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Pharmacology Connections to Nursing Practice 1st Edition Adams Koch Test Bank

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Pharmacology Connections to Nursing Practice 1st Edition Adams Koch Test Bank

ISBN-13: 978-0131525993

ISBN-10: 0131525999

 

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Pharmacology Connections to Nursing Practice 1st Edition Adams Koch Test Bank

ISBN-13: 978-0131525993

ISBN-10: 0131525999

 

 

 

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Adams: Pharmacology: Connections to Nursing Practice

Chapter 73

Pharmacotherapy of Asthma and Other Pulmonary Diseases

 

Learning Outcome 1 Identify anatomical structures associated with the lower respiratory tract, and their functions.

 

  1. The nurse is caring for a patient with severe asthma. When evaluating the outcomes of the patient’s care, the nurse recognizes the most important outcome is associated with:
  1. Decreased respiratory effort.
  2. The patient’s blood gases.
  3. The patient’s vital signs.
  4. Length of stay on the acute care unit.

Answer: 2

Rationale:      

  1. Outcomes associated with asthma treatment are most objectively evaluated by assessing the pH, O2, and CO2 levels of arterial blood. Emotions impact on respirations, and perceived respiratory effort is affected by anxiety and fear.
  2. Outcomes associated with asthma treatment are most objectively evaluated by assessing the pH, O2, and CO2 levels of arterial blood.
  3. Outcomes associated with asthma treatment are most objectively evaluated by assessing the pH, O2, and CO2 levels of arterial blood. Vital signs, particularly blood pressure and respiratory rate, are affected by multiple variables. They should be tracked, but they are not associated with the most important outcome.
  4. Outcomes associated with asthma treatment are most objectively evaluated by assessing the pH, O2, and CO2 levels of arterial blood. Length of stay is largely driven by cost factors in today’s health care system.

Cognitive Level: Synthesis

Client Need:   Physiological Integrity

Nursing Process: Evaluation

Learning Outcome 73-1

 

  1. A trauma patient has experienced a ruptured diaphragm. The nurse would anticipate that this patient would have difficulty:
  1. Carrying out the respiratory cycle.
  2. Primarily during exhalation.
  3. With an elevated pulse oximetry reading.
  4. Maintaining a high enough respiratory rate.

Answer: 1

Rationale:      

  1. Contraction and relaxation of the diaphragm are essential to the ventilation segment of the respiratory cycle.
  2. Contraction and relaxation of the diaphragm are essential to the ventilation segment of the respiratory cycle. Both inhalation and exhalation would be impaired.
  3. Contraction and relaxation of the diaphragm are essential to the ventilation segment of the respiratory cycle. The pulse oximetry reading would be low because of inadequate ventilation.
  4. Contraction and relaxation of the diaphragm are essential to the ventilation segment of the respiratory cycle. The patient’s chest will be unable to move adequately, and the respiratory rate will increase due to respiratory acidosis.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 73-1

 

  1. The nurse is triaging patients through the ED. An adult admission has a respiratory rate of 32 breaths per minute. The patient is not injured, but was brought to the ED because she started gasping after witnessing a drive-by shooting. The nurse recognizes that the patient’s rapid breathing is probably driven by:
  1. Increased perfusion in the cerebral cortex.
  2. Increased perfusion in the alveolar capillary bed.
  3. A sudden increase in blood pressure.
  4. Brainstem activity.

Answer: 4

Rationale:      

  1. The brainstem is highly influenced by emotions, particularly fear and anxiety. This patient experienced both, which led to a sudden rise in respiratory rate.
  2. There probably is increased perfusion throughout the body because of an acceleration of heart rate. However, the brainstem is highly influenced by emotions, particularly fear and anxiety. This patient experienced both, which led to a sudden rise in respiratory rate.
  3. We are not told the patient’s blood pressure. It might be elevated, but we don’t know for sure. The brainstem is highly influenced by emotions, particularly fear and anxiety. This patient experienced both, which led to a sudden rise in respiratory rate.
  4. The brainstem is highly influenced by emotions, particularly fear and anxiety. This patient experienced both, which led to a sudden rise in respiratory rate.

Cognitive Level: Synthesis

Client Need:   Physiological Integrity

Nursing Process: Assessment

Learning Outcome 73-1

 

 

Learning Outcome 2 Explain how the autonomic nervous system regulates airway diameter.

 

  1. The nurse is caring for a patient who is taking a non-selective beta blocker preparation for hypertension. The patient starts to complain of shortness of breath. The nurse realizes that this kind of beta blocker:
  1. Irritates the mucosa in the airways.
  2. Triggers bronchoconstriction in the airways.
  3. Promotes swelling inside airways.
  4. Produces mucous plugs that can totally block off airways.

