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Pharm Respiratory - Lower Respiratory (ch 37)

Terms in this set (72)

COPD
-emphysema
-chronic bronchitis
-asthma
3 classes of bronchodilators
1. beta-adrenergic agonists
2. anticholinergics
3. xanthine derivatives
albuterol drug class
-inhaled = short-acting beta2 agonist
-oral = long-acting beta2 agonist
zafirlukast drug class
oral leukotriene receptor antagonist (LTRA)
ipratropium drug class
inhaled anticholinergic
beclomethasone drug class
inhaled corticosteroid/glucocorticoid
salmeterol drug class
inhaled long-acting beta2 agonist
prednisone drug class
oral corticosteroid/glucocorticoid
aminophylline and theophylline drug class
xanthine derivative/methylxanthine
zileuton drug class
oral leukotriene receptor antagonist (LTRA)
tiotropium drug class
inhaled anticholinergic
fluticasone drug class
inhaled corticosteroid/glucocorticoid
formoterol drug class
inhaled long-acting beta2 agonist
terbutaline drug class
oral long-acting beta2 agonist
montelukast drug class
oral leukotriene receptor antagonist (LTRA)
albuterol indications
-inhaled: acute asthma attack
-oral: long-term control of asthma
salmeterol indications
maintenance treatment of asthma and COPD, not an acute attack (long-acting beta2 agonist)
xanthine derivative/methylxanthine (theophylline) indications
prevention of asthmatic symptoms and COPD, not for the relief of acute asthma attacks
which drugs are used to relieve acute asthma attacks?
-inhaled short-acting beta2 agonists (albuterol)
-intravenous corticosteroids
beta agonist contraindications (3)
-uncontrolled hypertension
-cardiac dysrhythmias
-high risk for stroke (because of vasoconstrictive drug action)
beta agonist adverse effects (6)
-tachycardia
-tremors
-headache
-hypertension
-hypotension
-insomnia
anticholinergic adverse effects (8)
-dry mouth or throat
-nasal congestion
-headache
-GI distress
-urinary retention
-increased intraocular pressure
-palpitations
-anxiety
leukotriene receptor antagonists (LTRA) adverse effects (5)
-liver damage (zileuton, zafirlukast)
-headache
-insomnia
-nausea
-diarrhea
theophylline (xanthine derivative) adverse effects (5)
-nausea
-vomiting
-palpitations
-tachycardia
-ventricular dysrhythmias
theophylline contraindications (4)
-uncontrolled cardiac dysrhythmias
-seizure disorders
-hyperthyroidism
-peptic ulcers
theophylline interactions (2)
-caffeine (increases theophylline levels, CNS adverse effects, cardiac adverse effects)
-cigarette smoking (decreases theophylline levels)
therapeutic blood level of theophylline
5-15 mcg/mL
symptoms of theophylline toxicity (5)
-restlessness
-nervousness
-tremors
-palpitations
-tachycardia

(NCLEX)
corticosteroid adverse effects (6)
-adrenal insufficiency/suppression of adrenal gland function
-increased susceptibility to infection
-fluid and electrolyte disturbances
-hypergylcemia
-osteoporosis, bone loss
-Cushing's syndrome
corticosteroid drug interactions (2)
-aspirin and NSAIDs increase risk of GI ulceration and bleeding
-concurrent use of glucocorticoids and hypoglycemic agents can counteract the effects/cause hyperglycemia
pt teaching: corticosteroid inhalers
rinse mouth immediately after using inhaler or nebulizer to prevent oral candidiasis/thrush
Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers?
a. "After you inhale the medication once, repeat until you obtain relief."
b. "Wait 1 to 2 minutes before you take a second puff of the same drug."
c. "Make sure that you puff out air several times after you inhale the medication."
d. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
b. "Wait 1 to 2 minutes before you take a second puff of the same drug."

