Deck 21: Drug Therapy for Asthma and Other Respiratory Problems

Question 1

Which type of asthma problem is helped most by bronchodilator drugs?

A) Thick mucus
B) Mucosal swelling
C) Bronchoconstriction
D) Large,flabby alveoli

Answer 1

Bronchoconstriction

Question 2

Which type of asthma problem is helped most directly by anti-inflammatory drugs?

A) Thick mucus
B) Mucosal swelling
C) Bronchoconstriction
D) Large,flabby alveoli

Answer 2

Mucosal swelling

Question 3

A patient reaches for the salmeterol (Serevent)inhaler with the onset of an asthma attack.What is your best instruction to the patient?

A) Use the albuterol (Proventil)inhaler instead.
B) Wait at least one full minute between puffs.
C) Attach the spacer to the inhaler before using it.
D) Take a deep breath,hold it for 15 seconds,and then exhale before using the inhaler.

Answer 3

Use the albuterol (Proventil)inhaler instead.

Question 4

Which of these bronchodilators is a cholinergic antagonist?

A) Albuterol
B) Terbutaline
C) Ipratropium
D) Aminophylline

Question 5

What is the main way iloprost (Ilomedin)is administered?

A) Oral inhalation
B) Subcutaneous injection
C) Sublingual tablet
D) Continuous intravenous infusion

Question 6

What is the most common route used to deliver short-acting beta-adrenergic agonists?

A) Oral
B) Intravenous
C) Transdermal
D) Inhalation

Question 7

A patient with asthma is prescribed albuterol (Proventil)as needed and salmeterol (Serevent)every 12 hours.When the patient asks why two inhaler drugs are needed,what is your best response?

A) "Albuterol opens your airways and salmeterol decreases the inflammation."
B) "I will check with the prescriber to determine whether you can just use one drug."
C) "Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks."
D) "Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange."

Question 8

Which part of the respiratory system is most affected by asthma?

A) Alveoli
B) Airway
C) Trachea
D) Cartilage

Question 9

Which part of the airway is affected by excessive mucus?

A) Lumen
B) Cartilage
C) Smooth muscle
D) Mucous membrane

Question 10

Which problem is the main adverse effect of epoprostenol (Flolan)?

A) Impotence
B) Prolonged bleeding
C) Severe hypertension
D) Congestive heart failure

Question 11

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD)than as therapy for asthma?

A) Epoprostenol (Flolan)
B) Warfarin (Coumadin)
C) Guaifenesin (Organidin)
D) Salmeterol (Serevent)

Question 12

Which statement about the pathology of asthma is true?

A) Breath sounds are normal between attacks.
B) Mucous plugs are the major cause of airway obstruction.
C) Eventually the alveoli are destroyed and gas exchange is limited.
D) During an attack,arterial oxygen levels and carbon dioxide levels are decreased.

Question 13

Drugs from which classes are considered the mainstays of therapy for pulmonary fibrosis?

A) Amiodarone and ambrisentan
B) Nonsteroidal anti-inflammatories and opiates
C) Corticosteroids and immunosuppressants
D) Disease-modifying antirheumatic drugs and aspirin

Question 14

A patient has been medicated during an asthma attack.Which assessment finding indicates that the therapy is ineffective?

A) Trachea is at the midline.
B) Oxygen saturation is 96%.
C) Respiratory rate is 22 breaths/min.
D) Peak expiratory flow is 40% below expected value.

Question 15

Which type of problem narrows the airways by tightening bronchial smooth muscle?

A) Alveoli
B) Emphysema
C) Chronic bronchitis
D) Bronchoconstriction

Question 16

A patient newly diagnosed with chronic obstructive pulmonary disease (COPD)is prescribed inhaled pirbuterol (Maxair)every 6 hours.You should instruct the patient to take additional drug doses during which specific times or conditions?

A) At bedtime
B) When feeling especially nervous
C) When feeling especially breathless
D) If the peak expiratory flow rate is 80% or greater than his or her personal best

Question 17

Which problem is a common side effect of beta-adrenergic agonist types of bronchodilators?

A) Hypertension
B) Urinary retention
C) Increased bleeding
D) Shortness of breath

Question 18

Why are long-acting beta-adrenergic agonists not useful during an actual acute asthma attack?

A) They are likely to cause allergies.
B) They need time to build up an effect.
C) They take too long to be absorbed by the intestinal tract.
D) They reduce inflammation rather than relax bronchial smooth muscle.

