Sherpath Chapter 8, Drugs for Allergy and Respiratory Problems: Drug Therapy for Asthma and Chronic Obstructive Pulmonary Disease

Question 1 of 17

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Which information would the nurse provide when discussing a new diagnosis of asthma with a patient?

• • “The symptoms will continue every day.”The actual symptoms of asthma occur from time to time, or intermittently.
• Correct
  • “Between attacks, there are no signs or symptoms.”Between attacks, the patient usually has no signs or symptoms.
• • “It is a short-term problem that resolves with treatment.”Asthma is a long-term condition that causes intermittent symptoms.
• • “A build-up of mucus in the lungs causes the symptoms.”The symptoms of asthma are caused by inflammation and constriction.

Question 2 of 17

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Which pathophysiological change occurs in asthma? Select all that apply. One, some, or all responses may be correct.

• • Overexcretion of histamineAsthma is not caused by overexcretion of histamine.
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  • Inflammation of the airwaysThere are two problems that cause asthma. Inflammation of the internal airways causes obstruction because the mucous membrane linings swell and secrete extra mucus.
• • Systemic respiratory infectionAsthma is not caused by a systemic respiratory infection.
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  • Constriction of the smooth muscleThere are two problems that cause asthma. Constriction of the smooth muscle causes narrowing of the airways through bronchoconstriction.
• • Proliferation of white blood cells in the lungsAsthma is not caused by a proliferation of white blood cells in the lungs.

Question 3 of 17

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Which assessment finding indicates that a patient is experiencing an asthma attack? Select all that apply. One, some, or all responses may be correct.

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  • WheezingSymptoms of an asthma attack include wheezing or a whistling sound.
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  • Dry, hacking coughSymptoms of an asthma attack include a dry, hacking cough.
• • Pink, frothy sputumPink, frothy sputum is a symptom of pulmonary edema.
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  • Shortness of breathShortness of breath is a symptom of an asthma attack.
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  • Tightness of the chestPatients having an asthma attack experience tightness of the chest.

Question 4 of 17

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Which response would the nurse provide when asked to explain chronic obstructive pulmonary disease (COPD)? Select all that apply. One, some, or all responses may be correct.

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  • “It is a progressive disease.”COPD is a progressive disease that causes breathing difficulty.
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  • “Symptoms are always present.”The symptoms of COPD are always present and become worse with inflammation.
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  • “Lung damage is not reversible.”The lung damage resulting from COPD is not reversible.
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  • “Upper and lower airways are obstructed.”COPD obstructs airflow passages in the upper and lower airways.
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  • “Large amounts of sticky mucus are produced.”The inflammation of COPD causes large amounts of sticky mucus to be produced.
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  • “The usual cause is cigarette smoke and air pollution.”The usual cause of COPD is cigarette smoking or exposure to secondhand smoke and air pollution.

Question 5 of 17

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Which finding would the nurse expect in a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. One, some, or all responses may be correct.

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  • WheezingCOPD causes wheezing.
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  • Chronic coughCOPD is characterized by a chronic cough.
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  • Enlarged chestOne symptom of COPD is an enlarged chest.
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  • Chest tightnessCOPD causes chest tightness.
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  • Shortness of breathShortness of breath is a symptom of COPD.
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  • Clear white, yellow, or green sticky mucusA characteristic symptom of COPD is the development of clear white, yellow, or green sticky mucus.

Question 6 of 17

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Which response would the nurse provide when asked to explain the difference between asthma controller and asthma reliever drugs? Select all that apply. One, some, or all responses may be correct.

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  • “Reliever drugs are short acting.”Asthma reliever drugs are short-acting bronchodilators.
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  • “Controller drugs must be taken daily.”Asthma controller drugs must be taken daily to be effective.
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  • “Reliever drugs stop an asthma attack.”Asthma reliever drugs have the main purpose of stopping an asthma attack.
• • “Reliever drugs are used to prevent asthma.”Asthma reliever drugs have no role in asthma prevention.
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  • “Controller drugs prevent excessive inflammation.”Asthma controller drugs are used to prevent excessive inflammation.
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  • “Controller drugs include longer-acting bronchodilators.”Asthma controller drugs include longer-acting bronchodilators.

