Download NGR6200 Asthma Review Questions with Complete Solutions Graded A+ and more Exams Nursing in PDF only on Docsity!
NGR6200 Asthma Review Questions with
Complete Solutions Graded A+
What are the three principle triggers for asthma? - Correct Answer1. Allergens and environmental factors
- URI
- psychological factors (stress)
What are some of the common triggers of asthma? - Correct Answer- Tobacco smoke
- wood smoke
- household sprays
- viruses
- other allergens
What component of speech should be documented in a patient that presents with an asthma exacerbation? - Correct Answer- Inability to speak in full sentences
(signal of a severe asthma exacerbation)
What part of the history is important to note in a patient with asthma? - Correct Answer1. How often have they had to use their bronchodilator
2.Have they ever been hospitalized for asthma and if so have they been intubated
Is wheezing a reliable indicator of asthma severity? - Correct AnswerNo.
It may be absent in between acute attacks and unable to hear because of diminished breath sounds
Patients with asthma often have a cough that worsens at_______? - Correct AnswerNight
Why is bronchoconstriction worse at night? - Correct AnswerCircadian rhythms occur with increased bronchoconstriction at 2-3 am
What other conditions go along with asthma? - Correct Answer- Allergic rhinitis
- allergic conjunctivitis
- eczema
- nasal polyps
What percussion note would be found in a patient with asthma? - Correct AnswerHyperresonance
Which phase of respiration would be longer in patients with asthma? - Correct AnswerExpiration
By measuring lung function (FEV1) forced expiratory volume by spirometry less than 80% predicted with a 12-15% improvement of FEV1 after bronchodilation confirms the diagnosis of ________? - Correct AnswerAsthma
What is "provocative testing" to rule out asthma? - Correct AnswerMethcholine challenge
- It will cause bronchoconstriction and is often performed by pulmonologists to diagnosis asthma. Resuscitation equipment must be available.
- A 20% fall in FEV-1 diagnoses asthma
What would the CXR look like in a patient with chronic asthma? - Correct Answer- Hyperinflation
- thickening of the bronchial wall
- diminished peripheral lung vascular shadows
What stages of asthma require a SABA? - Correct AnswerPatients regardless of their stage should have a SABA available
When is skin testing recommended? - Correct AnswerWhen asthma is persistent to find out about sensitivities to allergens and to optimize treatment and preventive measures
Patient with asthma are asked to monitor ________ because if the value is less than 80% of their personal best, more frequent monitoring and changes in medical therapy should be done. - Correct AnswerPeak expiratory flow rates (PEF)
When should a patient with wheezing receive a CXR? - Correct AnswerPatients with a first episode of wheezing require a CXR to rule out other causes
Do you need to get a CXR in a known asthmatic if there are no signs of pneumonia? - Correct AnswerNo
Why is it important to treat allergic rhinitis (AR) in patients with asthma? - Correct AnswerInflammatory mediators that drip from the nose into the lungs can aggravate asthma
How is exercise induced bronchospasm treated? - Correct AnswerSABA before exercising.
