Unit3 CH9/37

Question 1

A medical-surgical nurse is caring for a client with a history of asthma.
The client turns on the call light and states to the nurse “I’m feeling
short of breath, and I need my inhaler!”
Prescribed inhalers: salmeterol, albuterol, fluticasone

• What assessments should the nurse perform?
• What is the problem?
• What medication should the nurse administer?

Answer 1

• What assessments should the nurse perform?
Lung sounds, RR, heart sounds, HRR, oxygen saturation, work of
breathing, skin color (cyanosis). REMEMBER that there’s 2 important assessment Respiratory and Cardiac

• What is the problem?
Asthma attack, respiratory compromise, potential for respiratory
distress and declining oxygen saturation

• What medication should the nurse administer?
Albuterol -because this is a rescue inhaler

Question 2

The nurses asks the unlicensed assistant personnel (UAP) to obtain a
set of vitals while obtaining the medication.
VS: HR 102; RR 26; BP 128/70; O2 sat 87%

• What is the expected outcome / short term goal for this client?
• What interventions should the nurse perform?
• How will the nurse know the desired outcome has been achieved?

Answer 2

• What is the expected outcome / short term goal for this client?
Increase oxygen saturation to > 92%, decrease RR to normal limits, decrease work of breathing

• What interventions should the nurse perform?
Administer albuterol, apply oxygen, place client in upright position, keep calm

• How will the nurse know the desired outcome has been achieved?
Evaluate the client: assess vital signs; heart and lung assessment; client statements

Remember to document interventions and evaluation!

Question 3

A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response?

a. Increased sputum production
b. Increased heart rate
c. Increased respiratory rate
d. Increased ease of breathing

Answer 3

D

The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing

Question 4

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives?

a. Diarrhea
b. Palpitations
c. Bradycardia
d. Drowsiness

Answer 4

B

The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs

Question 5

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment?
a. An anticholinergic such as ipratropium
b. A short-acting beta2 agonist such as albuterol
c. A long-acting beta2 agonist such as salmeterol
d. A corticosteroid such as fluticasone

Answer 5

B

The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels

Question 6

The prescriber has changed the patient’s medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication?

a. The proper technique for inhalation must be followed.
b. The patient needs to keep it close by at all times to treat acute asthma attacks.
c. It needs to be taken every day on a continuous schedule, even if symptoms
improve.
d. When the asthma symptoms improve, the dosage schedule can be tapered and
eventually discontinued.

Answer 6

C

LTRAs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms
improve. These drugs are taken orally

Question 7

After receiving a nebulizer treatment with a beta agonist, the patient states she is feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse’s best response?

a. “This is an expected adverse effect. Let me take your pulse.”
b. “The next scheduled nebulizer treatment will be skipped.”
c. “I will notify the physician about this adverse effect.”
d. “We will hold the treatment for 24 hours.”

Answer 7

A

Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists.

Question 8

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?

a. “Take the corticosteroid inhaler first.”
b. “Take the bronchodilator inhaler first.”
c. “Take these two drugs at least 2 hours apart.”
d. “It does not matter which inhaler you use first.”

Answer 8

B

An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchial relaxation/dilation before administration of the anti-inflammatory drug.

Question 9

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects?

a. Fatigue and depression
b. Anxiety and palpitations
c. Headache and rapid heart rate
d. Oral candidiasis and dry mouth

Answer 9

D

Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids

Question 10

When evaluating a patient’s use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the
activation of the inhaler with her breathing. What intervention is most appropriate at this time?

a. Notify the prescriber that the patient is unable to use the MDI.
b. Obtain an order for a peak flow meter.
c. Obtain an order for a spacer device.
d. Ask the prescriber if the medication can be given orally

Answer 10

C

The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited

Question 11

The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate?

a. It is indicated for the treatment of acute bronchospasms.
b. It needs to be used with a spacer for best results.
c. Patients need to avoid drinking water for 1 hour after taking this drug.
d. It is used for the prevention of bronchospasms.