Pharm
During a teaching session for a patient who will be reaching a new prescription for the LTRA montelukast (Singular), the nurse will tell the patient that the drug has which therapeutic effect?
a. Improves the respiratory drive
b. Loosens and removed thickened secretions
c. Reduces inflammation in the airway
d. Stimulates immediate bronchodilation
c. Reduces inflammation in the airway

Pharm
What is the role of corticosteroids in the treatment of acute respiratory disorders?
a. They decrease inflammation.
b. They directly dilate the bronchi.
c. They stimulate the immune system.
d. They increase gas exchange in the alveoli.
a. They decrease inflammation.

Pharm
Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse?
a. "It will take about 3 or 4 weeks before you notice a therapeutic effect."
b. "Take the medication when you are short of breath and begin wheezing."
c. "This medication works by preventing the inflammation that causes your asthma attack."
d. "Increase fiber and fluid in your diet to prevent the common adverse effect of constipation."
c. "This medication works by preventing the inflammation that causes your asthma attack."

Pharm
A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?
a. take the albuterol at the same time each day
b. administer the albuterol inhaler prior to using the beclomethasone inhaler
c. use beclomethasone if experiencing an acute episode
d. avoid shaking the beclomethasone before use
b. administer the albuterol inhaler prior to using the beclomethasone inhaler

(the beta inhaler promotes bronchodilation and enhances the absorption of the corticosteroid)

ATI
A pt who has a hx of asthma is experiencing an acute episode of shortness of breath and needs to take a medication for immediate relief. The nurse will choose which medication that is appropriate for this situation?
a. a beta agonist, such as albuterol
b. a leukotrine receptor antagonist, such as montelukast
c. a corticosteroid, such as fluticasone
d. an anticholinergic, such as ipratropium
a. a beta agonist, such as albuterol

Pharm
After a nebulizer treatment with the beta agonist albuterol, the pt complains of feeling a little "shaky," with slight tremors of the hands. The pt's heart rate is 98 bpm, increased from the pretreatment rate of 88 bpm. The nurse knows that this reaction is an
a. expected adverse effect of the medication
b. allergic reaction to the medication
c. indication that he has received an overdose of the medication
d. idiosyncratic reaction to the medication
a. expected adverse effect of the medication

Pharm
A patient has been receiving aminophylline (xanthine derivative) infusion for 24 hrs. The nurse will assess for which adverse effects when assessing the patient during the infusion?
a. CNS depression
b. Sinus tachycardia
c. Increased appetite
d. Temporary urinary retention
b. Sinus tachycardia

Pharm
After a patient takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the patient needs to take next?
a. Hold the breath for 60 seconds
b. Rinse out the mouth with water
c. Follow the corticosteroid with a bronchodilator inhaler, if ordered
d. Repeat the dose in 15 minutes if the patient feels short of breath
b. Rinse out the mouth with water

Pharm
The nurse is teaching a patient about the inhaler Adair (salmeterol/fluticasone). Which statements by the patient indicate a correct understanding of this medication? (Select all that apply.)
a. "I will rinse my mouth with water after each dose."
b. "I need to use this inhaler whenever I feel short of breath, but not less than 4 hrs between doses."
c. "This medication is taken twice a day, every 12 hrs."
d. "I can take this inhaler if I get short of breath while exercising."
e. "I will call my doctor if I notice white patches inside my mouth."
a. "I will rinse my mouth with water after each dose."
c. "This medication is taken twice a day, every 12 hrs."
e. "I will call my doctor if I notice white patches inside my mouth."

Pharm
A patient who is taking a xanthine derivative for chronic bronchitis asks the nurse, "I miss my morning coffee. I can't wait to go home and have some." What is the nurse's best response?
a. "I know how you feel. I miss my coffee too."
b. "I can get some coffee for you. I'll be right back."
c. "It's important to not take coffee or other caffeinated products with this medicine as it may cause increased heart rate as well as other problems."
d. "You've been on this medicine for a few days. I can call your prescriber and ask whether you can have some coffee."
c. "It's important to not take coffee or other caffeinated products with this medicine as it may cause increased heart rate as well as other problems."

