Chapter 41: Drugs for Lower Respiratory Disorders Nursing School Test Banks

Chapter 41: Drugs for Lower Respiratory Disorders
Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen?
a. I should use albuterol when my symptoms worsen.
b. I will need to take oral prednisone on a daily basis.
c. My provider will prescribe prophylactic antibiotics.
d. My symptoms are reversible with proper medications.
ANS: A
Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 587
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is preparing to administer isoproterenol (Isuprel) to a patient who is experiencing an acute bronchospasm. The nurse understands that, because isoproterenol is a nonselective beta-adrenergic agonist, the patient will experience which effects?
a. Alpha- and beta-adrenergic agonist effects
b. Anticholinergic effects
c. A shorter duration of therapeutic effects
d. Cardiac and pulmonary effects
ANS: D
Non-selective beta-adrenergic agonists affect both beta1 and beta2 receptors, causing both tachycardia and bronchodilation. Alpha receptors are not affected.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 586
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication?
a. Failure to respond to the medication indicates a need for a higher dose.
b. Monitor for hypoglycemia symptoms when using this medication.
c. Palpitations are common with this drug even at normal, therapeutic doses.
d. Overuse of this medication can result in airway narrowing and bronchospasm.
ANS: D
Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 586
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order?
a. Albuterol, ipratropium bromide, steroid
b. Albuterol, steroid, ipratropium bromide
c. Ipratropium bromide, albuterol, steroid
d. Steroid, ipratropium bromide, albuterol
ANS: A
Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 588
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason?
a. To be more convenient for patients who require both medications
b. To improve compliance in patients who may forget to take both drugs
c. To increase forced expiratory volume, an indicator of symptom improvement
d. To minimize the side effects that would occur if the drugs are given separately
ANS: C
Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the FEV1. While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter drug side effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 588
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug?
a. An extra dose should be taken when symptoms worsen.
b. Anorexia and gastrointestinal upset are unexpected side effects.
c. Avoid caffeine while taking this medication.
d. Food will decrease the amount of drug absorbed.
ANS: C
Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 590
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is caring for a patient who is receiving intravenous theophylline. The patient complains of headache and nausea. The nurse will contact the provider to
a. change the medication to an oral theophylline.
b. obtain an order for a serum theophylline level.
c. request an order for an analgesic medication.
d. suggest an alternative methylxanthine medication.
ANS: B
Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 590
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to
a. decrease the dose of theophylline.
b. increase the dose of theophylline.
c. keep the theophylline dose as ordered.
d. discontinue the theophylline.
ANS: B
Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 589
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take?
a. Ask the patient if herbal medications are used.
b. Notify the provider to report theophylline toxicity.
c. Recommend that the patient increase fluid intake.
d. Request an order for renal function studies.
ANS: A
Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 593
TOP: NURSING PROCESS: Assessment/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching?
a. I will need to have periodic laboratory tests while taking this medication.
b. I will not take ibuprofen for pain or fever while taking this drug.
c. I will take one tablet daily at bedtime.
d. I will use this as needed for acute symptoms.
ANS: D
Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have an aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 594
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patients tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action?
a. Avoid using a spacer with the inhaled glucocorticoid medication.
b. Clean the inhaler with hot, soapy water after each use.
c. Consume yogurt daily while using this medication.
d. Rinse the mouth thoroughly with water after each use.
ANS: D
When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 595
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol
a. has a more immediate onset than the oral form.
b. may cause more side effects than the oral preparation.
c. requires an increased dose in order to have therapeutic effects.
d. will not lead to tolerance with increased doses.
ANS: A
Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects, since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 586
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests?
a. Cardiac enzymes and serum calcium
b. Electrolytes and a complete blood count
c. Liver function tests and serum glucose
d. Urinalysis and serum magnesium
ANS: C
The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 591
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A patient is brought to the emergency department and reports having taken a lot of acetaminophen extra-strength tablets 16 hours prior. The nurse will expect the provider to order
a. acetylcysteine (Mucomyst).
b. dornase alfa (Pulmozyme).
c. gastric lavage.
d. renal enzyme tests.
ANS: A
Acetylcysteine is used as an antidote for acetaminophen overdose if given within 12 to 24 hours of ingestion. Dornase alfa is used to treat cystic fibrosis. Gastric lavage is no longer used as treatment. Liver enzyme tests are indicated since acetaminophen is hepatotoxic.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 597
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report experiencing cough and a bad taste. The nurse will instruct the patient to perform which action?
a. Drink water before and after using the inhaler.
b. Schedule an appointment to discuss these effects with the provider.
c. Stop taking the medication immediately.
d. Use the inhaler only as needed for acute bronchospasms.
ANS: A
Cough and a bad taste are the most common side effects associated with cromolyn sodium, and these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 597
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Leave a Reply