143 Module 2 - Respiratory Drugs (PRACTICE QUESTIONS)

A patient is being treated with amphotericin B. Which of the following statements indicates that the patient has understood the patient teaching? A) The medication may cause diabetes. B) The medication will cause liver necrosis. C) The medication may cause kidney damage. D) The medication will cause pancreatitis.

Ans: C Feedback: The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus, the statement that the medication may cause kidney damage is the most appropriate.The medication will not cause diabetes, liver necrosis, or pancreatitis.

The nursing instructor is teaching a session explaining mast cell stabilizers. The instructor determines the session is successful when the students correctly choose which drug as an example? A. Beclomethasone B. Cromolyn C. Albuterol D. Montelukast

B. Cromolyn is an example of a mast cell stabilizer. Beclomethasone is an inhaled corticosteroid. Albuterol is a short-acting beta2 agonist. Montelukast is an example of a leukotriene modifier.

The nurse is preparing a teaching session for a client prescribed dextromethorphan orally. Which instruction should the nurse prioritize? A. Take the drug on an empty stomach. B. Swallow the whole tablet and do not chew it. C. Take the drug with a glass of milk. D. Dissolve the tablet in water and take the drug.

B. The nurse should instruct the client to swallow the whole tablet and not to chew it to ensure that the drug is absorbed properly. The nurse need not instruct the client to take the drug with a glass of milk, dissolve the tablet in water and take the drug, or take the drug on an empty stomach.

A nurse has just completed teaching with a client who has been prescribed a metered-dose inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary? A. I will make sure to take a slow, deep breath as I push on my inhaler. B. After I breathe in, I will hold my breath for 10 seconds. C. I do not need to rinse my mouth with this type of inhaler. D. If I use the spacer, I know I am only supposed to push on the i

C. Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route? A. Oral B. Intravenous C. Inhalation D. Subcutaneous

C. Salmeterol is administered via inhalation.

A physician orders metaproterenol by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? A. I can stop using this drug when I begin to feel better. B. I need to call the physician right away if I feel my heart beating fast after using the drug. C. I should use this inhaler whenever I get short of breath. D. I need to hold my breath as long as possible after I take a deep inhalation.

D. The client demonstrates effective teaching if he states that he'll hold his breath for as long as possible after inhaling the drug. Holding the breath increases the absorption of the drug into the alveoli. Metaproterenol (Alupent) needs to be used over an extended period for maximum effect. The client shouldn't use the inhaler whenever he feels out of breath because dependency can develop if the drug is used excessively. The client should adhere to the prescribed dosage. Tachycardia is an expected adverse reaction to metaproterenol. The client should be taught how to monitor his heart rate and contact the physician only if the heart rate exceeds 130 beats/minute.

Before administering a prescribed bronchodilator to a client experiencing acute breathing distress, which assessment(s) should the nurse complete? Select all that apply. A. Pulse B. Respiratory rate C. Lung sounds D. Blood pressure E. Blood glucose

A, B, C, D. Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to assess vital signs, including blood pressure, pulse, and respiratory rate and lung sounds. Blood glucose would only be necessary if the client had diabetes.

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? A. Vitamin B6 B. Vitamin C C. Vitamin E D. Vitamin D

A. Vitamin B6 (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy. Vitamins C, D, and E are not appropriate.

A patient is being treated for active tuberculosis with ethambutol (Myambutol). The patient states to the nurse that he cannot identify the red and green on the traffic lights when he is driving. Based on this finding, what medical intervention is most appropriate? A) Assess for photosensitivity. B) Discontinue ethambutol (Myambutol). C) Decrease the ethambutol (Myambutol) dose. D) Administer vitamin B 12.

Ans: B Feedback: The administration of ethambutol should be discontinued if optic neuritis develops. Optic neuritis is an inflammatory, demyelinating disorder of the optic nerve that decreases visual acuity and ability to differentiate red and green. The inability to distinguish red and green is not indicative of photosensitivity. The Ethambutol should not be decreased. There is no indication for the administration of vitamin B 12.

The nurse teaches a client receiving an inhaled corticosteroid about the possibility of developing oral thrush. Which action(s) would the nurse include in the teaching plan as a way to reduce this risk? Select all that apply. A. Cleaning the inhaler per package instructions B. Administering a dose only every other day C. Using proper technique when administering dose D. Performing strict oral hygiene E. Need to avoid eating after administration

A, C, D. To decrease the likelihood of developing oral thrush, a client should use strict oral hygiene, cleanse the inhaler as directed in the package instructions, and use proper technique when administering a dose. There is no need to avoid eating after administration, and using the drug only every other day would not be effective.

Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)? A. Amoxicillin B. Levofloxacin C. Keflex D. Ceftin

A. Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid is the antibiotic of choice. For clients who are allergic to penicillin, doxycycline or respiratory quinolones, such as levofloxacin or moxifloxacin, can be used. Other antibiotics previously prescribed to treat ABRS, including cephalosporins such as cephalexin and cefuroxime, are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

A client asks, What is the difference between antitussive medications and expectorants? What information should the nurse's response be based upon? A. Antitussives suppress coughing while expectorants loosen bronchial secretions. B. Antitussives liquefy bronchial secretions while expectorants assist in the expectoration of those secretions. C. Antitussives kill cold viruses while expectorants liquefy bronchial secretions. D. Both drug types loosen bronchial secretions for ease of removal.

A. Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

A patient with a persistent and debilitating cough is confused that his physician has prescribed codeine. He tells the nurse, I was sure that codeine was a narcotic that people take for pain. The nurse should cite what mechanism of action when describing this use of codeine? A) Depression of the cough center in the medulla oblongata B) Vasodilation of the alveolar capillaries C) Stimulation of the reticular activating system (RAS) D) Desensitization of the cough receptors in the sinuses and trac

A. Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

The health care provider has prescribed beclomethasone for long term control of asthma. The nurse is most correct to advise the client that beclomethasone is a: A. corticosteroid. B. leukotriene inhibitor. C. mast cell stabilizer. D. xanthine derivative.

A. Beclomethasone is a corticosteroid prescribed for long-term asthma control. Mast cell stabilizers help to decrease bronchospasm and mucous membrane inflammation. A xanthine derivative such as theophylline is a time-released bronchodilator. Leukotriene inhibitors help with bronchodilation and decrease airway edema.

A 43-year-old man is taking pseudoephedrine (Sudafed) for sinusitis. He calls the clinic to report that it feels like his heart is racing and that he can feel his heart beating fast. The nurse will instruct him to: A. stop taking the medication and come to the clinic as ordered by the health care provider. B. lie down after each dose. C. decrease the dosage by one half. D. continue taking the drug because the sensations will resolve with time.

A. Cardiovascular adverse effects such as palpitations, tachycardia, hypertension, and arrhythmias are possible with the administration of pseudoephedrine (Sudafed). If the client reports palpitations and tachycardia, the nurse should instruct him to stop the medication and come in to see his provider. This drug produces sympathomimetic effects and could aggravate any existing cardiovascular issues. The nurse would not instruct the client to change the dosage of any drug, and having the client lie down after each dose will not limit or alleviate sympathomimetic effects of the drug. Continuation of the drug would worsen the adverse effects and could cause serious complications.

A patient is experiencing anaphylaxis. Which Of the following medications will most likely be administered? A) Epinephrine B) Norepinephrine C) Acetylcysteine (Mucomyst) D) Dantrolene sodium (Dantrium)

A. Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine is not administered. Acetylcysteine (Mucomyst)is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.

A 17-year-old boy has been brought to the emergency department by his mother who is distraught by the fact that she caught him and his friend guzzling cough syrup. What assessment finding is suggestive of an overdose of dextromethorphan? A) Hallucinations B) Dysrhythmias C) Kussmaul's respirations D) Profound diaphoresis

A. The nurse observes for excessive suppression of the cough reflex (inability to cough effectively when secretions are present) or hallucinations with dosages that exceed recommendations of dextromethorphan. Kussmaul's respirations, dysrhythmias, and diaphoresis are not characteristic adverse effects.

A patient is advised to take a decongestant drug to relieve nasal congestion associated with hay fever. The patient is not comfortable with a nasal spray or drops and prefers an oral tablet. Which oral decongestant drugs can be administered to the patient? A. Pseudoephedrine B. Ephedrine C. Xylometazoline D. Tetrahydrozoline

A. The patient can take an oral preparation of pseudoephedrine. Xylometazoline, ephedrine, and tetrahydrozoline are usually available only in the form of nasal sprays or drops for topical use.

A patient has been taking oral amoxicillin to treat otitis media for the past 6 days and has told the nurse that his ear is now back to normal. He asks the nurse if he can now stop taking his antibiotics. How should the nurse respond? A) That's excellent that you're feeling better, but it's important to keep taking the antibiotics until they're all finished. B) Try reducing your dose by half. If your ear infection gets worse, resume the dose you've been talking until now. C) You should stop

A. The patient should take the full course of antibiotics and not discontinue them, even if the otitis media seems to be improving. Stopping prematurely can cause antibiotic resistance.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? A. Theophylline B. Levalbuterol C. Terbutaline D. Albuterol

A. Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.

A nurse is teaching a client with asthma about the proper use of the prescribed inhaled corticosteroid. Which adverse effect should the nurse be sure to address in client teaching? A. Increased respiratory secretions B. Bradycardia C. Oral candidiasis D. Decreased level of consciousness

ANS: C Rationale: Thrush or oral candidiasis is a fungal infection that presents with white lesions on the tongue and/or inner cheeks of the mouth. Clients should rinse their mouth after administration or use a spacer to prevent thrush, a common complication associated with use of inhaled corticosteroids. Increased respiratory secretions normally do not occur, although a cough may develop. Tachycardia, or a fast heart rate, rather than bradycardia, or a slow heart rate, is listed as an adverse effect. A decreased level of consciousness is not associated with this medication because it does not cause sedation nor is it an opiate.

A nurse is explaining to a client with asthma with a new prescription for prednisone what it is used for. What would be the most accurate explanation that the nurse could give? A. To ensure long-term prevention of asthma exacerbations B. To cure any systemic infection underlying asthma attacks C. To prevent recurrent pulmonary infections D. To gain prompt control of inadequately controlled, persistent asthma

ANS: D Rationale: Prednisone is used for a short-term (3-10 days) burst to gain prompt control of inadequately controlled, persistent asthma. It is not used to treat infection or to prevent exacerbations in the long term.

