PHARM chapter 18 Pulmonary
The nurse prepares to provide guaifenesin (Mucinex) as ordered. The patient asks, "What is this for?" Which of the following responses by the nurse is best? "It dries up your secretions so you won't feel so stuffy headed." "This helps thin the mucus so it is easier for you to cough it up." "This opens your airways to help you breathe." "It is a cough suppressant and will help reduce your coughing."
"This helps thin the mucus so it is easier for you to cough it up."
The nurse is counseling a patient who is taking bupropion (Wellbutrin). Which of the following statements is most important to include in the teaching? "Be sure you do not smoke while you are taking this medication, or you could overdose on nicotine and end up in the emergency room." "Your prescription is only good for 10 days, so you must have it filled soon or it will expire." "Smoking is a very hard habit to break, so we encourage you to seek support from others." "This medication can cause people to think about killing themselves, so it is imperative that you notify the doctor if you have any thoughts like that."
"This medication can cause people to think about killing themselves, so it is imperative that you notify the doctor if you have any thoughts like that." Correct. The most serious side effect is thoughts of suicide, and this teaching needs to be completed to keep the patient safe.
The nurse is talking to a patient newly prescribed nedocromil (Tilade) who asks, "Why do I have to take this medication? Why can"t I just take my inhaler when I have an asthma attack?" Which of the following responses by the nurse is best? "The nedocromil helps thin secretions so it is easier for you to clear your lungs." "By suppressing your immune system, this medication helps treat your asthma." "This medication helps decrease your body's reaction to things that set off an asthma attack." "This medication helps block asthma triggers from entering your lungs."
"This medication helps decrease your body's reaction to things that set off an asthma attack." Nedocromil is a mast cell stabilizer that reduces one's reaction to asthma triggers, reducing asthma attacks.
Patient orders read: "albuterol (Proventil) inhaler every 4 hours as needed for dyspnea." Place the following steps in appropriate order for the correct administration: A. Instruct the patient to inhale while depressing the inhaler to release a dose of medication. B. Shake the inhaler for about 5 seconds. C. Place the patient in High Fowler's or sitting position. D. Have the patient place the inhaler with lips around the mouthpiece. E. Have the patient hold her breath for about 10 seconds. F. Instruct the patient to breathe out fully.
1. First ANS: C. An inhaler is best administered with the patient in an upright position. This helps deposit most of the medication into the lungs to optimize absorption. 2. Second ANS: B. The inhaler needs to be shaken prior to administration to ensure appropriate mixing of the medication prior to administration. 3. Third ANS: F. The patient must breathe out fully to allow for deep inhalation of the medication. 4. Fourth ANS: D. The mouth creates a seal around the inhaler device to channel the medication into the patient's lungs. 5. Fifth ANS: A. Inhaling while depressing the inhaler allows the medication to be taken into the lungs. 6. Sixth ANS: E. Holding the breath for several seconds following administration of the medication assists in depositing and keeping the medication in the lungs, where it will be absorbed.
The nurse is preparing to provide a dose of over-the-counter dextromethorphan (Duratuss) cough syrup for a child. Based on the child's age and weight, the nurse determines the appropriate amount is 2 tsp. If there is 7.5 mg of the active ingredient in each 5 mL, what is the actual dose of medication the child is receiving (in mg)?
15 mg 7.5 mg/5 ml × 5 ml/1 tsp × 2 tsp = 15 mg
The nurse is preparing a dose of over-the-counter dextromethorphan (Robitussin) cough syrup for a child who weighs 25 kg. The dosage chart on the box reads as follows: Under 24 lb (under 2 years) Ask the doctor 24-47 lb 1 tsp 48-95 lb 2 tsp Over 95 lb 4 tsp How much medication (in tsp) will the nurse give?
2 tsp 2.2 lb/1 kg × 25 kg = 55 lb The chart indicates a child who weighs 55 lb should take 2 tsp.
