Chapter 31: Drugs Used to Treat Lower Respiratory Disease My Nursing Test Banks

Chapter 31: Drugs Used to Treat Lower Respiratory Disease

Test Bank

MULTIPLE CHOICE

1. A patient has questions regarding a recently prescribed antitussive agent. Which response by the nurse is the best?

a.

It will eliminate your cough at night.

b.

It will reduce the frequency of your cough.

c.

It should be used in the morning.

d.

It should be taken before sleep.

ANS: B

Antitussive agents act by suppressing the cough center in the brain. The expected therapeutic outcome is reduced frequency of nonproductive cough to promote rest. Antitussive agents should be taken as prescribed by the health care provider. Antitussives are not likely to eliminate a cough. Antitussives should be taken throughout the day.

DIF: Cognitive Level: Comprehension REF: p. 489 OBJ: 5 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. Which is a common expectorant in over-the-counter medications?

a.

Dextromethorphan

b.

Diphenhydramine

c.

Guaifenesin

d.

Codeine

ANS: C

Guaifenesin is used for symptomatic relief of conditions characterized by a dry, nonproductive cough such as the common cold, bronchitis, laryngitis, pharyngitis, and sinusitis. Guaifenesin is also used to remove mucous plugs from the respiratory tract. Dextromethorphan is an antitussive. Diphenhydramine is an anticholinergic agent with antihistaminic and antitussive properties. Codeine is an antitussive.

DIF: Cognitive Level: Knowledge REF: pp. 494-495 OBJ: N/A

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. What is the reason for administering potassium iodide to a patient with emphysema?

a.

To increase blood iodide levels

b.

To decrease mucus viscosity

c.

To reduce metabolic needs of the body

d.

To decrease bronchial irritation

ANS: B

Potassium iodide acts as an expectorant by stimulating the bronchial glands to secrete. This will decrease the viscosity of mucous plugs, which makes it easier for patients to cough up the dry hardened plugs blocking the bronchial tubes. Potassium iodide is not given to increase serum potassium iodide levels. Potassium does not reduce metabolic needs of the body or bronchial irritation.

DIF: Cognitive Level: Application REF: pp. 494-495 OBJ: 5 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Within minutes of the initiation of a nebulizer treatment with a sympathomimetic bronchodilator, the patient turns on his call light and states that he feels panicky and his heart is racing. Which action will the nurse take?

a.

Reassure the patient this is expected.

b.

Add more diluents to the nebulizer.

c.

Administer a sedative.

d.

Stop treatment and notify the health care provider.

ANS: D

Sympathomimetic drugs increase sympathetic nervous stimulation. Symptoms such as nervousness, palpitations, tremors, tachycardia, and anxiety typically are dose related. These symptoms should be reported to the health care provider immediately because the patient may require a decreased dosage. These symptoms could lead to further complications if allowed to persist and are not common adverse effects. Although this may be a common result, it is not an expected outcome. Diluting the medication would not decrease the dose. Although a sedative might be appropriate for the patient, this is not the intervention of choice.

DIF: Cognitive Level: Analysis REF: pp. 497-498 OBJ: 5 | 7 | 9

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

5. Premedication assessments before the use of anticholinergic bronchodilating agents should verify that the patient has no history of which condition?

a.

Diabetes

b.

Hypertension

c.

Liver disease

d.

Glaucoma

ANS: D

Anticholinergic bronchodilating agents cause mydriasis (dilation of the pupils) and cycloplegia (loss of power in the ciliary muscle); therefore, they should not be used in patients with a history of closed angle glaucoma. Diabetes, hypertension, and liver disease are not affected by the use of anticholinergic bronchodilating agents.

DIF: Cognitive Level: Comprehension REF: pp. 500-501 OBJ: 7 | 9

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

6. A patient is seen in the emergency department. The patient had been maintained on theophylline (Theo Dur), and a blood sample reveals the serum theophylline level is subtherapeutic. Which may cause a subtherapeutic serum level?

a.

Cimetidine use

b.

Drug tolerance

c.

Smoking

d.

Overuse of the inhaler

ANS: C

The patient is not tolerant to the drug if the serum theophylline levels are too low. Cimetidine would enhance the effects of theophylline, not decrease the effects. Smoking reduces the therapeutic effects of xanthine derivatives, including theophylline. Overuse of the inhaler would cause a high level of serum theophylline.

DIF: Cognitive Level: Application REF: p. 493 | p. 502

OBJ: 7 TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

7. What is the action of zafirlukast (Accolate), a leukotriene receptor antagonist?

a.

Dilates the alveolar sacs

b.

