Respiratory Pharmacology Exam

A 68-year-old woman with a history of moderate persistent asthma presents to the emergency department with shortness of breath. She receives a nebulizer treatment with albuterol.
Following the treatment, she informs the nurse that she feels “shaky,” and upon observation, slight tremors of her hands are noted. 
Based on the patient’s presentation and reaction post-nebulizer treatment, which of the following is the most likely explanation?

A 52-year-old male with a history of chronic obstructive pulmonary disease (COPD) is seen in the outpatient clinic. He reports increased breathlessness over the past month. His current medications include an inhaled corticosteroid and a long-acting beta-agonist.
Given the persistent symptoms, the physician considers adding theophylline to his regimen. During counseling about the medication, the patient inquires about the precautions associated with theophylline use.
Which of the following precautions and considerations should be addressed by the nurse when an HCP is prescribing theophylline? Select all that apply

A 38-year-old man, recently diagnosed with asthma, visits a respiratory clinic to understand the proper use of his newly prescribed metered-dose inhaler (MDI) containing a short-term beta agonist. During the session, he notices another patient using a spacer with their inhaler and asks the nurse whether he should be using one as well.
How should the nurse respond?

A 14-year-old girl is seen in a pediatric clinic after being diagnosed with mild persistent asthma. 
Her parents, having done some research on glucocorticoids, share their understanding of the medication with the nurse.
Based on their statements, which comment suggests the parents and their daughter might need more clarification about the inhaled glucocorticoid's side effects and precautions?

Complete the sentences by choosing from the list of options.

A patient with advanced chronic obstructive pulmonary disease (COPD) presenting with symptoms and signs of and   has been prescribed a

The nurse remains attentive to monitor for potential side effects of the medication. Some known side effects include and  

If the patient exhibits any of these manifestations, the nurse should recognize them as possibly being linked to the therapy.

A 3-month-old infant is admitted to the neonatal intensive care unit (NICU) due to respiratory distress. The medical team starts the baby on high-dose oxygen therapy to ensure adequate oxygenation.
The pediatric nurse is discussing the infant's care with a nursing student.
The student is asked to identify the potential complications that might arise from prolonged high-dose oxygen therapy in infants.
What should the student's response be?

A 55-year-old woman is admitted to the respiratory unit with a diagnosis of bronchitis.
Aware of certain contraindications associated with the prescribed medication, the nurse reviews the patient's medical history.
Which of the following two parameters would raise concern when using this medication?

A 29-year-old male has been newly diagnosed with asthma after experiencing recurrent episodes of wheezing and shortness of breath. His primary care provider is starting him on zafirlukast, a leukotriene receptor antagonist (LTRA).
The patient is keen on understanding how the medication works and when he should take it. He also wants to know about any potential side effects.
As the nurse in charge of his education, which of the following two statements would be most appropriate to explain to the patient about his new medication?

A 54-year-old man with a history of chronic bronchitis is being discharged from the hospital. As part of his management plan, he has been prescribed the anticholinergic inhaler ipratropium bromide to help reduce his bronchospasm. The nurse has been educating him about the proper use and expectations of the medication.
At the end of the session, which statement by the patient would indicate to the nurse that he has understood the instructions related to ipratropium bromide?

A client has been taking rifampin and isoniazid for the treatment of active tuberculosis. Which side effects does the nurse anticipate the client may experience while taking the medication? Select all that apply.

A 72-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) has been hospitalized due to an acute exacerbation. As he prepares for discharge, he is provided with prescriptions for both albuterol and salmeterol to manage his COPD symptoms.
During discharge education, the nurse explains the proper use of both inhalers.
When evaluating the patient's understanding of the education, which statement made by the patient suggests a need for further teaching?

A 67-year-old male with a smoking history of 40 pack-years is admitted to the emergency room with exacerbation of chronic respiratory symptoms. His oxygen saturation is 90% on room air, and the resident doctor is considering placing him on supplemental oxygen.
The head nurse is concerned about using a high concentration of oxygen in this patient, given his likely underlying medical condition.

What is the primary reason to avoid high oxygen concentrations in patients like him?

A 38-year-old alcoholic woman has recently been diagnosed with tuberculosis and started on a regimen that includes cycloserine, administered orally twice daily.
At her follow-up appointment a week later, the nurse informed her that she would need to have blood drawn to assess the serum concentration of the medication. The patient appears anxious about the upcoming procedure.
The nurse provides instructions about medication administration in relation to the test.

Which of the following is the most appropriate guidance?

A 45-year-old man with a history of chronic bronchitis has recently been prescribed a methylxanthine bronchodilator to help manage his respiratory symptoms. During the client education session, the nurse discusses potential drug interactions and dietary considerations.

Which of the following beverages would the nurse advise the client to avoid while taking this medication?

A 46-year-old man with a history of asthma presents to the primary care clinic for a routine follow-up. The nurse notes that the patient has been prescribed both pirbuterol and beclomethasone dipropionate via metered-dose inhalers. The patient is unsure about the correct sequence in which to use these medications. The nurse aims to instruct the patient on the best practices to ensure the effectiveness of both drugs.
How should the nurse guide the patient in administering these medications?

