Chapter 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease
Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonists d. Short-acting beta2 agonists
d. Short-acting beta2 agonists
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that: a. the patient should inhale suddenly to receive the maximum dose. b. the patient should activate the device and then inhale. c. the patient should store the MDI in the refrigerator between doses. d. the patient should wait 1 minute between puffs.
d. the patient should wait 1 minute between puffs.
Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered? "Gargle after using your inhaler." "Take the medication immediately at the onset of an attack." "Take your albuterol first, followed by the Flovent 5 minutes later." "Make sure you monitor your fingerstick blood glucose level each morning."
"Gargle after using your inhaler."
Which statement should the nurse include in the teaching for a patient who is to be started on zileuton [Zyflo]? "Use your zileuton [Zyflo] inhaler every 12 hours." "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." "Take the zileuton [Zyflo] 2 hours before eating breakfast each day." "Take an extra dose of zileuton [Zyflo] if you have an asthmatic attack."
"Have your blood drawn once a month for the next 3 months so that your liver function can be checked."
A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? "After you inhale the medication once, repeat until you obtain symptomatic relief." "Wait no longer than 30 seconds after the first puff before taking the second one." "Use a spacer with the inhaler and rinse your mouth after each dose administration." "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."
"Use a spacer with the inhaler and rinse your mouth after each dose administration."
A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective? "I'll take a dose as soon as I feel short of breath and start to cough." "While taking this medicine, I may be able to reduce my steroid medication." "This is the priority medication for preventing exercise-induced asthma symptoms." "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."
"While taking this medicine, I may be able to reduce my steroid medication."
A nurse should establish which outcomes on the care plan for a patient taking oral terbutaline? (Select all that apply.) Absence of tachycardia No reports of chest pain Less irritation of gum tissue Decrease in bronchospasm No jaundice or dark urine
Absence of tachycardia No reports of chest pain Decrease in bronchospasm
A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? Echinacea Cimetidine [Tagamet] Sunscreen products Caffeine
Caffeine
A patient who takes cromolyn for exercise-induced bronchospasm should follow which approach for maximum therapeutic effectiveness? It should be used infrequently because of systemic adverse effects. One 10-mg tablet should be taken at least 2 hours before exercising. It should be administered by inhalation 15 minutes before anticipated exertion. It should be used as a quick-relief agent if exercise triggers asthma symptoms.
It should be administered by inhalation 15 minutes before anticipated exertion.
Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.) More of the drug is delivered to the lungs and less to the oropharynx. Use of a spacer is not necessary. Less propellant is needed to deliver the medication. Less hand-lung coordination is required. DPIs pose no environmental risk.
More of the drug is delivered to the lungs and less to the oropharynx. Use of a spacer is not necessary. Less hand-lung coordination is required. DPIs pose no environmental risk.
To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? Only in an emergency On a continuing, daily basis To abort an asthma attack 2 weeks on, 2 weeks off
On a continuing, daily basis
A history of allergy to which substance is a contraindication to the use of ipratropium/albuterol [Combivent]? Mold Peanuts Penicillin Dairy products
Peanuts
A nurse teaches a patient with chronic obstructive pulmonary disease (COPD) about the adverse effects of tiotropium [Spiriva]. Which behavior by the patient would indicate that the teaching has been effective? Combines tiotropium with an antacid. Sucks on hard candy as needed. Prevents constipation with a stool softener. Wears long sleeves and a wide-brim hat.
Sucks on hard candy as needed.
Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? Increases the daily intake of vitamin D and calcium. Records daily peak expiratory flow rates. Supplements additional doses at times of stress. Uses alternate-day therapy to reduce adverse effects.
Supplements additional doses at times of stress.
Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times? Whenever needed (PRN) as a quick-relief agent Twice daily combined with an inhaled glucocorticoid Only with a long-acting beta2 agonist (LABA) If nighttime awakenings occur more than 2 days a week
Whenever needed (PRN) as a quick-relief agent
A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine
a. A long-acting inhaled beta2 agonist
A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent? a. Growth may be slowed, but eventual adult height will not be reduced. b. The growth rate is not impaired, but overall height will be reduced. c. The growth rate slows while the drug is used and only resumes when the drug is stopped. d. Long-term use of the drug results in a decrease in adult height.
a. Growth may be slowed, but eventual adult height will not be reduced.
