Pharmacology Made Easy 5.0 The Respiratory System Test

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?

- Suppresses the cough stimulus

- Reduce Surface Tension

- Reduces Inflammation

- Dries Mucous Membranes

Reduces surface tension.

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.

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include?

Select ALL:

Restlessness

Bradycardia

Insomnia

Muscle pain

Anxiety

Restlessness

Insomnia

Anxiety

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 medication is more likely to cause numbness of the extremities.Anxiety is correct. Anxiety is an adverse effect of pseudoephedrine.

A nurse should recognize that using pseudoephedrine to treat allergic rhinitis required cautious use with clients who have which of the following conditions?

Peptic ulcer disease

A seizure disorder

Anemia

Coronary artery disease

Coronary artery disease

Because pseudoephedrine, an oral sympathomimetic, can cause systemic vasoconstriction, it requires cautious use with clients who have severe hypertension or coronary artery disease.

A nurse is teaching a client who has a prescription for Zileuton. Which of the following instructions should the nurse include?

Check heart rate before taking the medication.

Take the medication only as needed before exercising.

Rinse mouth after using the medication.

Have laboratory tests performed at regular intervals.

Have laboratory tests performed at regular intervals.

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.

A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these medications are effective because they preform which of the following actions?

Decrease viscosity of nasal secretions

Block H2 receptors

Prevent histamine from binding to receptors

Reduce nasal congestion

Prevent histamine from binding to receptors.

Antihistamines treat allergic rhinitis and reduce swelling by blocking histamine from binding to the receptor sites.

For which of the following reasons should a client attach a spacer to a metered dose inhaler?

To increase the amount of medication delivered to the lungs

To increase the amount of medication delivered to the oropharynx

To increase the amount of medication delivered on exhalation

To increase the speed of medication delivery into the mouth

​To increase the amount of medication delivered to the lungs.

A spacer increases the amount of medication that reaches the lungs.

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects. Select all.

Muscle tremors

Increased intraocular pressure

Dry mouth

Insomnia

Urinary retention

Increased intraocular pressure,

dry mouth

urinary retention.

Muscle tremors is incorrect. Muscle tremors can occur with beta2 agonists, not with inhaled anticholinergics such as ipratropium.Increased intraocular pressure is correct. Increased intraocular pressure 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.Urinary retention is correct. Urinary retention can occur with inhaled anticholinergics such as ipratropium.

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?

Fever

Bruising

Polyuria

Palpitations

Palpitations

Although not common at therapeutic doses, beta2 agonists can cause cardiac stimulation, resulting in chest pain, palpitations, hypertension, and arrhythmias.

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?

Increases leukocyte activity

Blocks muscarinic receptors

Causes bronchodilation

Reduces inflammation

Reduces inflammation

Cromolyn, a mast cell stabilizer, reduces inflammation by inhibiting the inflammatory response.

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 clients drug level indicates toxicity?

Seizures

Constipation

Normal sinus rhythm

Somnolence

Seizures

Seizures are likely when plasma medication levels of theophylline, a methylxanthine, are higher than 30 mcg/mL, which indicates toxicity.

For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over-the-counter cold products?

Over-the-counter cold products can also contain guaifenesin.

Blood glucose levels are increased.

Rebound congestion is likely.

Medication tolerance is likely.

Over-the-counter cold products can also contain guaifenesin.

Many combination over-the-counter cold products contain guaifenesin. A client taking both might be taking excessive amounts of the medication. Combination products also contain multiple medications to treat different manifestations, some of which the client might not have. All medications have potential adverse effects, so the client should use only those medications required to treat existing manifestations and only in the recommended amounts.

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?

Blood pressure

Apical heart rate

Respiratory rate

Level of consciousness

Respiratory Rate

The greatest risk to clients who are taking codeine, an opioid agonist, is severe respiratory depression. Therefore, the respiratory rate is the priority assessment

A nurse is preparing to administer phenylephrine to a client. The nurse should identify that which of the following manifestations is an adverse effect of this drug?

Hypertension

Sleepiness

Hypotension

Constipation

Hypertension

Oral sympathomimetics stimulate the adrenergic receptors, causing blood vessel constriction, which can cause hypertension, cardiac arrhythmias, and heart palpitations.

A nurse is teaching a client who is taking prednisone for chronic asthma. Which of the following instructions should the nurse include?

"Avoid taking nonsteroidal anti-inflammatory drugs."

"Rinse your mouth after taking the medication to prevent a yeast infection."

"Stop taking the medication if you become nauseous."

"Change position slowly when standing up."

"Avoid taking nonsteroidal anti-inflammatory medication."

Gastric protective measures are essential for clients who are taking oral glucocorticoids. Anti-inflammatory medications can cause GI bleeding, so clients should not take them concurrently with prednisone.

- Inhaled, not oral, glucocorticoids can cause oral candidiasis.

- Prednisone, an oral glucocorticoid, does not cause postural hypotension. It can, however, cause hyperglycemia.

-To prevent acute adrenal insufficiency, clients should not stop taking the medication abruptly. Taking the medication with food can help minimize GI effects.

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?

Ipratropium

Beclomethasone

Acetylcysteine

Azelastine

Acetylcysteine

Acetylcysteine is a mucolytic that loosens thick respiratory secretions.

- Ipratropium reduces nasal secretions and is used to treat allergic and nonallergic rhinorrhea.

- Beclomethasone is a glucocorticoid that reduces inflammation.

- Azelastine is an intranasal antihistamine that treats allergic rhinitis.

Legal restrictions apply to the purchase of pseudoephedrine (Sudafed) because of which of the following risks?

Respiratory depression

Drug abuse

Drug tolerance

Rebound congestion

Drug misuse

Because it is possible to alter pseudoephedrine and epinephrine into methamphetamine, a commonly misused medication, the law restricts the medication's purchase.

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?

Thins mucus

Relaxes bronchial smooth muscle

Decreases inflammation

Increases the cough threshold

Decreases inflammation

Beclomethasone, an intranasal glucocorticoid, treats asthma by reducing inflammation.

- Beta2 agonists and methylxanthines cause bronchodilation by relaxing bronchial smooth muscle.

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine?

Reduced antitussive effect of dextromethorphan

Potentiation of depression of CNS actions

Increased renal reabsorption of the dextromethorphan

Delayed analgesic effect of the opioid

Potentiation of depression of CNS actions

Combining dextromethorphan with an opioid, such as morphine, increases the risk for decreased respirations and other depressed CNS responses.

A nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. Which of the following instructions should the nurse include?

"Take the medication as needed for acute asthma."

"Follow a low-sodium diet."

"Use an alternate-day dosing schedule."

"Increase weight-bearing activities."

"Increase weight-bearing activities."

Weight-bearing activity can help minimize bone loss, which is an adverse effect of fluticasone/salmeterol, an inhaled glucocorticoid and inhaled long-acting beta2 agonist (LABA) combination medication.

- Clients should use fluticasone/salmeterol on a regular schedule to treat chronic asthma.

- It is not necessary to follow a low-sodium diet when taking fluticasone/salmeterol, an inhaled glucocorticoid.

- Clients may take prednisone, an oral glucocorticoid, on an alternate-day dosing schedule to reduce adrenal suppression.

A nurse is teaching a client about the use of a mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects?

Suppresses the cough stimulus

Reduces inflammation

Thins and loosens mucus

Dries secretions

Thins and loosens mucus

Mucolytics make mucus less viscous to increase a cough's productivity.

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?

Muscle tremors

Drowsiness

Excitation

Insomnia

Drowsiness

The most common adverse effect of diphenhydramine, a first-generation antihistamine, is drowsiness.

A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include?

"Do not drink anything for 30 minutes after using the medication."

"Wait 5 minutes between using the medication and another inhaled medication."

"This medication is used to thin respiratory secretions."

"Check your pulse rate after inhaling the medication."

"Wait 5 minutes between using the medication and another inhaled medication."

Ipratropium, an inhaled anticholinergic, requires a 5 min wait between its administration and that of another inhaled medication to allow for bronchodilation to take effect.

A nurse in an outpatient clinic is preparing to provide education to a client who has asthma.

Nurses' Notes:

3 months ago: Client reports experiencing shortness of breath and coughing for the past month. Reports that they had an upper respiratory infection about a month ago that has improved. However, the shortness of breath and coughing continues and is worse at night and when exercising outside in the cold. Denies productive cough, sinus pain, and chest pain. Denies smoking.

No nasal drainage. Inspiratory wheezing auscultated bilaterally. No accessory muscle use.

Provider order pulmonary function test. Results reviewed by provider and prescriptions ordered.Today:During the past 4 weeks, the client reports experiencing shortness of breath and coughing while exercising outside. They are using their albuterol inhaler approximately 3 times a week. Inspiratory wheezing auscultated bilaterally. No accessory muscle use.

Instruct the client to notify the provider if they experience behavioral changes, such as agitation, depression, or suicidal thinking.