Answer 11

D
Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute
bronchospasms. The other statements are incorrect

Question 12

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for quick relief of asthma attacks? (Select all that apply.)

a. Salmeterol (Serevent) inhaler
b. Albuterol (Proventil) nebulizer solution
c. Intravenous systemic corticosteroids
d. Montelukast (Singulair)
e. Fluticasone (Flovent) Rotadisk inhaler

Answer 12

BC

Albuterol (a short-acting beta2 agonist) and intravenous systemic corticosteroids are used to provide quick relief for asthma. See
Box 37-2.

Question 13

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which
statement by the patient indicates that further instruction is needed? (Select all that apply.)

a. “I will rinse my mouth with water after using the inhaler and then spit out the
water.”
b. “I will gargle after using the inhaler and then swallow.”
c. “I will clean the plastic inhaler casing weekly by removing the canister and then
washing the casing in warm soapy water. I will then let it dry before
reassembling.”
d. “I will use this inhaler for asthma attacks.”
e. “I will continue to use this inhaler, even if I am feeling better.”
f. “I will use a peak flow meter to measure my response to therapy.”

Answer 13

BD

The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks.

Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing.

The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices.

Use of a peak flow meter assists in monitoring the patient’s response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.

Question 14

A patient has a metered-dose inhaler that contains 200 actuations (‘puffs’), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, identify how many days will this inhaler last at the prescribed dose.

Answer 14

50 days

Note the number of doses in the canister, and then calculate the number of days that the canister will last. For this question,
assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a dayequal four inhalations per day. Four divided into 200 yields 50; that is, the inhaler will last approximately 50 days.

Question 15

A patient will be receiving oral theophylline (Theo-Dur), 600 mg/day, in three divided doses. Identify how many milligrams the
patient will receive per dose. _______

Answer 15

200 mg

600 mg/day divided by 3 doses per day = 200 mg/dose

Question 16

1. A 70-year-old man is being treated for chronic obstructive pulmonary disease (COPD) with
   theophylline (Theo-Dur). What will be a priority assessment by the nurse?

A) Ingestion of fatty foods
B) Weight
C) Activity level
D) Use of nicotine

Answer 16

D

Nutritional status, weight, and activity level would be important for a nurse to know about a COPD
patient. However, it would be most important for the nurse to know whether the patient smokes or uses
tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the
metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect

Question 17

A patient presents to the emergency department (ED) having an acute asthma attack. An ED physician
has ordered a sympathomimetic (epinephrine). The nurse expects what as the therapeutic effect of this
drug?

A) Decrease the inflammatory response in the airways

B) Reduce the surface tension within the alveoli allowing for gas exchange

C) Inhibit the release of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the
allergic asthmatic response

D) Cause dilation of the bronchi with increased rate and depth of respiration

Answer 17

D

Epinephrine will cause the bronchi to dilate and also cause the rate and depth of respiration to increase.

Inhaled steroids decrease the inflammatory response and lung surfactants reduce the surface tension
within the alveoli. Mast cell stabilizers inhibit the release of histamine and SRSA to prevent the allergic
response.

Options A, B, and C are not correct

Question 18

An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced
asthma. What should the patient be instructed to do?

A) Use the inhaler every day at the same time each day.

B) Use the inhaler as soon as the symptoms start.

C) Use the inhaler 30 to 60 minutes before exercising to ensure peak therapeutic levels when needed.

D) Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness.

Answer 18

C

Teaching a patient about using an inhaled sympathomimetic for management of exercise-induced
asthma should include instructions to use the inhaler 30 to 60 minutes before exercising to ensure
therapeutic levels when needed. The inhaler would not be used daily and waiting until symptoms occur
will be too late for prevention. Options B and D are not correct

Question 19

A premature newborn is being treated for respiratory distress syndrome. The nurse teaches the parents about what adverse effect that can occur with the use of lung surfactants?

