RESPIRATORY DRUGs

pneumonia interventions

V - View ABGs, airway status E - Elevated HOB to 30 degrees N - Note GI complications (stress ulcers) T - Take notice of ventilator settings and alarms S - Suction tracheal tube

33. The clinic nurse is teaching the parent of a child with reactive airway disease about nebulizer treatments. Which statement indicates the teaching has been effective? 1. "I will use half the medication in the nebulizer at each treatment." 2. "The nebulizer treatment will take about 30 minutes or longer." 3. "I will use a disinfectant solution weekly when cleaning the nebulizer." 4. "I will rinse the nebulizer in clean water after each breathing treatment."

1. All the medication in the nebulizer should be used during the treatment; medication should not be stored in the nebulizer for later use. 2. The length of treatment is usually 10-15 minutes. If it takes longer, the parent should check the nebulizer equipment or compressor for defects or problems. 3. The nebulizer should be cleaned daily (not weekly) using a disinfecting solution or a solution containing one part white vinegar and four parts water. ✅4. The nebulizer should be cleaned with water after each treatment and allowed to air dry after loosely covering it with a clean paper towel. Storing the equipment wet promotes the growth of mold and bacteria.

41. The client diagnosed with rule-out deep vein thrombosis (DVT) is experiencing dyspnea and chest pain on inspiration. On assessment, the nurse finds a respiratory rate of 40. Which medication should the nurse anticipate the health-care provider ordering? 1. Warfarin (Coumadin), an oral anticoagulant. 2. Enoxaparin (Lovenox), a low-molecular-weight heparin. 3. Heparin, an intravenous anticoagulant. 4. Ticlopidine (Ticlid), an antiplatelet medication.

1. An oral anticoagulant would not be prescribed in an acute situation. 2. Lovenox is prescribed prophylactically to prevent deep vein thrombosis. The client is currently experiencing a complication of DVT; therefore, the nurse should not anticipate an order for this medication. ✅3. Heparin is the medication of choice for treating a pulmonary embolus, which the nurse should suspect with these signs and symptoms. Intravenous heparin will prevent further clotting. 4. Ticlid is a medication used to treat arterial, not venous, conditions. MEDICATION MEMORY JOGGER: Remember that antiplatelets work in the arteries and anticoagulants work in the veins.

3. The HCP prescribed amoxicillin/clavulanate (Augmentin), an antibiotic, for a client diagnosed with chronic obstructive pulmonary disease (COPD) who has a cold. Which intervention should the nurse implement? 1. Discuss the prescription with the HCP because antibiotics do not help viral infections. 2. Teach the client to take all the antibiotics as ordered. 3. Encourage the client to seek a second opinion before taking the medication. 4. Ask the client if he or she is allergic to sulfa drugs or shellfish.

1. Antibiotics do not treat viral infections, but HCPs will frequently prescribe prophylac- tic antibiotics for clients with comorbid conditions (such as COPD) to prevent a secondary bacterial infection. ✅2. Clients prescribed antibiotics should always be taught to take all the medication as ordered to prevent resistant strains of bacteria from developing. 3. There is no reason for a second opinion; this is standard medical practice. 4. This is a penicillin preparation, not a sulfa medication or iodine.

32. The 6-year-old child is experiencing an acute exacerbation of reactive airway disease. The child passed out, and the parents brought the child to the emergency department. Which intervention should the nurse implement first? 1. Administer subcutaneous epinephrine via a tuberculin syringe. 2. Administer a beta2-adrenergic agonist, albuterol (Ventolin), via nebulizer. 3. Administer intravenous methylprednisolone, a glucocorticoid. 4. Administer oxygen to maintain oxygen saturation above 95%.

1. Because the child is unconscious the nurse should prepare to administer epinephrine, a beta2-adrenergic agonist, but this is not the first action. 2. The client is unconscious; therefore, a nebulizer could not be administered to the child. It would be administered as soon as the child is conscious 3. If there is no response to the nebulizer, then the child should receive an intravenous glucocorticoid. ✅4. The first intervention should be administering oxygen to the child and then administering medication. Oxygen is considered a medication.

43. The HCP has ordered streptokinase (Streptase), a thrombolytic, intravenously for the client diagnosed with a pulmonary embolus. The client has intravenous heparin infusing at 1600 units per hour via a 20-gauge angiocath. Which intervention should the nurse implement? 1. Administer the streptokinase via a Y-tubing. 2. Start a second intravenous site to infuse the streptokinase. 3. Discontinue the heparin and infuse streptokinase via the 20-gauge angiocath. 4. Piggyback the streptokinase through the heparin line at the port closest to the client.

1. Blood or blood products are the only fluids infused through Y-tubing. ✅2. Heparin and streptokinase cannot be administered in the same intravenous line because they are incompatible. The nurse must start a second line to administer the streptokinase simultaneously with the heparin. The nurse does not need an order to do this. 3. The client needs both of these medications; therefore, the nurse cannot discontinue the heparin. Streptokinase is a thrombolytic, which will dissolve the clot in the pulmonary artery, but heparin, an anticoagulant, is prescribed to prevent reformation of the clot. 4. Heparin and streptokinase cannot be administered in the same intravenous line because they are incompatible. The nurse must start a second line to administer the streptokinase simultaneously with the heparin. The nurse does not need an order to do this.

11. The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication should the nurse anticipate the HCP prescribing? 1. Prednisone, a glucocorticoid. 2. Habitrol, a transdermal nicotine system. 3. Dextromethorphan (Robitussin), an antitussive. 4. Ceftriaxone (Rocephin), a cephalosporin.

1. Clients diagnosed with COPD are commonly prescribed a steroid (glucocorticoid) medication to decrease inflammation in the lungs. This client should already be taking this or a similar medication. The client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. 2. The client should quit smoking if still smoking, but the client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. 3. The client may require an antitussive but more likely would require a mucolytic to help to expectorate the thick tenacious sputum associated with COPD. ✅4. The client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. Rocephin is a broad-spectrum antibiotic.

31. The 8-year-old male child diagnosed with reactive airway disease is prescribed a cromolyn (Intal) inhaler. The child shares with the nurse that he wants to play baseball but can't because of his asthma. Which intervention should the nurse discuss with the child and parents? 1. Instruct the child to take the medication as soon as shortness of breath starts. 2. Teach the child to take a puff of the cromolyn inhaler 15 minutes before playing ball. 3. Encourage the child to play another sport that does not require running outside. 4. Inform the parents to notify the pediatrician if the child complains of a yellow haze.

1. Cromolyn is a safe and effective drug for prophylaxis of asthma, but it is not useful for aborting an ongoing attack. ✅2. Cromolyn can prevent bronchospasm in children subject to exercise-induced asthma. It should be administered 15 minutes prior to anticipated exertion. 3. The child with a chronic illness should be encouraged to live as normal a life as possible; therefore, encouraging the child not to play ball is not appropriate. 4. Cromolyn is devoid of significant adverse effects and drug interactions. A yellow haze is not an expected side effect or adverse effect of cromolyn.

6. Which over-the-counter herb should the nurse recommend for a client with a cold who has mild hypertension? 1. Crataegus laevigata, hawthorn. 2. Zingiber officinale, ginger. 3. Allium sativum, garlic. 4. Hydrastis canadensis, goldenseal.

1. Hawthorn is used for mild hypertension, congestive heart failure, and angina, but it does nothing for a cold or the flu. 2. Ginger is used to stimulate digestion and to help ease nausea and motion sickness. It does nothing for hypertension or the flu or colds. ✅3. Garlic is used for colds and the flu and can also be given for hypertension. It causes mild vasodilation and will not make hypertension worse. 4. Goldenseal is used for respiratory, digestive, and urinary infections, but it increases the effectiveness of some antihypertensive medications, beta blockers, and antidysrhythmics. It should be used with caution in clients who have cardiovascular disease, diabetes mellitus, or glaucoma. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal sup- plement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.

