week 10 sherpath

Question 1

Match the drug class with its anticipated action.

Reduce viscosity of secretions to allow for ejection of mucus

Suppress harmful or nonproductive cough

Liquefies and loosens thick mucous secretions

Relieves nasal congestion

Answer choices

Decongestants

Antitussives

Mucolytics

Expectorants

Answer 1

Reduce viscosity of secretions to allow for ejection of mucus
Expectorants

Suppress harmful or nonproductive cough
Antitussives

Liquefies and loosens thick mucous secretions
Mucolytics

Relieves nasal congestion
Decongestants

Question 2

By which mechanisms do expectorants loosen and thin respiratory secretions?

Select all that apply.

Direct activity with mucus to make it watery

Activation of sigma opioid receptors within the cough center

Direct stimulation of the secretory glands in the respiratory tract

Reflex stimulation in response to irritation of the gastrointestinal tract

Activation of alpha1-adrenergic receptors to constrict the -nasal blood vessels

Answer 2

Direct stimulation of the secretory glands in the respiratory tract

Reflex stimulation in response to irritation of the gastrointestinal tract

Question 3

Which statements accurately describe the pharmacodynamics of dextromethorphan?

Select all that apply.

It can cause central nervous system (CNS) depression.

It possesses analgesic properties.

Its onset of action is 15 to 30 minutes.

Both its time to peak concentration and duration of action are 2.5 hours.

It suppresses the cough reflex by numbing the stretch receptor cells in the respiratory tract

Answer 3

Its onset of action is 15 to 30 minutes.

Both its time to peak concentration and duration of action are 2.5 hours.

Question 4

Which drug undergoes metabolism to form cysteine, disulfides, and conjugates?

Acetylcysteine

Dextromethorphan

Guaifenesin

Pseudoephedrine

Answer 4

Acetylcysteine

Question 5

How long can a patient expect the effects of extended-release pseudoephedrine to last?

15 to 30 minutes

30 to 120 minutes

3 to 4 hours

8 to 12 hours

Answer 5

8 to 12 hours

Question 6

Which explanation describes why the nurse would call the health care provider because of a safety concern for Mr. Clark?

Dextromethorphan can significantly worsen his erectile dysfunction.

Dextromethorphan and pseudoephedrine can potentially worsen Mr. Clark’s glaucoma.

Pseudoephedrine can worsen gastrointestinal symptoms such as diarrhea, thereby exacerbating his irritable bowel syndrome.

The opioid antitussive represents a significant risk for abuse and addiction when given with pseudoephedrine and dextromethorphan, particularly in this patient.

Answer 6

Dextromethorphan and pseudoephedrine can potentially worsen Mr. Clark’s glaucoma.

Question 7

Which instructions would a nurse include when teaching a patient about the administration of guaifenesin?

Select all that apply.

Avoid alcohol while receiving guaifenesin.

Limit use to 3 to 5 days to avoid rebound congestion.

Increase water intake up to 3 L per day unless contraindicated.

Contact a health care provider if the product needs to be used longer than 2 weeks.

Report a fever of 100.4°F (38°C) or higher or symptoms lasting longer than 3 to 4 days.

Answer 7

Avoid alcohol while receiving guaifenesin

Increase water intake up to 3 L per day unless contraindicated.

Report a fever of 100.4°F (38°C) or higher or symptoms lasting longer than 3 to 4 days.

Question 8

Which conditions would alert a nurse to potentially unsafe treatment with pseudoephedrine?

Select all that apply.

Allergic rhinitis

Glaucoma

Hypertension

Hyperthyroidism

Osteoporosis

Answer 8

Glaucoma

Hypertension

Hyperthyroidism

Question 9

Which nursing considerations about acetylcysteine are accurate?

Select all that apply.

Acetylcysteine can be safely mixed with other drugs for administration.

Patients with chronic obstructive pulmonary disease (COPD) should cautiously, if at all, use inhaled acetylcysteine.

