Ch 55. Drugs Acting on the Lower Respiratory Tract

The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching?

"I need to shake the inhaler well before taking the medication." Explanation: Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.

An adolescent client is prescribed a leukotriene receptor antagonist as a part of a medication regime to manage his/her asthma. Which statement made by the client requires additional education on this classification of medications?

"I need to take the medication when I start to have problems breathing." Explanation: These drugs are not indicated for the treatment of acute asthmatic attacks because they do not provide any immediate effects on the airways. Patients need to be cautioned that they should not rely on these drugs for relief from an acute asthmatic attack. The remaining statements are all accurate information regarding this classification of medications.

The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which statement by the client indicates the need for further education?

"I will use this medication when I am having an asthma attack." Explanation: Cromolyn (Intal) is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders. Adverse reactions include drying of the throat and coughing or wheezing. It should not be used during an acute asthma attack because it may worsen the bronchospasm.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements?

"When I am short of breath, I will increase the use of my fluticasone." Explanation: Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.

A client has been admitted to a health care facility with asthma. The nurse is to administer theophylline to the client. To which clients can the nurse safely administer theophylline?

A 65-year-old male with asthma Explanation: The nurse can safely administer theophylline to the client who is 65 years of age. It needs to be administered cautiously in clients older 69 years or those with hepatic disease, cardiac disease, or hypertension.

The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy?

A client who is taking ipratropium should not take tiotropium because both drugs are anticholinergics. Theophylline and corticosteroids like budesonide and fluticasone are not necessarily contraindicated.

A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the health care provider to order?

A modified dose of aminophylline Explanation: Cigarette smoking and drugs that stimulate drug-metabolizing enzymes in the liver (e.g., phenobarbital, phenytoin) increase the rate of metabolism and, therefore, the dosage requirements of aminophylline.

A patient with acute respiratory symptoms is receiving a loading dose of theophylline. Which of the following signs of toxicity should alert the nurse to notify the primary health care provider immediately?

Abdominal cramps Explanation: It is important for the nurse to closely monitor the patient 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, or mental depression are not signs of theophylline toxicity.

A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem?

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

After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)?

Albuterol Explanation: Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.

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?

Asthma Explanation: 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.

Which of the following would a nurse identify as a surfactant?

Beractant Explanation: Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.

When describing the events of an asthma attack to a client, the nurse incorporates understanding that stimulation of alpha-adrenergic receptors results in which of the following?

Bronchoconstriction

The nurse should complete which of the following during acute breathing distress before initiation of a bronchodilator? Select all that apply

Check blood pressure. Check pulse. Check respiratory rate Explanation: Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.

A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid?

Chocolate Explanation: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?

Cigarette smoking Explanation: 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.

The nurse is providing education to a client who has been prescribed an antiasthmatic drug. The nurse should instruct the client to avoid excessive intake of what beverage?

Coffee Explanation: Clients 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. None of the other options contain sufficient amounts of caffeine to cause such an affect.

A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer?

Cromolyn Explanation: Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.

When describing the action of xanthines, which would the nurse include? (Select all that apply.)

Direct effect on the mobilization of calcium within the cell Stimulation of 2 prostaglandins leading to smooth muscle relaxation Inhibition of release of slow-reacting substance of anaphylaxis Although the exact action is unknown, it is thought that xanthines work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine.

Which of the following would be most important to assess before administering calfactant? (Select all that apply.)

Endotracheal tube placement Lung sounds Oxygen saturation levels Before administering calfactant, it would be important to ensure proper endotracheal tube placement because the drug is instilled directly into the trachea. In addition, lung sounds and oxygen saturation levels would be important as a baseline to evaluate effectiveness of the drug.

Isoproterenol is an anticholinergic agent.

False Explanation: Isoproterenol is a sympathomimetic agent.

After teaching a group of students about leukotriene receptor antagonists, the instructor determines a need for additional teaching when the students identify which agent as an example?

