A patient with asthma is starting montelukast. Which patient statement shows correct understanding of the drug?
"I will keep taking it every day, even when I have no symptoms."
✓
"I will take an extra tablet when I start to wheeze."
"I can stop it as soon as my breathing feels normal."
"I will use it in place of my rescue inhaler during an attack."
Correct Answer
"I will keep taking it every day, even when I have no symptoms."
Montelukast is a long-term controller that reduces airway inflammation and bronchoconstriction over time, so it is taken daily whether or not symptoms are present. Taking an extra tablet when wheezing starts does not stop an attack, because the drug does not act quickly. Stopping it once breathing feels normal lets inflammation and symptoms return. Using it in place of a rescue inhaler is unsafe, because a short-acting bronchodilator is needed for an acute attack.
Category: Leukotriene Modifiers
Question 2
For a patient with asthma, salmeterol must always be used together with which type of drug?
A leukotriene modifier
An inhaled corticosteroid
✓
An oral xanthine
A mast cell stabilizer
Correct Answer
An inhaled corticosteroid
Current labeling contraindicates using a long-acting beta-2 agonist such as salmeterol without an inhaled corticosteroid in asthma, because the bronchodilator alone does not treat the underlying airway inflammation and has been linked to serious asthma events. A leukotriene modifier is an add-on controller but does not meet this requirement. An oral xanthine is a separate bronchodilator option, not the required partner. A mast cell stabilizer is a preventive drug that is not the required pairing either.
Category: Beta-2 Agonists
Question 3
Repeated high doses of albuterol can lower the blood level of which electrolyte?
Sodium
Calcium
Potassium
✓
Chloride
Correct Answer
Potassium
Beta-2 stimulation drives potassium from the blood into cells, so frequent or high doses of albuterol can cause hypokalemia, which may contribute to dysrhythmias. Sodium levels are not lowered by this mechanism. Calcium is not shifted into cells by beta-2 agonists. Chloride is not a recognized electrolyte effect of albuterol.
Category: Beta-2 Agonists
Question 4
Which assessment finding shows that a dose of inhaled albuterol has been effective?
A faster heart rate
A fine tremor of the hands
A lower blood pressure
Less wheezing and easier breathing
✓
Correct Answer
Less wheezing and easier breathing
Albuterol relaxes bronchial smooth muscle, so the therapeutic response is reduced wheezing, less work of breathing and better oxygenation. A faster heart rate is an adverse effect, not a sign that the drug worked. A fine tremor of the hands is also a common adverse effect. A lower blood pressure is not the goal of bronchodilator therapy.
Category: Beta-2 Agonists
Question 5
Using inhaled ipratropium together with which drug can add to anticholinergic adverse effects such as urinary retention?
Oxybutynin
✓
Acetaminophen
Amoxicillin
Lisinopril
Correct Answer
Oxybutynin
Oxybutynin is an anticholinergic drug for overactive bladder, and combining it with ipratropium can add to effects such as dry mouth, constipation and urinary retention, so labeling advises avoiding the combination. Acetaminophen has no anticholinergic action. Amoxicillin does not add to these effects. Lisinopril is an ACE inhibitor without anticholinergic effects.
Category: Anticholinergic Bronchodilators
Question 6
A patient whose theophylline level has been stable for months quits smoking. What change should the nurse anticipate?
The theophylline level may fall below the effective range
The theophylline level may rise toward toxicity
✓
The theophylline level will not change
Theophylline will stop working until smoking resumes
Correct Answer
The theophylline level may rise toward toxicity
Tobacco smoke induces the liver enzymes that break down theophylline, so after a patient stops smoking the drug is cleared more slowly and its level can climb into the toxic range; the provider may need to lower the dose. A fall below the effective range is what happens when a patient starts smoking. Saying the level will not change ignores this well-known interaction. Theophylline does not stop working after smoking cessation; it accumulates instead.
Category: Xanthines
Question 7
Which antibiotic can raise theophylline levels into the toxic range when the two are taken together?
Amoxicillin
Cephalexin
Ciprofloxacin
✓
Nitrofurantoin
Correct Answer
Ciprofloxacin
Ciprofloxacin inhibits the liver enzymes that metabolize theophylline, so levels can rise and cause seizures or dysrhythmias; theophylline levels are watched closely or another antibiotic is chosen. Amoxicillin does not meaningfully change theophylline metabolism. Cephalexin is not known for this interaction. Nitrofurantoin also does not raise theophylline levels.