A) Kidney dysfunction
B) Cardiac arrhythmias
C) High fever
D) Collapsed lung

Answer 19

D

Lung surfactants used therapeutically can cause many adverse effects including pneumothorax
(collapsed lung), hypotension, pulmonary leak, hyperbilirubinemia, and sepsis. Other adverse effects
may occur in the infant related to the degree of immaturity of the child’s system and may not be related
to the drug therapy. Options A, B, and C are not correct.

Question 20

A 76-year-old man with asthma is being treated with an anticholinergic. What will the nurse be careful
to assess for?
A) Cardiac arrhythmias
B) Prostatic hypertrophy
C) Thyroid conditions
D) Parkinsonism

Answer 20

B

Anticholinergics can produce urinary hesitancy and urinary retention, conditions that would aggravate
the signs and symptoms of prostatic hypertrophy. Older patients given anti-cholinergics should be
encouraged to empty the bladder before taking the drug. These drugs are used to treat parkinsonism.
Thyroid conditions and cardiac arrhythmias are not cautions or contraindications to the use of these
drugs

Question 21

A patient with chronic bronchial asthma is prescribed montelukast (Singulair). What will the nurse
instruct the patient to avoid taking?
A) Aspirin
B) Penicillin
C) Sertraline (Zoloft)
D) Nifedipine (Procardia

Answer 21

A

The nurse would instruct the patient to avoid aspirin, which might cause an increased montelukast level
and toxicity. The other options do not cause drugdrug interactions with montelukast

Question 22

The nurse has admitted a patient (who takes ipratropium) to the respiratory unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). While writing a plan of care for this patient, what would be the most appropriate nursing diagnosis to use?

A) Deficient knowledge regarding alternative therapy

B) Imbalanced nutrition: Less than body requirements

C) Acute pain related to renal effects of the drug

D) Disturbed thought processes related to central nervous system (CNS) effects

Answer 22

B

Nursing diagnoses related to drug therapy might include acute pain related to CNS, gastrointestinal
(GI), or respiratory effects of the drug; imbalanced nutrition: Less than body requirements, related to
dry mouth and GI upset; and deficient knowledge regarding drug therapy. Options A, C, and D are not
correct

Question 23

A patient, diagnosed with asthma, has been prescribed tiotropium (Spiriva). What should the nurse
teach the patient about this drug? (Select all that apply.)

A) It makes you fatigued.
B) You need to stay out of direct sunlight.
C) It is an anticholinergic.
D) You only need to take it once a day.
E) It has a rapid onset of action and a long duration.

Answer 23

CDE

Tiotropium is the first drug approved for once-daily maintenance treatment of bronchospasm associated
with chronic obstructive pulmonary disease (COPD). Patients who cannot tolerate the sympathetic
effects of the sympathomimetics might respond to the anticholinergic drugs ipratropium (Atrovent) or
tiotropium. Tiotropium has a rapid onset of action and a long duration, with a half-life of 5 to 6 days.
Tiotropium is not associated with fatigue or photosensitivity.

Question 24

The nurse is providing health teaching to a newly diagnosed asthmatic patient. The patient has been
prescribed theophylline. What is contraindicated with the use of this drug?
A) Using insulin
B) Taking anti-inflammatory drugs
C) Exercising
D) Smoking cigarettes

Answer 24

D

Nicotine increases the metabolism of xanthines in the liver so that xanthine dosage must be increased in
patients who continue to smoke while using xanthines. In addition, extreme caution must be used if the
patient decides to decrease or discontinue smoking because severe xanthine toxicity can occur.
Bronchoconstriction is not caused by using insulin and anti-inflammatory drugs do not cause
bronchoconstriction. Exercise with a physician’s supervision is encouraged in individuals with asthma

Question 25

What action by the patient would indicate that the patient understands how to use an inhaler?
A) The patient inhales as soon as the inhaler enters his or her mouth.
B) The patient holds his or her breath for several seconds after releasing the medication.
C) The patient administers three doses of medication within a 1-minute time frame.
D) The patient exhales as soon as he or she compresses the inhaler.

