TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 76-80
Chapter 76: Drugs for Asthma
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. a chlorofluorocarbon (CFC) propellant is superior to a hydrofluoroalkane (HFA)
propellant.
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 2 puffs are needed, an interval of at least 1 minute should separate the first puff
from the second. CFC propellants will be discontinued because of damage to the
environment. The patient should begin inhaling and then activate the device. There is
no need to store the drug in the refrigerator.
DIF: Cognitive Level: Application REF: Administering Drugs by Inhalation
| Metered-Dose Inhalers TOP: Nursing Process: Planning MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
2. A patient newly diagnosed with asthma 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.
DIF: Cognitive Level: Application REF: Overview of Drugs for Asthma
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 gargling after each dose of the glucocorticoid.
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.
DIF: Cognitive Level: Application REF: Anti-Inflammatory Drugs |
Glucocorticoids | Adverse Effects | Inhaled Glucocorticoids 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.
DIF: Cognitive Level: Application REF: Drugs for Acute Severe
Exacerbations TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
5. A parent asks a nurse about growth suppression resulting from the use of an inhaled
, glucocorticoid in children. What will the nurse tell the parent?
a. Growth may be slowed, but eventual adult height will not be reduced.
b. The growth rate is not impaired, but overall height will be reduced.
c. The growth rate slows while the drug is used but resumes when the drug is
stopped.
d. Long-term use of the drug results in a decrease in adult height.
ANS: A
Glucocorticoids can slow growth in children and adolescents, but they do not reduce
the eventual adult height. The growth rate will return to normal within a year, even
when the drug is continued. Long-term use does not affect the eventual adult height.
DIF: Cognitive Level: Application REF: Anti-Inflammatory Drugs |
Glucocorticoids | Adverse Effects | Inhaled Glucocorticoids TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The
nurse will teach this patient about the importance of which action?
a. Lowering her calcium intake and increasing her vitamin D intake
b. Participating in weight-bearing exercises on a regular basis
c. Taking oral glucocorticoids during times of acute stress
d. Using two reliable forms of birth control to prevent pregnancy
ANS: B
Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in
premenopausal women. Patients should be encouraged to participate in weight-
bearing exercises to help minimize this side effect. Patients should increase both their
calcium and vitamin D intakes. Patients taking oral glucocorticoids need increased
steroids in times of stress. It is not necessary to use two reliable forms of birth control.
DIF: Cognitive Level: Application REF: Anti-Inflammatory Drugs |
Glucocorticoids | Adverse Effects | Inhaled Glucocorticoids TOP:
Nursing Process: Planning MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
7. A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI
as needed. The provider has added montelukast (Singulair) to the child’s regimen. Which
statement by the child’s parent indicates understanding of this medication?
a. “I may notice mood changes in my child.”
b. “I should give this medication twice daily.”
c. “I will give my child one 4-mg chewable tablet daily.”
d. “This drug can alleviate symptoms during an acute attack.”
ANS: A
Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent
, inflammation. Some patients have reported mood changes when taking this drug, so
parents should be warned of this effect. The medication is given once daily. The dose
for a 7-year-old child is 5 mg daily. The drug does not treat symptoms of an acute
attack.
DIF: Cognitive Level: Application REF: Montelukast TOP: Nursing
Process: Planning MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
8. A nurse is teaching a group of nursing students about the different formulations of beta2-
adrenergic agonist medications. Which statement by a student indicates understanding of
the teaching?
a. “Beta2-adrenergic agonists provide quick relief via any formulation.”
b. “Long-acting beta2 agonists may be used alone to prevent attacks.”
c. “Short-acting beta2 agonists are usually given by nebulizer.”
d. “Oral beta2 agonists are not useful for short-term treatment.”
ANS: D
Oral beta2 agonists are used only for long-term control. All formulations vary; long-
acting beta2 agonists (LABAs) and oral preparations are used for long-term control,
whereas short-acting beta2 agonists (SABAs) are useful for acute episodes. LABAs
are used in conjunction with inhaled glucocorticoids to prevent attacks. SABAs may
be given by MDI or nebulizer and usually are given by MDI.
DIF: Cognitive Level: Application REF: Bronchodilators | Beta2-
Adrenergic Agonists | Classification by Route and Time Course | Use in
Asthma TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
9. A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The
patient uses an inhaled glucocorticoid, montelukast (Singulair), and a SABA via MDI.
The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a
heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates
mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do?
a. Contact the provider to request a systemic glucocorticoid.
b. Contact the provider to suggest using a long-acting beta2 agonist.
c. Evaluate the need for teaching about MDI use.
d. Question the patient about how much albuterol has been used.
ANS: D
To determine the next course of action, it is important to assess the drugs given before
these symptoms were observed. Patients who continue to wheeze after using a SABA
need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used,
that will be the first intervention. LABAs are not used for exacerbations. If a patient
reports using a SABA without good results, evaluating the MDI technique may be
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