A student nurse is talking to a respiratory therapist about the various patients receiving nebulizer treatments. Which patient is most likely to receive acetylcysteine (Mucomyst)? A 31-year-old patient with an exacerbation of asthma A 43-year-old patient with bronchitis A 56-year-old patient with chronic obstructive pulmonary disease A 19-year-old patient with cystic fibrosis
A 19-year-old patient with cystic fibrosis Correct. Acetylcysteine works to break up thick mucus secretions commonly found in patients with cystic fibrosis.
Which of the following individuals is the most likely to receive caffeine citrate (Cafcit)? A 9-year-old girl diagnosed with asthma A 3-day-old boy born at 30 weeks' gestation A 28-year-old man diagnosed with pleurisy A 59-year-old woman diagnosed with sleep apnea
A 3-day-old boy born at 30 weeks' gestation Caffeine citrate is often used for premature infants whose brain development does not provide adequate stimulation to breathe. The caffeine stimulates breathing.
For whom is the use of oxygen therapy potentially dangerous? (Select all that apply.) A baby born at 27 weeks' gestation receiving high-flow oxygen A 17-year-old patient with status asthmaticus wearing a nonrebreather mask set at 15 L of O2 A 31-year-old patient with pneumonia who is on O2 at 2 L/min via nasal cannula A 4-year-old patient in a humidified mist tent with O2 at 28% A 71-year-old patient with chronic obstructive pulmonary disease with an O2 mask at 60%
A baby born at 27 weeks' gestation receiving high-flow oxygen A 71-year-old patient with chronic obstructive pulmonary disease with an O2 mask at 60% Correct. Patients with COPD are adapted to a low-oxygen environment, and a high level of oxygen delivered can be dangerous, reducing the drive to breathe. High flow oxygen given to premature infants can be harmful to the eyes.
COPD (chronic obstructive pulmonary disease)
A group of lung diseases that block airflow and make it difficult to breathe.
The nurse is visiting her father, who has been hospitalized with pneumonia. The nurse recognizes that her father has thick secretions and a frequent cough. Which of the following medications might the nurse inquire about to help her father? Triamcinolone (Azmacort) Acetylcysteine (Mucomyst) Aminophylline (Phyllocontin) Albuterol (Proventil)
Acetylcysteine (Mucomyst) Acetylcysteine is a mucolytic, which will help loosen and break up the thick secretions.
The nurse is providing care for a patient with a long-term history of asthma for an acute exacerbation. The patient is started on aminophylline (Phyllocontin). Which of the following side effects would the nurse include in the patient teaching? (Select all that apply.) Altered heart rhythm Excitability/CNS stimulation Constipation Drowsiness Increased blood sugar
Altered heart rhythm Excitability/CNS stimulation Increased blood sugar Correct. Aminophylline is known to cause heart dysrhythmias. Aminophylline is known to cause excitability/CNS depression. Aminophylline can cause an increase in blood sugar.
The nurse is taking a medication history from a patient with chronic obstructive pulmonary disease (COPD) who reports taking tiotropium (Spiriva). The nurse is aware the patient takes this medication in what type of formulation? Orally As an inhaled powder Sublingually As syrup
As an inhaled powder
Which of the following medications are used in the treatment of tuberculosis? INH Rifampin Both A and B None of the above
Both A and B
After reviewing a new prescription for theophylline (Slo-Bid), the nurse would ensure the patient understood which of the following? Careful monitoring with blood tests will be necessary. The medication can dampen libido in some patients. The medication can greatly increase the patient's risk of bleeding. Seizure medications may need to be increased to maintain effectiveness.
Careful monitoring with blood tests will be necessary. Theophylline has a narrow safety range, and blood tests are needed to monitor for appropriate dosing.
