Ch 32 Lower Respiratory System

1. When describing the drugs used to treat lower respiratory system conditions, the nursing instructor discusses chronic obstructive pulmonary disease (COPD). Which condition would the instructor include when discussing this condition related to the use of these drugs? Select all that apply. A) Asthma B) Pulmonary embolism C) Pulmonary hypertension D) Chronic bronchitis E) Pneumonia

@Ans: A, D Feedback: COPD encompasses asthma, chronic bronchitis, chronic obstructive bronchitis, emphysema, or a combination of the conditions.

7. After teaching a group of nursing students about xanthine derivatives, the instructor determines that the teaching was successful when the students state which of the following? Select all that apply. A) Xanthine derivatives cause flushing. B) The action of xanthine derivatives leads to bradycardia. C) Xanthine derivatives cause a reduction in airway inflammation. D) Xanthine derivatives cause hypoglycemia. E) Xanthine derivatives stimulate the CNS to promote bronchodilation.

Ans: A, E Feedback: Xanthine derivatives can cause flushing, tachycardia, and hyperglycemia. Xanthine derivatives elicit their effects by stimulating the CNS to promote bronchodilation.

15. A group of nursing students are reviewing information about mast cell stabilizers. The students demonstrate understanding of the information when they identify which of the following as an example? A) Beclomethasone B) Cromolyn C) Albuterol D) Montelukast

Ans: B Feedback: Cromolyn is an example of a mast cell stabilizer. Beclomethasone is an inhaled corticosteroid. Albuterol is a short-acting beta-2 agonist. Montelukast is an example of a leukotriene modifier.

21. A client with asthma has been prescribed an antiasthmatic drug. Before administering the drug, the nurse assesses the respiratory rate of the client. The nurse notifies the primary health care provider based on which finding? A) 10 breaths/min B) 14 breaths/min C) 18 breaths/min D) 22 breaths/min

Ans: A Feedback: The nurse should consider 10 breaths/min an abnormal respiratory rate and notify the primary health care provider. Respiratory rates below 12 breaths/min or above 24 breaths/min are considered abnormal. A respiratory rate between 12 breaths/min and 24 breaths/min is considered normal.

22. A client is prescribed albuterol for bronchospasm in chronic bronchial asthma. Which of the following nursing diagnoses would the nurse expect to see on the care plan as a result of the adverse reaction of albuterol? A) Anxiety B) Risk of Impaired Oral Mucous Membranes C) Ineffective Tissue Perfusion D) Risk of Injury

Ans: A Feedback: The nurse would most likely identify a nursing diagnosis of Anxiety related to the adverse reaction of albuterol. A nursing diagnosis of Risk of Impaired Mucous Membranes may be seen with the use of corticosteroids, which increase the risk of oral candidiasis. There is no increased risk of injury or ineffective tissue perfusion with the use of albuterol therapy.

6. A client is prescribed an inhaled corticosteroid. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply. A) Fungal infection B) Pharyngeal irritation C) Blurred vision D) Bradycardia E) Insomnia

Ans: A, B Feedback: Adverse reactions of inhaled corticosteroids include oral, laryngeal, and pharyngeal irritation and fungal infection. Blurred vision, bradycardia, and insomnia are not associated with inhaled corticosteroids.

17. A client is prescribed zileuton (Zyflo). The nurse instructs the client to contact the primary health care provider if which of the following occur? Select all that apply. A) Jaundice B) Pruritus C) Fatigue D) Dizziness E) Restlessness

Ans: A, B, C Feedback: Zileuton may cause liver damage, which may present with the following symptoms: upper right quadrant pain, nausea, fatigue, lethargy, pruritus, and jaundice.

16. A pediatric client is prescribed cromolyn. The nurse understands that this drug can be administered in which manner? Select all that apply. A) Via a nebulizer B) Orally C) Nasal spray D) Metered-dose inhaler E) Subcutaneous injection

Ans: A, B, C, D Feedback: Cromolyn may be administered via a nebulizer, as an aerosol metered spray, as a nasal spray, or orally. It is not given subcutaneously.

11. A client with chronic asthma comes to the clinic for a follow-up visit. A nurse should question the client about which of the following? Select all that apply. A) Allergies B) Frequency of attacks C) Severity of attacks D) Antiasthma drugs currently being taken E) Antiasthma drugs taken in the past

Ans: A, B, C, D, E Feedback: In clients with chronic asthma, the nurse questions the client concerning allergies, frequency and severity of attacks, factors that cause or relieve attacks, and any antiasthma drugs used currently or taken previously.

10. Before administering a prescribed bronchodilator to a client experiencing acute breathing distress, which of the following would be appropriate for the nurse to assess? Select all that apply. A) Blood pressure B) Blood glucose C) Pulse D) Lung sounds E) Respiratory rate

Ans: A, C, D, E Feedback: 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.

12. A client who is experiencing an acute asthmatic attack receives prescribed therapy with a bronchodilator. As part of the plan of care, the nurse would continue to assess which of the following every 4 hours? Select all that apply. A) Intake B) Blood pressure C) Output D) Lung sounds E) Accessory muscle use

Ans: A, C, D, E Feedback: The nurse should note the client's respiratory rate, lungs sounds, intake, and output and use of accessory muscles in breathing every 4 hours during an acute asthma attack.

3. A client is receiving theophylline. The nurse checks the client's serum theophylline level and finds it to be less than therapeutic. The nurse reviews the client's medical record, noting that which of the following might be a reason for this? Select all that apply. A) Nicotine B) Allopurinol C) Verapamil D) Phenytoin E) Ketoconazole

Ans: A, D, E Feedback: Nicotine, phenytoin (a hydantoin), and ketoconazole can decrease theophylline levels. Verapamil (a calcium channel blocker) and allopurinol can increase theophylline levels.

25. A client receives a loading dose of theophylline to treat acute respiratory symptoms. When assessing the client, the nurse would immediately notify the primary health care provider for which of the following? A) Constipation B) Abdominal cramps C) Bradycardia D) Mental depression

Ans: B Feedback: It is important for the nurse to closely monitor the client for signs of theophylline toxicity. The nurse should notify the primary health care provider immediately if any of the following signs of theophylline toxicity develop: anorexia, nausea, vomiting, diarrhea, confusion, abdominal cramping, headache, restlessness, insomnia, tachycardia, arrhythmias, or seizures. Constipation, bradycardia, and mental depression are not signs of theophylline toxicity.

26. A client who is receiving aminophylline complains of heartburn. Which of the following instructions should the nurse provide the client to help alleviate the condition? A) Eat small, frequent meals. B) Raise the head of the bed. C) Limit fluid intake with meals. D) Use strict oral hygiene.

Ans: B Feedback: When a client receiving aminophylline complains of heartburn, the nurse should instruct the client to remain upright with the head end of the bed raised. Eating small, frequent meals and limiting fluid intake with meals help alleviate the symptoms of nausea, and not of heartburn. Using strict oral hygiene helps prevent infection with Candida albicans seen with corticosteroid therapy.

14. Before leaving the hospital after an acute asthma attack, a client is given a prescription for fluticasone/salmeterol (Advair) 250/50 to inhale one puff twice a day. The nurse completing the client's discharge teaching should tell the client which of the following? Select all that apply. A) Take the medication as needed. B) Continue to carry a rescue inhaler. C) Check peak flow daily. D) Rinse mouth after each use. E) Shake meter well before using.

Ans: B, C, D Feedback: The drug is a dry powder inhaler that contains an inhaled corticosteroid and a long-acting beta agonist. The medication should be taken every day as per the directions on the label to prevent future exacerbations. The client should continue to carry a rescue inhaler and check peak flow around the same time each day. Advair does not need to be shaken prior to use as it is a dry powder inhaler. The client should be advised to rinse his mouth out after each use to prevent oral thrush.

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

Ans: B, C, D Feedback: 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.

9. A client is demonstrating how to use a peak flow meter. The nurse determines that the client is successful when he does which of the following? Select all that apply. A) Inhales as forcibly as possible B) Stands upright to allow the best inhalation possible C) Makes sure indicator is at lowest level on scale D) Makes sure lips are sealed tightly around the mouthpiece E) Measures peak flow rate at different times each day

Ans: B, C, D Feedback: When teaching a client to use a peak flow meter, instruct the client to make sure the indicator is at the lowest level, stand upright, make sure the lips form a tight seal around the mouthpiece, exhale as forcibly and as quickly as possible, and test peak flow at the same time each day.

4. The nurse is reviewing the history of a client who is prescribed a long-acting beta-2 agonist. Which of the following would alert the nurse to the need to administer this drug cautiously to the client? Select all that apply. A) Hyperlipidemia B) Hypertension C) Glaucoma D) Hyperthyroidism E) Diabetes

Ans: B, C, D, E Feedback: Long-acting beta-2 agonists should be used cautiously in clients with hypertension, cardiac dysfunction, hyperthyroidism, glaucoma, diabetes, prostatic hypertrophy, and history of seizures.

19. A nurse is developing a teaching plan about measures to reduce the risk of infection with Candida albicans from antiasthma therapy. The nurse includes this information because the client is prescribed which of the following? Select all that apply. A) Albuterol (Ventolin) B) Cromolyn (Gastrocrom) C) Fluticasone (Flovent) D) Tiotropium (Spiriva) E) Budesonide/formoterol (Symbicort)

Ans: B, C, E Feedback: Mast cell aerosols such as cromolyn and inhaled corticosteroids (ICSs) such as fluticasone and budesonide/formoterol have been associated with the development of oral thrush. Therefore, the client needs instructions on how to reduce his risk. Albuterol, a short-acting beta-2 agonist, and tiotropium, a cholinergic blocker, are not associated with the development of thrush.

2. The nurse instructs a client with asthma to always carry a rescue inhaler or quick-relief medication with him at all times. Which of the following would the client most likely carry? Select all that apply. A) Salmeterol (Serevent) B) Metaproterenol (Alupent) C) Tiotropium (Spiriva) D) Albuterol (Proventil) E) Formoterol (Foradil)

Ans: B, D Feedback: Short-acting beta agonists (SABAs) such as metaproterenol and albuterol are used as rescue treatment for asthma. Salmeterol and formoterol are long-acting beta agonists (LABAs). Tiotropium is a cholinergic blocking drug used to treat bronchospasm associated with COPD.

13. During stable chronic phases of asthma, the nurse should advise the client to monitor which of the following? Select all that apply. A) Blood pressure B) Wheezing C) Respiratory rate D) Coughing E) Peak flow changes

Ans: B, D, E Feedback: Clients with chronic stable asthma should monitor for symptoms such as wheezing, coughing, peak flow changes, and things that might be making the asthma worse.

5. A client with exercise-induced bronchospasm calls the physician's office to obtain a refill for his breathing medication. The client would most likely be prescribed which of the following? Select all that apply. A) Beclomethasone (Qvar) B) Levalbuterol (Xopenex) C) Theophylline (Theo-Dur) D) Mometasone (Asmanex) E) Bitolterol (Tornalate)

Ans: B, E Feedback: Beta-2 agonists, such as levalbuterol and bitolterol, are used to treat exercise-induced bronchospasm. Beclomethasone and mometasone are inhaled corticosteroids. Theophylline is a xanthine derivative.

31. The nurse is reviewing the medication record of a client with asthma and notes that the health care provider has prescribed a monoclonal antibody as part of the treatment plan. The nurse would anticipate administering which drug? A) Zafirlukast B) Zileuton C) Omalizumab D) Salmeterol

Ans: C Feedback: Omalizumab (Xolair) is a monoclonal antibody used in the treatment of asthma. Leukotriene receptor antagonists include montelukast (Singulair) and zafirlukast (Accolate). Zileuton (Zyflo) is classified as a leukotriene formation inhibitor. Salmeterol (Serevent Diskus) is a long-term beta-2 agonist.

23. A client has been admitted to a health care facility with acute bronchospasm. The primary health care provider prescribes the drug epinephrine. The nurse anticipates administering this drug by which route? A) Intravenous B) Intramuscular C) Subcutaneous D) Intradermal

Ans: C Feedback: The nurse should use the subcutaneous route to administer epinephrine for acute bronchospasm. Doses of epinephrine are measured in tenths of a milliliter. A tuberculin syringe is used for measuring and administering these drugs by the parenteral route. The other routes are not appropriate for this situation.

32. A nurse is providing care to a client receiving theophylline. The client has received two loading doses and the nurse is evaluating the client's theophylline levels. Which finding would the nurse interpret as a therapeutic drug level? A) 5 mcg/L B) 8 mcg/L C) 13 mcg/L D) 20 mcg/L

Ans: C Feedback: Therapeutic theophylline levels range from 10 to 20 mcg/L. The possibility of toxicity increases with levels over 15 mcg/L, with toxicity indicated with levels over 20 mcg/L.

