Respiratory Drugs - NCLEX Questions

Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? a) Osteoarthritis b) Hypothyroidism c) Diabetes mellitus d) Polycystic disease - c) Diabetes mellitus Rationale: Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels. Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a) Platelet count b) Neutrophil count c) Liver function tests d) Complete blood count - c) Liver function tests Rationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. A client has been taking isoniazid for 1½ months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a) Hypercalcemia b) Peripheral neuritis c) Small blood vessel spasm d) Impaired peripheral circulation - b) Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a) Use alcohol in small amounts only. b) Report yellow eyes or skin immediately. c) Increase intake of Swiss or aged cheeses. d) Avoid vitamin supplements during therapy. - b) Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy. A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? a) Should always be taken with food or antacids b) Should be double-dosed if one dose is forgotten c) Causes orange discoloration of sweat, tears, urine, and feces d) May be discontinued independently if symptoms are gone in 3 months - c) Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? a) Electrolyte levels b) Coagulation times c) Liver enzyme levels d) Serum creatinine level - c) Liver enzyme levels Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 or abuses alcohol. The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a) Beclomethasone first and then the salmeterol b) Salmeterol first and then the beclomethasone c) Alternating a single puff of each, beginning with the salmeterol d) Alternating a single puff of each, beginning with the beclomethasone - b) Salmeterol first and then the beclomethasone Rationale: Salmeterol (Serevent Diskus) is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective. A client has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? a) Coffee, cola, and chocolate b) Oysters, lobster, and shrimp c) Melons, oranges, and pineapple d) Cottage cheese, cream cheese, and dairy creamers - a) Coffee, cola, and chocolate Rationale: Theophylline (Theo-24) is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate. The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? a) "I must take the medication exactly as prescribed." b) "Once I start the medication, I will no longer be contagious." c) "I will not get any colds or infections while taking this medication." d) "This medication has minimal side effects and I can return to normal activities." - a) "I must take the medication exactly as prescribed." Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate change in activities, especially when driving or operating machinery if dizziness occurs. A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? a) "Clear the nasal passages after use." b) "Take the medication only as needed." c) "The medication should start to work immediately." d) "The medication works locally and decreases inflammation." - d) "The medication works locally and decreases inflammation." Rationale: Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation. The nurse is administering a dose of pirbuterol (Maxair Autohaler) to a client. The nurse should monitor for which side/adverse effect of this medication? a) Drowsiness b) Hypokalemia c) Hyperglycemia d) Increased pulse - d) Increased pulse Rationale: Pirbuterol is an adrenergic bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The other options are not side and adverse effects of this medication. Isoniazid is prescribed for a child with human immunodeficiency virus infection who has a positive Mantoux tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? a) 4 months b) 6 months c) 9 months d) 12 months - d) 12 months Rationale: For children with human immunodeficiency virus infection who demonstrate a positive Mantoux tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended. A client with an exacerbation of chronic obstructive pulmonary disease has been on oral glucocorticoids and is currently being weaned to triamcinolone (Azmacort) by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a) Chills, fever, and generalized rash b) Vomiting, diarrhea, and increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue - d) Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia. A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin (Rifadin) for treatment. The nurse teaches the client to perform which action? a) Report any change in urine color. b) Take both medications with food. c) Take both medications together once a day. d) Expect to take the medication for 2 to 3 weeks. - c) Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of drug-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks. A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? a) Platelet count 325,000 mm3 (325 × 109/L) b) Serum creatinine 1.0 mg/dL (88.3 mcmol/L) c) Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) d) Aspartate aminotransferase (AST) 55 U/L (55 U/L) - d) Aspartate aminotransferase (AST) 55 U/L (55 U/L) Rationale: Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal. A client has begun a course of therapy with rifampin. The home care nurse instructs the client on which measure due to an anticipated side effect? a) Wear dark clothing to avoid staining. b) Always take the medication with food or antacids. c) Double the next medication dose if one is forgotten. d) Stop the medication if symptoms disappear in 2 months. - a) Wear dark clothing to avoid staining. Rationale: Rifampin causes orange-red discoloration of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline (Theo-24). The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? a) 5 mg/mL b) 10 mg/mL c) 15 mg/mL d) 20 mg/mL - a) 5 mg/mL Rationale: Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL. If the laboratory result indicated a level of 5 mg/mL, the dosage of the medication would need to be increased.