7. The client who has been using oxymetazoline (Afrin) nasal spray for several weeks complains to the nurse that the spray no longer seems to work to clear the nasal passages. Which information should the nurse teach? 1. Increase the amount of sprays used until the desired effect has been reached. 2. This type of medication can cause rebound congestion if used too long. 3. Alternate the Afrin with a saline nasal spray every 2 hours. 4. Place the Afrin nasal spray in a vaporizer at night for the best results.

1. Increasing the number of sprays will only increase the problem. This medication is for short-term use only (that is, a few days). Longer use can cause a rebound congestion that can be difficult to resolve. ✅2. Afrin is recommended for short-term relief of nasal congestion for clients older than the age of 6 years. Longer use can cause a rebound congestion that can be difficult to resolve. 3. Afrin should be used every 10-12 hours only; using it more often increases the chance of developing a dependence on the medication and rebound congestion. 4. Afrin nasal spray is to be used intranasally; it is not an additive for a vaporizer.

34. The child with an acute asthma attack is prescribed a 7-day course of the systemic corticosteroid prednisolone. The mother asks the nurse, "Doesn't this medication cause serious side effects?" Which statement is the nurse's best response? 1. "Yes, this medication does have serious side effects, but your child needs the medication." 2. "The doctor would not have ordered a medication that has serious side effects." 3. "A short-term course of steroids will not cause serious side effects." 4. "There may be serious side effects if your child takes the medication for a long time."

1. Prolonged glucocorticoid therapy can cause serious adverse effects such as adrenal suppression, osteoporosis, hyperglycemia, and peptic ulcer disease. Short-term use does not cause these adverse effects. 2. Doctors often order medications that have serious side effects, but it must be done to treat the client. This statement is false and is not appropriate. ✅3. This is a true statement and the nurse's best response. 4. This is not the best response to the mother's question about her son's use of the medication. Prolonged glucocorticoid therapy can cause serious adverse effects, but short-term use does not cause these adverse effects.

47. The nurse is administering alteplase (Activase), a thrombolytic, to a client diagnosed with massive pulmonary emboli (PE). Which data indicates the medication is effective? 1. The client's PTT level is within therapeutic range. 2. The client is able to ambulate to the bathroom. 3. The client denies chest pain on inspiration. 4. The client's chest x-ray is normal.

1. The PTT test is used to monitor the anti-coagulant heparin, not the thrombolytic Activase. 2. A client with a massive PE would be on bed rest; therefore, ambulating would not indicate the medication is effective. ✅3. To determine if the medication is effective, the nurse must assess for an improvement in the signs or symptoms for the condition for which the medication was ordered. Chest pain is one of the most common symptoms of PE; denial of chest pain would indicate the medication is effective. 4. In the client diagnosed with a PE the chest x-ray is usually normal; therefore, it would not be used to determine if the thrombolytic is effective

37. The pediatric nurse is caring for a 7-year-old child with chronic reactive airway disease who is being discharged. The nurse must evaluate the breathing capacity of the child to determine the effectiveness of the medication regimen. Which interventions should the nurse implement when using the peak flow meter? Select all that apply. 1. Instruct the child to lie down in the bed in the supine position. 2. Tell the child to seal the lips tightly around the mouthpiece. 3. Note the number on the scale after the client gives a sharp, short breath. 4. Blow into the peak flow meter one time and obtain the results. 5. Move the pointer on the peak flow meter to zero.

1. The child should be standing up at the bedside, not lying down. ✅2. This is the correct way to obtain the peak flow meter results. ✅3. This is the correct way to take a reading from the peak flow meter. 4. The peak flow meter should be repeated three times, waiting at least 10 seconds between each attempt. The highest reading of the three attempts is recorded. ✅5. The pointer should be at zero every time the child attempts to blow into the peak flow meter.

45. The nurse is discharging the female client diagnosed with a pulmonary embolus (PE) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client understands the medication teaching? 1. "I should use a straight razor when I shave my legs." 2. "I will use a hard-bristled toothbrush to clean my teeth." 3. "An occasional nosebleed is common with this drug." 4. "It will be important for me to have regular bloodwork done."

1. The client is at risk for bleeding and should be encouraged to use an electric razor. 2. The client is at risk for bleeding, and a soft-bristled toothbrush should be used. 3. Any abnormal bleeding, such as a nose- bleed, is not expected and should be reported to the HCP. Unexplained bleeding is a sign of toxicity. ✅4. The client's International Normalized Ratio (INR) is monitored at routine intervals to determine if the medication is within the therapeutic range, INR 2-3.

24. The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective? 1. The client holds his or her breath for 5 seconds and then exhales forcefully. 2. The client states the canister is full when it is lying on top of the water. 3. The client exhales and then squeezes the canister as the next inspiration occurs. 4. The client connects the oxygen tubing to the inhaler before administering the dose.

1. The client should hold his or her breath as long as possible before exhaling to allow the medication to settle before administering another dose; 5 seconds is not long enough. 2. The client can check how much medica- tion is in a metered-dose canister by plac- ing the canister in a glass of water; if the canister stays under water, the canister is full, and if it floats on top of the water, it is empty. ✅3 This is the correct way to use an inhaler because it will carry the medication down into the lung. 4 Oxygen is not used when using an inhaler; oxygen is used to deliver the medication when using an aerosol.

21. Which information should the nurse discuss with the client diagnosed with reactive airway disease who is prescribed theophylline (Slo-Phyllin), a xanthine bronchodilator? 1. Instruct the client to take the medication on an empty stomach. 2. Explain that an increased heart rate and irritability are expected side effects. 3. Discuss the need to avoid large amounts of caffeine-containing drinks. 4. Tell the client to double the next dose if a dose is missed.

1. The client should take the medication with a glass of water or with meals to avoid an upset stomach. 2. The client should notify the health-care provider of a rapid or irregular heartbeat, vomiting, dizziness, or irritability because these are not expected side effects. ✅3. The client should avoid drinking large amounts of caffeine-containing drinks such as tea, coffee, cocoa, and cola. 4. If a dose is missed within an hour, the client should take the dose immediately, but if it is more than 1 hour, the client should skip the dose and stay on the original dosing schedule. The client should not double the dose

38. The 10-year-old child is being prescribed a cromolyn inhaler. Which statement indicates the child needs more teaching concerning the cromolyn inhaler? 1. "If I cannot take a deep breath, I will not use my cromolyn inhaler." 2. "I should not exhale into my inhaler after I have finished taking a puff." 3. "I should wait at least 1 hour to rinse my mouth after taking my inhaler." 4. "I should not stop taking my inhaler because I might have an asthma attack."

1. The cromolyn inhaler should be taken routinely and is not used for an acute asthma attack; therefore, the child understands the teaching. 2. Moisture (from exhaled air) will interfere with proper use of the inhaler; therefore, the child understands the teaching. ✅3. The child should rinse the mouth with water immediately after using the inhaler to help prevent throat irritation, dry mouth, and hoarseness. 4. Discontinuing the medication quickly can cause the child to have an acute attack of asthma. The child understands this.

25. The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 28 ug/mL. Which intervention should the nurse implement first? 1. Continue to monitor the aminophylline drip. 2. Assess the client for nausea and restlessness. 3. Discontinue the aminophylline drip. 4. Notify the health-care provider immediately.

1. The therapeutic level for theophylline is 10-20 ug/mL; therefore, the nurse should take action. 2. As the serum theophylline level rises above 20 ug/mL, the client will experience nausea, vomiting, diarrhea, insomnia, and restlessness. This theophylline level may result in serious effects, such as convulsion and ventricular fibrillation. Therefore, the client should not be assessed first. ✅3. The client has the potential for having convulsions and ventricular fibrillation because the theophylline level is too high; therefore, the nurse should discontinue the aminophylline drip first. 4. After discontinuing the aminophylline drip and then assessing the client for potential life-threatening complications, the nurse should notify the health-care provider. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

22. The client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast (Singulair). Which statement by the client warrants intervention by the nurse? 1. "I have been having a lot of headaches lately." 2. "I have started taking an aspirin every day." 3. "I keep this medication up on a very high shelf." 4. "I must protect this medication from extreme temperatures."