Answer: 2

Rationale:      

  1. Non-selective beta blockers negate the bronchodilating effects of binding to beta-adrenergic receptors. This in turn allows bronchoconstriction, which can lead to shortness of breath because of reduced airway diameter. Beta blockers do not irritate mucosa.
  2. Non-selective beta blockers negate the bronchodilating effects of binding to beta-adrenergic receptors. This in turn allows bronchoconstriction, which can lead to shortness of breath because of reduced airway diameter.
  3. Non-selective beta blockers negate the bronchodilating effects of binding to beta-adrenergic receptors. This in turn allows bronchoconstriction, which can lead to shortness of breath because of reduced airway diameter. Beta blockers do not promote swelling.
  4. Non-selective beta blockers negate the bronchodilating effects of binding to beta-adrenergic receptors. This in turn allows bronchoconstriction, which can lead to shortness of breath because of reduced airway diameter. Beta blockers do not produce mucous plugs.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 73-2

 

  1. A nurse is advising a patient about techniques for management of his exercise-induced asthma. The nurse’s presentation will focus on ways to:
  1. Avoid bronchoconstriction.
  2. Decrease the vigor of exercise.
  3. Eliminate aerobic activities.
  4. Slow down the respiratory rate.

Answer: 1

Rationale:      

  1. Exercise-induced asthma is best managed with environment controls and medication. Avoiding cold air and using an inhaler prior to exercise are useful techniques.
  2. Asthmatic individuals benefit from vigorous exercise. They need help in planning how to avoid bronchoconstriction during the process.
  3. Asthmatic individuals benefit from vigorous exercise. They need help in planning how to avoid bronchoconstriction during the process. Aerobic exercise should be encouraged.
  4. Asthmatic individuals benefit from vigorous exercise. They need help in planning how to avoid bronchoconstriction during the process. Both heart rate and respiratory rate should increase with exercise.

Cognitive Level: Comprehension

Client Need: Healthy Environment

Nursing Process: Implementation

Learning Outcome 73-2

 

 

 

 

  1. A nurse is caring for several patients receiving beta blocker therapy. The nurse has noted that some patients develop wheezing after beta blocker therapy. Which preparation would the nurse consider most problematic?
  1. Propranolol (Inderal)
  2. Atenolol (Tenormin)
  3. Metoprolol (Lopressor)
  4. Bisoprolol (Zebeta)

Answer: 1

Rationale:      

  1. Propranolol (Inderal) is a non-selective beta-adrenergic blocker. It will block beta-2 receptors in the lungs with possible consequent bronchoconstriction and wheezing.
  2. Propranolol (Inderal) is a non-selective beta-adrenergic blocker. It will block beta-2 receptors in the lungs with possible consequent bronchoconstriction and wheezing. Atenolol is a selective beta-1 receptor blocker, which is less likely to block beta-2 receptors in the lungs.
  3. Propranolol (Inderal) is a non-selective beta-adrenergic blocker. It will block beta-2 receptors in the lungs with possible consequent bronchoconstriction and wheezing. Metoprolol is a selective beta-1 receptor blocker, which is less likely to block beta-2 receptors in the lungs.
  4. Propranolol (Inderal) is a non-selective beta-adrenergic blocker. It will block beta-2 receptors in the lungs with possible consequent bronchoconstriction and wheezing. Bisoprolol is a selective beta-1 receptor blocker, which is less likely to block beta-2 receptors in the lungs.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome 73-2

 

Learning Outcome 3 Identify primary factors that can cause bronchoconstriction.

 

  1. A nurse is assisting a patient to master the use of a steroid inhaler. The patient says, “I don’t think I should be using steroids. I see steroids labeled as bad in the news at least once a week.” The nurse’s response is based on the fact that:
  1. Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile.
  2. The steroid preparations used to treat airway problems are very different from the steroids abused by people reported in the news media.
  3. Inhaled steroid use is usually short-termRemember, any risk to the patient is minimal.
  4. Steroids can be very risky, but the risk is necessary in this client’s case.

Answer: 1

Rationale:      

  1. Inhaled steroids are very useful in the management of chronic diseases like asthma and bronchitis. Because they are inhaled, their desired effect is local. The safety profile is good because the adverse effects are local as well.
  2. Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile. The core of all steroid preparations is the same.
  3. Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile. Some patients need to use these drugs long-term.
  4. Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile. It is inappropriate to tell the patient that inhaled steroids are very risky.

Cognitive Level: Comprehension

Client Need: Psychological Integrity

Nursing Process: Implementation

Learning Outcome 73-3

 

  1. A patient with asthma is experiencing difficulty with copious amount of tenacious sputum. A mucolytic drug is prescribed. The outcome the nurse would track is:
  1. Increased clearance of sputum.
  2. Decrease in wheezing.
  3. Resolution of atrial tachycardia.
  4. Decrease in respiratory rate with increase in depth.

Answer: 1

Rationale:      

  1. The intent of mucolytic therapy is to thin the mucus so that it can be more easily expectorated.
  2. The intent of mucolytic therapy is to thin the mucus so that it can be more easily expectorated. Wheezing is caused by constriction of the smooth muscle in the bronchial walls, and is not affected by mucolytics.
  3. The intent of mucolytic therapy is to thin the mucus so that it can be more easily expectorated. Heart rate is not directly affected by mucolytics.
  4. The intent of mucolytic therapy is to thin the mucous so that it can be more easily expectorated. Any effects on respiratory rate and depth are secondary to the clearance of mucus.

Cognitive Level: Comprehension

Client Need:   Physiological Integrity

Nursing Process: Evaluation

Learning Outcome 73-3

 

 

  1. The nurse is planning care for a patient with chronic lung disease. The patient is wheezing, with a HR of 130 and respiratory rate of 26 per minute; is using his accessory muscles of respiration; is coughing up yellow mucous; and has a pulse oximetry reading of 86%. The highest-priority nursing diagnosis is:
  1. Impaired Gas Exchange related to low pulse oximeter reading.
  2. Impaired Airway Clearance related to thick mucus.
  3. Injury (respiratory arrest), high risk for secondary to severe respiratory impairment.
  4. Decreased Cardiac Output related to tachycardia and rapid breathing.

