Asthma, COPD, TB questions from Leik Flashcards
A 30-year-old chef complains of pruritic hives over her chest and arms, but denies
difficulty swallowing or breathing. She reports a family history of allergic rhinitis and
asthma. Which of the following interventions is most appropriate?
A) Obtain a complete and thorough history
B) Recommend an oral antihistamine such as diphenhydramine 25 mg PO QID
C) Give an injection of epinephrine 1:1000 intramuscularly stat
D) Call 911
A) Obtain a complete and thorough history
Before prescribing medications, a thorough history must be obtained to determine possible causes of hives. The patient denied difficulty with swallowing and breathing, so there was no medical emergency that would require calling 911.
All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except: A) Albuterol inhaler (Proventil) B) Triamcinolone (Azmacort) C) Montelukast (Singulair) D) Cromolyn sodium inhaler (Intal)
A) Albuterol inhaler (Proventil) Albuterol is a short-acting bronchodilator that is used for immediate relief of shortness of breath in patients with asthma. It works by opening the air passages but does not have any steroidal/anti-inflammatory effect such as triamcinolone (Azmacort), nor an effect such as a leukotriene blocker (Singulair).
Steroids and leukotrienes help the inflamed channels to remain open and clear but take longer to get into the system to work.
The following children are considered at higher risk for tuberculosis (TB) except:
A) A child who has recently been diagnosed with leukemia
B) An infant whose family is homeless
C) A child who was born in Japan
D) A Hispanic child with asthma who is using a steroid inhaler
C) A child who was born in Japan Japan is not considered a high-risk country for tuberculosis (TB) infection; other Asian countries, such as India,
Bangladesh, Pakistan, China, and the Philippines, have a higher incidence.
Other high-risk areas are Africa, the Western Pacific, and Europe (Russia).
Additional risk factors for TB are immunocompromised status (HIV, steroid therapy), homelessness, injection drug users, and working or residing with people at high risk for TB.
Which of the following individuals is most likely to be at higher risk for osteoporosis?
A) 70-year-old woman of African ancestry who walks daily for exercise
B) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg
daily for the past 12 years to control her severe asthma
C) 55-year-old Caucasian woman who is an aerobics instructor
D) 45-year-old Asian woman who has been on high-dose steroids for 1 week
B) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the past 12 years to control her severe asthma
Risk factors for osteoporosis include postmenopause, early menopause, use of chronic steroids, smoking, excessive use of alcohol, sedentary lifestyle, insufficient intake of calcium and vitamin D in the diet, and being an Asian or Caucasian female.
An asthmatic exacerbation is characterized by all of the following symptoms except: A) Tachycardia B) Severe wheezing C) Chronic coughing D) Tachypnea
C) Chronic coughing
A patient experiencing respiratory distress from an asthmatic exacerbation presents with tachypnea (>20 breaths/min), tachycardia or bradycardia, cyanosis, and anxiety. The patient appears exhausted, fatigued, and diaphoretic and uses accessory muscles to help with breathing. Physical exam reveals cyanosis and “quiet” lungs with no wheezing or breath sounds audible.
A “chronic” cough is not a symptom of an acute exacerbation but is commonly present in people with asthma Although cough usually accompanies dyspnea and wheezing, it may present in isolation as a precursor of typical asthmatic symptoms, or it may remain the predominant or sole symptom of asthma. Cough-variant asthma is a type of asthma in which the main symptom is a dry, nonproductive cough.
A 10-year-old boy who was recently accepted onto his school’s soccer team has a history of exercise-induced asthma. He wants to know when he should use his
albuterol inhaler. The nurse practitioner would advise the patient to:
A) Premedicate 10 to 15 minutes before starting exercise
B) Wait until he starts to exercise before using the inhaler
C) Premedicate 30 minutes before starting exercise
D) Wait until he finishes his exercise before using his inhaler
A) Premedicate 10 to 15 minutes before starting exercise
Exercise-induced asthma is best controlled by using the Proventil inhaler (bronchodilator) approximately 10 to 15 minutes before exercise, to prevent vasospasm of the
bronchioles and shortness of breath with exercise.
The effects of these bronchodilators usually last approximately 4 hours. They also work quickly to open
up the bronchioles if an acute attack/shortness of breath occurs.
All of the following pharmacological agents are used to treat inflammation in the lungs of asthmatic patients except:
A) Nedocromil sodium (Tilade) two sprays QID
B) Cromolyn sodium inhaler (Intal) two puffs QID
C) Long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours
D) Fluticasone inhaler (Flovent) two puffs BID
C) Long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours
Theophylline is used to control inflammation of the lungs. Nedocromil sodium (Tilade), cromolyn sodium (Intal), and fluticasone inhaler (Flovent) help to treat inflammation.
A 13-year-old boy’s peak expiratory flow results indicate 60% to 80% of the predicted range. How would you classify his asthma?
A) Mild intermittent asthma
B) Mild persistent asthma
C) Moderate persistent asthma
D) Severe asthma
C) Moderate persistent asthma
The Global Initiative for Asthma has four
clinical classifications of severity:
intermittent (normal FEV1 between exacerbations,
FEV1 >80%),
mild persistent (FEV1 >80%),
moderate persistent (FEV1 60%– 80%), and
severe persistent (FEV1 <60%).
Daily symptoms with more than one nighttime episode of symptoms per week, 60% to 80% FEV1, and greater than 30% FEV1 variability and need for short-acting beta-2 agonist for symptom control, are
classified as moderate persistent severity in patients older than 12 years of age.