1. These drugs are generally safe and well- tolerated, with a headache being the most common side effect; therefore, this statement would not warrant intervention by the nurse. ✅2. This medication interacts with aspirin, warfarin, erythromycin, and theophylline; therefore, this statement warrants further intervention by the nurse. 3. All medications should be kept out of the reach of children, and keeping the medication on a high shelf would not warrant intervention by the nurse. 4. This medication does not need to be kept from extreme temperatures; it is the antiasthmatic zafirlukast (Accolate) that must be protected from extremes of temperature, light, and humidity. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indi- cates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an indepen- dent action during intervention or notify the health-care provider because medica- tions can result in serious or even life- threatening complications.

4. The female client asks the nurse why her teenage child would have many boxes of Sudafed, an over-the-counter cold and allergy medication, in her room. Which statement is the nurse's best response? 1. "Has your child always had allergy problems?" 2. "Teenagers will try to take care of their own health problems." 3. "Has the teenager's behavior at school or at home changed recently?" 4. "Remove the medication and say nothing to the teenager about it."

1. These may be allergy medications when used legally, but they are also the ingredients in illegal methamphetamine production. Quantities of any medication in a teenager's room should be investigated. 2. Teenagers do try to develop independence, but it is always the parent or guardian's responsibility to monitor the child's health. ✅3. This situation could indicate the teenager is involved with the drug culture, taking or manufacturing drugs. The nurse should assess for signs of drug involvement. 4. The parent is responsible for determining the teenager's activities; the situation should be discussed with the teenager

19. Which data indicates the antibiotic therapy has not been successful for a client diagnosed with a bacterial pneumonia? 1. The client's hematocrit is 45%. 2. The client is expectorating thick, green sputum. 3. The client's lung sounds are clear to auscultation. 4. The client has no complaints of pleuritic chest pain.

1. This hematocrit is normal, but this does not indicate that the client is responding to the antibiotics. ✅2. Thick, green sputum is a symptom of pneumonia, which indicates the antibiotic therapy is not effective. If the sputum were changing from a thick, green sputum to a thinner, lighter-colored sputum, it would indicate an improvement in the condition. 3. The symptoms of pneumonia include crackles and wheezing in the lung fields. Clear lung sounds indicate an improvement in the pneumonia and that the medication is effective. 4. Pleuritic chest is a symptom of pneumonia, and no chest pain indicates the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symp- toms, or lack thereof, for which the medication was prescribed.

15. The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first? 1. Prednisone, a glucocorticoid, for a client diagnosed with chronic bronchitis. 2. Oxygen via nasal cannula at 2 L/min for a client diagnosed with pneumonia. 3. Lactic acidophilus (Lactinex) to a client receiving IVPB antibiotics. 4. Cephalexin (Keflex), an antibiotic, to a client being discharged.

1. This is an oral preparation and one that can be given daily; this is not the first medication to be administered. ✅2. Oxygen is considered a medication and should be a priority whenever it is ordered. A client diagnosed with pneumonia will have some amount of respiratory compromise, and the ordered 2 L/min indicates a client with a chronic lung disease. This is the priority medication. 3. Lactinex is administered to replace the good bacteria in the body destroyed by the antibiotic, but it does not need to be administered first. 4. Keflex is an oral antibiotic, but this client is being discharged, indicating the client's condition has improved. This client could wait until the oxygen is initiated. MEDICATION MEMORY JOGGER: Oxygen is a medication, and the nurse should remember basic principles that apply to oxygen administration. The test taker could choose the correct answer based on Maslow's Hierarchy of Needs and breathing/oxygen is the priority.

14. The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client's prescription for prednisone, a glucocorticoid? 1. Take all the prednisone as ordered until the prescription is empty. 2. Take the prednisone on an empty stomach with a full glass of water. 3. Stop taking the prednisone if a noticeable weight gain occurs. 4. The medication should never be abruptly discontinued.

1. This is instruction for an antibiotic. Prednisone is not abruptly discontinued because cortisol (a glucocorticoid) is necessary to sustain life and the adrenal glands will stop producing cortisol while the client is taking it exogenously. 2. Prednisone can produce gastric distress; it is given with food to minimize the gastric discomfort. 3. Weight gain is a side effect of steroid therapy, and the client should not stop taking the medication if this occurs. This medication must be tapered off if the client is to stop the medication—if the client is able to discontinue the medication at all. ✅4. Prednisone is not abruptly discontinued because cortisol (a glucocorticoid) is necessary to sustain life and the adrenal glands stop producing cortisol while the client is taking it exogenously. The medication must be tapered off to prevent a life-threatening complication.

27. The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works? 1. Nebulizers are small, handheld pressurized devices that deliver a measured dose of an antiasthma drug with activation. 2. A nebulizer is an inhaler that delivers an antiasthma drug in the form of a dry, micronized power directly to the lungs. 3. A nebulizer is a small machine used to convert an antiasthma drug solution into a mist that is delivered though a mouthpiece. 4. Nebulizers are small devices that are used to crush glucocorticoids so that the client can place them under the tongue for better absorption.

1. This is the description of how a metered-dose inhaler works. 2. This is the description of how a dry-powder inhaler works. ✅3. This is the description of how a nebulizer works. Nebulizers take several minutes to deliver the same amount of drug contained in one puff from an inhaler. They are usually used at home but can be used in the hospital. 4. This is not the description of how a nebulizer works. Glucocorticoids are not used sublingually to treat acute or chronic asthma

35. The child diagnosed with reactive airway disease is prescribed a cromolyn inhaler. The mother asks the nurse to explain how this medication helps control her child's asthma. Which statement is the best explanation to give to the mother? 1. This medication diminishes the mediator action of leukotrienes. 2. This medication blocks the release of mast cell mediators. 3. This medication causes relaxation of the bronchial smooth muscle. 4. This medication decreases bronchial airway inflammation.

1. This is the explanation for administering leukotriene blockers. ✅2. This is the correct explanation for administering a cromolyn inhaler; it prevents the asthma attack by blocking the release of mast cell mediators. 3. This is the explanation for administering theophylline, a bronchial dilator. 4. This is the explanation for administering glucocorticoids, such as prednisone.

46. The client diagnosed with a pulmonary embolus (PE) is receiving intravenous heparin, and the HCP prescribes 5 mg warfarin (Coumadin) orally once a day. Which statement best explains the scientific rationale for prescribing these two anticoagulants? 1. Coumadin interferes with production of prothrombin. 2. It takes 3-5 days to achieve a therapeutic level of Coumadin. 3. Heparin is more effective when administered with warfarin. 4. Coumadin potentiates the therapeutic action of heparin.

1. This is the scientific rationale for why Coumadin is prescribed to prevent thrombus formation, but it is not the rationale for why the medications are administered together. ✅2. Heparin has a short half-life and is prescribed as soon as a PE is suspected. The client must go home having taken an oral anticoagulant such as Coumadin, which has a long half-life and needs at least 3-5 days to reach a therapeutic level. Discontinuing the heparin prior to achieving a therapeutic level of Coumadin places the client at risk for another PE. 3. Heparin and warfarin work in different steps in the bleeding cascade. 4. This is a false statement; heparin and warfarin work in different steps in the bleeding cascade.

29. The 28-year-old female client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast sodium (Singulair). Which statement by the client indicates the client teaching is effective? 1. "I will not drink coffee, tea, or any type of cola drinks." 2. "I will take this medication at the beginning of an asthma attack." 3. "It is all right to take this medication if I am trying to get pregnant." 4. "I should not decrease the dose or suddenly stop taking this medication."

