Deck 44: Pharmacotherapy of Asthma and Other Pulmonary Disorders

Question 1

The nurse is teaching a client about the use of an albuterol rescue inhaler.Which nursing diagnosis is most appropriate to avoid the adverse effects of albuterol?

A)Knowledge,Deficient related to proper use of albuterol inhaler
B)Gas Exchange,Impaired related to inadequate response to albuterol
C)Airway Clearance,Ineffective related to excess mucus formation
D)Activity Intolerance related to ineffective drug therapy

Answer 1

Knowledge,Deficient related to proper use of albuterol inhaler

Question 2

Over the course of treatment for chronic asthma,a client develops an allergy to the propellants in rapid-acting metered-dose inhalers (MDI).What option would the nurse expect to be used to address this problem after discharge?

A)Oral medication of the same class as the metered-dose inhaler
B)Nebulizer treatments
C)A concentrated-dose metered-dose inhaler
D)A dry powder inhaler (DPI)

Answer 2

A dry powder inhaler (DPI)

Question 3

A client in acute respiratory distress on a medical unit is receiving a nebulizer albuterol treatment.The client is annoyed because he already has an albuterol metered-dose inhaler (MDI).The nurse's response to the client's concern is based on the knowledge that:

A)Nebulized therapy is more cost-effective in the inpatient setting.
B)Suspension of the medication in liquid and delivery over a longer period increase the bronchodilator's effectiveness.
C)The nebulized form of the drug will have fewer negative effects on this distressed client.
D)The agitated and dyspneic client is unlikely to be able to use a metered-dose albuterol inhaler effectively.

Answer 3

Suspension of the medication in liquid and delivery over a longer period increase the bronchodilator's effectiveness.

Question 4

An adult is admitted to the emergency department with a respiratory rate of 32 breaths per minute and gasping.The nursing interview reveals the client witnessed a drive-by shooting.The nurse recognizes the client's rapid breathing is probably driven by:

A)brainstem activity.
B)increased perfusion in the cerebral cortex.
C)increased perfusion in the alveolar capillary bed.
D)a sudden increase in blood pressure.

Question 5

The nurse is teaching an asthmatic client about the use of a corticosteroid inhaler prior to discharge.The expected outcome of this therapy is:

A)less histamine formation,with less mucus in the upper airway.
B)less swelling and mucus formation,and decreased hyperresponsiveness to allergens.
C)resolution of all asthma symptoms.
D)decreased inflammation of the midsized bronchial tubes.

Question 6

The nurse is planning care for a client with chronic obstructive pulmonary disease (COPD).The client's symptoms are wheezing,tachycardia,increased respiratory rate,coughing up yellow mucus,and a low oxygen level.The highest-priority nursing diagnosis is:

A)Falls,Risk for
B)Knowledge,Deficient
C)Gas Exchange,Impaired
D)Anxiety.

Question 7

A client is learning metered-dose inhaler technique.The client says,"I don't understand why I have to use this thing.Can't I just take pills?" The nurse responds that the inhalation route:

A)is easier to master than is oral therapy.
B)is less expensive than is oral therapy.
C)is more likely to lead to termination of the disease process than are pills.
D)delivers the medication directly to the site,resulting in lower doses and fewer systemic side effects.

Question 8

A client with degenerative arthritis is provided with a spacer along with a corticosteroid metered-dose inhaler.The nurse recognizes that the spacer assists this client to:

A)compensate for decreased dexterity.
B)use a larger dose of the steroid.
C)progress with weaning from the steroid drug.
D)avoid thrush infections.

Question 9

A client with limited strength in the hands is being prepared for discharge with a dry powder inhaler (DPI).The discharge nurse teaches the client that an advantage of this inhaler is that:

A)The client can activate the inhaler with less pressure than is needed for a metered-dose inhaler.
B)This inhaler has no dose limits.
C)The client can increase the effectiveness of the powder by instilling it into a small nebulizer.
D)The client can activate the inhaler simply by inhaling.

