Lecture 10: respiratory Flashcards
A 35-year-old patient is diagnosed with asthma and prescribed a combination of an inhaled glucocorticoid and a long-acting beta2 agonist (LABA). What is the rationale for combining these medications?
A. To prevent exercise-induced bronchospasm.
B. To reduce inflammation and provide long-term bronchodilation.
C. To treat acute asthma exacerbations.
D. To prevent systemic adverse effects.
Correct Answer: B
Explanation:
Glucocorticoids reduce airway inflammation, while LABAs provide sustained bronchodilation. This combination helps manage chronic asthma symptoms and prevent exacerbations. It is not intended for acute relief (eliminates C) and does not directly address exercise-induced bronchospasm (eliminates A). Systemic adverse effects are minimized by inhalation, but that’s not the primary purpose (eliminates D).
Which adverse effect is most commonly associated with inhaled glucocorticoids?
A. Tachycardia.
B. Oral candidiasis.
C. Weight gain.
D. Neutropenia.
Correct Answer: B
Explanation:
Inhaled glucocorticoids can cause oral candidiasis (thrush) due to local immunosuppression in the oropharynx. Rinsing the mouth after use and employing a spacer can minimize this risk. Tachycardia (A) is more common with beta2 agonists, weight gain (C) with systemic steroids, and neutropenia (D) is not a typical side effect.
A patient with COPD is prescribed a phosphodiesterase-4 (PDE-4) inhibitor. What should the nurse educate the patient about regarding potential side effects?
A. Increased heart rate and palpitations.
B. Dry mouth and dizziness.
C. Weight loss and mood changes.
D. Muscle cramps and tremors.
Correct Answer: C
Explanation:
PDE-4 inhibitors, like roflumilast, are used in COPD to reduce inflammation and prevent exacerbations. Adverse effects include gastrointestinal symptoms, weight loss, and neuropsychiatric symptoms such as mood changes. The other options do not align with PDE-4 inhibitors’ known side effects.
When educating a patient about using a dry powder inhaler (DPI), which statement indicates correct understanding?
A. “I should shake the inhaler before using it.”
B. “I need to coordinate pressing the device while inhaling.”
C. “I will breathe in quickly and deeply after activating the device.”
D. “I will rinse my mouth before using the inhaler.”
Correct Answer: C
Explanation:
DPIs are breath-activated devices, and the patient should inhale quickly and deeply to ensure proper drug delivery to the lungs. Shaking (A) and hand-breath coordination (B) are unnecessary for DPIs, and rinsing the mouth before (D) is not relevant.
A patient is prescribed a short-acting beta2 agonist (SABA) for acute asthma exacerbations. What should the nurse include in patient teaching about this medication?
A. “Use this medication daily to prevent asthma symptoms.”
B. “Wait at least 30 minutes between puffs.”
C. “This medication will provide quick relief of wheezing and shortness of breath.”
D. “It is important to rinse your mouth after using this medication.”
Correct Answer: C
Explanation:
SABAs provide rapid relief of bronchospasm and acute asthma symptoms. They are not intended for daily use (eliminates A). The correct waiting time between puffs is 1 minute, not 30 (eliminates B). Rinsing the mouth is relevant for inhaled glucocorticoids, not SABAs (eliminates D).
Which medication is most appropriate for preventing exercise-induced bronchospasm (EIB)?
A. Montelukast.
B. Inhaled short-acting beta2 agonist (SABA).
C. Inhaled long-acting beta2 agonist (LABA).
D. Inhaled glucocorticoid.
Correct Answer: B
Explanation:
SABAs, such as albuterol, are effective for preventing EIB when used immediately before exercise. Montelukast (A) may be used for maintenance, and LABAs (C) are for long-term control, not acute prevention. Glucocorticoids (D) reduce inflammation but do not prevent EIB acutely.
Which method of inhalation delivers the highest percentage of medication directly to the lungs?