Instruct the client to rinse their mouth with water and gargle after using their budesonide/formoterol inhaler.

Instruct the client to use the budesonide/formoterol inhaler for long-term management of asthma.-that they should rinse mouth with water and gargle after using budesonide/formoterol inhaler; and to notify provider if they experience behavioral changes such as agitation, depression, or suicidal thinking. It is a combination inhaler of a short acting beta2-adrenergic agonist (budesonide) and an inhaled corticosteroid (formoterol) used for long term management of asthma. It can cause oropharyngeal candidiasis (thrush), therefore the client should rinse their mouth with water and gargle after each use of the inhaler. Montelukast is a leukotriene modifier and can cause adverse neuropsychiatric effects. The nurse should instruct the client to notify their provider if they have behavioral changes such as agitation, depression, or suicidal thinking.

The nurse does not need to encourage the client to increase fluid intake or suck on hard candy because they have not been prescribed an anticholinergic medication. The nurse should teach the client to administer their albuterol inhaler prior to exercise, not after. The client has not been prescribed any medications that require blood levels to be monitored. The nurse should teach the client that montelukast is used for long term management of asthma, not acute shortness of breath. The client should also be taught that montelukast should be taken in the evening, not the morning.

A nurse in an outpatient clinic is caring for a client.

Today:A client presents to the clinic today with reports of shortness of breath while walking and a cough for the past 3 months.Current smoker, reports smoking 1 pack per day for the past 55 years. History of hypertension, hyperlipidemia, and depression.Alert and oriented to person, place, and time. Dyspneic while walking in clinic. Shallow, rapid breaths. Bilateral expiratory wheezing. Nonproductive, dry cough. No pleural friction rub. No cyanosis, accessory muscle use, or pursed lip breathing. Sinus tachycardia rhythm, S1 S2, no murmurs or extra heart sounds. Radial and pedal pulses +1 bilaterally. Pedal edema of lower extremities +1.Chest x-ray, pulmonary function test, and laboratory tests ordered.Provider reviewed results. Prescriptions ordered.

Drag word choices:

The client is at risk for developing

bone loss, oral candidiasis, and hyperglycemia.

The nurse should identify that the client is at risk for developing bone loss, oral candidiasis, and hyperglycemia due to use of glucocorticoids. The nurse's findings indicate that the client has chronic obstructive pulmonary disease and should be prescribed glucocorticoids to decrease the inflammation and bronchial hyperactivity. Oral glucocorticoids are prescribed for short-term use to relieve dyspnea. Inhaled glucocorticoids, such as fluticasone, are prescribed for long-term management to prevent exacerbations of dyspnea. With long-term use of oral or inhaled glucocorticoids greater than 10 days, a client is at risk for developing oral candidiasis, bone loss, and hyperglycemia. To prevent oral candidiasis, the client should rinse their mouth with water and gargle after each inhalation of the glucocorticoid. The client should take supplemental calcium and vitamin D, as well as perform weight bearing exercises to prevent bone loss. The nurse should also instruct the client to monitor their blood glucose.

A nurse is caring for client in an outpatient clinic.

Nurses' Notes

1100:The client presents to the clinic with reports of runny nose, sneezing, itchy eyes, congestion, and sinus pressure. Reports having difficulty breathing through nose, coughing while lying down, and fatigue. Manifestations started during the spring while outside gardening. Denies fever and chills.

Physical assessment: Bilateral swelling and erythema of the nasal turbinates. Clear drainage post oropharynx. Retracted tympanic membranes bilaterally. Lungs clear to auscultation bilaterally.

1115:Provider prescriptions received. Visit summary reviewed with client to discuss the newly prescribed medication.

Neurological: Headaches

Drowsiness

Respiratory: nose bleeds

GI: sore throat, dry mouth

The nurse should educate the client about the potential adverse effects of budesonide nasal spray and cetirizine. Budesonide is a nasal corticosteroid with adverse effects of headaches, epistaxis (nose bleeds), dry mouth, and sore throat. Cetirizine is a 2nd generation antihistamine with adverse effects of drowsiness and dry mouth. Methylamines, such as theophylline, can cause seizures. Sympathomimetics, such as phenylephrine, can cause rebound congestion. Opioid antitussives, such as codeine, can cause respiratory depression. Mucolytics, such as acetylcysteine, can cause bronchospasm. Oral corticosteroids, such as prednisone, can cause peptic ulcer disease. Leukotriene inhibitors, such as zileuton, can cause liver damage and suicidal thinking.