If the patient is also prescribed a bronchodilator, acetylcysteine should be given 10 to 15 minutes before the bronchodilator.

Patients may develop runny nose, nausea, vomiting, drowsiness, headache, and dizziness while receiving acetylcysteine.

For the common cold and other respiratory conditions, the most common route of administration for acetylcysteine is inhalation through a nebulizer.

Answer 9

Patients with chronic obstructive pulmonary disease (COPD) should cautiously, if at all, use inhaled acetylcysteine.

Patients may develop runny nose, nausea, vomiting, drowsiness, headache, and dizziness while receiving acetylcysteine.

For the common cold and other respiratory conditions, the most common route of administration for acetylcysteine is inhalation through a nebulizer.

Question 10

A patient asks a nurse when he or she should expect to start experiencing the effects of pseudoephedrine. Which time frame would the nurse share?

5 to 10 minutes

15 to 30 minutes

3 to 4 hours

5 to 6 hours

Answer 10

15 to 30 minutes

Question 11

Which statements describe the pharmacokinetics of guaifenesin?

Select all that apply.

It is readily absorbed in the gastrointestinal tract.

It is largely protein bound.

The drug undergoes hydrolysis.

Its metabolism extensively involves the cytochrome P450 system.

Guaifenesin is excreted in urine.

Answer 11

It is readily absorbed in the gastrointestinal tract

The drug undergoes hydrolysis.

Guaifenesin is excreted in urine.

Question 12

Which counseling point regarding the pharmacokinetics and pharmacodynamics of dextromethorphan would a nurse include in patient teaching?

Dextromethorphan’s effects last for about 12 hours.

Because it is an opioid drug, it may cause analgesia and excessive drowsiness.

The drug is an antitussive that works through suppressing the cough reflex within the cough center.

The drug is well absorbed in the lungs when inhaled deeply through a nebulizer.

Answer 12

The drug is an antitussive that works through suppressing the cough reflex within the cough center.

Question 13

Which patients would a nurse determine can safely receive inhaled acetylcysteine?

Select all that apply.

A patient with diabetes

A patient with asthma

An older adult with a history of drug abuse

A patient with benign prostatic hyperplasia

An older adult with uncontrolled hypertension

Answer 13

A patient with diabetes

An older adult with a history of drug abuse

A patient with benign prostatic hyperplasia

An older adult with uncontrolled hypertension

Question 14

Which clinical manifestation alerts a nurse to a possible drug-drug interaction in a patient with Parkinson disease who developed the common cold and is receiving selegiline and pseudoephedrine?

Hepatotoxicity

Hypertension

Muscle aches and cramps

Renal dysfunction

Answer 14

Hypertension

Question 15

Which counseling points would a nurse provide a patient who has been prescribed an antitussive containing codeine?

Select all that apply.

Avoid alcohol while receiving the codeine-containing antitussive.

Potential side effects include sedation, dizziness, nausea, vomiting, and constipation.

Increase water intake to help loosen secretions for them to be coughed up.

Report any changes in sputum or mucus color, chest tightness, or difficulty breathing to a health care provider.

Avoid driving or other activities that require mental alertness in the event dizziness and sedation occur

Answer 15

Avoid alcohol while receiving the codeine-containing antitussive.

Potential side effects include sedation, dizziness, nausea, vomiting, and constipation.

Report any changes in sputum or mucus color, chest tightness, or difficulty breathing to a health care provider.

Avoid driving or other activities that require mental alertness in the event dizziness and sedation occur

Question 16

Which drug causes a nurse to carefully consider the patient’s drug list for potential drug-drug interactions due to its metabolism through CYP450 2D6?

Acetylcysteine

Dextromethorphan

Guaifenesin

Pseudoephedrine

Answer 16

Dextromethorphan

Question 17

Which class of drugs used in the management of pulmonary diseases decreases the production of and inhibits the release of leukotrienes, histamine, and prostaglandins; inhibits the activity of eosinophils and leukocytes; and decreases vascular permeability to decrease airway edema?

