Question 1

A patient with persistent,frequent asthma exacerbations asks a nurse about a long-acting beta₂-agonist medication. What will the nurse tell this patient?

Accepted Answer

LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs,and they are not used PRN. LABAs increase the risk of asthma-related deaths.

Question 2

A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?

Accepted Answer

LABAs are preferred over SABAs for COPD. Oral beta₂ agonists are not first-line therapy. Although theophylline,a methylxanthine,was once standard therapy in COPD,it is no longer recommended. It is used only if beta₂ agonists are not available.

Question 3

A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device?

Accepted Answer

The Advair Diskus is a dry powder inhaler and is activated by inhalation; therefore,hand-lung coordination is not required. There is no need for a spacer. Patients who use the Diskus take 1 inhalation twice daily.

Question 4

A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:

Accepted Answer

Fluoroquinolone antibiotics increase theophylline levels,so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics,giving the theophylline once daily,and changing to a LABA are not indicated.

Question 5

A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid,montelukast [Singulair],and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute,a heart rate of 96 beats per minute,and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do?

Accepted Answer

To determine the next course of action,it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used,that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results,evaluating the MDI technique may be warranted.

Question 6

A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication?

Accepted Answer

Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent inflammation. Some patients have reported mood changes when taking this drug,so parents should be warned of this effect. The medication is given once daily. The dose for a 7-year-old child is 5 mg daily. The drug does not treat symptoms of an acute attack.

Question 7

A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute,a prolonged expiratory phase,tight wheezes,and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA],90 mcg/puff,every 4 hours for 2 days. The nurse will expect to administer which drug?

Accepted Answer

Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute exacerbations. During asthma flares,nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated,because oxygen saturations are low despite the increased work of breathing. Increasing the dose of albuterol and giving theophylline are not indicated. Salmeterol is a long-term beta agonist and is not useful in an acute attack.

Question 8

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta₂-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

Accepted Answer

Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta₂-adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation.

Question 9

A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication?

Accepted Answer

Dosing for aminophylline is based on each patient's serum theophylline levels. The loading dose usually is 6 mg/kg; after that,the maintenance infusion is titrated according to the theophylline levels. A serum theophylline level of 15 mcg/mL is within the therapeutic range,so dosing would not need to change. The patient's total loading dose will be 180 mg,but infusions should never be given at a rate faster than 25 mg/min.

Question 10

A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta₂-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV₁)is 75% of predicted values. The nurse will expect this patient to be started on which regimen?

Accepted Answer

This patient has moderate persistent asthma,which requires step 3 management for initial treatment. Step 3 includes daily inhalation of a low-dose glucocorticoid/LABA combination supplemented with a SABA as needed. A daily low-dose glucocorticoid with an as-needed SABA is used for step 2 management. A daily medium-dose glucocorticoid/LABA is used for step 4 management. Patients requiring step 1 management do not need daily medications.

Question 11

A patient with asthma will be using a metered-dose inhaler (MDI)for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

Accepted Answer

When two puffs are needed,an interval of at least 1 minute should separate the first puff from the second. Sudden inhalation can cause bronchospasm. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.

Question 12

A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?

Accepted Answer

Like oral glucocorticoids,inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. Patients should increase both their calcium and vitamin D intakes. Patients taking oral glucocorticoids need increased steroids in times of stress. It is not necessary to use two reliable forms of birth control.

Question 13

A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent?

Accepted Answer

Glucocorticoids can slow growth in children and adolescents,but they do not reduce the eventual adult height. The growth rate will return to normal within a year,even when the drug is continued. Long-term use does not affect the eventual adult height.

Question 14

A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose,the patient reports only mild relief within 30 minutes. What will the nurse tell the patient?

Accepted Answer

Tiotropium shows therapeutic effects in about 30 minutes,with improved bronchodilation occurring with subsequent doses,up to 8 days. The medication is given once daily,with inhalation of one capsule. Peak effects occur in 3 hours.

Question 15

Which medication should be used for asthma patients as part of step 1 management?

Accepted Answer

Patients needing step 1 management have intermittent,mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs,along with inhaled glucocorticoids,are used for step 3 management.

Question 16

A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?

Accepted Answer

The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these,patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid.

Question 17

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.)

Accepted Answer

Glucocorticoids act by reducing bronchial hyperreactivity and airway edema and increasing airway responsiveness to beta₂-adrenergic agonists. They do not reduce the number of beta₂-adrenergic agonist receptors. They help reduce the synthesis of inflammatory mediators.

Question 18

A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?

Accepted Answer

The most common adverse effects of this combination drug are dry mouth and irritation of the pharynx. The patient should be reassured that these are common and minor effects. Systemic anticholinergic side effects are rare. It is not necessary to discontinue the medication. Patients with peanut allergy may have severe anaphylactic reactions,but the patient's symptoms are not those associated with anaphylaxis.

Question 19

A nurse is teaching a group of nursing students about the different formulations of beta₂-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching?

Accepted Answer

Oral beta₂ agonists are used only for long-term control. All formulations vary; long-acting beta₂ agonists (LABAs)and oral preparations are used for long-term control,whereas short-acting beta₂ agonists (SABAs)are useful for acute episodes. LABAs are used in conjunction with inhaled glucocorticoids to prevent attacks. SABAs may be given by MDI or nebulizer and usually are given by MDI.

Question 20

A patient with severe,chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss:

Accepted Answer

For patients with chronic,severe COPD,the risk of exacerbations may be reduced with roflumilast. Theophylline is used only when other bronchodilators are not effective. Oral steroids are not indicated for this use. Ipratropium is used to treat bronchospasm in COPD.

Quiz 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease

A patient with persistent,frequent asthma exacerbations asks a nurse about a long-acting beta₂-agonist medication. What will the nurse tell this patient?

A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?

A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device?

A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:

A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication?

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta₂-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication?

A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?

A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent?

A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose,the patient reports only mild relief within 30 minutes. What will the nurse tell the patient?

Which medication should be used for asthma patients as part of step 1 management?

A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.)

A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?

A nurse is teaching a group of nursing students about the different formulations of beta₂-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching?

A patient with severe,chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss:

Quiz 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease

A patient with persistent,frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient?

A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?

A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device?

A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:

A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication?

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication?

A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?

A parent asks a nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent?

A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose,the patient reports only mild relief within 30 minutes. What will the nurse tell the patient?

Which medication should be used for asthma patients as part of step 1 management?

A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.)

A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?

A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching?

A patient with severe,chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss:

A patient with persistent,frequent asthma exacerbations asks a nurse about a long-acting beta₂-agonist medication. What will the nurse tell this patient?

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta₂-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

A nurse is teaching a group of nursing students about the different formulations of beta₂-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching?