Topic 6 Respiratory System PDF

Performance Exit Topic 6 Respiratory System Due Jun 16, 2024 by 11:59 pm Final Score 20% 7 out of 35 questions answered correctly Completed on Jun 16...

Performance Exit Topic 6 Respiratory System Due Jun 16, 2024 by 11:59 pm Final Score 20% 7 out of 35 questions answered correctly Completed on Jun 16, 2024 10:04 pm Incorrect (28) Report content error Which assessment finding in the patient’s chart demonstrates to the nurse that albuterol administration was effective? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Clear lung sounds No evidence of side effects Albuterol level > 20 mcg/mL Ambulating three times a day Free from cardiac dysrhythmias Rationale After administration of a bronchodilator, such as albuterol, the nurse would evaluate data in the patient’s chart to determine drug effectiveness. The patient would be free of wheezing, without increased work of breathing. The patient would also be unharmed from any side effects of the drug. The nurse would evaluate the patient’s tolerance to activity; the ability to ambulate multiple times per day would indicate that the patient is tolerating activity well. The patient being free from cardiac dysrhythmias, including tachycardia, would indicate that the patient is unharmed from any potential side effects of the drug. Albuterol levels would not be measured to determine the efficacy of the drug therapy. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes. p. 475  Report content error Which data, when trended by the nurse from the first visit to today’s, demonstrates that the patient’s bronchodilator for chronic obstructive pulmonary disease (COPD) is effective? FEV1 Activity  Heart rate Theophylline level Rationale Patients with COPD usually have a decrease in forced expiratory volume. Bronchodilators increase the FEV1, the index used to evaluate asthma and obstructive lung disease as well as the patient’s response to bronchodilator therapy. Tolerance to activity should increase if bronchodilators are effective, allowing for easier breathing. In this case, the patient’s activity level declined, as the patient was once ambulating but is now using a wheelchair. An increase in heart rate is a side effect of bronchodilators for which the nurse would monitor; however, it does not indicate drug effectiveness. Theophylline levels should be monitored and should remain within the therapeutic range. The therapeutic range for adults is 5 to 15 mcg/mL; theophylline levels of more than 20 mcg/mL indicate toxicity, which is occurring in this case. p. 478 Report content error Which drug disrupts the inflammatory response and is indicated for the treatment of asthma? Salmeterol Ipratropium  Montelukast Theophylline Rationale Montelukast is a leukotriene receptor antagonist indicated for the treatment of asthma, and it is effective in reducing the inflammatory symptoms of asthma triggered by allergic and environmental stimuli. Salmeterol causes bronchodilation and plays a small or no role in the inflammatory response. Ipratropium is the oldest and most commonly used anticholinergic drug used in the treatment of chronic obstructive pulmonary disorder. Theophylline is a xanthine derivative that causes bronchodilation by increasing the levels of the energy-producing substance cyclic adenosine monophosphate. p. 480 Report content error Which patient teaching would the nurse include regarding the safe use of tiotropium in a patient with bronchospasm associated with chronic obstructive pulmonary disorder? “Be sure to avoid eating chocolates.” “You should increase your fluid intake.” “This medication should be taken in the evening.”  “Wash the HandiHaler with warm water and dry before use.” Rationale Tiotropium is an anticholinergic drug administered by inhalation using only the HandiHaler device, which is a dry-powder capsule inhaler. This device should be washed with warm water and dried before use. Thus the nurse would instruct the patient to wash the HandiHaler with warm water and dry it before use. Theophyllines have diuretic properties, so chocolate must be avoided when taking theophyllines, as chocolate contains caffeine. However, this is not a concern with tiotropium. Fluid intake is increased during treatment with xanthenes, such as theophylline, not tiotropium, because xanthenes have a diuretic effect. Leukotriene receptor antagonists, not tiotropium, should be used in the evening for maximum effectiveness. p. 476 Report content error Which over-the-counter drug categories are available for the treatment of cough? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Analgesics Antitussives  Expectorants Antimicrobials Antihistamines Rationale The drugs available for cough are made up of one or more categories of drugs such as antitussives (relief from cough), antihistamines (treat runny nose), and expectorants (loosen chest congestion). These drugs are used to treat the symptoms associated with cough. Analgesics are used for pain relief. Antimicrobials are not used to treat cough; they are used to treat infections. p. 464 Report content error Which condition is considered to be an adverse reaction of albuterol? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Chest pain Skin rashes Tachycardia Palpitations  Hypoglycemia Rationale Albuterol is used for the treatment of asthma. If albuterol is used in larger or more frequent doses, dose-related adverse reactions may be seen. These effects may develop as the drug loses its beta2-specific actions. Chest pain, tachycardia, and palpitations are potential adverse reactions of albuterol. The drug does not affect skin integrity; therefore it does not cause skin rashes. Albuterol may cause hyperglycemia, not hypoglycemia. p. 475 Report content error Which adverse drug effect is the nurse alert for in an older adult patient taking diphenhydramine? Insomnia Hay fever Hypertension Urinary retention Rationale The most common adverse effects with diphenhydramine include sedation and anticholinergic effects, including dry mouth, urinary retention, and constipation. Insomnia is an adverse effect of adrenergic drugs. Hay fever is a symptom of allergic rhinitis and not a side effect of diphenhydramine. Hypertension is a side effect of excessive dosages of topically applied adrenergic nasal decongestants. p. 465 Report content error Which statement contains the most important information to share with a patient receiving diphenhydramine? 'Do not drive after taking this drug.' 'Take this drug on an empty stomach.' 'Do not take this drug for more than 2 days.' 'Make sure you drink a lot of liquids while on this drug.' Rationale Traditional antihistamines cause drowsiness; therefore the patient should not drive after taking diphenhydramine. Diphenhydramine is ideally administered with food, not on an empty stomach, to minimize gastrointestinal distress. There is no evidence to indicate that the patient should limit the time frame for administration of diphenhydramine or to force fluids while receiving therapy. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 465 Report content error Which assessment question would the nurse ask before administering an albuterol inhaler to a patient with asthma? “Do you have an allergy to milk?” “Do you have an autoimmune disorder?” “When was the last time you ate or drank?” “Have you ever taken this medication before?” Rationale A contraindication to albuteroluse is milk protein hypersensitivity or allergy, as some asthma inhalers contain lactose. Autoimmune disorders are not a concern with albuterol administration. The time at which the patient last ate or drank is not relevant to albuterol administration. A patient can take albuterol whether the patient has taken it before or not. p. 475  Report content error Which information would the nurse include when instructing a patient on how to address a common side effect of antitussives? Take acetaminophen or ibuprofen. Avoid operating heavy machinery. Monitor blood pressure every day. Increase fluid intake to eight glasses a day. Rationale One of the most common side effects of antitussives is drowsiness; therefore patients should avoid driving or operating heavy machinery. Taking acetaminophen or ibuprofen may help with the symptoms of sinusitis or acute pharyngitis, but it does not address any side effects of antitussives. Monitoring blood pressure while taking antitussives is not necessary. Although increasing fluid intake can assist with the loosening of secretions, it does not relate to any side effects of antitussives. p. 469  Report content error Which instruction will a nurse provide a patient receiving dextromethorphan for cough to ensure safe administration? 'Use a humidifier while sleeping.' 'Elevate your bed while sleeping.' 'Increase your fluid intake to 3000 mL per day.' 