A
A client prescribed an albuterol (Proventil) via inhaler asks the nurse why they can't just take a pill. Which response should the nurse provide?
1. "When you inhale the prescription the blood supply in the lungs absorbs it rapidly resulting in quicker effects."
2. "Oral prescriptions will not relieve your symptoms; you must have an inhaled prescription for relief of symptoms."
3. "Oral prescriptions produce too many side effects."
4. "The prescription cannot be absorbed in the GI tract because the acid in the stomach will destroy it."
Answer: 1
Explanation:
1. The respiratory system offers a rapid and efficient mechanism for absorbing prescriptions. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances.
2. Albuterol (Proventil) can be given orally (PO) but has a faster onset of action if inhaled.
3. Inhaled prescriptions also produce side effects.
4. Oral prescriptions are effective with
The nurse has completed client education about the use of a metered-dose inhaler (MDI) and spacer. Which statement made by the client indicates further teaching is required?
1. "While I depress the canister I will make sure that I inhale slowly."
2. "After each use of my metered-dose inhaler (MDI) I will rinse my mouth."
3. "It is important that I drink plenty of fluids while I am using the metered-dose inhaler (MDI)."
4. "I should keep the spacer moist between uses by storing it in a plastic zip bag."
Answer: 4
Explanation:
1. The client should inhale slowly while depressing the cannister to help deliver a measured dose of the prescription during each breath.
2. Rinsing the mouth after using the metered-dose inhaler (MDI) is correct; it will help reduce oral absorption of the drug.
3. Fluids are encouraged to liquefy pulmonary secretions when using the metered-dose inhaler (MDI).
4. The spacer and inhaler should be rinsed with water and allowed to air-dry.
The nurse has provided education for a client prescribed zafirlukast (Accolate). Which statement made by the client indicates an understanding of the information?
1. "Zafirlukast will activate my fight-or-flight response."
2. "I can use this prescription for acute asthma attacks."
3. "This prescription will dilate my airways so I can breathe better."
4. "This decreases the inflammation in my lungs."
Answer: 4
Explanation:
1. Zafirlukast does not stimulate the sympathetic nervous system.
2. Zafirlukast is ineffective for acute asthma attacks.
3. Zafirlukast is not a bronchodilator.
4. Zafirlukast prevents airway edema and inflammation by blocking leukotriene receptors in the airways.
Which long-term control prescriptions have an anti-inflammatory mechanism of action?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Immunomodulators
2. Methylxanthines
3. Mast cell stabilizers
4. Leukotriene modifiers
5. Inhaled corticosteroids
Answer: 3, 4, 5
Explanation:
1. Immunomodulators have a monoclonal antibody mechanism of action.
2. The mechanism of action for methylxanthines is bronchodilation.
3. Mast cell stabilizers have an anti-inflammatory mechanism of action.
4. Leukotriene modifiers have an anti-inflammatory mechanism of action.
5. Inhaled corticosteroids have an anti-inflammatory mechanism of action.
Which condition is an adverse effect of a beta-adrenergic agonist?
1. Bradycardia
2. Constipation
3. Tachycardia
4. Runny nose
Answer: 3
Explanation:
1. Beta-adrenergic agonists cause tachycardia, not bradycardia.
2. Diarrhea can occur with some leukotrienes.
3. Tachycardia is common, along with restlessness.
4. Dry mucous membranes can occur.
The nurse has provided a client with asthma education about bronchodilators. Which statement made by the client indicates an understanding of the information?
1. "The prescription widens the airways because it decreases the production of mucus that narrows them."
2. "The prescription widens the airways because it decreases the production of histamine that narrows them."
3. "The prescription widens the airways because it acts on the parasympathetic nervous system."
4. "The prescription widens the airways because it stimulates the fight-or-flight response of the nervous system."
Answer: 4
Explanation:
1. Bronchodilators do not decrease the production of mucus.
2. Bronchodilators do not decrease the production of histamine.
3. Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system.
4. During the fight-or-flight response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs.
Which assessment should the nurse conduct for the client receiving beclomethasone (Beconase) nasal spray?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Assess the client's mouth for any sign of fungal infection.
2. Assess the client's blood glucose prior to administration of nasal spray.
3. Assess if the client has blown his nose prior to administration of nasal spray.
4. Assess if the client has had a change in taste.
5. Assess the client for any hoarseness or change in voice.
Answer: 1, 3, 4, 5
Explanation:
1. Clients may develop candidiasis so the mouth should be assessed.
2. There is no need to assess the client's blood glucose.
3. The client should gently blow the nose prior to use to clear the nasal passages.
4. Clients may experience a change in taste.
5. Clients may experience a change in voice as a local effect.
Which information should the nurse include in the education for the client prescribed Montelukast (Singulair)?
1. This prescription is indicated for acute asthma attacks.
2. Montelukast should be taken 30 minutes prior to exercise.
3. Montelukast should not be used in pediatric clients.
4. This prescription has very few side effects.
Answer: 3
Explanation:
1. Montelukast is ineffective for acute asthma attacks.
2. Montelukast should be taken 2 hours before activity.
3. Montelukast is the only prescription approved for pediatric use.
4. Montelukast has very few side effects.
Which statement is true regarding dry powder inhalers (DPI)?
1. The prescription has to be reconstituted prior to administration.
2. The prescription is delivered by fine mist.
3. The device is activated by inhalation.
4. The canister must be pressed for the prescription to be delivered.
Answer: 3
Explanation:
1. The use of dry powder inhalers does not require the reconstitution of a prescription.
2. Nebulizers deliver medications in fine mist.
3. The client activates the device by inhaling.
4. A metered dose device requires that the client press the cannister prior to inhaling the prescription.
A nurse is explaining the process of respiration to a client. Which information should be given?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "Moving air in and out of the lungs is called ventilation."
2. The smooth muscle in the alveoli helps to pull air into the lungs.
3. Exchange of oxygen and carbon dioxide occurs across a thin capillary membrane.
4. Respiration is not effective without perfusion.
5. Your basic respiratory drive is determined by your brain.
Answer: 1, 3, 4, 5
Explanation:
1. Ventilation is the process of moving air into and out of the lungs.
2. Alveoli is not made up of smooth muscle.
3. The blood stays in capillaries. A thin membrane separates airway from capillary.
4. Perfusion is the blood flow through the lungs. Without this blood flow, the oxygen carbon dioxide exchange does not take place.
5. The rate is determined by neurons in the brainstem and can be affected by a number of factors.
A client asks the nurse why they must continue to take their asthma prescription when they have not had an asthma attack in several months. Which response should the nurse provide the client?
1. "The prescription should be taken indefinitely to prevent future asthma attacks."
2. "The prescription is still needed to decrease inflammation in your airways and help prevent an attack."
3. "The prescription needs to be taken or your lungs can become increasingly damaged if you continue to have asthma attacks.
4. "The prescription should be taken for at least a year and if you have not had an asthma attack within that year you will be able to stop taking your prescription."
Answer: 2
Explanation:
1. This response does not provide specific information as to why the client should continue to take their prescription.
2. Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs.
3. Telling a client that their lungs will become increasingly damaged is non-therapeutic and is not accurate information.
4. Long-term treatment of asthma continues indefinitely, not for just 1 year.
Which information should the nurse include in the education for the client prescribed inhaled ipratropium (Atrovent)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Wait 15 minutes between inhaled dosages.
2. The prescription may also be used for acute asthma attacks.
3. Report any increased dyspnea.
4. Report any changes in urinary pattern.
5. Use the medication consistently, not occasionally.
Answer: 3, 4, 5
Explanation:
1. It is only necessary to wait 2-3 minutes between dosages.
2. Anticholinergic drugs will not terminate an acute asthma attack, as peak effects may take 1 to 2 hours.
3. The client should be advised to report any symptoms of deteriorating respiratory status such as increased dyspnea.
4. Anticholinergic drugs can result in urinary retention, and the client should report any changes in urinary patterns.
5. To get the most benefit from ipratropium (Atrovent), it must be used consistently.
The nurse is providing education for a client prescribed albuterol (ProAir HFA). Which information should the nurse include in the teaching?
