Deck 73: Pharmacotherapy of Asthma and Other Pulmonary Disorders

Question 1

A nurse is teaching an asthmatic patient about his steroid inhaler prior to discharge.The expected outcome of this therapy is:
1)Less swelling and mucus formation, and decreased bronchospasm.
2)Decreased inflammation of the mid-sized bronchial tubes.
3)Less histamine formation, with less mucus in the upper airway.
4)Resolution of all asthma symptoms.

Answer 1

1

Question 2

A patient in acute respiratory distress on a medical unit is receiving a nebulizer albuterol treatment.The patient is annoyed because he already has an albuterol MDI.The nurse's response to the patient's concern is based on the knowledge that:
1)Suspension of the medication in liquid and delivery over a longer period increase the bronchodilator's effectiveness.
2)The agitated and dyspneic patient is unlikely to be able to use a metered-dose albuterol inhaler effectively.
3)The nebulized form of the drug will have fewer negative effects on this distressed patient.
4)Nebulized therapy is more cost-effective in the inpatient setting.

Answer 2

1

Question 3

The nurse is admitting a patient with a provisional diagnosis of asthma.The patient reports that she has asthma attacks about every other day.She has had three episodes that awakened her at night in the last month.She reports that she has trouble working on days when she has an attack.The nurse concludes this patient's care will be planned on the assumption that the patient has a certain level of asthma, namely:
1)Intermittent asthma.
2)Mild persistent asthma.
3)Severe asthma.
4)Moderate persistent asthma.

Answer 3

2

Question 4

A patient with degenerative arthritis is provided with a spacer along with a steroid-based metered-dose inhaler.The nurse recognizes that the use of the spacer assists this patient to:
1)Use a larger dose of the steroid.
2)Compensate for decreased dexterity.
3)Avoid thrush infections.
4)Progress with weaning from the steroid drug.

Question 5

A patient with limited strength in his hands is being prepared for discharge with a dry powder inhaler.The discharge nurse teaches the patient the advantage of this inhaler.This teaching is based on the knowledge that:
1)The patient can activate the inhaler with less pressure than needed for a metered-dose inhaler.
2)The patient can activate the inhaler simply by inhaling.
3)The patient can increase the effectiveness of the powder by instilling it into a small nebulizer.
4)This inhaler has no dose limits.

Question 6

A nurse in an intensive care unit is planning care for a patient with severe bronchospasms triggered by a known allergy to peanuts he consumed at a party.The nurse recognizes that these abrupt spasms are related to antibodies that trigger:
1)Contractions of the muscles in the walls of the large bronchiole tubes.
2)The formation of sticky mucous plugs.
3)Swelling of the juncture between the alveolus and the capillary bed.
4)Formation of thick membrane between the alveoli and the capillary bed.

Question 7

A nurse is advising a patient about techniques for management of his exercise-induced asthma.The nurse's presentation will focus on ways to:
1)Avoid bronchoconstriction.
2)Decrease the vigor of exercise.
3)Eliminate aerobic activities.
4)Slow down the respiratory rate.

Question 8

Over the course of treatment for chronic asthma, a patient develops an allergy to the propellants in metered-dose inhalers.What option would the nurse expect to be used to address this problem after discharge?
1)A dry powder inhaler
2)A concentrated-dose metered-dose inhaler
3)Nebulizer treatments
4)Oral medication of the same class as the metered-dose inhaler

Question 9

The nurse is triaging patients through the ED.An adult admission has a respiratory rate of 32 breaths per minute.The patient is not injured, but was brought to the ED because she started gasping after witnessing a drive-by shooting.The nurse recognizes that the patient's rapid breathing is probably driven by:
1)Increased perfusion in the cerebral cortex.
2)Increased perfusion in the alveolar capillary bed.
3)A sudden increase in blood pressure.
4)Brainstem activity.

Question 10

The nurse is caring for a patient who is taking a non-selective beta blocker preparation for hypertension.The patient starts to complain of shortness of breath.The nurse realizes that this kind of beta blocker:
1)Irritates the mucosa in the airways.
2)Triggers bronchoconstriction in the airways.
3)Promotes swelling inside airways.
4)Produces mucous plugs that can totally block off airways.

Question 11

The nurse is planning care for a patient with chronic lung disease.The patient is wheezing, with a HR of 130 and respiratory rate of 26 per minute; is using his accessory muscles of respiration; is coughing up yellow mucous; and has a pulse oximetry reading of 86%.The highest-priority nursing diagnosis is:
1)Impaired Gas Exchange related to low pulse oximeter reading.
2)Impaired Airway Clearance related to thick mucus.
3)Injury (respiratory arrest), high risk for secondary to severe respiratory impairment.
4)Decreased Cardiac Output related to tachycardia and rapid breathing.