A patient is being assessed by the home care nurse on the appropriate use of her metered- dose inhalers. Which of the following will assist in proper administration of the inhaler? A) Use of a spacer B) Administration of a corticosteroid first C) Pushing fluids D) Exhaling immediately after administration

Ans: A Feedback: The patient should be instructed to use a spacer to increase compliance and accuracy of administration. The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The patient should hold her breath for several seconds after administration of the inhaler.

A patient who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this patient's most likely diagnosis? A) Active tuberculosis B) Latent tuberculosis C) Mycobacterium avium complex D) Human immunodeficiency virus

Ans: B Feedback: Although use of INH by itself for treatment of latent TB is appropriate, use with other anti- TB drugs is essential for treatment of active TB. INH would not be used exclusively in the treatment of HIV or MAC.

A 72-year-old woman with a 60-pack-year history of cigarette smoking has developed chronic obstructive pulmonary disease (COPD) and has consequently been prescribed albuterol, a beta 2 -adrenergic agonist. When administering this medication, the nurse should be aware that A) the drug carries a higher potential for hepatotoxicity in this patient than in a younger patient. B) the drug may be less effective than in a younger patient due to decreased beta- receptor function. C) the patient will need

Ans: B Feedback: Beta-adrenergic agonists are less effective in older adults as a result of the decreased function of the beta-receptor system. The potential for hepatotoxicity is not increased, and a beta-blocker is not indicated. Serial blood work is not necessary.

A patient is experiencing an acute asthma attack. Which of the following medications is contraindicated for the treatment of acute bronchospasm? A) Aminophylline B) Cromolyn (Intal) C) Albuterol (Proventil) D) Formoterol (Foradil)

Ans: B Feedback: Cromolyn stabilizes mast cells and is not used in acute bronchospasm. Aminophylline is used in limited cases but is administered for acute asthma attack. Albuterol and formoterol are used for acute asthma attack.

A patient suffers from bronchial asthma. Which of the following medications is a mixed-acting adrenergic drug that may be administered? A) Epinephrine B) Ephedrine C) Pseudoephedrine D) Isoproterenol

Ans: B Feedback: Ephedrine is a mixed-acting adrenergic drug that acts by stimulating alpha1 and beta receptors and causing release of norepinephrine from presynaptic terminals. Itis used in the treatment of bronchial asthma. Epinephrine is not a mixed-acting adrenergic drug. Pseudoephedrine is a related drug, stimulating alpha1 and beta receptors. It is used as a nasal decongestant. Isoproterenol isa synthetic catecholamine that acts on beta 1 - and beta 2 -adrenergic receptors.

A pediatric patient is administered epinephrine to treat bronchospasm as a result of acute asthma. What effect should the patient be monitored for? A) Edema B) Syncope C) Bradycardia D) Hemorrhage

Ans: B Feedback: Epinephrine is mainly used in children for treatment of bronchospasm due to asthma or allergic reactions. Parenteral epinephrine may cause syncope when given to asthmatic children. Epinephrine will not increase edema or cause bradycardia or hemorrhage.

A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and decreased sensation in his great toes. Which laboratory values should be assessed? A) Hematocrit and hemoglobin B) ALT and AST (liver function) C) Urine culture and sensitivity D) Erythrocyte count and differential

Ans: B Feedback: Hepatotoxicity and peripheral neuropathy are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function. The hematocrit and hemoglobin are not indicated with the described symptoms. Erythrocyte count and differential are not indicated with these symptoms.

A patient's medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, which of the following statements is true? A) The two drugs should be administered at least 30 minutes apart, with ipratropium administered first. B) The two drugs can be mixed in the nebulizer immediately before administration. C) The two drugs should be administered at least 30 minutes apart, with albuterol administered first. D) The

Ans: B Feedback: It is appropriate to mix ipratropium bromide inhalation solution in the nebulizer with albuterol or metaproterenol if the mixture is used within 1 hour. These drugs have a synergistic effect.

A 4-year-old boy was diagnosed with acute otitis media and began a course of oral amoxicillin. The boy's mother has contacted the clinic and states that there has been no significant improvement in her son's ear infection since beginning the antibiotics 3 days ago. The nurse should consider which of the following explanations for this phenomenon? A) The boy has not been receiving the medication consistently. B) The boy's ear infection has a viral etiology. C) The boy's ear infection is caused

Ans: B Feedback: Many people with acute otitis media do not benefit from antibiotics because the cause of their illness is viral, not bacterial. This possibility is more likely than incorrect administration of antibiotic resistance. Parenteral administration would be no more effective in this case.

An influenza outbreak has spread through a long-term care residence, affecting many of the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the nurse has liaised with a physician to see if residents may be candidates for treatment with what drug? A) Saquinavir mesylate B) Oseltamivir phosphate C) Lamivudine D) Ribavirin

Ans: B Feedback: Oseltamivir phosphate (Tamiflu) is used to treat active influenza. Saquinavir mesylate is a protease inhibitor. Lamivudine is used to treat hepatitis B. Ribavirin treats RSV.