Fluticasone Explanation: Fluticasone is an inhaled steroid. Montelukast is a leukotriene receptor antagonist. Zileuton is a leukotriene receptor antagonist. Zafirlukast is a leukotriene receptor antagonist.

Where should the nurse initially direct a client who is interested in learning more about the management of asthma?

Global Initiative for Asthma (GINA) Explanation: Management of asthma involves prevention of airway inflammation and avoidance of triggers for better symptom control. Because of asthma's significance as a world health problem, the Global Initiative for Asthma (GINA) published asthma guidelines of diagnosis, management, and education. These guidelines emphasize the importance of classifying asthma severity and the assessment of asthma control. While the other options may provide information on asthma, the GINA is most inclusive.

A nurse is required to educate a patient prescribed albuterol on the adverse effects associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the patient to report to the health care provider?

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

When teaching a patient to use a dry powder inhaler, which of the following is true? Select all that apply:

Hold breath for 10 seconds. Inhale quickly. To properly use a dry powder inhaler prepare the medication for inhalation, place mouthpiece to lips, inhale quickly, hold your breath for 10 seconds, do not swallow capsules provided, and do not place inhaler in water.

Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching?

I should see some results in about 3 to 4 days." Explanation: Inhaled steroids, such as triamcinolone, can take from 2 to 3 weeks to reach effective levels, so the client should be encouraged to take them to reach and then maintain the effective levels. The drug is not effective for acute attacks. It can cause hoarseness and sore throat. The client should rinse his mouth after using the inhaler to decrease the risk of systemic absorption and decrease gastrointestinal upset and nausea.

A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse?

I'll keep taking my medications until I'm not experiencing any more symptoms." Explanation: Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.

The nurse has admitted a client with COPD to the unit with an acute exacerbation. The client takes ipratropium. When writing a plan of care for this client, what would be an appropriate nursing diagnosis to use?

Imbalanced nutrition: Less than body requirements Explanation: Nursing diagnoses related to drug therapy might include acute pain related to CNS, GI, or respiratory effects of the drug; Imbalanced nutrition: Less than body requirements, related to dry mouth and GI upset; and Deficient knowledge regarding drug therapy.

The triage nurse in the emergency department has a 42-year-old client with asthma present for treatment. The client's respiratory rate is 40 breaths per minute. Based on this objective data, what is the correct nursing diagnosis for this client?

Ineffective breathing pattern Explanation: The correct nursing diagnosis is Ineffective Breathing Pattern related to impaired airway as manifested by tachypnea. The other options may be applicable, but they do not take priority over the ineffective breathing pattern.

The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take?

Inform the health care provider that the client has toxic theophylline levels. Explanation: To determine theophylline dosage, prescribers should measure serum theophylline levels. Therapeutic range is 5 to 15 mcg/mL (27.75 to 83.25 µmol/L); toxic levels are 20 mcg/mL (111 µmol/L) or above. The health care provider must be informed of this elevated serum level.

A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route?

Inhalation Explanation: Salmeterol is administered via inhalation.

The nurse is providing education to a client with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action?

Inhaled corticosteroid agents reduce airway inflammation. Explanation: 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 or reduce bronchodilation or respiratory rate.

A neonate is receiving beractant. The nurse understands that this agent is administered by which route?

Intratracheal Explanation: Beractant is administered intratracheally.

Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA?

Leukotriene receptor antagonists Explanation: Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.

Which medication is used to treat acute airflow obstruction?

Metaproterenol Explanation: Metaproterenol is a short-acting beta-2 agonist used as a quick-relief medication. Beclomethasone is an inhaled corticosteroid used as a long-term control medication. Montelukast is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Azelastine is a second-generation antihistamine.

An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?

Mix the drug with saline. Explanation: Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.

A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective?

Monitoring respirations for bilateral chest movement Explanation: Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug. Suctioning should be avoided for at least 2 hours after the surfactant is instilled into the newborn's endotracheal tube. Neither the delivery of supplemental oxygen nor position changes are related to the delivery of the medication into the infant's lungs.

