LOWER RESP DRUGS 1.The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention?

Continue to assess the patient’s oxygenation. The therapeutic theopylline level is 10 to 20 mcg/mL. The nurse should continue interventions and monitor oxygenation.

2. In discharge teaching, the nurse will emphasize to a patient receiving a beta-agonist bronchodilator the importance of reporting which side effect?

Tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.

3. What over-the-counter product will the nurse instruct the patient to avoid when taking montelukast (Singulair)?

St. John’s wort St. John’s wort has been shown to decrease serum montelukast (Singulair) levels. The other substances do not interact with montelukast.

4. The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention?

Monitoring patient for potential chest pain Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patient with coronary artery disease. Cautious use of these agents is indicated if the patient has coronary artery disease.

5. The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast (Accolate) in the patient teaching?

“This medication will prevent the inflammation that causes your asthma attack.” Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.

6. A patient with a history of asthma is short of breath and says, “I feel like I’m having an asthma attack.” What is the nurse’s highest priority action? Administering a beta2 adrenergic agonist In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense. A beta2-adrenergic agonist will provide immediate relief,

7. A patient has taken metaproterenol (Alupent). What is the nurse’s priority action?

Monitoring for heart rate >100 beats/min The beta1 properties of this drug can cause increased heart rate and palpitations.

8. The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What will the nurse do? Teach the child to use a spacer.

If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.

9. The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? The patient with atrial fibrillation with a rate of 100

The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This patient should not receive epinephrine.

10. The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a patient. What is the nurse’s best action?

Administer the albuterol, wait 5 minutes, administer ipratropium bromide, then beclomethasone several minutes later. Administering the bronchodilator albuterol (Proventil) first allows the other drugs to reach deeper into the lungs as the bronchioles dilate.

11. Which instruction will the nurse include when teaching a patient about the proper use of metered-dose inhalers?

“Hold your breath for 10 seconds if you can after you inhale the medication.”

Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.

12. What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)? Liquefying and loosening of bronchial secretions Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.

13. A patient is prescribed ipratropium (Atrovent) and cromolyn sodium (Intal). What will the nurse teach the patient?

“Take the ipratropium (Atrovent) at least 5 minutes before the cromolyn (Intal).”

When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.

14. A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse’s best action?

Hold the next dose of theophylline. The patient is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.