Decreases leukotriene release

c.

Inhibits histamine release

d.

Increases viscosity of secretions

ANS: B

Leukotrienes are a class of anti inflammatory agents that block leukotriene formation, and they are part of the inflammatory pathway that causes bronchoconstriction. Leukotrienes work to reduce bronchoconstriction, and they do not inhibit histamine release or affect viscosity of secretions.

DIF: Cognitive Level: Knowledge REF: pp. 505-506 OBJ: 6 | 10

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. What is albuterol (Proventil) used to treat?

a.

Acute bronchospasm

b.

Acute allergies

c.

Nasal congestion

d.

Dyspnea on exertion

ANS: A

The short-acting beta agonists have a rapid onset (few minutes) and are used to treat acute bronchospasm. Beta agonists are not used to treat allergies. Decongestants are used for nasal congestion. Long-acting beta agonists are used for exertional dyspnea.

DIF: Cognitive Level: Knowledge REF: pp. 497-498 OBJ: 8

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

9. From where do the fluids of the respiratory tract originate?

a.

Specialized mucous glands called goblet cells

b.

Lymph fluid drawn across nasal membranes by osmosis

c.

Specialized beta cells in the islets of Langerhans

d.

Cells that produce aqueous humor

ANS: A

The fluids of the respiratory tract originate from specialized mucous glands (goblet cells) and serous glands that line the respiratory tract. The goblet cells produce gelatinous mucus that forms a thin layer over the interior surfaces of the trachea, bronchi, and bronchioles. Lymph does not make up fluid in the respiratory tract. The beta cells in the islets of Langerhans are located in the pancreas. Cells that produce aqueous humor are located in the interior of the eye.

DIF: Cognitive Level: Knowledge REF: p. 484 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. What structures in the respiratory tract assist in removing foreign bodies such as smoke and bacteria?

a.

Villi

b.

Golgi bodies

c.

Ciliary hairs

d.

Erector pili

ANS: C

Normally, respiratory tract fluid forms a protective layer over the trachea, bronchi, and bronchioles. Foreign bodies, such as smoke particles and bacteria, are caught in the respiratory tract fluid and are swept upward by ciliary hairs that line the bronchi and trachea to the larynx, where they are removed by the cough reflex. The villi are hair like protrusions into the intestine emanating from the wall of the intestine. The purpose of the villi is to slow the passage of food and allow food particles to be captured among these finger like villi, so that the blood inside the villi can absorb the nutrients in the food. The primary function of the Golgi apparatus, an organelle found in most eukaryotic cells, is to process proteins targeted to the plasma membrane, lysosomes, or endosomes and those that will be formed from the cell and to sort them within vesicles. Thus, it functions as a central delivery system for the cell. Erector pili are small muscles that cause hairs on the skin to rise when contracted.

DIF: Cognitive Level: Knowledge REF: p. 484 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse is providing instruction about ipratropium (Atrovent) to a patient with chronic obstructive pulmonary disease (COPD). Which is a common adverse effect that tends to resolve with therapy?

a.

Anxiety

b.

Dry mouth

c.

Tachycardia

d.

Urine retention

ANS: B

Dry mouth is usually mild and tends to resolve with continued therapy. Anxiety, tachycardia, and urine retention are not common adverse effects.

DIF: Cognitive Level: Knowledge REF: p. 501 OBJ: 5 | 9

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. An adult patient is admitted for an asthma attack. Which assessment obtained by the nurse would support that albuterol (Proventil) was effective?

a.

Decrease in wheezing present on auscultation

b.

Less dyspnea while positioned in a high Fowlers position

c.

Sputum production is clear and watery

d.

Respiratory rate decreased to 38 breaths/min

ANS: A

A bronchodilator would open the airways and result in a reduction of wheezing. Less dyspnea while positioned in a high Fowlers position, clear and watery sputum, and a respiratory rate decreased to 38 breaths/min would not indicate that the medication was effective.

DIF: Cognitive Level: Application REF: p. 498 OBJ: 8

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

13. A child has been diagnosed with asthma and the nurse is providing education to the family. Which statement by the mother indicates a need for further teaching?

a.

I will place the stuffed animals in the freezer overnight.

b.

We will confine our dog to the kitchen area.

c.

I should wash bedding in hot water.

d.

A damp cloth should be used when I dust.

ANS: B

Pets should be removed from the home or kept outside if at all possible.

DIF: Cognitive Level: Application REF: p. 493 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. The nurse is providing nutrition information to a patient diagnosed with a lower respiratory tract disease. What is the rationale for limiting caffeine?

a.

Caffeine increases the respiratory rate.

b.