Question 7 of 17

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Which medication would the nurse expect to incorporate into the plan of care for a patient who uses an asthma reliever drug once a day? Select all that apply. One, some, or all responses may be correct.

• • Oral glucocorticosteroidsOral glucocorticosteroids are prescribed for Step 5 or when a reliever drug is needed more than once a day.
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  • Long-acting beta₂-agonistIn Step 4, a reliever drug is needed daily along with a long-acting beta₂-agonist.
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  • Sustained-release theophyllineIn Step 4, a reliever drug is needed daily along with sustained-release theophylline.
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  • Leukotriene receptor antagonistIn Step 4, a reliever drug is needed daily along with a leukotriene receptor antagonist.
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  • High-dose inhaled corticosteroidIn Step 4, a reliever drug is needed daily along with a high-dose inhaled corticosteroid.
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  • Medium-dose inhaled corticosteroidIn Step 4, a reliever drug is needed daily along with a medium-dose inhaled corticosteroid.

Question 8 of 17

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Which step of drug therapy would the nurse expect to be prescribed for a patient who experiences daytime asthma symptoms more than twice a week that limit activity?

• • Step 2Step 2 treatment for asthma is prescribed for daytime symptoms that occur not more than twice a week that do not limit activity.
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  • Step 3Step 3 treatment for asthma is prescribed for daytime symptoms that occur more than twice a week that limit activity.
• • Step 4Step 4 treatment for asthma is prescribed for daytime symptoms that occur more than twice a week that require the need of a daily reliever drug.
• • Step 5Step 5 treatment for asthma is prescribed for daily symptoms that occur more than twice a week that require the need of a reliever drug more than once a day.

Question 9 of 17

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Which instruction would the nurse provide to a patient who is prescribed a short-acting beta₂-adrenergic agonist (SABA) and an inhaled corticosteroid for asthma treatment?

• Correct
  • Use the SABA medication first.When a SABA and an inhaled corticosteroid are prescribed together, always use the SABA first to open the airway and allow the corticosteroid to reach the respiratory tract.
• • Use the inhaled corticosteroid first.The inhaled corticosteroid is to be used after the SABA because it will not reach the respiratory tract if the respiratory passages are constricted.
• • Use the SABA medication for 1 dose, followed by the inhaled corticosteroid for 1 dose, and then another SABA dose.The SABA should be used first, before the corticosteroid.
• • Use the inhaled corticosteroid for 1 dose, followed by 2 doses of the SABA medication for 2 doses.The SABA should be used first, before the corticosteroid, regardless of the number of doses.

Question 10 of 17

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Which drug would the nurse expect to be prescribed for a patient with asthma who has difficulty remembering to take medications?

• • AlbuterolAlbuterol is a short-acting beta₂-agonist. It is not mixed with a corticosteroid.
• • IpratropiumIpratropium is a cholinergic antagonist. It is not mixed with a corticosteroid.
• • ArformoterolArformoterol is a long-acting beta₂-agonist. It is not mixed with a corticosteroid.
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  • Vilanterol with fluticasoneSometimes, so that patients have fewer drugs to take and remember, a long-acting beta₂-agonist may be combined with an inhaled corticosteroid in one inhaler. An example is vilanterol combined with the inhaled corticosteroid fluticasone.

Question 11 of 17

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Which assessment finding indicates that a patient with asthma is experiencing an adverse reaction to a bronchodilator?

• • Bad taste in the mouthA bad taste in the mouth is a common side effect of using oral inhaled bronchodilators.
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  • Chest painIf a bronchodilator is heavily used, it can be absorbed throughout the body and cause constriction of blood vessels in the heart muscle, leading to chest pain.
• • Dry mouthA dry mouth is a common side effect of using oral inhaled bronchodilators.
• • HeadacheA headache is a common side effect of using oral inhaled bronchodilators.

Question 12 of 17

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For which asthma medication would the nurse instruct the patient to “use as needed”?

• • FormoterolFormoterol is a long-acting beta₂-antagonist that is to be taken every day.
• • IpratropiumIpratropium is a cholinergic antagonist that should be taken every day.
• • BudesonideBudesonide is an inhaled corticosteroid that is to be taken every day.
• Correct
  • LevalbuterolLevalbuterol is a short-acting beta₂-antagonist that is given with the onset of an asthma attack.

