Chapter 16: Asthma and Chronic Obstructive Pulmonary Disease Medications

Chapter 16: Asthma and Chronic Obstructive Pulmonary Disease Medications

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A primary care nurse practitioner (NP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms. The patient’s forced expiratory volume in 1 second (FEV₁) is 80% of the predicted value. The patient’s current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should prescribe:

ANS:  C

This patient has symptoms of mild, persistent asthma. The preferred controller medication in adults and children with persistent asthma is a low-dose ICS. Montelukast is a leukotriene modifier, which may be considered as an alternative to a low-dose ICS but is not the first option to try. Ipratropium is often used during an acute exacerbation but not for long-term control. LABA medications are used in patients with moderate persistent symptoms.

DIF:    Cognitive Level: Applying (Application)                           REF:   210

2. A primary care NP sees an adolescent patient for a hospitalization follow-up after an asthma exacerbation. The patient reports having daily symptoms with nighttime awakening 4 or 5 nights per week and misses school several days each month. The patient currently uses a salmeterol/fluticasone LABA twice daily and albuterol as needed. The patient requires a refill of the albuterol prescription once a month. The patient does not have any known allergies. The NP should:

ANS:  A

The patient has moderate persistent asthma not well controlled with the current regimen. The next step is to prescribe a high-dose ICS to be taken along with the LABA and to refer to an asthma specialist. Theophylline is recommended in the 5- to 11-year age group. Omalizumab is indicated if the patient has allergies. Ipratropium is used during acute exacerbations.

DIF:    Cognitive Level: Applying (Application)                           REF:   210

3. A 50-year-old patient who recently quit smoking reports a frequent morning cough productive of yellow sputum. A chest x-ray is clear, and the patient’s FEV₁ is 80% of predicted. Pulse oximetry reveals an oxygen saturation of 97%. The primary care NP auscultates clear breath sounds. The NP should:

ANS:  D

For patients with stable COPD having respiratory symptoms with FEV1 between 60% and 80% of predicted, inhaled bronchodilators may be used. COPD is not reversible, and the symptoms will not subside. ICS therapy or long-acting anticholinergics are recommended when FEV₁ is less than 60%.

DIF:    Cognitive Level: Applying (Application)                           REF:   212 – 213

4. A primary care NP is evaluating a patient who has COPD. The patient uses a LABA twice daily. The patient reports having increased exertional dyspnea, a frequent cough, and poor sleep. The patient also uses a short-acting b-adrenergic agonist (SABA) five or six times each day. Pulse oximetry reveals an oxygen saturation of 92%. The patient’s FEV₁/forced vital capacity is 65, and FEV1 is 55% of predicted. The NP should prescribe a(n):

ANS:  D

Providers should administer combination inhaled therapies for symptomatic patients with stable COPD and FEV₁ less than 60%. Oral corticosteroids have not been shown to be effective, even in severe cases of COPD. Long-acting anticholinergic medications may be used as monotherapy in early stages of COPD. Long-acting theophylline is poorly tolerated because of side effects.

DIF:    Cognitive Level: Applying (Application)                           REF:   213