Category: Xanthines
Question 8
A patient taking theophylline reports nausea, vomiting, restlessness and a racing heartbeat. What should the nurse suspect first?
An expected therapeutic effect
An allergic reaction
Undertreated asthma
Drug toxicity
✓
Correct Answer
Drug toxicity
Nausea, vomiting, restlessness and tachycardia are classic signs of theophylline toxicity, so the nurse holds the next dose, notifies the provider and expects a serum level to be drawn. These findings are not an expected therapeutic effect, which is easier breathing. An allergic reaction would typically involve hives, swelling or wheezing. Undertreated asthma causes respiratory symptoms, not vomiting and restlessness.
Category: Xanthines
Question 9
A patient taking theophylline drinks several cups of coffee and an energy drink every day. What should the nurse teach?
Limit caffeine, because it adds to the drug's stimulant adverse effects
✓
Take each dose with coffee to improve absorption
Caffeine is safe because it lowers the theophylline level
Stop theophylline on days when caffeine is consumed
Correct Answer
Limit caffeine, because it adds to the drug's stimulant adverse effects
Caffeine is also a xanthine, so it adds to theophylline's nervousness, restlessness, tachycardia and other stimulant effects and can push the patient toward toxicity. Taking each dose with coffee to improve absorption is wrong, because coffee does not improve absorption and adds stimulation. Saying caffeine is safe because it lowers the theophylline level is wrong, because caffeine can raise the level rather than lower it. Stopping theophylline on days when caffeine is consumed would leave the airways unprotected; the patient limits caffeine instead.
Category: Xanthines
Question 10
Before and during zileuton therapy, the nurse should monitor which laboratory tests?
Kidney function tests
Liver function tests
✓
Thyroid function tests
Serum lipid levels
Correct Answer
Liver function tests
Zileuton can injure the liver, so liver enzymes are checked before treatment and periodically during it, and the drug is avoided in active liver disease. Kidney function tests are not the required monitoring for this drug. Thyroid function tests are not affected by zileuton. Serum lipid levels are not a monitoring concern with leukotriene modifiers.
Category: Leukotriene Modifiers
Question 11
A parent reports that a teenager taking montelukast has become agitated and has talked about wanting to die. How should the nurse interpret this report?
Normal mood changes of adolescence
A sign that the dose is too low
A serious neuropsychiatric reaction to the drug
✓
A reaction to a missed dose
Correct Answer
A serious neuropsychiatric reaction to the drug
Montelukast carries a boxed warning for serious neuropsychiatric events, including agitation, aggression, depression and suicidal thinking, so the provider is notified at once and the drug is usually stopped. Dismissing the change as normal adolescent mood swings could miss a dangerous reaction. A low dose does not cause suicidal thinking. A missed dose does not produce these effects either.
Category: Leukotriene Modifiers
Question 12
A patient who takes warfarin is started on zafirlukast. Which finding should the nurse watch for?
A falling serum potassium
A rising blood glucose
A slowing heart rate
A rising INR
✓
Correct Answer
A rising INR
Zafirlukast inhibits the metabolism of warfarin, which raises the prothrombin time and INR and increases bleeding risk, so the INR is monitored closely. A falling serum potassium is not caused by this combination. A rising blood glucose is not a known effect of zafirlukast. A slowing heart rate is not expected from either drug.
Category: Leukotriene Modifiers
Question 13
How does cromolyn reduce asthma symptoms?
It keeps mast cells from releasing histamine and other mediators
✓
It blocks histamine at H1 receptors
It relaxes airway smooth muscle directly
It blocks acetylcholine at muscarinic receptors
Correct Answer
It keeps mast cells from releasing histamine and other mediators
Cromolyn is a mast cell stabilizer: it prevents mast cells from releasing histamine and other inflammatory mediators, so it works only when used before trigger exposure. Blocking histamine at H1 receptors describes antihistamines. Relaxing airway smooth muscle directly describes bronchodilators such as beta-2 agonists and xanthines. Blocking acetylcholine at muscarinic receptors describes anticholinergics such as ipratropium.
Category: Mast Cells and Biologics
Question 14
A patient receives a subcutaneous injection of omalizumab in the clinic. Why is the patient observed for a period afterward?
Severe bradycardia is common
Anaphylaxis can occur after any dose
✓
Blood glucose often drops sharply
Seizures are a frequent reaction
Correct Answer
Anaphylaxis can occur after any dose
Omalizumab carries a boxed warning for anaphylaxis, which can occur after the first dose or after many doses, so treatment is started in a healthcare setting prepared to treat anaphylaxis, patients are observed after injections there, and all patients are taught to recognize the signs. Severe bradycardia is not a typical effect. Sharp drops in blood glucose are not associated with this drug. Seizures are not a frequent reaction.
Category: Mast Cells and Biologics
Question 15
A patient prescribed inhaled cromolyn asks whether it will stop an asthma attack once wheezing starts. What should the nurse explain?
It is the fastest-acting rescue drug for asthma
It works only when taken together with an antibiotic
It helps prevent attacks with regular use but does not relieve one already underway
✓
It should be used only after the rescue inhaler has failed
Correct Answer
It helps prevent attacks with regular use but does not relieve one already underway
Cromolyn stabilizes mast cells before they release their mediators, so it is a preventive drug taken regularly and has no role in relieving acute bronchospasm. Calling it the fastest-acting rescue drug is wrong, because a short-acting beta-2 agonist such as albuterol fills that role. Saying it works only with an antibiotic is wrong, because it has no link to antibiotics. Using it only after the rescue inhaler has failed is wrong, because a patient whose rescue inhaler is not working needs emergency care, not a preventive drug.
Category: Mast Cells and Biologics
Question 16
Which local adverse effect is common with inhaled corticosteroids?
Gum overgrowth
Ringing in the ears
Excess salivation
Hoarseness
✓
Correct Answer
Hoarseness
Corticosteroid deposited on the vocal cords can cause hoarseness, or dysphonia, and drug left in the mouth can lead to oral thrush; using a spacer and rinsing after each dose lower both risks. Gum overgrowth is linked to drugs such as phenytoin. Ringing in the ears is linked to salicylates and some other drugs. Excess salivation is a cholinergic effect, not a steroid effect.
Category: Inhaled Corticosteroids
Question 17
Which eye problems have been reported with long-term use of inhaled corticosteroids?
Cataracts and glaucoma
✓
Conjunctivitis and styes
Night blindness and dry eyes
Retinal tears and floaters
Correct Answer
Cataracts and glaucoma
Long-term inhaled corticosteroid use has been linked to cataracts, increased intraocular pressure and glaucoma, so patients report any change in vision and those with a history of these conditions are monitored closely. Conjunctivitis and styes are eye infections not tied to this drug class. Night blindness and dry eyes are linked to problems such as vitamin A deficiency. Retinal tears and floaters are not a recognized effect of these drugs.
Category: Inhaled Corticosteroids
Question 18
Right after inhaling a puff from a metered-dose inhaler, what should the patient do?
Exhale right away through the mouthpiece
Hold the breath for several seconds, then breathe out slowly
✓
Cough hard to move the drug deeper
Take the next puff immediately without pausing
Correct Answer
Hold the breath for several seconds, then breathe out slowly
Holding the breath briefly after the puff gives the medication time to settle in the airways before the patient breathes out slowly. Exhaling right away through the mouthpiece blows drug back out before it can deposit. Coughing hard does not move the drug deeper and can expel it. Taking the next puff immediately is wrong, because patients are taught to pause between puffs.
Category: Inhaler Technique
Question 19
Why is a spacer recommended for a patient who uses a metered-dose inhaler containing a corticosteroid?
It removes the need to prime the inhaler
It turns the medication into a dry powder
More drug reaches the lungs and less stays in the mouth
✓
It makes the drug act for a longer time
Correct Answer
More drug reaches the lungs and less stays in the mouth
A spacer holds the released puff so the patient can inhale it slowly, which improves delivery to the lungs, helps patients who have trouble coordinating the puff with a breath, and lowers the amount deposited in the mouth and throat. A spacer does not remove the need to prime a new inhaler. It does not turn the spray into a dry powder. It does not lengthen the drug's duration of action.
Category: Inhaler Technique
Question 20
A patient with asthma says the albuterol rescue inhaler has been needed much more often than usual lately. How should the nurse interpret this?
The inhaler is working exactly as intended
The patient should switch to salmeterol for attacks
The patient needs a different brand of albuterol
Asthma control is worsening and the provider should be told
✓
Correct Answer
Asthma control is worsening and the provider should be told
Increasing use of a rescue inhaler is a key sign that asthma is poorly controlled, so the provider should reassess the controller regimen and the asthma action plan. Frequent rescue use does not mean the inhaler is working as intended. Salmeterol is a long-acting drug that must never be used to treat an attack. A different brand of albuterol would not address worsening inflammation.
Category: Beta-2 Agonists