Chapter 21 Review Qs & Evolve

Question 1

1. What is the goal of drug therapy for asthma and/or COPD?

A. To cure asthma or COPD B. To improve airflow and reduce symptoms C. To thicken bronchiolar cartilage and increase alveolar size D. To decrease alveolar recoil and improve contraction of bronchiolar smooth muscle

Answer 1

B

Question 2

2. Which drugs are long-acting beta agonists? (Select all that apply.)

A. budesonide (Pulmicort) B. formoterol (Foradil) C. ipratropium (Atrovent) D. levalbuterol (Xopenex) E. nedocromil (Tilade) F. salmeterol (Serevent) G. tiotropium (Spiriva)

Answer 2

B F

Question 3

3. Which beta-adrenergic agonist is most effective as a rescue drug?

A. Arformoterol (Brovana) B. Formoterol (Foradil) C. Levalbuterol (Xopenex) D. Salmeterol (Serevent)

Answer 3

C

Question 4

4. A patient who received a bronchodilator 20 minutes ago now has all of the following responses. For which one do you notify the prescriber immediately?

A. Change in oxygen saturation from 89% to 95% B. Bad taste in the mouth C. Chest pain on exertion D. Dryness of the mouth and throat

Answer 4

C

Question 5

5. Which symptoms or conditions are side effects of cholinergic antagonist drugs? Select all that apply.

A. Anorexia B. Blurred vision C. Constipation D. Diarrhea E. Sleepiness F. Urinary retention G. Watery eyes

Answer 5

B C F

Question 6

6. Which drug classes are used as therapy for pulmonary artery hypertension (PAH)? Select all that apply.

A. Endothelin-receptor antagonists B. Inhaled corticosteroids C. Mucolytics D. Phosphodiesterase inhibitors E. Long-acting beta agonists F. Prostacyclin agents G. Short-acting beta agonists H. Vitamin K antagonists

Answer 6

A D F H

Question 7

7. When a patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid at the same time, why must he or she wait 5 minutes after using the bronchodilator before using the inhaled corticosteroid?

A. When the two drugs are taken one right after the other, the effects of both are reduced.
B. When the two drugs are taken one right after the other, the side effects are more severe.
C. Giving the bronchodilator first allows the inhaled corticosteroid to be more effective.
D. Giving the bronchodilator first reduces the risk for an allergic reaction to the inhaled corticosteroid.

Answer 7

C

Question 8

8. Which sign or symptom in a patient who is using a short-acting beta agonist (SABA) as a rescue drug indicates that he or she is using the inhaler very frequently?

A. Tremors B. Urinary incontinence C. Oral candidiasis (thrush) D. Widely dilated pupils of the eye

Answer 8

A

Question 9

9. A patient who has COPD asks what exactly guaifenesin (Mucinex) does to help him breathe better. What is your best answer?

A. “It thins the lining of your lung air sacs making it easier for oxygen to enter your body.” B. “It decreases inflammation and reduces your risk for lung infections.” C. “It suppressed your cough reflex so that you can breathe better while sleeping.” D. It thins your lung secretions making it easier for you to cough them out.”

Answer 9

D

Question 10

10. Which problem indicates that a patient may be excessively using his or her beclomethasone (QVAR) inhaler?

A. The presence of thick white cheesy material on the tongue and roof of the mouth
B. The onset of muscle cramps in the legs while at rest
C. The need to get up to urinate 3 to 4 times every night
D. The development of a dry, tickling cough

Answer 10

A

Question 11

11. What is the most important point to teach a patient using a long-acting beta agonist (LABA)?

A. Brush your teeth and rinse your mouth 3 times daily to prevent a bad taste. B. Take the drug daily as prescribed even when you have no symptoms. C. Use a reliable form of contraception while taking this drug. D. Keep the inhaler with you at all times.

Answer 11

B

Question 12

12. Which precaution should you teach a woman taking bosentan (Tracleer)?

A. Use strict aseptic technique while handling this drug.
B. Avoid drinking caffeine while on this drug.
C. Use a reliable form of contraception
D. Rinse your mouth 4 times daily

Answer 12

C

Question 13

A nurse is performing an admission assessment on a patient admitted with a respiratory diagnosis. What respiratory disorder is actually a combination of two disorders?

Asthma

Chronic obstructive pulmonary disease (COPD)

Emphysema

Chronic bronchitis

Answer 13

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a respiratory disorder that is a combination of chronic bronchitis and emphysema. Other less common respiratory disorders that involve the lung tissue rather than the airways and result in impairment of gas exchange are pulmonary artery hypertension (PAH) and pulmonary fibrosis Asthma, emphysema, and chronic bronchitis are not a combination of two disorders.