1. This medication does not stimulate the central nervous system; therefore, the client does not need to avoid caffeine-containing products. This statement indicates that the teaching is not effective. 2 These medications are not used to treat an acute exacerbation of reactive airway disease. They are adjunctive drugs given as part of the asthma regimen. This statement indicates the teaching is not effective. 3. The safety of these drugs has not been established in pregnancy and breastfeeding. This statement indicates that the teaching has not been effective. ✅4. The client should not suddenly stop taking the medication or decrease the dose. This statement indicates the teaching has been effective. Singulair is used with other types of asthma medications and should be continued if the client has an acute asthma attack.

30. Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma? 1. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication. 2. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustained-relief theophylline. 3. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments. 4. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed.

1. This type of medical treatment would be used for a client with mild persistent asthma. 2. This medical treatment would be prescribed for a client with moderate persistent asthma. 3. The most severe class, severe persistent asthma, is managed with daily inhalation of a glucocorticoid (high dose), plus salmeterol, a long-acting inhaled agent. ✅4. Mild intermittent asthma is treated on a PRN basis; long-term control medication is not needed. The occasional acute attack is managed by inhaling a short-acting beta2 agonist. If the client needs the beta2 agonist more than twice a week, moving to Step 2 (mild persistent asthma) may be indicated.

18. The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor? 1. The white blood cell (WBC) count. 2. The hemoglobin and hematocrit. 3. The blood glucose level. 4. The BUN and creatinine.

1. White blood cells are monitored to detect the presence of an infection, not for steroids. 2. The hemoglobin and hematocrit are monitored to detect blood loss, not for steroid therapy. ✅3. Steroid therapy interferes with glucose metabolism and increases insulin resistance. The blood glucose levels should be monitored to determine if an intervention is needed. 4. The BUN and creatinine levels are monitored to determine renal status. The adrenal glands produce cortisol MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration including which client assessment data and laboratory data should be monitored prior to administering the medication.

8. Which statement is the scientific theory for prescribing zinc preparations for a client with a cold? 1. Zinc binds with the viral particle and reduces the symptoms of a cold. 2. Zinc decreases the immune system's response to a virus. 3. Zinc activates viral receptors in the body's immune system. 4. Zinc blocks the virus from binding to the epithelial cells of the nose.

1. Zinc does not bind the viral particle. Symptoms are diminished by blocking the ability of the virus to bind with the nasal lining. 2. Zinc is a micronutrient found in the body that helps to increase the body's immune system. 3. Activating viral receptors would increase the symptoms of a cold. ✅4. Theoretically, zinc blocks viral binding to nasal epithelium. Observation has shown that increased amounts of zinc can prevent the binding and prevent the development of symptoms of the rhinovirus.

39. The nurse is teaching the mother of a 9-year-old child with severe reactive airway disease. The child is prescribed salmeterol (Serevent) by metered dose inhaler (MDI) every 12 hours. Which instruction should the nurse include when discussing the medication with the mother? 1. Instruct the mother to perform and record a daily salmeterol level. 2. Inform the mother to notify the HCP if the child vomits or becomes irritable. 3. Tell the mother to observe the child for a sore throat and respiratory infection. 4. Recommend that the medication be refrigerated at all times.

1.Serum salmeterol levels are not obtained. 2. This would apply to theophylline, not salmeterol. ✅3. Salmeterol is used when the client has not been responsive to other medications; side effects include pharyngitis and upper respiratory tract infections. The parent should be aware of the side effects. 4. Salmeterol does not need to be refrigerated

1. The client diagnosed with arterial hypertension develops a cold. Which information regarding over-the-counter medications should the nurse teach? 1. Try to find a medication that will not cause drowsiness. 2. Over-the-counter medications are not as effective as a prescription. 3. Over-the-counter medications are more expensive than prescriptions. 4. Do not take over-the-counter medication unless approved by the HCP.

1.The client should be informed about the dangers of self-medicating with over- the-counter (OTC) medications. Many OTC medications work by causing vasoconstriction, which will increase the client's hypertension. 2.Efficacy of medications depends on the medication and strength. Most OTC medications were at one time prescription medications. There are many variables, and this statement is too general to be true. 3. The expense of the medications is not the relevant point for this client. The problem is to inform the client about the actions of many OTC medications and the effect on the client's hypertension. ✅4. Many OTC medications work by causing vasoconstriction, which will increase the client's hypertension; the client should only take medications (approved by the HCP) that will not affect the client's hypertension. CHAPTER 4 PULMONARY SYSTEM success pharm

16. The client diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed morphine sulfate (MS Contin). Which statement is the scientific rationale for prescribing this medication? 1. MS Contin will depress the respiratory drive. 2. Morphine dilates the bronchi and improves breathing. 3. MS Contin is not addicting, so it can be given routinely. 4. Morphine causes bronchoconstriction and decreased sputum.

1.The nurse does not administer medications to decrease the respiratory drive for any client—especially not one diagnosed with pulmonary disease. ✅2. Morphine is a mild bronchodilator, and the continuous-release formulation provides a sustained effect for the client. 3. All forms of morphine can be addicting. 4. Bronchoconstriction would increase the client's difficulty in breathing and trap sputum below the constricted bronchus.

20. The nurse is preparing to administer an IVPB antibiotic to a client diagnosed with pneumonia; 10 mL of the medication is mixed in 100 mL of saline. At what rate would the nurse set the pump to infuse the medication in 30 minutes?

220 mL/hour. The nurse should set the pump at 220 mL/hour. Pumps are set at an hourly rate. 60 minutes divided by 30 equals 2. 100 + 10 = 110 110 multiplied by 2 = 220.

What administration considerations apply to ipratropium?

Follow manufacturer's instructions for using delivery devices. Follow dosage limits and schedules. Allow the prescribed time between puffs. Delay use of other inhalants for 5 minutes. Do not use as an emergency rescue medication. Rinse the mouth after use to reduce unpleasant taste.

What administration considerations apply to albuterol?

Follow manufacturer's instructions for using delivery devices. Use short-acting preparations for acute exacerbations. Use long-acting preparations for long-term control. Inhale beta2-adrenergic agonists before inhaling glucocorticoids. Follow dosage limits and schedules. Watch for signs and triggers of impending exacerbations of asthma. Keep a log of the frequency and intensity of exacerbations. Notify the provider of changes in patterns of exacerbations.

40. The health-care provider has ordered theophylline 5 mg/kg/q 6 hours for a child who weighs 35 lb. How much medication would the nurse administer in each dose?

79.5 mg. First, convert the child's weight to kilograms: 35 ÷ 2.2 = 15.9 kg. Then, determine how many milligrams should be given with each dose: 15.9 kg × 5 mg = 79.5 mg per dose.

A nurse is teaching a newly licensed nurse regarding care for a client who has a hemothorax. What should be included in this review? DESCRIPTION OF DISORDER/DISEASE PROCESS NURSING CARE: describe three nursing interventions. MEDICATIONS: describe two medications used for hemothorax.

ALTERATION IN HEALTH (DIAGNOSIS): Hemothorax is an accumulation of blood in the pleural space. NURSING CARE ● Administer oxygen therapy. ● document ventilator settings hourly if the client is receiving ventilation. ● Monitor ABGs, saO2, CBC, and chest x‐ray findings. ● Position the client to maximize ventilation (high‐Fowler's = 90°). ● Provide emotional support to the client and family. ● Monitor chest tube drainage. ● Administer medications as prescribed. ● encourage prompt medical attention when manifestations of infection occur. ● Auscultate heart and lung sounds and monitor vital signs every 4 hr. MEDICATIONS ● Benzodiazepines (sedatives): Lorazepam or midazolam can be used to decrease anxiety. ● Opioid agonists (pain medications): Morphine sulfate and fentanyl are opioid agents used to treat moderate to severe pain. These medications act on the mu and kappa receptors that help alleviate pain. NCLEX® Connection: Physiological Adaptation, Medical Emergencies

Pulmozyme (dornase alfa)

Actions/Indications Enzyme that hydrolyzes the DNA in sputum reducing sputum viscosity in children with cystic fibrosis Nursing Implications Administered via nebulizer Monitor for dysphonia and pharyngitis

Corticosteroids (inhaled)

Actions/Indications Exert a potent, locally acting anti-inflammatory effect to decrease the frequency and severity of asthma attacks. May also delay pulmonary damage that occurs with chronic asthma. Also used for chronic lung disease and croup syndromes Nursing Implications Not for treatment of acute wheezing Rinse mouth after inhalation to decrease incidence of fungal infections, dry mouth, and hoarseness Minimal systemic absorption makes inhaled steroids the treatment of choice for asthma maintenance program

Corticosteroids (oral, parenteral)

Actions/Indications Suppress inflammation and normal immune response Used for acute asthma exacerbations, wheezing with chronic lung disease, and severe croup Nursing Implications May cause hyperglycemia May suppress reaction to allergy tests Consult physician if vaccinations are ordered during course of systemic corticosteroid therapy Short courses of therapy are generally safe. Very effective, but long-term or chronic use can result in peptic ulceration, altered growth, and numerous other side effects. Children on long-term dos- ing should have growth assessed

What are the therapeutic uses for montelukast?

