Respiratory Drugs - NCLEX Questions
When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? a) "I use my corticosteroid inhaler each time I feel short of breath." b) "I see my doctor if I have an upper respiratory infection and always get a flu shot." c) "I use my bronchodilator inhaler before walking so I don't become short of breath." d) "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."
a) "I use my corticosteroid inhaler each time I feel short of breath." Rationale: Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.
A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding his prescription? a) "I will take the daily dose at bedtime." b) "I need to drink at least 2 liters of fluid per day." c) "I know to avoid changing brands of the medication without my health care provider's approval." d) "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider (HCP)."
a) "I will take the daily dose at bedtime." Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. Additionally, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the HCP before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the HCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline (Theo-24). The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? a) 5 mg/mL b) 10 mg/mL c) 15 mg/mL d) 20 mg/mL
a) 5 mg/mL Rationale: Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL. If the laboratory result indicated a level of 5 mg/mL, the dosage of the medication would need to be increased.
A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? a) Coffee b) Oatmeal c) Ginger ale d) Bagel with cream cheese
a) Coffee Rationale: Theophylline is a xanthine bronchodilator. Before a serum level of the medication is drawn, the client should avoid taking foods or beverages that contain xanthine, such as colas, coffee, or chocolate; therefore, the client is told to avoid coffee before the test. The items in the other options do not need to be avoided before this test.
A client has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? a) Coffee, cola, and chocolate b) Oysters, lobster, and shrimp c) Melons, oranges, and pineapple d) Cottage cheese, cream cheese, and dairy creamers
a) Coffee, cola, and chocolate Rationale: Theophylline (Theo-24) is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.
A client has begun a course of therapy with rifampin. The home care nurse instructs the client on which measure due to an anticipated side effect? a) Wear dark clothing to avoid staining. b) Always take the medication with food or antacids. c) Double the next medication dose if one is forgotten. d) Stop the medication if symptoms disappear in 2 months.
a) Wear dark clothing to avoid staining. Rationale: Rifampin causes orange-red discoloration of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider.
A client taking rifampin (Rifadin) reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? a) Notify the health care provider. b) Chart the finding as a normal response to the rifampin. c) Get the client into bed, and put the bed in Trendelenburg's position. d) Immediately start prescribed intravenous (IV) fluids to prevent shock.
b) Chart the finding as a normal response to the rifampin. Rationale: Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the health care provider.
A client has been taking isoniazid for 1½ months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a) Hypercalcemia b) Peripheral neuritis c) Small blood vessel spasm d) Impaired peripheral circulation
b) Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake.
A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a) Use alcohol in small amounts only. b) Report yellow eyes or skin immediately. c) Increase intake of Swiss or aged cheeses. d) Avoid vitamin supplements during therapy.
b) Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.
The nurse should monitor the client receiving the first dose of albuterol (Proventil HFA) for which side effect of this medication? a) Drowsiness b) Tachycardia c) Hyperkalemia d) Hyperglycemia
b) Tachycardia Rationale: Albuterol is a bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. The items in the other options are not side effects of this medication.
Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? a) Skin color b) Urine color c) Hydration status d) Respiratory effort
b) Urine color Rationale: Isoniazid is an antituberculosis medication. The most serious adverse effect associated with isoniazid is hepatic injury, which on rare occasions has been fatal; therefore, monitoring of liver function tests and for signs and symptoms of liver injury is the priority. Dark urine is a sign of liver injury and the client should be taught to report this, and the nurse should assess for this. Skin color, hydration status, and respiratory effort are not directly related to adverse effects of this medication.
A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication? a) Just after the next meal b) Just before the next meal c) 4 hours after discontinuing the IV form d) Immediately on discontinuing the IV form
c) 4 hours after discontinuing the IV form Rationale: With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication. If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion.
A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? a) Electrolyte levels b) Coagulation times c) Liver enzyme levels d) Serum creatinine level
c) Liver enzyme levels Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 or abuses alcohol.
Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a) Platelet count b) Neutrophil count c) Liver function tests d) Complete blood count
c) Liver function tests Rationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.
A nurse is preparing to administer albuterol (Proventil HFA) to a client. Which parameters should the nurse assess before and during therapy? a) Nausea and vomiting b) Headache and level of consciousness c) Lung sounds and presence of dyspnea d) Urine output and blood urea nitrogen level
c) Lung sounds and presence of dyspnea Rationale: Albuterol is an adrenergic bronchodilator. The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.
A client with tuberculosis (TB) has a prescription for rifampin (Rifadin). What instruction should the nurse include in the client's teaching plan? a) Yellow-colored skin is common with this medication. b) The medication must always be taken on an empty stomach. c) Wearing glasses instead of soft contact lenses will be necessary. d) As soon as the cultures come back negative, the medication may be stopped.
c) Wearing glasses instead of soft contact lenses will be necessary. Rationale: Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by rifampin. Any sign of possible jaundice (yellow-colored skin) should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures give negative results.
Isoniazid is prescribed for a child with human immunodeficiency virus infection who has a positive Mantoux tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? a) 4 months b) 6 months c) 9 months d) 12 months
d) 12 months Rationale: For children with human immunodeficiency virus infection who demonstrate a positive Mantoux tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.
A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? a) Platelet count 325,000 mm3 (325 × 109/L) b) Serum creatinine 1.0 mg/dL (88.3 mcmol/L) c) Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) d) Aspartate aminotransferase (AST) 55 U/L (55 U/L)
d) Aspartate aminotransferase (AST) 55 U/L (55 U/L) Rationale: Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.
A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? a) Dry mouth b) Cramping diarrhea c) Frequent headaches d) Difficulty tying shoes
d) Difficulty tying shoes Rationale: The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid.
A client taking theophylline has a serum theophylline level of 15 mcg/mL. How does the nurse interpret this laboratory value? a) Below therapeutic range b) In excess of the therapeutic range c) Near the top of the therapeutic range d) In the middle of the therapeutic range
d) In the middle of the therapeutic range Rationale: The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.
A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? a) Insufficient dosage of the medication, which needs to be increased b) Probable interaction of this medication with an over-the-counter cold remedy c) Tolerance to the medication, indicating a need for a stronger type of bronchodilator d) Paradoxical bronchospasm, which must be reported to the health care provider (HCP)
d) Paradoxical bronchospasm, which must be reported to the health care provider (HCP) Rationale: The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld and the HCP should be notified.
The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? a) "I must take the medication exactly as prescribed." b) "Once I start the medication, I will no longer be contagious." c) "I will not get any colds or infections while taking this medication." d) "This medication has minimal side effects and I can return to normal activities."
a) "I must take the medication exactly as prescribed." Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate change in activities, especially when driving or operating machinery if dizziness occurs.
The client has a prescription to receive pirbuterol (Maxair Autoinhaler) two puffs and beclomethasone dipropionate (Beclovent) two puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? a) Administering the pirbuterol before the beclomethasone b) Alternating a single puff of each hourly, beginning with the beclomethasone c) Alternating a single puff of beclomethasone with pirbuterol; repeat the steps d) Administering the pirbuterol; wait 30 minutes and administer the beclomethasone
a) Administering the pirbuterol before the beclomethasone Rationale: Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
The nurse would expect the health care provider (HCP) to add which medication to the regimen of the client receiving isoniazid? a) Niacin b) Neurontin c) Pyridoxine (vitamin B6) d) Cyanocobalamin (vitamin B12)
c) Pyridoxine (vitamin B6) Rationale: isoniazid is an anti-tuberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Neurontin is used to prevent seizures, and cyanocobalamin is used to treat anemia.
A client with an exacerbation of chronic obstructive pulmonary disease has been on oral glucocorticoids and is currently being weaned to triamcinolone (Azmacort) by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a) Chills, fever, and generalized rash b) Vomiting, diarrhea, and increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue
d) Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.
A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? a) Coffee b) Orange juice c) Mineral water d) Cranberry juice
a) Coffee Rationale: Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects. Orange juice, mineral water, and cranberry juice are fluids that are allowed.
