respiratory meds

(11) The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication would the nurse anticipate the HCP prescribing?

"rusty" sputum indicates infection and an antibiotic should be ordered. The pt will more than likely need a mucolytic to help expectorate the thick tenacious sputum associated with COPD..they are commonly prescribed a steroid (glucocorticoid) med to decrease inflammation in the lungs. Rocephin is a broad-spectrum antibiotic.

(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?

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(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?

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(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?

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(48) The nurse is preparing to hang the next bag of heparin. The client's current laboratory values are as follows: PT 13.4 Control 12.9 INR 1 PTT 92 Control 36

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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?

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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 action should the nurse implement?

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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?

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The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective?

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The client is receiving an intravenous infusion of heparin. The bag hanging has 25,000 units of heparin in 500 mL of D5W at 14 mL per hour via an intravenous pump. How many units of heparin is the client receiving

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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?

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The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 22 CONTROL 12.9 INR 2.6 PT 39 CONTROL 36 Which action should the nurse implement?

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Treatment for mild persistent asthma

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Treatment for moderate persistent asthma

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(5) The client with the flu has been taking acetylcysteine (Mucomyst), a mucolytic. Which adverse effect would the nurse assess for?

1. Bronchospasm (correct) bronchospasms can impair pt's breathing..it is an adverse reaction and a reason to discontinue the med immediately 2. Nausea. (side effect) 3. Fever. (not r/t to med) 4. Drowsiness (usually antihistamines are the cold medicines that cause drowsiness...mucomyst helps pt to expectorate secretions, which will keep pt awake.

(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. (this med is used only for short-term, longer use can result in rebound congestion) 2. This type of medication can cause rebound congestion if used too long. (correct) 3. Alternate the Afrin with a saline nasal spray every 2 hours. (should only be used every 10-12 hours) 4. Place the Afrin nasal spray in a vaporizer at night for the best results. (used intranasally)

(13) The client diagnosed with emphysema is admitted to the surgical unit for a cholecystectomy (gallbladder removal). Which postoperative intervention should the nurse implement?

2. The client should be administered oxygen at 1-3 L/min. Clients with chronic lung disease have developed carbon dioxide narcosis; 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. 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. 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.

The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works?

A nebulizer is a small machine used to convert an antiasthma drug solution into a mist that is delivered though a mouthpiece. 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.

Which meds should be questioned?

Acetylcysteine (Mucomyst), a mucolytic, to a client who is coughing forcefully. Patient needs to be assessed for bronchospasm.

This is the description of how a metered-dose inhaler works.

small, handheld pressurized devices that deliver a measured dose of an antiasthma drug with activation.

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?

Currently the medications used to treat resistant bacteria are the aminoglycoside 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. The client should be placed on contact and possibly droplet precautions. Airborne isolation is required for tuberculosis.

Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma?

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.

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?

Morphine is a mild bronchodilator, and the continuous-release formulation provides a sustained effect for the client.

(9)The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication?

Opioid • slow peristalsis=constipation • increase fluid intake • cause drowsiness, driving is discouraged • hydrocodone is a cough suppressant and a mucolytic is an expectorant....these are opposite-acting meds

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.

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.

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?

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. Prednisone can produce gastric distress; it is given with food to minimize the gastric discomfort.

The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor?

Steroid therapy interferes with glucose metabolism and increases insulin resistance. The blood glucose levels should be monitored to determine if an intervention is needed.

The client with the flu is prescribed the over-the-counter cough suppressant dextromethorphan. Which information should the nurse teach regarding this medication?

Take the medication every 4-8 hours as needed for cough • does not have addiction potention • Does not produce drowsiness, driving is okay • does not slow heart rate, to reason to hold a beta blocker med

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?

Teach pt to take all antibiotics as ordered. • this is a penicillin preparation, not sulfa (sulfa or iodine med would need to be assessed for allergy to shellfish) • antibiotics don't treat viral infections, but will frequently be prescribed as prophylaxis in COPD pt's to prevent secondary bacterial infection.

Which assessment data best indicates the client with reactive airway disease has "good" control with the medication regimen?

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.

Which information should the nurse teach the client who is prescribed a glucocorticoid inhaler?

The client should increase fluid intake, especially water, because it will make the mucus thinner and help the medication work more effectively. Antacids decrease the absorption of medication; therefore, the medication should not be taken with or within 2 hours of taking an antacid. The client should take the last dose a few hours before bedtime so that the medication does not produce insomnia.

Which information should the nurse discuss with the client diagnosed with reactive airway disease who is prescribed theophylline (Slo-Phyllin), a xanthine bronchodilator?

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 drinks. 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.

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The most severe class, severe persistent asthma, is managed with daily inhalation of a glucocorticoid (high dose), plus salmeterol, a long-acting inhaled agent.

The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 28 μg/mL. Which action should the nurse implement first?

The therapeutic level for theophylline is 10-20 μg/mL; therefore, the nurse should take action. As the serum theophylline level rises above 20 μg/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. 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. After discontinuing the aminophylline drip and then assessing the client for potential life-threatening complications, the nurse should notify the health-care provider.

Which data would indicate that the antibiotic therapy has not been successful for a client diagnosed with a bacterial pneumonia?

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. 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. Pleuritic chest is a symptom of pneumonia, and no chest pain indicates the medication is effective.

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?

This medication does not stimulate the central nervous system; therefore, the client does not need to avoid caffeine-containing products. 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. 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.

The client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast (Singulair). Which statement by the client would warrant intervention by the nurse?

This medication interacts with aspirin, warfarin, erythromycin, and theophylline; therefore, this statement warrants further intervention by the nurse. • These drugs are generally safe and well-tolerated, with a headache beinThis 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.

This is the description of how a dry-powder inhaler works.

an inhaler that delivers an antiasthma drug in the form of a dry, micronized power directly to the lungs.