A. Dry powder inhaler (DPI).
B. Metered-dose inhaler (MDI) with a spacer.
C. Nebulizer.
D. Respimat.
Correct Answer: C
Explanation:
Nebulizers deliver medication continuously with each breath, ensuring good delivery to the lungs and minimal coordination. DPIs (A) and MDIs with spacers (B) improve drug delivery compared to standalone MDIs but are less effective than nebulizers. Respimat (D) is efficient but not superior to nebulizers in this context.
A patient taking montelukast reports new-onset depression and suicidal thoughts. What is the nurse’s priority action?
A. Educate the patient that mood changes are a common side effect.
B. Encourage the patient to continue the medication and monitor symptoms.
C. Notify the healthcare provider immediately.
D. Recommend switching to an inhaled glucocorticoid.
Correct Answer: C
Explanation:
Neuropsychiatric effects, including depression and suicidality, are serious adverse effects of montelukast. The healthcare provider should be informed immediately to evaluate and possibly discontinue the medication. Continuing without action (B) or independently suggesting alternatives (D) is inappropriate.
Which statement best explains the mechanism of action of anticholinergic drugs in COPD?
A. “They decrease mucus production in the airways.”
B. “They prevent bronchoconstriction by blocking muscarinic receptors.”
C. “They reduce airway inflammation and edema.”
D. “They improve ciliary movement in the bronchioles.”
Correct Answer: B
Explanation:
Anticholinergic drugs block muscarinic receptors, reducing bronchoconstriction in COPD. While they may have a mild effect on mucus production (A), their primary action is on bronchoconstriction. They do not significantly affect inflammation (C) or ciliary movement (D).
What is the most appropriate treatment for a patient experiencing a severe asthma exacerbation?
A. Inhaled glucocorticoid and long-acting beta2 agonist (LABA).
B. Oxygen, systemic glucocorticoid, and nebulized albuterol.
C. Oral montelukast and nebulized anticholinergic.
D. Inhaled dry powder beta2 agonist.
Correct Answer: B
Explanation:
Severe asthma exacerbations require immediate treatment with oxygen for hypoxemia, systemic glucocorticoids to reduce airway inflammation, and nebulized albuterol (SABA) for bronchodilation. LABAs (A) and montelukast (C) are for long-term management, not acute care.
A patient is prescribed a metered-dose inhaler (MDI) for asthma management. Which patient teaching is most important?
A. “Activate the inhaler after completing a deep breath.”
B. “Wait at least 1 minute between puffs of the same medication.”
C. “Hold your breath for 3 seconds after inhaling the medication.”
D. “Store the inhaler in a refrigerator to maintain drug potency.”
Correct Answer: B
Explanation:
Patients should wait 1 minute between puffs to allow the first dose to act and prepare the airway for the next dose. Activation of the inhaler should occur at the start of inhalation (not after; eliminates A). Holding the breath for 10 seconds maximizes drug deposition in the lungs, not 3 seconds (eliminates C). MDIs do not need refrigeration (eliminates D).
What is the primary reason nebulizers are preferred over other inhalation devices during severe asthma exacerbations?
A. They require minimal patient effort and coordination.
B. They deliver the medication faster than other methods.
C. They have no systemic adverse effects.
D. They are less expensive than other inhalation devices.
Correct Answer: A
Explanation:
Nebulizers do not require hand-breath coordination, making them ideal for patients in distress. While effective delivery occurs over a longer duration (eliminates B), nebulizers can still cause systemic side effects if the medication is absorbed (eliminates C). Nebulizers are typically more expensive (eliminates D).
A patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium. Which statement by the patient indicates correct understanding of the medication?