Pharm
The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level?
a. Toxic
b. Therapeutic
c. Subtherapeutic
d. Life threatening
b. Therapeutic
(10-15 mcg/mL)

Pharm
Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect?
a. Tachycardia
b. Nonproductive cough
c. Hypoglycemia
d. Sedation
a. Tachycardia

Pharm
Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels?
a. Garlic
b. Echinacea
c. Peppermint oil
d. St. John's wort
d. St. John's wort

Pharm
The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription?
a. Thrombocytopenia
b. Coronary artery disease
c. Mycobacterium tuberculosis
d. Chronic obstructive pulmonary disease
b. Coronary artery disease

Pharm
A nurse is caring for a client who is receiving long-term treatment for systemic lupus erythematosus with prednisone. The nurse should inform the client to expect to undergo which of the following diagnostic tests to monitor for long-term complications of prednisone?
a. pulmonary function tests
b. electrocardiograms
c. liver function studies
d. bone density scans
d. bone density scans

ATI
A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)?
a. Quicker peak action
b. Shorter onset of action
c. Extended time of action
d. Longer duration of action
d. Longer duration of action

Pharm
Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)?
a. "I will rinse my mouth with water after each use."
b. "I will wash the plastic inhaler casing once a month."
c. "I will take two puffs to treat an acute asthma attack."
d. "I will not use my albuterol inhaler while I am taking AeroBid."
a. "I will rinse my mouth with water after each use."
(flunisolide is a corticosteroid)

Pharm
The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful?
a. "I will not drink grapefruit juice while taking this drug."
b. "I may gain weight as a result of taking this medication."
c. "This inhaler is not to be used alone to treat an acute asthma attack."
d. "Nausea and vomiting are common adverse effects of this medication."
c. "This inhaler is not to be used alone to treat an acute asthma attack."

Pharm
Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client?
a. Liver enzymes
b. Cardiac enzymes
c. Renal function tests
d. Complete blood count
a. Liver enzymes

Pharm
Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.)
a. Latex
b. Lactose
c. Cellulose
d. Povidone
e. Chlorhexidine
b. Lactose
c. Cellulose
d. Povidone

Pharm
The nurse is teaching a group of pts about the use of bronchodilators. It is important to remind them that using bronchodilators too frequently may cause which adverse effects? (Select all that apply)
a. blurred vision
b. increased heart rate
c. decreased heart rate
d. nausea
e. nervousness
f. tremors
b. increased heart rate
d. nausea
e. nervousness
f. tremors

workbook
For pts taking a leukotriene receptor agonist, the nurse should include which information in the pt teaching?
a. if a dose is missed, the pt may take a double dose to maintain blood levels
b. the pt should gargle or rinse the mouth after using the inhaler
c. the medication should be taken at the first sign of bronchospasm
d. improvement should be seen within a week of use
d. improvement should be seen within a week of use

workbook
Which drug acts by blocking leukotrienes, thus reducing inflammation in the lungs?
a. cromolyn (Intal)
b. montelukast (Singulair)
c. theophylline (elixophyllin)
d. albuterol (Proventil)
b. montelukast (Singulair)

workbook
A pt is experiencing status asthmaticus. The nurse will prepare to administer which drug first?
a. epinephrine
b. methylprednisolone (Solu-Medrol)
c. cromolyn (Intal)
d. montelukast (Singulair)
a. epinephrine

workbook
When a pt is taking parenteral xanthine derivatives such as aminophylline, the nurse should monitor for which adverse effect?
a. decreased respirations
b. hypotension
c. tachycardia
d. hypoglycemia
c. tachycardia

workbook
Which of the following pt factors would most concern the nurse in a pt who is taking theophylline?
a. the pt has increased fluid intake
b. the pt smokes a pack of cigarettes a day
c. the pt has bradycardia
d. the pt complains of sleepiness
b. the pt smokes a pack of cigarettes a day