Adjunctive therapy in the treatment of allergic rhinitis, asthma, and exercise induced bronchospasm

What are the therapeutic uses for phenylephrine?

Allergic rhinitis, sinusitis, and the common cold

What is the brand/trade names for ipratropium?

Atrovent, Atrovent HFA

What is the brand/trade name for diphenhydramine?

Benadryl

COPD management

C-Cigarette smoking cessation, corticoseteriods O-Oxygen if hypoxic P-PFTs + Pneumococcal vaccine, (flu vaccine if not given for that year) + Pulmonary Rehabilitation D-Dilators

What administration considerations apply to acetylcysteine?

Give via nebulizer that does not contain metal or rubber parts or direct instillation into tracheostomy tube. Clear the airway before aerosol administration. Assess the client's ability to cough before administration. Expect a sulfur-like (rotten egg) odor. Have suction equipment available. Thoroughly clean equipment after treatment

Dextromethorphan action/indications

Cough suppressants ( hydrocodone) Relieve irritation, nonproductive cough by direct effect on the cough center in the medulla, which suppress the cough reflex Used for the common cold, sinusitis, pneumonia, bronchitis

What are the therapeutic uses for guaifenesin?

Coughs related to viral upper respiratory tract infections Reduces viscosity of thickened secretions by increasing respiratory tract fluid Used for the common cold, pneumonia, and other conditions requiring mobilization and subsequent expectoration of mucus

What are the therapeutic uses for acetylcysteine?

Decrease viscosity of mucous secretions. Reverse acetaminophen (Tylenol) overdose.

What is the brand/trade name for dextromethorphan?

Delsym

What administration considerations apply to diphenhydramine?

Do not crush or chew enteric-coated formulations. Do not take with alcohol or other CNS depressants. Take 30 min to 2 hr before activity for motion sickness.

What administration considerations apply to phenylephrine?

Do not exceed the recommended dose. Use topical decongestants no longer than 3 to 5 days to avoid rebound congestion.

What administration considerations apply to theophylline?

If a dose is missed, do not double the dose. Have the client chew the chewable tablets thoroughly. Do not crush or chew sustained-release or enteric-coated preparations. Maintain scheduled interval between doses.

What administration considerations apply to beclomethasone dipropionate, fluticasone, and prednisone?

Inhaled:Use on a regular schedule rather than PRN.Do not use these drugs for an acute attack.When using concurrently with a beta2-adrenergic agonist inhaler, use the beta2 agonist first to dilate the airway before using the glucocorticoid. Oral:Use oral therapy twice daily for 5 to 10 days.For long-term use (10 days or more), take once daily using alternate-day dosing.Taper the dose slowly when symptoms are controlled to establish the lowest possible oral dose.Take supplemental doses as needed in times of stress (illness, surgery). Nasal:Use a nasal metered-dose spray device.Use the full dose initially and taper to the lowest effective dose. Expect the full therapeutic effect to take 2 to 3 weeks.Use a nasal decongestant first if the nares are completely blocked.

What are the therapeutic uses for albuterol?

Long-term management of asthma Prevention of exercise-induced bronchospasm Treatment of ongoing asthma exacerbations

What are the therapeutic uses for theophylline?

Long-term management of chronic asthma

What are the therapeutic uses for beclomethasone dipropionate, fluticasone, and prednisone?

Long-term management of chronic asthma. Short-term management of post-exacerbation symptoms (oral).

What are the therapeutic uses for cromolyn?

Long-term treatment of allergy-related asthma Prophylaxis for exercise-induced bronchospasm Prophylaxis for seasonal allergy symptoms Management of allergic rhinitis (intranasally) Actions/Indications Prevent release of histamine from sensitized mast cells, resulting in decreased frequency and intensity of allergic reactions in children with asthma or chronic lung disease. Also used as preexposure treatment for allergens

What are the therapeutic uses for cetirizine?

Management of allergic rhinitis and chronic idiopathic urticaria

What are the therapeutic uses for diphenhydramine?

Management of:Mild allergic reactions (seasonal allergic rhinitis, cough, urticaria, mild transfusion reaction)Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm)Motion sicknessInsomnia. Short-term use: no longer than 2 consecutive weeks (first-generation H1 antagonists)

What is the brand/trade name for cromolyn

Mast cell stabilizers (cromolyn, nedocromil) Administered via inhalation For prophylactic use, not to relieve bronchospasm during an acute wheezing episode. Can be used 10 to 15 minutes prior to exposure to allergen, to decrease reaction to allergen

What administration considerations apply to cetirizine?

May take with or without food. Do not take with other over-the-counter antihistamines. Expect dose to be lower in clients who have compromised renal or liver function.

What is the brand/trade name for guaifenesin?

Mucinex

A nurse is planning care for a client who is receiving mechanical ventilation. NURSING INTERVENTIONS: describe three nursing actions to maintain the client's airway.

NURSING INTERVENTIONS ● Assess the position and placement of the tube. ● document tube placement in centimeters at the client's teeth or lips. ● Use two staff members for repositioning and resecuring the tube. ● Apply protective barriers (soft wrist restraints) according to hospital protocol to prevent self‐extubation. ● Use caution when moving the client. ● suction oral and tracheal secretions to maintain tube patency. ● support ventilator tubing to prevent mucosal erosion and displacement. ● Have a resuscitation bag with a face mask available at the bedside at all times in case of ventilator malfunction or accidental extubation. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems

A nurse is reviewing discharge instructions for a client who has a new prescription for ipratropium. NURSING INTERVENTIONS: List at least three.

NURSING INTERVENTIONS ● Observe the client for dry mouth when taking this medication. ● encourage the client to suck on hard candies to help moisten dry mouth while taking ipratropium. ● encourage the client to increase fluid intake, and to report headaches or blurred vision. ● Monitor heart rate. Palpitations can occur, which can indicate toxicity of ipratropium. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration

A nurse is caring for a client who has asthma and a prescription for prednisone. NURSING INTERVENTIONS: include at least three.

NURSING INTERVENTIONS ● Watch for decreased immune function. ● Monitor for hyperglycemia. ● Advise the client to report black, tarry stools. ● Observe for fluid retention and weight gain. ● Monitor the throat and mouth for aphthous lesions (canker sores). NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration

What is the brand/trade name for phenylephrine?

Neo-Synephrine

What administration considerations apply to guaifenesin?

Notify provider if cough worsens or high fever develops. Use only when needed. Do not take with combination products for colds that also contain guaifenesin. Do not chew or crush sustained-release formulations. Expectorant Encourage deep breathing before coughing in order to mobilize secretions Maintain adequate fluid intake Assess breath sound frequently

Causes of Dyspnea

P-Pulmonary Bronchial Constriction P-Possible Foreign Body P-Pulmonary Embolus (PE) P-Pneumothorax P-Pump Failure P-Pneumonia

A nurse is caring for a client who has tuberculosis. PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM NURSING CARE: include three nursing interventions. COMPLICATIONS: identify one potential complication.

PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. TB is transmitted through aerosolization (airborne route). Once inside the lung, the body encases the TB bacillus with collagen and other cells. This can appear as a Ghon tubercle on a chest x‐ray. Only a small percentage of people infected with TB actually develop an active form of the infection. The TB bacillus can lie dormant for many years before producing the disease. TB primarily affects the lungs but can spread to any organ in the blood. NURSING CARE Nursing interventions ● Administer heated and humidified oxygen therapy as prescribed. ● Prevent infection transmission. ● Wear an N95 or HePA respirator when caring for clients who are hospitalized with TB. ● Place the client in a negative airflow room, and implement airborne precautions. ● Use barrier protection when the risk of hand or clothing contamination exists. ● Have the client wear a surgical mask if transportation to another department is necessary. ● Transport the client using the shortest and least busy route. ● Teach the client to cough and expectorate sputum into tissues that are disposed of by the client into provided sacks. ● Administer medications as prescribed. ● Promote adequate nutrition. ● encourage fluid intake and a well‐balanced diet for adequate caloric intake. COMPLICATIONS Miliary TB: The organism invades the bloodstream and can spread to multiple body organs with complications including the following: ● Headaches, neck stiffness, and drowsiness (can be life‐threatening) ● Pericarditis: dyspnea, swollen neck veins, pleuritic pain, and hypotension due to an accumulation of fluid in the pericardial sac that inhibits the heart's ability to pump effectively ● Nursing Actions: Treatment is the same as for pulmonary TB. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems

A nurse is caring for a client who has a pulmonary embolism. PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM NURSING CARE: describe three nursing interventions. MEDICATIONS: identify two.

PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM: A pulmonary embolism (Pe) occurs when a substance (solid, gaseous, or liquid) enters venous circulation and forms a blockage in the pulmonary vasculature. emboli originating from deep‐vein thrombosis (dVT) are the most common cause. Tumors, bone marrow, amniotic fluid, and foreign matter can also become emboli. NURSING CARE ● Administer oxygen therapy as prescribed to relieve hypoxemia and dyspnea. ● Position the client to maximize ventilation (high‐Fowler's = 90%). ● initiate and maintain iV access. ● Administer medications as prescribed. ● Provide emotional support and comfort to control client anxiety. ● Monitor changes in level of consciousness and mental status. MEDICATIONS ● Anticoagulants: enoxaparin, heparin, and warfarin ● Thrombolytic therapy: alteplase, reteplase, and tenecteplase NCLEX® Connection: Physiological Adaptation, Unexpected Response to Therapies

What is the brand/trade names for albuterol?

Proventil, Ventolin

A nurse is reviewing the plan of care for a client who has acute respiratory distress syndrome (Ards). What should be included in the plan of care? RISK FACTORS: describe three conditions related to Ards. NURSING CARE: describe three nursing actions to maintain oxygenation. COMPLICATIONS: identify two complications of Ards.

RISK FACTORS ● Can result from localized lung damage or from the effects of other systemic problems ● Aspiration ● Pulmonary emboli (fat, amniotic fluid) ● Pneumonia and other pulmonary infections NURSING CARE ● sepsis ● Near‐drowning accident ● Trauma ● damage to the central nervous system ● smoke or toxic gas inhalation ● drug ingestion/toxicity (heroin, opioids, salicylates) ● Maintain a patent airway and monitor respiratory status every hour as needed. ● suction the client as needed. ● Assess lung sounds. ● Assess and document sputum color, amount, and consistency. ● Oxygenate before suctioning secretions to prevent further hypoxemia. ● Mechanical ventilation often is required. PeeP often is used to prevent alveolar collapse during expiration. ● Monitor for pneumothorax. (A high PeeP can cause the lungs to collapse.) ● Obtain ABGs as prescribed and following each ventilator setting adjustment. ● Maintain continuous eCG monitoring for changes that can indicate increased hypoxemia, especially when repositioning and applying suction. ● Continually monitor vital signs, including saO2. ● Position the client to facilitate ventilation and perfusion. COMPLICATIONS ● endotracheal tube ◯ Trauma during intubation or long‐term intubation ◯ Can cause damage to trachea and vocal cords ◯ Nursing Actions: Consider a tracheostomy for long‐term ventilation. ● Aspiration pneumonia nursing actions ◯ Check the cuff on the endotracheal tube for leaks. ◯ Assess suction contents for gastric secretions. ◯ Verify NG tube placement. ● infection nursing actions ◯ Prevent infection by using proper hand hygiene and suctioning technique. ◯ Assess color, amount, and consistency of secretions. ● Blocked endotracheal tube ◯ The high‐pressure alarm on the ventilator can indicate a blocked endotracheal tube. ◯ Nursing Actions: suction secretions to relieve a mucous plug or insert an oral airway to prevent biting on the tube. ● Altered position of endotracheal tube nursing actions ◯ Check tube positioning every 1 to 2 hr and as needed. ◯ Assess breath sounds, saO2, and chest movement. ◯ secure endotracheal tube per institution's guidelines to maintain tube placement. ● Mechanical ventilation ◯ increased intrathoracic pressure ◯ PeeP increases intrathoracic pressure, which can cause a decreased blood return to the heart, decreased cardiac output and/or hypotension. ◯ decreased cardiac output can activate the renin‐angiotensin‐aldosterone system, leading to fluid retention and/or decreased urine output. ◯ Nursing Actions: Monitor input and output, weight, and hydration status. ◯ Client education: Avoid using the Valsalva maneuver (straining with bowel movement), because it can further increase intrathoracic pressure. ● Barotrauma: Ventilation with positive pressure causes damage to the lungs (pneumothorax, subcutaneous emphysema). NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems

A nurse in a clinic is discussing health promotion and disease management with a client who has rhinitis. What should the nurse include in this discussion? RISK FACTORS: identify three risk factors for rhinitis. EXPECTED FINDINGS: describe at least four. CLIENT EDUCATION: describe two client self‐care activities. MEDICATIONS: identify two over‐the‐counter medications the client can use.

RISK FACTORS ● recent exposure to viral, bacterial or influenza infections ● Lack of current immunization status (pneumonia, influenza) ● exposure to plant pollen, molds, animal dander, foods, medications, and environmental contaminants ● Tobacco smoke ● substance use (alcohol, cocaine) ● Presence of a foreign body ● inactivity and immobility EXPECTED FINDINGS ● excessive nasal drainage, runny nose (rhinorrhea), nasal congestion ● Purulent nasal drainage ● sneezing and pruritus of the nose, throat, and ears ● itchy, watery eyes ● sore, dry throat ● red, inflamed, swollen nasal mucosa ● Low‐grade fever CLIENT EDUCATION ● rest (8 to 10 hr/day), increased fluid intake (at least 2,000 mL/day) ● Use of a home humidifier or breathing steamy air after running hot shower water ● Proper disposal of tissues and use of cough etiquette MEDICATIONS: ●Brompheniramine/pseudoephedrine, ●cromolyn sodium, ●phenylephrine, ●antipyretics NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention

What are the therapeutic uses for ipratropium?

Relief of bronchoconstriction in clients who have COPD. Decreases secretions in clients with COPD.

What administration considerations apply to montelukast?

Schedule montelukast once daily in the evening. Available as tablets, chewable tablets, and oral granules. Mix oral granules with applesauce, carrots, rice, or ice cream or place directly on the tongue. To prevent EIB, take at least 2 hr before exercising and do not repeat the dose for 24 hr.

What is the brand/trade name for montelukast?

Singulair

What administration considerations apply to codeine, dextromethorphan?

Use only on a short-term basis. Use the lowest effective dose. Use only when needed. Should be used only with nonproductive coughs in the absence of wheezing

What administration considerations apply to cromolyn?

