There is no such thing as a safe drug. All drugs have the ability to cause injury.

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1 Pulmonary System 4 There is no such thing as a safe drug. All drugs have the ability to cause injury. Richard A. Lehne PRACTICE QUESTIONS A Client with an Upper Respiratory Infection 1. The client diagnosed with arterial hypertension develops a cold. Which information regarding over-the-counter medications should the nurse teach? 1. Try to find a medication that will not cause drowsiness. 2. Over-the-counter medications are not as effective as a prescription. 3. Over-the-counter medications are more expensive than prescriptions. 4. Do not take over-the-counter medication unless approved by the HCP. 2. The client with the flu is prescribed the over-the-counter cough suppressant dextromethorphan. Which information should the nurse teach regarding this medication? 1. Take the medication every 4 8 hours as needed for cough. 2. The medication can cause addiction if taken too long. 3. Do not drive or operate machinery while taking the drug. 4. Do not take a beta blocker while taking this medication. 3. The HCP prescribed amoxicillin/clavulanate (Augmentin), an antibiotic, for a client diagnosed with chronic obstructive pulmonary disease (COPD) who has a cold. Which intervention should the nurse implement? 1. Discuss the prescription with the HCP because antibiotics do not help viral infections. 2. Teach the client to take all the antibiotics as ordered. 3. Encourage the client to seek a second opinion before taking the medication. 4. Ask the client if he or she is allergic to sulfa drugs or shellfish. 4. The female client asks the nurse why her teenage child would have many boxes of Sudafed, an over-the-counter cold and allergy medication, in her room. Which would be the nurse s first response? 1. Has your child always had allergy problems? 2. Teenagers will try to take care of their own health problems. 3. Has the teenager s behavior at school or at home changed recently? 4. Remove the medication and say nothing to the teenager about it. 5. The client with the flu has been taking acetylcysteine (Mucomyst), a mucolytic. Which adverse effect would the nurse assess for? 1. Bronchospasm. 2. Nausea. 3. Fever. 4. Drowsiness. 77

2 78 PHARMACOLOGY SUCCESS 6. Which over-the-counter herb should the nurse recommend for a client with a cold who has mild hypertension? 1. Crataegus laevigata, hawthorn. 2. Zingiber officinale, ginger. 3. Allium sativum, garlic. 4. Hydrastis canadensis, goldenseal. 7. The client who has been using oxymetazoline (Afrin) nasal spray for several weeks complains to the nurse that the spray no longer seems to work to clear the nasal passages. Which information should the nurse teach? 1. Increase the amount of sprays used until the desired effect has been reached. 2. This type of medication can cause rebound congestion if used too long. 3. Alternate the Afrin with a saline nasal spray every 2 hours. 4. Place the Afrin nasal spray in a vaporizer at night for the best results. 8. Which is the scientific theory for prescribing zinc preparations for a client with a cold? 1. Zinc binds with the viral particle and reduces the symptoms of a cold. 2. Zinc decreases the immune system s response to a virus. 3. Zinc activates viral receptors in the body s immune system. 4. Zinc blocks the virus from binding to the epithelial cells of the nose. 9. The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication? 1. Teach the client to monitor the bowel movements for constipation. 2. Driving or operating machinery is all right while taking this medication. 3. This medication usually causes insomnia, so plan for rest periods. 4. This medication is more effective when taken with a mucolytic. 10. The nurse on a medical unit is administering 0900 medications. Which medication should the nurse question administering? 1. Acetylcysteine (Mucomyst), a mucolytic, to a client who is coughing forcefully. 2. Cefazolin (Ancef), an antibiotic, IVPB to a client diagnosed with the flu. 3. Diphenhydramine (Benadryl), an antihistamine, to a client who is congested. 4. Dextromethorphan (Robitussin), an antitussive, to a client who has pneumonia. A Client with Lower Respiratory Infection 11. The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating rusty-colored sputum. Which medication would the nurse anticipate the HCP prescribing? 1. Prednisone, a glucocorticoid. 2. Habitrol, a transdermal nicotine system. 3. Dextromethorphan (Robitussin), an antitussive. 4. Ceftriaxone (Rocephin), a cephalosporin. 12. The female client is being admitted to a medical unit with a diagnosis of pneumonia. Which intervention would the nurse implement? Rank in order of implementation. 1. Start an intravenous access line. 2. Administer the IVPB antibiotic. 3. Teach to notify the nurse of any vaginal itching. 4. Obtain sputum and blood cultures. 5. Place an identity band on the client. 13. The client diagnosed with emphysema is admitted to the surgical unit for a cholecystectomy (gallbladder removal). Which postoperative intervention should the nurse implement? 1. Have the patient turn, cough, and breathe deeply every shift. 2. Administer oxygen to the client at 4 L/min. 3. Assess the surgical site for delayed healing. 4. Medicate frequently with morphine 15 mg IVP.

3 14. The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client s prescription for prednisone, a glucocorticoid? 1. Take all the prednisone as ordered until the prescription is empty. 2. Take the prednisone on an empty stomach with a full glass of water. 3. Stop taking the prednisone if a noticeable weight gain occurs. 4. The medication should never be abruptly discontinued. 15. The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first? 1. Prednisone, a glucocorticoid, for a client diagnosed with chronic bronchitis. 2. Oxygen via nasal cannula at 2 L/min for a client diagnosed with pneumonia. 3. Lactic acidophilus (Lactinex) to a client receiving IVPB antibiotics. 4. Cephalexin (Keflex), an antibiotic, to a client being discharged. 16. The client diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed morphine sulfate (MS Contin). Which statement is the scientific rationale for prescribing this medication? 1. MS Contin will depress the respiratory drive. 2. Morphine dilates the bronchi and improves breathing. 3. MS Contin is not addicting, so it can be given routinely. 4. Morphine causes bronchoconstriction and decreased sputum. 17. The client diagnosed with adult respiratory distress syndrome (ARDS) has been found to have a disease-causing organism resistant to the antibiotics being given. Which intervention should the nurse implement? 1. Monitor for therapeutic blood levels of the aminoglycoside antibiotic prescribed. 2. Prepare to administer the glucocorticoid medication ordered intramuscularly. 3. Obtain an order for repeat cultures to confirm the identity of the resistant organism. 4. Place the client on airborne isolation precautions. 18. The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor? 1. The white blood cell (WBC) count. 2. The hemoglobin and hematocrit. 3. The blood glucose level. 4. The BUN and creatinine. 19. Which data would indicate that the antibiotic therapy has not been successful for a client diagnosed with a bacterial pneumonia? 1. The client s hematocrit is 45%. 2. The client is expectorating thick, green sputum. 3. The client s lung sounds are clear to auscultation. 4. The client has no complaints of pleuritic chest pain. 20. The nurse is preparing to administer an IVPB antibiotic to a client diagnosed with pneumonia; 10 ml of the medication is mixed in 100 ml of saline. At what rate would the nurse set the pump to infuse the medication in 30 minutes? Answer A Client with Reactive Airway Disease CHAPTER 4 PULMONARY SYSTEM Which information should the nurse discuss with the client diagnosed with reactive airway disease who is prescribed theophylline (Slo-Phyllin), a xanthine bronchodilator? 1. Instruct the client to take the medication on an empty stomach. 2. Explain that an increased heart rate and irritability are expected side effects. 3. Discuss the need to avoid large amounts of caffeine-containing drinks. 4. Tell the client to double the next dose if a dose is missed.

4 80 PHARMACOLOGY SUCCESS 22. The client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast (Singulair). Which statement by the client would warrant intervention by the nurse? 1. I have been having a lot of headaches lately. 2. I have started taking an aspirin every day. 3. I keep this medication up on a very high shelf. 4. I must protect this medication from extreme temperatures. 23. The client with reactive airway disease is taking the oral sympathomimetic bronchodilator metaproterenol (Alupent) three times a day. Which intervention should the nurse implement? 1. Instruct the client to take the last dose a few hours before bedtime. 2. Teach the client to decrease the fluid intake when taking this medication. 3. Have the client demonstrate the correct way to use the inhaler. 4. Encourage the client to take the medication with an antacid. 24. The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective? 1. The client holds his or her breath for 5 seconds and then exhales forcefully. 2. The client states the canister is full when it is lying on top of the water. 3. The client exhales and then squeezes the canister as the next inspiration occurs. 4. The client connects the oxygen tubing to the inhaler before administering the dose. 25. The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client s serum theophylline level is 28 g/ml. Which action should the nurse implement first? 1. Continue to monitor the aminophylline drip. 2. Assess the client for nausea and restlessness. 3. Discontinue the aminophylline drip. 4. Notify the health-care provider immediately. 26. Which assessment data best indicates the client with reactive airway disease has good control with the medication regimen? 1. The client s peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. 2. The client s lung sounds are clear bilaterally, both anterior and posterior. 3. The client has only had three acute exacerbations of asthma in the last month. 4. The client s monthly serum theophylline level is 18 g/ml. 27. The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works? 1. Nebulizers are small, handheld pressurized devices that deliver a measured dose of an antiasthma drug with activation. 2. A nebulizer is an inhaler that delivers an antiasthma drug in the form of a dry, micronized power directly to the lungs. 3. A nebulizer is a small machine used to convert an antiasthma drug solution into a mist that is delivered though a mouthpiece. 4. Nebulizers are small devices that are used to crush glucocorticoids so that the client can place them under the tongue for better absorption. 28. Which information should the nurse teach the client who is prescribed a glucocorticoid inhaler? 1. Advise the client to gargle after each administration. 2. Instruct the client to use the inhaler on a PRN basis. 3. Encourage the client not to use a spacer when using the inhaler. 4. Teach the client to check his or her forced expiratory volume daily.

