Pharmacology Practice Quiz for the Examination Chapter 37

PREPARATION FOR THE NCLEX EXAMINATION QUESTIONS : EVOLVE 1. A patient who is taking ipratropium (Atrovent) for asthma is complaining of a dry cough. Which action should the nurse implement first? a. Listening to the patient's lungs b. Giving dextromethorphan 30 mg c. Instructing the patient to drink water d. Administering the rescue therapy ANS : A Before making a recommendation, the nurse completes a patient assessment to rule out an exacerbation of asthma because the cough may be a clinical indicator of a more serious problem in a patient who has asthma. 2. Which medication disrupts the inflammatory response and is indicated in the treatment of asthma? a. Ipratropium (Atrovent) b. Montelukast (Singulair) c. Theophylline (Theo-Dur) d. Salmeterol (Serevent) ANS : B Montelukast is a leukotriene-receptor antagonist indicated in the treatment of asthma and allergic rhinitis and acts by binding to the D4 leukotriene receptor in the respiratory tract. 3. A patient who received methylprednisolone (Solu-Medrol) IV over 4 days for acute asthma is being prepared for discharge by the nurse. Which instruction is the nurse's priority for inclusion in patient teaching if this patient is discharged with a prescription for fluticasone (Flovent)? a. Rinse your mouth with water after using fluticasone. b. Avoid situations that can expose you to the antigen. c. Take prednisone (Deltasone) at the same time daily. d. Administer albuterol before other asthma medication. ANS : B The nurse instructs the patient to avoid potential exposure to the antigen because subsequent exposure to an antigen can trigger a hypersensitivity reaction and result in airway impairment. This is important for a patient recovering from an acute asthma attack because residual pulmonary secretions are likely to remain in the lungs, so another attack could have devastating results. 4. A patient with chronic obstructive pulmonary disease (COPD) is retaining carbon dioxide. Which respiratory therapy should the nurse administer to lower the patient's carbon dioxide level? a. Fluticasone propionate (Flovent) b. Oxygen by way of nasal cannula, 2 L/min c. Albuterol nebulizer (Proventil) d. Salmeterol (Serevent Diskus) ANS : C The patient is retaining carbon dioxide because of an impaired forced expiratory volume, so the nurse needs to administer a bronchodilator, such as albuterol, to increase the size of the airways and permit more ventilation. 5. After an acute asthma attack, which medication is used to prevent airway reactivity and increased secretions? a. Theophylline (Elixophyllin) b. Fluticasone propionate (Flonase) c. Salmeterol (Serevent Diskus) d. Albuterol (Ventolin) ANS : B Fluticasone propionate is a glucocorticoid that is administered by way of inhalation to reduce bronchial hyperreactivity by suppressing the immune response to antigens. This means that when the individual comes in contact with the antigen, bronchoconstriction does not occur because the inflammatory response is suppressed; thus, fluid is not mobilized to the site and vessels maintain their normal permeability, resulting in a normal amount of respiratory secretions. The remaining options have no effect on bronchial secretions. 6. Which asthma medication is not available for inhalation? a. Fluticasone propionate (Flonase) b. Salmeterol (Serevent) c. Theophylline (Theo-Dur) d. Ipratropium (Atrovent) ANS : C Theophylline is available in oral, rectal, parenteral, and topical formulations, but not in an inhalable formulation. 7. A patient experiences acute bronchospasm after being exposed to peanuts on an airplane. Which instruction should the nurse include in patient teaching to prevent future exposure to the precipitating factor for this patient's asthma? (Select all that apply.) a. Avoid albuterol and ipratropium (Combivent). b. Always carry asthma medication. c. Use albuterol (Proventil) for rescue therapy. d. Read the labels of processed foods to see if they contain peanuts. e. Inhale triamcinolone (Azmacort) as needed. f. To avoid peanuts, refrain from traveling. ANS : A, D PREPARATION FOR THE NCLEX EXAMINATION QUESTIONS : EVOLVE peanuts or peanut products. The nurse also instructs her to avoid asthma products containing anticholinergic agents, and ipratropium in particular because individuals with peanut allergy have greater risk of allergy to the anticholinergic agent and because ipratropium in aerosol form is associated with bronchospasm. 8. A patient is taking zileuton (Zyflo). Which medication, if ordered, should the nurse question? a. Erythromycin b. Rifampin c. Aspirin d. Propranolol ANS : D Propranolol levels are increased when taken concurrently with zileuton. 9. Which medication is administered first to a patient who has acute dyspnea, wheezing, hypercapnea, and hypoxemia? a. Beta2agonists b. Glucocorticoids c. Anticholinergics d. Leukotriene modifiers ANS : A This patient is experiencing an acute obstructive respiratory attack, which may be a result of asthma, bronchitis, or emphysema. The first drug that should be administered is the beta2agonist, and it should be delivered by way of inhalation. Beta2agonists are effective in the relief of acute bronchospasm because they act quickly. 