Answer 25

B

Holding the breath prevents exhalation of medication still remaining in the mouth. The patient should
inhale when the canister is compressed, not as soon as the inhaler enters his or her mouth. The patient
should only administer one dose of medication at a time and the patient should wait to exhale until after
the breath has been held as long as possible

Question 26

A patient, newly diagnosed with chronic obstructive pulmonary disease (COPD), calls the clinic and
asks the nurse to explain what the newly prescribed medications are for. What would be the most
appropriate response by the nurse?

A) The medications that have been ordered for you are what the physician thinks will help you the
most.
B) The medications that have been ordered for you are to help you breathe easier.
C) The medications that have been ordered for you are designed to work together to help you feel
better.
D) The medications that have been ordered for you are to help relieve the inflammation and promote
dilation of the bronchi

Answer 26

D

Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation. The
other options do not give the patient information about the use of these new medications.

Question 27

The nurse is caring for a patient who is taking an adrenergic bronchodilator. In what disease process
should adrenergic bronchodilators be used cautiously?
A) Liver failure
B) Renal failure
C) Respiratory failure
D) Heart failure

Answer 27

D

Adrenergic drugs cause cardiac stimulation. Patients with liver failure, renal failure, or respiratory
failure do not need to use adrenergic bronchodilators cautiously.

Question 28

The patient is a 34-year-old man who recently started taking theophylline. The nurse knows that
medication teaching has been successful when he agrees to what activity?
A) Avoiding caffeine
B) Eating foods high in potassium
C) Limiting fluid intake to 1,000 mL a day
D) Taking the medicine on an empty stomach

Answer 28

A

Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate.
Caffeine also stimulates heart rate. This can have an additive effect

Question 29

The nurse caring for a 38-year-old patient started on albuterol (Proventil) should advise the patient that
he or she may experience what adverse effect?
A) Polydipsia
B) Tachycardia
C) Hypotension
D) Diarrhea

Answer 29

B

Adrenergic agents stimulate beta1-adrenergic receptors in the heart as well as beta2-adrenergic
receptors in the lungs

Question 30

The nursing instructor is discussing bronchodilators with a group of nursing students. The students
understand the instruction when they identify what drug is most effective in treating acute
bronchospasm?
A) Ipratropium bromide (Atrovent)
B) Epinephrine (Adrenalin)
C) Cromolyn (Intal)
D) Ephedrine

Answer 30

B

Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction, with therapeutic
effects in 5 minutes that last 4 hours. It is considered the drug of choice for the treatment of acute
bronchospasm

Question 31

A patient with chronic obstructive pulmonary disease (COPD) presents at the emergency department in
acute respiratory distress. The patient’s family tells the nurse that the patient’s problems began right
after the patient took his or her first dose of ipratropium (Atrovent). What would the nurse suspect is
the problem?

A) An allergy to milk
B) Overexertion by the patient
C) Patient not taking the medications correctly
D) An allergy to soy product

Answer 31

D

Question 32

The nurse has provided health teaching for a 15-year-old boy newly diagnosed with asthma. What
statement, made by the patient, indicates that he has a good understanding of the teaching the nurse has
done regarding inhalers?
A) I should hold my breath when administering a puff.
B) The aerosol canister should be shaken well before using.
C) I need to take three short quick breaths when I administer the inhaler.
D) A second aerosol medication cannot be administered until 30 minutes after the first aerosol

Answer 32

B

Inhalers should be shaken well, immediately before each use. It would not be appropriate to teach the
patient to hold his breath when administering a puff, to take three short quick puffs when administering
the inhaler, or that a second aerosol medication should not be administered until 30 minutes after the
first dose of aerosol medication.