The nurse is assisting in the care of a patient who smokes two packs of cigarettes per day. The patient has been prescribed a 14-mg nicotine patch (NicoDerm). The patient expresses a desire to smoke. Which action by the nurse is best? Allow the patient to smoke one cigarette four times daily to curb cravings. Contact the physician to request an order for Nicorette gum as needed. Inform the patient that smoking is against institutional policy and is not good for her. Contact the pharmacy and request a 21-mg patch to replace the 14-mg patch.
Contact the physician to request an order for Nicorette gum as needed.
The nurse is assisting in the admission process for a patient with a history of asthma. In addition to a rescue inhaler, the nurse would expect the patient may take which of the following medications? Theophylline Phenylephrine (Dimetapp) Bupropion (Wellbutrin) Cromolyn sodium (Intal)
Cromolyn sodium (Intal) Correct. Cromolyn sodium is a mast cell stabilizer that helps reduce incidence of asthma attacks.
The nurse is caring for a sick child at home who has a bad cough. The nurse would choose an over-the-counter cough syrup that contained which of the following active ingredients? Phenylephrine Dextromethorphan Albuterol Flunisolide
Dextromethorphan Dextromethorphan is a cough suppressant that will decrease the cough reflex and can be used to treat coughs related to illness.
Anticholinergic
Dilate bronchi by blocking acetylcholine stimulate SNS (represess PNS)=fight/flight response: Increased HR and BP Treatment: Ipratropium Bromide (Atrovent) Tiotropium (Spiriva) -opium-
Antibiotics, which illness is this used to treat what are the drugs used?
Drugs that block the growth and reproduction of bacteria Pneumonia Tuberculosis Treatment: INH (isoniazid) AND Rifadin
Mucolytics are used to suppress cough.
False; antitussives suppress coughing; mucolytics break up very thick secretions.
Respiration
Inhalation and exhalation of air.
While working at a family practice physician's office, the nurse would counsel patients taking over-the-counter decongestants to be cautious and check with their physician if they were also taking which of the following? (Select all that apply.) Barbiturates MAO inhibitors Seizure medications Beta blockers Histamine blockers
MAO inhibitors beta blockers
Which class of medications is given to prevent asthma attacks? Antitussives Mucolytics Expectorants Mast cell stabilizers
Mast cell stabilizers
Antiviral Medications and what it is used to treat
Prevent growth of further virus, not cure, influenza and RSV Treatment: Zanmivir and Osteltamivir phosphate (Influenza) Ribavirin (RSV) -vir(in)-
The nurse is caring for a patient who reports taking ipratropium (Atrovent) and budesonide (Pulmicort) inhalers. Which action by the nurse is best? Contact the physician to clarify which inhaler should be used. Use the ipratropium daily and the budesonide for rescue purposes. Provide the ipratropium first, and then the budesonide. Provide the budesonide first, and then the ipratropium.
Provide the ipratropium first, and then the budesonide. Ipratropium should be given first because it opens the airways. Then the glucocorticoid can be more effectively deposited in the lungs.
The nurse is working with a patient in a long-term care facility who takes metaproterenol (Alupent). The nurse is aware that the patient's blood pressure that morning was 118/68. Which action should the nurse take? Hold the metaproterenol. Contact the physician for instructions. Provide the metaproterenol. Contact the RN for instructions.
Provide the metaproterenol. The medication should be administered. The BP is within normal limits, but the medication can increase the BP.
The nurse is taking a dose of multisymptom cold medication and is aware that which of the following active ingredients will help reduce nasal congestion? Guaifenesin Pseudoephedrine Acetylcysteine Codeine
Pseudoephedrine
Antitussive/Expectorant
Relieves cough, loosens and helps expel thick mucus secretions Codeine for antitussive to help patient sleep guaifenesin (Duratess,mucinex, robitussin) to help body get rid of mucus secretions
Beta-adrenergic agonists
Stimulate the beta-receptors in the sympathetic nervous system=bronchodilation Treatment -terol- epinephrine for severe dyspnea mulit-dose inhalers (MDIs)
The nurse is visiting an infant in the neonatal intensive care unit who has been placed on caffeine citrate for respiratory stimulation. The nurse would attribute which of the following observations to the medication? (Select all that apply.) The infant turns her head when her cheek is stroked. The infant does not produce tears when she cries. The infant has a low-grade fever. The infant is fussy and has difficulty sleeping. The infant is wearing eye shields.