Question 12

A nurse is caring for several patients receiving beta blocker therapy.The nurse has noted that some patients develop wheezing after beta blocker therapy.Which preparation would the nurse consider most problematic?
1)Propranolol (Inderal)
2)Atenolol (Tenormin)
3)Metoprolol (Lopressor)
4)Bisoprolol (Zebeta)

Question 13

The nurse is collaboratively setting goals for the inpatient management of new-onset asthma in a child.The nurse prioritizes the patient's nursing diagnoses, and gives which goal the highest priority?
1)The patient's pulse oximetry values will remain above 92% the majority of the time.
2)The patient's mother will correctly demonstrate the use of a peak flow meter.
3)The patient's lung sounds will demonstrate only scattered wheezes by discharge.
4)The patient will sleep uninterruptedly for four hours at a stretch every night.

Question 14

A small child with an RSV infection and bronchiolitis is being sent home from the ED with a prescription for albuterol.The parents are to obtain a nebulizer from a medical equipment rental store.In order to ensure that the treatments will relieve the child's bronchospasm, the nurse will emphasize:
1)Giving the treatments at exact intervals.
2)Combining the treatments with supplemental oxygen.
3)Continuing each treatment until all the medication is gone from the reservoir.
4)Following up the treatment with deep-breathing exercises and controlled coughing.

Question 15

A patient is learning metered-dose inhaler technique.The patient says, "I don't understand why I have to use this thing.Can't I just take pills?" The nurse's response is based on the knowledge that:
1)The inhalation route is safer and more effective than are pills.
2)The inhalation route is less expensive than is oral therapy.
3)The inhalation route is easier to master than is oral therapy.
4)The inhalation route is more likely to lead to termination of the disease process than are pills.

Question 16

The nurse is caring for an elective orthopedic surgery patient with mild intermittent asthma.During the second postoperative day, the patient has an asthmatic episode while eating lunch.When contacting the physician for orders, the nurse is seeking an order for:
1)Intravenous aminophylline.
2)A Medrol dose pack.
3)A short-acting selective beta-agonist inhaler.
4)Subcutaneous epinephrine.

Question 17

The nurse is caring for a patient with severe asthma.When evaluating the outcomes of the patient's care, the nurse recognizes the most important outcome is associated with:
1)Decreased respiratory effort.
2)The patient's blood gases.
3)The patient's vital signs.
4)Length of stay on the acute care unit.

Question 18

A patient with asthma is experiencing difficulty with copious amount of tenacious sputum.A mucolytic drug is prescribed.The outcome the nurse would track is:
1)Increased clearance of sputum.
2)Decrease in wheezing.
3)Resolution of atrial tachycardia.
4)Decrease in respiratory rate with increase in depth.

Question 19

A nurse is assisting a patient to master the use of a steroid inhaler.The patient says, "I don't think I should be using steroids.I see steroids labeled as bad in the news at least once a week." The nurse's response is based on the fact that:
1)Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile.
2)The steroid preparations used to treat airway problems are very different from the steroids abused by people reported in the news media.
3)Inhaled steroid use is usually short-term, so any risk to the patient is minimal.
4)Steroids can be very risky, but the risk is necessary in this client's case.

Question 20

A trauma patient has experienced a ruptured diaphragm.The nurse would anticipate that this patient would have

Question 21

The nurse is teaching a patient about the use of an albuterol rescue inhaler.Which nursing diagnosis is most appropriate to avoid inappropriate responses to albuterol later on?
1)Knowledge Deficit related to proper use of albuterol inhaler
2)Injury (cardiac damage), risk for related to excess beta-1 stimulation from albuterol
3)Impaired Gas Exchange related to inadequate response to albuterol
4)Ineffective Airway Clearance related to excess mucus formation

Question 22

A patient with moderate and persistent asthma has obtained control with a formoterol inhaler q.i.d.for bronchospasm for several years.In the past couple of weeks, however, he has been reporting more chest tightness and wheezing during the day.He also uses a steroid inhaler and oral sustained-release zileuton.The nurse recognizes that the initial medical response to this challenge will be:
1)Discontinuation of the formoterol.
2)Discontinuation of the inhaled steroid.
3)Increasing the dose of formoterol.
4)Increasing the dose of the inhaled steroid.

Question 23

A patient is admitted with an acute exacerbation of bronchitis and emphysema.Intravenous SoluMedrol is to be administered every six hours.Which nursing diagnosis best reflects the nurse's concern related to adverse effects?
1)Injury, risk for related to fractures associated with steroid-driven bone demineralization
2)Decreased Cardiac Output, risk for related to hypertension associated with steroid-driven fluid retention
3)Disturbed Sleep Patterns, risk for related to circadian rhythm disruption associated with around-the-clock steroid administration
4)Impaired Oral Mucous Membranes, risk for related to effects of steroid administration

Question 24

The nurse is caring for an asthmatic patient who has taken Accolate (zafirlukast)for a number of years.Coumadin is being added to the patient's medications because of atrial fibrillation.What concern does the nurse have related to this addition?
1)Less Coumadin will be needed to achieve the desired INR.
2)The patient will be at greater risk for stroke because of drug interaction.
3)Warfarin necrosis is a distinct possibility.
4)The patient might experience an increase in BUN and creatinine values.

Question 25

The nurse is caring for a patient with chronic bronchitis and a history of glaucoma.The nurse recognizes that which drug would NOT be an appropriate choice for the control of the patient's bronchospasm?
1)formoterol (Foradil)
2)ipratropium (Atrovent)
3)cromolyn (Intal)
4)dyphylline (Lufyllin)

Question 26

The nurse is helping a patient establish goals in respect to the control of his asthma with medications.The nurse emphasizes to the patient that the most effective class of drugs for maintaining control of asthma are those that:
1)Reverse bronchospasm.
2)Present bronchospasm.
3)Prevent local inflammation.
4)Stabilize mast cells in the airways.

Question 27

A mother is struggling to manage a child with moderate persistent asthma at home.The mother is motivated to learn because of the number of medications her child must take and the overwhelming expense of managing these drugs.The nurse teaches the mother about environmental control.Which strategies are most likely to be effective?
1)Hardwood floor and plastic-covered mattress and pillow in the child's bedroom
2)Keeping the child's immunizations up-to-date and wearing a face mask in public
3)Limiting intake of protein and foods with red and yellow dyes
4)Home-schooling the child and limiting his contact with other children who might have upper respiratory infections

Question 28

A patient is having difficulty controlling persistent asthma, and is admitted to an inpatient medical unit.Her admission EKG demonstrates sinus rhythm with a PR interval of 0.18, a QT interval of 0.52 seconds, and no ST segment elevation.An albuterol nebulizer treatment is ordered.Prior to its administration, the nurse expresses concern about:
1)The PR interval.
2)The QT interval.
3)The heart rate.
4)The ST segment.

Question 29

A nurse is caring for a patient with asthma and type 2 DM.The nurse knows that which respiratory drug is most likely to elevate the patient's blood sugar?
1)Albuterol
2)Aminophylline
3)Triamcinolone
4)Tiotropium

Question 30

The nurse is admitting a patient with an exacerbation of asthma.His medication list includes albuterol, salmeterol, budesonide, cromolyn, and zafirkulast.He states that takes these medicines every day, except for the albuterol.When planning the patient's care, the nurse recognizes:
1)The patient's combination of medications is appropriate according to current practice guidelines.
2)The patient's therapy is adequate, except that he should be using the albuterol daily.
3)The patient is taking too many medications, and several should be discontinued.
4)The patient needs several additional preparations if the asthma control standards of the Agency for Healthcare Research and Quality are to be met.

Question 31

The nurse is caring for a patient with newly detected asthma.When planning care for this patient, the nurse is aware that the patient's heavy alcohol intake could make him intolerant of certain respiratory medications, including:
1)Albuterol and ipratropium.
2)Cromolyn and levalbuterol.
3)Aminophylline and montelukast.
4)Nedocromil and budesonide.

Question 32

A patient with persistent asthma has a history of multiple allergies, including to peanuts and soy.The nurse knows this history serves as a contraindication for the administration of which prophylactic medication?
1)Ipratropium (Atrovent)
2)Triamcinolone (Azmacort)
3)Cromolyn (Intal)
4)Zafirlukast (Accolate)

Question 33

The nurse is evaluating the ABGs of a patient who was admitted in severe respiratory distress 24 hours ago.The nurse recognizes that which blood gases are normal?
1)pH 7.42, paCO₂ 35, HCO₃ 22
2)pH 7.27, paCO₂ 38, HCO₃ 14
3)pH 7.48, paCO₂ 32, HCO₃ 18
4)pH 7.26, paCO₂ HCO₃ 29