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CH. 36: Lower Respiratory Disorders

Terms in this set (15)

a. "I should use albuterol when my symptoms worsen."

Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible.
1. The nurse is caring for a patient recently diagnosed with mild emphysema and provides
teaching about the disease and medications for treatment. Which statement by the patient
indicates understanding of the medication regimen?
a. "I should use albuterol when my symptoms worsen."
b. "I will need to take oral prednisone on a daily basis."
c. "My provider will frequently prescribe prophylactic antibiotics."
d. "My symptoms are reversible with proper medications."
d. Cardiac and pulmonary effects

Nonselective sympathomimetic epinephrine is an alpha1, beta1, and beta2 agonist that is
given to promote bronchodilation and elevate blood pressure. It does not have anticholinergic
effects.
2. The nurse is preparing to administer epinephrine to a patient who is experiencing an acute
bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and
beta-adrenergic agonist, the patient will experience which effects?
a. Decreased blood pressure
b. Anticholinergic effects
c. A shorter duration of therapeutic effects
d. Cardiac and pulmonary effects
d. Overuse of this medication can result in airway narrowing and bronchospasm.

Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.
3. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms.
What information will the nurse include when teaching this patient about this medication?
a. Failure to respond to the medication indicates a need for a higher dose.
b. Monitor for hypoglycemia symptoms when using this medication.
c. Palpitations are common with this drug even at normal, therapeutic doses.
d. Overuse of this medication can result in airway narrowing and bronchospasm.
a. Albuterol, ipratropium bromide, steroid

Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect.
4. A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an
inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this
patient about disease and medication management, the nurse will instruct the patient to
administer these medications in which order?
a. Albuterol, ipratropium bromide, steroid
b. Albuterol, steroid, ipratropium bromide
c. Ipratropium bromide, albuterol, steroid
d. Steroid, ipratropium bromide, albuterol
c. To increase forced expiratory volume, an indicator of symptom improvement

Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the forced expiratory volume in 1 second (FEV1). While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter the drug's side effects.
5. A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient
who has chronic obstructive pulmonary disease (COPD). The nurse explains that this
combination product is prescribed primarily for which reason?
a. To be more convenient for patients who require both medications
b. To improve compliance in patients who may forget to take both drugs
c. To increase forced expiratory volume, an indicator of symptom improvement
d. To minimize the side effects that would occur if the drugs are given separately
c. Avoid caffeine while taking this medication.

Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed.
6. The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when
discharged home from the hospital. What information will the nurse include when teaching
the patient about this drug?
a. An extra dose should be taken when symptoms worsen.
b. Anorexia and gastrointestinal upset are unexpected side effects.
c. Avoid caffeine while taking this medication.
d. Food will decrease the amount of drug absorbed.
b. obtain an order for a serum theophylline level.

Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism.
7. The nurse is caring for a patient who is receiving intravenous theophylline. The patient
complains of headache and nausea. The nurse will contact the provider to:
a. change the medication to an oral theophylline.
b. obtain an order for a serum theophylline level.
c. request an order for an analgesic medication.
d. suggest an alternative methylxanthine medication.
b. A larger than typical dose of theophylline.

Tobacco smoking increases the metabolism of theophylline, so patients who smoke may
require a higher dose for therapeutic effects.
8. The nurse is caring for a patient who will begin taking theophylline at home. During the
assessment, the nurse learns that the patient smokes. The nurse expects that the patient will
eventually require which of the following?
a. A smaller than typical dose of theophylline.
b. A larger than typical dose of theophylline.
c. A typical dose of theophylline.
d. A change in medication since theophylline is contraindicated in those who smoke.
a. Ephedra.

Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients
should be questioned about use of herbal medications. To determine toxicity, serum drug
levels must be drawn; at this point, the patient reports symptoms of theophylline side effects.
9. A patient who has been taking theophylline at home reports having palpitations and jitteriness.
Which of the following could interact with theophylline to increase side effects such as these?
a. Ephedra.
b. Acetaminophen.
c. Ibuprofen.
d. Diphenhydramine.
d. "I will use this as needed for acute symptoms."

Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin as they will block the effects of montelukast. This medication is recommended to be given in the evening.
10. The nurse provides teaching for a patient who will begin taking montelukast sodium
(Singulair). Which statement by the patient indicates a need for further teaching?
a. "I will need to have periodic laboratory tests while taking this medication."
b. "I will not take ibuprofen for pain or fever while taking this drug."
c. "I will take one tablet daily at bedtime."
d. "I will use this as needed for acute symptoms."
d. Rinse the mouth thoroughly with water after each use.

When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective.
11. A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The
nurse notes white spots on the patient's tongue and oral mucous membranes. After notifying
the provider, the nurse will remind the patient to perform which action?
a. Avoid using a spacer with the inhaled glucocorticoid medication.
b. Clean the inhaler with hot, soapy water after each use.
c. Consume yogurt daily while using this medication.
d. Rinse the mouth thoroughly with water after each use.
a. has a more immediate onset than the oral form.

Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance.
12. A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The
patient asks the nurse about the difference between using an oral form of albuterol and the
inhaled form. The nurse will explain that the inhaled form of albuterol:
a. has a more immediate onset than the oral form.
b. may cause more side effects than the oral preparation.
c. requires an increased dose in order to have therapeutic effects.
d. will not lead to tolerance with increased doses.
c. Liver function tests and serum glucose

The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.
13. The nurse is performing a medication history on a patient who reports long-term use of
montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will
contact the provider to discuss an order for which laboratory tests?
a. Cardiac enzymes and serum calcium
b. Electrolytes and a complete blood count
c. Liver function tests and serum glucose
d. Urinalysis and serum magnesium
d. Tiotropium works by relaxing and dilating the bronchioles.

Tiotropium is an anticholinergic drug used for maintenance treatment of bronchospasms
associated with COPD. It inhibits M3 receptor response to acetylcholine, thereby relaxing
smooth muscle of bronchi; it dilates the bronchi. Patients should discard any capsules that are
opened and not used immediately. Dry mouth is a common side effect. It is not to be used as a
rescue inhaler.
14. The nurse is caring for a patient diagnosed with COPD who has been prescribed tiotropium
(Spiriva). Which statement will the nurse include in the education?
a. Remove the capsules from the packaging and place in your 7-day med box.
b. If you experience dry mouth, stop taking the medication immediately.
c. Use tiotropium as needed for sudden breathing problems.
d. Tiotropium works by relaxing and dilating the bronchioles.
a. Drink water before and after using the inhaler.

Cough and a bad taste are the most common side effects associated with cromolyn sodium, and these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm.
15. A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report
experiencing cough and a bad taste. The nurse will instruct the patient to perform which
action?
a. Drink water before and after using the inhaler.
b. Schedule an appointment to discuss these effects with the provider.
c. Stop taking the medication immediately.
d. Use the inhaler only as needed for acute bronchospasms.
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