A patient is experiencing an acute asthma attack. What is the most common first-line therapy for relief of an acute asthma attack? A) Inhaled steroid B) Leukotriene modifier C) Beta 2 -adrenergic agonist D) Xanthine

Ans: C Feedback: A patient experiencing an acute asthma attack should be administered a beta 2 - adrenergic agonist. The patient can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

An elderly patient with a long-standing history of schizophrenia has been admitted to the hospital for treatment of hyponatremia. The nurse reviews the patient's medical chart and reads that the patient was previously treated with phenothiazine antipsychotics. What medication may this patient have been treated with? A) Aminophylline (Theophylline) B) Acetylsalicylic acid (aspirin) C) Chlorpromazine (Thorazine) D) Dantrolene sodium (Dantrium)

Ans: C Feedback: Chlorpromazine (Thorazine) is the prototype phenothiazine. Aminophylline (Theophylline)is a xanthine agent administered to increase bronchioles. Acetylsalicylic acid (aspirin) and dantrolene sodium (Dantrium) are not phenothiazines.

An adult patient with a diagnosis of asthma has been prescribed montelukast (Singulair). The nurse should teach the patient that this drug will help relieve symptoms by A) reducing the muscle tone in the alveoli and facilitating gas exchange. B) relaxing smooth muscle in the bronchi and bronchioles. C) preventing the bronchoconstriction and inflammation that is caused by leukotrienes. D) preventing mast cells from releasing histamine.

Ans: C Feedback: Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes.

A patient who suffers from asthma is given theophylline. Theophylline will have an increased effect if taken with A) Ritalin. B) atomoxetine (Strattera). C) modafinil (Provigil). D) caffeine

Ans: D Feedback: Caffeine increases the effects of theophylline.Ritalin, Provigil, and Strattera are noted to have this effect.

A patient is using an albuterol (Proventil) inhaler, which is a bronchodilator. Which of the following patient teaching interventions isa priority for the patient who experiences shortness of breath related to constriction of airways? A) Administer insulin to decrease hand shaking. B) Administer ibuprofen (Advil) to decrease inflammation. C) Exercise should be limited to one time per week. D) Stop smoking due to the bronchoconstriction.

Ans: D Feedback: Cigarette smoking will increase bronchoconstriction, so the patient should be encouraged to stop. The albuterol causes handshaking. Insulin will not decrease hand shaking. The patient will not require ibuprofen (Advil). The patient should be encouraged to exercise, and it should not be limited to one time per week.

A teenage boy has been brought to the emergency department (ED) by his football coach, who states that the boy has not responded to his normal rescue inhaler. The care team has opted for the administration of subcutaneous epinephrine. The ED nurse should anticipate what assessment finding subsequent to the administration of this drug? A) Increased level of consciousness within 2 to 5 minutes B) Immediate bronchodilation C) An immediate decrease in respiratory rate D) Bronchodilation within 5 to

Ans: D Feedback: For acute asthma attacks, subcutaneous (Sub-Q) administration of epinephrine usually produces bronchodilation within 5 to 10 minutes; maximal effects may occur within 20 minutes. An increase in LOC is not a priority, and respiratory rate would not likely decrease.

A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma? A) Inhaled corticosteroid agents will depress the central nervous system. B) Inhaled corticosteroid agents will reduce respiratory rate. C) Inhaled corticosteroid agents will reduce bronchodilation. D) Inhaled corticosteroid agents will reduce airway inflammation.

Ans: D Feedback: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system. Inhaled corticosteroid agents do not affect bronchodilation or constriction.

A patient has been using phenylephrine (Neo-Synephrine) for nasal congestion. He states to the nurse that he is using more every day because his nose is so congested. What effect is the medication producing? A) Reflex bradycardia B) Mucosal hemorrhage C) Tachycardia D) Rebound congestion

Ans: D Feedback: Overuse of nasal decongestants leads to decreased effectiveness (tolerance), irritation and ischemic changes in the nasal mucosa, and rebound congestion. These effects can be minimized by using small doses only when necessary and for no longer than 3 to 5 days. Phenylephrine will not produce reflex bradycardia, mucosal irritation, or tachycardia.

A patient is prescribed an adrenergic bronchodilator for airway constriction. Which Of the following conditions will require it to be administered cautiously? A) Liver failure B) Renal failure C) Respiratory constriction D) Seizure disorder

Ans: D Feedback: The administration of adrenergic bronchodilators should be used cautiously in patients with hypertension, hyperthyroidism, diabetes mellitus, and seizure disorders. The patient with liver failure and renal failure can be administered adrenergic bronchodilators. The patient with respiratory constriction should receive adrenergic bronchodilators.

A 3-year-old child is seen in the pediatric office for a dry, hacking cough. The mother is requesting a prescription for dextromethorphan. In providing patient education, which of the following provides the most effective teaching regarding the use of dextromethorphan in children? A) Dextromethorphan suppresses cough in children. B) Dextromethorphan is ineffective in children. C) Dextromethorphan must be combined with codeine. D) Dextromethorphan raises blood pressure in children.

B. Although antitussives continue to be used and adults report beneficial effect in reducing cough, antitussives, particularly dextromethorphan, have not been demonstrated to be effective in children and adolescents. Adverse effects of dextromethorphan in children include behavioral disturbances and respiratory depression, not high blood pressure.

A client diagnosed with chronic obstructive pulmonary disease (COPD) has been prescribed bronchodilators by nebulizer for home use. What should the nurse teach the client to do to best assure effective use of the nebulizer? A. Take the exact number of puffs that have been prescribed. B. Sit in a fully upright position when administering the medication. C. Gargle with an alcohol-based mouthwash after each dose. D. Keep an extra oxygen tank on hand for propelling the medication.