- May need ICS with SABA if frequent use
A patient with hypertension would have worsening respiratory symptoms with which class of drugs? - Correct AnswerNon selective beta adrenergic antagonists such as:
- propranolol
- carvedilol
- labetalol
Should a child be excused for gym class due to asthma? - Correct AnswerChanges in treatment plan are indicated to allow for physical activity
What do schools require for children with asthma? - Correct AnswerProviders will need to fill out a specific form outlining the treatment plan
How are asthma and COPD different? - Correct AnswerAsthma is fully reversible, COPD is not
What is a good way to describe the medications used for asthma to a patient? - Correct AnswerRelievers (SABAs) and controllers (ICS, leukotriene antagonists)
Which drugs can exacerbate asthma? - Correct AnswerHypersensitivity to aspirin or NSAIDs and beta blockers
Do obese individuals have higher rates of asthma? - Correct AnswerYes
Which racial group has increased prevalence of asthma? - Correct AnswerAfrican Americans
Do all patients with asthma regardless of the classification need a SABA? - Correct AnswerYes
Small hand-held, pressurized devices that deliver a measured dose of drug with each activation are called____________? - Correct AnswerMetered dose inhalers (MDIs)
The type of inhaler used to treat asthma in the form of a dry, micronized powder inhaled directly into the lungs is called_________? - Correct AnswerDry powder inhaler (DPI)
The device used to treat asthma that serves the purpose to increase delivery of drugs to the lungs and decrease deposition of drug on the oropharyngeal mucosa is called a_____________? - Correct AnswerSpacer
What is the MOA of Beta-2 agonists such as albuterol, levalbuterol, and pirbuterol? - Correct Answer- relaxes smooth muscles to promote bronchodilation
Long acting beta 2 agonists should only be used in conjunction with what other type of asthma medication for the control of persistent asthma? - Correct AnswerInhaled corticosteroids (ICS)
Improper use of the long acting beta-2 agonists such as salmeterol can cause death because the bronchodilating effect is delayed. Deaths associated with the improper use of salmeterol lead to a_______________? - Correct AnswerBlack Box Warning
Are long acting inhaled beta-2 agonists ever used as monotherapy for asthma? - Correct AnswerNo.
- Used without a controller, long acting agents can increase the risk of death
Patients that require daily use of bronchodilators more than twice a week use, need to have better control of their asthma by using_____________? - Correct AnswerInhaled glucocorticoids (ICS)
Following the "rules of two" if asthma symptoms occur >2/week what additional medication is needed? - Correct AnswerA controller agent such as an ICS
How long does it take to achieve maximal benefits with the use of inhaled glucocorticoids?
- Correct AnswerShort term effects may be evident in 3-4 days. Maximum benefit takes 4- weeks
Can inhaled glucocorticoids be used for rescue of asthma symptoms? - Correct AnswerICSs are used for prophylaxis of asthma symptoms, not for rescue
Oropharyngeal candidiasis and dysphonia (hoarseness, speaking difficulty) as well as local deposition of inhaled glucocorticoids are the most common adverse effects of____________? - Correct AnswerInhaled glucocorticoids (ICS)
To minimize the adverse effects of inhaled glucocorticoids, patients should be advised to do the following to reduce drug deposition in the oropharynx that may lead to oral candidiasis. - Correct AnswerGargle with alcohol based wash and employ a spacer device if indicated
Inhaled glucocorticoids are very safe and highly effective in the treatment of asthma because they have minimal adverse effects and _________? - Correct AnswerGo directly to the target area
Drugs that reduce the symptoms of asthma by suppressing inflammation, decreasing synthesis and release of inflammatory mediators, decreasing infiltration and activity of inflammatory cells, decreasing edema in the airway mucosa, and increasing number of beta-2 receptors are called_________? - Correct AnswerGlucocorticoids
What are the components of Advair? - Correct AnswerFluticasone (ICS) and salmeterol (a long acting inhaled beta -2 agonist)
Advair inherited a Black Box Warning because of the __________component of the combination drug. - Correct AnswerSalmeterol
How is Advair 500/50, 250/50, 150/50 dosed? - Correct AnswerBID (The salmeterol component of 50 mg is constant)
What is the nebulized inhaled corticosteroid approved for use in children? - Correct AnswerPulmicort Respules
Which ICS is pregnancy Category B? - Correct AnswerPulmicort
Is there systemic absorption of ICS? - Correct AnswerMinimal (less than 1%)
When would a "step down" of the controller medication be initiated in a patient with persistent asthma? - Correct AnswerRecommended 3 months before trying to step down
Patients with severe asthma exacerbation are usually treated with bronchodilators and __________glucocorticoids? - Correct AnswerOral
Oral glucocorticoids have a higher risk of toxicity than ICSs and adverse effects. The most severe complication from oral glucocorticoids is a risk of ______? - Correct AnswerAdrenal suppression
What older agent used to treat asthma has been mostly replaced because it has a narrow therapeutic range as well as many drug-drug reactions? - Correct AnswerTheophylline
What is the ideal plasma level of theophylline? - Correct Answer5 mcg/ml
This drug is a methylxanthine with pharmacologic properties like those of theophylline.
