Chapter 18: Drugs for Asthma and Other Respiratory Problems Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 18: Drugs for Asthma and Other Respiratory Problems

Test Bank

MULTIPLE CHOICE

1. How are asthma and chronic obstructive pulmonary disease (COPD) different?
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.
ANS: B
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.

PTS: 0 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 330 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. Which statement about the pathology of asthma is true?
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.
ANS: A
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.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 329 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

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

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

4. 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?
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.
ANS: C
Even though both drugs are beta2 agonists, they are both normally prescribed for the patient with asthma. Short-acting (but rapid-acting) beta2 agonists (albuterol) are used to reduce the severity or stop an asthma attack. Long-acting beta2 agonists (salmeterol) can prevent attacks when taken daily; however, their onset of action is so slow that these drugs are not helpful to stop an attack that has already started.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

5. 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?
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
ANS: C
Unlike for asthma, short-acting beta2 adrenergic agonists often are prescribed on a schedule and as an additional rescue drug for the patient with COPD. Extra doses may be needed to open the airways whenever the patient feels especially breathless.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

6. A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is the nurses best instruction to the patient?
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.
ANS: A
Salmeterol is a long-acting beta2 agonist. This type of drug needs time to build up an effect and is useful in preventing asthma attacks. The effects of this drug are longer lasting, but are not of value during an acute asthma attack.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

7. 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?
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.
ANS: D
When used as prescribed, inhaled drugs go more to the site where the intended responses are needed (the airways) and less drug is absorbed systemically. Thus inhaled drugs have fewer (but still have some) side effects. Oral drugs always have systemic side effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

8. 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?
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.
ANS: A
Because damage can occur with any asthma attack, the main focus of therapy should be on attack prevention rather than just on symptom management.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

9. 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?
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.
ANS: C
Washing the DPI may cause the medication in the inhaler to clump together. This action reduces the precision of the delivery of the drug to the patient.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

10. 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?
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.
ANS: A
The therapeutic range for theophylline is very narrow (10 to 20 mcg/mL). If the drug blood levels are lower than 10 mcg/mL, the patients symptoms will not be controlled. If the drug blood levels are higher than 20 mcg/mL, the patient may have serious adverse reactions. Blood levels of this drug need to be monitored closely to ensure safe and effective drug delivery.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

11. A child who weighs 20 kg is prescribed an intravenous (IV) aminophylline (Truphylline) loading dose of 500 mg. What is the nurses best action?
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.
ANS: B
The recommended loading dose of IV aminophylline is 5 to 7 mg/kg, which is a dosage between 100 and 140 mg. The 500-mg prescription is between four and five times the recommended dose. It is possible that this is the dosage that is needed; however, because it is very far out of the recommended range, the dosage should be rechecked with the prescriber (and a pharmacist). If this dosage is to be administered, the child should be in an intensive care unit.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

12. Which assessment is most important for the nurse to perform before administering a bronchodilator by inhalation?
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
ANS: A
The intended action of bronchodilators is to widen the airways to improve breathing. Listening to the lungs with a stethoscope determines drug effectiveness by comparing the patients breath sounds before and after therapy.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

13. A patient is receiving aminophylline (Truphylline) intravenously. Which change in assessment findings indicates to the nurse the possibility of drug toxicity?
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
ANS: D
Methylxanthines, including aminophylline, stimulate the sympathetic nervous system. Signs and symptoms of toxicity include central nervous system irritability, restlessness, temperature elevation, tremors, tachycardia, nausea and vomiting, palpitations, and dizziness.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

14. A patient who is prescribed oral terbutaline (Breathine) reports all of the following signs and symptoms. Which does the nurse report to the prescriber?
a. Difficulty sleeping
b. Taste changes
c. Chest pain
d. Dry mouth
ANS: C
Terbutaline is a beta2 agonist that dilates airways and constricts blood vessels. Expected side effects of this drug include dry mouth, feeling of nervousness, difficulty sleeping, bad taste in the mouth, rapid heart rate, and increased blood pressure. When a patient is extra sensitive to the drug or has other cardiac problems, constriction of the blood vessels may include the coronary arteries and lead to angina (chest pain) or a heart attack. Notify the prescriber immediately if a patient develops chest pain.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