B. Clients should sit in Fowler's position when inhaling nebulized medications. Compressed air (not oxygen) is used. Inhalers (not nebulizers) require a prescribed number of puffs. The client should rinse the mouth after administration, but an alcohol-based solution is not necessary.

A community health nurse is cautious when recommending the use of OTC cold remedies to patients. The use of pseudoephedrine would most likely be contraindicated in which of the following patients? A) A woman who is breastfeeding B) A man with a history of angina and hypertension C) A man who has diagnoses of chronic obstructive pulmonary disease and diabetes D) A woman who has myasthenia gravis

B. Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. Breast-feeding does not necessarily contraindicate the use of pseudoephedrine, though caution would be warranted. The other listed medical diagnoses do not contraindicate the use of pseudoephedrine.

A 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan? A. Dextromethorphan works on the receptors in the throat to prevent a cough. B. Dextromethorphan works in the medulla to suppress the cough reflex. C. Dextromethorphan works by relaxing the smooth muscles in the bronchioles. D. Dextromethorphan works by inhib

B. Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.

A patient is admitted to the emergency room with inspiratory stridor and air hunger after a bee sting. Which of the following medications will the nurse prepare for administration? A) Ipratropium bromide (Atrovent) B) Epinephrine (Adrenalin) C) Cromolyn (Intal) D) Pseudoephedrine

B. Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. Itis not used for acute attacks. Pseudoephedrine Is not administered for acute bronchoconstriction.

A male college student has presented to the campus medical clinic reporting cold symptoms that he has been experiencing for the past 2 weeks. He tells the nurse that he has been taking OTC decongestants twice daily since the onset of the cold. What teaching point should the nurse provide to this student? A. Over-the-counter decongestants don't normally work; you'll likely need to get a prescription for something more effective. B. You might find yourself more congested than ever as your body com

B. Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided.

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? A. Antihistamine B. Mucolytic C. Peripherally acting antitussive D. Expectorant E. Centrally acting antitussive

B. Mucolytic drugs may be used by patients suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis to reduce the viscosity of respiratory secretions by direct action on the mucus. Mucolytic drugs increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. Expectorants increase the production of respiratory secretions, which in turn appear to decrease the viscosity of the mucus. This helps to raise secretions from the respiratory passages. Antitussives are cough suppressants. Antihistamines are used to treat allergic reactions.

A patient is administered isoniazid (INH) for tuberculosis. Which of the following adverse effects will result in discontinuation of the medication? A) Weight gain B) Jaundice C) Fever D) Arthralgia

B. Potentially serious adverse effects of INH include hepatotoxicity and peripheral neuropathy. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. Weight gain, fever,and arthralgia are not the most known adverse effects of isoniazid (INH).

An elderly patient has presented to the clinic for a scheduled visit and states that he has been taking a combination antitussive/ decongestant/expectorant for several weeks in order to prevent the common cold. The nurse should cite which of the following effects of long-term use of OTC cold remedies? Select all that apply. A) Chronic epistaxis B) Anticholinergic effects C) Chronic congestion D) Damage to the nasal mucosa E) Hepatotoxicity

C, D. Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Do not use nose drops or sprays more often or longer than recommended. Excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. These drugs are not associated with chronic epistaxis, anticholinergic effects, or hepatotoxicity.

A nursing instructor is teaching the student about expectorants. The student demonstrates an understanding of how they work by making which statement? A. Expectorants break down thick and tenacious mucus in the lower portions of the lungs. B. Expectorants help relax the patient and therefore stop coughing. C. Expectorants increase production of respiratory secretions, which in turn appears to decrease the viscosity of the mucus. D. Expectorants suppress the coughing reflex.

C. An expectorant increases the production of respiratory secretions, which in turn appears to decrease the viscosity of mucus and therefore helps the client remove secretions more easily. Mucolytics break down thick and tenacious mucus in the lower portions of the lungs. Expectorants do not suppress the coughing reflex or cause sedation in the client.

A client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the primary health care provider will prescribe? A. hydrocodone B. dextromethorphan C. guaifenesin D. benzonatate

C. Because this client needs to cough up respiratory secretions, the client would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing the viscosity and thus making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.

Which agent acts directly on the medullary cough center? A. Tetrahydrozoline B. Benzonatate C. Codeine D. Ephedrine

C. Codeine, a centrally acting antitussive, works directly on the medullary cough center. Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine and tetrahydrozoline are topical nasal decongestants.

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? A. Dilated and reactive pupils B. Heart rate of 100 beats/minute C. Respiratory rate of 16 breaths/minute D. Urine output of 40 ml/hour

C. In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 16 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? A. Gastrointestinal upset B. Alcohol intake C. Cigarette smoking D. Hyperthyroidism

C. Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary. Hyperthyroidism, gastrointestinal, upset or alcohol intake requires cautious use of the drug because these conditions may be exacerbated by the systemic effects of the drug. The drug dosage may need to be decreased in these situations.

A patient is scheduled to receive an immunization. In which of the following patients may the administration of a live vaccine be contraindicated? A) Patient with renal insufficiency B) Patient with hepatic failure C) Patient taking steroid therapy D) Patient over the age of 65 years

C. Patients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before receiving a live-virus vaccine. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Patients over the age of 65 should receive immunizations as needed to protect from infectious disease.