It also intensifies the adverse effects of theophylline on the CNS and the heart. This drug competes with theophylline for drug metabolizing enzymes, thereby causing theophylline levels to rise and forms should be avoided. What is__________? - Correct AnswerCaffeine
AEDs such as phenobarbital, phenytoin, and rifampin induce hepatic drug metabolizing enzymes which causes theophylline levels to (increase or decrease)? How should theophylline doses be adjusted? - Correct AnswerInduction would decrease theophylline levels and require larger doses.
Cimetidine and fluoroquinolone antibiotics inhibit hepatic metabolism causing theophylline levels to (increase or decrease)? How should theophylline doses be adjusted? - Correct AnswerInhibition will lead to increased levels.
The theophylline dose will need to be decreased.
Why would a patient on theophylline that stops smoking have symptoms of theophylline toxicity? - Correct AnswerNicotine is an inducing agent and once it was stopped, less theophylline would be needed
Leukotriene Antagonists and Other Agents for Asthma - Correct AnswerSingular (montelukast) which helps treat asthma symptoms is indicted for maintenance therapy. What is the name of the inflammatory agent blocked by this drug?
Inflammatory mediators such as leukotrienes are similar to histamine and can increase airway inflammation and bronchoconstriction. Leukotriene _________ can improve the effect of inflammation and improve asthma symptoms. - Correct Answerantagonists (LTRA's)
Why are ICS preferred over leukotriene antagonists (LTRA) in the treatment of asthma? - Correct AnswerLTRAs block only one inflammatory mediator and ICS block 8 or more
After starting a LTRA, why is it important to monitor the patient's mood? - Correct AnswerDepression and suicidality have been noted with LTRAs
What does the "mab" stand for in Omalizumab (Xolair)? - Correct AnswerMonoclonal antibody technology ($$$$)
Why do patients have to wait in the office for observation after administration with Xolair? - Correct AnswerHypersensitivity reaction (anaphylaxis) can occur
What is the Black Boxed warning on Xolair? - Correct AnswerAnaphylaxis
What is the mechanism of action of cromolyn? - Correct AnswerMast cell stabilizer
Is ipratropium used for asthma? - Correct Answerno, but usually only used in the emergency room
What is the MOA of ipratropium? - Correct Answer- blocks muscarinic receptors in the lung causing bronchodilation
Diagnosis of Asthma - Correct Answer• History:
- ask about hospitalizations for asthma
- how often they need their bronchodilator
- Ask to see the canister, check the exp date
- Do they have atopy?
- Spirometry
- FEV1 Normal is > 80 % (an increase of 6-12% after bronchodilation indicates asthma)
- Children under 6 years old can't perform
- Patients without symptoms may still have reflux that can make airways constrict
- Beta 2 agonists may relax the LES making acid reflux more likely
- Esomeprazole (Nexium) does not improve asthma symptoms in patients with poorly controlled asthma without typical GERD symptoms
- Go ahead and try it for patients with symptoms of GERD
Some asthma patients are given a PPI even if they don't have symptoms of GERD, T/F? - Correct AnswerTrue
Goals of Therapy - Correct Answer• Prevent chronic symptoms, coughing and breathlessness
- Maintain "near" pulmonary function
- Prevent acute exacerbations and hospitalizations
- When to refer?
