Unit7: Chapter 55 (Karch 7th Ed) - Drugs Acting on the Lower Respiratory Tract Flashcards
- 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
Ans: D
Feedback:
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.
- A 6-year-old child weighing 52 pounds has had a loading dose of aminophylline (Truphylline). The
nurse is ready to administer the regular prescribed dose of 4 mg/kg every 4 hours for three doses. How
many milligram will the patient receive in 12 hours?
A) 44 mg
B) 94 mg
C) 284 mg
D) 344 mg
Ans: C
Feedback:
First, using the formula: 2.2 pounds and 52 pounds: times kg, determine the child’s weight in kg
(52/2.2 = 23.64). Next, using the formula of amount of drug prescribed times weight in kg, determine
the amount the child will receive in one dose (4 times 23.64 = 94.56). To determine the mg in a 12-hour
period multiply 94.56 times 3 = 283.68. Round to 284 mg. Options A, B, and D are not correct.
- A patient is in the clinic to have blood drawn to assess his or her theophylline level. The patient is taking theophylline (Theo-Dur) and appears to being doing well on the drug. He or she reports no
problems. What serum level will the nurse expect the patient to have?
A) Between 0.5 to 5 mcg/mL
B) Between 10 to 20 mcg/mL
C) Between 25 to 35 mcg/mL
D) Between 40 to 50 mcg/mL
Ans: B
Feedback:
Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5
mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL
would be too high and could cause serious adverse effects.
- 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
Ans: D
Feedback:
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.
- 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.
Ans: C
Feedback:
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
- 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
Ans: D
Feedback:
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.
7. A patient who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the physician prescribe? A) Ipratropium or budesonide B) Isoetharine or montelukast C) Nedocromil or cromolyn D) Aminophylline or caffeine
Ans: C
Feedback:
Nedocromil and cromolyn are mast cell stabilizers used in the treatment of asthma. Aminophylline and
caffeine are xanthines. Ipratropium is an anti-cholinergic drug and budesonide is a corticosteroid.
Isoetharine is a sympathomimetic drug and montelukast is a leukotriene receptor antagonist.
8. 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
Ans: B
Feedback:
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.
9. 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)
Ans: A
Feedback: The nurse would instruct the patient to avoid aspirin, which might cause an increased montelukast level
and toxicity. The other options do not cause drug drug interactions with montelukast.
- A patient presents at the emergency department in acute respiratory distress. A quick assessment by the
triage nurse indicates that the patient experienced difficulty breathing immediately after taking
Combivent for the first time. The nurse suspects that the patient may be allergic to what?
A) Aspirin
B) Penicillin
C) Peanuts
D) Ragweed pollen
Ans: C
Feedback:
Combivent is a combination drug of ipratropium and albuterol. The propellant used to make
ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, and
ragweed pollen are not associated with this drug.
- 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
Ans: B
Feedback:
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.
- 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
Ans: C, D, E
Feedback:
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.
- 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
Ans: D
Feedback:
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.
- 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
Ans: B
Feedback:
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.
- 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.
Ans: D
Feedback:
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.