A patient with a long-standing history of asthma has failed to achieve adequate symptom control with first-line drugs. As a result, her care provider has prescribed theophylline. The nurse is aware of the narrow therapeutic range of this drug and has taught the patient to recognize the signs and symptoms of toxicity. These include which of the following? A) Polyuria and polyphagia B) Confusion and decreased level of consciousness C) Agitation and dysrhythmias 590 590 [Date] D) Chest pain and sho

C. Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other dysrhythmias, and tonic-clonic convulsions. Ventricular dysrhythmias or convulsions may be the first sign of toxicity. Chest pain, shortness of breath, polyuria, polyphagia, and decreased level of consciousness do not accompany theophylline overdose.

A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation? A. The health care provider will most likely order continuation of the salmeterol with increased dosage. B. The husband made the correct decision in giving the extra doses. C. Salmeterol is contraindicated based on his wife's

C. The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.

A patient with asthma has been prescribed ipratropium (Atrovent) 2 puffs QID. The nurse should recognize which of the following as the most likely goal of this treatment? A) Promoting short-term relief of acute asthma symptoms B) Relieving acute bronchoconstriction C) Promoting long-term management of asthma symptoms D) Promoting blood flow in the alveolar capillaries

C. The anticholinergic bronchodilators are most useful in the long-term management of asthma and other conditions producing bronchoconstriction. These drugs are not used in the management of acute exacerbations of asthma. They do not promote alveolar blood flow.

A patient is administered amoxicillin (Amoxil). The generic name of this medication indicates that it belongs to which drug group? A) Selective serotonin reuptake inhibitors B) Diuretics C) Penicillins D) ACE inhibitors

C. The generic name often indicates the drug group (e.g., drugs with generic names ending in cillin are penicillins). Selective serotonin reuptake inhibitors are medications that have antidepressant effects; SSRI is a broad classification, not a generic name. Diuretics are medications that increase urine output; diuretic is a broad classification, not a generic name. ACE inhibitor is the broad classification for the angiotensin-converting enzyme inhibitors, not the generic name.

A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take? A. Aspirates for blood return before injecting the medication B. Encourages the client to decrease caloric intake due to increased appetite C. Informs the client to limit fluid intake due to fluid retention D. Assesses fasting blood glucose levels

D. Adverse effects of methylprednisolone (Solu-Medrol) include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.

The nurse is evaluating the education of a client that uses albuterol for an acute asthma attack. The nurse knows that the lesson has been effective when the client states that albuterol is which of the following types of medication? A. Leukotriene modifier B. Antiasthma C. LABA D. SABA

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

During the summer, a female client experiences increased periods of acute symptoms of her asthma. The health care provider increases the dose frequency of which of her medications? A. Epinephrine B. Salmeterol C. Omalizumab D. Albuterol

D. Albuterol is the initial drug of choice for acute bronchospasm.

A patient is prescribed an antitussive agent with codeine. Which of the following statements by the patient indicates that the nurse's teaching has been effective? A) I will take this medication whenever I am coughing. B) This medication may make me anxious and nervous. C) I will call my physician if I develop diarrhea when I take it. D) This medication will cause drowsiness, and I will not drive.

D. Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat,trachea, or lungs. Since they are combined with codeine, they will also depress the CNS and induce drowsiness. The medication should not be given every time the patient coughs. The medication will not cause anxiety and nervousness. The medication will cause constipation, not diarrhea.

A 55-year-old male patient has been living with type 1 diabetes for many years and has begun to experience diabetic nephropathy over the past year. How will this patient's current health status influence the possible use of pseudoephedrine in the treatment of cold symptoms? A) The patient should monitor his blood glucose levels more frequently when taking pseudoephedrine. B) The use of pseudoephedrine is absolutely contraindicated by the fact that the patient has diabetes and takes insulin. C) T

D. Because pseudoephedrine is excreted primarily via the kidneys, caution in patients with renal impairment is important. It may be necessary to reduce the dosage to avoid potential drug accumulation and drug toxicity.The presence of diabetes warrants caution, but it is not an absolute contraindication.

An older adult client has been prescribed ipratropium by metered-dose inhaler and the nurse has provided education on using the device. When demonstrating the technique back to the nurse, the client is unable to coordinate pressing down on the inhaler and maintaining a seal with their lips. What is the nurse's best action? A. Identify a trusted family member to be responsible for administration. B. Request an increased dose from the health care provider to offset the client's incorrect technique

D. Clients who struggle to use MDI's often benefit from the use of a spacer, and the nurse should attempt to obtain one. This is preferable to a change in medications. Delegating to a family member is often impractical, particularly when a medication must be administered multiple times daily. The client's technique would likely result in an insufficient dose being delivered, but it would not be possible to offset this by an increased dose with any precision.

What statement best describes how the common cold is effected by and managed using medication therapy? A. Because of the way cold viruses are spread, antibiotics are the most important protective and curative measure. B. Herbal remedies containing zinc have not demonstrated any ability to reduce the symptoms generally associated with a cold. C. Colds may be difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. D. The tend

D. Common colds are caused by viruses, not bacteria. The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance making treatment more challenging. Herbal preparations containing oral zinc have demonstrated ability to reduce the duration and severity of cold symptoms in adults. While immunity issues increase the risk of developing a cold, it is not the sole factor related to the risk for developing a cold.

