Karch Chapter 55

A client with asthma has been prescribed an albuterol inhaler. What recommendation should the nurse include in client teaching?

"Stop smoking to reduce bronchoconstriction."

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."

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.

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

Beta2-adrenergic agonist

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

Chocolate

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

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

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

Relaxation of smooth muscle

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

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators

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

A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to:

sit in a fully upright position when administering the medication.

A nurse is teaching a newly diagnosed client with asthma how to manage the disease. What should the nurse encourage this client to do?

stop smoking cigarettes

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."

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."

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."

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

15 mcg/mL

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

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

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

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

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

Adrenal insufficiency

A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the health care provider to give the client?

Albuterol

The parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations?

Albuterol

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

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

A client recently began taking theophylline for treatment of asthma. Which changes in the client's lifestyle would suggest that the client understands proper use of the drug and management of the disease?

Avoiding caffeine

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

Beractant

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

Beta-2 selective adrenergic agonist

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

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

Cigarette smoking

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

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

An adult client with newly diagnosed asthma presents for client education regarding situations that could precipitate an asthma attack. In this teaching, which precipitants would the nurse state may trigger an attack? Select all that apply.

Exercise Allergens Mold Cigarette smoke

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

Global Initiative for Asthma (GINA)

An older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease. When administering the drug, what action should the nurse perform to reduce the client's risk for developing oral candidiasis?

Have the resident rinse his or her mouth after each dose of the drug.

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

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."

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.

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

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.

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

Intratracheal

The nurse is caring for a client with chronic obstructive pulmonary disease. The plan of care will focus on what client problem?

Lack of patent airway

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

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

Long-acting beta-2 agonists

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

Lung sounds Endotracheal tube placement Oxygen saturation levels

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.

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

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

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

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

A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client's concern?

Remember that your salmeterol isn't effective when you take it at the time of an asthma attack."

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.

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

Tachycardia

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.

An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the client be instructed to do?

Use the inhaler 30 to 60 minutes before exercising.

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

A child with repeated asthma attacks may be treated with which drugs? a. A leukotriene receptor antagonist b. A beta-blocker c. An inhaled corticosteroid d. An inhaled beta-agonist e. A surfactant f. A mast cell stabilizer

a. A leukotriene receptor antagonist c. An inhaled corticosteroid d. An inhaled beta-agonist f. A mast cell stabilizer

A person with hypertension and known heart disease has frequent bronchospasms and asthma attacks that are most responsive to sympathomimetic drugs. This patient might be best treated with a. an inhaled sympathomimetic to decrease systemic effects. b. a xanthine. c. no sympathomimetics because they would be contraindicated. d. an anticholinergic.

a. an inhaled sympathomimetic to decrease systemic effects.

Treatment of obstructive pulmonary disorders is aimed at a. opening the conducting airways or decreasing the effects of inflammation. b. blocking the autonomic reflexes that alter respirations. c. blocking the effects of the immune and inflammatory systems. d. altering the respiratory membrane to increase the flow of oxygen and carbon dioxide.

a. opening the conducting airways or decreasing the effects of inflammation.

Cheyne-Stokes respiration

abnormal pattern of breathing characterized by apneic periods followed by periods of tachypnea; may reflect delayed blood flow through the brain

The nurse teaching a client about theophylline will include the identification of which possible symptoms of toxicity?

agitation and arrhythmias

Clients who are using inhalers require careful teaching about which information? a. Avoiding food 1 hour before and 2 hours after dosing b. Storage of the drug c. Administration techniques to promote therapeutic effects and avoid adverse effects d. Lying flat for as long as 2 hours after dosing e. Timing of administration f. The difference between rescue treatment and prophylaxis

b. Storage of the drug c. Administration techniques to promote therapeutic effects and avoid adverse effects e. Timing of administration f. The difference between rescue treatment and prophylaxis

A patient with many adverse reactions to drugs is tried on an inhaled steroid for treatment of bronchospasm. For the first 3 days, the patient does not notice any improvement. You should a. switch the patient to a xanthine. b. encourage the patient to continue the drug for 2 to 3 weeks. c. switch the patient to a sympathomimetic. d. try the patient on surfactant.

b. encourage the patient to continue the drug for 2 to 3 weeks.

The xanthines a. block the sympathetic nervous system. b. stimulate the sympathetic nervous system. c. directly affect the smooth muscles of the respiratory tract. d. act in the CNS to cause bronchodilation.

c. directly affect the smooth muscles of the respiratory tract.

Your patient has been maintained on theophylline for many years and has recently taken up smoking. The theophylline levels in this patient would be expected to a. rise because nicotine prevents the breakdown of theophylline. b. stay the same because smoking has no effect on theophylline. c. fall because substances in cigarettes stimulate liver metabolism of theophylline. d. rapidly reach toxic levels.

c. fall because substances in cigarettes stimulate liver metabolism of theophylline.

Respiratory distress syndrome occurs in a. babies with frequent colds. b. babies with genetic allergies. c. premature and low-birth-weight babies. d. babies stressed during the pregnancy.

c. premature and low-birth-weight babies.

The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline?

coffee

Leukotriene receptor antagonists act to block production of a component of slow-reacting substance of anaphylaxis. They are most beneficial in treating a. seasonal rhinitis. b. pneumonia. c. COPD. d. asthma.

d. asthma.

Lung surfactants used therapeutically are a. injected into a developed muscle. b. instilled via a nasogastric tube. c. injected into the umbilical artery. d. instilled into an endotracheal tube properly placed in the baby's lungs

d. instilled into an endotracheal tube properly placed in the baby's lungs

mast cell stabilizer

drug that works at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and the release of slow-reacting substance of anaphylaxis (SRSA)

sympathomimetics

drugs that mimic the effects of the sympathetic nervous system

leukotriene receptor antagonists

drugs that selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of slow-reacting substance of anaphylaxis (SRSA)

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

exercise allergens pollutants cigarette smoke

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

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.

The nurse is providing education to the parents of a child who has been newly diagnosed with asthma. During teaching, the nurse should explain that asthma attacks occur when mast cells release substances that cause what reaction?

inflammation.

bronchodilator

medication used to facilitate respirations by dilating the airways; helpful in symptomatic relief or prevention of bronchial asthma and bronchospasm associated with chronic obstructive pulmonary disease

xanthines

naturally occurring substances, including caffeine and theophylline, that have a direct effect on the smooth muscle of the respiratory tract, both in the bronchi and in the blood vessels

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.