Question 10

A trauma client has experienced a ruptured diaphragm.The nurse would anticipate that this client will have difficulty:

A)with an elevated oxygen level.
B)primarily during exhalation.
C)maintaining a high enough respiratory rate.
D)carrying out the respiratory cycle.

Question 11

The nurse is collaboratively setting goals for the inpatient management of new-onset asthma in a child.The nurse prioritizes the client's nursing diagnoses and gives which goal the highest priority?

A)The client will report improved ease of breathing by discharge.
B)The client will sleep uninterrupted for four hours at a stretch every night during admission.
C)The client's parents will verbalize the importance of the medication regimen by discharge.
D)The client's mother will correctly demonstrate the use of an inhaler with a spacer by discharge.

Question 12

The nurse is admitting a client with a history of asthma attacks every other day and three episodes at night in the last month.The client reports activity is somewhat limited.The nurse anticipates that the health care provider will determine the client's level of asthma to be:

A)severe.
B)mild persistent.
C)intermittent.
D)moderate persistent.

Question 13

A client with chronic obstructive pulmonary disease (COPD)is experiencing difficulty with copious amounts of tenacious sputum.A mucolytic drug is prescribed.The outcome the nurse would track is:

A)increase in clearance of sputum.
B)decrease in respiratory rate with increase in depth.
C)resolution of atrial tachycardia.
D)decrease in wheezing.

Question 14

A client with moderate and persistent asthma has obtained control with a formoterol inhaler qid for bronchospasm for several years.In the past couple of weeks,however,the client has been reporting more chest tightness and wheezing during the day.The nurse recognizes that the most likely problem is that the client:

A)is not taking the medication as directed.
B)needs to have the dose reduced and work back up to the full dose.
C)has developed a tolerance to the medication.
D)needs an inhaled steroid.

Question 15

A nurse is caring for several clients receiving bronchodilator therapy for asthma.The nurse has noted that some clients develop hyperglycemia during therapy.Which bronchodilator would the nurse consider problematic?

A)Albuterol (Proventil)
B)Ipratropium (Atrovent)
C)Aminophylline (Truphylline)
D)Theophylline (Theo-Dur)

Question 16

The nurse is assisting a client to master the use of a steroid inhaler.The client 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:

A)The steroid preparations used to treat airway problems are very different from the steroids abused by people reported in the news media.
B)Steroids can be very risky,but the risk is necessary in this client's case.
C)Inhaled steroids are very useful in managing reactive airways,with a fairly good safety profile.
D)Inhaled steroid use is usually short term,so any risk to the client is minimal.

Question 17

A nurse in an intensive care unit is planning care for a client with severe bronchospasms triggered by a known allergy to peanuts.The nurse recognizes that constriction is related to inflammatory mediators that trigger:

A)formation of sticky mucous plugs.
B)formation of thick membrane between the alveoli and the capillary bed.
C)constriction of the muscles in the walls of the large bronchiole tubes.
D)swelling of the juncture between the alveolus and the capillary bed.

Question 18

The nurse is admitting a client with an exacerbation of asthma.The medication list includes albuterol,salmeterol,budesonide,cromolyn,and zafirlukast.The client takes these medicines every day,except for the albuterol.When planning the client's care,the nurse recognizes that:

A)The client is taking too many medications,and several should be discontinued.
B)The therapy is adequate,except that the client should be using the albuterol daily.
C)The client needs several additional preparations if the asthma control standards of the Agency for Healthcare Research and Quality are to be met.
D)The client's combination of medications is appropriate according to current practice guidelines.

Question 19

The nurse is caring for an orthopedic surgical client with mild intermittent asthma.During the second postoperative day,the client has an asthma attack while eating lunch.The nurse expects the health care provider to give an order for:

A)subcutaneous epinephrine.
B)a short-acting selective beta-agonist inhaler.
C)an oral corticosteroid.
D)theophylline.

Question 20

A mother is struggling to manage her child's moderate persistent asthma at home.The mother asks the nurse if there are any nonpharmacologic measures she can use.Which strategies are most likely to be effective?

A)Keeping the child's immunizations up-to-date and wearing a face mask in public
B)Limiting intake of protein and foods with red and yellow dyes
C)Avoiding stimuli such as secondhand smoke,pollutants,and cold air
D)Homeschooling the child and limiting his contact with other children who might have upper respiratory infections

Question 21

The nurse helps a client establish goals to control asthma with medications.The nurse emphasizes that the preferred drugs for long-term control of asthma are:

A)inhaled corticosteroids.
B)inhaled beta 2 agonists.
C)anticholinergics.
D)systemic corticosteroids.

Question 22

The nurse explains to a client that inhaled corticosteroid medications are used in the long-term management of asthma to decrease:
Select all that apply.

A)inflammation of the airways.
B)mucus production.
C)bronchial hyperresponsiveness to allergens.
D)bronchial constriction.
E)edema.

Question 23

A client admitted with persistent asthma has a history of hypertension.Which class of asthma drugs must be used cautiously with clients who have hypertension?

A)Inhaled corticosteroids
B)Oral short-acting beta-adrenergic agonists
C)Inhaled anticholinergic medications
D)Mast cell stabilizers

Question 24

The nurse is discharging an asthma client with a new prescription for nedocromil (Tilade).What should the nurse instruct the client about this drug?
Select all that apply.

A)It may cause a bitter taste.
B)It can used to terminate an acute asthma attack.
C)It may take up to a week of therapy before benefits are obtained.
D)It should be used on an as-needed basis for optimal benefits.
E)Headache is a common side effect.

Question 25

When planning care for a client newly diagnosed with asthma,the nurse is aware that heavy caffeine intake could make the client intolerant of certain respiratory medications,including:

A)cromolyn.
B)albuterol.
C)budesonide.
D)montelukast.

Question 26

A client asks the nurse why the health care provider has ordered the asthma medication in inhalant rather than oral form.What is the nurse's best response?
Select all that apply.

A)Inhaling an asthma medication offers a rapid and efficient way to get the medication directly into your lungs."
B)Inhaling an asthma medication results in an almost instantaneous onset of action,which will relieve your symptoms much more quickly."
C)Inhaling an asthma medication will control your symptoms with smaller doses,reducing the risk of systemic effects."
D)Inhaling an asthma medication is an effective way to get the medication right into your lungs and is also a lot less expensive than oral medications."
E)Inhaling an asthma medication automatically increases the onset of the medication,resulting in quicker relief of your symptoms."

Question 27

The nurse has taught a group of clients with asthma the importance of knowing when to use quick-relief medications and when to use long-acting medications.The nurse knows the clients have understood the teaching when they identify which medications as long acting?
Select all that apply.

A)budesonide (Pulmicort)
B)nedocromil (Tilade)
C)zafirlukast (Accolate)
D)albuterol (Ventolin)
E)ipratropium (Atrovent)

Question 28

A client has been prescribed beclomethasone (Beconase)for long-term management of persistent asthma.Prior to discharge,the nurse teaches the client about possible side effects,including:
Select all that apply.

A)hoarseness.
B)dry mouth.
C)changes in taste.
D)nervousness.
E)insomnia.

Question 29

The admitting nurse suspects a client has moderate persistent asthma because:
Select all that apply.

A)Symptoms occur every day.
B)Symptoms occur more than one night a week.
C)Symptoms affect daily activity.
D)Symptoms occasionally affect daily activity.
E)Symptoms occur two times a month.

Question 30

A client is prescribed zafirlukast (Accolate)for persistent,chronic asthma.Which nursing interventions take priority?
Select all that apply.

A)Instruct the client not to take aspirin while on a zafirlukast regimen.
B)Instruct the client to take zafirlukast on an empty stomach.
C)Discuss the possibility of headache.
D)Encourage the client to report any hair loss..
E)Instruct the client to prevent falls by avoiding sudden changes in position.

Question 31

The nurse in a pulmonary clinic knows that theophylline (Theo-Dur)should not be prescribed for:
Select all that apply.

A)a teenager taking erythromycin for acne.
B)a client taking lorazepam for anxiety.
C)a client taking ciprofloxacin for prostatitis.
D)a client with elevated liver enzymes.
E)a client taking St.John's wort for menopausal symptoms.

Question 32

The nurse is caring for a client 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 client's bronchospasm?

A)Cromolyn (Intal)
B)Dyphylline (Lufyllin)
C)Formoterol (Foradil)
D)Ipratropium (Atrovent)

Question 33

The nurse in a pulmonary clinic is evaluating several clients' theophylline levels.Which levels would take the highest priority?
Select all that apply.

A)8 mcg/mL
B)19 mcg/mL
C)21 mcg/mL
D)12 mcg/mL
E)15 mcg/mL

Question 34

The nurse instructs a client with asthma that quick-relief medications that should be used for acute symptoms include:
Select all that apply.

A)albuterol (Proventil).
B)ipratropium (Atrovent).
C)beclomethasone (Beconase).
D)cromolyn (Intal).
E)montelukast (Singulair).

Question 35

The nurse is planning strategies for managing a new asthma client's symptoms.Which strategies will decrease the risk for bronchospasms?
Select all that apply.

A)Educating the client regarding the use of asthma medications
B)Educating the client regarding environmental control measures
C)Successfully managing comorbidities
D)Not making changes once asthma control has been achieved
E)Using the maximum amount of medication allowed to achieve asthma control

Question 36

An asthmatic client has been taking Accolate (zafirlukast)for a number of years.Coumadin is being added to the client's medications because of atrial fibrillation.What concern does the nurse have related to this addition?

A)Warfarin may significantly decrease prothrombin time (PT).
B)The client might experience an increase in BUN and creatinine values.
C)Less warfarin (Coumadin)will be needed to achieve the desired prothrombin time (PT).
D)The client will be at greater risk for stroke because of drug interaction.

Question 37

A pediatric nurse is educating a 6-year-old and the mother on the use of a metered-dose inhaler (MDI)with a spacer.The mother asks what the spacer is for.The nurse responds:
Select all that apply.

A)Without the spacer,most of the medication does not get into the lungs because the heavier particles fall out into the throat."
B)It can be difficult to properly coordinate pressing the canister and inhaling so the medication falls into the mouth instead of getting to the lungs."
C)The spacer holds the medication during inhalation,so your child will not have to worry about coordination."
D)The spacer is automatically activated when your child inhales,making it a lot easier to get the medication into the lungs."
E)The spacer vaporizes the medication so your child can inhale it.More medication gets directly into the lungs."

Question 38

A client with persistent asthma has a history of multiple allergies,including peanuts and soy.The nurse knows that,given this history,which prophylactic medication should be avoided?

A)Cromolyn (Intal)
B)Ipratropium (Atrovent)
C)Triamcinolone (Azmacort)
D)Zafirlukast (Accolate)

Question 39

The nurse is providing discharge instruction to a client newly diagnosed with asthma.The client has been prescribed albuterol (Proventil)for bronchospasm.Which side effects should the nurse explain to the client?
Select all that apply.

A)Restlessness
B)Tremor
C)Nervousness
D)Abnormal EKG
E)Hypertensive crisis

Question 40

The nurse is reviewing the admission history of a client taking zileuton (Zyflo CR)in the emergency department.Which patient reports would take highest priority during the physical assessment?
Select all that apply.

A)Sinusitis
B)Nausea
C)Yellow skin
D)Abdominal pain
E)Throat pain

Question 41

The nurse,discharging a client recently diagnosed with asthma,explains that symptoms that should be reported immediately to the health care provider include:
Select all that apply.

A)difficulty breathing.
B)feeling breathless when speaking.
C)increased anxiety.
D)increased activity level.
E)increased appetite.

Question 42

The priority assessment for a client receiving asthma medications to determine effectiveness of therapy should include:
Select all that apply.

A)increased ease of breathing.
B)improved signs of peripheral oxygenation.
C)absence of adventitious sounds.
D)normal hepatic function.
E)therapeutic levels of medications.

Question 43

The nurse explains to a client that drugs that activate beta 2-adrenergic receptors:

A)relax bronchiolar smooth muscle.
B)result in airway diameter narrowing.
C)increase labored breathing
D)decrease production of viscous secretions.