The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a) Beclomethasone first and then the salmeterol b) Salmeterol first and then the beclomethasone c) Alternating a single puff of each, beginning with the salmeterol d) Alternating a single puff of each, beginning with the beclomethasone
b) Salmeterol first and then the beclomethasone Rationale: Salmeterol (Serevent Diskus) is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? a) Should always be taken with food or antacids b) Should be double-dosed if one dose is forgotten c) Causes orange discoloration of sweat, tears, urine, and feces d) May be discontinued independently if symptoms are gone in 3 months
c) Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently.
Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? a) Osteoarthritis b) Hypothyroidism c) Diabetes mellitus d) Polycystic disease
c) Diabetes mellitus Rationale: Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.
A client taking albuterol (ProAir HFA) by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? a) Get more exercise each day. b) Use a dehumidifier in the home. c) Drink increased amounts of fluids every day. d) Take an extra dose of albuterol before bedtime.
c) Drink increased amounts of fluids every day. Rationale: A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions. This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake. Additional exercise will not effectively clear bronchial secretions. A dehumidifier will dry secretions, making the situation worse. The client should not take additional medication.
Which of the following statements by a client taking montelukast (Singulair) should indicate the need for further teaching? a) "I will need to have my liver function checked." b) "I can take the medication with food or without." c) "I may be able to decrease the use of my metered-dose inhaler." d) "I will take the medication when I first notice I am having trouble breathing."
d) "I will take the medication when I first notice I am having trouble breathing." Rationale: Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening.
A nurse has administered a dose of salmeterol (Serevent Diskus) to a client. The client develops a generalized rash and urticaria, and the eyelids begin to swell. Which action should the nurse take? a) Apply a lanolin-based cream to the rash. b) Encourage the client to drink fluids quickly. c) Assess the client's vision with a Snellen chart. d) Call the health care provider (HCP) immediately.
d) Call the health care provider (HCP) immediately. Rationale: Hypersensitivity reaction can occur in clients taking salmeterol. Signs include rash, urticaria, and swelling of the face, lips, or eyelids. The nurse should call the HCP immediately if any of these occur.
The nurse is administering a dose of pirbuterol (Maxair Autohaler) to a client. The nurse should monitor for which side/adverse effect of this medication? a) Drowsiness b) Hypokalemia c) Hyperglycemia d) Increased pulse
d) Increased pulse Rationale: Pirbuterol is an adrenergic bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The other options are not side and adverse effects of this medication.
A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin (Rifadin) for treatment. The nurse teaches the client to perform which action? a) Report any change in urine color. b) Take both medications with food. c) Take both medications together once a day. d) Expect to take the medication for 2 to 3 weeks.
c) Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of drug-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.
A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? a) "Clear the nasal passages after use." b) "Take the medication only as needed." c) "The medication should start to work immediately." d) "The medication works locally and decreases inflammation."
d) "The medication works locally and decreases inflammation." Rationale: Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.
A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? a) "Inhaled glucocorticoids cure the condition." b) "Inhaled glucocorticoids treat this condition more effectively." c) "Inhaled glucocorticoids decrease the symptoms more quickly." d) "Inhaled glucocorticoids are preferred because of decreased adverse effects."
d) "Inhaled glucocorticoids are preferred because of decreased adverse effects." Rationale: Triamcinolone is an adrenocorticosteroid. Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. COPD is a progressive condition and cannot be cured. Options 2 and 3 are incorrect.
The client questions the nurse as to why the health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which fact? Select all that apply. a) Dry powder inhalers have fewer side effects. b) Dry power inhalers pose no environmental risks. c) Dry power inhalers can be administered more frequently. d) Dry powder inhalers deliver more medication to the lungs. e) Dry powder inhalers require less hand-to-lung coordination.
b) Dry power inhalers pose no environmental risks. d) Dry powder inhalers deliver more medication to the lungs. e) Dry powder inhalers require less hand-to-lung coordination. Rationale: DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the health care provider.