1. Administer the prescription 15 to 30 minutes prior to activity.
2. Albuterol can be used for prevention of an asthma attack.
3. Oral solutions can terminate an acute asthma attack.
4. A nebulizer must be used to deliver the prescription.
Answer: 1
Explanation:
1. Albuterol should be administered 15 to 30 minutes prior to activity.
2. Albuterol is not recommended for short-acting prophylaxis.
3. Oral solutions are not used to terminate acute asthma attacks.
4. Only the actuator that comes with the canister should be used to administer the albuterol.
Which are leukotriene modifiers primarily used for?
1. Status asthmaticus
2. Treat infection
3. Bronchodilation in asthma
4. Prophylaxis of asthma symptoms
Answer: 4
Explanation:
1. Leukotrienes are not used for treatment of status asthmaticus.
2. Leukotrienes do not reduce infection.
3. Anticholinergics are bronchodilators.
4. Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components
A client tells the nurse, "My healthcare provider told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis." Which response should the nurse provide the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "Are you certain you do not have asthma?"
2. "Chronic bronchitis has no relation to COPD."
3. "COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders."
4. "As COPD progresses, it becomes emphysema."
5. "Both diagnoses are correct."
Answer: 3, 4, 5
Explanation:
1. There is no reason to ask this question. The client with chronic bronchitis will have a COPD diagnosis.
2. The three specific COPD conditions are asthma, chronic bronchitis, and emphysema.
3. The three specific COPD conditions are asthma, chronic bronchitis, and emphysema.
4. COPD is progressive, with the terminal stage being emphysema.
5. Chronic bronchitis is a form of COPD, so both diagnoses are plausible.
Which information should the nurse include when discussing inhalation therapy as part of a treatment plan for the client's asthma?
1. Inhalation therapy is effective because it provides around-the-clock therapy, as opposed to oral medications.
2. Inhalation therapy is the preferred treatment for adolescents because it is easier for them to manage.
3. Inhalation therapy is effective because it provides both systemic and local relief of symptoms.
4. Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract.
Answer: 4
Explanation:
1. Inhalation therapy does not provide around-the-clock therapy.
2. Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage.
3. Inhalation therapy does not provide systemic relief of symptoms.
4. The major advantage of aerosol therapy is that it delivers the drugs to their direct site of action.
Which information should the nurse include in the education for a client with asthma?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Drink additional fluids.
2. Eat small, frequent meals.
3. Sleep in a warm room.
4. Complete activity in the morning and rest in the afternoon.
5. Avoid foods high in protein.
Answer: 1, 2
Explanation:
1. Drinking sufficient fluids will help to liquefy and mobilize mucus.
2. Small, frequent meals of calorie and nutrient dense foods help to prevent fatigue and maintain nutrition.
3. Cooler room temperatures make breathing easier.
4. Activities and rest should be alternated and balanced.
5. There is no need to avoid foods high in protein
A client receiving ipratropium (Atrovent) tells the nurse they are going to stop taking their prescription because of the bitter taste left in their mouth after its use. Which response should the nurse provide the client?
1. "A bitter taste may indicate you are experiencing a serious side effect."
2. "This is a common side effect that will go away over time."
3. "You can decrease that side effect by rinsing your mouth after use."
4. "You may be administering too high of a dose."
Answer: 3
Explanation:
1. The client is not experiencing a serious side effect; there is no need to stop the medication.
2. The bitter taste will not go away in time; the client must rinse their mouth.
3. Ipratropium (Atrovent) produces a bitter taste, which may be relieved by rinsing the mouth after use.
4. The dosage amount does not affect the bitter taste that occurs with the use of the prescription.
Which statement made by a client provided education about the use of albuterol (VoSpire ER) indicates further education is required?
1. "This is a short-acting beta agonist."
2. "The effects can last up to 12 hours."
3. "I can use this for chronic asthma."
4. "I can use this as needed for acute episodes."