The infant has a low-grade fever. The infant is fussy and has difficulty sleeping. Caffeine citrate is a stimulant and may cause fussiness and difficulty sleeping. Caffeine citrate can cause a fever.
The nurse is instructing a patient how to take the prescribed theophylline (TheoCap). Which of the following actions by the patient ensures the patient understood the instructions? The patient takes the medication daily on an empty stomach with a glass of water. The patient takes the medication during an acute asthma attack. The patient takes the medication up to four times each day, as needed for wheezing. The patient takes the medication every night at bedtime.
The patient takes the medication daily on an empty stomach with a glass of water. Theophylline is taken on an empty stomach with a glass of water to maximize absorption.
Xanthines (methylxanthines)
Theophylline and Aminophylline Used to treat Asthma LOW safety margin
The nurse is assisting a patient newly diagnosed with influenza who has been given a prescription for oseltamivir (Tamiflu). The nurse recognizes the patient is aware of potential side effects by which of the following statements? "I might feel my heart racing when I take this medication." "The medication is likely to make me feel hungry often." "This medication may cause nervousness or difficulty sleeping." "Some people get really constipated when they take this."
This medication may cause nervousness or difficulty sleeping."
The nurse is attempting to stop smoking and has tried to quit "cold turkey" multiple times. This time he is willing to seek help and wants to use a medication that will make his desire to smoke fade away. Which of the following medications will the physician most likely prescribe? Varenicline (Chantix) Bupropion (Budeprion) Flunisolide (Aerobid) Nicotine (Nicotrol)
Varenicline (Chantix) Varenicline is used with behavior modification techniques to convince the person's brain that smoking is not pleasurable.
Mucolytics
agents that destroy or dissolve mucus Treatment: Acetylcysteine
Asthma medications can be given via which of the following routes? Oral Inhalation Intravenously All of the above
all of the above
Which class of pulmonary medications suppresses coughing? Antitussives Mucolytics Expectorants Mast cell stabilizers
antitussives
Caffeine is given to prevent______. Asthma Pneumonia Apnea COPD
apnea
inspiration
breathing in
experation
breathing out
decongestants
constrict blood vessels of nasal passages and limit blood flow, which causes swollen tissues to shrink so that air can pass more freely through the passageways Treatment: phenylephrine AND pseudoephedrine -ephrine- Never given to kids under 2 must be monitored with acetaminophen and ibuprofen
Mast Cell Stabilizers
cromolyn sodium and nedocromil sodium Nebulizer/inhaler used to prevent asthma attacks
dyspnea
difficulty breathing
Apnea is most common in athletes.
false;
Cystic fibrosis is treated with antiviral medications.
false; treated with mucolytics
smoking cessation
hypnosis behavioral therapy transdermal patch gum Buproprio Hydrochloride Varenicline ( convinces brain)
Oxygen as treatment
hypoxia COPD= these patients have adapted to low O2 levels and giving too much will hurt or kill them dyspnea carbon monoxide poisoning
Glucocorticoids
suppresses immune system = reduced inflammation *Lowest effective dose for shortest period of time* Prophylaxis not acute: Beclomethasone Fluticason Mometasone Triamcinalone Budesonide Flumisolide -asone- AND -ide- Acute: Dexamethasone Prednisone Methylprednisalone
Alveoli
tiny sacs of lung tissue specialized for the movement of gases between air and blood
Alveoli are where O2 and CO2 are exchanged.
true
t/f Glucocorticoids are used during severe asthma attacks.
true
respiratory stimulants
used to stimulate respirations Caffiene citrate theophylline