Anticholinergics

Beta2-adrenergic agonists

Glucocorticoids

Leukotriene modifiers

Answer 17

Glucocorticoids

Question 18

Which range is the targeted therapeutic adult dosage range of theophylline?

1 to 5 mcg/mL

10 to 20 mcg/mL

30 to 40 mcg/mL

50 to 60 mcg/mL

Answer 18

10 to 20 mcg/mL

Question 19

Which statement describes a pharmacodynamic difference between albuterol and salmeterol?

Albuterol is considered “long-acting” and salmeterol is considered “short-acting.”

Salmeterol’s effects last for 3 to 4 hours, and albuterol has an extended duration of action up to 12 hours.

Because of the onset of action, albuterol should not be used during an acute attack of asthma, but instead, salmeterol should be used.

Based on pharmacodynamics, albuterol is typically dosed as needed based on symptoms whereas salmeterol is dosed twice daily.

Answer 19

Based on pharmacodynamics, albuterol is typically dosed as needed based on symptoms whereas salmeterol is dosed twice daily.

Question 20

Which statement is accurate regarding the pharmacokinetic profile of zafirlukast?

Food does not affect the absorption of zafirlukast.

Zafirlukast is minimally protein bound (<5%).

Zafirlukast undergoes hepatic metabolism.

Zafirlukast undergoes urinary excretion.

Answer 20

Zafirlukast undergoes hepatic metabolism.

Question 21

When can a patient anticipate ipratropium’s onset of action?

2 to 3 minutes

5 to 15 minutes

20 to 30 minutes

45 to 60 minutes

Answer 21

5 to 15 min

Question 22

Which teaching points would a nurse provide to Mr. Marx?

Select all that apply.

Encourage Mr. Marx to stop smoking.

Advise Mr. Marx to use the montelukast when he feels the onset of an asthma attack.

Emphasize the importance of taking his montelukast on a daily basis, even in the absence of symptoms.

Advise Mr. Marx to speak to his health care provider about making the albuterol -scheduled instead of as needed to gain better control of his asthma.

Educate Mr. Marx that montelukast may cause adrenal suppression and worsen his diabetes, and he should closely monitor his blood glucose levels.

Answer 22

Encourage Mr. Marx to stop smoking.

Emphasize the importance of taking his montelukast on a daily basis, even in the absence of symptoms.

Question 23

Which patients will a nurse determine can safely receive treatment with a beta2-adrenergic agonist?

Select all that apply.

A patient with an active systemic fungal infection

A patient with benign prostatic hyperplasia

A patient with a cardiac dysrhythmia

A patient with hepatic encephalopathy

A patient with uncontrolled hypertension

Answer 23

A patient with an active systemic fungal infection

A patient with benign prostatic hyperplasia

A patient with hepatic encephalopathy

Question 24

Which order of instructions would a nurse provide a patient using a metered-dose inhaler?

Breathe out through the mouth, and then take a slow deep breath through the mouth while pushing the top of the medication canister at the same time.

Wait for 2 minutes if a second dose is required.

Hold the mouthpiece 1 to 2 inches from the mouth, or place the inhaler mouthpiece between the teeth, sealing the lips around it.

Insert the medication canister into the plastic mouthpiece.

Shake the inhaler well and remove the cap from the mouthpiece.

Hold breath for a few seconds, exhaling slowly through pursed lips.

Answer 24

Insert the medication canister into the plastic mouthpiece.

Shake the inhaler well and remove the cap from the mouthpiece.

Hold the mouthpiece 1 to 2 inches from the mouth, or place the inhaler mouthpiece between the teeth, sealing the lips around it.

Breathe out through the mouth, and then take a slow deep breath through the mouth while pushing the top of the medication canister at the same time.