10. The nurse instructs a patient to avoid caffeine and stimulants when the individual is self-administering which medication? a. Montelukast (Singulair) b. Albuterol (Ventolin) c. Flunisolide (AeroBid) d. Tiotropium (Spiriva) ANS : B The nurse instructs a patient who self-administers albuterol to avoid substances such as caffeine and other stimulants that will augment the sympathetic stimulation of albuterol. Excessive stimulation may result in severe hypertension, angina, and serious dysrhythmias. 11. The nurse receives laboratory values for a patient with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? a. Life threatening b. Toxic c. Therapeutic d. Subtherapeutic ANS: C The therapeutic theophylline level is 10 to 20 mcg/mL 12. Which herbal product, when taken with theophylline, can decrease theophylline’s serum drug levels? a. Peppermint oil b. St. John’s wort c. Echinacea d. Garlic ANS: B St. John’s wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels 13. The nurse is providing care to a patient prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in thepatient’s medical historywould alert the nurse to question this medication order? a. Thrombocytopenia b. Chronic obstructive pulmonary disease c. Coronary artery disease d. Mycobacterium tuberculosis ANS: C Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2receptors in the lungs. Stimulation of beta1receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patients with coronary artery disease. 14. A nurse is providing education to a patient taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol over other beta2 agonists such as albuterol? a. Longer duration of action b. Extended time of action c. Quicker peak action d. Shorter onset of action ANS: A Salmeterol has a longer duration of action, requiring the patient to use it only twice a day instead of three or four times a day with albuterol. 15. The nurse is teaching a patient about the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast. Which statement would be appropriate by the nurse? a. “Take the medication when you are short of breath and begin wheezing.” b. “It will take about 3 or 4 weeks before you notice a therapeutic effect.” c. “This medication works by preventing the inflammation that causes your asthma attack.” PREPARATION FOR THE NCLEX EXAMINATION QUESTIONS : EVOLVE d. “Increase fiber and fluid in your diet to prevent the common adverse effect of constipation.” ANS: C LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast. 16. What is the role of corticosteroids in the treatment of acute respiratory disorders? a. They stimulate the immune system. b. They increase gas exchange in the alveoli. c. They decrease inflammation. d. They directly dilate the bronchi. ANS: C Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation. 17. Which a. b. c. d. statement by a patient best indicates an understanding of the teaching on flunisolide? “I will wash the plastic inhaler casing once a month.” “I will rinse my mouth with water after each use.” “I will take two puffs to treat an acute asthma attack.” “I will not use my albuterol inhaler while I am taking AeroBid.” ANS: B Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the patient’s bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week. 18. Which a. b. c. d. statement by the nurse would be included when teaching a patient about the proper use of metered-dose inhalers? “Wait 1 to 2 minutes before you take a second puff of the same drug.” “Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler.” “After you inhale the medication once, repeat until you obtain relief.” “Make sure that you puff out air several times after you inhale the medication.” ANS: A If a second puff of the same drug is ordered, instruct the patient to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the patient to wait 2 to 5 minutes between the medications or to take as prescribed 19. The nurseperforms discharge teachingwith a patient whois prescribed the anticholinergic inhaler ipratropium bromide. Which statement by the patient indicates to the nurse that teaching has been successful? a. “Nausea and vomiting are common adverse effects of this medication.” b. “I will notdrink grapefruit juice while taking this drug.” c. “This inhaler is not to be used alone to treat an acute asthma attack.” d. “I may gain weight as a result of taking this medication.” ANS: C Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a directacting bronchodilator is needed to treat an acute asthma attack. 20. Which a. b. c. d. laboratory value would the nurse assess before administering zafirlukast to a patient? Renal function tests Complete blood count Liver enzymes Cardiac enzymes ANS: C Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy 21. Before administering an LTRA medication, the nurse would assess the patient for allergies to which substance? (Select all that apply.) a. Povidone b. Chlorhexidine c. Lactose d. Latex e. Cellulose ANS: A, C, E Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs. 22. The nurse is providing discharge teaching to a patient receiving a beta-agonist bronchodilator. What side effect would the nurse emphasize the patient needs to report? a. Hypoglycemia b. Nonproductive cough c. Sedation d. Tachycardia ANS: D A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness