Question 1

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?

Accepted Answer

Albuterol is a bronchodilator and should be used first to open the airways, followed by ipratropium bromide for further bronchodilation, and finally the steroid to reduce inflammation in the now more open airways.

Question 2

The nurse provides teaching for a patient who will begin taking montelukast sodium (Singulair). Which statement by the patient indicates a need for further teaching?

Accepted Answer

Montelukast sodium (Singulair) is a leukotriene receptor antagonist used for asthma and allergic rhinitis. It is taken orally, usually once daily, in the evening. It is not used as needed for acute symptoms, so the patient's statement that indicates a need for further teaching is D. Laboratory tests are not usually required unless the patient has preexisting liver disease. Patients should also avoid taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) while taking this medication, but ibuprofen specifically is not contraindicated.

Question 3

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?

Accepted Answer

Theophylline is a stimulant medication and caffeine can increase its effects, leading to potential side effects such as palpitations, tremors, and insomnia. It is important to avoid caffeine while taking this medication. Choices A, B, and D are incorrect. An extra dose of theophylline should not be taken without consulting a healthcare provider, anorexia and gastrointestinal upset are common side effects of theophylline, and food can actually increase the amount of drug absorbed, not decrease it.

Question 4

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?

Accepted Answer

Using albuterol when symptoms worsen is a correct statement as albuterol is a rescue medication used for bronchodilation during exacerbations of emphysema. Taking oral prednisone on a daily basis is not recommended for mild emphysema, as it has numerous side effects. Prophylactic antibiotics are not typically prescribed for emphysema unless there is an accompanying bacterial infection. While some symptoms of emphysema can be reversible with proper medications, mild emphysema is not curable and treatment is aimed at slowing the progression of the disease and managing symptoms.

Question 5

A patient who has been taking theophylline at home reports having palpitations and jitteriness. Which of the following could interact with theophylline to increase side effects such as these?

Accepted Answer

Ephedra is a sympathomimetic drug that can interact with theophylline, leading to increased heart rate, palpitations, and jitteriness. Acetaminophen, ibuprofen, and diphenhydramine do not interact with theophylline in this way.

Question 6

A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patient's tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action?

Accepted Answer

The patient is experiencing oral thrush, which is a common side effect of inhaled glucocorticoid medication. The nurse should remind the patient to rinse their mouth thoroughly with water after each use to reduce the risk of developing thrush. Avoiding a spacer may decrease the effectiveness of the medication. Cleaning the inhaler regularly is important but will not directly address the oral thrush. Consuming yogurt may help to prevent thrush, but it should not be the primary intervention in this case.

Question 7

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?

Accepted Answer

Montelukast is known to have hepatotoxic effects and the provider may order liver function tests to monitor for any liver damage. Albuterol can also cause hyperglycemia in some patients, so serum glucose may also be ordered. Cardiac enzymes, serum calcium, electrolytes, complete blood count, urinalysis, and serum magnesium may not be necessary based on the medications reported by the patient.

Question 8

The nurse is preparing to administer epinephrine to a patient who is experiencing an acute bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and beta-adrenergic agonist, the patient will experience which effects?

Accepted Answer

Epinephrine is a nonselective alpha- and beta-adrenergic agonist, which means it will have both cardiac and pulmonary effects. It will increase heart rate and contractility while also dilating bronchioles to increase air flow to the lungs. It may also cause mild vasoconstriction, leading to a slight increase in blood pressure. There are no anticholinergic effects associated with epinephrine. The duration of its therapeutic effects may vary depending on the patient and the dose administered.

Question 9

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:

Accepted Answer

The inhaled form of albuterol has a more immediate onset than the oral form because it goes directly to the lungs where it is needed.

Question 10

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?

Accepted Answer

Overuse of albuterol can result in airway narrowing and bronchospasm.

Question 11

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?

Accepted Answer

Drinking water before and after using the inhaled medication can help alleviate the cough and bad taste side effects. These are common side effects of inhaled cromolyn sodium and do not typically require stopping the medication or using it only as needed for acute bronchospasms. However, the patient may still want to follow up with the provider to discuss these effects and ensure that the medication is still appropriate for their treatment plan.

Question 12

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:

Accepted Answer

Theophylline is a medication used to treat respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). However, it has a narrow therapeutic index, which means that small changes in dosage can result in toxicity. Symptoms of theophylline toxicity include headache, nausea, vomiting, and seizures. Therefore, if a patient complains of such symptoms, a serum theophylline level should be obtained to assess for toxicity. Changing the medication to an oral form or suggesting an alternative medication will not address the current potential toxicity. Requesting an order for an analgesic medication is not appropriate as the headache is likely a symptom of the medication toxicity.

Question 13

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 expects that the patient will eventually require which of the following?

Accepted Answer

Smoking can increase the metabolism of theophylline, leading to lower blood levels and potentially reduced effectiveness of the medication. Therefore, a larger than typical dose of theophylline may be required to achieve the desired therapeutic effect. However, it is important to also consider potential adverse effects and monitor the patient closely.

Question 14

The nurse is caring for a patient diagnosed with COPD who has been prescribed tiotropium (Spiriva). Which statement will the nurse include in the education?

Accepted Answer

Tiotropium works by relaxing and dilating the bronchioles, making it easier for the patient to breathe. Option A is incorrect because the capsules need to be kept in their packaging until ready for use to protect them from light and moisture. Option B is incorrect because dry mouth is a common side effect of tiotropium and does not require immediate cessation of the medication. Option C is incorrect because tiotropium is a maintenance medication and should be taken on a regular schedule to prevent breathing problems, not used as needed for sudden attacks.

Question 15

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?

Accepted Answer

The combination of ipratropium bromide and albuterol sulfate is primarily prescribed to increase forced expiratory volume, which indicates an improvement in breathing and symptom relief for COPD patients.

Quiz 36: Lower Respiratory Disorders

The nurse provides teaching for a patient who will begin taking montelukast sodium (Singulair) . Which statement by the patient indicates a need for further teaching?