Pharm Made Easy Respiratory System Drugs

Pharm Made easy Respiratory System Drugs 1. For which of the following reasons should a client attach a spacer to a metered-dose inhaler? A: To increase the amount of drug delivered to the lungs. Rationale: A spacer increases the amount of drug that reaches the lungs. 2. A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client? A: Acetylcysteine. Rationale: Acetylcysteine is a mucolytic that loosens thick respiratory secretions. 3. A nurse is teaching a client who has prescription for zileuton. Which of the following instructions should the nurse include? A: Have laboratory tests performed at regular intervals. Rationale: Zileuton, a leukotriene modifier, can cause liver injury. The nurse should monitor liver function once a month for 3 months, then every 2 to 3 months during the first year of treatment. 4. A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects? A: Reduces surface tension. Rationale: Expectorants act by reducing the surface tension and viscosity of respiratory secretions. This results in thinning thick mucus, making it easier to cough out of the lungs and drain out of the nose and sinuses. 5. A nurse is teaching a client about using intranasal glucocorticoids. Which of the following instructions should the nurse give? A: Allow at least 2 weeks for the full therapeutic effect. Rationale: glucocorticoids can take 2 or 3 weeks to see the full therapeutic effect of intranasal glucocorticoids. 6. A nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. Which of the following instructions should the nurse include? A: Increase weight-bearing activity. Rationale: Weight-bearing activity can help minimize bone loss, which is an adverse effect of fluticasone propionate/salmeterol, an inhaled glucocorticoid. 7. A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine? A: Potentiation of depression of CNS actions Rationale: Combining dextromethorphan with an opioid, such as morphine, increases the risk for decreased respirations and other depressed CNS responses. 8. For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over-the- counter cold products? A: Over-the-counter cold products can also contain guaifenesin. Rationale: Many combination over-the-counter cold products contain guaifenesin. A client taking both might be taking excessive amounts of the drug. Combination products also contain multiple drugs to treat different manifestations, some of which the client might not have. All drugs have potential adverse effects, so the client should use only those drugs required to treat existing symptoms and only in the recommended amounts. 9. A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include? A: Wait 5 min between using the drug and another inhaled drug, Rationale: Ipratropium, an inhaled anticholinergic, requires a 5-min wait between its administration and that of another inhaled drug to allow for bronchodilation to take effect. 10. A nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug? A: Palpitations Rationale: Although not common at therapeutic doses, beta agonists can cause cardiac stimulation, resulting in chest pain, palpitations, hypertension, and arrhythmias. 11. A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include? (Select all that apply.) A:  Restlessness is correct. Restlessness is an adverse effect of pseudoephedrine, an oral sympathomimetic.  Bradycardia is incorrect. Pseudoephedrine is more likely to cause tachycardia, not bradycardia.  Insomnia is correct. Insomnia is an adverse effect of pseudoephedrine.  Muscle pain is incorrect. Muscle pain is not an adverse effect of pseudoephedrine. The drug is more likely to cause numbness of the extremities.  Anxiety is correct. Anxiety is an adverse effect of pseudoephedrine. 12. A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects? (Select all that apply.) A:  Muscle tremors is incorrect. Muscle tremors can occur with beta2 agonists, not with inhaled anticholinergics such as ipratropium.  Urinary retention is correct. Urinary retention can occur with ipratropium, an inhaled anticholinergic.  Dry mouth is correct. Ipratropium can dry oral secretions.  Insomnia is incorrect. Methylxanthines, not inhaled anticholinergics such as ipratropium, can cause insomnia  Tachycardia is incorrect. Tachycardia can occur with beta2 agonists, not with inhaled anticholinergics such as ipratropium. 13. A nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity? A: Seizures Rationale: Seizures are likely when plasma drug levels of theophylline, a methylxanthine, are higher than 30 mcg/mL, which indicates toxicity. 14. A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone/salmeterol via inhaler for asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler? A: Albuterol will increase the absorption of fluticasone. Rationale: Albuterol, an inhaled, short-acting beta2 agonist, causes bronchodilation, which will increase the absorption of fluticasone, an inhaled glucocorticoid. 15. A nurse is preparing to administer phenylephrine to a client. The nurse should identify that that which of the following manifestations is an adverse effect of this drug? A: Headache Rationale: Oral sympathomimetics stimulate the adrenergic receptors, causing blood vessel constriction, which can cause nervousness, headache, blurred vision, and tremors. 16. A nurse is teaching a client about the use of a mucolytic to treat a cough. The nurse should include that mucolytic has which of the following therapeutic effects? A: Thins and loosens mucus Rationale: Mucolytics make mucus less viscous to increase a cough's productivity. 17. A nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious with clients who have which of the following conditions? A: Coronary artery disease Rationale: pseudoephedrine, an oral sympathomimetic, can cause systemic vasoconstriction, it requires cautious Because use with clients who have severe hypertension or coronary artery disease. 