Use with a nebulizer or metered-dose inhaler. Expect several weeks of use for full effects to become apparent. Administer four times daily on a fixed schedule. Use the inhaler 15 min before exercising to prevent exercise- induced bronchospasm. Do not use to relieve an acute asthma exacerbation

A nurse is assessing a client following a thoracentesis. Use the ATi Active Learning Template: Therapeutic Procedure to complete this item. NURSING INTERVENTIONS (PRE, INTRA, POST): List three postprocedure nursing actions the nurse should take while caring for this client.

Using the ATI Active Learning Template: Therapeutic Procedure NURSING INTERVENTIONS (PRE, INTRA, POST) ● Apply a dressing over the puncture site, and assess dressing for bleeding or drainage. ● Monitor vital signs and respiratory status (respiratory rate and rhythm, breath sounds, oxygenation status) hourly for the first several hours after the thoracentesis. ● Auscultate lungs for reduced breath sounds on side of thoracentesis. ● encourage the client to deep breathe to assist with lung expansion. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests

What is the brand/trade names for theophylline?

Theolair, Theochron,Theo-24

What is the brand/trade name for cetirizine?

Zyrtec

What is the brand/trade names for beclomethasone dipropionate and fluticasone?

beclomethasone dipropionate: QVAR fluticasone: Flovent, Flonase

10. The nurse on a medical unit is administering 0900 medications. Which medication should the nurse question administering? 1. Acetylcysteine (Mucomyst), a mucolytic, to a client who is coughing forcefully. 2. Cefazolin (Ancef), an antibiotic, IVPB to a client diagnosed with the flu. 3. Diphenhydramine (Benadryl), an antihistamine, to a client who is congested. 4. Dextromethorphan (Robitussin), an antitussive, to a client who has pneumonia.

✅1. An adverse effect of Mucomyst is bronchospasm. This client should be assessed for bronchospasm before administering a dose of Mucomyst. 2. Antibiotics are frequently administered to clients with viral infections to prevent secondary bacterial infections. This client is considered at risk or the client would not be in a hospital receiving care. There is no reason to question this medication. 3. Antihistamines are prescribed for congestion; there is no reason to question this medication. 4. A symptom of pneumonia is a cough. There is no reason to question this medication.

13. The client diagnosed with emphysema is admitted to the surgical unit for a cholecystectomy (gallbladder removal). Which postoperative interventions should the nurse implement? Select all that apply. 1. Have the patient turn, cough, and breathe deeply every 2 hours. 2. Administer oxygen to the client at 4 L/min. 3. Assess the surgical dressing every 4 hours. 4. Medicate frequently with morphine 15 mg IVP. 5. Use the incentive spirometer every 4 hours.

✅1. Clients undergoing surgery are en- couraged to turn, cough, and deep breathe (TC&DB) a minimum of every 2 hours. Clients with emphysema should TC&DB more often than every 2 hours. 2. The client should be administered oxygen at 1-3 L/min. Clients with chronic lung disease have developed carbon dioxide nar- cosis; high levels of carbon dioxide have destroyed the client's first stimulus for breathing. Oxygen hunger is the body's backup system for sustaining life. Adminis- tering oxygen at levels above 2 L/min at rest and 3 L/min during activity may cause the client to stop breathing ✅3. Clients diagnosed with chronic lung disease are frequently prescribed long-term steroid therapy. Steroids delay wound healing. The nurse should assess the wound to determine that the surgical incision is healing as desired. 4. Morphine can cause respiratory compromise, especially when given frequently and in large doses. This client is already at risk for respiratory complications from the emphysema. ✅5. The client should use the incentive spirometer to help prevent pneumonia; every 4 hours is an appropriate time span.

17. The client diagnosed with adult respiratory distress syndrome (ARDS) has been found to have a disease-causing organism resistant to the antibiotics being given. Which intervention should the nurse implement? 1. Monitor for therapeutic blood levels of the aminoglycoside antibiotic prescribed. 2. Prepare to administer the glucocorticoid medication ordered intramuscularly. 3. Obtain an order for repeat cultures to confirm the identity of the resistant organism. 4. Place the client on airborne isolation precautions.

✅1. Currently the medications used to treat resistant bacteria are the amino-glycoside antibiotics. Vancomycin is the drug of choice, but gentamycin may also be used. These medications can be toxic to the auditory nerve and to the kidneys. The therapeutic range is 10-20 mg/dL. The nurse should monitor the blood levels. 2. If ordered, the steroid would be given intravenously, not intramuscularly. 3. The culture does not need to be repeated; this would add unnecessary expense to the client. 4. The client should be placed on contact and possibly droplet precautions. Airborne isolation is required for tuberculosis.

2. The client with the flu is prescribed the over-the-counter cough suppressant dextromethorphan. Which information should the nurse teach regarding this medication? 1. Take the medication every 4-8 hours as needed for cough. 2. The medication can cause addiction if taken too long. 3. Do not drive or operate machinery while taking the drug. 4. Do not take a beta blocker while taking this medication.

✅1. Dextromethorphan is relatively safe in the recommended dose range of 10-30 mg every 4-8 hours. At these levels it does not produce respiratory depression and side effects are not common. 2. This medication does not have the potential to cause addiction. 3. This medication does not produce drowsiness, so driving or operating machinery while taking dextromethorphan is acceptable. 4. The medication does not slow the heart rate, and there is no reason for a client not to take a prescribed beta blocker medication while taking dextromethorphan

28. Which information should the nurse teach the client who is prescribed a glucocorticoid inhaler? 1. Advise the client to gargle after each administration. 2. Instruct the client to use the inhaler on a PRN basis. 3. Encourage the client not to use a spacer when using the inhaler. 4. Teach the client to check his or her forced expiratory volume daily.

✅1. Gargling after each administration will help decrease the development of oropharyngeal yeast infections. 2. Glucocorticoids are intended for preventive therapy, not for aborting an ongoing asthma attack, and they should not be taken on a PRN basis. 3. A spacer, a device that attaches directly to the metered-dose inhaler, should be used because a spacer increases the delivery of the drug to the lungs and decreases deposition of the drug on the oropharyngeal mucosa. 4. Forced expiratory volume is the single most useful test of lung function, but the instrument required is a spirometer, which is expensive, cumbersome, and not suited for home use.

9. The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication? 1. Teach the client to monitor the bowel movements for constipation. 2. Driving or operating machinery is all right while taking this medication. 3. This medication usually causes insomnia, so plan for rest periods. 4. This medication is more effective when taken with a mucolytic.

✅1. Hydrocodone is an opioid and can slow the peristalsis of the bowel, resulting in constipation. The client should be aware of this and increase the fluid intake and use bulk laxatives and stool softeners, if needed. 2. Opioids can cause drowsiness, so driving or operating machinery should be discouraged. 3. Opioids usually cause the client to be drowsy, not have insomnia. 4. Hydrocodone is a cough suppressant and a mucolytic is an expectorant. These are opposite-acting medications.

5. The client with the flu has been taking acetylcysteine (Mucomyst), a mucolytic. Which adverse effect should the nurse assess for? 1. Bronchospasm. 2. Nausea. 3. Fever. 4. Drowsiness.

✅1. Mucomyst can cause bronchospasm, which will impair the client's breathing, not improve it. An adverse reaction is a reason to immediately discontinue the medication. 2. Nausea is a side effect of many medications and can usually be managed by taking the medication with food. A side effect is not an adverse effect. 3. Fever would result from the cold, flu, or infection, not from the medication. 4. Drowsiness is caused by some cold and flu preparations, usually the antihistamines. Mucomyst causes the client to expectorate secretions, which will keep the client awake.

44. The client diagnosed with a massive pulmonary embolus is ordered the thrombolytic streptokinase. The nurse notes on the medication administration record that the client is allergic to the "-mycin" medications, including streptomycin. Which intervention should the nurse implement? 1. Call the HCP to report the allergy. 2. Administer the medication as ordered. 3. Call the pharmacist to substitute medication. 4. Check the bleeding-time laboratory values.