30. A group of nursing students are reviewing information about leukotriene modifiers. The students demonstrate understanding of this class of drugs when they identify that these drugs are given by which route? A) Nebulization B) Metered-dose inhaler C) Nasal spray D) Orally

Ans: D Feedback: Leukotriene modifiers are only administered orally.

20. A nurse is caring for a 30-year-old client who is receiving albuterol for asthma. The client complains of feeling dizzy, especially when he stands up after sitting. The nurse suspects that a possible interaction with another drug could be causing the client's problem. Which of the following drugs should the nurse consider as a possible cause? A) Warfarin B) Uterine stimulants C) Methylxanthines D) Methyldopa

Ans: D Feedback: The nurse should consider methyldopa as a cause for the client's complaint of dizziness on standing, suggesting hypotension. Methyldopa and albuterol interact, leading to hypotension. Albuterol does not interact with warfarin. Interaction between albuterol and uterine stimulants leads to severe hypotension, and not severe headache. There is an increased risk of cardiotoxicity when methylxanthines are given along with albuterol.

27. A nurse is teaching a client who is prescribed albuterol about the adverse reactions associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the client to report to the health care provider? A) Fall in blood pressure B) Increased nighttime urination C) Hearing impairment or deficit D) Headache and flushing

Ans: D Feedback: The nurse should instruct the client to contact the health care provider if palpitations, tachycardia, chest pain, muscle tremors, dizziness, headache, flushing, or difficulty with urination or breathing occurs. Fall in blood pressure, increased nighttime urination, and hearing impairment are not adverse effects associated with a sympathomimetic bronchodilator.

29. A client is prescribed inhaled corticosteroid therapy along with bronchodilator therapy. Which of the following points should the nurse include in the teaching plan? A) "Stop corticosteroid therapy immediately if you notice any adverse effects." B) "Before each dose of corticosteroid, rinse the mouth thoroughly with water." C) "The corticosteroid drug provides rapid relief during an asthma attack." D) "Take the corticosteroid several minutes after the bronchodilator dose."

Ans: D Feedback: The nurse should instruct the client to take the corticosteroid several minutes after the bronchodilator dose. This helps in enhancing the application of the steroid into the bronchial tract. Corticosteroid therapy should never be stopped abruptly. The mouth should be rinsed thoroughly with water after each dose of corticosteroid to prevent the occurrence of fungal infections. The steroid drug does not provide rapid relief during an asthma attack, as it does not dilate the bronchus.

24. A 10-year-old child with asthma is prescribed high doses of an inhaled corticosteroid. The nurse would discuss which of the following with the child and parents as being affected? A) Blood pressure B) Skin turgor C) Urine output D) Rate of growth

Ans: D Feedback: The nurse should monitor the rate of growth of the child. Children are at risk for a reduction in growth when oral corticosteroids or higher doses of the inhalant form are used. Blood pressure, skin turgor, and urine output are not altered with corticosteroid therapy.

28. A nurse is caring for a client who is receiving cromolyn orally. Which of the following instructions would the nurse include in the client's teaching plan? A) Do not take the drug at bedtime. B) Swallow the drug without chewing. C) Take the drug with food or milk. D) Take the drug at least 30 minutes before meals.

Ans: D Feedback: When administered orally, cromolyn is given 30 minutes before meals and at bedtime. The oral form of the drug comes in an ampule. The ampule is opened and the contents are poured into a glass of water. The nurse stirs the mixture thoroughly. The client must drink all of the mixture. The drug may not be mixed with any other substance (e.g., fruit juice, milk, or foods).

8. A nurse is developing a teaching plan for a client who is to use a dry powder inhaler. Which of the following would the nurse include in the teaching plan? Select all that apply. A) Place device in water to clean. B) Swallow capsules provided. C) Hold inhaler 1 to 2 inches from mouth. D) Hold breath for 10 seconds. E) Inhale quickly.

Ans: D, E Feedback: To properly use a dry powder inhaler, the client should do the following: prepare the medication for inhalation, place the mouthpiece close to the lips, inhale quickly, hold breath for 10 seconds, not swallow capsules provided, and not place the inhaler in water.