A nurse has taught an adult patient about the fact that guaifenesin is not necessarily an effective way of liquefying secretions. To help liquefy the patient's secretions, the nurse should encourage which of the following measures? A) Reducing salt intake B) Deep breathing and exercises C) Gargling with normal saline D) Increasing fluid intake

D. Drinking plenty of water while taking guaifenesin may help loosen mucus in the lungs. Deep breathing, gargling with normal saline, and reducing salt intake do not necessarily help liquefy and mobilize secretions.

An emergency department nurse enters a patient's room with an order to administer epinephrine subcutaneously to treat his asthma attack. The patient's wife asks the nurse why it could not be given by mouth. Which of the following is the best response by the nurse? A) The medication he is to receive is only given by an injection in the arm. B) The medication is administered this way because it works faster than by mouth. C) The medication is given many ways, but this is the way it was ordered. D)

D. Epinephrine is not given orally because enzymes in the GI tract and liver destroy it. The medication can be given through inhalation, intravenously, and subcutaneously.The medication will work more quickly in a parenteral form but is not given orally. Statingto the patient that this method is the way the physician ordered it to be given will belittle the patient and not provide adequate patient

A client is taking guaifenesin 200 mg every 4 hours. What finding would best indicate the medication has had the desired outcome? A. Client remains free of nasal congestion. B. Client reports increased energy and decreased malaise. C. Client reports reduced coughing. D. Client is able to mobilize secretions.

D. Expectorants such as guaifenesin are agents given orally to liquefy respiratory secretions and allow for their easier removal. Consequently, an outcome of mobilizing secretions would be identified rather than outcomes related to frequency of coughing, absence of malaise, or decreased nasal congestion.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? A. Albuterol causes stimulation of the bronchial tissue. B. Albuterol decreases vital capacity. C. Albuterol blocks the stimulation of the beta-2 receptors. D. Albuterol causes relaxation of the bronchial smooth muscles.

D. The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.

A patient has asked the nurse if it would be appropriate to use dextromethorphan to treat her cough. What type of cough is best suited to treatment with dextromethorphan? A) An occasional, productive cough B) A cough that is nearly continuous and that is accompanied by copious secretions C) A cough that occurs when the patient is exposed to airborne irritants D) A dry, nonproductive cough

D. The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed.

A patient who is being administered isoniazid(INH) for tuberculosis has a yellow color in the sclera of her eye. What other finding would lead you to believe that hepatotoxicity has developed? A) Diarrhea B) Numbness C) Diminished vision D) Light-colored stools

D. The presence of light-colored stools is suggestive of hepatotoxicity. Diarrhea, numbness, and diminished vision are not related to hepatotoxicity of isoniazid (INH).

A 12-year-old boy was recently diagnosed with asthma, and his primary care provider has prescribed a corticosteroid to be administered by metered-dose inhaler. This drug achieves a therapeutic effect by which of the following means? A) By increasing the number of beta-adrenergic receptors B) By increasing the muscle tone in the smooth muscle of the trachea C) By increasing the permeability of the alveolar membrane D) By increasing the number of binding sites on erythrocytes

Ans: A Feedback: Corticosteroids increase the number of beta- adrenergic receptors and increase or restore responsiveness of beta receptors to beta- adrenergic bronchodilating drugs. They do not influence the permeability of alveoli, muscle tone, or the structure of red blood cells.

A patient has begun taking antiasthmatic drugs. The patient should avoid excessive intake of what beverage? A) Coffee B) Grapefruit C) Green tea D) Acai juice

Ans: A Feedback: Patients taking antiasthmatic drugs should generally avoid excessive intake of caffeine- containing fluids such as coffee, tea, and cola drinks. These beverages may increase bronchodilation but also may increase heart rate and cause palpitations, nervousness, and insomnia with bronchodilating drugs.

A client is diagnosed with a viral upper respiratory tract infection. Which of the following is appropriate treatment for the client? Select all that apply: A. Increase of fluid intake. B. Use of antitussive for nonproductive cough. C. Use of comfort measures. D. Decrease of fluid intake. E. Administration of an antibiotic.

A, B, C. Administration of an antibiotic is not indicated in viral upper respiratory infection. Clients should be counseled on appropriate comfort measures including increased fluid intake if not contraindicated and the use of over-the-counter medication if warranted.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem? A. Adrenal insufficiency B. Pituitary insufficiency C. Pancreatic insufficiency D. Renal insufficiency

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

A client reports to the nurse, My head is stuffed up and I can't breathe through my nose. Nasal discharge is noted upon examination. The client is diagnosed with a common cold. The nurse should prepare to provide medication instructions related to what classification of medication directed at the client's nasal mucosa? A. decongestant B. antitussant C. expectorant D. antihistamine

A. Nasal decongestants relieve nasal congestion and swelling by constricting arterioles and reducing blood flow to nasal mucosa. Antihistamines refer to a type of medication that treats allergy symptoms. The goal of antitussive therapy is to suppress nonpurposeful coughing. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? A. I can't use a spacer or holding chamber with the MDI. B. I will shake the MDI container before I use it. C. I will take a slow, deep breath in after pushing down on the MDI. D. Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use.

A. The client can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining client statements are accurate and indicate the client understands how to use the MDI correctly.

