Question 1

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)?

Accepted Answer

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.

Question 2

A patient reaches for the salmeterol (Serevent)inhaler with the onset of an asthma attack.What is the nurse's best instruction to the patient?

Accepted Answer

Salmeterol is a long-acting beta₂agonist.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.

Question 3

A home care patient with chronic obstructive pulmonary disease (COPD)has oral candidiasis.What additional information does the nurse obtain from this patient?

Accepted Answer

Excessive use of steroid inhalers reduces local immune function and increases the patient's risk for oral-pharyngeal infections,including candidiasis.

Question 4

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 can't be taken as a pill.What is the nurse's best response?

Accepted Answer

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.

Question 5

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD)than as therapy for asthma?

Accepted Answer

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.

Question 6

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

Accepted Answer

A peak expiratory flow rate of 40% below the patient's 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.

Question 7

A patient who is prescribed oral terbutaline (Breathine)reports all of the following signs and symptoms.Which does the nurse report to the prescriber?

Accepted Answer

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.

Question 8

Which assessment is most important for the nurse to perform before administering a bronchodilator by inhalation?

Accepted Answer

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 patient's breath sounds before and after therapy.

Question 9

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?

Accepted Answer

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.

Question 10

How are asthma and chronic obstructive pulmonary disease (COPD)different?

Accepted Answer

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.

Question 11

A patient is receiving aminophylline (Truphylline)intravenously.Which change in assessment findings indicates to the nurse the possibility of drug toxicity?

Accepted Answer

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.

Question 12

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 nurse's best response?

Accepted Answer

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 patient's 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.

Question 13

A patient is prescribed an inhaled bronchodilator and an inhaled corticosteroid.What precaution for using these drugs does the nurse stress to the patient?

Accepted Answer

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.

Question 14

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 nurse's best response?

Accepted Answer

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.

Question 15

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 nurse's best action?

Accepted Answer

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.

Question 16

A child who weighs 20 kg is prescribed an intravenous (IV)aminophylline (Truphylline)loading dose of 500 mg.What is the nurse's best action?

Accepted Answer

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.

Question 17

Which statement about the pathology of asthma is true?

Accepted Answer

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.

Question 18

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?

Accepted Answer

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.

Question 19

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?

Accepted Answer

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.

Question 20

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 nurse's best response?

Accepted Answer

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

Quiz 18: Drugs for Asthma and Other Respiratory Problems

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD) ?

A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack.What is the nurse's best instruction to the patient?

A home care patient with chronic obstructive pulmonary disease (COPD) has oral candidiasis.What additional information does the nurse obtain from this patient?

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 can't be taken as a pill.What is the nurse's best response?

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma?

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

A patient who is prescribed oral terbutaline (Breathine) reports all of the following signs and symptoms.Which does the nurse report to the prescriber?

Which assessment is most important for the nurse to perform before administering a bronchodilator by inhalation?

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?

How are asthma and chronic obstructive pulmonary disease (COPD) different?

A patient is receiving aminophylline (Truphylline) intravenously.Which change in assessment findings indicates to the nurse the possibility of drug toxicity?

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 nurse's best response?

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 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 nurse's best response?

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 nurse's best action?

A child who weighs 20 kg is prescribed an intravenous (IV) aminophylline (Truphylline) loading dose of 500 mg.What is the nurse's best action?

Which statement about the pathology of asthma is true?

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 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 nurse's best response?

Quiz 18: Drugs for Asthma and Other Respiratory Problems

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD) ?

A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack.What is the nurse's best instruction to the patient?

A home care patient with chronic obstructive pulmonary disease (COPD) has oral candidiasis.What additional information does the nurse obtain from this patient?

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 can't be taken as a pill.What is the nurse's best response?

Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma?

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

A patient who is prescribed oral terbutaline (Breathine) reports all of the following signs and symptoms.Which does the nurse report to the prescriber?

Which assessment is most important for the nurse to perform before administering a bronchodilator by inhalation?

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?

How are asthma and chronic obstructive pulmonary disease (COPD) different?

A patient is receiving aminophylline (Truphylline) intravenously.Which change in assessment findings indicates to the nurse the possibility of drug toxicity?

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 nurse's best response?

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 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 nurse's best response?

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 nurse's best action?

A child who weighs 20 kg is prescribed an intravenous (IV) aminophylline (Truphylline) loading dose of 500 mg.What is the nurse's best action?

Which statement about the pathology of asthma is true?

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 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 nurse's best response?

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 can't be taken as a pill.What is the nurse's best response?