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Chapter 25: Lower Respiratory Disorder Drugs

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Chapter 25: Lower Respiratory Disorder Drugs

14 problems · 0 figures

Case Study 25.1.1 §25.1 source ↗

Read the following clinical scenario to answer the questions that follow. This case study will evolve throughout the chapter.

Harold Watson is a 65-year-old client who presents to his primary care physician with complaints of worsening shortness of breath, chronic cough, and increased sputum production over the past few months. He reports that these symptoms have significantly impacted his daily activities, and he has also noticed a decrease in his ability to perform simple tasks around the house. Harold reports that he quit smoking 10 years ago but was a heavy smoker for 30 years. He reports smoking roughly one pack of cigarettes per day when he was smoking.

History
Hypertension

Current Medications
Metoprolol 100 mg daily

Based on the assessment of Harold, what diagnosis should the nurse anticipate from the health care provider?
  1. a.
    Elevated blood pressure
  2. b.
    COPD
  3. c.
    Allergic reaction
  4. d.
    Bronchospasm
Table 25.7 in the book ↗
Vital Signs Physical Examination
Temperature: 98.7°F

• Head, eyes, ears, nose, throat (HEENT): Denies any changes in vision. No difficulty hearing.

• Cardiovascular: S1, S2 noted. Denies chest pain. Capillary refill less than 3 seconds.

• Respiratory: Decreased breath sounds in the lower lung fields, prolonged expiration and mild wheezing.

• GI: Abdomen soft, nontender, nondistended; bowel sounds present in all four quadrants.

• GU: Denies difficulty with urination.

• Neurological: Alert and oriented ×4. Denies any dizziness, numbness, or tingling in extremities.

• Integumentary: No wounds noted.
Blood pressure: 145/90 mm Hg
Heart rate: 92 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 91% on room air
Height: 5'6"
Weight: 175 lb

Answer

B. COPD
Based on Harold’s smoking history, decreased breath sounds, prolonged expiration, and mild wheezing, the nurse should anticipate a diagnosis of COPD.

Case Study 25.1.2 §25.1 source ↗

Table 25.7 in the book ↗
Vital Signs Physical Examination
Temperature: 98.7°F

• Head, eyes, ears, nose, throat (HEENT): Denies any changes in vision. No difficulty hearing.

• Cardiovascular: S1, S2 noted. Denies chest pain. Capillary refill less than 3 seconds.

• Respiratory: Decreased breath sounds in the lower lung fields, prolonged expiration and mild wheezing.

• GI: Abdomen soft, nontender, nondistended; bowel sounds present in all four quadrants.

• GU: Denies difficulty with urination.

• Neurological: Alert and oriented ×4. Denies any dizziness, numbness, or tingling in extremities.

• Integumentary: No wounds noted.
Blood pressure: 145/90 mm Hg
Heart rate: 92 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 91% on room air
Height: 5'6"
Weight: 175 lb

Read the following clinical scenario to answer the questions that follow. This case study will evolve throughout the chapter.

Harold Watson is a 65-year-old client who presents to his primary care physician with complaints of worsening shortness of breath, chronic cough, and increased sputum production over the past few months. He reports that these symptoms have significantly impacted his daily activities, and he has also noticed a decrease in his ability to perform simple tasks around the house. Harold reports that he quit smoking 10 years ago but was a heavy smoker for 30 years. He reports smoking roughly one pack of cigarettes per day when he was smoking.

History
Hypertension

Current Medications
Metoprolol 100 mg daily

Based on Harold’s past medical history of chronic obstructive pulmonary disease (COPD) and the physical examination, which of the following medications would be the highest priority to administer to him?
  1. a.
    Salmeterol
  2. b.
    Ipratropium bromide
  3. c.
    Tiotropium
  4. d.
    Ephedrine

Answer

A. Salmeterol
Beta-adrenergic agonists, such as salmeterol, are often used as part of long-term management for COPD. They provide bronchodilation and help improve airflow by relaxing the airway smooth muscles.

Case Study 25.2.3 §25.2 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Harold Watson’s health care provider calls him at home to discuss the results of his x-ray. The provider confirms the diagnosis of COPD and discusses a treatment plan with Harold. Part of the plan is a prescription for a beclomethasone inhaler.

Harold asks the provider how beclomethasone will help his COPD. Which response by the provider is accurate?
  1. a.
    “It will reduce the inflammation in your airways.”
  2. b.
    “This medication should be used only when you have trouble breathing.”
  3. c.
    “You can stop using this medication when you feel better.”
  4. d.
    “This medication will reverse the damage to your lungs.”

Answer

A. “It will reduce the inflammation in your airways.”
Corticosteroids like beclomethasone work to reduce and prevent inflammation in the airways.

Case Study 25.2.4 §25.2 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Harold Watson’s health care provider calls him at home to discuss the results of his x-ray. The provider confirms the diagnosis of COPD and discusses a treatment plan with Harold. Part of the plan is a prescription for a beclomethasone inhaler.

The provider educates Harold to rinse his mouth after using the inhaler. Why does he need to rinse his mouth?
  1. a.
    To help avoid allergic reaction
  2. b.
    To get rid of the taste
  3. c.
    To help the medication absorb
  4. d.
    To help prevent candidiasis

Answer

D. To help prevent candidiasis
Corticosteroids can cause the adverse reaction of candidiasis. Rinsing the mouth helps to prevent candidiasis.

25-1 §25.RQ source ↗

A nurse is caring for a client with acute bronchospasm. The health care provider orders albuterol, a short-acting beta-2 adrenergic agonist. What is the most appropriate rationale for administering albuterol to the client?
  1. a.
    To reduce airway inflammation
  2. b.
    To stimulate cholinergic receptors
  3. c.
    To induce bronchodilation
  4. d.
    To suppress the immune response

Answer

C. To induce bronchodilation
Albuterol is a short-acting beta-agonist that works by stimulating beta-2 adrenergic receptors in the airway smooth muscles.