The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect? A. Increased heart rate and restlessness B. Drowsiness causing a nap C. Increased mucus expectoration D. Increased nonproductive cough

A. The nurse instructs the parents on the side effects of the bronchodilator, albuterol sulfate. The side effect of this medication is restlessness, anxiety, fear, palpitations, and tremors. It is important for the parents to realize this so they understand the actions of the 4-year-old. Once the bronchial tree is open, cough is decreased but mucus expectoration could increase. The medication does not cause drowsiness.

Why are inhaled steroids used to treat asthma and COPD? A. They act locally to decrease release of inflammatory mediators B. They act locally to decrease histamine release C. They act locally to improve mobilization of edema D. They act locally to increase histamine release

A. When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of beta-adrenergic receptor activity, that may promote smooth muscle relaxation and inhibit bronchoconstriction.

A patient with a recent diagnosis of asthma is anxious because she experienced an asthma attack and was unable to relieve the symptoms despite taking several puffs of her prescribed salmeterol (Serevent). How should the nurse respond to the patient's concerns? A) Remember that your Serevent isn't effective when you take it at the time of an asthma attack. B) It's important to take your Serevent as soon as you feel the first sensation of an asthma attack. C) Unfortunately, Serevent can take up to

Ans: A Feedback: Formoterol (Foradil) and salmeterol (Serevent) are long-acting beta 2 -adrenergic agonists used only for prophylaxis of acute bronchoconstriction. They are not effective in acute attacks because they have a slower onset of action than the short-acting drugs.

A home care nurse is visiting a patient, and the assessment will include blood pressure and heart rate. The patient's grandson has a large amount of pseudoephedrine (Sudafed) inthe kitchen. For what might the nurse suspect the patient's grandson is using the pseudoephedrine? A) Methamphetamine production B) Treatment of bronchial asthma C) Treatment of sinusitis D) To increase appetite

Ans: A Feedback: Pseudoephedrine and ephedrine are ingredients used in making methamphetamine, a highly addictive and illegal drug of abuse. Pseudoephedrine is used in the treatment of bronchospasm but is not the drug of choice. Pseudoephedrine is used in the treatment of sinusitis, but, in large quantities, the nurse should suspect methamphetamine production. Pseudoephedrine will increase basal metabolic rate but is not the drug of choice to increase appetite.

A patient is started on albuterol (Proventil). Of what adverse reaction should the patient be warned? A) Polydipsia B) Tachycardia C) Hypotension D) Diarrhea

Ans: B Feedback: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The patient will not experience polydipsia, hypotension, or diarrhea.

A patient is administered rifampin (Rifadin). Which of the following facts should the patient be taught? A) When taking it with warfarin (Coumadin), an increased anticoagulant effect occurs. B) It decreases hepatic enzymes and decreases metabolism of drugs. C) It has an increased serum half-life, so it is more effective than rifabutin (Mycobutin). D) The urine, tears, sweat, and other body fluids will be a discolored red-orange.

Ans: D Feedback: The patient's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the patient should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.

A client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system? A. renal B. cardiovascular C. neurological D. gastrointestinal

B. Because pseudoephedrine is a stimulant, cardiac symptoms are a notable adverse effect, especially in the acute stage of the overdose. All the other systems should be monitored, but the cardiac-related adverse reactions have priority.

A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow? A. Expectorants B. Decongestants C. Antitussives D. Mucolytics

B. Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism? A. Non-selectively binding to central and peripheral H1 receptors B. Vasoconstriction of small blood vessels of the nasal membranes C. Anesthetizing stretch receptors in the respiratory passages D. Selectively binding to peripheral H1 receptors

B. Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to non-selectively bind to peripheral H1 receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors only; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness? A. They treat multiple symptoms in a cost-effective manner. B. They come into direct contact with nasal mucosa. C. Their effects last for 48 to 72 hours. D. They are absorbed systemically.

B. With nasal decongestants, topical preparations (i.e., nasal solutions or sprays) are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa.

A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient? A. The physician can give you eye drops to prevent any problems. B. There are no significant problems with wearing contact lenses. C. You should switch to wearing your glasses while taking this medication. D. Only wear your contact lenses during the day and take them out in the evening before bed.

C. The nurse informs the patient that rifampin may discolor contact lenses and that the patient may want to wear eyeglasses during treatment.

A client is experiencing an acute asthmatic attack. Which agent would be most effective? A. Mast cell stabilizer B. Leukotriene receptor antagonist C. Inhaled steroid D. Beta-2 selective adrenergic agonist

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

A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? A. Emphysema B. Chronic bronchitis C. Pneumonia D. Asthma

D. Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma. This class of medication is not typically associated with the long term management of any of the other options.

A 70-year-old client is being treated for chronic obstructive pulmonary disease (COPD) with theophylline. What will be a priority assessment by the nurse? A. weight B. activity level C. intake of fatty foods D. use of nicotine

D. Nutritional status, weight, and activity level would be important for a nurse to know about a COPD client. However, it would be most important for the nurse to know whether the client smokes or uses tobacco in other ways, or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.

A male client presents to the health care provider's office with reports of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion? A. Damage of the nasal concha B. Chronic nasal polyps C. Burning of the nares secondary to chronic use of nasal sprays D. Rebound nasal swelling

D. Rebound nasal swelling can occur with excessive or extended use of nasal sprays.