Question 14

Why are mucolytics helpful in the management of chronic obstructive pulmonary disease (COPD)?

Mucus becomes less sticky and is easier to cough up.

Airways widen and air moves more freely through them.

Mucus-secreting cells are inhibited and less mucus is produced.

Less mucus is trapped in the alveoli, and they then have better recoil.

Answer 14

Mucus becomes less sticky and is easier to cough up.

Mucolytics break the connections holding the protein and mucus molecules together. This results in thinner, less sticky mucus that is easier to cough up.

Question 15

A patient asks how prescribed corticosteroids help with her breathing. What is your best response?

“They are fast-acting bronchodilators that relax the muscles in your airway.”

“They prevent the bronchial muscles from getting tight.”

“They thin excess secretions in your lungs.”

“They reduce inflammation that narrows the airways.”

Answer 15

“They reduce inflammation that narrows the airways.”

Corticosteroid drugs are similar to natural cortisol that prevent or limit inflammation by slowing or stopping inflammatory mediator production. Corticosteroids are not fast-acting bronchodilators and do not relax muscles in the airway. They also do not prevent the bronchial muscles from getting tight. Mucolytics and not corticosteroids thin increased secretions in the airways.

Question 16

The nurse is performing discharge teaching to a patient with a prescription for an aerosol inhaler with a spacer. What teaching tip for using an aerosol inhaler with a spacer is correct?

Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer.

If you are prescribed to take two puffs, wait at least 5 minutes before taking the second puff.

Breathe in quickly and shallow. If the spacer makes a whistling sound, you are breathing in too slowly.

Three times a day clean the plastic mouthpiece and the cap of the inhaler by thoroughly rinsing them in warm, running tap water.

Answer 16

Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer.

After removing the caps from the spacer and the inhaler, insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. If two puffs are prescribed, wait at least 1 minute and not 5 minutes before taking the second puff. Breathe in slowly (not quickly) and deeply (not shallow). If the spacer makes a whistling sound, you are breathing in too fast (not slowly). At least once each day, and not three times a day, clean the plastic mouthpiece and the cap of the inhaler by thoroughly rinsing them in warm, running tap water.

Question 17

A nurse is teaching a patient whose peak expiratory rate flow (PERF) reading is 85% of the patient’s personal best. What should the nurse teach the patient to do next with regard to his or her prescribed asthma medications?

Skip the controller dose.

Take controller medications as ordered.

Use the rescue drug.

Use the rescue drug and seek emergency help.

Answer 17

Take controller medications as ordered.

A decrease in PERF of 15% to 20% below the expected value for a person may occur when the airways are narrowed. The patient needs to take the controller medications as ordered and not skip the controller dose. Long-acting beta-adrenergic agonists (LABAs) or controllers should be taken as prescribed even when symptoms of asthma are not present because these drugs are used to prevent an attack, not stop an attack that has already started. A short-acting adrenergic (SABA) inhaler or rescue drug does not need to be used if the patient’s PERF is 85% of the personal best. When the PERF value drops below 50%, revealing a dangerously low airflow into and out of the airways, a rescue drug must be used and emergency measures sought. Some drugs reduce the attack severity or stop the attack (rescue or reliever drugs), and other drugs actually prevent the attack (controller drugs). Do not use long-acting adrenergic (LABAs) inhalers for immediate relief of symptoms during an asthma attack. Only a short-acting adrenergic (SABA) inhaler will be effective.

Question 18

The nurse is providing discharge instructions to a patient prescribed an inhaled anti-inflammatory. What side effect is the patient at risk for when taking this drug?

Thrush

Dry eyes

Shortness of breath

Increased mouth secretions

Answer 18

Thrush

Thrush (oropharyngeal candidiasis) is a medical condition in which a yeast-like fungus called Candida albicans overgrows in the mouth and throat. Thrush may be triggered to occur by a variety of factors, including illness, pregnancy, medications, smoking, or dentures.

This patient is at an increased risk for oral infection, specifically a candida fungal infection known as “thrush.” Other side effects of inhaled anti-inflammatories include cough, bad taste (not sweet taste), mouth dryness (not increased mouth secretion), and teary of the eyes (not dry eyes). Shortness of breath is not a side effect of taking inhaled anti-inflammatory drugs, but is one of the reasons this drug may be given. Check for thrush by inspecting the patient’s mouth and throat for the appearance of any white or cream-colored patches of a cheesy coating on the mucous membranes, roof of the mouth, and tongue.

