Zafirlukast c. Ipratroprium d. Epinephrine
Answer: A. Rationale: Beractant is used to replace the surfactant that is missing in the lungs of neonates with RDS. Zafirlukast is used for the prevention and long-term treatment of asthma in adults and children 5 years and older. Ipratropium is a maintenance drug used for symptoms related to asthma-induced bronchospasms, bronchitis, or pulmonary emphysema. Epinephrine is used in treatment of acute bronchospasm in adults and children, including that caused by anaphylaxis.
The nurse is assessing a patient diagnosed with bronchitis, who presents with a dry, nonproductive cough. What medication will the nurse expect the doctor to prescribe so that the cough can become productive? a. Guaifenesin (Mucinex) b. Dextromethorphan (Benylin) c. Acetylcysteine (Mucomyst) d. Hydroxyzine (Vistaril)
Answer: A. Rationale: Guaifenesin is used to produce a productive cough and to thin secretions by reducing the adhesiveness and surface tension of secretions, allowing for easier movement out of the lungs. The other answers are incorrect.
A client has begun therapy with theophylline. A nurse plans to teach the client to limit the intake of which of the following while taking this medication? A. Coffee, cola, and chocolate B. Oysters, lobster, and shrimp C. Melons, oranges, and pineapple D. Cottage cheese, cream cheese, and dairy creamers
Answer: A. Coffee, cola, and chocolate Rationale: Theophylline is a methylxanthine and the patient should avoid xanthine-containing foods such as coffee, cola, and chocolate due to the increased risk for tachycardia and arrhythmias
Which of the following indicates successful use of cholestyramine (Questran) in a client with jaundice due to obstructive gallbladder disease? A. Decreased inflammation B. Decreased itching C. Decreased pain D. Decreased cholesterol levels
Answer: B is correct. Questran binds with bile acids that are excreted in the stools. It prevents the accumulation of bile acids on the skin, thereby decreasing itching.
The ED nurse administers epinephrine to a patient having an anaphylactic reaction. What is the expected therapeutic effect of this medication? a. Directly affects smooth muscle of the respiratory tract, increasing the force of contractions by the diaphragm which results in more air entering the lungs. b. Dilates the bronchi with increased rate and depth of respirations. c. Blocks muscarinic cholinergic receptors which decreases contractility of smooth muscles, resulting in decreased bronchospasms. d. Reduces surface tension within alveoli, allowing expansion of the alveoli for gas exchange.
Answer: B. Rationale: Epinephrine dilates bronchi with increased rate and depth of respirations. Aminophylline directly affects smooth muscle of the respiratory tract, increasing the force of contractions by the diaphragm, which allows for more air to enter the lungs. Ipratropium blocks muscarinic cholinergic receptors, which decreases contractility of smooth muscles, resulting in decreased bronchospasms. Beractant reduces surface tension within alveoli, allowing expansion of the alveoli for gas exchange.
Which of the following teachings should a nurse provide a patient regarding the technique of using a corticosteroid inhaler? a. It is not necessary to rinse your mouth after using inhaler. b. When taking a puff you should inhale as quickly and deeply as you can. c. Press the canister down, breathe in slowly and deeply, hold your breath for a few seconds then exhale slowly. d. A spacer is not necessary
Answer: C Rationale: Spacers are suggested because they prevent the medication from collecting on the tongue or back of throat. Inhalers can cause Candida infections, that is why it is important to rinse mouth after use. Breathing in slowly and holding the breath allows the medication to move further down the airway.
The nurse is providing education to a patient newly diagnosed with asthma regarding their medication. When explaining how bronchodilators work, the nurse states: a. "These drugs work by helping to break down mucus." b. These drugs work by increasing cough production to clear the airways." c. "These drugs work by dilating the airways to allow for respirations." d. "These drugs block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways."
Answer: C. Rationale: Bronchodilators dilate the airways to allow for respirations. Mucolytics break down mucus. Expectorants increase cough production to clear the airways. Antihistamines block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways.
The nurse knows that the patient understands his new medication, ipratropium, when he states: a. "This medicine is a pill that I will take every morning." b. "I should only take this medicine in an emergency." c. "I should use this medication with a metered-dose inhaler (MDI)." d. "This medication will increase bronchospasms, making it easier for me to breathe."
Answer: C. Rationale: Ipratropium should be used with a MDI to avoid systemic absorption. All the other answer choices are incorrect.
A client 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 best action? A. Call a code B. Ask the client to describe the symptoms C. Administer a beta-2 adrenergic agonist D. Administer a long-acting glucocorticoid
Answer: C. Administer a beta-2 adrenergic agonist. Rationale: Beta-2 adrenergic agonists act on beta-2 receptors in the lungs causing bronchodilation. As a rescue drug used in acute exacerbations of asthma, beta-2 agonists dilate the airways allowing more oxygen in
A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions? A. "It is not necessary to avoid the use of alcohol." B. "The medication should be taken with meals to decrease flushing.: C. "Clay-colored stools are a common side effect and should not be of concern." D. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
Answer: D is correct. Flushing is a side effect of this medication. Aspirin or a NSAID can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease the GI upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are sign of hepatic dysfunction and should be immediately reported to the health care provider
The nurse provided education about a topical decongestant medication, Ephedrine, that the patient will be starting. Which of the following statements shows patient understanding? a. "I can continue taking this medication if I have a lesion in my mouth." b. "I can use this medication long term without any serious side effects." c. "I can continue using my other medications which contain pseudoephedrine while taking Ephedrine without any adverse drug-interactions. d. "This medication will relieve nasal congestion that can occur with a cold or allergies."
Answer: D. Rationale: Patients should use caution with decongestants when there are lesions or erosions in the mucous membranes because this could lead to systemic absorption of the medication. Decongestants should not be used more than 3-5 days because this can lead to rebound congestion and potential abuse of the decongestant. Using decongestants with other sympathomimetic drugs may result in toxic or non-effective responses, so use needs to be monitored carefully. Decongestants are used to relieve nasal congestion resulting from the common cold, sinusitis, and allergic rhinitis.
A patient has just been prescribed Zafirlukast for long-term treatment of asthma. After looking through the patient's other current medications, the nurse notifies the physician that Zafirlukast has a toxic drug interaction with: a. Penicillin b. Chlorothiazide c. Acetaminophen d. Warfarin
Answer: D. Rationale: Zafirlukast can have a toxic reaction with warfarin, propranolol, theophylline, terfenadine, calcium-channel blockers, cyclosporine, and aspirin. No significant drug interaction would occur with penicillin, chlorothiazide, or acetaminophen.
When taking antihistamines, the patient should be reminded of the following (Select all that apply) : a. "I can take this medication with apple juice, grapefruit juice, and orange juice." b. "I should avoid use of other OTC drugs while on this medication." c. "I can take this medication with food and a full glass of water." d. "I can use sugarless lozenges if I have dry mouth from this medication." e. "I can use this medication to treat common cold or flu symptoms."
Answers: B, C, D. Rationale: When taking antihistamines, the patient should avoid drinking apple, grapefruit, and/or orange juice 2 hours before and after dose. The patient can take antihistamines with food and a full glass of water to prevent GI upset. Antihistamines are used for allergy symptom relief, not for common cold or flu symptoms. Other OTC drugs should be avoided while taking antihistamines. Sugarless lozenges can be used if dry mouth becomes problematic.
A client is admitted with an exacerbation of asthma following a respiratory viral illness. Which clinical manifestations characteristic of a severe asthma attack does the nurse expect to assess? Select all that apply. a. Accessory muscle use b. Chest tightness c. High-pitched expiratory wheeze d. Prolonged inspiratory phase e. Tachypnea
Asthma is an obstructive lung disease characterized by hyperreactive airways and chronic inflammation. Asthma exacerbations occur due to various triggers (eg, allergens, respiratory infection, exercise, cold air), resulting in edema, hypersecretion of mucus, and bronchospasm. Narrowing of the airways culminates in increased airway resistance, air trapping, and lung hyperinflation. In severe asthma, breath sounds may be diminished due to closure of bronchioles. Absent breath sounds in a client with asthma are a medical emergency. Clinical manifestations of an asthma exacerbation include: ● Accessory respiratory muscle use related to increased work of breathing and diaphragm fatigue ● Chest tightness related to air trapping ● Cough from airway inflammation and increased mucus production ● Diminished breath sounds related to hyperinflation ● High-pitched expiratory wheezing caused by narrowing airways; wheezing may be heard on both inspiration and expiration as asthma worsens ● Tachypnea related to inability to take a full, deep breath Clients with obstructive lung disease (eg, asthma, chronic obstructive pulmonary disease) develop prolonged expiratory phase as a physiologic response to hyperinflation and trapped air. UWorld. Retrieved from https://www.uworld.com/ClientApp/V3/apps/Qbank/
. A client has been prescribed guaifenesin (Robitussin). The nurse realizes that the purpose of the drug is to accomplish what? A. To treat allergic rhinitis and prevent motion sickness B. To loosen bronchial secretions so they can be eliminated by coughing C. To compete with histamine for receptor sites, thus preventing a histamine response D. To stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa
B
A client is prescribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the client's theophylline serum levels to maintain which therapeutic range? A. 1 to 10 mcg/mL B. 10 to 20 mcg/mL C. 20 to 30 mcg/mL D. 30 to 40 mcg/mL
B
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? a. Discontinue b. Increase c. Monitor closely d. Decrease
B
A patient presents at the clinic with a dry, nonproductive cough. The patient is diagnosed with bronchitis, and it is determined she will need help thinning sputum so that the cough can become productive. What does the nurse expect the physician to prescribe? a. Dextromethorphan b. Guaifenesin c. Codeine d. Any of the above
B
The client is using an H1 receptor antagonist. Which of the following statements indicates that the client understands drug therapy: a. I will use my bronchodilator is my wheezing increases b. I will report fever, blurred vision, or eye pain c. This is the only drug I will need to treat my asthma attacks d. I will use this drug only when I feel an attack coming on
B
The client tells the nurse that she has a bad cold, is coughing, and feels like she has "stuff" in her lungs. What should the nurse do? a. Administer dextromethorphan b. Administer guaifensin c. Encourage the client to drink fluids hourly d. Administer pseudoephedrine
B
The nurse plans which intervention to decrease the flushing reaction of niacin? a. Administer niacin with an antacid. b. Administer aspirin 30 minutes before nicotinic acid. c. Administer diphenhydramine hydrochloride (Benadryl) with niacin. d. Apply cold compresses to the head and neck.