Question 19

What is a common side effect of inhaled anti-inflammatory drugs for asthma?

A) Anemia
B) Bronchoconstriction
C) Cutaneous itching
D) Dry mouth

Question 20

The use of which drug or drugs is/are associated with later development of pulmonary artery hypertension (PAH)?

A) Amiodarone and ambrisentan
B) Macitentan and cyclophosphamide
C) Fenfluramine/phentermine
D) Disease-modifying antirheumatic drugs

Question 21

What is the most important precaution to teach a patient about anti-inflammatory drugs used for respiratory problems?

A) To keep the drug with them at all times to use for sudden narrowing of the airways.
B) To take the drug daily,even when symptoms of airway obstruction are not present.
C) To avoid crowds and people who are ill because of the greatly increased risk for infection.
D) To brush their teeth at least four times daily to remove the drug from the mouth and improve taste.

Question 22

A patient who has been prescribed an inhaled corticosteroid develops a thick white coating on the tongue and patches on the inside cheeks.What is your best action?

A) Instruct the patient to stop using the inhaler until the coating is gone.
B) Obtain a culture of the coating and take the patient's temperature.
C) Hold the dose and notify the prescriber immediately.
D) Document the finding and notify the prescriber.

Question 23

Why are xanthines seldom used to treat asthma now?

A) They increase bronchial secretions at the same time that they induce bronchial dilation.
B) They have no role in preventing bronchoconstriction or inflammation.
C) They are all administered intravenously.
D) They have severe systemic side effects.

Question 24

A patient taking montelukast (Singulair)for the last 2 months has the following blood laboratory test values.Which value do you report to the prescriber immediately?

A) White blood cell count of 10,500 cells/mm³
B) Lactate dehydrogenase 950 IU/L
C) Potassium 3.6 mEq/L
D) Hematocrit 32%

Question 25

A home care patient with chronic obstructive pulmonary disease (COPD)has oral candidiasis.What additional information should you obtain from this patient?

A) "How often are you using your steroid inhaler?"
B) "Do you share a toothbrush with any members of your family?"
C) "When was the last time your inhaler drug prescriptions were filled?"
D) "Have you taken any over-the-counter drugs for a cold or flu lately?"

Question 26

For which asthma patient is a beta₂-adrenergic agonist best delivered by nebulizer?

A) 3-year-old child who has a broken leg
B) 16-year-old boy who has a broken nose
C) 25-year-old woman who is 8 months pregnant
D) 60-year-old man who has an enlarged prostate gland

Question 27

A patient is starting on the drug cromolyn sodium.Which statement made by the patient indicates a need for clarification about the purpose,administration schedule,or side effects of this drug?

A) "If I get a skin rash,I will call my doctor right away."
B) "I will keep using the drug even if I don't notice a difference in my asthma after the first week."
C) "I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs."
D) "I have been trying to inhale deeply when I trigger the inhaler so that more of the drug reaches my lungs."

Question 28

A patient is prescribed to receive 90 mcg of levalbuterol (Xopenex)every 4 hours by oral inhalation.The available drug is levalbuterol 45 mcg/puff.How many total puffs will you tell this patient to take daily?

A) 4 puffs
B) 8 puffs
C) 12 puffs
D) 16 puffs

Question 29

Which instruction is most important to teach a patient using an aerosol inhaler with a spacer?

A) "Breathe in rapidly until the spacer makes a continuous whistling sound."
B) "Seal your lips tightly around the spacer's mouthpiece."
C) "Release both doses into the spacer before breathing in."
D) "Avoid breathing back into the spacer."

Question 30

A patient with asthma asks why he must take regularly scheduled systemic drugs when he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta agonist inhaler.What is your best response?

A) "Frequent asthma attacks,even if they are halted relatively quickly,damage the bronchial tissues over time."
B) "If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema."
C) "Using only short-acting beta agonists will lead to drug resistance and then the drug won't work when you need it."
D) "Inhaled beta agonist drugs only treat the constriction aspects of asthma and do not help the inflammatory aspects of the disease."

Question 31

A 75-year-old patient with chronic obstructive pulmonary disease (COPD)is prescribed tiotropium (Spiriva),an inhaled drug that must be loaded into a HandiHaler with each dose.The patient has all of the following health problems.For which problem do you suggest to the prescriber that this drug may not be appropriate?