The client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler?

Nervousness Explanation: Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.

A patient presents at the Emergency Department (ED) in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the patient may be allergic to what?

Peanuts Explanation: Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, or ragweed pollen are not associated with this drug.

An adult client with a diagnosis of asthma has been prescribed montelukast. The nurse should teach the client that this drug will help relieve symptoms by which mechanism?

Preventing the bronchoconstriction and inflammation that is caused by leukotrienes Explanation: Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes. This information makes all the remaining options incorrect.

A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?

Relaxation of smooth muscle Explanation: Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation. None of the other options describe the bronchial dilation affected of the anticholinergic classification of medications.

The client with asthma has been ordered an inhaler and the nurse is teaching how to prevent Candida infections. Which would the nurse include in the instructions?

Rinse mouth with water after each use. Explanation: The client should be taught to rinse his mouth out with water after using oral inhalers to prevent a Candida oral infection. Candida is a yeast that can grow in the mouth, it is important that they have good oral hygiene but rinsing the mouth is sufficient. The client would not brush teeth between puffs, nor would they clean a spacer with alcohol. A spacer allows for better usage of the drug especially in children.

When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited?

Slow-reacting substance of anaphylaxis Explanation: Mast cell stabilizers work at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis. Epinephrine is not affected by mast cell stabilizers. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins.

The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching?

Tachycardia Explanation: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.

After teaching a group of students about inhaled steroids, the instructor determines that the teaching was successful when the students state:

The drugs are not for use during an acute attack. Explanation: The drugs are not for emergency use or use during an acute attack because their onset of action is slow. Systemic absorption is not typical with inhalation unless the patient did not administer the drug properly or has lesions that allowed absorption of the drug. Inhalation decreases the effectiveness of the inflammatory cells leading to decreased swelling and promotion of beta adrenergic receptor activity. The drugs are rapidly absorbed, but take 2 to 3 weeks to reach effective levels.

A client has been prescribed a inhaled steroid for the treatment of asthma. What information should the nurse include when providing medication education to the client? Select all that apply.

The medication is not intended to treat an acute asthma attack Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency Rebound nasal congestion is a adverse effect of this form of medication Promptly report a fever or any other indication of infection to your health provider Inhaled steroids are not intended to treat an acute asthma attack or status asthmaticus because these drugs will not provide the immediate relief that is needed. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenal insufficiency with sudden withdrawal. Monitor the patient for any sign of respiratory infection; continued use of steroids during an acute infection can lead to serious complications related to the depression of the inflammatory and immune responses. Instruct the patient to continue to take the drug to reach and then maintain effective levels since the drug can take 2 to 3 weeks to reach effective levels. Nasal rebound congestion is considered an adverse effect of this classification of medications.

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators Explanation: 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 client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning which intervention will assist a client in the proper use of the device?

Using a spacer Explanation: The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI). The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The client should hold the breath for several seconds after administration of the inhaler.

What is considered a possible trigger for an asthma attack? Select all that apply.

exercise allergens pollutants cigarette smoke Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.

A client has been prescribed medication therapy for the treatment of newly diagnosed asthma. During teaching, the nurse should alert the client to potential exacerbation of what concurrent medical condition?

gastroesophageal reflux disease Explanation: Asthma may aggravate gastroesophageal reflux disease because antiasthma medications that dilate the airways also relax muscle tone in the gastroesophageal sphincter and may increase acid reflux. The relationship between asthma medications and the other options is not supported by research data.

Which statement made by a nurse providing care to a newborn prescribed surfactant therapy indicates a need for additional instructions to ensure the medication's effectiveness?

"The baby requires suctioning every 1 hour for 4 hours after the instillation of surfactant." Explanation: Suction the infant immediately before administration, but do not suction for 2 hours after administration unless clinically necessary, to allow the drug time to work.

The nurse assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic?

15 mcg/mL Explanation: Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.

The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time?