A. “I will use this medication during an acute flare-up.”
B. “This medication will help prevent bronchospasms.”
C. “I need to take this medication with food to avoid side effects.”
D. “I will rinse my mouth immediately after using this medication.”
Correct Answer: B
Explanation:
Tiotropium is a long-acting muscarinic antagonist (LAMA) that prevents bronchospasms in COPD. It is not used for acute flare-ups (eliminates A). It is not affected by food (eliminates C). Rinsing the mouth is more relevant to inhaled glucocorticoids (eliminates D).
A patient receiving oral glucocorticoids for severe asthma exacerbation asks why the dose is being tapered. What is the nurse’s best response?
A. “Tapering the dose prevents adrenal suppression.”
B. “This reduces the risk of developing oral candidiasis.”
C. “Tapering minimizes the risk of drug resistance.”
D. “It helps prevent an immediate asthma flare-up.”
Correct Answer: A
Explanation:
Tapering oral glucocorticoids prevents adrenal suppression, a common adverse effect of long-term steroid use. Oral candidiasis (B) is an adverse effect of inhaled glucocorticoids. Drug resistance (C) and immediate flare-ups (D) are not related to tapering.
Which medication is most effective for managing acute bronchospasm?
A. Inhaled short-acting beta2 agonist (SABA).
B. Inhaled glucocorticoid.
C. Leukotriene receptor antagonist.
D. Phosphodiesterase-4 inhibitor.
Correct Answer: A
Explanation:
SABAs are the gold standard for rapid relief of acute bronchospasms. Inhaled glucocorticoids (B) are for long-term control. Leukotriene receptor antagonists (C) and PDE-4 inhibitors (D) are not used for acute symptoms.
What is the primary role of leukotriene receptor antagonists in asthma management?
A. Provide immediate relief of acute symptoms.
B. Reduce the risk of exercise-induced bronchospasm.
C. Suppress the effects of inflammatory mediators.
D. Stimulate bronchodilation through beta2 activation.
Correct Answer: C
Explanation:
Leukotriene receptor antagonists, such as montelukast, suppress inflammatory mediators, reducing bronchoconstriction, mucus production, and airway edema. They do not provide immediate relief (eliminates A) or directly stimulate bronchodilation (eliminates D). While they can reduce exercise-induced bronchospasm, it is not their primary role (eliminates B).
A nurse is educating a patient on the adverse effects of montelukast. What is the most important symptom to report immediately?
A. Persistent dry cough.
B. Sudden mood changes or suicidal thoughts.
C. Increased nasal congestion.
D. Diarrhea and abdominal discomfort.
Correct Answer: B
Explanation:
Neuropsychiatric effects, including mood changes and suicidal thoughts, are serious side effects of montelukast and must be reported immediately. Persistent cough (A) and nasal congestion (C) are unrelated to montelukast. Diarrhea (D) is a less concerning side effect.
A patient is prescribed a combination of a beta2 agonist and an anticholinergic for COPD. What is the benefit of this combination?
A. It increases the anti-inflammatory effects of the medications.
B. It prevents the need for systemic glucocorticoids.
C. It enhances bronchodilation through complementary mechanisms.
D. It eliminates the risk of side effects from either drug.
Correct Answer: C
Explanation:
Combining beta2 agonists and anticholinergics enhances bronchodilation by relaxing bronchial smooth muscles through different pathways. This combination does not reduce inflammation (A) or eliminate the need for systemic steroids in exacerbations (B). Side effects (D) may still occur.
Why are inhaled corticosteroids preferred over oral corticosteroids for long-term asthma management?
A. They are more effective in reducing inflammation.
B. They have fewer systemic adverse effects.
C. They require less frequent dosing.
D. They provide quicker relief during acute attacks.
Correct Answer: B
Explanation:
Inhaled corticosteroids act locally in the lungs, minimizing systemic adverse effects compared to oral corticosteroids. They are equally effective in reducing inflammation (eliminates A) but do not offer quicker relief for acute attacks (eliminates D).
Which drug combination is most appropriate for managing severe COPD with frequent exacerbations?