B
What adverse effect of most oral antihistamines presents a priority safety concern for adult clients? a. Nasal burning b. Drowsiness c. Nonproductive cough d. Dry mouth
B
What is the most important thing for the nurse to teach a client who is switching allergy medications from diphenhydramine (Benadryl) to fexofenadine (Allegra)? A. This medication can potentially cause dysrhythmias B. This medication has fewer sedative effects C. This medication has increased bronchodilating effects D. This medication causes less gastrointestinal upset.
B
The client is using a betaadrenergic agonist for the treatment of asthma. The nurse teaches that the action of this drug is: A. Reducing mucus production B. Relaxing smooth muscle, causing bronchodilation C. Liquefying mucus D. Reducing cough
B Rationale: Betaadrenergic agonists stimulation beta receptors in the respiratory tract and cause rapid relaxation of smooth muscle (bronchodilation). Teaching this to patients reinforces that the use of a betaadrenergic agonist is for acute exacerbations of asthma
A clinician is providing teaching for inhaled corticosteroid technique. Which information should be included in teaching? a. "Press the canister down, breathe in slowly, and deeply, hold your breath for a few seconds and then slowly exhale." b. "Spacers are not necessary. They are mostly for convenience and ease of handling the inhaler." c. "You should inhale as quickly and as deeply as possible when you take a puff from the inhaler." d. "It is not necessary to rinse your mouth after using your inhaler."
Breathing in slowly and deeply and then holding one's breath allows for the medication to move further down the airway. If possible, count to ten before exhaling. Spacers are typically suggested as they prevent the medication from collecting on the tongue and the back of the throat. Because inhalers leave a residue in the mouth, they can increase the risk of developing Candida infections. The patient should always rinse his or her mouth after use. Nurse Plus Academy, 2018. NCLEX-RN physiological integrity practice test questions. Retrieved from https://nurse.plus/physiological-integrity-test-nclex-rn-questions/
A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? A. Hypolipidemia B. Normolipidemia C. Hyperlipidemia D. Alipidemia
C
A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer? a. cholestyramine (Questran) b. colestipol (Colestid) c. gemfibrozil (Lopid) d. simvastatin (Zocor)
C
A nurse is obtaining a patient history to determine the most appropriate treatment. The nurse learns that his patient has active peptic ulcer disease. Which medication is contraindicated for this patient? a. Lovastatin b. Ezetimibe c. Niacin d. Cholestyramine
C
A patient's total cholesterol level was 250mg/dL. The nurse practitioner decides to prescribe Lovastatin. What statement made by the patient indicates a need for patient education? a. "I will take this medication every night before bedtime." b. "I know it is important to modify my diet and exercise more often." c. "This cholesterol medication alone will cure my high cholesterol levels." d. "I should limit my alcohol intake while I am on this medication."
C
Client teaching regarding the use of antileukotriene agents such as zafirlukast (Accolate) should include which statement? A. "Take the medication as soon as you begin wheezing." B. "It will take about 3 weeks before you notice a therapeutic effect." C. "This medication will prevent the inflammation that causes your asthma attack." D. "Increase fiber and fluid in your diet to prevent the side effect of constipation."
C
Mr. Lou, 68 years old, is prescribed zafirlukast drug therapy. The nurse is aware that due to his age, he may experience decreased renal clearance of zafirlukast. What measure is the nurse expected to take? a. Advise a quiet environment or exercise. b. Advise increased fluid intake. c. Arrange for frequent follow-up appointments. d. Monitor the serum zafirlukast levels carefully.
C
Nursing intervention for a client on an expectorant includes: a. Assessing liver function tests b. Assessing cardiac dysrhythmias c. Assessing for signs of increased sputum production d. Monitoring blood glucose for hypoglycemia
C
The nurse teaches the client that the major disadvantage of antitussive therapy with dextromethorphan is that: A. The medication is irritating to the bronchial tree B. The medication is very expensive C. The dose of the medication the client receives could cause drowsiness D. The client may use the medication for 14 days
C
The nurse understands that cholesterol is carried through the blood by means of lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Very-low-density lipoprotein (VLDL) B. Apolipoprotein B-100 C. Low-density lipoprotein (LDL) D. High-density lipoprotein (HDL)
C
What is the most important thing for the nurse to teach a patient with a history of diabetes mellitus who has started on albuterol PRN? A. Take Tylenol for headaches when taking albuterol B. Monitor for orthostatic hypotension every 2 hours when taking albuterol C. Monitor blood glucose levels every 4 hours when taking albuterol D. An antianxiety agent may be prescribed to help with nervousness
C
Which of the following statements indicates a need for additional teaching about lovastatin therapy? a. "I should call my doctor if I start to feel unusual muscle pains." b. "I can take this medication before bed with some milk." c. "I will make sure to take my statin in the morning after eating breakfast." d. "I cannot take this medication during pregnancy."
C
Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? A. platelet count B. neutrophil count C. liver function test D. complete blood count
C: Zafirlukast is used with caution for those with impaired hepatic function
A client with chronic bronchitis tells the home health nurse of being exhausted all day due to coughing all night and being unable to sleep. The client can feel thick mucus in the chest and throat. Which interventions can the nurse suggest to help mobilize secretions and improve sleep? Select all that apply. a. Increase fluids to at least 8 glasses (2-3 L) of water a day b. Sleep with a cool mist humidifier c. Take prescribed guaifenesin cough medicine before bedtime d. Use abdominal breathing and the huff cough technique at bedtime e. Use pursed-lip breathing during the night
Chronic bronchitis is characterized by excessive mucus production, chronic cough, and recurrent respiratory tract infections. Interventions to help reduce viscosity of mucus, facilitate secretion removal, and promote comfort include the following: ● Increasing oral fluids to 2-3 L/day if not contraindicated prevents dehydration and keeps secretions thin ● Cool mist humidifier increases room humidity of inspired air ● Guaifenesin (Robitussin) is an expectorant that reduces the viscosity of thick secretions by increasing respiratory tract fluid; drinking a full glass of water after taking the medication is recommended. ● Abdominal breathing with the huff, a forced expiratory cough technique, is effective in mobilizing secretions into the large airways so that they can be expectorated ● Chest physiotherapy (postural drainage, percussion, vibration) ● Airway clearance handheld devices, which use the principle of positive expiratory pressure to help loosen secretions when the client exhales through the mouthpiece Pursed lip breathing prolongs exhalation, reduces air trapping in the lungs, and decreases dyspnea. It does not help to thin secretions. UWorld. Retrieved from https://www.uworld.com/ClientApp/V3/apps/Qbank/
A patient who has a history of chronic bronchitis is admitted to the medical unit. The healthcare provider notes the red blood cell count is elevated. Which of these is the likely contributing factor to this lab result in this patient? a. Chronic Hypoxia b. Hypercapnia c. Decreased Fluid Intake d. Insensible Water Loss
Chronic hypoxia, from reduced air exchange, leads to low oxygen levels in the body. The kidneys respond to chronic hypoxia by releasing erythropoietin, which stimulates red blood cell production. The red blood cell count is elevated to compensate for the hypoxia, or low oxygen levels. More cells are available to carry and deliver the maximum amount of oxygen. Nurse Plus Academy, 2018. NCLEX-RN physiological integrity practice test questions. Retrieved from https://nurse.plus/physiological-integrity-test-nclex-rn-questions/
Client teaching for clients on dextromethorphan should include: a. Continuing the drug at higher doses if the cough is not relieved after several days b. Monitor intake and output c. Reducing the dosage of the drug if insomnia occurs d. Notify the physician if the drug no longer seems effective
D
For a patient who is in the late stages of chronic bronchitis, which of the following would indicate the patient has developed cor pulmonale? a. Venous stasis ulcers b. Hypocapnia c. Night sweats d. Hepatomegaly
Cor pulmonale, or right-sided heart failure, is the result of a lung condition, such as chronic bronchitis or COPD. The diseased lungs deliver less oxygen to the right ventricle, putting a strain on the heart from pulmonary hypertension. Over time, the right ventricle fails, causing increased venous pressure and liver enlargement (hepatomegaly). Common early symptoms include fatigue, tachypnea, shortness of breath on exertion, and a cough. Nurse Plus Academy, 2018. NCLEX-RN physiological integrity practice test questions. Retrieved from https://nurse.plus/physiological-integrity-test-nclex-rn-questions/
The nurse knows that the client's total cholesterol level should be within which range? A. 150 to 200 mg/dL B. 200 to 225 mg/dL C. 225 to 250 mg/dL D. Greater than 250 mg/dL
Correct Answer: A Rationale: The Fourth Report of the National Cholesterol Education Program (NCEP) recommends that total cholesterol levels be under 200 mg/dL.
Nursing intervention for a client on an expectorant includes: A. Assessing of cardiac dysrhythmias. B. Assessing for signs of increased sputum production. C. Assessing liver function tests. D. Monitoring blood glucose for hypoglycemia.
Correct Answer: B Rationale: Expectorants act by reducing the thickness of bronchial secretions. Therefore, increased sputum production from a client would be expected and should be recorded.
Fexofenadine relieves allergy symptoms by which of the following mechanisms? A. Preventing the sneeze reflex B. Blocking the action of histamine C. Preventing mast cells from rupturing D. Thinning respiratory secretions
Correct Answer: B Rationale: Fexofenadine is a second generation antihistamine that selectively blocks the effects of histamine at H1receptor sites to decrease allergic response.