5 CHAPTER 4 PULMONARY SYSTEM The 28-year-old female client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast sodium (Singulair). Which statement by the client indicates the client teaching is effective? 1. I will not drink coffee, tea, or any type of cola drinks. 2. I will take this medication at the beginning of an asthma attack. 3. It is all right to take this medication if I am trying to get pregnant. 4. I should not decrease the dose or suddenly stop taking this medication. 30. Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma? 1. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication. 2. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustainedrelief theophylline. 3. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments. 4. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed. A Child with Reactive Airway Disease 31. The 8-year-old male child diagnosed with reactive airway disease is prescribed a cromolyn (Intal) inhaler. The child shares with the nurse that he wants to play baseball but can t because of his asthma. Which intervention should the nurse discuss with the child and parents? 1. Instruct the child to take the medication as soon as shortness of breath starts. 2. Teach the child to take a puff of the cromolyn inhaler 15 minutes before playing ball. 3. Encourage the child to play another sport that does not require running outside. 4. Inform the parents to notify the pediatrician if the child complains of a yellow haze. 32. The 6-year-old child is experiencing an acute exacerbation of reactive airway disease. The child passed out, and the parents brought the child to the emergency department. Which intervention should the nurse implement first? 1. Administer subcutaneous epinephrine via a tuberculin syringe. 2. Administer a beta 2 -adrenergic agonist, albuterol (Ventolin), via nebulizer. 3. Administer intravenous methylprednisolone, a glucocorticoid. 4. Administer oxygen to maintain oxygen saturation above 95%. 33. The clinic nurse is teaching the parent of a child with reactive airway disease about nebulizer treatments. Which statement indicates the teaching has been effective? 1. I will use half the medication in the nebulizer at each treatment. 2. The nebulizer treatment will take about 30 minutes or longer. 3. I will use a disinfectant solution weekly when cleaning the nebulizer. 4. I will rinse the nebulizer in clean water after each breathing treatment. 34. The child with an acute asthma attack is prescribed a 7-day course of the systemic corticosteroid prednisolone. The mother asks the nurse, Doesn t this medication cause serious side effects? Which statement is the nurse s best response? 1. Yes, this medication does have serious side effects, but your child needs the medication. 2. The doctor would not have ordered a medication that has serious side effects. 3. A short-term course of steroids will not cause serious side effects. 4. There may be serious side effects if your child takes the medication for a long time.

6 82 PHARMACOLOGY SUCCESS 35. The child diagnosed with reactive airway disease is prescribed a cromolyn inhaler. The mother asks the nurse to explain how this medication helps control her child s asthma. Which statement is the best explanation to give to the mother? 1. This medication diminishes the mediator action of leukotrienes. 2. This medication blocks the release of mast cell mediators. 3. This medication causes relaxation of the bronchial smooth muscle. 4. This medication decreases bronchial airway inflammation. 36. Which statement indicates to the nurse that the 13-year-old child understands the zone system for monitoring the treatment of asthma? 1. When I am in the green zone, it means good control and I do not need any medication. 2. If I am in the black zone, it means I should go to the emergency department. 3. If I am in the red zone, it means I should take my cromolyn and steroid inhaler. 4. The yellow zone means I tell my mom so she can give me a nebulizer treatment. 37. The pediatric nurse is caring for a 7-year-old child with chronic reactive airway disease who is being discharged. The nurse must evaluate the breathing capacity of the child to determine the effectiveness of the medication regimen. Which interventions should the nurse implement when using the peak flow meter? Select all that apply. 1. Instruct the child to lie down in the bed in the supine position. 2. Tell the child to seal the lips tightly around the mouthpiece. 3. Note the number on the scale after the client gives a sharp, short breath. 4. Blow into the peak flow meter one time and obtain the results. 5. Move the pointer on the peak flow meter to zero. 38. The 10-year-old child is being prescribed a cromolyn inhaler. Which statement indicates the child needs more teaching concerning the cromolyn inhaler? 1. If I cannot take a deep breath, I will not use my cromolyn inhaler. 2. I should not exhale into my inhaler after I have finished taking a puff. 3. I should wait at least 1 hour to rinse my mouth after taking my inhaler. 4. I should not stop taking my inhaler because I might have an asthma attack. 39. The nurse is teaching the mother of a 9-year-old child with severe reactive airway disease. The child is prescribed theophylline (Bronkodyl) 100 mg po every 12 hours. Which instructions should the nurse include when discussing the medication with the mother? 1. Instruct the mother to perform and record a daily theophylline level. 2. Inform the mother to notify the HCP if the child vomits or becomes irritable. 3. Tell the mother to give the medication at 8:00 A.M. and 8:00 P.M. 4. Recommend that the medication be refrigerated at all times. 40. The health-care provider has ordered theophylline 5 mg/kg/q 6 hrs for a child who weighs 35 lbs. How much medication would the nurse administer in each dose? Answer A Client with Pulmonary Embolus 41. The client diagnosed with rule-out deep vein thrombosis (DVT) is experiencing dyspnea and chest pain on inspiration. On assessment, the nurse finds a respiratory rate of 40. Which medication should the nurse anticipate the health-care provider ordering? 1. Warfarin (Coumadin), an oral anticoagulant. 2. Enoxaparin (Lovenox), a low molecular weight heparin. 3. Heparin, an intravenous anticoagulant. 4. Ticlopidine (Ticlid), an antiplatelet medication.