A. Long-acting beta2 agonist (LABA) and inhaled glucocorticoid.
B. Short-acting beta2 agonist (SABA) and leukotriene receptor antagonist.
C. Phosphodiesterase-4 inhibitor and oral glucocorticoid.
D. Anticholinergic and systemic glucocorticoid.
Correct Answer: A
Explanation:
LABAs combined with inhaled glucocorticoids are effective for managing severe COPD and reducing exacerbations. SABAs (B) are for acute relief, and PDE-4 inhibitors (C) are adjuncts. Anticholinergics and systemic glucocorticoids (D) are used during acute exacerbations.
A nurse is caring for a pediatric patient on inhaled glucocorticoids. Which assessment finding is most concerning?
A. Increased appetite.
B. Slowed growth over 6 months.
C. Mild hoarseness.
D. Frequent colds.
Correct Answer: B
Explanation:
Slowed growth in children is a significant adverse effect of prolonged inhaled glucocorticoid use. Increased appetite (A) and hoarseness (C) are less severe. Frequent colds (D) are common but not specific to glucocorticoid use.
A patient is prescribed a long-acting beta2 agonist (LABA) and an inhaled corticosteroid. Which statement by the patient indicates a need for further teaching?
A. “I will take the LABA regularly even when I feel well.”
B. “The corticosteroid will help reduce airway inflammation.”
C. “I can stop using the LABA once my symptoms improve.”
D. “Using both medications together prevents worsening asthma.”
Correct Answer: C
Explanation:
LABAs must be taken consistently as prescribed for long-term control, even when symptoms improve. Discontinuing the LABA can lead to uncontrolled asthma. The other statements are correct regarding LABA and corticosteroid use.
A nurse is educating a patient on how to use a spacer with a metered-dose inhaler (MDI). What is the primary purpose of the spacer?
A. It ensures the medication is properly mixed before inhalation.
B. It increases the amount of medication that reaches the lungs.
C. It eliminates the need to shake the inhaler.
D. It reduces the risk of tachycardia from the medication.
Correct Answer: B
Explanation:
The spacer helps ensure more medication reaches the lungs by reducing deposition in the oropharynx. It does not mix the medication (A), eliminate the need for shaking (C), or reduce systemic side effects like tachycardia (D).
Which statement is correct regarding the mechanism of action of phosphodiesterase-4 (PDE-4) inhibitors in COPD?
A. “They enhance bronchodilation by activating beta2 receptors.”
B. “They reduce airway inflammation by decreasing cAMP breakdown.”
C. “They inhibit leukotriene synthesis to prevent bronchospasm.”
D. “They block histamine release from mast cells.”
Correct Answer: B
Explanation:
PDE-4 inhibitors prevent cAMP breakdown, leading to reduced inflammation, decreased mucus production, and improved airway clearance. They do not activate beta2 receptors (A), inhibit leukotrienes (C), or block histamine release (D).
A patient on an inhaled glucocorticoid reports hoarseness and oral white patches. What is the nurse’s priority action?
A. Discontinue the medication immediately.
B. Advise the patient to rinse their mouth after each use.
C. Administer an antifungal medication for oral thrush.
D. Recommend switching to a short-acting bronchodilator.
Correct Answer: B
Explanation:
Hoarseness and oral thrush are common adverse effects of inhaled glucocorticoids. Rinsing the mouth and gargling after use can prevent these side effects. Antifungal treatment (C) is needed only if the infection persists despite preventive measures.
Which patient statement indicates effective understanding of the use of inhaled short-acting beta2 agonists (SABAs)?
A. “I will use this medication every morning to prevent symptoms.”
B. “This medication is used for quick relief during asthma attacks.”
C. “SABAs should be taken with food to reduce side effects.”
D. “I will not need other medications for my asthma if I use a SABA.”
Correct Answer: B
Explanation:
SABAs are rescue medications for acute asthma symptoms. They are not used daily (A) or with food (C), and they do not replace long-term control medications (D).
