**** Pharm Chp. 30 Respiratory Drugs

A client with asthma asks the nurse which type of medication will decrease bronchoconstriction associated with asthma. Which response by the nurse is the most correct? "Bronchodilators." "Corticosteroids." "Expectorants." "Antitussives."

"Bronchodilators." Bronchodilators decrease bronchoconstriction. Corticosteriods, expectorants, and antitussives do not decrease bronchoconstriction.

A client with asthma asks the nurse which type of medication will decrease inflammation associated with asthma. What is the best response by the nurse? "Corticosteroids." "Expectorants." "Bronchodilators." "Antitussives."

"Corticosteroids." Glucocorticoids, also known as corticosteroids, may be applied directly to the nasal mucosa to prevent symptoms of allergic rhinitis. When applied consistently, they decrease the secretion of inflammatory mediators, reduce tissue edema, and cause a mild vasoconstriction.

A client asks the nurse what the most commonly used OTC antitussive is. Which response by the nurse is most appropriate? "Dextromethorphan" "Guaifenesin (Mucinex)" "Benzonatate (Tessalon)" "Acetylcysteine (Mucomyst)"

"Dextromethorphan" The most frequently used OTC antitussive is dextromethorphan, which is included in most severe cold and flu preparations. Dextromethorphan is chemically similar to the opioids and also acts on the CNS to raise the cough threshold. Although it does not have the abuse potential of opioids, in large amounts, dextromethorphan can cause slurred speech, dizziness, drowsiness, euphoria, and lack of motor coordination.

A client has been prescribed fexofenadine (Allegra) for allergic rhinitis. Which statement made by the client indicates the need for further teaching? "This medication is available only in pill form." "I will take this medication every day to prevent symptoms of allergies." "I will take this medication only when I have seasonal allergy symptoms." "This medication does not cause drowsiness."

"I will take this medication only when I have seasonal allergy symptoms." Antihistamines are most effective when taken prophylactically to prevent allergic symptoms. This medication is available only in pill form, should be taken every day to prevent symptoms, and does cause drowsiness.

A client asks the nurse what the goal of treatment for allergic rhinitis is. Which response by the nurse is the most appropriate? "Relief of symptoms and suppression of immune system." "Prevention of symptoms and decreased immune response." "Prevention of occurrence and relief of symptoms." "Suppression of cough and immune system."

"Prevention of occurrence and relief of symptoms." The therapeutic goals of treating allergic rhinitis are to prevent its occurrence and to relieve its symptoms. Drugs used to treat allergic rhinitis may thus be grouped into two basic categories: preventers and relievers.

A client asks the nurse what ventilation is. What is the most appropriate response by the nurse? "Ventilation is the process by which gases are exchanged." "Ventilation is the process of moving air into and out of the lungs." "Ventilation is the blood flow through the lung." "Ventilation is taking a breath in."

"Ventilation is the process of moving air into and out of the lungs." Ventilation is the process of moving air into and out of the lungs. Respiration is the process by which gases are exchanged. Perfusion is the blood flow through the lungs. Inspiration is taking a breath in.

Which medications are used in the medication treatment plan of COPD? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Bronchodilators 2. Expectorants 3. Mucolytics 4. Antibiotics 5. Oxygen

1. Bronchodilators 2. Expectorants 3. Mucolytics 4. Antibiotics 5. Oxygen Chronic bronchitis and emphysema are two disorders of COPD that often require multiple drug therapy. Bronchodilators, expectorants, mucolytics, antibiotics, and oxygen may offer symptomatic relief.

A nurse is reviewing medications with a client with asthma. The client has been prescribed an intranasal corticosteroid but cannot remember the name of the medication. Which medications does the nurse know as intranasal corticosteroids? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Fluticasone (Flonase Allergy Relief) 2. Budesonide (Rhinocort Allergy Spray) 3. Diphenhydramine (Benadryl) 4. Oxymetazoline (Afrin) 5. Triamcinolone (Nasacort)

1. Fluticasone (Flonase Allergy Relief) 2. Budesonide (Rhinocort Allergy Spray) 5. Triamcinolone (Nasacort) Intranasal corticosteroids, when used consistently, decrease secretion of inflammatory mediators, reduce tissue edema, and cause mild vasoconstriction. There are three drugs in the intranasal corticosteroid class: fluticasone, budesonide, and triamcinolone.

