Student Review Questions, Chapter 44, Drugs for Asthma and Other

Bronchoconstrictive Disorders

1.
Multiple Choice
While volunteering at the local free clinic for the urban homeless, you assess
an elderly black man who presents with dyspnea and wheezing. After
instructing him on the effective use of an inhaler for his asthma, you tell him
that African Americans have a higher death rate from asthma than whites
and Hispanics. Why is the African American death rate higher from asthma?

*Urban living

Increased access to healthcare

Race or ethnicity

Genetics

Rationale: Compared with whites, African Americans and Hispanics have a

higher prevalence and African Americans have a higher death rate from
asthma. However, the differences are usually attributed to urban living and
lesser access to health care, rather than race or ethnic group.

2.
Multiple Choice
A 6-year-old boy presents at your primary care office with an elevated
temperature, bilateral ear pain, and irritability. He has a history of asthma.
What instructions are quite important for antipyretics and analgesics before
leaving the office?

*Administer only acetaminophen for fever and discomfort.

Administer twice the recommended dose for the first 2 days.

Administer half the recommended dose for the first 2 days.

Administer only NSAIDs for fever and discomfort.

Rationale: In about 25% of clients with asthma, aspirin and other

nonsteroidal anti-inflammatory drugs (NSAIDs) can precipitate an asthma
attack and should be avoided.

3.
Multiple Choice
Your patient, a 53-year-old overweight woman, presents with increasing
asthma symptoms. She also reports heartburn at least four nights per week.
What would you expect the physician to prescribe?

*Proton-pump inhibitor therapy

Initiate corticosteroid inhalers

Antihistamines

NSAIDs

Rationale: It has been suggested that in individuals with inadequate control

of their asthma symptoms, a trial of an H2-blocker or proton-pump inhibitor
therapy may be of benefit as asthma may aggravate GERD.

4.
Multiple Choice
Your patient, an elderly woman, insists her asthma is exacerbated by her
least favorite television show. While explaining that her dislike for the show’s
host may be a contributing factor, you explain that an asthma attack is
caused by substances released from mast cells, which cause:

*Bronchoconstriction and inflammation.

Smooth muscle dilation.

Decreased capillary permeability and fluid leakage.

Bronchodilation and capillary permeability.

Rationale: When lung tissues are exposed to causative stimuli, mast cells
release substances that cause bronchoconstriction and inflammation.

5.
Multiple Choice
The mother of your patients, 7-year-old twin boys, is hungry for additional
information on the management of asthma. She’s particularly interested in
preventing exacerbations with the newest information available. Where
would you direct her for more information?

*NAEPP Guidelines
Centers for Disease Control Education Center

National Association of Educational Pulmonologists

National Education Association

Rationale: Because of asthma’s significance, NIH assembled experts who

established “Guidelines for the Diagnosis and Management of Asthma.”
These were updated in 2007, including an expanded portion on childhood
asthma.

6.
Multiple Choice
Your aunt, a 30-pack year smoker, has developed COPD. Knowing you’re a
nurse, she’s asking what she can expect over the next several years. You tell
her that is she quits smoking today, she can expect:

*Increasing dyspnea.

Decreasing dyspnea.

Activity tolerance.

Maintain her quality of life.

Rationale: Anatomic and physiologic changes occur over several years and
lead to increasing dyspnea, activity intolerance, and reduced quality of life.

7.
Multiple Choice
The goals of pharmacotherapy for asthma management are to reduce acute
asthma episodes and maintain long-term control of persistent asthma. Two
major groups of medications are used, one with a directly positive effect on
the other’s efficacy. Which medication group affects both pathophysiologies?

*Anti-inflammatory drugs

Proton-pump inhibitors

Bronchodilators

H2-blockers

Rationale: Reducing inflammation also reduces bronchoconstriction.

8.
Multiple Choice
Adrenergics are a category of bronchodilators used in the treatment of
asthma and COPD. A specific adverse effect contraindicates these
medications for patients with cardiac tachydysrhythmias, etc. In what
conditions is cautious use recommended? (Select all that apply.)

*Hypertension

*Seizure disorders

*Diabetes mellitus

Severe coronary artery disease

Rationale: Adrenergic drugs are contraindicated in severe coronary artery

disease; they should be used cautiously in clients with hypertension,
diabetes mellitus, and seizure disorders.

9.
Multiple Choice
Your patient, a 27-year-old athlete with newly diagnosed asthma, presents at
your office for patient education regarding situations that could precipitate
an asthma attack. Your teaching includes that acute episodes of asthma may
last minutes to hours. In your teaching, which of the following precipitants do
you state may cause the asthma? Select all that apply.

*Exercise

*Allergens

*Pollutants

Warm weather

Rationale: Precipitants may include allergens (eg, pollens, molds), airway

irritants and pollutants (eg, chemical fumes, cigarette smoke, automobile
exhaust), cold air, and exercise.

10.
Multiple Choice
A 5-year-old boy is brought to the ED with an asthma exacerbation, including
wheezing (a high-pitched, whistling sound caused by turbulent airflow
through an obstructed airway). Those who have asthma chronically present
with what signs, even when they may appear symptom free? Select all that
apply.

*Airway inflammation

*Damaged airway mucosa

Elevated temperature

Bradycardia

Rationale: Inflammation and damaged airway mucosa are chronically present

in asthma, even when clients appear symptom free.