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 antiinflammatory 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.