Answer: 1

Rationale:      

  1. The pulse oximeter reading of 86% is too low, and indicates gas exchange is seriously impaired. Increasing the level of oxygen in the patient’s bloodstream is the highest priority.
  2. The pulse oximeter reading of 86% is too low, and indicates gas exchange is seriously       impaired. Increasing the level of oxygen in the patient’s bloodstream is the highest priority. Airway clearance is not seriously impaired if the patient is able to cough up mucus.
  3. The pulse oximeter reading of 86% is too low, and indicates gas exchange is seriously impaired. Increasing the level of oxygen in the patient’s bloodstream is the highest priority. The patient could be at risk for arrest if the problem is not addressed, but the respiratory rate suggests this is not yet imminent.
  4. The pulse oximeter reading of 86% is too low, and indicates gas exchange is seriously impaired. Increasing the level of oxygen in the patient’s bloodstream is the highest priority. The rapid heart rate is a compensatory mechanism.

Cognitive Level: Synthesis

Client Need: Physiological Integrity

Nursing Process: Diagnosis

Learning Outcome 73-3

 

Learning Outcome 4 Explain the role of inflammation and bronchospasm in the pathogenesis of asthma.

 

  1. A nurse is teaching an asthmatic patient about his steroid inhaler prior to discharge. The expected outcome of this therapy is:
  1. Less swelling and mucus formation, and decreased bronchospasm.
  2. Decreased inflammation of the mid-sized bronchial tubes.
  3. Less histamine formation, with less mucus in the upper airway.
  4. Resolution of all asthma symptoms.

Answer: 1

Rationale:      

  1. Corticosteroids decrease all of the components of asthma, including swelling, mucus, and spasms.
  2. Corticosteroids decrease all of the components of asthma, including swelling, mucus, and spasms. The effects are distributed along the entire bronchial tree.
  3. Corticosteroids decrease all of the components of asthma, including swelling, mucus, and spasms. The effects are distributed throughout the airway tree.
  4. Corticosteroids decrease all of the components of asthma, including swelling, mucus, and spasms.  However, not all asthma symptoms will resolve.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome 73-4

 

 

 

 

 

 

 

 

  1. A nurse in an intensive care unit is planning care for a patient with severe bronchospasms triggered by a known allergy to peanuts he consumed at a party. The nurse recognizes that these abrupt spasms are related to antibodies that trigger:
  1. Contractions of the muscles in the walls of the large bronchiole tubes.
  2. The formation of sticky mucous plugs.
  3. Swelling of the juncture between the alveolus and the capillary bed.
  4. Formation of thick membrane between the alveoli and the capillary bed.

Answer: 1

Rationale:      

  1. Allergic reactions can occur when a hypersensitive person is inadvertently exposed to an allergen, causing IgE antibodies to release histamine and other irritating substances. Bronchospasm results quickly.
  2. Allergic reactions can occur when a hypersensitive person is inadvertently exposed to an allergen, causing IgE antibodies to release histamine and other irritating substances. Bronchospasm results quickly. Mucous plugs might form, but the primary issue is the bronchospasms, which are clamping down on the airway.
  3. Allergic reactions can occur when a hypersensitive person is inadvertently exposed to an allergen, causing IgE antibodies to release histamine and other irritating substances. Bronchospasm results quickly. The problem is above the level of the capillary bed.
  4. Allergic reactions can occur when a hypersensitive person is inadvertently exposed to an allergen, causing IgE antibodies to release histamine and other irritating substances. Bronchospasm results quickly. The problem is above the level of the capillary bed.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-4

 

  1. The nurse is collaboratively setting goals for the inpatient management of new-onset asthma in a child. The nurse prioritizes the patient’s nursing diagnoses, and gives which goal the highest priority?
  1. The patient’s pulse oximetry values will remain above 92% the majority of the time.
  2. The patient’s mother will correctly demonstrate the use of a peak flow meter.
  3. The patient’s lung sounds will demonstrate only scattered wheezes by discharge.
  4. The patient will sleep uninterruptedly for four hours at a stretch every night.

Answer: 1

Rationale:      

  1. Adequate pulse oximetry values demonstrate that therapy is effective, giving this goal the highest priority during hospitalization.
  2. Adequate pulse oximetry values demonstrate that therapy is effective, giving this goal the highest priority during hospitalization. The patient’s mother needs to learn the appropriate use of the PFM by discharge.
  3. Adequate pulse oximetry values demonstrate that therapy is effective, giving this goal the highest priority during hospitalization. Wheezing will come and go depending on the severity of the asthma and the timing of drug administration.
  4. Adequate pulse oximetry values demonstrate that therapy is effective, giving this goal the highest priority during hospitalization. Sound sleep in important, but is difficult to attain when monitoring a sick child, as is necessary in an acute care setting.

Cognitive Level: Synthesis

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-4

 

 

Learning Outcome 5 Compare the advantage and disadvantage of using the inhalation route of drug administration of pulmonary drugs.

