PREP U-Chapter 55-Drugs Acting on the Lower Respiratory Tract

A client has been prescribed theophylline intravenously and began the therapy 3 days ago. The nurse suspects that the serum drug level is above therapeutic levels when the client makes what statement(s)? Select all that apply

"I don't want lunch, I feel nauseated.", "It feels like my heart is beating faster than usual", "The headache I mentioned yesterday still hasn't gone away.", "I need to tell you that I vomited a few minutes ago." Theophylline has a narrow therapeutic range. S/S of theophylline toxicity include anorexia, nausea, vomiting, HA, agitation, nervousness, and insomnia. If serum levels continue to increase, the client can experience tachycardia and other arrhythmias, tonic clonic convulsions, and other serious adverse effects.

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

"I need to shake the inhaler well before taking the medication"

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

"I should see results in about 3-4 days". Inhaled steroids such as Triamcinolone can take 2-3 weeks to reach effective levels, so the client should be encouraged that the drug is not effective for acute attacks. It can cause hoarseness and sore throat.

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." Cromolyn is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders.

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." Salmeterol is a long acting beta 2 adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short acting drug.

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 my fluticasone." Fluticasone is an inhaled steroid and should not be used during acute asthma attacks.

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

9:30.

A male client presents to the emergency department in bronchospasm. He has a history of smoking two backs 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 a client's history, what would the nurse expect the health care provider to order?

A modified dose of aminophylline. Cigarette smoking and drugs that stimulate drug metabolizing enzymes in the liver like phenytoin increase the rate of metabolism and therefore the dosage requirements 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

Tom, age 42, is prescribed ipratropium bromide as an anticholinergic agent for treating asthma. The nurse caring for Tom needs to develop a plan of care. What must be included in the plan? Select all that apply.

Advise the patient that ipratropium is used to abort an asthma attack in progress. Advise the patient to avoid using ipratropium if allergic to soybeans, legumes, or soya lecithin. Remind the patient that ipratropium must be taken daily, despite the absence of symptoms of asthma.

Tom, age 42 is prescribed ipratropium bromide as an anticholinergic agent for treating asthma. The nurse caring for Tom needs to develop a plan of care. What must be included in the plan?

Advise the patient to avoid using ipraotropium if allergic to soybeans, legumes, or lecithin. Remind the patient that ipraotropium must be taken daily, despite the absence of symptoms of asthma. Rationale: It is important to avoid if allergic to soy beans, legumes, or soya lecithin because it may cause serious adverse effects. It is also important to remind the patient that ipraotropium must be taken daily, despite the absence of sx. It should be used prophylactically to reduce the frequency and severity of future asthma attacks, and it will not abort an asthma attack in progress. Overuse of ipratropium may induce adverse effects and therefore should be avoided.

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

Agitation and arrhythmias.

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

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 suggest the parents to use in these situations?

Albuterol It is a bronchodilator

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.

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

Albuterol.

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 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.

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

Beractant

A client is experiencing an acute asthma attack. What agent would be most effective?

Beta 2 selective adrenergic agonist. A beta 2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after inhalation.

What is the most common first line therapy for acute asthma attack?

Beta-2-adrenergic agonist

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 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 dose of theophylline if the client has a current history of which of the following?

Cigarette smoking. Nicotine increases the metabolism of Xanthines; therefore an increased dosage would be necessary.

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.

Which medication is contraindicated for the treatment of acute bronchospasm?

Cromolyn. Cromolyn stabilizes mast cells and is not used in acute bronchospasm.

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 the 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.

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

Endotracheal tube placement, lung sounds, oxygen saturation levels

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

Exercise, allergens, pollutants, cigarette smoker

Isoproterenol is an anticholinergic agent. True or False?

False. Isoproterenol is a sympathomimetic agent.

A client is prescribed a steroid to help decrease inflammation in their respiratory tract. When providing medication education to a client what should the nurse identify as the primary benefit of administering the medication by inhaler?

Fewer systemic effects. Inhaling the steroids tends to decrease the numerous systemic effects that are associated with steroid use. Steroids are not prescribed for the management of acute symptoms since they can take 2-3 weeks to reach effective levels. Should not be used during pregnancy or lactation.