A young couple with a 20-month-old toddler visits a community health clinic.
Parents express concern about their child's frequent sneezing and watery eyes, especially after playing outside.
They believe these symptoms might be related to allergies and are considering using an over-the-counter (OTC) allergy medication they saw at the local pharmacy.
As a nurse, you want to provide them with general education on the use of OTC allergy medications for children.

What instructions should be appropriate and which ones not in order to teach the parents?

A 68-year-old female patient is in the intensive care unit following a severe respiratory failure. She is intubated and on mechanical ventilation. The nurse observes a buildup of secretions in the endotracheal (ET) tube and prepares to suction it out. A nursing student is observing the procedure. After the nurse completes the suctioning, the student is asked to describe the correct procedure for suctioning through an endotracheal tube.
Which of the following statements by the nursing student indicates a correct understanding of the procedure?

A 55-year-old woman presents to the outpatient clinic complaining of intermittent sneezing, itchy eyes, and nasal congestion, suggestive of allergic rhinitis. The physician recommends a first-generation H1 antihistamine for symptom relief. The patient is a school bus driver and asks about any potential side effects or precautions she should be aware of, given her profession. The nurse begins counseling her on the implications of taking first-generation H1 antihistamines.
Which statement by the nurse would be most accurate?

A 54-year-old male with a history of chronic bronchitis visits the outpatient clinic for his routine follow-up.
As the nurse is reviewing his medications, the patient is unsure about the timing of administering the two inhalers.
How should the nurse guide the patient in terms of the sequence and timing of using these medications?

A 66-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with worsening cough and shortness of breath. She reports taking multiple over-the-counter medications to manage her persistent cough, including an antitussive containing codeine that she started 2 days ago. The healthcare team is concerned about her use of codeine in the context of her respiratory history.
Why is caution advised when using antitussives with codeine in patients like her, who have respiratory insufficiency?

A 47-year-old female patient with severe persistent asthma not well-controlled on high-dose inhaled corticosteroids and long-acting beta-agonists is started on omalizumab therapy. On her follow-up visit after 3 months of treatment, she reported some new symptoms. The nurse knows that some of these might be potential side effects of omalizumab. Which of the following three symptoms are commonly associated with omalizumab?

A 56-year-old male, admitted to the respiratory ward due to an exacerbation of his chronic obstructive pulmonary disease (COPD), has been receiving theophylline intravenously to help manage his symptoms. The attending pulmonologist has decided to transition the patient to an oral form of the medication and has prescribed an immediate-release version. The nursing team is responsible for ensuring a seamless transition from IV to oral medication.
When should the nurse administer the first dose of the oral theophylline to the patient?

A 32-year-old woman presents to the outpatient clinic with a history of recurrent wheezing, coughing, and shortness of breath, especially during the spring months. She has been diagnosed with allergic asthma and has been prescribed cromolyn sodium as part of her treatment regimen. The nurse, while explaining the mechanism of the medication, mentions its primary therapeutic goal for patients with allergic asthma.

What is the primary goal of administering cromolyn sodium in the management of allergic asthma?

A 42-year-old man is seen at the outpatient pulmonary clinic with symptoms consistent with bronchial asthma. As part of his management, the physician considers prescribing Zafirlukast. The nurse knows that before initiating this medication, a particular laboratory test is often ordered to assess potential risks.
Which of the following laboratory tests is typically ordered before administering Zafirlukast?

A 59-year-old male with a history of moderate to severe plaque psoriasis has been recommended to start monoclonal antibody therapy. During the assessment, the nurse reviews the patient's past medical history. Given the potential risks associated with monoclonal therapy, it's important for the nurse to determine if the patient has a history of any pre-existing infections. Which of the following infections would be a concern prior to initiating monoclonal antibody therapy?

The infections of concern will be and

Mrs. Jenny a 57-year-old female with a history of chronic obstructive pulmonary disease (COPD) has been prescribed revefenacin by her primary care physician. During her nursing consultation, she expresses uncertainty about the medication and asks for further guidance. The nurse decides to highlight the essential precautions associated with revefenacin.
Which of the following precautions should the nurse prioritize when discussing the use of revefenacin with the patient? Select all that apply

A 3-day-old preterm infant is admitted to the neonatal intensive care unit (NICU) with signs of respiratory distress syndrome (RDS). The pediatrician has ordered the administration of poractant alfa as part of the treatment plan. The nurse, aware of the specific considerations associated with the drug, prepares for the administration.
What are the key nursing implications the nurse should consider when administering poractant alfa to this infant? Select all that apply

A 56-year-old woman with a known history of asthma presents to the emergency department after using her prescribed bronchodilator inhaler. Instead of the expected relief, she complains of worsening shortness of breath and tightness in her chest immediately after the inhalation. 

Complete the diagram below by dragging from the choice below what condition the client is most likely experiencing, two actions the nurse would take to address that condition, and two parameters to monitor to assess the client's condition.