Drugs for Asthma and Other Respiratory Problems

Understanding Pharmacology Essentials for Medication Safety

Nursing
25
Questions
0
True/False
22
Choices
3
Essay
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Questions

Q1
Free

How are asthma and chronic obstructive pulmonary disease (COPD) different?

Multiple Choice
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A) COPD is a genetic disease whereas asthma is largely caused by allergies.
B) Breathing problems with asthma are reversible but those with COPD are permanent.
C) Asthma is a disease of children and younger adults whereas COPD is found only in older adults.
D) Breathing problems with COPD can lead to death, whereas those with asthma are not severe enough to be fatal.
Answer:
B) Breathing problems with asthma are reversible but those with COPD are permanent.

Explanation:
Asthma is a problem of airway obstruction caused by constriction of the bronchial smooth muscles that surround the airways and by inflammation in the airways. It occurs in episodes or attacks. Between attacks, the airways are open. Thus the problem is intermittent and reversible. COPD, however, has permanent airway changes and is not cured by therapy. Both disorders can cause such severe airway obstruction that death occurs.
Q2
Free

Which statement about the pathology of asthma is true?

Multiple Choice
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A) Breath sounds are normal between attacks.
B) Mucous plugs are the major cause of airway obstruction.
C) Eventually the alveoli are destroyed and gas exchange is limited.
D) During an attack, arterial oxygen levels and carbon dioxide levels are decreased.
Answer:
A) Breath sounds are normal between attacks.

Explanation:
The two causes of reversible and intermittent airway obstruction with asthma are bronchoconstriction and inflammation. Between asthma attacks the airways are open and normal breath sounds are heard. Mucous plugs can make the airway obstruction worse, but are not major causes of airway obstruction. Asthma affects only the airways, not the alveoli.
Q3
Free

A patient has been medicated during an asthma attack. Which assessment finding indicates to the nurse that the therapy is ineffective?

Multiple Choice
expand_more
A) Trachea is at the midline.
B) Oxygen saturation is 96%.
C) Respiratory rate is 22 breaths per minute
D) Peak expiratory flow is 40% below expected value
Answer:
D) Peak expiratory flow is 40% below expected value

Explanation:
A peak expiratory flow rate of 40% below the patients personal best indicates that the patient is still having difficulty moving air into the respiratory passages because of airway narrowing. The asthma is not responding sufficiently to the drug. Although the respiratory rate is slightly high, many conditions can cause this and it alone is not an indication of ineffective drug response.
Q4

A patient with asthma is prescribed albuterol (Proventil) as needed and salmeterol (Serevent) every 12 hours. When the patient asks the nurse why two inhaler drugs are needed, what is the nurses best response?

Multiple Choice
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A) Albuterol opens your airways and salmeterol decreases the inflammation.
B) I will check with the prescriber to determine whether you can just use one drug.
C) Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks.
D) Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange.
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Q5

A patient newly diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed inhaled pirbuterol (Maxair) every 6 hours. The nurse instructs the patient to take additional drug doses during which specific times or conditions?

Multiple Choice
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A) At bedtime
B) When feeling especially nervous
C) When feeling especially breathless
D) If the peak expiratory flow rate is 80% or greater than his or her personal best
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Q6

A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is the nurses best instruction to the patient?

Multiple Choice
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A) Use the albuterol (Proventil) inhaler instead.
B) Wait at least one full minute between puffs.
C) Attach the spacer to the inhaler before using it.
D) Take a deep breath, hold it for 15 seconds, and then exhale before using the inhaler.
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Q7

A patient with chronic obstructive pulmonary disease (COPD) who is prescribed a short-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug cant be taken as a pill. What is the nurses best response?

Multiple Choice
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A) Inhaled drugs work more slowly.
B) Inhaled drugs have no side effects.
C) Oral drugs are usually more expensive.
D) Oral drugs have more systemic side effects.
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Q8

A patient with asthma asks why he must take regularly scheduled systemic drugs when he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta agonist inhaler. What is the nurses best response?

Multiple Choice
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A) Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time.
B) If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema.
C) Using only short-acting beta agonists will lead to drug resistance and then the drug wont work when you need it.
D) Inhaled beta agonist drugs only treat the constriction aspects of asthma and do not help the inflammatory aspects of the disease.
Answer:

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Q9

A patient is prescribed a dry powder inhaler (DPI) for chronic obstructive pulmonary disease (COPD). Which statement made by the patient indicates to the nurse that more instruction is needed?

Multiple Choice
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A) I wont exhale into the inhaler.
B) The inhaler will be kept in the drawer of my bedroom dresser.
C) I will wash the inhaler mouthpiece daily with soap and water.
D) Ill inhale twice as hard through this inhaler as I do with my aerosol inhaler.
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Q10

A patient receiving aminophylline (Theophylline) by continuous IV infusion for a severe asthma attack asks why a blood sample must be drawn. What is the nurses best response?

Multiple Choice
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A) The blood level of this drug that causes dangerous side effects is close to the level needed to help open the airways.
B) The blood test helps us evaluate how well the drug is working to open your airways and improve your oxygen intake.
C) The blood test helps determine how much of this drug you are making naturally and how much we are giving you.
D) This blood tests assesses whether you are developing an allergy to this drug.
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Q11

A child who weighs 20 kg is prescribed an intravenous (IV) aminophylline (Truphylline) loading dose of 500 mg. What is the nurses best action?