A) Reduced hearing
B) Visual impairment
C) Chronic high blood pressure
D) Arthritis of hands and knees

Question 32

Which action should be taught to the individual prescribed to use a dry-powder inhaler for asthma control?

A) Shake the inhaler well before using.
B) Breathe in deeply to pull the drug into your lungs.
C) Keep the inhaler in the refrigerator between uses.
D) Clean the mouthpiece daily by rinsing it in warm running water.

Question 33

How do mucolytics help asthma and chronic obstructive lung disease (COPD)?

A) Reducing inflammation
B) Inducing bronchodilation
C) Reducing mucus thickness
D) Enhancing respiratory rate

Question 34

How are asthma and chronic obstructive pulmonary disease (COPD)different?

A) COPD is a genetic disease whereas asthma is largely caused by allergies.
B) Breathing problems with asthma are reversible but those with COPD are permanent.
C) Asthma is a disease of children and younger adults whereas COPD is found only in older adults.
D) Breathing problems with COPD can lead to death,whereas those with asthma are not severe enough to be fatal.

Question 35

A patient with chronic obstructive pulmonary disease (COPD)who is prescribed a short-acting inhaled beta₂ agonist reports hating the inhaler and asks why the drug can't be taken as a pill.What is the nurse's best response?

A) "Inhaled drugs work more slowly."
B) "Inhaled drugs have no side effects."
C) "Oral drugs are usually more expensive."
D) "Oral drugs have more systemic side effects."

Question 36

A patient is prescribed a dry-powder inhaler (DPI)for chronic obstructive pulmonary disease (COPD).Which statement made by the patient indicates that more instruction is needed?

A) "I won't exhale into the inhaler."
B) "The inhaler will be kept in the drawer of my bedroom dresser."
C) "I will wash the inhaler mouthpiece daily with soap and water."
D) "I'll inhale twice as hard through this inhaler as I do with my aerosol inhaler."

Question 37

A patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid.What precaution for using these drugs should you stress to the patient?

A) "Use the corticosteroid right before meals to reduce mucus secretion."
B) "Use the bronchodilator inhaler only in the morning to prevent sleep difficulties."
C) "Use the bronchodilator first,wait at least 5 minutes,then use the corticosteroid."
D) "Use the corticosteroid first,wait at least 5 minutes,then use the bronchodilator."

Question 38

A patient who is prescribed oral terbutaline (Brethine)reports all of the following signs and symptoms.Which should you report to the prescriber?

A) Difficulty sleeping
B) Taste changes
C) Chest pain
D) Dry mouth

Question 39

Which assessment is most important to perform before administering a bronchodilator by inhalation?

A) Listening with a stethoscope to the patient's breath sounds.
B) Measuring blood pressure in the sitting and standing positions.
C) Asking questions to assess the patient's cognition and mental status.
D) Checking the oral mucous membranes for white or cream-colored patches.

Question 40

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)?

A) Relaxing bronchial smooth muscle,leading to wider airways
B) Reducing mucosal swelling in the lumens,leading to wider airways
C) Triggering the sympathetic nervous system,leading to deeper respirations
D) Controlling anxiety,leading to an increased ability to focus on respiratory effort

Question 41

A patient receiving a prostacyclin agent and an endothelin-receptor antagonist for treatment of pulmonary artery hypertension (PAH)has an international normalized ratio (INR)of 1.9.What is your best action?

A) Document the INR level as the only action.
B) Hold the next dose of the drugs and notify the prescriber.
C) Ask the patient whether he or she has lost more than 3 lb this week.
D) Inspect the infusion site for any other indications of inflammation or infection.

Question 42

What is the most important precaution to teach a patient who has a continuous infusion of treprostinil to manage pulmonary artery hypertension?

A) "Avoid crowds and people who are ill."
B) "Use at least two reliable forms of birth control."
C) "Go to the nearest emergency room if the line clogs."
D) "Report a headache lasting 24 hours to your prescriber immediately."

Question 43

A patient who weighs 125 lb is prescribed to receive treprostinil (Remodulin)1.25 ng/kg/min for the next 4 hours.What is the total dose this patient should receive in 4 hours?

Question 44

Which responses are possible side effects of inhaled beta₂-adrenergic agonists? (select all that apply)

A) Bad taste in the mouth
B) Increased salivation
C) Difficulty sleeping
D) Rapid heart rate
E) Hypotension