A patient is currently taking pseudoephedrine (Sudafed) for relief of common cold like symptoms. You caution the patient not to take the medication at night. What is the rationale for this caveat? A. Can cause gastric reflux B. Can cause insomnia C. Can cause urinary frequency D. Can cause elevated blood sugars
Correct Answer: B Rationale: Pseudoephedrine is a sympathomimetic that stimulates alpha and beta adrenergic receptors, which causes many CNS and cardiovascular side effects, including tension, anxiety, restlessness, tremor, insomnia, weakness, hallucinations, and convulsions.
You are a nurse working in a community clinic. Your patient mentions she has started taking dextromethorphan to relieve her cough. Which of the following should you include in your patient education? A. Unlike codeine, this drug is safe to use as an antitussive for patients with asthma. B. Patients taking MAOIs should reduce their dextromethorphan doses by half. C. You should not take this drug if you have a history of liver problems. D. Increase your dose if your cough does not improve after several days.
Correct Answer: C Rationale: Dextromethorphan is not indicated for cough related to asthma, should not be taken in combination with MAOIs, and is contraindicated in patients with hepatic impairment. Patients should seek medical care if symptoms persist.
Which of the following is characterized by skeletal muscle destruction and could result from statin therapy? A. Muscular dystrophy B. Muscular contractions C. Rhabdomyolysis D. Myasthenia gravis
Correct Answer: C Rationale: Rhabdomyolysis is a serious adverse reaction associated with statin therapy. It causes skeletal muscle destruction, and symptoms should be reported immediately
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse? A. Headache. B. Slight nausea. C. Muscle pain. D. Fatigue.
Correct Answer: C Rationale: Rhabdomyolysis is a serious but rare side effect of ezetimibe. Reports of muscle pain should be reported immediately to minimize complications, such as acute renal failure and death
Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? A. Platelet count B. Complete blood count C. Liver function tests D. Neutrophil count
Correct Answer: C Rationale: Zafirlukast is used with caution in patients with impaired hepatic function. (Reference: Silvestri, L.A. (2005). Comprehensive Review for the NCLEXRN Examination 3rd Edition. Philadelphia: Saunders
The nurse teaches the patient that the primary purpose of inhaled glucocorticoids is to: A. Aid in the ability to cough up mucus. B. Relax bronchial smooth muscles. C. Achieve bronchodilation. D. Prevent respiratory distress
Correct Answer: D Rationale: The primary purpose of inhaled glucocorticoids is to prevent respiratory distress. The patient should be advised that this medication should not be used during an acute asthma attack.
A client receiving theophylline is due to have a theophylline level drawn. A nurse questions the client to ensure that the client has not ingested which of the following substances before the blood sample is drawn? A. Sedatives B. Narcotics C. Glucose D. Caffeine
Correct Answer: D Rationale: Theophylline is a xanthine bronchodilator. The client should avoid taking in foods or beverages that contain xanthine before the test.
A 68yearold woman with a history of myocardial infarction is beginning a new prescription for lovastatin (Mevacor). Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) A. "Call if you get new prescriptions from other providers, because several medications can interact with lovastatin." B. "Return to the clinic every 6 to 12 months so we can run blood tests for possible side effects." C. "Take your medication once a day, first thing in the morning, with a full glass of water for best results." D. "Take one 325mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."
Correct Answers: A,B,E Rationale: Lovastatin is known to interact with many drugs, including several antibiotics, other cholesterol drugs, digoxin, warfarin, and also with grapefruit juice. Patients taking lovastatin should have occasional blood tests for CK and ALTs to monitor for liver and muscle damage associated with statin therapy. A healthy diet, rich in fruits and vegetables, should be encouraged to reduce the risk of heart disease in patients receiving statin therapy.
The healthcare provider prepares to administer a corticosteroid to a patient with a diagnosis of asthma. What is the rationale for administering this drug to this patient? a. Promote bronchodilation b. Decrease airway swelling c. Prevent respiratory infections d. Promote expectoration of mucus
Corticosteroids and other anti-inflammatory drugs work by reducing inflammation, swelling, and mucus production in the airways of a person with asthma. As a result, the airways are less inflamed and less likely to react to asthma triggers. Inhaled corticosteroids are the primary treatment for asthma. Nurse Plus Academy, 2018. NCLEX-RN physiological integrity practice test questions. Retrieved from https://nurse.plus/physiological-integrity-test-nclex-rn-questions/
A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions regarding the medication. Which statement by the client would indicate an understanding of the instructions? A. "It is not necessary to avoid the use of alcohol." B. "The medication should be taken with meals to decrease flushing." C. "Clay-colored stools are a common side effect and should not be of concern." D. "Ibuprofen (Motrin) taken 30 mins before the nicotinic acid should decrease the flushing."
D
A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor? a. Blood urea nitrogen b. Complete blood count c. Cardiac enzymes d. Liver enzymes
D
A patient is receiving acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use following administration of this drug? A. Ambu bag B. Intubation tray C. NG tube D. Suction equipment
D
A patient is taking gemfibrozil, a fibric acid derivative. Which of the following should not be included as a possible adverse effect during patient education? a. Gallstones b. Rhabdomyolysis c. Elevated liver enzymes d. Kidney stones
D
A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame? a. 60 minutes b. 45 minutes c. 15 minutes d. 30 minutes
D
Cromolyn Sodium (Intal) inhaler is prescribed for a client with allergic asthma. A nurse provides instructions regarding the side effects of this medication. The nurse tells the client that which undesirable effect is associated with this medication? A. insomnia B. constipation C. hypotension D. bronchospasm
D-bronchospasm is a major adverse effect of this medication
The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy? ● Theophylline ● Ipratropium ● Budesonide ● Fluticasone
Explanation: A client who is taking tiotropium should not take ipratropium because both drugs are anticholinergics and can cause an increase in adverse effects. Theophylline and corticosteroids like budesonide and fluticasone are not necessarily contraindicated
A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? ● Guaifenesin ● Acetylcysteine ● Dextromethorphan ● Benzonatate
Explanation: Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.
A client is instructed to take diphenhydramine (Benadryl) after an allergic reaction. Which statement by the client indicates successful teaching concerning the administration of diphenhydramine (Benadryl)? ● "I will still be able to have my after-dinner drink with this medication." ● "I will eat a diet low in sodium while taking this medication." ● "I should not drive my car after taking this medication." ● "I can take this medication every 2 hours until I feel better."
Explanation: The administration of diphenhydramine (Benadryl) causes drowsiness, and the client should not operate machinery, such as driving. The client should not combine diphenhydramine with alcohol due to central nervous system depression. The client will not need to limit sodium with this medication. The client should adhere to the dosing schedule and not take the medication every 2 hours
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 needs suctioning just prior to the installation of the surfactin." ● "Suctioning should be avoided for at least 2 hours after the surfactant installation." ● "The baby should be suctioned after the instillation of the surfactant only if clinically necessary." ● "The baby requires suctioning every 1 to 4 hours after the instillation of surfactant."
Explanation: The infant should be suctioned immediately before administration to ensure a clear airway. Do not suction for 2 hours after administration unless clinically necessary, to allow the drug time to work
A history of an allergy to which would be a contraindication to the us of anticholinergics? (Select all that apply). ● Soy ● Peanuts ● Shellfish ● Iodine ● Eggs
Explanation: The use of ipratropium and tiotropium is contraindicated in the presence of a known allergy to soy products or peanuts because the aerosol contains a protein associated with peanut allergies
When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism? ● Vasoconstriction of small blood vessels of the nasal membranes ● Selectively binding to peripheral H1 receptors ● Nonselectively binding to central and peripheral H1 receptors ● Anesthetizing stretch receptors in the respiratory passages
Explanation: Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to nonselectively bind to peripheral H1receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors only; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.
A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow? ● Antitussives ● Decongestants ● Expectorants ● Mucolytics
Explanation:Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.
The nurse assesses these symptoms in a client with bacterial pneumonia: chills, elevated temperature, tachypnea, productive cough of yellow sputum, shortness of breath, and fatigue. Based on the assessment data, what is the most appropriate nursing diagnosis (ND) for this client? a. Impaired gas exchange b. Impaired spontaneous ventilation c. Ineffective breathing pattern d. Risk for infection
Impaired gas exchange is a deficit in oxygenation and/or elimination of carbon dioxide at the alveolar-capillary membrane. Impaired gas exchange related to a bacterial infectious process as evidenced by shortness of breath and tachypnea is an appropriate ND for a client with pneumococcal pneumonia. Impaired spontaneous ventilation is the inability to maintain independent ventilation to support life and requires mechanical ventilation. Based on this client's assessment data, it is not an appropriate ND. This client is demonstrating an ineffective breathing pattern; however, this problem is secondary to impaired gas exchange. An increased respiratory rate is the body's attempt to compensate for hypoxia caused by consolidations and secretions preventing adequate gas exchange in the lungs. Impaired gas exchange is the primary problem that is causing the ineffective respirations and is the more appropriate ND for this client. Risk for infection is the increased risk for invasion of microorganisms. However, this client has an actual, not potential infection, so this is not an appropriate ND. UWorld. Retrieved from https://www.uworld.com/ClientApp/V3/apps/Qbank/
A nurse is caring for a college athlete who was recently diagnosed with moderate persistent asthma. Which common asthma trigger should the nurse teach this client to avoid? a. Latex-containing products b. Penicillin antibiotics c. Secondhand cigarette smoke d. Strenuous physical activity
In clients with asthma, the airways are chronically inflamed with varying degrees of airway obstruction that can be exacerbated by exposure to triggering agents. Common asthma triggers include: e. Allergens: Dander (eg, cat, dog), dust mites, pollen f. Drugs: Beta blockers; nonsteroidal anti-inflammatory agents, including aspirin g. Environmental: Chemicals, sawdust, soaps/detergents h. Infectious: Upper respiratory infections i. Intrinsic: Emotional stress, gastrointestinal reflux disease j. Irritants: Aerosols/perfumes, cigarette smoke (including secondhand smoke), dry/polluted air Although physical activity is an asthma trigger, athletes with asthma do not need to avoid activity altogether. Rather, they may take an inhaled bronchodilator 20 minutes before activity to help prevent exercise-induced asthma attacks. In addition, this client may be prone to minor musculoskeletal injuries (eg, sprains, strains) due to an active lifestyle; the nurse should teach about alternatives to common over-the-counter nonsteroidal anti-inflammatory medications that may be used for analgesia (eg, acetaminophen [Tylenol]). Educational objective: The nurse should teach an active young adult with asthma to identify and manage common triggers of asthma attacks, including cigarette smoke and nonsteroidal anti-inflammatory medications. Clients with asthma should take an inhaled bronchodilator 20 minutes before athletic activity to prevent exercise-induced asthma attacks. UWorld. Retrieved from https://www.uworld.com/ClientApp/V3/apps/Qbank/
A client with chronic obstructive pulmonary disease is prescribed with Ipratropium (Combivent). Upon reviewing the medical history of the patient, the nurse questions the prescription if which of the following is noted? A. History of smoking B. History of allergy to egg. C. History of allergy to peanut. D. History of previous infection.