Multiple Choice
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A) Administer the drug by IV push.
B) Hold the dose and contact the prescriber immediately.
C) Administer the drug by continuous infusion over 20 to 30 minutes.
D) Assess the childs peak expiratory flow rate and then administer the drug as prescribed.
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Q12

Which assessment is most important for the nurse to perform before administering a bronchodilator by inhalation?

Multiple Choice
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A) Listening with a stethoscope to the patients breath sounds
B) Measuring blood pressure in the sitting and standing positions
C) Asking questions to assess the patients cognition and mental status
D) Checking the oral mucous membranes for white or cream-colored patches
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Q13

A patient is receiving aminophylline (Truphylline) intravenously. Which change in assessment findings indicates to the nurse the possibility of drug toxicity?

Multiple Choice
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A) Heart rate increase from 72 to 82 beats per minute
B) Hourly urine output decrease from 50 mL to 40 mL
C) Pulse oximetry increase from 91% to 92%
D) Temperature increase from 99o F to 101o F
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Q14

A patient who is prescribed oral terbutaline (Breathine) reports all of the following signs and symptoms. Which does the nurse report to the prescriber?

Multiple Choice
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A) Difficulty sleeping
B) Taste changes
C) Chest pain
D) Dry mouth
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Q15

A 75-year-old patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva), an inhaled drug that must be loaded into a Handihaler with each dose. The patient has all of the following health problems. For which problem does the nurse suggest to the prescriber that this drug may not be appropriate?

Multiple Choice
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A) Reduced hearing
B) Visual impairment
C) Chronic high blood pressure
D) Arthritis of hands and knees
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Q16

A patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid. What precaution for using these drugs does the nurse stress to the patient?

Multiple Choice
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A) Use the corticosteroid right before meals to reduce mucus secretion.
B) Use the bronchodilator inhaler only in the morning to prevent sleep difficulties.
C) Use the bronchodilator first, wait at least 5 minutes, then use the corticosteroid.
D) Use the corticosteroid first, wait at least 5 minutes, then use the bronchodilator.
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Q17

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)?

Multiple Choice
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A) Relaxing bronchial smooth muscle, leading to wider airways
B) Reducing mucosal swelling in the lumens, leading to wider airways
C) Triggering the sympathetic nervous system, leading to deeper respirations
D) Controlling anxiety, leading to an increased ability to focus on respiratory effort
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Q18

A home care patient with chronic obstructive pulmonary disease (COPD) has oral candidiasis. What additional information does the nurse obtain from this patient?

Multiple Choice
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A) How often are you using your steroid inhaler?
B) Do you share a toothbrush with any members of your family?
C) When was the last time your inhaler drug prescriptions were filled?
D) Have you taken any over-the-counter drugs for a cold or flu lately?
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Q19

A patient who has been prescribed an inhaled corticosteroid develops a thick white coating on the tongue and patches on the inside cheeks. What is the nurses best action?

Multiple Choice
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A) Instruct the patient to stop using the inhaler until the coating is gone.
B) Obtain a culture of the coating and take the patients temperature.
C) Hold the dose and notify the prescriber immediately.
D) Document the finding and notify the prescriber.
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Q20

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma?

Multiple Choice
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A) theophylline (Theo-Dur)
B) montelukast (Singulair)
C) guaifenesin (Organidin)
D) salmeterol (Serevent)
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Q21

A patient taking montelukast (Singulair) for the last 2 months has the following blood laboratory test values. Which value does the nurse report to the prescriber immediately?

Multiple Choice
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A) White blood cell count of 10,500 cells/mm3
B) Lactate dehydrogenase 950 IU/L
C) Potassium 3.6 mEq/L
D) Hematocrit 32%
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Q22

A patient is starting on the drug cromolyn sodium. Which statement made by the patient indicates a need for clarification about the purpose, administration schedule, or side effects of this drug?

Multiple Choice
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A) If I get a skin rash, I will call my doctor right away.
B) I will keep using the drug even if I dont notice a difference in my asthma after the first week.
C) I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs.
D) I have been trying to inhale deeply when I trigger the inhaler so that more of the drug reaches my lungs.
Answer:

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Q23

[Multiple Response] Which responses are possible side effects of inhaled beta2 adrenergic agonists? (Select all that apply.)
a. Bad taste in the mouth
b. Increased salivation
c. Difficulty sleeping
d. Rapid heart rate
e. Hypotension
f. Diarrhea

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Q24

[Multiple Response] Which responses are possible side effects of inhaled beta2 adrenergic agonists? (Select all that apply.)
a. Bad taste in the mouth
b. Increased salivation
c. Difficulty sleeping
d. Rapid heart rate
e. Hypotension
f. Diarrhea

Essay
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Q25

[Sequencing] A patient has been prescribed an aerosol inhaler without a spacer. In what order does the nurse teach the patient to perform these steps?
A. Remove the canister and clean the plastic case and cap of the inhaler.
B. Shake the inhaler.
C. Remove the cap from the mouth piece.
D. Hold your breath for at least 10 seconds.
E. Tilt your head back slightly and breathe out fully.
F. Open your mouth and place the mouthpiece 1 to 2 inches away.
G. Press down firmly on the canister of the inhaler.
H. Breathe in deeply through your mouth.
I. Exhale slowly.

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