Chapter 8: Respiratory Medications Answer Key V2

8.9 Beta-2 Adrenergic Agonists – Answer Key

1. Answers:
   1. Audible wheezes, wheezes upon auscultation, low oxygen saturations, tachycardia. Client may appear distressed and anxious.
   2. Shake inhaler before administering. Do four shots into the air away from the client’s face to prime the inhaler.
   3. When the amount of salbutamol is too high, it binds with beta-1 receptors, leading to tachycardia, shaky, anxiety and nausea. These effects are transient. The client should not be taking their salbutamol inhaler more than 2x/week as a rescue inhaler. If they are, they need to go back to their prescriber as their controller meds may need to be adjusted.
2. Answers:
   1. Correct: Use SABA with acute bronchospasm or prior to exercise induced bronchospasm. Use a spacer to improve the med reaching the lungs.
   2. Incorrect: This is partially correct, take before exercise, but only 15 minutes prior.
   3. Correct: yes, beta 2 adrenergic meds can cause temporary tachycardia and tremor.
   4. If a client becomes pregnant, discuss with prescriber if salbutamol is the best choice. Benefit will outweigh risk.
3. Answer: False: salmeterol is a long-acting beta-2 adrenergic agonist. It is not a rescue med but used as part of the long-term management of asthma or COPD.

8.12 Leukotriene Receptor Antagonists V2 – Answer Key

1. Answers:

1. 1. Incorrect: This med is not a rescue or reliever med. Only a beta 2 adrenergic medication, such as salbutamol, should be used for acute bronchospasm.
   2. Correct: there is a risk of neurological changes such as depression, increased risk of suicidal thoughts, aggression and nightmares. Report any behaviour changes to the health care team.
   3. Correct: This med can be taken with or without food. If using granules, ingest package as soon as possible after opening.
   4. Correct: only take the med as prescribed. Never double up medications due to risk of overdose or adverse effects.
2. Answer – False:  Montelukast is an oral medication.  For inhaled respiratory medications, follow the instructions as outlined by the health care providers and product instructions.

8.14 Clinical Reasoning and Decision Making Learning Activities – Answer Key

Asthma Scenario

1. The correct answer is c) Albuterol.  Albuterol is a Beta-2 agonist that relaxes smooth muscle to cause bronchodilation and assist the client with the work of breathing.  It is a rapid-acting bronchodilator that is used during asthma attacks.
2. The nurse should instruct the client to take the following steps to safely administer albuterol:

• Insert the inhaler into the spacer and shake the canister
• Breathe out all the way
• Press down on the inhaler and breathe in slowly through the mouth
• Breathe in for 10 seconds or as long as you can tolerate
• Remove the inhaler from the mouth
• Wait 30 seconds between doses

3. After administering the medication, the nurse should assess the client’s vital signs and lung sounds, paying special attention to the respiratory rate, pulse oximetry, and heart rate for signs of improvement, as well as for potential side effects such as tachycardia.
4. The nurse should educate the client regarding the correct method to administer albuterol, potential side effects, and the signs and symptoms of an asthma exacerbation.  The nurse should ensure the client has a written copy of their asthma action plan and verify that the client can explain the plan to ensure proper understanding. The nurse should also explain the importance of always having albuterol on hand and to help the client make plans for refills so as to not run out of medication.
5. To ensure correct use of the inhaler, the nurse should ask the client to provide a return demonstration. You can review additional information about asthma in the “Conditions and Diseases relate to Gas Exchange” section and albuterol in the “Beta-2 Agonist” section of this chapter.
6. Allergy Scenario: The correct answer is b) Epinephrine.  Epinephrine is used to rapidly treat severe allergic reactions.

Review questions  

3. 3. 1. Answer C. Take the medication regularly, even when symptoms are not present.
      2. Answer A. Monitor for blood levels to avoid toxicity.

You can review additional information about epinephrine and the use of Epi-Pens in the “Alpha and Beta Receptor Agonists (Catecholamines)” section of the “Autonomic Nervous System” chapter.