25-2 §25.RQ source ↗

A client is ordered 60 mg of prednisone daily to be taken in three divided doses. How much will the client take for each dose?
  1. a.
    20 mg
  2. b.
    15 mg
  3. c.
    30 mg
  4. d.
    10 mg

Answer

A. 20 mg
60 ÷ 3 = 20.

25-3 §25.RQ source ↗

A nurse is reviewing the medication regimen of a client with asthma. The client is prescribed theophylline, a xanthine derivative. The nurse understands that theophylline is primarily used for what particular purpose?
  1. a.
    Acute relief of bronchospasm
  2. b.
    Prevention of exercise-induced asthma
  3. c.
    Long-term control of asthma symptoms
  4. d.
    Reduction of airway inflammation

Answer

C. Long-term control of asthma symptoms
Theophylline is a xanthine derivative medication used for long-term control of asthma symptoms.

25-4 §25.RQ source ↗

A nurse is caring for a client with COPD who is prescribed ipratropium bromide, a respiratory anticholinergic medication. What is the most appropriate rationale for administering ipratropium bromide to the client?
  1. a.
    To reduce airway inflammation
  2. b.
    To stimulate cholinergic receptors
  3. c.
    To induce bronchodilation
  4. d.
    To suppress the immune response

Answer

C. To induce bronchodilation
Ipratropium bromide is a respiratory anticholinergic medication that acts by blocking the action of acetylcholine, a neurotransmitter that causes bronchoconstriction. By blocking acetylcholine, ipratropium bromide helps to relax the smooth muscles in the airways, leading to bronchodilation and improved airflow.

25-5 §25.RQ source ↗

The loading dose of theophylline is 4.6 mg/kg. The client for whom it is prescribed weighs 121 pounds. How much will the nurse give for the loading dose?
  1. a.
    125 mg
  2. b.
    155 mg
  3. c.
    250 mg
  4. d.
    253 mg

Answer

D. 253 mg
First the nurse needs to determine the client’s weight in kilograms: 121 l b ÷ 2.2 k g = 55 k g . 55 k g × 4.6 m g / k g = 253 m g .

25-6 §25.RQ source ↗

A nurse is providing education to a client prescribed montelukast, a leukotriene modifier, for the management of asthma. The nurse informs the client about potential side effects of this medication. Which side effect should the nurse include in the client education?
  1. a.
    Dry mouth and blurred vision
  2. b.
    Increased heart rate and palpitations
  3. c.
    Headache and dizziness
  4. d.
    Excessive drowsiness and sedation

Answer

C. Headache and dizziness
The most commonly reported side effects of montelukast include headache and dizziness.

25-7 §25.RQ source ↗

A nurse is assessing a client who has been prescribed a respiratory anticholinergic medication. What medical history would be a concern for this nurse when administering the anticholinergic medication?
  1. a.
    History of hypertension
  2. b.
    History of osteoarthritis
  3. c.
    History of migraines
  4. d.
    History of urinary retention

Answer

D. History of urinary retention
Respiratory anticholinergic medications have the potential to worsen urinary retention due to their ability to relax smooth muscles, including those in the urinary tract.

25-8 §25.RQ source ↗

A nurse is educating a client who has been taking methylprednisolone for an extended period. The nurse emphasizes the importance of gradually tapering the medication instead of abruptly stopping it. Which risk is the nurse concerned about?
  1. a.
    Allergic reactions
  2. b.
    Gastrointestinal bleeding
  3. c.
    Adrenal insufficiency
  4. d.
    Neurological impairment

Answer

C. Adrenal insufficiency
Abruptly stopping methylprednisolone, a corticosteroid medication, can lead to adrenal insufficiency. Long-term use of corticosteroids suppresses the adrenal glands, causing them to produce less cortisol. When the medication is abruptly discontinued, the adrenal glands may not be able to produce enough cortisol on their own, leading to adrenal insufficiency.

25-9 §25.RQ source ↗

A nurse is providing education to a client who has been prescribed salmeterol, a long-acting beta-2 adrenergic agonist. The nurse instructs the client on the proper use of the medication. Which of the following statements by the client indicates a need for further education?
  1. a.
    “I should use salmeterol for quick relief during an asthma attack.”
  2. b.
    “I will rinse my mouth after using the inhaler to prevent throat irritation.”
  3. c.
    “Salmeterol is a long-acting medication that helps prevent asthma symptoms.”
  4. d.
    “I should not exceed the prescribed dosage of salmeterol in a 24-hour period.”

Answer

A. “I should use salmeterol for quick relief during an asthma attack.”
Salmeterol is a long-acting beta-agonist that is not intended for quick relief during an asthma attack.

25-10 §25.RQ source ↗

A nurse is caring for a client who has been prescribed tiotropium, an anticholinergic medication used to manage COPD. The nurse provides education to the client regarding the medication. Which of the following statements made by the client indicates an understanding of tiotropium?
  1. a.
    “This medication will help reduce airway inflammation.”
  2. b.
    “I should take this medication during an acute COPD exacerbation.”
  3. c.
    “Tiotropium works by relaxing the muscles in my airways.”
  4. d.
    “I can take an extra dose of tiotropium if I experience worsening symptoms.”

Answer

C. “Tiotropium works by relaxing the muscles in my airways.”
Tiotropium is an anticholinergic medication that works by blocking the action of acetylcholine, a neurotransmitter that causes bronchoconstriction. By blocking acetylcholine, tiotropium helps to relax the smooth muscles in the airways, leading to bronchodilation and improved airflow.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.