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

Global Initiative For Asthma (GINA)

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. The nurse should instruct the patient to contact the healthcare provider if palpitations, tachycardia, chest pain, muscle tremors, dizziness, headache, flushing, or difficulty with urination or breathing occurs.

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

Increased serum theophylline levels.

A triage nurse in the ED has a 42 year old client with asthma presents 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. The correct nursing diagnosis is Ineffective Breathing Pattern related to impaired airway as manifested by tachypnea.

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

Inform the health care provider that the client has toxic theophylline levels. Normal range of Theophylline is 5-15

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

Inhalation

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

Intratracheal

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

Ipratropium Therapy. A client taking ipraotropium should not take tiotropium because both drugs are anticholinergics.

Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use?

It helps decrease systemic absorption.

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

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

Leukotriene receptor antagonists. Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA.

A client diagnosed with asthma, is prescribed a leukotriene receptor antagonist. The nurse will discuss the importance of which diagnostic lab tests to determine how effectively the medication is being metabolized and excreted? Select all that apply.

Liver function, kidney function

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

Which medication is used to treat acute airflow obstruction?

Metaproterenol. Metaproterenol is a short acting beta 2 agonist used as a quick relief medication.

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

Mix the drug with saline. Metaproterenol is mixed with saline in the nebulizer chamber for administration.

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

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

An older adult client, diagnosed with COPD, is being considered for corticosteroid therapy. The nurse should anticipate that these drugs may be administered by what routes? Select all that apply

Oral, parenteral

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

Peanuts. 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 allergy.

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. Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused be leukotrienes.

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. The anticholinergic bronchodilators are the most useful in the long term management of asthma and other conditions producing bronchoconstriction.

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

Relaxation of smooth muscle. Anticholinergics can be used as bronchodilators because of their effect on on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilaton.

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. Short acting Beta 2 agonist

A female client presents to the ED 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. When statement is correct in this situation?

Salmetrol is contraindicated based on wife's condition. The FDA has issued a black box warning that initiating Salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.

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

Slow-reacting substance of anaphylaxis

A client is 73 years of age and has a history of coronary artery diseases and COPD. She is being started on Formoterol (Foradil). The nurse would assess the client for which of the following conditions? Select all that apply.

Tachycardia, Hypertension

The client is 73 years of age and has a history of coronary artery disease and COPD. She is being started on formoterol (Foradil). The nurse would assess the client for which of the following conditions?

Tachycardia, hypertension. Older adults taking bronchodilators are at increased risk for adverse reactions related to the cardiovascular system, such as tachycardia, arrhythmias, palpitations, and hypertension.

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

Tachycardia.

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 instillation of surfactant. Suction the infant immediately before administration, but do not suction for 2 hours after the administration unless clinically necessary, to allow the drug time to work.

A hospital client's medication administration record specifies concurrent doses of nebulized ipraotropium and albuterol at 0800 and 2000. When administering these drugs, the nurse should base the intervention on which fact?

The two drugs can be mixed in the nebulizer immediately before administration.

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators.

A client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussing medication instructions with this client?

This medication should be taken on an empty stomach. The bioavailability of this drug is markedly decreased by the presence of food.

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

Throat irritation

A client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning with intervention will assist a client in the proper use of the device?

Using a spacer

A client is being assessed by the home care nurse for the appropriate use of a metered dose in haler. Instructions concerning which intervention will assist a client in the proper use of this device?

Using a spacer-this holds the drug while the patient inhales.

The client has been admitted to the ED in status asthmatics. The ED nurse should anticipate administering which medication?

beta2 agonist in high doses. Management of status asthmaticus entails beta2 agonists in high doses as often as every 20 mins for 1-2 hours.

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 Caffeine has sympathomimetic effects that may increase the 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 of high calorie food would not have important implications for his albuterol drug therapy.

According to the national asthma education and prevention program (NAEPP) Expert panel Guidelines, a client prescribed a short acting beta 2 agonist may take this medication how often during an acute exacerbation of asthmatic symptoms?

up to 3 treatments at 20 min intervals.