Chapter 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease

Chapter 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

a.	the patient should inhale suddenly to receive the maximum dose.
b.	the patient should activate the device and then inhale.
c.	the patient should store the MDI in the refrigerator between doses.
d.	the patient should wait 1 minute between puffs.

 

 

ANS:  D

When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Sudden inhalation can cause bronchospasm. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 921

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta₂-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

a.	“I should use the glucocorticoid as needed when symptoms flare.”
b.	“I will need to use the beta2-adrenergic agonist drug daily.”
c.	“The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators.”
d.	“The glucocorticoid is used as prophylaxis to prevent exacerbations.”

 

 

ANS:  D

Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta₂-adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 919-921

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?

a.	Ask whether the patient is rinsing the mouth after each dose.
b.	Request an order for an antifungal medication.
c.	Suggest that the patient be tested for a bronchial infection.
d.	Tell the patient to discontinue use of the glucocorticoid.

 

 

ANS:  A

The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 922-923

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?

a.	Four puffs of albuterol, oxygen, and intravenous theophylline
b.	Intramuscular glucocorticoids and salmeterol by metered-dose inhaler
c.	Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen
d.	Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg

 

 

ANS:  C

Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute exacerbations. During asthma flares, nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated, because oxygen saturations are low despite the increased work of breathing. Increasing the dose of albuterol and giving theophylline are not indicated. Salmeterol is a long-term beta agonist and is not useful in an acute attack.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 932

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies