Chapter 37: Bronchodilators

1. The nurse evaluates a theophylline level of 14 mcg/mL as

A) subtherapeutic.
B) therapeutic.
C) toxic.
D) life-threatening.

The therapeutic theopylline level is 10 to 20 mcg/mL.

2. Discharge teaching to a patient receiving a beta-agonist bronchodilator should

emphasize reporting which side effect?

A) Tachycardia
B) Nonproductive cough
C) Hypoglycemia
D) Sedation

A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic

nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and
increased alertness.

3. Which over-the-counter product, when taken with theophylline, can decrease

theophylline’s serum drug levels?

A) Caffeine
B) Diphenhydramine
C) St. John’s wort
D) Echinacea

St. John’s wort has been shown to enhance the rate of theophylline metabolism, thus
decreasing serum levels.

4. Nonselective adrenergic agonist bronchodilators should be used cautiously in

patients with

A) coronary artery disease.

B) COPD.
C) hyperkalemia.
D) premature labor.
Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the
heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase
heart rate and contractility, increasing oxygen demand. This increased oxygen
demand may lead to angina or myocardial ischemia in patients with coronary artery
disease.

5. The advantage of salmeterol (Serevent) over other beta2 agonists such as

albuterol (Proventil) is:

A) shorter onset of action.

B) better side effect profile.
C) quicker peak action.
D) longer duration of action.

Salmeterol has a longer duration of action, requiring the patient to use it only twice
a day instead of four times a day with albuterol.

6. Patient teaching regarding the use of antileukotriene drugs such as zafirlukast

(Accolate) should include which statement?

A) “Take the medication as soon as you begin wheezing.”

B) “It will take about 3 weeks before you notice a therapeutic effect.”
C) “This medication works by preventing the inflammation that causes your
asthma attack.”
D) “Increase fiber and fluid in your diet to prevent the common side effect of
constipation.”

Antileukotriene drugs block the inflammatory response of leukotrienes and thus the
trigger for asthma attacks. Response to these drugs is usually noticed within 1 week.
They are not used to treat an acute asthma attack.

7. Which respiratory medication is an antileukotriene drug?

A) Flunisolide (Aerobid)
B) Epinephrine (Adrenalin)
C) Cromolyn sodium (Intal)
D) Montelukast (Singulair)

Montelukast is an antileukotriene drug. Epinephrine is an adrenergic agonist.

Cromolyn is a mast cell stabilizer. Flunisolide is a corticosteroid.
8. Corticosteroids are useful in the treatment of acute respiratory disorders
secondary to their ability to

A) stimulate the immune system.

B) directly dilate the bronchi.
C) increase gas exchange in the alveoli.
D) decrease inflammation.

Corticosteroids suppress the immune system. They do not directly affect

bronchodilation but rather prevent bronchoconstriction as a response to
inflammation.

9. A patient demonstrates understanding of flunisolide (AeroBid) by stating

A) “I will take two puffs to treat an acute asthma attack.”

B) “I will rinse my mouth with water after each use.”
C) “I will immediately stop taking my oral prednisone as soon as I start using the
AeroBid.”
D) “I will not use my albuterol inhaler while I am taking AeroBid.”

Flunisolide is an inhaled corticosteroid. Rinsing the mouth will help prevent oral
candidal infections. It is not used to treat an acute asthma attack and should be
taken with the patient’s bronchodilator medications. If the patient is taking oral
prednisone, it needs to be tapered off in order to prevent acute adrenal crisis since
flunisolide is minimally absorbed systemically.

10. Mast cell stabilizers are most effective in treating bronchoconstriction

associated with which condition?

A) Emphysema
B) Exposure to cold
C) Allergens
D) Infection

Mast cell stabilizers work by preventing the release of chemical mediators that
cause bronchospasm and are most effective in preventing asthma caused by
extrinsic factors such as allergens or exercise.

11.A patient is prescribed albuterol for treatment of an electrolyte imbalance.

Which disorder would the nurse assess this patient for?
A) Hyperkalemia
B) Hypocalcemia
C) Hypernatremia
D) Hyperphosphatemia

Beta2 agonists are thought to stimulate the Na+-K+ adenosinetriphosphatase

(ATPase) ion pump contained within cell membranes. This facilitates a temporary
shift of potassium ions from the bloodstream into the cells, resulting in a temporary
decrease in serum potassium levels. This makes these drugs also useful in treating
patients with acute hyperkalemia.

12. The physician orders ipratropium bromide (Atrovent), albuterol (Proventil),

and beclomethasone (Beclovent) inhalers for your patient. Which action will the
nurse take?

A) Question the order; three inhalers should not be given at one time.
B) Administer the bronchodilator first, wait a few minutes, and then administer
the anticholinergic followed by the corticosteroid several minutes later.
C) Administer each inhaler at 30-minute intervals.
D) Administer the beclomethasone first, followed by ipratropium and albuterol 5
minutes later.

Administering the bronchodilator first allows the other drugs to reach deeper into
the lungs as the bronchioles dilate. Anticholinergics also help bronchodilate but to a
lesser extent. Steroids do not dilate and are therefore given last.

13. Which statement would be included when teaching a patient about the proper
use of metered-dose inhalers?

A) “After you inhale the medication once, repeat until you obtain relief.”
B) “Make sure that you puff out air repeatedly after you inhale the medication.”
C) “Hold your breath for 10 seconds if you can after you inhale the medication.”
D) “Hold the inhaler in your mouth, take a deep breath, and then compress the
inhaler.”

Holding the breath for 10 seconds allows the medication to be absorbed in the
bronchial tree rather than being immediately exhaled.

14. The nurse knows that teaching has been successful if the patient, who is using
the anticholinergic inhaler ipratropium bromide (Atrovent) states

A) “I will increase my intake of caffeine.”

B) “I may gain weight as a result of taking this medication.”
C) “Nausea and vomiting are common adverse effects of this medication, so I will
always take it with meals.”
D) “This inhaler is not to be used alone to treat an acute asthma attack.”

Feedback: INCORRECT
Although ipratropium works to prevent bronchoconstriction and thus secondarily
leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute
asthma attack.

15. Prior to administering an antileukotriene medication, the nurse would assess

the patient for allergies to which substance? (Select all that apply.)

A) lactose
B) povidone
C) cellulose
D) chlorhexedine

Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives is important

to note because these are inactive ingredients in antileukotriene drugs.

16. Which laboratory value should the nurse assess prior to administering
zafirlukast to a patient?

A) Liver enzymes
B) Cardiac enzymes
C) Renal function tests
D) Complete blood count

Since zafirlukast may lead to liver dysfunction, liver enzyme levels should be
monitored regularly, especially early in the course of therapy.