15. 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?
a. Reduced hearing
b. Visual impairment
c. Chronic high blood pressure
d. Arthritis of hands and knees
ANS: D
The Handihaler is a dry powder inhaler that needs to be loaded by the patient and requires considerable manipulation. This action can be difficult or even impossible for patients with arthritis of the hands. This drug delivery choice is not appropriate for this patient and the nurse should ask the prescriber to consider an inhaler type that does not require loading of the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

16. A patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid. What precaution for using these drugs does the nurse stress to the patient?
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.
ANS: C
When a patient is prescribed both an inhaled bronchodilator and anti-inflammatory, give the bronchodilator first, then wait at least 5 minutes before giving the inhaled anti-inflammatory. Giving the bronchodilator first allows the greatest widening of the airways so that the anti-inflammatory can be inhaled more deeply into the respiratory tract and be more effective.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

17. How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)?
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
ANS: B
Corticosteroids decrease the production of the body chemicals that trigger inflammation. Inhaled corticosteroids can prevent or reduce the inflammation in the airways that leads to mucosal swelling in the airway lumen. This swelling narrows the lumen, reducing airflow.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 336 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

18. A home care patient with chronic obstructive pulmonary disease (COPD) has oral candidiasis. What additional information does the nurse obtain from this patient?
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?
ANS: A
Excessive use of steroid inhalers reduces local immune function and increases the patients risk for oral-pharyngeal infections, including candidiasis.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Analysis MSC: Client Needs Category: Physiological Integrity

19. 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?
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.
ANS: D
When a patient is prescribed an anti-inflammatory drug, there is an increased risk of opportunistic infections. A thick white coating on the tongue and mucous membrane suggests that the patient has developed a candidiasis (yeast) infection that will need to be treated with an antifungal drug. The nurse should document the finding and notify the prescriber so that appropriate treatment actions can be taken.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

20. Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma?
a. theophylline (Theo-Dur)
b. montelukast (Singulair)
c. guaifenesin (Organidin)
d. salmeterol (Serevent)
ANS: C
The presence of thick mucus in the respiratory tract is continuous in COPD and intermittent in asthma. It is often necessary to use systemic mucolytic agents or drugs that decrease mucous production in COPD, but is only rarely indicated for asthma.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 338 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

21. 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?
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%
ANS: B
The white blood cell count, lactate dehydrogenase, and hematocrit values are abnormal; however, only the lactate dehydrogenase level is very high (four to five times normal). This value indicates liver impairment. Leukotriene inhibitors can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

22. 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?
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.
ANS: C
Cromolyn sodium is a prophylactic (preventive) drug that stabilizes mast cell membranes, inhibiting inflammatory responses in the tissues it contacts. It is not useful during acute attacks.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. 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
ANS: A, C, D
Beta2 adrenergic agonists have actions similar to the sympathetic division of the autonomic nervous system. When these drugs are used heavily, they can have systemic effects, which include rapid heart rate, increased blood pressure, a feeling of nervousness, and difficulty sleeping. The inhaled drugs can dry the mouth and throat and also may leave a bad taste in the mouth. These drugs, even when absorbed systemically, do not cause diarrhea.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 332 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

SEQUENCING

1. 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.

ANS:
1. C
2. B
3. E
4. F
5. H
6. G
7. D
8. I
9. A
First, the cap is removed before shaking the inhaler so that the drug is fully activated and no time is lost after shaking to remove the cap. The head is tilted back slightly and the patient breathes out fully. The mouth is opened and the mouthpiece placed 1 to 2 inches away. This gets the inhaler in the best position to ensure an adequate dose. (The mouthpiece is not placed in the mouth because many people reflexively hold their breath, and the drug goes out the nose instead of into the trachea and bronchi.) As the patient begins to breathe in deeply through the mouth, the patient presses down firmly on the canister of the inhaler to release one dose. This ensures that more drug reaches the airways. The patient continues to breathe in slowly and deeply (usually over 3 to 5 seconds) to move the drug lower in the airways. The breath should be held for at least 10 seconds to allow the drug to reach deep into the lungs, then breathed out slowly. This enhances exposure to the drug. Finally, at least once a day the canister should be removed and the plastic case and cap cleaned by thoroughly rinsing it in warm, running tap water. To keep the mouthpiece and cap clean, it should be done after, rather than before, using the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

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