What is the primary action of anticholinergic drugs in managing respiratory conditions?
A. Inhibiting beta1 receptors to improve cardiac output.
B. Blocking muscarinic receptors to prevent bronchoconstriction.
C. Increasing cAMP production to enhance bronchodilation.
D. Reducing mast cell degranulation to decrease inflammation.
Correct Answer: B
Explanation:
Anticholinergic drugs block muscarinic receptors in the airways, reducing bronchoconstriction. They do not affect beta1 receptors (A), increase cAMP (C), or directly reduce mast cell activity (D).
Which finding indicates a therapeutic response to montelukast in a patient with asthma?
A. Improved exercise tolerance and reduced wheezing.
B. Immediate relief of chest tightness and dyspnea.
C. Decreased need for rescue inhaler within 5 minutes.
D. Resolution of nasal congestion within 30 minutes.
Correct Answer: A
Explanation:
Montelukast, a leukotriene receptor antagonist, reduces airway inflammation and bronchoconstriction, improving exercise tolerance and decreasing wheezing over time. It does not provide immediate relief (B) or act quickly (C, D).
A patient with COPD is prescribed roflumilast. What is an important nursing consideration?
A. Assess for signs of hypokalemia.
B. Monitor for weight loss and depression.
C. Evaluate for signs of adrenal insufficiency.
D. Educate on the risk of oral thrush.
Correct Answer: B
Explanation:
Roflumilast, a PDE-4 inhibitor, can cause weight loss and neuropsychiatric symptoms, including depression. Hypokalemia (A) and adrenal insufficiency (C) are unrelated. Oral thrush (D) is more common with inhaled glucocorticoids.
A patient is using a nebulizer for the first time. Which statement by the nurse is most appropriate?
A. “Hold your breath for 15 seconds after inhaling the medication.”
B. “Ensure you exhale forcefully into the nebulizer mask.”
C. “Sit upright and breathe normally while using the nebulizer.”
D. “The medication will work within 30 seconds after nebulization.”
Correct Answer: C
Explanation:
For effective nebulizer use, the patient should sit upright and breathe normally. Holding the breath (A) and exhaling into the mask (B) are unnecessary. Nebulized medications take several minutes to act, not 30 seconds (D).
What is the purpose of systemic glucocorticoids in acute asthma exacerbations?
A. To promote bronchodilation by relaxing airway muscles.
B. To reduce airway inflammation and improve oxygenation.
C. To prevent rebound bronchoconstriction.
D. To replace inhaled glucocorticoids for long-term control.
Correct Answer: B
Explanation:
Systemic glucocorticoids reduce airway inflammation, improving oxygenation during acute exacerbations. They do not directly promote bronchodilation (A) or replace inhaled glucocorticoids for maintenance (D).
What is the main advantage of using a respimat inhaler over a metered-dose inhaler (MDI)?
A. No hand-breath coordination is required.
B. It delivers medication as a fine mist for better lung deposition.
C. It eliminates the need for a spacer device.
D. It provides a pre-measured dose without the risk of overdose.
Correct Answer: B
Explanation:
The respimat inhaler delivers medication as a fine mist, improving lung deposition compared to MDIs. It still requires some hand-breath coordination (eliminates A). A spacer is not necessary for MDIs but does not apply to respimats (eliminates C).
Which class of medications is most appropriate for reducing mucus production in COPD?
A. Short-acting beta2 agonists.
B. Anticholinergics.
C. Phosphodiesterase-4 inhibitors.
D. Leukotriene receptor antagonists.
Correct Answer: C
Explanation:
PDE-4 inhibitors reduce inflammation and mucus production in COPD. Anticholinergics (B) primarily prevent bronchoconstriction. Beta2 agonists (A) focus on bronchodilation, and leukotriene receptor antagonists (D) are for asthma, not COPD.