Caffeine can result in thicker lung secretions.

c.

Caffeine will increase the anxiety response associated with dyspnea.

d.

Caffeine can cause bronchospasm.

ANS: B

Avoid caffeine containing beverages because caffeine is a weak diuretic. Diuresis promotes thickening of lung secretions, making it more difficult to expectorate them.

DIF: Cognitive Level: Application REF: pp. 493-494 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. The nurse is teaching a patient with a history of COPD to self administer tiotropium (Spiriva) by dry powder inhalation. Which information provided by the nurse is accurate?

a.

The medication capsules can be used multiple times.

b.

Press on the canister while inhaling.

c.

Avoid breathing into the mouthpiece.

d.

Wash the device with cold water.

ANS: C

The patient should not breathe into the mouthpiece at any time. Capsules are meant to be used as a single dose and should be disposed of after taking the daily dose. The HandiHaler uses capsules of medication that should be pierced before the patient inhales. The inhaler should be washed with hot water.

DIF: Cognitive Level: Application REF: p. 501 OBJ: 5 | 9

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. The health care provider in an outpatient clinic has prescribed omalizumab (Xolair) to a patient. Which primary outcome will the nurse teach the patient to expect?

a.

Easier expectoration of phlegm

b.

Less frequent asthma exacerbations

c.

Increased moisture of the mucous membranes

d.

Liquefaction of thick secretions

ANS: B

The primary therapeutic outcome associated with omalizumab therapy is reduced frequency of acute asthmatic exacerbations. Easier expectoration of phlegm, increased moisture of the mucous membranes, and liquefaction of thick secretions are not outcomes of omalizumab.

DIF: Cognitive Level: Application REF: p. 507 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. The nurse is obtaining a history of respiratory symptoms on a patient with the diagnosis of COPD. The patient reports smoking one pack of cigarettes per day for the past 20 years. The nurse calculates the pack years as:

a.

5.

b.

10.

c.

20.

d.

40.

ANS: C

Pack years is defined as number of packs of cigarettes smoked per day times the number of years of smoking; 1 20 = 20.

DIF: Cognitive Level: Analysis REF: p. 490 OBJ: N/A

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

18. A resident in a long term care facility diagnosed with COPD has a new medication order for indacaterol. When the nurse is providing education to the resident regarding this medication, information will include that:

a.

it is a short-acting beta antagonist.

b.

the patient should wait approximately 5 minutes between inhalations.

c.

onset of action is within 5 minutes.

d.

duration of action is about 12 hours.

ANS: C

Onset of action is within 5 minutes. Indacaterol is an ultra-long-acting beta 2 agonist.

Patients using inhaled bronchodilators should wait approximately 10 minutes. Duration of action is about 24 hours.

DIF: Cognitive Level: Application REF: p. 498 OBJ: 5 | 10

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

19. Which statement(s) is/are true regarding the nursing assessment of a patient with a respiratory disorder? (Select all that apply.)

a.

Central cyanosis typically is observed on the fingers and earlobes.

b.

Clubbing of the fingernails is a sign of hypoxia.

c.

As oxygen levels diminish, mental alertness will progressively deteriorate.

d.

The normal respiratory rate in an adult is 10 breaths/min.

e.

Episodes of apnea are present in Cheyne-Stokes.

ANS: B, C, E

Fingernail clubbing is a sign of hypoxia. Mental status will deteriorate as the oxygen level in the body diminishes. Apnea is present in Cheyne-Stokes respirations. Central cyanosis is not observed on the fingers and earlobes. The normal respiratory rate in an adult is more than 10 breaths/min.

DIF: Cognitive Level: Application REF: pp. 490-491 OBJ: 2 | 4 | 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

20. What is true about arterial blood gases (ABGs)? (Select all that apply.)

a.

They are measured from an arterial sample.

b.

They measure partial pressures of carbon dioxide.

c.

They measure blood pH.

d.

They measure partial pressures of sodium

e.

They measure partial pressures of oxygen.

ANS: A, B, C, E

ABGs are taken from samples from arterial blood, which must be drawn and analyzed immediately. ABGs measure partial pressures of carbon dioxide and bicarbonate, pH, and partial pressures of oxygen. ABGs do not measure partial pressures of sodium.

DIF: Cognitive Level: Comprehension REF: p. 485 OBJ: 3 | 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

21. The nurse is completing the admission of an older adult patient with a history of COPD whose diagnosis is pneumonia. Which assessments would be most important to include in obtaining the history? (Select all that apply.)

a.

Smoking history and exposure to second hand smoke

b.

Current medications

c.