Hold breath for a few seconds, exhaling slowly through pursed lips.

Wait for 2 minutes if a second dose is required.

Question 25

Which effect would a nurse anticipate might occur in a patient receiving inhaled fluticasone who is also prescribed hydrochlorothiazide for hypertension?

Increased risk for hypokalemia

Increased risk for immunosuppression

Increased clearance of fluticasone, decreasing risk for side effects

Reduced clearance of fluticasone, increasing risk for side effects

Answer 25

Increased risk for hypokalemia

Question 26

Which statements made about theophylline by a patient with asthma would alert the nurse that further intervention is warranted?

Select all that apply.

“I should take an extra dose during an asthma attack.”

“If I accidentally miss a dose, I can double up on my next dose.”

“I should avoid smoking and being around smoke while I am taking the drug.”

“I should avoid caffeine as much as possible while receiving theophylline.”

“I will routinely follow up with my health care provider to have my drug levels determined.”

Answer 26

“I should take an extra dose during an asthma attack.”

“If I accidentally miss a dose, I can double up on my next dose.”

Question 27

Match the drug class to its mechanism of action.

Decrease production/release of leukotrienes, histamine, & prostaglandins

Inhibit muscarinic receptors in the lungs to improve lung function

Relax bronchial smooth muscle to cause bronchodilation

Stimulate adrenergic receptors in the sympathetic nervous system

Answer choices

Beta2-Adrenergic Agonists

Anticholinergics

Glucocorticoids

Theophylline

Leukotriene Modifiers

Answer 27

Decrease production/release of leukotrienes, histamine, & prostaglandins
Glucocorticoids

Inhibit muscarinic receptors in the lungs to improve lung function
Anticholinergics

Relax bronchial smooth muscle to cause bronchodilation
Theophylline

Stimulate adrenergic receptors in the sympathetic nervous system
Beta2-Adrenergic Agonists

Question 28

Which drug should be administered at least 1 hour before meals or 2 hours after meals?

Albuterol

Montelukast

Zafirlukast

Zileuton

Answer 28

Zafirlukast

Question 29

Which drug has a quick onset of action and is recommended for use during an acute asthma attack or chronic obstructive pulmonary disease (COPD) exacerbation?

Albuterol

Fluticasone propionate

Salmeterol

Zafirlukast

Answer 29

Albuterol

Question 30

Which counseling points would a nurse provide in patient teaching regarding the use of an inhaled glucocorticoid for asthma?

Select all that apply.

Palpitations and tremors are expected side effects associated with inhaled glucocorticoid therapy.

Rinse the mouth and gargle with water after using an inhaled corticosteroid to minimize the risk for an oral fungal infection.

Glucocorticoids are indicated for the acute treatment of symptoms and should be used on an “as-needed” basis for symptoms.

Drug levels should be routinely assessed to ensure the patient is not receiving too much or too little of the inhaled glucocorticoid.

Because long-term use of inhaled glucocorticoids may cause potential bone loss, adequate vitamin D and calcium intake, along with weight-bearing exercises, is recommended.

Answer 30

Rinse the mouth and gargle with water after using an inhaled corticosteroid to minimize the risk for an oral fungal infection.

Because long-term use of inhaled glucocorticoids may cause potential bone loss, adequate vitamin D and calcium intake, along with weight-bearing exercises, is recommended.

Question 31

Which patients receiving theophylline would a nurse monitor more closely?

Select all that apply.

A patient with phenylketonuria

A patient who is a social smoker

A patient with acute narrow-angle glaucoma

A patient who excessively consumes energy drinks

A patient receiving ciprofloxacin for a urinary tract infection

Answer 31

A patient who is a social smoker

A patient who excessively consumes energy drinks

A patient receiving ciprofloxacin for a urinary tract infection

Question 32

Which teaching points should be included for a patient prescribed montelukast?

Select all that apply.