What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.) a. Reduced bronchial hyperreactivity b. Reduced edema of the airway c. Reduced number of bronchial beta2 receptors d. Increased responsiveness to beta2-adrenergic agonists e. Increased synthesis of inflammatory mediators
a. Reduced bronchial hyperreactivity b. Reduced edema of the airway d. Increased responsiveness to beta2-adrenergic agonists
A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss: a. adding roflumilast [Daliresp] once daily. b. changing to oral theophylline twice daily. c. prescribing oral steroids once daily. d. Using an ipratropium/albuterol combination twice daily.
a. adding roflumilast [Daliresp] once daily.
A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication? a. "After the loading dose has been given, the patient will receive 6 mg/kg/hr." b. "Dosing is titrated based on the serum theophylline levels." c. "If the patient's serum theophylline level is less than 15 mcg/mL, the rate should be reduced." d. "The patient will receive a loading dose of 180 mg over 5 minutes."
b. "Dosing is titrated based on the serum theophylline levels."
A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a. Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c. Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy
b. Participating in weight-bearing exercises on a regular basis
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug? a. Four puffs of albuterol, oxygen, and intravenous theophylline b. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen d.
A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching? a. "Beta2-adrenergic agonists provide quick relief via any formulation." b. "Long-acting beta2 agonists may be used alone to prevent attacks." c. "Short-acting beta2 agonists are usually given by nebulizer." d. "Oral beta2 agonists are not useful for short-term treatment."
d. "Oral beta2 agonists are not useful for short-term treatment."
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a. "I should use the glucocorticoid as needed when symptoms flare." b. "I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."
d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."
A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? a. "You may have another dose in 4 hours." b. "You may need to take two inhalations instead of one." c. "You should have peak effects in about 6 hours." d. "You should see improved effects within the next week."
d. "You should see improved effects within the next week."
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient? a. LABAs are safer than short-acting beta2 agonists. b. LABAs can be used on an as-needed basis to treat symptoms. c. LABAs reduce the risk of asthma-related deaths. d. LABAs should be combined with an inhaled glucocorticoid.
d. LABAs should be combined with an inhaled glucocorticoid.
A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? Oral theophylline [Elixophyllin] Subcutaneous omalizumab [Xolair] Inhaled mometasone furoate [Asmanex] High-dose albuterol [Proventil] via nebulizer treatment
High-dose albuterol [Proventil] via nebulizer treatment
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication? a. "I may notice mood changes in my child." b. "I should give this medication twice daily." c. "I will give my child one 4-mg chewable tablet daily." d. "This drug can alleviate symptoms during an acute attack."
a. "I may notice mood changes in my child."
A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device? a. "You do not need good hand-lung coordination to use this device." b. "You will begin to inhale before activating the device." c. "You will need to use a spacer to help control the medication." d. "You will take 2 inhalations twice daily."
a. "You do not need good hand-lung coordination to use this device."
Which drugs are used to treat COPD? (Select all that apply.) a. Anticholinergic medications b. Glucocorticoids c. Leukotriene modifiers d. Long-acting beta2 agonists e. Monoclonal antibodies
a. Anticholinergic medications b. Glucocorticoids d. Long-acting beta2 agonists
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do? a. Ask whether the patient is rinsing the mouth after each dose. b. Request an order for an antifungal medication. c. Suggest that the patient be tested for a bronchial infection. d. Tell the patient to discontinue use of the glucocorticoid.
a. Ask whether the patient is rinsing the mouth after each dose.
A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV1) is 75% of predicted values. The nurse will expect this patient to be started on which regimen? a. Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed b. Daily low-dose inhaled glucocorticoid and a SABA as needed c. Daily medium-dose inhaled glucocorticoid/LABA combination d. No daily medications; just a SABA as needed
a. Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed
A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss: a. changing to a different antibiotic. b. reducing the theophylline dose. c. giving theophylline once daily. d. switching from theophylline to a LABA.
b. reducing the theophylline dose.
A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do? a. Contact the provider to request a systemic glucocorticoid. b. Contact the provider to suggest using a long-acting beta2 agonist. c. Evaluate the need for teaching about MDI use. d. Question the patient about how much albuterol has been used.
d. Question the patient about how much albuterol has been used
A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do? a. Contact the provider to report systemic anticholinergic side effects. b. Discontinue the aerosol treatment immediately. c. Notify the provider of a possible allergic reaction. d. Reassure the patient that these are expected side effects.
d. Reassure the patient that these are expected side effects.