7 42. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client s current laboratory values are as follows: PT 22 PT 39 Control 12.9 Control 36 INR 2.6 Which action should the nurse implement? 1. Question administering the medication. 2. Prepare to administer AquaMEPHYTON (vitamin K). 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered. 43. The HCP has ordered streptokinase (Streptase), a thrombolytic, intravenously for the client diagnosed with a pulmonary embolus. The client has intravenous heparin infusing at 1600 units per hour via a 20-gauge angiocath. Which intervention should the nurse implement? 1. Administer the streptokinase via a Y-tubing. 2. Start a second intravenous site to infuse the streptokinase. 3. Discontinue the heparin and infuse streptokinase via the 20-gauge angiocath. 4. Piggyback the streptokinase through the heparin line at the port closest to the client. 44. The client diagnosed with a massive pulmonary embolus is ordered the thrombolytic streptokinase. The nurse notes on the Medication Administration Record that the client is allergic to the -mycin medications, including streptomycin. Which action should the nurse implement? 1. Call the HCP to report the allergy. 2. Administer the medication as ordered. 3. Call the pharmacist to substitute medication. 4. Check the bleeding-time laboratory values. 45. The nurse is discharging the female client diagnosed with a pulmonary embolus (PE) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client understands the medication teaching? 1. I should use a straight razor when I shave my legs. 2. I will use a hard-bristled toothbrush to clean my teeth. 3. An occasional nosebleed is common with this drug. 4. It will be important for me to have regular bloodwork done. 46. The client diagnosed with a pulmonary embolus (PE) is receiving intravenous heparin, and the HCP prescribes 5 mg warfarin (Coumadin) orally once a day. Which statement best explains the scientific rationale for prescribing these two anticoagulants? 1. Coumadin interferes with production of prothrombin. 2. It takes 3 5 days to achieve a therapeutic level of Coumadin. 3. Heparin is more effective when administered with warfarin. 4. Coumadin potentiates the therapeutic action of heparin. CHAPTER 4 PULMONARY SYSTEM The nurse is administering alteplase (Activase), a thrombolytic, to a client diagnosed with massive pulmonary emboli (PE). Which data indicates the medication is effective? 1. The client s PTT level is within therapeutic range. 2. The client is able to ambulate to the bathroom. 3. The client denies chest pain on inspiration. 4. The client s chest x-ray is normal.

8 84 PHARMACOLOGY SUCCESS 48. The nurse is preparing to hang the next bag of heparin. The client s current laboratory values are as follows: PT 13.4 PTT 92 Control 12.9 Control 36 INR 1 Which intervention should the nurse implement first? 1. Discontinue the heparin infusion. 2. Prepare to administer protamine sulfate. 3. Notify the health-care provider. 4. Assess the client for bleeding. 49. The client is receiving an intravenous infusion of heparin. The bag hanging has 25,000 units of heparin in 500 ml of D 5 W at 14 ml per hour via an intravenous pump. How many units of heparin is the client receiving every hour? Answer 50. The client is receiving an intravenous infusion of heparin. The bag hanging has 40,000 units of heparin in 500 ml of D 5 W. The HCP has ordered the medication to be delivered at 1200 units per hour. At what rate would the nurse set the intravenous pump? Answer