Rationale: The client with a peanut allergy should not take ipratropium because the product contains soy lecithin, which is in the same plant family as peanuts.
A patient has been receiving an aminophylline infusion for 24 hours. The nurse will assess for which adverse effect when assessing the patient during the infusion? A. CNS depression B. Sinus Tachycardia C. increased appetite D. temporary urinary retention
Rationale: Aminophylline can cause excitement and possible cardiac side effects in high concentrations.
Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize reporting which side effect? A. Hypoglycemia B. Nonproductive cough C. Sedation D. Tachycardia
Rationale: Beta-2 agonists are designed to bind selectively to receptors in the lungs but sometimes the cardiovascular and musculoskeletal receptors are affected and adverse reactions such as tachycardia can occur.
The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? A. "I will take the medication on an empty stomach." B. "I won't drink alcohol while taking this medication." C. I won't do activities that require mental alertness while taking this medication." D. "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."
Rationale: Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or engage in central nervous system depressants, operating a care, or engaging in other activities requiring mental awareness during use.
A client with COPD has an acute bronchospasm. The nurse knows that which is the best medication for this emergency situation? A. zafirlukast (Accolate) B. epinephrine (Adrenalin) C. dexamethasone (Decadron) D. oxtriphylline-theophyllinate (Choledyl)
Rationale: Epinephrine is a strong alpha AND beta adrenergic receptor, resulting in bronchial relaxation and vasoconstriction and would be indicated in an acute bronchospasm. Zafirlukast is for long-term treatment of asthma. Dexamethasone is a steroid to treat inflammation and not indicated in an acute bronchospams. Oxytriphylline-theophyllinate is a cough medicine that acts as a bronchodilator but is also not indicated in an acute bronchospasm.
A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? A. Take an extra dose if fever develops B. Take the medication with meals only C. Take the tablet with a full glass of water D. Decrease the amount of daily fluid intake
Rationale: Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.
A client demonstrates understanding of flunisolide (AeroBid) by saying that he will do what? A. Take two puffs to treat an acute asthma attack. B. Rinse his mouth with water after each use. C. Immediately stop taking his order prednisone when he starts using AeroBid. D. Not use his albuterol inhaler while he is taking AeroBid.
Rationale: Inhaled corticosteroids such as flunisolide can cause fungal infections in the mouth. Rinsing out the mouth after each use helps prevent this from happening.
A patient comes into the clinic with a non-productive cough that he has been treating with Dextromethorphan. Upon performing her assessment, the nurse realizes the patient is hypotensive, nauseous, and exhibiting muscle twitching. The nurse should check if the patient is also taking which of the following drugs? a. MAOIs b. NSAIDs c. Beta blockers d. Statin
Rationale: MAOIs and other CNS depressants interact with Dextromethorphan and can cause harmful effects, including hypotension, fever, nausea, myoclonic jerks, and coma. The other drugs would not result in this type of reaction with Dextromethorphan
The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? A. Beclomethasone first and then the salmeterol B. Salmeterol first and then the beclomethasone C. Alternating a single puff of each, beginning with the salmeterol D. Alternating a single puff of each, beginning with the beclomethasone
Rationale: Salmeterol is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are given on the same time schedule. This allows for widening of air passages by the bronchodilator which then makes the glucocorticoid more effective.
A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking this medication? A. Coffee, cola, and chocolate B. Oysters, lobster, and shrimp C. Melons, oranges, and pineapple D. Cottage cheese, cream cheese, and dairy creamers
Rationale: Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate
Zafirlukast is prescribed for a client with bronchial asthmas. Which laboratory test does the nurse expect to be prescribed before the administration of the medication? A. Platelet count B. Neutrophil count C. Liver function tests D. Complete blood count
Rationale: Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used in caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication.
A client is experiencing an asthma attack. The nurse assesses extreme anxiety, dyspnea, nonproductive cough, inspiratory and expiratory wheezing, and diminished breath sounds. Respirations are 36/min, pulse is 122/min, and pulse oximeter shows 87% on room air. Which is the priority nursing diagnosis (ND) for this client? a. Anxiety related to hypoxia and fear of suffocation b. Impaired gas exchange related to alveolar hypoventilation c. Ineffective airway clearance related to abnormal viscosity of mucus d. Ineffective breathing pattern related to decreased lung expansion
The priority ND is impaired gas exchange related to alveolar hypoventilation and reduced oxygen available for exchange as evidenced by tachycardia, tachypnea, dyspnea, and hypoxemia. The assessment data that support a deficit in oxygenation and gas exchange include: ● High-pitched wheezing on inspiration and expiration. Wheezing is usually heard on expiration; when heard on inspiration as well, it indicates an even greater degree of bronchospasm, airway resistance, and hypoxemia. ● Diminished breath sounds during an asthma attack indicate reduced delivery of inspired oxygen due to hyperinflation, air trapping, and alveolar hypoventilation. ● Decreased oxygen saturation (pulse oximeter of 87% on room air) in the presence of tachycardia and tachypnea indicates significant impaired gas exchange and hypoxemia. Anxiety related to hypoxia and fear of suffocation as evidenced by tachycardia and tachypnea is an appropriate ND for a client with asthma, but it is not the priority ND. Low-pitched wheezing (rhonchi) and cough can indicate the presence of excessive secretions in the airway. These symptoms are expected findings in asthmatic clients. Based on the client's assessment data, there is no immediate risk of airway compromise. Ineffective airway clearance is not the priority ND. Ineffective breathing pattern related to anxiety, and edema and constriction of the bronchi, as evidenced by dyspnea and tachypnea, are appropriate NDs for a client with asthma but are not the priority ND. UWorld. Retrieved from https://www.uworld.com/ClientApp/V3/apps/Qbank/
The nurse is providing discharge instructions on the proper use of prescribed short-acting beta agonist and inhaled corticosteroid metered-dose inhalers to a client with newly diagnosed asthma. Which instructions should the nurse include? Select all that apply. a. "Omit the beclomethasone if albuterol is effective." b. "Rinse your mouth well after using the beclomethasone inhaler and do not swallow the water." c. "Take the albuterol inhaler apart and wash it after every use." d. "Use the albuterol inhaler first if needed, then the beclomethasone inhaler." e. "Use the beclomethasone inhaler first, then albuterol, if needed."
When using an ICS metered-dose inhaler (MDI), small particles of the medication are deposited and can impact the tongue and mouth. Rinsing the mouth and throat well after using the MDI and not swallowing the water are recommended to help prevent a Candida infection (thrush) (white spots on tongue, buccal mucosa, and throat), a common side effect of ICSs. The use of a spacer with the inhaler can also decrease the risk of developing thrush When both MDIs are to be taken at the same time, clients are instructed to take the SABA first to open the airways and then the ICS to provide better delivery of the medication. It is important for the nurse to clarify indications and sequencing as the SABA is a rescue drug taken on an as-needed basis and is not always taken with the ICS Inhaled corticosteroids (eg, fluticasone, beclomethasone) are not rescue drugs. They are prescribed to be taken on a regular schedule (eg, morning, bedtime) on a long-term basis to prevent exacerbations and should not be omitted even if the SABA is effective. Taking the albuterol (Proventil) inhaler apart, washing the mouthpiece (not canister) under warm running water, and letting it air dry at least 1-2 times a week is recommended. Medication particles can deposit in the mouthpiece and prevent a full dose of medication from being dispensed. Taking the ICS inhaler apart and cleaning it every day is recommended. UWorld. Retrieved from https://www.uworld.com/ClientApp/V3/apps/Qbank/
A client is receiving an antitussive. Which interventions would the nurse include in the client's plan of care to help prevent pooling of secretions in the client's lungs? Select all that apply. ● Increase fluid intake ● Change positions frequently ● Limit fluid intake ● Maintain the same position as much as possible Refrain from trying to cough
● Explanation: Changing positions frequently and increasing fluid intake can help facilitate the removal of secretions. The nurse would not limit fluid and this would be contraindicated. Maintaining the same position predisposes the client to develop pneumonia. Refraining from cough will not allow full expansion of the lungs or clearing exudate from the airways.
A 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan? ● Dextromethorphan works in the medulla to suppress the cough reflex. ● Dextromethorphan works on the receptors in the throat to prevent a cough. ● Dextromethorphan works by inhibiting allergen response. ● Dextromethorphan works by relaxing the smooth muscles in the bronchioles.
● Explanation: Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.
Which of the following may increase the risk of asthma-related death? ● Inhaled corticosteroids ● Short acting beta2 agonists ● Long acting beta2 agonists Leukotriene receptor antagonists
● Explanation: Long acting beta2 agonists have been shown in studies to increase the risk of asthma-related deaths, especially among African Americans
