NURSING 112 - Chapter 37: Respiratory Drugs,Lilley: Pharmacology and the Nursing Process, 8th Edition

NURSING 112 - Chapter 37: Respiratory Drugs,Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. 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 ANS: D The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 593 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. 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 ANS: 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. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 585 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. 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 (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent) ANS: 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. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long- acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 582 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. 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. ANS: C These drugs 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. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 592 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. After receiving a nebulizer treatment with a beta agonist, the patient complains of 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.” ANS: A Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 583 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. 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.” ANS: B An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 592 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. 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 ANS: D Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 592 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 8. The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be: a. below the therapeutic level. b. at a therapeutic level. c. above the therapeutic level. d. at a toxic level. ANS: C Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 585 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. 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 doctor 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. ANS: C The use of a spacer may be in