 

  1. A patient is learning metered-dose inhaler technique. The patient says, “I don’t understand why I have to use this thing. Can’t I just take pills?” The nurse’s response is based on the knowledge that:
  1. The inhalation route is safer and more effective than are pills.
  2. The inhalation route is less expensive than is oral therapy.
  3. The inhalation route is easier to master than is oral therapy.
  4. The inhalation route is more likely to lead to termination of the disease process than are pills.

Answer: 1

Rationale:      

  1. The inhaled route delivers the drug directly to the lungsRemember, lower doses are possible, and there are fewer systemic side effects.
  2. The inhaled route delivers the drug directly to the lungsRemember, lower doses are possible, and there are fewer systemic side effects. Unfortunately, there is considerable expense involved with some inhalers.
  3. The inhaled route delivers the drug directly to the lungsRemember, lower doses are possible, and there are fewer systemic side effects. More manual dexterity is required to master an inhaler or other device than to take pills.
  4. The inhaled route delivers the drug directly to the lungsRemember, lower doses are possible, and there are fewer systemic side effects. These drugs are used to control pulmonary problems; they are not curative.

Cognitive Level: Knowledge

Client Need: Psychological Integrity

Nursing Process: Implementation

Learning Outcome 73-5

 

 

  1. A patient with degenerative arthritis is provided with a spacer along with a steroid-based metered-dose inhaler. The nurse recognizes that the use of the spacer assists this patient to:
  1. Use a larger dose of the steroid.
  2. Compensate for decreased dexterity.
  3. Avoid thrush infections.
  4. Progress with weaning from the steroid drug.

Answer: 2

Rationale:      

  1. Spacers allow the patient with decreased mobility or poor coordination to use a metered-dose inhaler more effectively. The dose of the drug is not affected.
  2. Spacers allow the patient with decreased mobility or poor coordination to use a metered-dose inhaler more effectively.
  3. Spacers allow the patient with decreased mobility or poor coordination to use a metered-dose inhaler more effectively. Thrush infection of the throat can still be an issue if the patient does not rinse the mouth after using the steroid.
  4. Spacers allow the patient with decreased mobility or poor coordination to use a metered-dose inhaler more effectively. Weaning from the steroid is not affected.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 73-5

 

  1. A patient in acute respiratory distress on a medical unit is receiving a nebulizer albuterol treatment. The patient is annoyed because he already has an albuterol MDI. The nurse’s response to the patient’s concern is based on the knowledge that:
  1. Suspension of the medication in liquid and delivery over a longer period increase the bronchodilator’s effectiveness.
  2. The agitated and dyspneic patient is unlikely to be able to use a metered-dose albuterol inhaler effectively.
  3. The nebulized form of the drug will have fewer negative effects on this distressed patient.
  4. Nebulized therapy is more cost-effective in the inpatient setting.

Answer: 1

Rationale:      

  1. The patient in acute distress benefits from the administration of a nebulizer treatment because the medication is delivered over a relatively longer period of time. Suspension in liquid particles with the use of a mouthpiece or mask and the assistance of a professional provider ensures that the medication will get to the lung’s surfaces.
  2. The patient in acute distress benefits from the administration of a nebulizer treatment because the medication is delivered over a relatively longer period of time. Suspension in liquid particles with the use of a mouthpiece or mask and the assistance of a professional provider ensures that the medication will get to the lung’s surface. The patient might have difficulty using an inhaler at this point, but that is not the primary rationale for the nebulizer technique.
  3. The patient in acute distress benefits from the administration of a nebulizer treatment because the medication is delivered over a relatively longer period of time. Suspension in liquid particles with the use of a mouthpiece or mask and the assistance of a professional provider ensures that the medication will get to the lung’s surface. The side effects might actually be more severe, particularly nervousness and increased heart rate.
  4. The patient in acute distress benefits from the administration of a nebulizer treatment because the medication is delivered over a relatively longer period of time. Suspension in liquid particles with the use of a mouthpiece or mask and the assistance of a professional provider ensures that the medication will get to the lung’s surface. Nebulized treatments are more expensive because of additional equipment, supplies, and personnel.

Cognitive Level: Knowledge

Client Need: Psychological Integrity

Nursing Process: Implementation

Learning Outcome 73-5

 

Learning Outcome 6 Describe the types of devices used to deliver aerosol therapies via the inhalation route.

 

  1. A patient with limited strength in his hands is being prepared for discharge with a dry powder inhaler. The discharge nurse teaches the patient the advantage of this inhaler. This teaching is based on the knowledge that:
  1. The patient can activate the inhaler with less pressure than needed for a metered-dose inhaler.
  2. The patient can activate the inhaler simply by inhaling.
  3. The patient can increase the effectiveness of the powder by instilling it into a small nebulizer.
  4. This inhaler has no dose limits.

Answer: 2

Rationale:      

  1. Dry powder inhalers are activated by inhaling, which is an advantage to the patient with decreased upper body strength. No pressure is required.
  2. Dry powder inhalers are activated by inhaling, which is an advantage to the patient with decreased upper body strength.
  3. Dry powder inhalers are activated by inhaling, which is an advantage to the patient with decreased upper body strength. The powder cannot be removed easily, and is not appropriate for nebulization.
  4. Dry powder inhalers are activated by inhaling, which is an advantage to the patient with decreased upper body strength. DPIs do have dose limits.

Cognitive Level: Knowledge

Client Need: Psychological Integrity

Nursing Process: Implementation

Learning Outcome 73-6

 

 

  1. Over the course of treatment for chronic asthma, a patient develops an allergy to the propellants in metered-dose inhalers. What option would the nurse expect to be used to address this problem after discharge?
  1. A dry powder inhaler
  2. A concentrated-dose metered-dose inhaler
  3. Nebulizer treatments
  4. Oral medication of the same class as the metered-dose inhaler

Answer: 1

Rationale:      

  1. Dry powder inhalers contain no propellants.
  2. Dry powder inhalers contain no propellants, and would be the appropriate choice for this patient. The MDI is no longer an option.
  3. Dry powder inhalers contain no propellants, and would be the appropriate choice for this patient. Nebulizer treatments are not portable enough for daily use.
  4. Dry powder inhalers contain no propellants, and would the appropriate choice for this patient. Oral medications would increase the systemic side effects.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-6

 

 

 

  1. A small child with an RSV infection and bronchiolitis is being sent home from the ED with a prescription for albuterol. The parents are to obtain a nebulizer from a medical equipment rental store. In order to ensure that the treatments will relieve the child’s bronchospasm, the nurse will emphasize:
  1. Giving the treatments at exact intervals.
  2. Combining the treatments with supplemental oxygen.
  3. Continuing each treatment until all the medication is gone from the reservoir.
  4. Following up the treatment with deep-breathing exercises and controlled coughing.

Answer: 3

Rationale:      

  1. The health care provider will order the frequency of treatments. Some treatments are ordered every four hours, others as needed. It is essential that all the medication be given with each treatment, or the child won’t get the full effect of the bronchodilator.
  2. The health care provider will order the frequency of treatments. Some treatments are ordered every four hours, others as needed. It is essential that all the medication be given with each treatment, or the child won’t get the full effect of the bronchodilator. Supplemental oxygen will not be ordered for the aftermath of RSV.
  3. The health care provider will order the frequency of treatments. Some treatments are ordered every four hours, others as needed. It is essential that all the medication be given with each treatment, or the child won’t get the full effect of the bronchodilator.
  4. The health care provider will order the frequency of treatments. Some treatments are ordered every four hours, others as needed. It is essential that all the medication be given with each treatment, or the child won’t get the full effect of the bronchodilator. Deep breathing and controlled coughing are not appropriate in this situation.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 73-6

 

 

 

 

 

 

 

 

 

Learning Outcome 7 Explain the three basic principles of asthma management recommended by the National Asthma Education and Prevention Program.

 

  1. The nurse is admitting a patient with a provisional diagnosis of asthma. The patient reports that she has asthma attacks about every other day. She has had three episodes that awakened her at night in the last month. She reports that she has trouble working on days when she has an attack. The nurse concludes this patient’s care will be planned on the assumption that the patient has a certain level of asthma, namely:
  1. Intermittent asthma.
  2. Mild persistent asthma.
  3. Severe asthma.
  4. Moderate persistent asthma.

Answer: 2

Rationale:      

  1. Patients with intermittent asthma have episodes less than twice a week, and they do not have activity limitations. This patient fits the profile for mild persistent asthma, with attacks that occur between three and six times per week and more than twice a month at night.
  2. This patient fits the profile for mild persistent asthma, with attacks that occur between three and six times per week and more than twice a month at night.
  3. This patient fits the profile for mild persistent asthma, with attacks that occur between three and six times per week and more than twice a month at night. Severe asthma involves continuous signs and symptoms.
  4. This patient fits the profile for mild persistent asthma, with attacks that occur between three and six times per week and more than twice a month at night. Moderate asthma involves daily episodes and at least one nighttime episode weekly.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-7

 

  1. The nurse is caring for an elective orthopedic surgery patient with mild intermittent asthma. During the second postoperative day, the patient has an asthmatic episode while eating lunch. When contacting the physician for orders, the nurse is seeking an order for:
  1. Intravenous aminophylline.
  2. A Medrol dose pack.
  3. A short-acting selective beta-agonist inhaler.
  4. Subcutaneous epinephrine.

Answer: 3

Rationale:      

  1. Short-acting selective beta-agonist therapy via the inhaled route is the most appropriate therapy for mild intermittent asthma, used on as-needed basis. Aminophylline is reserved for persistent asthma.
  2. Short-acting selective beta-agonist therapy via the inhaled route is the most appropriate therapy for mild intermittent asthma, used on as-needed basis. Steroids are reserved for persistent asthma.
  3. Short-acting selective beta-agonist therapy via the inhaled route is the most appropriate therapy for mild intermittent asthma, used on as-needed basis.
  4. Short-acting selective beta-agonist therapy via the inhaled route is the most appropriate therapy for mild intermittent asthma, used on as-needed basis. Epinephrine is reserved for the emergency treatment of severe attacks that do not respond to other drugs.