Pulsus paradoxus is more likely to be associated with \: A) Sarcoidosis B) Acute bronchitis C) Status asthmaticus D) Bacterial pneumonia
C) Status asthmaticus Pulsus paradoxus is most likely to be seen with status asthmaticus.
With inspiration, systolic pressure drops due to the increased pressure (positive pressure). Some pulmonary risks of having increased pressure include
asthma and emphysema. Cardiac causes for pulsus paradoxus include tamponade, pericarditis, and cardiac effusion.
A 70-year-old man with open-angle glaucoma is prescribed Betimol (timolol) ophthalmic drops. All of the following are contraindications to Betimol ophthalmic drops except:
A) Overt heart failure or sinus bradycardia
B) History of asthma
C) Second- or third-degree atrioventricular (AV) block
D) Migraine headaches
D) Migraine headaches Migraines are not a contraindication to Betimol (timolol).
Contraindications include bronchial asthma, asthma history, severe COPD, uncompensated heart failure, second- or third-degree AV block, sinus
bradycardia, and cardiogenic shock.
Caution should be used if the following
conditions are present: closed-angle glaucoma, peripheral vascular disease, bronchospastic disease, diabetes, hyperthyroidism, and myasthenia gravis.
A 40-year-old Black man with asthma and hypertension has been following a lowfat, low-sodium diet and walking three times a week for the past 6 months. His blood pressure readings from the past two visits were 160/95 and 170/100 mmHg. On this visit, it is 160/90. What is the most appropriate action for the nurse practitioner to follow at this visit?
A) Continue the lifestyle modifications and recheck his blood pressure again in 4 weeks
B) Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily
C) Initiate a prescription of atenolol (Tenormin) 25 mg PO daily
D) Refer the patient to a cardiologist for a stress EKG
B) Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily The Eighth Joint National Committee (JNC 8)-recommended pharmacological treatment for Black adult hypertensive patients (without chronic kidney disease or diabetes) is a thiazide-type diuretic or calcium channel blocker (CCB), used alone or
in combination.
For White adults, the JNC 8 recommends a thiazide-type diuretic or angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) or a CCB, used alone or in combination.
Do not combine an ACE inhibitor with an ARB. Although unusual, a serious adverse effect from these two drug classes is angioedema.
Beta-blockers should be avoided in patients with chronic lung disease, such as asthma and chronic obstructive pulmonary disease (COPD),
because they can cause bronchoconstriction.
Peak expiratory flow (PEF) meters are used to monitor asthma by using personal
best measurements. All of the following factors are used to determine the PEF
except:
A) Age
B) Gender
C) Height
D) Weight
D) Weight Peak expiratory flow volume is determined by using height, gender, and age. Weight is not used in the formula.
What is the most powerful known risk factor for the development of active tuberculosis? A) Asthma B) HIV infection C) Chronic obstructive pulmonary disease D) Chronic bronchitis
B) HIV infection HIV is the most powerful known risk factor for the development of active tuberculosis (TB).
All HIV-infected persons should receive TB testing. People living with HIV are 20 to 30 times more likely to develop TB than those without HIV. Treatment of HIV-infected persons with latent TB infection
(LTBI) is a high priority.
A 30-year-old woman with mild persistent asthma and allergic rhinitis is seen in an urgent care clinic for complaints of shortness of breath and wheezing. She
reports using her albuterol inhaler two to three times per day for 4 days the previous week. She reports waking up for 3 nights due to wheezing the past week. She had previously been prescribed low-dose flunisolide (AeroBid), two inhalations twice per
day. Vital signs reveal a temperature of 99.0°F, pulse of 88 beats/min, and respiratory rate of 14 breaths/min. Which of the following actions is the next step?
A) Administer nebulized albuterol treatment
B) Prescribe a Medrol dose pack
C) Use the spirometer to assess severity of symptoms
D) Add a long-acting beta-agonist inhaler
C) Use the spirometer to assess severity of symptoms The patient is having an acute asthmatic exacerbation. The patient’s vital signs reveal a respiratory rate of 14
breaths/min and pulse of 88 beats/min, which are within normal limits (not in respiratory distress).
Before administering nebulized albuterol, use the spirometer to quantify the degree of impairment and listen to the breath sounds. Then after the treatment, recheck spirometry to evaluate the patient’s response.
The nebulizer treatment can be repeated in 20 minutes as needed.
Change the patient’s prescription
to a combination steroid and long-acting beta-agonist inhaler plus a Medrol dose pack.
An asthmatic 20-year-old woman who was seen for a viral upper respiratory infection 2 weeks ago presents to the nurse practitioner’s office complaining of a
recent onset of shortness of breath, inspiratory and expiratory wheezing, and chest tightness. She has been using her albuterol inhaler four to six times a day with poor relief. She is unable to speak in full sentences. When the nurse practitioner quickly
evaluates the patient, she notices that the patient is pale, diaphoretic, fatigued, and using her sternocleidomastoid accessory muscles for respiration. Her respiratory rate is 32 breaths/min and pulse is 130 beats/min. Which of the following interventions
is not indicated?
A) Administer oxygen by nasal cannula
B) Give the patient a nebulized short-acting beta 2 agonist
C) Quickly assess the patient with the pulse oximeter and check breath sounds
D) Initiate cardiopulmonary resuscitation (CPR) immediately
D) Initiate cardiopulmonary resuscitation (CPR) immediately
Although the patient is in obvious respiratory distress, CPR is not yet warranted. This patient is at
very high risk for acute respiratory failure.