Question 19

A nurse has been ordered to administer a dry-powder inhaler to a patient. What should be done first before giving this drug?

Moisten the capsule before inserting it in the inhaler.

Place the inhaler in water for proper cleaning.

Keep the inhaler in a dry place at room temperature.

Shake the inhaler several times before using.

Answer 19

Keep the inhaler in a dry place at room temperature.

The powder used in a dry-powder inhaler may already be loaded in the inhaler or may have to be placed in the inhaler each time it is used. The technique used with dry-powder inhalers differs from that of standard aerosol inhalers (metered dose inhalers [MDIs]) because the powder must remain dry to be active. Box 21-3 describes teaching tips for how to use a dry-powder inhaler. The capsule must be kept dry, not moistened. The inhaler should not be washed or placed in water. An inhaler for dry powder should not be shaken.

Question 20

A nurse is caring for a patient with asthma who has been ordered to receive a bronchodilator and another inhalation drug. How should the nurse administer both drugs at the same time to this patient?

Give both drugs together.

Give the bronchodilator 5 minutes after the other drug.

Give the bronchodilator 5 minutes before the other drug.

Allow 30 minutes between giving the two drugs.

Answer 20

Give the bronchodilator 5 minutes before the other drug.

If a patient is to receive two or more drugs by inhaler for breathing problems, give the bronchodilator first and wait at least 5 minutes before giving the next drug. This action allows time for the bronchodilator to widen the airways so the next drug can be inhaled more deeply into the respiratory tract and be more effective. Giving both drugs together does not allow for the best absorption of the drugs. Giving the bronchodilator 5 minutes after the other drug does not allow for the best absorption of the drugs. Allowing 30 minutes between the two drug doses is not necessary.

Question 21

A patient with COPD is being given a mucolytic. What drug is typically administered using a nebulizer face mask?

Guaifenesin (Mucinex)

Acetylcysteine (Mucomyst)

Albuterol (Proventil)

Salmeterol (Serevent)

Answer 21

Acetylcysteine (Mucomyst)

Mucomyst is commonly given for patients with (COPD) and works by breaking the connections that hold the protein and mucus molecules, resulting in thinner, less sticky mucus that is easier to cough up and spit out. Mucomyst is most commonly delivered with a nebulizer face mask and is also available as an oral drug. Typically 1 to 10 mL of a 20% solution is placed in a medication nebulizer and the patient uses a mask to breathe in the mist containing the drug every 6 hours. The drug has few side effects but does have a very unpleasant odor. Some patients experience nausea and even vomiting from the smell. Guaifenesin (Mucinex) is a systemic mucolytic drug that is taken orally and is not given by nebulizer. Albuterol can be used as a rescue drug using a nebulizer face mask, but it is a short-acting beta2 agonist, not a mucolytic drug. Salmeterol is not a mucolytic drug and is not administered using a nebulizer.

Question 22

A patient is taking an inhaled anticholinergic agent. What side effect can occur if this agent reaches the bloodstream?

Urinary incontinence

Diarrhea

Headache

Seizure

Answer 22

Headache

Cholinergic antagonists can cause some specific side effects if they reach the bloodstream. These effects include headache, urinary retention and not urinary incontinence, blurred vision, eye pain, and nausea. Diarrhea and seizures are not side effects of anticholinergic agents. Cholinergic antagonists, also known as anticholinergic drugs, block the parasympathetic nervous system. These drugs let a person’s natural epinephrine and norepinephrine bind to smooth muscle receptors leading to bronchodilation. One way to remember the side effects of cholinergic antagonists is the rhyme “can’t see, can’t spit, can’t pee, can’t…poop.”

Question 23

A patient with asthma has a positive expiratory rate flow reading of 60% of the personal best. Which type of medication would you expect the patient to take at this point?

Short-acting beta2-adrenergic agonist (SABA)

Long-acting beta2-adrenergic agonist (LABA)

Cholinergic antagonist

Mucolytic

Answer 23

Short-acting beta2-adrenergic agonist (SABA)

A PERF value below 60% shows a low airflow into and out of the airways, requiring a short-acting beta2-adrenergic agonist (SABA) rescue drug be used as soon as possible. Long-acting beta2-adrenergic agonists (LABAs) are prevention or controller drugs. Cholinergic antagonists are prevention or controller drugs. Mucolytics are prevention or controller drugs used primarily for chronic obstructive pulmonary disease.