Respiratory Medications Flashcards
increased fluid helps to liquefy secretions for more effective coughing.
TRUE OR FALSE
TRUE
Guaifenesin
(Mucinex)
Cold medication and cough medicine
It can thin mucus. This may make it easier to clear from the head, throat, and lungs.
Guaifenesin is an expectorant. It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth. Guaifenesin is used to reduce chest congestion caused by the common cold, infections, or allergies.
The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client’s bedside if needed?
The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors.
Diphenhydramine
(Benadryl)
Diphenhydramine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny
nose. Diphenhydramine is used to treat sneezing, runny nose, watery eyes, hives, skin rash, itching, and other cold or allergy symptoms
Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with___________ or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes ____________the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.
food; drowsiness
Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are _______spasm, cough, __________congestion, throat irritation, and wheezing.
Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.
bronchospasm; nasal
__________is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.
Terbutaline
Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired ______________
hepatic function.;
Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.
A common side effect of Isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with _______________
pyridoxine (vitamin B6) intake
Isoniazid is _____________, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include ________________.
hepatotoxic; yellow skin and sclera
A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication?
1.
Should always be taken with food or antacids
2.
Should be double-dosed if 1 dose is forgotten
3.
Causes orange discoloration of sweat, tears, urine, and feces
4.
May be discontinued independently if symptoms are gone in 3 months
Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.
The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding?
1.
Impaired sense of hearing
2.
Gastrointestinal side effects
3.
Orange-red discoloration of body secretions
4.
Difficulty in discriminating the color red from green
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs.
Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin
Isoniazid therapy can cause an elevation of _____________-enzyme levels and hepatitis.
hepatic
Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol.
The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure?
1.
Beclomethasone first and then the salmeterol
2.
Salmeterol first and then the beclomethasone
3.
Alternating a single puff of each, beginning with the salmeterol
4.
Alternating a single puff of each, beginning with the beclomethasone
Salmeterol is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule.
TRUE OR FALSE
TRUE
This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
Rifabutin - what is it for and what are three side effects ?
Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis.
Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange–colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flulike syndrome.
Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include ______________________-
These foods include coffee, cola, and chocolate
The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect?
“I have a severe headache.”
2.
“My feet are quite swollen.”
3.
“I am nauseated and may vomit.”
4.
“My lips and tongue are swollen.”
Omalizumab is an antiinflammatory used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an anaphylaxis.
Antiviral medications for influenza must be taken exactly as ______________. These medications do not prevent the spread of influenza and clients are usually contagious for up to ____________days after the initiation of antiviral medications. Secondary ___________infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.
prescribed; 2; bacterial
___________________may be used to treat allergic rhinitis. The medication works locally and decreases _______________. The client should be instructed to clear the nasal passages _________________-use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.
Intranasal corticosteroids; inflammation; before
Pirbuterol is an adrenergic ______________. Side and adverse effects include ___________________
bronchodilator; tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache
What is Ribavirin and what is special about its administration ?
Ribavirin is an antiviral respiratory medication used mainly for hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent. Ribavirin is not administered orally, intramuscularly, or subcutaneously.
Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken?
1.
4 months
2.
6 months
3.
9 months
4.
12 months
For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.
tapering of a glucocorticoid could result in adrenal insufficiency
TRUE OR FALSE
TRUE
The client being changed from oral to inhalation glucocorticoids could experience signs of ___________insufficiency.
adrenal
A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms?
1.
Chills, fever, and generalized rash
2.
Vomiting, diarrhea, and increased thirst
3.
Blurred vision, headache, and insomnia
4.
Anorexia, nausea, weakness, and fatigue
The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.
A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action?
1.
Report any change in urine color.
2.
Take both medications with food.
3.
Take both medications together once a day.
4.
Expect to take the medications for 2 to 3 weeks.
Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status.
Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption.
The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.
What is Cycloserine and what is special about it ?
Cycloserine is an antituberculosis medication that requires weekly serum medication level determinations to monitor for neurotoxicity and other adverse effects.
Peak concentrations are measured 2 hours after dosing and should be between 25 and 35 mcg/mL
isoniazid is ____________-toxic;
hepatotoxic
A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up?
1.