✅1. Streptokinase is a foreign protein extracted from the cultures of streptococci bacteria, and streptomycin is derived from Streptomyces. As a result, this could possibly cause the client to have an allergic reaction. The nurse should discuss this allergy with the HCP. 2. The nurse should not administer this medication until determining if the client is at risk for an allergic reaction. 3. The pharmacist is not licensed to change an HCP order. 4. Bleeding times could be assessed after it is determined that the streptokinase will not cause the client to have an allergic reaction

26. Which assessment data indicates the client with reactive airway disease has "good" control with the medication regimen? 1. The client's peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. 2. The client's lung sounds are clear bilaterally, both anterior and posterior. 3. The client has only had three acute exacerbations of asthma in the last month. 4. The client's monthly serum theophylline level is 18 ug/mL. 5. The client is taking the medication as directed by the health-care provider.

✅1. The PEFR is defined as the maximal rate of airflow during expiration in a relatively inexpensive, handheld device. If the peak flow is less than 80% of personal best, more frequent monitoring should be done. The PEFR should be measured every morning. 2. A normal respiratory assessment does not indicate that the medication regimen is effective and has "good" control. 3. Three asthma attacks in the last month would not indicate the client has "good" control of the reactive airway disease. 4. A serum theophylline level between 10 and 20 ug/mL indicates the medication is within the therapeutic range, but it is not the best indicator of the client's control of the signs or symptoms. Taking the medication as directed is appropriate for the client but it does not indicate the medication regimen is effective.

23. The client with reactive airway disease is taking the oral sympathomimetic bronchodilator metaproterenol (Alupent) three times a day. Which intervention should the nurse implement? 1. Instruct the client to take the last dose a few hours before bedtime. 2. Teach the client to decrease the fluid intake when taking this medication. 3. Have the client demonstrate the correct way to use the inhaler. 4. Encourage the client to take the medication with an antacid.

✅1. The client should take the last dose a few hours before bedtime so that the medication does not produce insomnia. 2. The client should increase fluid intake, especially water, because it will make the mucus thinner and help the medication work more effectively 3. This medication is taken orally; therefore, there is no reason for the client to demonstrate the correct way to use an inhaler. 4. Antacids decrease the absorption of medication; therefore, the medication should not be taken with or within 2 hours of taking an antacid.

36. Which statement indicates to the nurse that the 13-year-old child understands the zone system for monitoring the treatment of asthma? 1. "When I am in the green zone, it means good control and I do not need any medication." 2. "If I am in the black zone, it means I should go to the emergency department." 3. "If I am in the red zone, it means I should take my cromolyn and steroid inhaler." 4. "The yellow zone means I tell my mom so she can give me a nebulizer treatment."

✅1. The zone system is used to help children monitor their treatment. The child uses a peak flow meter, which monitors breathing capacity and shows which zone—green, yellow, or red—the child's peak flow is in. Treatment, if needed, is then based on which zone the peak flow meter shows. Green zone means all clear; no asthma symptoms are present. 2. There is no such zone as the black zone. 3. The red zone indicates a medical alert—a bronchodilator should be taken and the child should seek medical attention for acute severe asthma. The cromolyn and steroid inhaler are not used for an acute asthma attack. 4. The yellow zone indicates caution because an acute episode may be present. The control is insufficient. The child should inhale a short-acting beta2 agonist. If this fails to return the child to the green zone, a short course of oral glucocorticoids may be needed

42. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 22 PT 39 Control 12.9 Control 36 INR 3.6 Which intervention should the nurse implement? Select all that apply. 1. Question administering the medication. 2. Prepare to administer AquaMEPHYTON (vitamin K). 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered. 5. Assess the client for abnormal bleeding.

✅1.The INR is above the therapeutic range; therefore, the nurse should question administering this medication. ✅2. Vitamin K is the antidote for Coumadin toxicity, therefore the nurse may administer this with a HCP order. 3. There is no reason to notify the HCP to request an increase in the dose because the client is above the therapeutic range. 4. The INR is above therapeutic range therefore the nurse should not administer the medication. ✅5. The INR is above therapeutic range therefore the nurse should assess the client for bleeding. MEDICATION MEMORY JOGGER: When trying to remember which laboratory value correlates with which anticoagulant, here's a helpful hint: "PT boats go to war (warfarin), and if you cross the small 't's' in 'Ptt' with one line it makes an 'h' (heparin)."

12. The female client is being admitted to a medical unit with a diagnosis of pneumonia. Which intervention would the nurse implement? Rank in order of performance. 1. Start an intravenous access line. 2. Administer the IVPB antibiotic. 3. Teach to notify the nurse of any vaginal itching. 4. Obtain sputum and blood cultures. 5. Place an identity band on the client

✅5, 4, 1, 2, 3 5. The laboratory technician who will draw the blood cultures will need the band to identify the client before drawing the specimen, and the nurse will need the band before administering the medication. Checking for the right client is one of the five rights of medication administration. 4. Cultures are obtained prior to the initiation of antibiotics to prevent skewing of the results. 1. An intravenous line must be initiated before the nurse can administer IV medications. 2. Intravenous antibiotics should be administered within 1-2 hours of the order being written. This should always be considered a "now" medication 3. Superinfections are a potential complication of antibiotic therapy. Vaginal yeast infections occur when the good bacteria are killed off by the antibiotic. Diarrhea from destruction of intestinal flora is also a possibility.

Question: 1 of 11 Administering oxygen therapy with a nonrebreather mask has which of the following advantages? A.,Offers the highest oxygen concentration of the low-flow systems B. Provides oxygen concentrations of 40% to 60% C. Incorporates a design that requires minimal monitoring of the client D. Is designed for safety once the mask's valves and flaps are sealed

✅A. A nonrebreather mask delivers oxygen concentrations of 60% to 80%. Thus, it provides a higher fraction of inspired oxygen (FiO2) than other low-flow systems such as a nasal cannula (delivering about 24% to 44%) or a simple mask (delivering 40% to 60%). B. Depending on the client's breathing pattern, a nonrebreather mask can deliver oxygen concentrations of 60% to 80%. C. Clients who are receiving oxygen through a nonrebreather mask need to be monitored closely because deflation of the reservoir bag (from which the client draws all inspired oxygen) decreases oxygen delivery and can cause the client to breathe exhaled carbon dioxide, resulting in risk to the client D. The design of the mask allows expired air to escape during inhalation but prevents inhalation of room air. So, if the oxygen source malfunctions or is depleted and the valves and flaps are sealed, the client would be unable to breathe room air.

Question: 2 of 11 Oxygen therapy is prescribed for a client who is brought to an emergency department in the early stages of hypoxia. When assessing this client, a nurse should expect which of the following findings? A. Elevated blood pressure B. Decrease respiratory rate C. Cyanosis D. Peripheral edema

✅A. During the early stages of hypoxia, blood pressure is usually elevated (unless shock is the cause of the client's hypoxia). In the late stages of hypoxia, clients are likely to develop hypotension. B.A declining respiratory rate is a common finding in the late stages of hypoxia. In the early stages, vital sign changes include increases in both the heart and respiratory rates. D. Peripheral edema is a sign of chronic hypoxia, which is experienced by clients who have long-standing COPD. Skills Modules 3.0 (35)

A client is undergoing pulmonary function tests for diagnosis of a respiratory condition. Which type of condition would pulmonary function tests most likely diagnose? Insomnia Allergies Lupus Fibromyalgia

✅Allergies Pulmonary function tests are performed to determine the function of the lungs. They may be ordered as part of diagnostic procedures or to monitor the condition of a client with a known lung condition. Pulmonary function tests can be used to diagnose such conditions as allergies, asthma, or chronic bronchitis. Lupus This is not a condition of the lung, so a pulmonary function test would not be used to diagnose this illness. Fibromyalgia This is not a condition of the lung, so a pulmonary function test would not be used to diagnose this illness. Insomnia This is not a condition of the lung, so a pulmonary function test would not be used to diagnose this illness.