Insomnia may occur when receiving this medication.

You can anticipate experiencing dry mouth with montelukast.

You may experience a racing heart or chest pain with this medication.

Report suicidal thoughts to your provider immediately.

You should not stop taking this medication abruptly because it may cause adrenal suppression.

Answer 32

Insomnia may occur when receiving this medication.

Report suicidal thoughts to your provider immediately.

Question 33

Which drugs are anticholinergics?

Select all that apply.

Zileuton

Aclidinium

Tiotropium

Budesonide

Theophylline

Arformoterol

Answer 33

Aclidinium

Tiotropium

Question 34

Which effect will a nurse anticipate for a patient who is receiving both zafirlukast and warfarin?

Increased warfarin levels, thereby decreasing the risk for bleeding

Increased warfarin levels, thereby increasing the risk for bleeding

Reduced warfarin levels, thereby decreasing the risk for bleeding

Reduced warfarin levels, thereby increasing the risk for bleeding

Answer 34

Increased warfarin levels, thereby increasing the risk for bleeding

Question 35

A patient with chronic obstructive pulmonary disease (COPD) has been prescribed ipratropium. The patient also takes diphenhydramine for allergic rhinitis and cimetidine for gastroesophageal reflux disease. Which effect caused by which drug does the nurse anticipate will occur when administered with ipratropium?

Increased levels and toxicity of ipratropium caused by cimetidine

Decreased levels and loss of effects of ipratropium caused by cimetidine

Additive anticholinergic effects caused by diphenhydramine

Reduced efficacy of ipratropium caused by diphenhydramine

Answer 35

Additive anticholinergic effects caused by diphenhydramine

Question 36

A patient with chronic obstructive pulmonary disease (COPD) complains of dry mouth, blurry vision, cough, and difficulty urinating but cannot recall the name of the inhaler that was recently prescribed. Which drug does the nurse determine the patient is likely receiving based on the symptoms?

Albuterol

Fluticasone

Ipratropium

Theophylline

Answer 36

Ipratropium

Question 37

A patient has been prescribed fluticasone propionate for asthma management. The patient also has type 2 diabetes mellitus and dyslipidemia, which are medically managed. Which effect and action does the nurse anticipate may occur when fluticasone propionate is started for this patient?

Increased lipids; adjustment of cholesterol medications

Decreased lipids; discontinuation of cholesterol medications

Increased blood glucose; adjustment of diabetes medications

Decreased blood glucose; discontinuation of diabetes medications

Answer 37

Increased blood glucose; adjustment of diabetes medications

Question 38

Which patient parameters would a nurse assess to help a health care provider determine an accurate dose for and monitor theophylline in a patient with asthma?

Select all that apply.

Age

Height

Weight

Smoking status

Presence of liver disease

Presence of heart disease

Answer 38

Age

Weight

Smoking status

Presence of liver disease

Presence of heart disease

Question 39

Which statements made about salmeterol by a patient with asthma would alert the nurse that further intervention is warranted?

Select all that apply.

“I should use this when I feel an asthma attack is coming on.”

“I will make sure to also use my steroid inhaler and will never use salmeterol by itself.”

“I should only take the amount of salmeterol the health care provider prescribed.”

“I will follow up with my health care provider to have my liver tested after starting salmeterol.”

“I should rinse my mouth after I inhale salmeterol because I might develop a yeast infection.”

Answer 39

“I should use this when I feel an asthma attack is coming on.”

“I will follow up with my health care provider to have my liver tested after starting salmeterol.”

“I should rinse my mouth after I inhale salmeterol because I might develop a yeast infection.”

Question 40

A patient with asthma has been prescribed salmeterol. The patient also takes aspirin, atenolol, furosemide, and phenobarbital. Which drug would be expected to decrease bronchodilation when given with salmeterol?

Aspirin

Atenolol

Furosemide

Phenobarbital

Answer 40

Atenolol