'Restrict activities that require mental alertness.' Rationale Dextromethorphan is a nonopioid antitussive drug that may also cause sedation, drowsiness, or dizziness. The nurse would advise the patient to avoid activities that require mental alertness. It helps prevent injury to the patient. Use of a humidifier helps maintain hydration levels but does not reduce the risk for injury to the patient. Elevating one's head while sleeping helps with lung expansion and promotes breathing. Fluid intake should be increased when decongestants are administered, because fluids help liquefy secretions and make them easier to cough up. p. 468 Report content error Which is the correct mechanism of action of dextromethorphan? Acts on the medulla to suppress the cough reflex Changes a productive cough into a nonproductive cough Loosens bronchial secretions to be eliminated by coughing Acts in combination with a histamine 1 (H1) antihistamine to decrease rhinitis Rationale Dextromethorphan, an antitussive, acts on the cough-control center in the medulla to suppress the cough reflex. Expectorants change a nonproductive cough to a less frequent, productive cough and also work to loosen bronchial secretions to allow for easier expectoration. Intranasal glucocorticoids act in combination with an H1 antihistamine to decrease symptoms of rhinitis. p. 469 Report content error Which mode of action is associated with the drug tiotropium? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected  Dilates the bronchi Antagonizes acetylcholine action Relaxes the smooth muscles of the bronchi Blocks muscarinic cholinergic receptors Stimulates the central nervous system (CNS) Rationale Tiotropium is classified as an anticholinergic drug. Tiotropium blocks muscarinic cholinergic receptors and antagonizes acetylcholine action by inhibiting the M3 receptor response to acetylcholine, thereby relaxing the smooth muscles of the bronchi. It also dilates the bronchi. Methylxanthine (xanthine) derivatives stimulate the CNS. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. Item writers (those who write the questions) are also aware of this and attempt to avoid offering you such “helpful hints.” p. 476 Report content error Which instruction would the nurse provide to a patient who has been diagnosed with diabetes and is taking a beta2 agonist? “This may cause your blood sugar to be lower.” “This may cause your blood sugar to be higher.” “You may need a lower dose because you have diabetes.” “You may need a higher dose because you have diabetes.” Rationale The beta2 agonists may increase blood glucose levels, so the nurse would inform the diabetic patient of this fact and instruct the patient to closely monitor serum glucose levels. Beta2 agonists do not decrease blood glucose levels in patients with diabetes. The dose of the beta2 agonist is not affected by the patient having diabetes. p. 476 Report content error Which type of drug would be administered first to a patient with a history of asthma presenting to the clinic with acute dyspnea, wheezing, hypercapnia, and hypoxemia? Beta2-adrenergic agonists Glucocorticoids Anticholinergics  Leukotriene modifiers Rationale This patient is experiencing an acute asthmatic attack. The first drug that would be administered is a beta2-adrenergic agonist, and it would be delivered by way of inhalation. Beta2-adrenergic agonists are effective in the relief of acute bronchospasm because they act quickly. Glucocorticoids may be administered in an acute attack but only after the beta2-adrenergic agonists have dilated the bronchioles; however, glucocorticoids are not indicated for rescue therapy. Anticholinergics and leukotriene modifiers are indicated in the maintenance of obstructive respiratory disease. p. 475 Report content error Which rationale explains why a nurse will teach a patient prescribed diphenhydramine to stop drinking alcohol while receiving therapy? Alcohol increases central nervous system depression. Alcohol diminishes the action of diphenhydramine. Alcohol increases diphenhydramine levels in the body. Alcohol and diphenhydramine interaction produce skin rashes. Rationale Diphenhydramine and alcohol show an additive effect and increase central nervous system depression. Therefore the nurse would instruct the patient to stop alcohol consumption to avoid this condition. Alcohol does not diminish the action of diphenhydramine, because they show an additive effect. Alcohol does not inhibit the metabolism of diphenhydramine; therefore it does not increase its level in the body. Alcohol and diphenhydramine coadministration does not produce skin rashes. p. 465 Report content error Which patient condition would be appropriately treated by a prescribed antibiotic? Watery nasal discharge and sneezing Watery eyes and runny or stuffy nose Itchy throat and watery nasal discharge Tenacious, yellow nasal discharge and nasal congestion Rationale A bacterial infection secondary to a cold causes discoloration of the nasal discharge. White blood cells and cellular debris are by-products of the fight against bacterial infection, and they discolor nasal secretions. Therefore the patient with a tenacious, yellow nasal discharge should be treated with an antibiotic. The patient with watery nasal discharge and sneezing has common cold symptoms and does not require