18. A nurse is teaching a client who is taking prednisone for chronic asthma. Which of the following instructions should the nurse include? A: "Avoid taking nonsteroidal anti-inflammatory drugs." Rationale: Gastric protective measures are essential for clients who are taking oral glucocorticoids. Anti-inflammatory drugs can cause GI bleeding, so clients should not take them concurrently with prednisone. 19. Legal restrictions apply to the purchase of pseudoephedrine because of which of the following risks? A: Drug abuse Rationale: Because it is possible to alter pseudoephedrine and epinephrine into methamphetamine, a commonly abused drug, the law restricts the drugs' purchase. 20. A nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make? A: Respirations Rationale: The greatest risk to clients who are taking codeine, an opioid agonist, is severe respiratory depression. Therefore, the respiratory rate is the priority assessment. 21. A nurse is teaching a client about montelukast. Which of the following instructions should the nurse A include? A: Take the drug once day in the evening. Rationale: Montelukast, a leukotriene modifier, is most effective when taken once per day in the evening. 22. A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions? A: Prevent histamine from binding to receptors Rationale: Antihistamines treat allergic rhinitis and reduce swelling by blocking histamine from binding to the receptor sites. 23. A nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects? A: Decreases inflammation Rationale: Beclomethasone, an intranasal glucocorticoid, treats asthma by reducing inflammation. 24. A nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug? A: Drowsiness Rationale: The most common adverse effect of diphenhydramine, a first-generation antihistamine, is drowsiness. 25. A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects? A: Reduces inflammation Rationale: Cromolyn sodium, a mast cell stabilizer, reduces inflammation by inhibiting the inflammatory response. Upper respiratory tract Pharynx - Sinuses - Nose -Trachea Lower respiratory tract Bronchi - Bronchioles - Alveoli - Lungs Case study Which of the following drugs is appropriate for this client at this time? A: Albuterol Rationale: Albuterol is a short-acting beta2 agonist that you administer to relieve acute bronchospasm. Formoterol and salmeterol are long acting beta2 agonists you give every 12 hours to prevent bronchospasm. Theophylline is a long-acting methylxanthine to prevent bronchospasm. After the client is reassessed, the provider prescribes a stat parenteral dose of a glucocorticoid. Recognizing the adverse effects of glucocorticoids, you should monitor the client for which of the following? (Select all that apply.) A: Hyperglycemia Infection Gastric bleeding Rationale: Glucocorticoids may cause glucose intolerance and hyperglycemia. It is essential to monitor glucose levels for clients receiving these drugs. They may also increase the risk for or mask an existing infection. They can also increase gastric acid secretion, causing peptic ulcer disease with possible gastric bleeding. These drugs are not known to cause thrombophlebitis or dysrhythmias. As the client continues to stabilize, she is prescribed prednisone by mouth. You review her history and the drugs she has been taking. Which of the following drugs might interact adversely with prednisone? A: Ibuprofen Rationale: Nonsteroidal anti-inflammatory drugs, such as ibuprofen, can increase the risk of gastrointestinal ulceration and should be avoided. Levothyroxine, a thyroid hormone, should not interact with the prednisone. This drug does, however, interact with oral anticoagulants. Atorvastatin, an HMG-CoA reductase inhibitor, should not interact with the prednisone. This drug does, however, interact with macrolide antibiotics. Potassium-sparing diuretics, such as spironolactone, should not interact with prednisone. This drug does, however, interact with cardiac glycosides. Diuretics that can cause potassium loss should be avoided. The following day, the client is stable and being prepared for discharge. You explain that she will continue to take prednisone orally at home, as prescribed, and that she should watch for and report which of the following to her usual provider? (Select all that apply.) A: Black, tarry stools Sore throat Muscle weakness Rationale: Prednisone, an oral glucocorticoid, increases the risk for gastric ulceration. Black, tarry stools can indicate gastrointestinal bleeding. This drug also increases the risk for infection. Clients should watch for and report early signs of infection, such as a sore throat or fever. Prednisone also can result in fluid and electrolyte disturbances. Muscle weakness can indicate hypokalemia. Persistent cough is an adverse effect of angiotensin-converting enzyme inhibitors, such as Lisinopril (Zestril). Urinary retention can be an adverse effect of anticholinergic agents. Next, the provider tells the client that she will also take albuterol via a metered-dose inhaler (MDI). When instructing the client about using the MDI, you should include which of the following information? A: Wait at least 1 minute before inhaling the second puff. Rationale: Most clients are prescribed two puffs of the inhaler with each dose. Waiting at least 1 minute, or the prescribed interval, before taking the second puff allows time for the bronchodilation, which may increase the absorption of the next puff. The client should take a slow, deep breath lasting for 3 to 5 seconds to facilitate delivery to the air passages. It is not necessary to block either nasal passage while inhaling; in fact, it could interfere with optimal inhalation of the drug. Activities Which of