Question 1

The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair).The patient reports sensitivity to aspirin.Which statement by the patient indicates a need for further teaching?

Accepted Answer

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 for pain or fever if they have aspirin sensitivity.Patients will achieve maximum effectiveness if the drug is taken in the evening.

Question 2

A patient who has been taking theophylline at home reports having palpitations and jitteriness.What action will the nurse take?

Accepted Answer

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.Increasing fluid intake will not alleviate symptoms.Renal function studies are not indicated.

Question 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?

Accepted Answer

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.

Question 4

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?

Accepted Answer

The beta₂ agonists can increase serum glucose levels and montelukast can elevate liver enzymes,so these should be monitored in patients taking these medications.

Question 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?

Accepted Answer

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 (FEV?).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.

Question 6

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?

Accepted Answer

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.

Question 7

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

Accepted Answer

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.

Question 8

The nurse is caring for a patient diagnosed with COPD who has been prescribed tiotropium.Which statement will the nurse include in the education?

Accepted Answer

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.

Question 9

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 reports this to the provider and will expect the provider to

Accepted Answer

Tobacco smoking increases the metabolism of theophylline,so the dose should be increased.Decreasing the dose will lead to subtherapeutic effects.

Question 10

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?

Accepted Answer

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.

Question 11

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?

Accepted Answer

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.

Question 12

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?

Accepted Answer

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.

Question 13

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?

Accepted Answer

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.

Question 14

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

Accepted Answer

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.

Question 15

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?

Accepted Answer

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.

Quiz 36: Lower Respiratory Disorders

The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair) .The patient reports sensitivity to aspirin.Which statement by the patient indicates a need for further teaching?

A patient who has been taking theophylline at home reports having palpitations and jitteriness.What action will the nurse take?

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?

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 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?