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  • August 11, 2024
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  • 2024/2025
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  • chapter 36 lower respiratory disorders

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STUVIA 2024/2025
Chapter 36: Lower Respiratory Disorders
The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching
about the disease and medications for treatment. Which statement by the patient indicates
understanding of the medication regimen?
a. "I should use albuterol when my symptoms worsen."
b. "I will need to take oral prednisone on a daily basis."
c. "My provider will frequently prescribe prophylactic antibiotics."
d. "My symptoms are reversible with proper medications." - ✔✔ANS: A

Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute
flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of
adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic
resistance. Symptoms of emphysema are not reversible.

The nurse is preparing to administer epinephrine to a patient who is experiencing an acute
bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and
beta-adrenergic agonist, the patient will experience which effects?
a. Decreased blood pressure
b. Anticholinergic effects
%


c. A shorter duration of therapeutic effects
d. Cardiac and pulmonary effects - ✔✔ANS: D

Nonselective sympathomimetic epinephrine is an alpha1, beta1, and beta2 agonist that is given to
promote bronchodilation and elevate blood pressure. It does not have anticholinergic effects.

A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What
information will the nurse include when teaching this patient about this medication?
a. Failure to respond to the medication indicates a need for a higher dose.
b. Monitor for hypoglycemia symptoms when using this medication.
c. Palpitations are common with this drug even at normal, therapeutic doses.
d. Overuse of this medication can result in airway narrowing and bronchospasm. - ✔✔ANS: D

Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so
patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of
drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm
and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can
occur. Palpitations are common with increased doses but not at therapeutic doses.




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, STUVIA 2024/2025
A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled
glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about
disease and medication management, the nurse will instruct the patient to administer these
medications in which order?
a. Albuterol, ipratropium bromide, steroid
b. Albuterol, steroid, ipratropium bromide
c. Ipratropium bromide, albuterol, steroid
d. Steroid, ipratropium bromide, albuterol - ✔✔ANS: A

Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium
bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This
helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for
improved effect.

A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has
chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is
prescribed primarily for which reason?
a. To be more convenient for patients who require both medications
b. To improve compliance in patients who may forget to take both drugs
c. To increase forced expiratory volume, an indicator of symptom improvement
%

d. To minimize the side effects that would occur if the drugs are given separately - ✔✔ANS: C

Combivent is more effective and has a longer duration of action than if either agent is used alone, and
the two agents combined increase the forced expiratory volume in 1 second (FEV1). While it is more
convenient and may improve compliance, this is not the primary reason for using it. The combination
does not alter the drug's side effects.

The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged
home from the hospital. What information will the nurse include when teaching the patient about this
drug?
a. An extra dose should be taken when symptoms worsen.
b. Anorexia and gastrointestinal upset are unexpected side effects.
c. Avoid caffeine while taking this medication.
d. Food will decrease the amount of drug absorbed. - ✔✔ANS: C

Caffeine and theophylline are both xanthine derivatives and should not be taken together because of
the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range
and must be dosed carefully; patients should never increase or decrease the dose without consulting
their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does
not prevent the full dose from being absorbed.


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