Asthma Treatment includes: - Correct Answer• Allergy testing
- Immunotherapy
- Control allergies
- Non drug measures-environmental control
- Patient education
- Rescue vs. control
- Home management program
- Form for school-permission to carry inhaler
- Refer for specialty care
Examples of Leukotriene Modifiers: - Correct Answer• Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
Two types of Bronchodilators: - Correct Answer• Bronchodilators (short acting SABAs)
- Long acting bronchodilators (LABAs
Example of Long acting bronchodilators (LABAs) - Correct Answer• Salmeterol (Serevent)
- Formoterol (Foradil)
- Arformoterol (Brovana)
Example of Short Acting Bronchodilator's (SABAs) - Correct Answer• Beta2 adrenergic agonists:
Examples of Anti-inflammatory agents for Asthma: - Correct Answer• Glucocorticoids (oral and inhaled)
- Cromolyn (Intal)
- Example of IgE Antagonist - Correct AnswerOmalizumab (Xolair)
- Example of Methylxanthines: - Correct Answer-Theophylline
- Example of Anticholinergics - Correct Answer-Ipratropium (Atrovent)
Management of Asthma
- Mild Intermittent: - Correct Answer• Mild symptoms <2 times a week
- PRN with quick relief beta2 agonist
Management of Asthma
Assessment and Plan with Asthma and HTN - Correct Answer• Consider alternative medication rather than a BB
- Could an ACEI be used?
- Is she at greater risk for ACEI cough?
- What other agent could be considered?
Pregnant Patients with Asthma - Correct Answer• Adequate oxygenation is essential for the fetus
- Monitor PEF during pregnancy
- Treat with ICS (Pulmicort Category C)
- Inhaled beta2 agonists are less likely to affect uterine contractions
Inhaled beta2 agonists are less likely to affect uterine contractions, T/F? - Correct AnswerTrue
Treatment of Asthma in Children: What is the dose of Oral prednisolone for a child during exacerbation? - Correct Answer• Oral prednisolone 1-2 mg/kg/day for 5-7 days
Assessment and Plan for Asthma: Mild Persistent - Correct AnswerAssessment:
- Asthma (mild persistent)
- AR
- Eczema
Plan:
- Start Xopenex 0.63% every 4-6 hours prn via neb
- Start Pulmicort Respules 0.25 daily
- Start Nasonex 1-2 sprays daily
- Start Zyrtec 5mg nightly
- Environmental control
- Refer to asthma and allergy specialist
- Low dose steroid cream for eczema for 2 weeks
- Follow up in one week
TX Asthma in Older Adults with ICS's: - Correct Answer• Try ICS to see how much is COPD and if it is reversible
- If lung function improves, it is reversible and ICS can be continued
TX Asthma in Older Adults with Beta2 Agonists's: - Correct Answer• Beta2 agonists can cause more tremors and tachycardia in older adults with cardiovascular disease
- Anticholinergics areusually more beneficial in older adults Problems with Asthma Treatments in the Elderly: - Correct Answer• Theophylline levels can become elevated in the elderly
- Systemic corticosteroids can cause confusion, agitation and changes in glucose metabolism
- ICS can reduce bone mineral content-make sure calcium and vitamin D requirements are met
- Nonselective beta blockers and NSAIDs can cause asthma exacerbations
Maintain (near) normal lung function and normal activity levels. Reduce Risk
Prevent exacerbations: - Correct AnswerPrevent exacerbations. Minimize need for emergency care, hospitalization. Prevent loss of lung function (or, for children, prevent reduced lung growth). Minimize adverse effects of therapy.
Schedule follow-up care with Asthma? When should you see patients? - Correct Answer• Every 2-6 weeks while gaining control
- Every 1-6 months to monitor control
- Every 3 months if step down in therapy is anticipated
Patient Education for Self-Management for Long Term Control: - Correct Answer- Use medications ICS's, which will reduce inflammation to prevent symptoms.
- Should be taken daily; will not give quick relief.
Patient Education for Self-Management for Quick Relief: - Correct Answer- short-acting beta2-agonists (SABAs) relax airway muscles to provide fast relief of symptoms.
- Will not provide long-term asthma control.
- If used >2 days/week (except as needed for exercise-induced asthma), the patient may need to start or increase long-term control medications.