the following information should you include when teaching a client about the use of an albuterol inhaler for asthma management? A: Use it periodically to prevent exercise-induced asthma. Rationale: Albuterol is a short-acting beta2 agonist that clients should use only as needed to stop an acute asthma exacerbation or 30 minutes before exercising to prevent exercise-induced bronchospasm. Salmeterol is an example of a drug that clients take every 12 hours for long-term asthma management. They should keep albuterol canisters away from heat and direct sunlight, but they should not refrigerate them. Inhaled glucocorticoids, such as beclomethasone, may cause oral yeast infections. They are not an adverse effect of albuterol. Which of the following information indicates that a client who is taking theophylline needs further instruction? A: The client drinks two cups of coffee each morning. Rationale: Caffeine may increase CNS stimulation, causing nervousness, insomnia, and tremors. It may also increase cardiac stimulation and cause tachycardia. Instruct clients taking methylxanthines to avoid caffeine intake. Alcohol use is not a contraindication for theophylline use. Exercise is appropriate for clients who have asthma. Theophylline should not impair the client's ability to operate a motor vehicle. Primary care providers should not prescribe theophylline for clients who have severe liver or renal impairment. You should instruct a client who is taking zileuton to report which of the following possible indications of a serious adverse effect of this drug? A: Abdominal pain Rationale: Zileuton may cause liver damage and hepatitis. Clients should report any signs of hepatic toxicity, such as abdominal pain or jaundice. Dysphagia, or difficulty swallowing, is not likely to result from taking zileuton, although this drug can cause neck pain and rigidity. Zileuton is unlikely to cause blurred vision, although it can cause conjunctivitis. Bradycardia is unlikely to result from taking zileuton, although this drug can cause chest pain. You are obtaining a health history from a client who is to start using a new ipratropium inhaler. Which of the following information from the client's history alerts you to take further action? (Select all that apply.) A: Peanut allergy Glaucoma Rationale: Clients who are allergic to peanuts or do not take ipratropium, an anticholnergic drug, because the medication preparation may contain peanut oil and soy lecithin. This drug requires caution with clients who have glaucoma because of the risk for increased intraocular pressure. Clients who have a seizure disorder or who take MAOIs or thyroid hormones can take ipratropium. The drug is inappropriate for clients who have prostatic hypertrophy. You should advise a client who is taking beclomethasone to watch for which of the following possible indications of an adverse effect of this drug? A: White coating in the mouth Rationale: Beclomethasone, an inhaled glucocorticoid, may cause oropharyngeal candidiasis. Clients should gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat, and report any white patches inside the mouth or on the tongue. Leukotriene modifiers are more likely to cause liver injury and abdominal pain. Muscle twitching and palpitations may indicate methylxanthine toxicity. You should recognize that which of the following is a contraindication for taking codeine? A: Emphysema Rationale: Codeine is unsafe for clients who have decreased respiratory reserve, such as with emphysema or asthma. Cataracts are not a contraindication for codeine use, although the drug can exacerbate some types of glaucoma due to a possible increase in intracranial pressure. Codeine may cause constipation, hypotension, and reduced respiration. Cautious use is essential for clients with hypothyroidism because the drug can worsen bradycardia. Codeine can help suppress a nonproductive cough. You are instructing a client about using cromolyn via inhalation to treat exercise-induced bronchospasm. You advise the client to take the drug A: 15 minutes before exercising. Rationale: Cromolyn may prevent exercise-induced asthma if used 15 minutes before exercising. Cromolyn is not effective at stopping bronchospasm. Clients may use cromolyn via nebulizer up to 4 times per day to prevent bronchospasm. Using the inhaler at bedtime will not prevent exerciseinduced asthma. You should monitor a client taking dextromethorphan because of the potential for which of the following? A: Drug abuse Rationale: Dextromethorphan can cause euphoria and hallucinations at high doses. Monitor clients taking it for the potential for abuse. Dextromethorphan is unlikely to cause tachycardia, fluid retention, or blurred vision, although it can cause dizziness, dyspepsia, and constipation. You are instructing a client who has a new prescription for cetirizine. Which of the following information should you be sure to include? A: Administer the drug prophylactically during allergy seasons. Rationale: Cetirizine is a second-generation antihistamine used primarily to relieve symptoms associated with seasonal allergic rhinitis. Increasing fluids if possible may help reduce dry mouth and constipation. Taking cetirizine in the morning will not minimize its adverse effects. Taking antihistamines with food may help reduce gastric distress. You should instruct a client using phenylephrine spray for nasal congestion to do which of the following to avoid rebound congestion? A: Limit the drug's use to 3 to 5 days. Rationale: Clients should use phenylephrine, a topical sympathomimetic, short-term to prevent rebound congestion. Using an intranasal glucocorticoid, tapering the dose, and instilling the drug in one nostril may help wean the client off of a topical sympathomimetic after extended use, but these actions will not prevent rebound congestion.