Question 33

The nurse is writing a plan of care for a patient newly admitted to the floor with an asthma attack that
occurred while exercising. What would be the most appropriate intervention for this patient?
A) Assist patients with moderate to severe asthma in obtaining a home nebulizer unit
B) Try to prevent or reduce panic, which may initiate bronchospasm
C) Teach patient to use an inhaler before exercising
D) Monitor peak flow rates, especially in children

Answer 33

C

Teach patient who use one of these drugs for exercise-induced asthma to use it 30 to 60 minutes before
exercising to ensure peak therapeutic effects when they are needed. The most important intervention
would be to use a bronchodilator as prophylaxis for a patient with exercise-induced asthma. It would
not be monitoring peak flow rates, trying to prevent or reduce panic, or assisting patient in obtaining a
home nebulizer unit

Question 34

A patient tells the nurse that a friend has recommended the use of caffeine to treat the patient’s asthma.
The nurse counsels the patient to begin treatment immediately with the prescribed medication for what
reason?
A) Caffeine can aggravate the drugs used to treat asthma.
B) Most natural products are less toxic or more potent than traditional asthma medications.
C) Natural products decrease the adverse effects associated with adrenergic bronchodilators.
D) Delays in appropriate treatment can have serious, even fatal, consequences

Answer 34

D

The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources.
These drugs were formerly the main treatment choices for asthma and bronchospasm. However,
because they have a relatively narrow margin of safety, and they interact with many other drugs, they
are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have
serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with
adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than
prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have
an additive effect.

Question 35

Epinephrine, formerly the drug of choice for acute attacks of bronchoconstriction, has been replaced by
what?
A) Short-acting bronchodilators are the drug of choice in this situation.
B) Nothing has replaced epinephrine as drug of choice in this situation.
C) Self-administered metered-dose inhalers (MDIs)
D) Long-acting beta2-adrenergic agonists (LABAs)

Answer 35

B

Epinephrine, the prototype drug, is the drug of choice in adults and children for the treatment of acute
bronchospasm, including that caused by anaphylaxis; it is also available for inhalation therapy. Because
epinephrine is associated with systemic sympathomimetic effects, it is not the drug of choice for
patients with cardiac conditions. Options A, C, and D are not correct

Question 36

A patient has an acute asthma attack. A bronchodilator is used to bring the exacerbation under control
What drug would be used to prevent acute bronchoconstriction?

A) Salbutamol (Ventolin)
B) Salmeterol (Serevent)
C) Fenoterol (Berotec)
D) Terbutaline (Bricanyl)

Answer 36

B

Salmeterol (Serevent) and formoterol (Foradil) and are long-acting beta2-adrenergic agonists used only
for prophylaxis of acute bronchoconstriction

Question 37

A patient is prescribed salmeterol with dosage on a 4 to 6 hour schedule for treatment of exerciseinduced asthma. What is the recommended dosing schedule of asthma experts regarding this drug?

A) 30 minutes before exercise to prevent dyspnea during exercise
B) Every 15 minutes during exercise to prevent dyspnea
C) As needed to treat or prevent dyspnea during exercise
D) Every 1 to 2 hours to treat or prevent dyspnea during exercise

Answer 37

A

Salmeterol (Serevent) adult and pediatric (12-year-old and older): two puffs every 12 hours; or two
puffs 30 to 60 minutes before exercise

Question 38

The pharmacology instructor is explaining the difference between bronchodilators and antiinflammatory drugs. How does an anti-inflammatory drug reduce bronchoconstriction?

A) Increases ability to metabolize medication
B) Decreases formation of mucus secretions
C) Increases reactivity to medication
D) By decreasing airway hyperreactivity to various stimuli

Answer 38

D

Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the
airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for
bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation
prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that
decreases mucosal edema and formation of mucus secretions that narrow airways. Anti-inflammatory
drugs do not increase the ability to metabolize medication or increases reactivity to medication

Question 39

28. Why are inhaled steroids used to treat asthma and chronic obstructive pulmonary disease (COPD)?

A) They act locally to decrease release of inflammatory mediators.
B) They act locally to improve mobilization of edema.
C) They act locally to increase histamine release.
D) They act locally to decrease histamine release

Answer 39

A

When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory
cells. This has two effects, which are decreased swelling associated with inflammation and promotion
of beta-adrenergic receptor activity, which may promote smooth muscle relaxation and inhibit
bronchoconstriction

Question 40

The nurse is caring for a patient with chronic obstructive pulmonary disease. The plan of care will
focus on what patient problem?