Chief complaint and onset of symptoms

d.

Support system

e.

Home oxygen use

f.

Liver function

ANS: A, B, C, D, E

It is important to assess present and past respiratory history (including smoking history and exposure to second hand smoke), obtain thorough medication history, ascertain the chief complaint and current pulmonary symptoms (including cough and sputum color), determine the patients support system, and ask about any home treatments when obtaining information from a patient with acute and chronic lung disease. Liver function testing is not necessary for the assessment of this patient.

DIF: Cognitive Level: Application REF: pp. 490-491 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

22. Which physical assessment(s) would be pertinent to the patient with asthma? (Select all that apply.)

a.

Lung sounds

b.

Patient color

c.

Respiratory rate and effort

d.

Peak expiratory flow

e.

Pulse oximetry reading

f.

Bowel sounds

ANS: A, B, C, D, E

Lung sounds, pallor and color, respiratory rate and effort, peak expiratory flow, and pulse oximetry should be assessed in the patient with asthma. Assessment of bowel sounds is not pertinent.

DIF: Cognitive Level: Application REF: pp. 490-491 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

23. Which principle(s) would be when teaching a patient to use a steroid inhaler? (Select all that apply.)

a.

Frequent oral hygiene is necessary.

b.

The inhaler should be used on a PRN basis only.

c.

Rinse and spit after inhalation of the medication.

d.

When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first.

e.

Hold the breath for 10 seconds during inhalation of the medication.

ANS: A, C, D, E

Steroid medications may predispose patients to secondary fungal infections in the mouth. To prevent this, patients should be instructed on good oral hygiene technique and told to gargle and rinse the mouth with a hydrogen peroxide mouthwash after each aerosol treatment. In addition to good oral hygiene, patients should rinse and spit after inhalation of the medication. When a bronchodilator and steroid are prescribed, the bronchodilator should be administered as the first puff of medication and, after waiting a few minutes, the steroid medication should be administered. This procedure facilitates bronchodilation so that the second medication will have a better chance of reaching lower parts of the lungs. Patients should hold their breath for 10 seconds during inhalation of the medication so that the medication is fully inhaled. Steroid inhalers should be used on a regular basis to prevent symptoms.

DIF: Cognitive Level: Application REF: pp. 492-493 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

24. Which statement(s) about acetylcysteine is/are true? (Select all that apply.)

a.

It reduces viscosity of secretions.

b.

It treats acetaminophen toxicity.

c.

It is stored at room temperature.

d.

It is given to improve airway flow.

e.

It is odorless.

f.

It is administered by inhalation.

ANS: A, B, D, F

Acetylcysteine is given to reduce the viscosity of secretions, used to treat acetaminophen toxicity, used to improve airway flow, and is a mucolytic given by inhalation. Acetylcysteine should be refrigerated after opening and has an odor similar to that of rotten eggs.

DIF: Cognitive Level: Comprehension REF: pp. 496-497 OBJ: N/A

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

25. Which statement(s) about ipratropium bromide (Atrovent) is/are true? (Select all that apply.)

a.

It is administered by aerosol inhalation.

b.

It relieves nasal congestion.

c.

It decreases mucus secretion.

d.

It has minimal effect on ciliary activity.

e.

It is used for short term treatment of bronchospasm.

f.

It may cause tachycardia or urinary retention.

ANS: A, D, F

Ipratropium bromide is administered by aerosol inhalation, has minimal effect on ciliary activity, and may cause tachycardia, urinary retention, or exacerbation of pulmonary symptoms. Ipratropium bromide does not relieve nasal congestion; has minimal effect on mucous secretion, sputum volume, and viscosity; and is used as a bronchodilator for long term treatment of reversible bronchospasm associated with COPD.

DIF: Cognitive Level: Comprehension REF: pp. 500-501 OBJ: 5 | 9

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

26. The nurse is preparing to administer two inhalations of ipratropium bromide (Atrovent). When providing this medication, the nurse will instruct the patient to: (Select all that apply.)

a.

hold the canister horizontally.

b.

keep the eyes closed.

c.

exhale through the mouthpiece.

d.

wait 15 seconds before the second inhalation.

e.

shake the canister thoroughly prior to use.

ANS: B, D, E

The eyes should be kept closed because temporary blurred vision may result if the aerosol is sprayed into the eyes. The patient should wait approximately 15 seconds, and repeat the second inhalation. The canister should be shaken thoroughly prior to use. The base of the canister should be held vertically. The patient should inhale through the mouthpiece.

DIF: Cognitive Level: Application REF: p. 500 OBJ: 5 | 9

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

Leave a Reply