(cigarettes decrease theophylline levels)

workbook
The pt who has asthma may be prescribed which type of inhaled drug for its anti-inflammatory effects?
a. corticosteroid
b. anticholinergic
c. xanthine derivative
d. beta adrenergic
a. corticosteroid

workbook
A nurse is providing teaching to the parents of a school-age child who has asthma about medications for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve an acute asthma attack?
a. salmeterol
b. cromolyn
c. fluticasone
d. albuterol
d. albuterol

ATI
A pt is to receive a new prescription for an ipratropium (Atrovent) inhaler. The nurse will assess for which potential contraindications? (Select all that apply)
a. allergy to soy lecithin
b. allergy to peanuts
c. allergy to iodine products
d. hypertension
e. seizure disorders
a. allergy to soy lecithin
b. allergy to peanuts

workbook
A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include?
a. "Limit fluid intake while taking this medication."
b. "Increase your intake of vitamin B12 while taking this medication."
c. "Rinse your mouth after each use of this medication."
d. "You can take the medication as needed."
c. "Rinse your mouth after each use of this medication."
(beclomethasone = inhaled corticosteroid)

ATI
A nurse is teaching a pt who has a prescription for long-term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the pt to monitor for which of the following adverse effects of this medication?
a. weight gain
b. nervousness
c. bradycardia
d. constipation
a. weight gain
(prednisone = corticosteroid)

ATI
A nurse is providing instructions to the parent of an adolescent client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include?
a. "You can take this medication to abort an asthma attack."
b. "Tremors are an adverse effect of this medication."
c. "Prolonged use of this medication can cause hyperglycemia."
d. "This medication can slow skeletal growth rate."
b. "Tremors are an adverse effect of this medication."

ATI
A client with chronic asthma develops Cushing's syndrome. Development of the complication can most likely be attributed to long-term use of:
1. prednisone
b. theophylline
c. metaproterenol (Alupent)
d. cromolyn (Intal)
1. prednisone

(Cushing's syndrome results from excessive use of glucocorticoids)

Critical Thinking textbook
Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical hx for which disorder in which the medication should be used with caution?
1. osteoarthritis
2. hypothyroidism
3. diabetes mellitus
4. polycystic disease
3. diabetes mellitus
(bronchodilator, oral beta agonist, may increase blood glucose levels)

NCLEX
A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking this medication?
1. coffee, cola, and chocolate
2. oysters, lobster, and shrimp
3. melons, oranges, and pineapple
4. cottage cheese, cream cheese, and dairy creamers
1. coffee, cola, and chocolate
(avoid caffeine when taking xanthine derivatives)

NCLEX
The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure?
1. beclomethasone first and then the salmeterol
2. salmeterol first and then the beclomethasone
3. alternating a single puff of each, beginning with the salmeterol
4. alternating a single pull of each, beginning with the beclomethasone
2. salmeterol first and then the beclomethasone
(bronchodilator then corticosteroid)

NCLEX
The nurse is teaching a client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is needed?
1. "I need to take the medication every day at the same time."
2. "I can take aspirin or my antihistamine if I need it."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my health care provider."
2. "I can take aspirin or my antihistamine if I need it."

prednisone = glucocorticoid

NCLEX
Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication?
1. platelet count
2. neutrophil count
3. liver function tests
4. complete blood count
3. liver function tests
(LTRA)

NCLEX
A nurse is planning to teach about inhalant medications to a client who had a new diagnosis of exercise-induced asthma. What medication should the nurse plan to instruct the client to use prior to physical activity?
a. cromolyn
b. beclomethasone
c. budesonide
d. tiotropium
a. cromolyn

(stabilizes mast cells, which inhibits the release of histamine and other inflammatory mediators. Should be used 10-15 min before planning to exercise to prevent bronchospasms)

ATI
A nurse is assessing a client who takes oral theophylline for relief of chronic bronchitis. The nurse should recognize that which of the following findings indicates toxicity to theophylline?
a. constipation
b. tremors
c. fatigue
d. bradycardia
b. tremors

ATI
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