Cognitive Level: Synthesis

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-7

 

  1. A mother is struggling to manage a child with moderate persistent asthma at home. The mother is motivated to learn because of the number of medications her child must take and the overwhelming expense of managing these drugs. The nurse teaches the mother about environmental control. Which strategies are most likely to be effective?
  1. Hardwood floor and plastic-covered mattress and pillow in the child’s bedroom
  2. Keeping the child’s immunizations up-to-date and wearing a face mask in public
  3. Limiting intake of protein and foods with red and yellow dyes
  4. Home-schooling the child and limiting his contact with other children who might have upper respiratory infections

Answer: 1

Rationale:      

  1. Environmental controls call for limiting a child’s contact with potential allergens, particularly at night, when the airway is most reactive. Hardwood floors hold less dust. Plastic coverings reduce dust mites. Both are potent allergens in children.
  2. Environmental controls call for limiting a child’s contact with potential allergens, particularly at night, when the airway is most reactive. Hardwood floors hold less dust. Plastic coverings reduce dust mites. Both are potent allergens in children. Immunizations are important, but are not considered an environmental control. A face mask in public is not an effective strategy, and will cause the child to be ostracized.
  3. Environmental controls call for limiting a child’s contact with potential allergens, particularly at night, when the airway is most reactive. Hardwood floors hold less dust. Plastic coverings reduce dust mites. Both are potent allergens in children. Protein limitation is not indicated. Some individuals are sensitive to dyes, and should be treated by an allergist.
  4. Environmental controls call for limiting a child’s contact with potential allergens, particularly at night, when the airway is most reactive. Hardwood floors hold less dust. Plastic coverings reduce dust mites. Both are potent allergens in children. Home schooling actually might exacerbate the child’s problem and worsen social isolation.

Cognitive Level: Synthesis

Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome 73-7

 

 

 

 

 

 

Learning Outcome 8 Compare and contrast indications for pharmacotherapy with the short- versus long-acting beta-adrenergic agents.

 

  1. The nurse is admitting a patient with an exacerbation of asthma. His medication list includes albuterol, salmeterol, budesonide, cromolyn, and zafirkulast. He states that takes these medicines every day, except for the albuterol. When planning the patient’s care, the nurse recognizes:
  1. The patient’s combination of medications is appropriate according to current practice guidelines.
  2. The patient’s therapy is adequate, except that he should be using the albuterol daily.
  3. The patient is taking too many medications, and several should be discontinued.
  4. The patient needs several additional preparations if the asthma control standards of the Agency for Healthcare Research and Quality are to be met.

Answer: 1

Rationale:      

  1. Current practice guidelines recommend a long-acting bronchodilator and a steroid for long-term management. Mast cell stabilizer and leukotriene modifiers are also appropriate. Albuterol is appropriate as an “as needed” short-acting inhaler.
  2. Current practice guidelines recommend a long-acting bronchodilator and a steroid for long-term management. Mast cell stabilizer and leukotriene modifiers are also appropriate. Albuterol is appropriate as an “as needed” short-acting inhaler. It should not be used unless needed.
  3. Current practice guidelines recommend a long-acting bronchodilator and a steroid for long-term management. Mast cell stabilizer and leukotriene modifiers are also appropriate. Albuterol is appropriate as an “as needed” short-acting inhaler. None of these medications should be stopped.
  4. Current practice guidelines recommend a long-acting bronchodilator and a steroid for long-term management. Mast cell stabilizer and leukotriene modifiers are also appropriate. Albuterol is appropriate as an “as needed” short-acting inhaler. These guidelines were established by the National Institutes of Health, and are endorsed by the AHRQ.

Cognitive Level: Synthesis

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-8

 

 

  1. A patient with moderate and persistent asthma has obtained control with a formoterol inhaler q.i.d. for bronchospasm for several years. In the past couple of weeks, however, he has been reporting more chest tightness and wheezing during the day. He also uses a steroid inhaler and oral sustained-release zileuton. The nurse recognizes that the initial medical response to this challenge will be:
  1. Discontinuation of the formoterol.
  2. Discontinuation of the inhaled steroid.
  3. Increasing the dose of formoterol.
  4. Increasing the dose of the inhaled steroid.

 

Answer: 3

Rationale:      

  1. Patients sometimes develop resistance to the beta-adrenergic binding effects of inhaled bronchodilators. If the patient has been getting good results from a preparation, the initial response is to increase the dose.
  2. Patients sometimes develop resistance to the beta-adrenergic binding effects of inhaled bronchodilators. If the patient has been getting good results from a preparation, the initial response is to increase the dose. Stopping the steroid has no benefit, and will increase inflammation, which eventually makes bronchoconstriction worse.
  3. Patients sometimes develop resistance to the beta-adrenergic binding effects of inhaled bronchodilators. If the patient has been getting good results from a preparation, the initial response is to increase the dose.
  4. Patients sometimes develop resistance to the beta-adrenergic binding effects of inhaled bronchodilators. If the patient has been getting good results from a preparation, the initial response is to increase the dose. Increasing the dose of the anti-inflammatory steroid will have minimal effect at this point.