A) Pain
B) Obstructed airway
C) Activity intolerance
D) Adverse effects of medication therapY

Answer 40

B

Asthma, emphysema, chronic obstructive pulmonary disease (COPD), and respiratory distress
syndrome (RDS) are pulmonary obstructive diseases. All but RDS involve obstruction of the major
airways. RDS obstructs the alveoli. Pain, activity intolerance, and adverse effects of medication therapy
are conditions identified to detect, manage, and minimize the unexpected outcomes the nurse should be
especially aware of the potential for an obstructed airway in these patients

Question 41

The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary
disease (COPD). The patient asks the nurse what COPD means. What would be the nurse’s best
response?

A) It is an umbrella term for diseases like acute bronchitis.
B) It means that the lungs have been damaged in such a way that there airflow is limited in and out of
the lungs.
C) It means your lungs can’t expand and contract like they are supposed to, which makes it hard for
you to breathe.
D) It is a term that covers so many lung diseases I can’t list them all

Answer 41

B

The obstruction of asthma, emphysema, and COPD can be related to inflammation that results in
narrowing of the interior of the airway and to muscular constriction that results in narrowing of the
conducting tube. With chronic inflammation, muscular and cilial action is lost, and complications
related to the loss of these protective processes can occur, such as infections, pneumonia, and
movement of inhaled substances deep into the respiratory system. In severe COPD, air is trapped in the
lower respiratory tract, the alveoli degenerate and fuse together, and the exchange of gases is greatly
impaired.

Question 42

The nurse is caring for a child who has been newly diagnosed with asthma. What environmental
modifications should the nurse encourage the parents to make to help their child avoid future attacks?
(Select all that apply.)
A) Make sure the child begins herbal therapy as soon as possible.
B) Avoid crowded areas as much as possible.
C) Keep the child away from any known allergens.
D) Encourage the child to use a broom to sweep the bedroom every day.
E) Keep the child away from areas that are filled with cigarette smoke

Answer 42

BCE

Parents need to be encouraged to take measures to prevent acute attacks, including avoidance of known
allergens, smoke-filled rooms, and crowded or dusty areas. OTC drugs and herbal remedies should be
avoided if possible. The child should not be sweeping the bedroom because this will produce a lot of
dust

Question 43

The nursing instructor is talking to a group of nursing students about the treatment regimen for children
with asthma. The students indicate they understand the information when they identify which class of
drugs that comprise this regimen? (Select all that apply.)
A) Long-acting inhaled steroids
B) Xanthines
C) Leukotriene-receptor antagonists
D) Topical steroid nasal decongestants
E) Beta-agonists

Answer 43

ACE

Antiasthmatics are frequently used in children. The leukotriene-receptor antagonists have been found to
be especially effective for long-term prophylaxis in children. Acute episodes are best treated with a
beta-agonist and then a long-acting inhaled steroid or a mast cell stabilizer. Xanthines (e.g.,
theophylline) have been used in children, but because of their many adverse effects and the better
control afforded by newer agents, its use is reserved for patients who do not respond to other therapies.
Topical steroid nasal decongestants may be used for symptom relief for nasal congestion but are not a
regular part of asthma therapy in children

Question 44

A patient with asthma is going to begin taking an inhaled steroid. The nurse teaching the patient that
what adverse effects may occur when using this drug? (Select all that apply.)
A) Headache
B) Rebound congestion
C) Sepsis
D) Epistaxis
E) Depression

Answer 44

ABD

Adverse effects associated with the use of inhaled steroids include irritability, not depression, headache,
rebound congestion, local infection, not sepsis and epistaxis

Question 45

The nursing instructor is discussing the use of sympathomimetics in patients who have acute
bronchospasm. The instructor shares with the students that this classification of drugs is contraindicated
or only used with great caution in patients with what disorders? (Select all that apply.)
A) Hypothyroidism
B) Cardiac disease
C) Kidney disease
D) Diabetes mellitus
E) Peripheral vascular disease

Answer 45

BDE

Before administering a sympathomimetic the nurse should assess for possible contraindications or
cautions that include any known allergies to any drug in this class, cigarette use, cardiac disease,
vascular disease, arrhythmias, diabetes, and hyperthyroidism. Sympathomimetics have no known
adverse effects in hypothyroidism or kidney disease.