15 minutes prior to exercising Explanation: Albuterol for exercise induced bronchospasm should be administered 15 minutes prior to exercising.

A client who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert its full effects within which time frame?

20 minutes Explanation: When given intravenously, epinephrine peaks in approximately 20 minutes. It would be at this time that the drug is most effective.

A client is prescribed salmeterol as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time?

30 minutes before engaging in exercise Explanation: To prevent an exercise-induced asthma attack, the client should take one inhalation of salmeterol 30 minutes before starting exercise. The options would not be effective in preventing an attack.

A patient who is prescribed ipratropium administers the drug at 9:15 AM. The patient should begin to notice the drug beginning to act at which time?

9:30 AM Explanation: Inhaled ipratropium has an onset of action of 15 minutes, so the patient should begin to feel the effects of the drug at 9:30 AM.

The nurse is performing a routine assessment of a client whose medical record indicates a history of asthma. What assessment findings would the nurse expect? Select all that apply.

Airway inflammation Damaged airway mucosa Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free. Elevated temperature and bradycardia are unrelated to the client's asthma. Confusion can occur during an acute attack, but it would not be expected otherwise.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication?

Albuterol causes relaxation of the bronchial smooth muscles. Explanation: 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.

The client has been diagnosed with asthma and is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?

Albuterol first, wait five minutes and then follow with flunisolide Explanation: Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.

One method of reducing bronchoconstriction is removing excessive secretions from the respiratory tract. Patients can take several actions on their own to help manage secretions. Which will not help manage secretions?

Asking the physician to prescribe inhaled corticosteroids Explanation: Although inhaled corticosteroids may be prescribed in the treatment of respiratory disorders, they act by reducing inflammation, not by removing secretions from the airway. The patient can thin secretions and make them easier to remove by consuming adequate amounts of fluids each day. The patient can also take mechanical measures, such as practicing deep breathing and coughing, to remove secretions.

A client is experiencing an acute asthmatic attack. Which agent would be most effective?

Beta-2 selective adrenergic agonist Explanation: 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.

What is the most common first-line therapy for relief of an acute asthma attack?

Beta2-adrenergic agonist Explanation: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client 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.

A nurse is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following?

Coffee Explanation: The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol.

the nurse is providing education to a client who has been prescribed an antiasthmatic drug. The nurse should instruct the client to avoid excessive intake of what beverage?

Coffee Explanation: Clients 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. None of the other options contain sufficient amounts of caffeine to cause such an affect.

Which of the following effects would result from the action of montelukast?

Decreased eosinophil migration Explanation: Montelukast selectively and competitively blocks receptors for the production of leukotrienes D4 and E4, which are components of slow-reacting substance of anaphylaxis. As a result, the drug blocks many of the signs and symptoms of asthma, such as neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction.

A patient tells you that a friend of theirs has recommended the use of caffeine to treat the patient's asthma. What would be the most important reason a nurse should counsel this patient not to delay prescribed treatment for the use of natural health products?

Delays in appropriate treatment can have serious, even fatal, consequences Explanation: The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. These drugs were once the main treatment choices for asthma and bronchospasm. However, because they have a relatively narrow margin of safety, and they interact with many other drugs, they are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have an additive effect.

A client is admitted to the emergency department with inspiratory stridor and air hunger. When anticipating treatment, the nurse will prepare which medication for administration?

Epinephrine Explanation: 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. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.

A client who smokes is receiving theophylline orally. Because of his history of smoking, the nurse expects the health care provider to do what with the theophylline dosing?

Increase Explanation: Nicotine from smoking interferes with the ability of the body to metabolize theophylline. Due to decreased metabolism, the dosage of theophylline would be increased.

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following?

Increased serum theophylline Explanation: When administering zileuton along with theophylline, the nurse should monitor for increased serum theophylline. Serum zileuton levels and pulse rate are not increased when zileuton is administered along with theophylline. Increased prothrombin time is seen when warfarin, and not theophylline, is given along with zileuton.

The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take?