Answer: 3
Explanation:
1. Albuterol is a short-acting beta agonist that is frequently used for aborting or terminating an acute asthma attack. Asthma has an inflammatory and a bronchoconstriction component.
2. The effects of a short-acting beta agonist are only 2 to 6 hours.
3. Albuterol is used to treat acute episodes of asthma, not chronic asthma.
4. Albuterol is a short-acting beta agonist that is used as needed for acute episodes of asthma.
A client with COPD tells the nurse, "I don't see why I need to stop smoking because the damage to my lungs is already done." Which statement should the nurse provide the client?
1. "If you stop smoking, your lungs have a good chance of improving quickly."
2. "Your symptoms may be lessened if you aren't smoking."
3. "You should at least try because smoking is associated with other diseases."
4. "If you stop smoking the disease process will not advance."
Answer: 2
Explanation:
1. Depending on the extent of damage, the client's lungs may not get better at all, but may just stop getting worse.
2. Smoking cessation has been shown to result in fewer respiratory symptoms.
3. Smoking cessation has been shown to slow the progression of COPD and decrease the risk of other diseases from occurring.
4. Smoking cessation has been shown to slow the progression of COPD.
For which adverse effect should the nurse assess a client receiving a methylxanthine?
1. "Have you experienced any recent coughing?"
2. "Have you experienced any weight loss?"
3. "How have you been sleeping?"
4. "Have you experienced any urinary retention?"
Answer: 3
Explanation:
1. Methylxanthine is not associated with coughing.
2. Weight loss is not specifically associated with the use of methylxanthine.
3. Adverse effects of methylxanthine include insomnia.
4. Methylxanthine is not associated with urinary retention.
Which priority question should the nurse ask a client prior to the administration of ipratropium (Atrovent)?
1. "Are you allergic to soy?"
2. "Do you have diabetes mellitus?"
3. "Do you have seizures?"
4. "Do you have gout?"
Answer: 1
Explanation:
1. Ipratropium is contraindicated in patients with hypersensitivity to soy as soya lecithin is
used as a propellant in the inhaler.
2. Anticholinergic prescriptions do not impact glucose levels.
3. Anticholinergic prescriptions do not affect seizure disorders.
4. Anticholinergic prescriptions are not contraindicated in clients with gout.
Which should the nurse recognize is a long-term control prescription used to treat asthma?
1. Systemic corticosteroids
2. Intermediate acting beta2-adrenergic agonists
3. Anticholinergics
4. Mast cell stabilizers
Answer: 4
Explanation:
1. Systemic corticosteroids are a quick relief prescription.
2. Intermediate acting beta2-adrenergic agonists are a quick relief prescription.
3. Anticholinergics are a quick relief prescription.
4. Mast cell stabilizers are long-term control prescriptions used to treat asthma.
For which class of prescription should the nurse monitor a client for a fungal infection of the throat?
1. Methylxanthines
2. Inhaled beta-adrenergic agonists
3. Mast cell inhibitors
4. Inhaled corticosteroid
Answer: 4
Explanation:
1. Methylxanthines do not cause fungal infection.
2. Beta-adrenergic agonists can cause throat irritation, but not an infection.
3. Mast cell inhibitors do not cause fungal infection.
4. Glucocorticoids weaken the immune system and cause candidiasis of the throat.
A client has been prescribed a leukotriene modifier. Which assessment finding would cause the nurse to question this prescription?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. A client who is 72 years old
2. Type II diabetic
3. A client with chronic kidney disease
4. The client with chronic hepatitis C
5. The client with a history of a CVA 2 years ago
Answer: 1, 4
Explanation:
1. Patients who are older than age 65 have been found to experience an increased frequency of infections when taking leukotriene modifiers.
2. A leukotriene modifier can be prescribed safely to a client with type II diabetes.
3. A leukotriene modifier can be prescribed safely to a client with chronic kidney disease.
4. Significant hepatic dysfunction is a contraindication to this medication as it is extensively metabolized by the liver.
5. There is no contraindication for the use of a leukotriene modifier for a client with history of CVA.