Platelet count 325,000 mm3 (325 × 109/L)
2.
Serum creatinine 1.0 mg/dL (88.3 mcmol/L)
3.
Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L)
4.
Aspartate aminotransferase (AST) 55 U/L (55 U/L)
Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.
Rifampin causes ________________of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an ______________unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.
orange-red discoloration; empty stomach
Ethambutol causes this significant adverse effect ?
optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green
Orange-red discoloration of secretions occurs with this tuberculosis medication ?
Orange-red discoloration of secretions occurs with rifampin.
Impaired hearing results from antituberculosis therapy with
streptomycin
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted?
1.
5 mg/mL (20 mcmol/L)
2.
10 mg/mL (40 mcmol/L)
3.
15 mg/mL (60 mcmol/L)
4.
20 mg/mL (79 mcmol/L)
Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity.
The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.
The nurse is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what should the nurse plan to do?
1.
Place the head of the bed flat.
2.
Ensure that naloxone is readily available.
3.
Flush the catheter with 6 mL of sterile water.
4.
Aspirate with a syringe to ensure a cerebrospinal fluid (CSF) return.
Epidural analgesia is used for clients with expected high levels of postoperative pain. The nurse carefully checks the medication, notes the client’s level of sedation, and makes sure that the head of bed is elevated 30 degrees unless contraindicated. The nurse aspirates with a syringe to make sure that no CSF return occurs. If CSF returns with aspiration, the catheter has migrated from the epidural space into the subarachnoid space. The catheter is not flushed with 6 mL of sterile water.
Naloxone should be readily available for use if respiratory depression should occur.
Antitussive medication is used to
prevent or relieve a cough.
Benzonatate is a locally acting ______________that decreases the intensity and frequency of cough without eliminating the cough reflex.
antitussive
A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication?
1.
Coffee
2.
Orange juice
3.
Mineral water
4.
Cranberry juice
Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects.
Orange juice, mineral water, and cranberry juice are fluids that are allowed.
A client taking albuterol by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions?
1.
Get more exercise each day.
2.
Use a dehumidifier in the home.
3.
Drink increased amounts of fluids every day.
4.
Take an extra dose of albuterol before bedtime.
A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions.
This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake.
Additional exercise will not effectively clear bronchial secretions. A dehumidifier will dry secretions, making the situation worse. The client should not take additional medication.
A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication?
1.
Just after the next meal
2.
Just before the next meal
3.
4 hours after discontinuing the IV form
4.
Immediately on discontinuing the IV form
With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication.
If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion.
A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription?
1.
“I will take the daily dose at bedtime.”
2.
“I need to drink at least 2 liters of fluid per day.”
3.
“I know to avoid changing brands of the medication without my health care provider’s approval.”
4.
“I’ll avoid over-the-counter cough and cold medications unless approved by my health care provider.”
The client taking a single daily dose of theophylline, a xanthine bronchodilator, should
take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia.
The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the health care provider (HCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the HCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.
Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by __________.
If rifampin is not tolerated on an empty stomach, it may be _____________.
The client may be on the medication for 12 months even if cultures give negative results.
rifampin; taken with food
Cromolyn sodium is an anti________. anti _____________, and and ___________cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway ___________________ in some clients with asthma. It has no bronchodilating action
antiasthmatic, antiallergic, and mast cell stabilizer; hyperresponsiveness
Sustained-release preparations can be broken open, crushed, or chewed.
TRUE OR FALSE
FALSE
Sustained-release preparations should not be broken open, crushed, or chewed.
Guaifenesin is an expectorant and should be taken with _________________to decrease the viscosity of secretions
a full glass of water
Albuterol is an adrenergic ______________. The nurse assesses
bronchodilator
respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.
The client taking adrenergic bronchodilators may experience ____________________, which is evidenced by the client’s wheezing. This can occur with excessive use of ____________-. Further medication should be withheld and the HCP should be notified.
paradoxical bronchospasm; inhalers
Dose-related peripheral_____________ is one of the more common adverse effects of isoniazid
neuropathy
Dry Powdered Inhalers vs Metered Dose Inhalers
DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment.
Both types of inhalers have side effects. Frequency of use is prescribed by the health care provider.