Question 46

Before administering any medication, what is the nurse’s priority action regarding patient safety?
a. Verifying orders with another nurse
b. Documenting the medications given
c. Counting medications in the medication cart drawers
d. Checking the patient’s identification using two identifiers

Answer 46

D

Verifying the patient’s identity, using two identifiers, before administering any medication is essential for the patient’s safety and
reflects checking one of the “Nine Rights” of medication administration. Documentation is done after the medications are given.

Question 47

When administering medication by IV bolus (push), the nurse will occlude the IV line by which method?
a. Not pinching the IV tubing at all
b. Pinching the tubing just above the injection port
c. Pinching the tubing just below the injection port
d. Pinching the tubing just above the drip chamber of the infusion set

Answer 47

B

Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port.

Question 48

While the nurse is assisting a patient in taking his medications, the medication cup falls to the floor, spilling the tablets. What is the nurse’s best action at this time?
a. Discarding the medications and repeating preparation
b. Asking the patient if he will take the medications
c. Waiting until the next dose time, and then giving the medications
d. Retrieving the medications and administering them to avoid waste

Answer 48

A

Medications that fall to the floor must be discarded, and the procedure must be repeated with new medications. The other actions are not appropriate

Question 49

When giving a buccal medication to a patient, which action by the nurse is appropriate?
a. Encouraging the patient to swallow, if necessary
b. Administering water after the medication has been given
c. Placing the medication between the upper or lower molar teeth and the cheek
d. Placing the tablet under the patient’s tongue and allowing it to dissolve
completely

Answer 49

C

Buccal medications are properly administered between the upper or lower molar teeth and the cheek. Caution the patient against swallowing, and do not administer with water.

Question 50

A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the
proper technique for administering eardrops to this child?
a. Administer the drops without pulling on the ear lobe.
b. Straighten the ear canal by pulling the lobe upward and back.
c. Straighten the ear canal by pulling the pinna down and back.
d. Straighten the ear canal by pulling the pinna upward and outward.

Answer 50

C

Question 51

A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during
teaching sessions with the patient?
a. Repeat subsequent puffs, if ordered, after 5 minutes.
b. Inhale slowly while pressing down to release the medication.
c. Inhale quickly while pressing down to release the medication.
d. Administer the inhaler while holding it 3 to 4 inches away from the mouth

Answer 51

B

Question 52

A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the medication. The nurse needs to remember which correct instruction regarding how to give this medication?
a. Break the tablet into halves or quarters.
b. Dissolve the tablet in a small amount of water before giving it.
c. Do not crush or break the tablet before administration.
d. Crush the tablet as needed to ease administration

Answer 52

C

Sustained-release (SR) and enteric-coated tablets or capsules are forms of medications that must not be crushed before
administration so as to protect the gastrointestinal lining or the medication itself. Do not break, dissolve, or crush these tablets
before administering

Question 53

When administering nasal spray, which instruction by the nurse is appropriate?
a. “You will need to blow your nose before I give this medication.”
b. “You will need to blow your nose after I give this medication.”
c. “When I give this medication, you will need to hold your breath.”
d. “You need to sit up for 5 minutes after you receive the nasal spray.

Answer 53

A

Clear the nasal passages before receiving nasal spray. Blowing one’s nose after receiving the medication will remove the
medication from the nasal passages. The patient will receive the spray while inhaling through the open nostril and needs to remain in a supine position for 5 minutes afterward