Cognitive Level: Synthesis

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-8

 

  1. 24. The nurse is teaching a patient about the use of an albuterol rescue inhaler. Which nursing diagnosis is most appropriate to avoid inappropriate responses to albuterol later on?
  1. Knowledge Deficit related to proper use of albuterol inhaler
  2. Injury (cardiac damage), risk for related to excess beta-1 stimulation from albuterol
  3. Impaired Gas Exchange related to inadequate response to albuterol
  4. Ineffective Airway Clearance related to excess mucus formation

Answer: 1

Rationale:      

  1. Correct inhaler use is essential to allow albuterol to penetrate deep enough into the airway to dilate the bronchioles.
  2. Correct inhaler use is essential to allow albuterol to penetrate deep enough into the airway to dilate the bronchioles. Although it is a non-selective beta agonist, albuterol does not cause much beta-1 stimulation via the inhaled route.
  3. Correct inhaler use is essential to allow albuterol to penetrate deep enough into the airway to dilate the bronchioles. Inappropriate use of an inhaler is a bigger problem than is lack of effectiveness of the drug for most patients.
  4. Correct inhaler use is essential to allow albuterol to penetrate deep enough into the airway to dilate the bronchioles. Mucus formation is not an issue with albuterol use.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Diagnosis

Learning Outcome 73-8

 

 

Learning Outcome 9 Describe the nurse’s role in the pharmacological management of lower respiratory tract disorders.

 

  1. The nurse is caring for a patient with newly detected asthma. When planning care for this patient, the nurse is aware that the patient’s heavy alcohol intake could make him intolerant of certain respiratory medications, including:
  1. Albuterol and ipratropium.
  2. Cromolyn and levalbuterol.
  3. Aminophylline and montelukast.
  4. Nedocromil and budesonide.

Answer: 1

Rationale:      

  1. Liver disease, including alcohol abuse, is a relative contraindication for the leukotriene inhibitors and the xanthines. Beta agonists and anticholinergics do not have the same effect on the liver.
  2. Liver disease, including alcohol abuse, is a relative contraindication for the leukotriene inhibitors and the xanthines. Mast cell stabilizers and beta agonists do not have the same effect on the liver.
  3. Liver disease, including alcohol abuse, is a relative contraindication for the leukotriene inhibitors and the xanthines.
  4. Liver disease, including alcohol abuse, is a relative contraindication for the leukotriene inhibitors and the xanthines. Mast cell stabilizers and corticosteroids do not have the same effect on the liver.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-9

 

 

  1. A nurse is caring for a patient with asthma and type 2 DM. The nurse knows that which respiratory drug is most likely to elevate the patient’s blood sugar?
  1. Albuterol
  2. Aminophylline
  3. Triamcinolone
  4. Tiotropium

Answer: 3

Rationale:      

  1. Corticosteroids tend to elevate blood sugar. This is more likely to occur with long-term use and at higher doses. Albuterol does not have much effect on blood sugar.
  2. Corticosteroids tend to elevate blood sugar. This is more likely to occur with long-term use and at higher doses. Aminophylline does not have much effect on blood sugar.
  3. Corticosteroids tend to elevate blood sugar. This is more likely to occur with long-term use and at higher doses.
  4. Corticosteroids tend to elevate blood sugar. This is more likely to occur with long-term use and at higher doses. Tiotropium does not have much effect on blood sugar.

 

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 73-9

 

 

  1. The nurse is caring for a patient with chronic bronchitis and a history of glaucoma. The nurse recognizes that which drug would NOT be an appropriate choice for the control of the patient’s bronchospasm?
  1. formoterol (Foradil)
  2. ipratropium (Atrovent)
  3. cromolyn (Intal)
  4. dyphylline (Lufyllin)

Answer: 2      

Rationale:      

  1.  LA beta blockers do not affect intraocular pressure and therefore could be an appropriate choice.
  2. Ipratropium is an anticholinergic that can elevate intraocular pressure. It is not a good choice for the patient with glaucoma.
  3. Mast cell stabilizers do not affect intraocular pressure and therefore could be an appropriate choice.
  4.  Xanthines do not affect intraocular pressure and therefore could be an appropriate choice.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-9

 

Learning Outcome 10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

 

  1. The nurse is caring for an asthmatic patient who has taken Accolate (zafirlukast) for a number of years. Coumadin is being added to the patient’s medications because of atrial fibrillation. What concern does the nurse have related to this addition?
  1. Less Coumadin will be needed to achieve the desired INR.
  2. The patient will be at greater risk for stroke because of drug interaction.
  3. Warfarin necrosis is a distinct possibility.
  4. The patient might experience an increase in BUN and creatinine values.

Answer: 1

Rationale:      

  1. Both drugs utilize the same enzyme pathwayRemember, the effects of Coumadin are potentiated. This will elevate the INR so that less Coumadin is needed.
  2. Both drugs utilize the same enzyme pathwayRemember, the effects of Coumadin are potentiated. This will elevate the INR so that less Coumadin is needed. This lowers the risk of stroke.
  3. Both drugs utilize the same enzyme pathwayRemember, the effects of Coumadin are potentiated. This will elevate the INR so that less Coumadin is needed. Necrosis is a rare side effect of Coumadin.
  4. Both drugs utilize the same enzyme pathwayRemember, the effects of Coumadin are potentiated. This will elevate the INR so that less Coumadin is needed. BUN and creatinine are not affected.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome 73-10

 

 

  1. A patient is having difficulty controlling persistent asthma, and is admitted to an inpatient medical unit. Her admission EKG demonstrates sinus rhythm with a PR interval of 0.18, a QT interval of 0.52 seconds, and no ST segment elevation. An albuterol nebulizer treatment is ordered. Prior to its administration, the nurse expresses concern about:
  1. The PR interval.
  2. The QT interval.
  3. The heart rate.
  4. The ST segment.