A nurse is reviewing medications with a client recently diagnosed with COPD. The client asks how they can prevent further exacerbations of the COPD. Which should be included in the plan of care regarding COPD? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Smoking cessation 2. Exercise 3. Healthy eating program 4. Take medications as prescribed 5. Use oxygen therapy as needed

1. Smoking cessation 4. Take medications as prescribed 5. Use oxygen therapy as needed Two primary disorders classified as COPD are chronic bronchitis and emphysema.c Both are associated with smoking tobacco products and air pollutants. After years of chronic inflammation, the bronchioles lose their elasticity and the alveoli dilate to maximum size to get more air into the lungs. The patient suffers from extreme dyspnea from even the slightest physical activity. Long-term oxygen therapy assists breathing. Taking medications as prescribed is also important to the disease process.

A client is prescribed montelukast (Singulair), a leukotriene modifier. Which best describes why this medication was added to the treatment of the client's asthma? 1. The medication is used for the prophylaxis of asthma. 2. The medication is important for an acute bronchospasm. 3. The medication has serious adverse effects including immunosuppression. 4. The medication should not have been added to the treatment.

1. The medication is used for the prophylaxis of asthma. Leukotriene modifiers are added to the treatment of asthma when bronchodilators and corticosteroids are unable to. Leukotriene modifiers are added to reduce inflammation and ease bronchoconstriction by modifying the action of the leukotrienes, which are mediators of the inflammatory response. Leukotriene modifiers have adverse effects of headache, cough, nasal congestion, GI upset, and psychiatric effects such as depression and suicidal thinking.

A nurse is reviewing medications with a client with asthma. The client has been prescribed an intranasal corticosteroids. Which should be included in teaching the client about intranasal corticosteroids? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. The medication will decrease secretion of inflammatory mediators. 2. It takes 2-3 weeks of therapy before optimal benefits are attained. 3. Stop taking all other medications. 4. You may experience a runny nose and sneezing. 5. Follow up with the prescriber in 4 weeks.

1. The medication will decrease secretion of inflammatory mediators. 2. It takes 2-3 weeks of therapy before optimal benefits are attained. Intranasal corticosteroids, when used consistently, decrease secretion of inflammatory mediators, reduce tissue edema, and cause mild vasoconstriction. They are administered with a metered-spray device that delivers a consistent dose of drug per spray and require 2-3 weeks of therapy before optimal benefits are attained. The most frequently reported adverse effects are a burning sensation in the nose immediately after spraying and drying of the nasal mucosa.

A nurse is teaching a client who has uncontrolled asthma about the addition of two new medications. Cromolyn and montelukast (Singulair) have been added. The client asks why these medications were added. What is the nurse's best response? 1. They are used as second-line drugs for the treatment of asthma. 2. Both work together in a synergist approach. 3. The prescriber is discontinuing the albuterol (Proventil) and ipratropium (Atrovent). 4. The prescriber is trying something new.

1. They are used as second-line drugs for the treatment of asthma. The mast cell stabilizers and leukotriene modifiers are second-line drugs for the treatment of asthma. These drugs are prescribed when bronchodilators and corticosteroids are unable to control asthma symptoms.

A client with asthma is being discharged after a short stay for an exacerbation of asthma. The nurse is reviewing the medication regimen. The client asks why they are only prescribed an oral corticosteroid for 10 days. Which is the nurse's response? 1. "I should call the prescriber and confirm." 2. "You can take it longer." 3. "Treatment time is usually limited to 10 days and then a reevaluation is necessary." 4. "Don't worry about it."

3. "Treatment time is usually limited to 10 days and then a reevaluation is necessary." Oral corticosteroids are prescribed for severe, persistent asthma. Treatment time is limited to the shortest length possible, usually 5 to 7 days. If taken for longer than 10 days, oral corticosteroids may produce significant adverse effects such as adrenal gland suppression, peptic ulcers, and hyperglycemia.

Classmates of a hospitalized child want to bring a gift for their friend. Which gift is the most appropriate for this child based on the known causes of asthma? Flowers A stuffed animal A book A plant

A book A book can provide entertainment without the risk of exposure to a possible cause of asthma for the client. Flowers or a plant could contain pollen or mold; a stuffed animal might contain dust or dust mites.

Antihistamines should be used with caution in clients with asthma or COPD. What is the rationale for this caution? Anticholinergic effects of antihistamines can trigger angioedema. Most people with asthma are allergic to antihistamines. Antihistamines cause severe headache when given to clients with COPD or asthma. Anticholinergic effects of antihistamines can trigger bronchospasm.

Anticholinergic effects of antihistamines can trigger bronchospasm. Use with extreme caution in patients with asthma or COPD. Keep resuscitative equipment accessible. Anticholinergic effects of antihistamines can trigger bronchospasm.

A healthy client asks the nurse what types of medications can be taken for the common cold. Which drug classes should the nurse include in client education? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Antitussives Expectorants Decongestants Antihistamines Antipyretics

Antitussives Expectorants Decongestants Antihistamines Antipyretics Decongestants, antihistamines, expectorants, antitussives, and antipyretics are used to treat symptoms of the common cold.

During an asthma attack, the bronchioles become swollen and contracted with excessive mucous secretion. How is this manifested in the client? Having fits of coughing Being able to inhale but not exhale Requiring oxygen Going into respiratory arrest

Being able to inhale but not exhale The attack creates bronchospasm, characterized by intense breathlessness, difficulty or painful breathing, coughing, and gasping for air. Air should be able to leave the lung with no energy expenditure required, but during an asthma attack, air gets trapped in the alveoli and is not able to escape. Respiratory arrest can occur if the attack continues. Coughing is not a characteristic of an asthma attack. Administering oxygen is not helpful until the bronchioles are opened.

The client asks the nurse to identify possible causes of allergic rhinitis. Which causes should the nurse include in the client education? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Asthma Dust mites Mold Pollen Tobacco smoke

Dust mites Mold Pollen Tobacco smoke The exact cause of allergic rhinitis is often difficult to pinpoint; however, common causes include pollen from weeds, grasses, and trees; molds; dust mites; certain foods; and animal dander. Nonallergenic factors such as chemical fumes, tobacco smoke, or air pollutants such as ozone can contribute to the symptoms. Asthma is incorrect because it is not a cause of allergic rhinitis.

The nurse explains common triggers for asthma attacks to a client who was recently diagnosed. Which triggers should the nurse include in the teaching session? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Household dust Aspirin (ASA) Exercise in dry, warm climates Tobacco smoke Acetaminophen (Tylenol)

Household dust Aspirin (ASA) Tobacco smoke Tobacco smoke, household dust, and medications like aspirin and ibuprofen are just a few examples of asthma triggers. Acetaminophen (Tylenol) is incorrect because this medication is not known to be an asthma trigger.

Decongestants should be used with caution in patients with which diagnoses? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Hyperthyroidism Diabetes Hypertension Heart disease Allergic rhinitis

Hyperthyroidism Diabetes Hypertension Heart disease Patients with thyroid disorders, hypertension, diabetes, or heart disease should use decongestants only on the direction of their healthcare practitioner. Allergic rhinitis is incorrect because decongestants can be used safely with this group of individuals.

The nurse explains to the client the different ways to administer inhalation medications. Which administration technique should not be included in the teaching session? Dry powder inhaler Hypodermic syringe Nebulizer Metered-dose inhaler

Hypodermic syringe A hypodermic syringe is a piston syringe that is fitted with a hypodermic needle for giving injections. A dry powder inhaler (DPI) is a small device that is activated by the process of inhalation to deliver a fine powder directly to the bronchial tree. Turbuhalers and rotahalers are types of DPIs. A nebulizer is a small machine that vaporizes a liquid drug into a fine mist that can be inhaled, often using a facemask. A metered-dose inhaler (MDI) uses a propellant to deliver a measured dose of drugs to the lungs during each breath. The patient times the inhalation to the puffs of drug emitted from the MDI.

The client wants to know why the physician prescribed an inhaled form of a beta-adrenergic stimulator instead of an oral form. What is the best response by the nurse? It produces fewer side effects. It causes bronchodilation. It works quickly to decrease inflammation. It produces little systemic toxicity.

It produces little systemic toxicity. Inhaled beta-adrenergic drugs produce little systemic toxicity because only small amounts of the drug are absorbed. When given orally, a longer duration of action is achieved, but systemic side effects such as tachycardia and tremor are more frequently experienced. Beta-adrenergic drugs do not decrease inflammation; both the oral and inhaled forms cause bronchodilation.

A client has been diagnosed with allergic rhinitis. Which symptoms would the nurse expect to observe? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Nasal congestion Wheezing Watery eyesallergic rhinitis.Sneezing Urticaria

Nasal congestion Watery eyes Sneezing Allergic rhinitis is a common disorder affecting millions of people annually. Symptoms resemble those of the common cold: tearing eyes, sneezing, nasal congestion, postnasal drip, and itching of the throat. Wheezing is incorrect because it is not a symptom of allergic rhinitis. Urticaria is incorrect because it is not a symptom of allergic rhinitis.

The client asks the nurse which antihistamines are available as intranasal sprays. Which response by the nurse is most appropriate? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Loratadine (Claritin) Diphenhydramine (Benadryl) Olopatadine (Patanase) Azelastine (Astelin) Neo-synephrine (Afrin)

Olopatadine (Patanase) Azelastine (Astelin) Azelastine (Astelin) is approved for nonallergic rhinitis. Although it is a first-generation agent, azelastine causes less drowsiness than do others in its class because it is applied locally to the nasal mucosa, and limited systemic absorption occurs. Olopatadine (Patanase) is a second-generation antihistamine approved in 2008 for allergic rhinitis.

What is the correct term for blood flow through the lung? Perfusion Inspiration Respiration Expiration

Perfusion Although they have no smooth muscle, the alveoli are abundantly rich in capillaries. An extremely thin membrane in the alveoli allows gases to move readily between the internal environment of the blood and the inspired air. As oxygen crosses this membrane, it is exchanged for carbon dioxide, a cellular waste product that travels from the blood to the air. The lung is richly supplied with blood. Blood flow through the lung is called perfusion. Inspiration, expiration, and respiration are not the terms for blood flow through the heart.

The client complains of numbness of the throat and tongue after taking benzonatate (Tessalon). What instruction should the nurse provide for the client? Take one-half the prescribed dose. Swallow the medication whole. Stop taking benzonatate immediately, because this is a life-threatening emergency. Take benzonatate with an antihistamine.

Swallow the medication whole Benzonatate is a nonopioid antitussive which has a local anesthetic-like effect on stretch receptors in the lung. The client needs to swallow the medication whole. Chewing this medication causes numbness of the tongue and throat. It is outside the nurse's scope of practice to change the medication order. This is not a life-threatening emergency and the benzonatate does not need to be stopped immediately. Taking benzonatate with an antihistamine will not stop the numbness of the throat and tongue.

A client has prescriptions for albuterol (Proventil HFA) and salmeterol (Serevent). Which instruction should the nurse provide for this client? They should not be taken together. The order of administration does not matter. Take salmeterol first. Take albuterol first.

Take albuterol first Albuterol is a bronchodilator, and should be used before the anti-inflammatory drug salmeterol. The bronchioles should be opened in order for the action of the anti-inflammatory drug to be most effective. The medications should not be taken together. The order of administration does matter. The salmeterol should be taken second.

The nurse is caring for a client with asthma. The client asks the nurse what structures make up the upper respiratory tract. Which response by the nurse is the most appropriate? The nose, nasal cavity, pharynx, and paranasal sinuses The lungs and associated structures The nose and paranasal sinuses The nose, nasal cavity, pharynx, and the lungs

The nose, nasal cavity, pharynx, and paranasal sinuses The URT consists of the nose, nasal cavity, pharynx, and paranasal sinuses. These passageways warm, humidify, and clean the air before it enters the lungs. The URT traps and removes particulate matter and many pathogens before they reach the lower portions of the lungs, where they would be able to access the capillaries of the systemic circulation.

The nurse teaches the client that they were prescribed a first-generation antihistamine to avoid alcohol and other CNS depressants. What is the rationale for this particular teaching topic? The antihistamine will not work if combined with alcohol or a CNS depressant. The sedating effects will be increased. The combination will cause insomnia. Anaphylaxis is more likely when antihistamines are taken with alcohol.

The sedating effects will be increased Care must be taken to avoid alcohol and other CNS depressants when taking antihistamines, as their sedating effects can be additive. This combination can cause increased sedation.

The nurse explains to the client why inhalation medications work rapidly. What should the nurse include in the teaching? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. There is a rich blood supply to the lungs. The inside surface of the lungs is small, and the dose is concentrated in that area. There is a large surface area inside the lungs. Inhaled medications are given at very high doses. Inhaled medications are given with food.

There is a rich blood supply to the lungs. There is a large surface area inside the lungs. The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli and the rich blood supply to these areas result in an almost instantaneous onset of action for inhaled substances.

Xanthines are not as popular as they were 20 years ago. Why has this group of medications lost its popularity? They have a slower onset. They are related to caffeine. They produce less effective bronchodilation. They interact with a large number of other drugs.

They interact with a large number of other drugs The xanthines (theophylline, aminophylline) are chemically related to caffeine but have been replaced by safer, more effective drugs. Side effects such as nausea, vomiting, and CNS stimulation are relatively common; dysrhythmias might be observed at high doses; and there is a narrow margin of safety with theophylline because it reacts to a large number of other drugs.

After taking the medication guaifenesin (Mucinex), the client complains of coughing up phlegm. What is the best response by the nurse? This requires further investigation. This is indicative of an allergic reaction. This means there is probably more pathology present. This is normal.

This is normal Guaifenesin, an expectorant, stimulates the flow of bronchial secretions. The increased secretions thin the mucous, allowing it to be removed with less forceful coughing.