Inform the health care provider that the client has toxic theophylline levels. Explanation: To determine theophylline dosage, prescribers should measure serum theophylline levels. Therapeutic range is 5 to 15 mcg/mL (27.75 to 83.25 µmol/L); toxic levels are 20 mcg/mL (111 µmol/L) or above. The health care provider must be informed of this elevated serum level. Reference:

When teaching a client about their prescribed asthma therapy, the nurse understands that which medications may increase the risk of asthma-related death?

Long-acting beta-2 agonists Explanation: Long-acting beta-2 agonists may increase the risk of asthma-related death. ICSs are contraindicated in clients with hypersensitivity to the corticosteroids, acute bronchospasm, status asthmaticus, or other acute episodes of asthma and can cause throat irritation, hoarseness, upper respiratory tract infection, and fungal infections of the mouth and throat. SABA bronchodilators are drugs used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema but can cause tachycardia, palpations, arrhythmias, hypertension, nervousness, anxiety, and insomnia. The mast cell stabilizer is contraindicated in clients with known hypersensitivity to the drugs and during attacks of acute asthma, because they may worsen bronchospasm during the acute asthma attack. A mast cell stabilizer is used cautiously during pregnancy (pregnancy category B) and lactation and in clients with impaired renal or hepatic function.

A client with a diagnosis of asthma has been prescribed ipratropium 2 puffs QID. What is the most likely goal of this treatment?

Promoting long-term management of asthma symptoms Explanation: 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.

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?

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

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?

Salmeterol is contraindicated based on his wife's condition. Explanation: 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 client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussion medication instructions with this client?

The medication should be taken on an empty stomach. Explanation: Administer drug on an empty stomach, 1 hour before or 2 hours after meals; the bioavailability of these drugs is decreased markedly by the presence of food. None of the other options present accurate information regarding the administration of this class of medications.

A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which common adverse effects of the drug?

Throat irritation Explanation: The most common adverse effects of inhaled albuterol include throat irritation, palpitations, sinus tachycardia, anxiety tremor, and increased blood pressure. Serious adverse effects such as bronchospasm, urticaria, and angiedema rarely occur. Headache, dyspepsia, and muscle cramps are frequent adverse effects of oral albuterol only.

A client has been admitted to the emergency department (ED) in status asthmaticus. The ED nurse should anticipate administering which medication?

beta2 agonists in high doses Explanation: Management of status asthmaticus entails beta2 agonists in high doses and as often as every 20 minutes for 1 to 2 hours. While montelukast, a leukotriene modifier, is prescribed in the management of asthma, it is not the drug of choice for status asthmaticus. Corticosteroids are used after the respiratory crisis has been stabilized. Theophylline is given in oral not intravenous form to promote bronchial dilatation.

A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient

has a high coffee intake. Explanation: Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy.

A client with asthma that has not been successfully controlled with other medications is prescribed theophylline. When providing education to the client about the medication, what adverse effect would the nurse mention?

insomnia Explanation: Adverse effects of theophylline are associated with blood levels of the drug. At normal therapeutic levels, adverse effects are uncommon. At slightly higher levels, however, GI effects (e.g., nausea, diarrhea, vomiting) and central nervous system effects (e.g., irritability, headache, insomnia) can occur. As levels increase, potentially life-threatening effects can occur, including tachycardia, arrhythmias, hypotension, seizures, and brain damage. Theophylline achieves bronchodilation (not bronchoconstriction) through relaxation of smooth muscle; therefore, relaxation of smooth muscle is a therapeutic effect, not an adverse effect. At high serum levels, the drug can cause tachycardia, not bradycardia.

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to

rebound bronchoconstriction. Explanation: Patients who self-administer albuterol may use their MDIs more frequently than recommended. This practice can result in rebound bronchoconstriction, which may motivate the patient to increase MDI use, stimulating the cycle of rebound congestion. Overuse of albuterol is not linked to pneumonia or hepatotoxicity. Albuterol is not an anticholinergic drug.