treatment with an antibiotic. Likewise, watery eyes and runny or stuffy nose do not indicate a bacterial infection. Itchy throat and watery nasal discharge commonly occur with colds and are not associated with bacterial infections. Test-Taking Tip: White blood cells and cellular debris are by-products of the fight against the bacterial infection. Try to find an option which signifies a characteristic change to the body secretion. p. 464 Report content error Which adverse drug reaction may occur with dextromethorphan hydrobromide? Psychosis Agranulocytosis Hemolytic anemia Hypotension Rationale Psychosis may occur in patients receiving dextromethorphan hydrobromide. Agranulocytosis, hemolytic anemia, and hypotension are not expected adverse reactions associated with dextromethorphan hydrobromide. p. 468 Report content error Which side effect may occur in a patient receiving tiotropium? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Myalgia Insomnia Dry mouth Constipation Hypoglycemia Rationale Tiotropium is an anticholinergic drug that is used in the treatment of chronic obstructive pulmonary disease. The drug may produce side effects such as myalgia, insomnia, dry mouth, and constipation. Hyperglycemia, not hypoglycemia, is an adverse reaction, not side effect, associated with tiotropium. p. 476 Report content error Which action would be most critical for a nurse to take in the case of an asthmatic patient who reports significant shortness of breath? Initiating a rapid response Asking the patient to describe the symptoms Administering a short-acting beta2-adrenergic agonist Administering a long-acting glucocorticoid Rationale In an acute asthma attack, the short-acting beta2-adrenergic agonists are the first line of defense. Thus the most critical action for the nurse to take in this case would be to administer a short-acting beta 2- adrenergic agonist, which would provide immediate relief. Initiating a rapid response would not be necessary, and the patient should not be asked many questions when an asthma attack is occurring. A long- acting glucocorticoid would not be appropriate during an acute asthma attack; this is for preventive maintenance therapy only. Test-Taking Tip: Multiple-choice questions can be challenging because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. p. 475 Report content error Which type of drug will a nurse expect to be included in the treatment plan of a patient who comes to the emergency department with urticaria following contact with shrubs? Antitussive Expectorant Antihistamine Decongestant Rationale Urticaria following contact with shrubs indicates an allergic reaction. All allergic reactions are mediated by histamine. Therefore an antihistamine should be included in the treatment plan. Antitussives are medications that help suppress the cough reflex. Expectorants help in coughing up excessive mucus and clearing the airway. Decongestants usually relieve congestion of the upper and lower respiratory tract. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet). p. 466 Report content error Which assessment is a priority for a nurse administering diphenhydramine to a patient who is also taking narcotics for chronic pain? Heart rate Temperature Blood pressure Respiratory rate Rationale Diphenhydramine can cause central nervous system (CNS) depression if taken with alcohol, narcotics, hypnotics, or barbiturates. Because of the risk for CNS depression, the priority assessment for the nurse would be respiratory rate. Although heart rate, temperature, and blood pressure are also monitored, they are not related to monitoring for CNS depression. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 465 Report content error Which patient assessment finding will cause the nurse to suspect a risk for developing complications if diphenhydramine is administered? Cigarette smoking Narrow-angle glaucoma Chronic productive cough Hypothyroidism Rationale Diphenhydramine is contraindicated for patients with narrow-angle glaucoma, because it has anticholinergic effects in addition to antihistamine activity. Therefore its use may further aggravate the condition. Patients who smoke, have a chronic productive cough, and who have hypothyroidism can expect to safely receive diphenhydramine. p. 464 Report content error Which condition may be caused by exposure to animal dander? Sinusitis Acute rhinitis Allergic rhinitis Acute pharyngitis Rationale Allergic rhinitis is caused by environmental allergens. It may include exposure to pollen or foreign substances, such as animal dander. Inflammation of the mucous membranes of one or more of the maxillary, frontal, ethmoid, or sphenoid sinuses is called sinusitis. Acute rhinitis is not associated with exposure to an allergen. However, manifestations are the same as that of allergic rhinitis. Acute pharyngitis is caused by the virus, beta-hemolytic streptococci (strep throat), or other bacteria. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 463  Report content error Which adverse reaction would the nurse include in patient teaching regarding the use of albuterol? Hypoglycemia Drowsiness Hypotension Tachycardia Rationale Albuterol is a beta-agonist bronchodilator that stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia. Thus the nurse would include tachycardia in patient teaching regarding the use of albuterol. Hypoglycemia, drowsiness, and hypotension are not expected to occur with albuterol therapy. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago was completely forgotten. p. 475 Report content error Which patient condition listed in the medical record would be concerning to the nurse when reviewing the medication reconciliation list and noting a new prescription for tiotropium? Gout Diabetes Hypertension Narrow-angle glaucoma Rationale The nurse would alert the health care provider about a patient with narrow-angle glaucoma who has received a new prescription for tiotropium. This drug could worsen the patient’s glaucoma, and it is to be used with caution in patients with glaucoma. Gout, diabetes, and hypertension are not contraindications or precautions to treatment with tiotropium. p. 476  Report content error Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis? Dryness Drowsiness Palpitations Constipation Rationale H1 antagonists exert anticholinergic effects, including constipation, dry mouth, and blurred vision. The drug’s capacity for drying the mucous membranes makes them useful in treating upper respiratory infections and allergic rhinitis. Drowsiness, palpitations, and constipation are adverse effects of H1, which should be reported immediately to the primary health care provider. p. 464 Report content error Which response would the nurse give to a patient who Which response would the nurse give to a patient who states that an albuterol metered-dose inhaler (MDI) does not seem to provide effective relief? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected “Is the canister empty?” “Show me how you use your MDI.” “You probably need a different prescription.” “Do you have a spacer attached to your device?” “How often do you use the medication?” Rationale If the beta2 agonist is given by MDI or dry-powder inhaler (DPI), correct use of the inhaler and dosage intervals need to be explained to the patient. If the patient does not receive effective relief from the inhaler, either the canister is empty or the technique is faulty. A spacer device may be attached to the inhaler to improve drug delivery to the lung with less deposition in the mouth. Excessive use of the aerosol drug can lead to tolerance and loss of drug effectiveness. Telling the patient that the patient probably needs a different prescription is outside the nurse’s scope of practice. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, look at all of  the choices and select the one that most nearly matches the answer that you recalled. It is important that you consider all of the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all of the choices, you are not maximizing your chances of correctly answering each question. p. 482 Correct (7) Report content error Which antihistamine drug is most likely to cause significant drowsiness? Cetirizine Loratadine Fexofenadine Diphenhydramine Rationale Diphenhydramine is a first-generation antihistamine. Its use may cause drowsiness, dizziness, and sedation. Because of its sedating effects, diphenhydramine may be used as a sleep aid. Cetirizine, loratadine, and fexofenadine are second-generation antihistamines, which are also known as nonsedating antihistamines. Therefore cetirizine, loratadine, and fexofenadine are less likely to cause drowsiness. However, cetirizine is more sedating than the other two drugs. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 464 Report content error Which drug can be recommended to a patient for the treatment of the common cold? Antibiotic Antihistamine Opioid antitussive Intranasal glucocorticoid Rationale An antihistamine can be recommended to a patient for the treatment of the common cold. An antihistamine decreases nasopharyngeal secretions by blocking histamine receptors, providing relief. Antibiotics are prescribed for bacterial infections, not viruses. An opioid antitussive is used to treat cough and pain. An intranasal glucocorticoid is used to treat allergic rhinitis. p. 465 Report content error If a patient has been prescribed diphenhydramine, which patient parameter will require the nurse to contact the health care provider? Background Watery and slightly red eyes, watery nasal discharge, frequent sneezing, ear fullness, nasal congestion, and mild fever (100°F) Diagnosis Allergic rhinitis Clinical Closed-angle glaucoma History Complete Red blood cells: 4×1012 /L Blood White blood cells: 8×109 /L Count Platelets: 200×109 /L Report Hemoglobin: 14 g/dL Other Labs Serum creatinine: 1.1 mg/dL Platelet count Closed-angle glaucoma  Serum creatinine White blood cell (WBC) count Rationale Diphenhydramine is contradicted in patients with closed-angle glaucoma. The nurse would immediately report this to health care provider and instead of it, a safer medicine should be prescribed. A value of 200×109 /L falls under the normal range of platelets. Also, 8×109 /L falls under the normal range of WBC count. Hence there is no requirement of reporting a CBC report and clinical history of the patient. The patient's serum creatinine level is normal and is not a concern with diphenhydramine therapy. p. 465 Report content error Which drug is most appropriate for a patient experiencing an acute asthma attack? Albuterol Epinephrine Tiotropium Theophylline Rationale Albuterol is the first choice for treating a patient experiencing an acute asthma attack. Albuterol promotes cyclic adenosine monophosphate (cAMP) production and enhances bronchodilation. Epinephrine is a nonselective sympathomimetic that is used for acute bronchospasm caused by anaphylaxis from an allergic reaction. It is used in emergency situations to restore circulation and increase airway patency. Tiotropium is an anticholinergic drug used for maintenance therapy of chronic asthma and treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). Theophylline is used for maintenance therapy in patients with chronic stable asthma and other COPD conditions when other drugs have failed to show improvement. p. 475 Report content error Which instruction would the nurse include when teaching a patient about the proper use of metered-dose inhalers? “After you inhale the medication once, repeat until you obtain relief.” “Make sure that you puff out air repeatedly after you inhale the drug.” “Hold your breath for a few seconds, if you can, after you inhale the drug.” “Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler.” Rationale Holding the breath for a few seconds following inhalation with a metered-dose inhaler allows the drug to be absorbed in the bronchial tree rather than be immediately exhaled. Thus the nurse would instruct the patient to hold the breath for a few seconds after inhaling the drug. The patient would not be instructed to repeat the dose of the drug until relief is obtained, as the patient could overdose. The patient would not be taught to puff out air repeatedly, as the patient’s breath must be held to ensure absorption. The inhaler would not be held in the mouth while taking a deep breath. Instead, the patient would breathe out through the mouth, then take a slow, deep breath in through the mouth; at the same time, the inhaler would be compressed. p. 482 Report content error Which respiratory disorder may contribute to wheezing? Asthma Emphysema Bronchiectasis Chronic bronchitis Rationale Asthma is an inflammatory disorder associated with the airway walls, and it is characterized by bronchospasm, wheezing, mucus secretions, and dyspnea. Emphysema and bronchiectasis may include all of the same symptoms except wheezing. Likewise, the symptoms of chronic bronchitis do not include wheezing. Test-Taking Tip: Read the question carefully before looking at the answers. First, determine what the question is really asking and look for keywords. Second, read each answer thoroughly and see if it completely covers the material asked by the question. Third, narrow the choices by immediately eliminating answers that you know are incorrect. p. 473 Report content error The health care provider recommends using a metered- dose inhaler for delivering albuterol. Place in the correct order the steps the patient will use with a metered-dose inhaler. 1. Shake the inhaler well. 2. Removal of the cap from the mouthpiece.  3. Breathe out through the oral passage. 4. Inhale and press the canister once. Rationale The patient should first shake the inhaler well and then detach the cap from the mouthpiece. The patient should then keep the mouthpiece of the inhaler in the mouth. First, one should breathe out through the mouth and then slowly inhale deeply through the mouth. The patient should press the top of the medication canister at the same time. For a few seconds, the patient should hold the breath, and then slowly breathe out through pursed lips. p. 482