Answer: 2

Rationale:      

  1. The prolonged QT interval is of concern when albuterol nebulizer treatments are ordered due to the risk of ventricular dysrhythmia. The PR interval is normal.
  2. The prolonged QT interval is of concern when albuterol nebulizer treatments are ordered due to the risk of ventricular dysrhythmia.
  3. The prolonged QT interval is of concern when albuterol nebulizer treatments are ordered due to the risk of ventricular dysrhythmia. No heart rate is given; by definition, sinus rhythm falls within 60–160 BPM.
  4. The prolonged QT interval is of concern when albuterol nebulizer treatments are ordered due to the risk of ventricular dysrhythmia. Lack of ST segment elevation is a normal finding.

Cognitive Level: Synthesis

Client Need:   Physiological Integrity

Nursing Process: Assessment

Learning Outcome 73-10

 

 

 

 

 

 

  1. A patient with persistent asthma has a history of multiple allergies, including to peanuts and soy. The nurse knows this history serves as a contraindication for the administration of which prophylactic medication?
  1. Ipratropium (Atrovent)
  2. Triamcinolone (Azmacort)
  3. Cromolyn (Intal)
  4. Zafirlukast (Accolate)

Answer: 1

Rationale:      

  1. Ipratropium contains a substance derived from soya lecithinRemember, it is contraindicated in the presence of soy allergies.
  2. Ipratropium contains a substance derived from soya lecithinRemember, it is contraindicated in the presence of soy allergies. Triamcinolone does not contain soy or peanut product.
  3. Ipratropium contains a substance derived from soya lecithinRemember, it is contraindicated in the presence of soy allergies. Cromolyn does not contain soy or peanut product.
  4. Ipratropium contains a substance derived from soya lecithinRemember, it is contraindicated in the presence of soy allergies. Zafirlukast does not contain soy or peanut product.

Cognitive Level: Knowledge

Client Need: Safe, Effective Care Environment

Nursing Process: Assessment

Learning Outcome 73-10

 

Learning Outcome 11 Use the nursing process to care for patients who are receiving pharmacotherapy for lower respiratory disorders.

 

  1. The nurse is helping a patient establish goals in respect to the control of his asthma with medications. The nurse emphasizes to the patient that the most effective class of drugs for maintaining control of asthma are those that:
  1. Reverse bronchospasm.
  2. Present bronchospasm.
  3. Prevent local inflammation.
  4. Stabilize mast cells in the airways.

Answer: 3

Rationale:      

  1. Corticosteroids are currently recommended for the control of asthma in the inhaled form because they prevent the inflammation that sets of bronchospasm.
  2. Corticosteroids are currently recommended for the control of asthma in the inhaled form because they prevent the inflammation that sets of bronchospasm.
  3. Corticosteroids are currently recommended for the control of asthma in the inhaled form because they prevent the inflammation that sets of bronchospasm.
  4. Corticosteroids are currently recommended for the control of asthma in the inhaled form because they prevent the inflammation that sets of bronchospasm.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 73-11

 

  1. The nurse is evaluating the ABGs of a patient who was admitted in severe respiratory distress 24 hours ago. The nurse recognizes that which blood gases are normal?
  1. pH 7.42, paCO2 35, HCO3 22
  2. pH 7.27, paCO2 38, HCO3 14
  3. pH 7.48, paCO2 32, HCO3 18
  4. pH 7.26, paCO2 HCO3 29

Answer: 1

Rationale:      

  1. These are normal blood gases.
  2. These indicate uncompensated metabolic acidosis.
  3. These indicate partially compensated respiratory alkalosis.
  4. These indicate uncompensated respiratory alkalosis.

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 73-11

 

 

  1. A patient is admitted with an acute exacerbation of bronchitis and emphysema. Intravenous SoluMedrol is to be administered every six hours. Which nursing diagnosis best reflects the nurse’s concern related to adverse effects?
  1. Injury, risk for related to fractures associated with steroid-driven bone demineralization
  2. Decreased Cardiac Output, risk for related to hypertension associated with steroid-driven fluid retention
  3. Disturbed Sleep Patterns, risk for related to circadian rhythm disruption associated with around-the-clock steroid administration
  4. Impaired Oral Mucous Membranes, risk for related to effects of steroid administration

Answer: 3

Rationale:      

  1. Around-the-clock-steroid administration perturbs the body’s circadian rhythm of serum cortisol levels. Sleep disturbance is common if steroids are administered orally or parenterally after 6 p.m. Bone demineralization is a consequence of long-term steroid therapy.
  2. Around-the-clock steroid administration perturbs the body’s circadian rhythm of serum cortisol levels. Sleep disturbance is common if steroids are administered orally or parenterally after 6 p.m. High serum levels of exogenous steroids will have a mineralocorticoid effect with sodium and water retention, but this is less likely to be a problem with the short-term administration that is probable in this situation.
  3. Around-the-clock steroid administration perturbs the body’s circadian rhythm of serum cortisol levels. Sleep disturbance is common if steroids are administered orally or parenterally after 6 p.m.
  4. Around-the-clock steroid administration perturbs the body’s circadian rhythm of serum cortisol levels. Sleep disturbance is common if steroids are administered orally or parenterally after 6 p.m. Oral mucous membrane problems are an issue only with steroids inhaled by mouth.

 

Cognitive Level: Synthesis

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome 73-11

 

 

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