Question 13 of 17

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In which order would the nurse instruct a patient to use a metered-dose inhaler with a spacer?

1. Insert the mouthpiece of the inhaler into the non-mouthpiece end of the spacer.
2. Shake the whole unit vigorously 3 or 4 times.
3. Exhale, place the mouthpiece into the mouth, seal the lips, and press down firmly on the inhaler to release one dose into the spacer.
4. Breathe in slowly and deeply.
5. Remove the mouthpiece from the mouth, keep the lips closed, and hold the breath for 10 seconds before exhaling slowly.
6. Wait at least 1 minute before repeating.

When using a metered-dose inhaler with a spacer, the patient should be instructed to insert the mouthpiece of the inhaler into the non-mouthpiece end of the spacer; shake the whole unit vigorously 3 or 4 times; fully exhale and then place the mouthpiece into the mouth and seal the lips around it; press down firmly on the inhaler to release 1 dose of the drug into the spacer; breathe in deeply and slowly; remove the mouthpiece and keep the lips closed; hold the breath for at least 10 seconds before exhaling slowly; and wait at least 1 minute before taking another puff.

Question 14 of 17

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Which instruction would the nurse include when teaching a patient about the administration of a dry-powder inhaler for the treatment of asthma? Select all that apply. One, some, or all responses may be correct.

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  • “Breathe in forcefully.”When using a dry-powder inhaler, the patient should be instructed to breathe in forcefully. The patient’s breath pulls the drug in.
• • “Rinse the inhaler in water.”The inhaler should never be washed or placed in water.
• • “Shake the inhaler before using it.”The inhaler should never be shaken.
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  • “Exhale fully away from the inhaler.”The patient should be instructed to exhale fully after taking the inhaler out of the mouth because the breath will moisten the powder and cause it to clump.
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  • “Place the lips over the mouthpiece.”The patient should be instructed to place the mouthpiece in the mouth and close the lips over the mouthpiece.
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  • “Remove the inhaler from the mouth before exhaling.”The patient should be instructed to remove the inhaler from the mouth before exhaling.

Question 15 of 17

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Which information would the nurse provide when asked to explain the purpose of an inhaled corticosteroid in the treatment of asthma?

• • Has systemic effectsAn inhaled corticosteroid is limited to the respiratory tract.
• • Is used as a rescue drugInhaled corticosteroids are not used as rescue drugs for asthma.
• • Serves as a bronchodilatorInhaled corticosteroids do not cause bronchodilation.
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  • Prevents the release of histamineInhaled corticosteroids prevent mast cells from releasing histamine, which is a mediator of inflammation.

Question 16 of 17

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Which instruction would the nurse include when teaching a patient about the administration of an inhaled corticosteroid for the treatment of asthma? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Rinse the mouth after each use.”The mouth should be rinsed after each use to minimize the development of oral fungal infections.
• Correct
  • “Use the inhaler daily as prescribed.”The medication should be used daily as prescribed, even when no symptoms are present.
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  • “Do not use to treat an acute asthma attack.”The medication is not a bronchodilator and would not be helpful during an acute asthma attack.
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  • “Use the metered-dose inhaler to take this medication.”The medication should be used with a metered-dose inhaler or a dry-powder inhaler.
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  • “Report any development of white patches in the mouth.”The health care provider should be notified if white patches develop in the mouth, as this could indicate the development of a fungal infection.

Question 17 of 17

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Which question would the nurse ask a patient who reports the development of white patches in the mouth from using an inhaled corticosteroid?

• • “Are you using the inhaler every day?”The inhaler should be used every day. This question will not help determine the reason for the development of white patches in the patient’s mouth.
• • “Are you experiencing any constipation?”Constipation is a potential adverse effect from the use of a cholinergic antagonist and not an inhaled corticosteroid.
• Correct
  • “Are you rinsing your mouth after each use?”The patient should be instructed to rinse the mouth after each use of the inhaler to minimize the development of a fungal infection.
• • “Are you limiting the use to acute asthma attacks?”Inhaled corticosteroids are not bronchodilators and will not be effective in the event of an acute asthma attack.