NURS 640 FINAL EXAMS ACTUAL QUESTIONS
AND ANSWERS SURE A+
✔✔Bronchodilator Therapies - ✔✔act primarily on airway smooth muscle to reverse
bronchoconstriction of asthma. Rapid relief of symptoms, but has little or no effect on
the underlying inflammatory process.
✔✔B2- Agonists - ✔✔Relaxes airway smooth muscle cells of the airways, where they
act as functional antagonists, reversing & preventing contraction of airway smooth
muscle cells by all known bronchoconstrictors.
Given by inhalation to reduce side effects.
SABAs such as albuterol & terbutaline have a duration of action of 3-6 hrs. They have
rapid onset of bronchodilation, therefore used as needed for symptom relief. Increased
use of SABAs indicates that asthma is not controlled.
LABAs include salmeterol & formoterol, have duration of action over 12 hrs & are given
2x daily. Indacaterol is given once daily. LABAs have replaced the regular use of
SABAs, but LABAs should not be given in the absence of ICS therapy because they
don't control the underlying inflammation. They improve asthma control and reduce
exacerbations when given w/ ICS, which allows asthma to be controlled at lower doses
of corticosteroids.
Most common side effects are tremors and palpitations.
✔✔Anticholinergics - ✔✔Muscarinic receptor antagonists such as ipratropium bromide
prevent cholinergic nerve-induced bronchoconstriction & mucus secretion.
,Less effective than B2 agonists.
May be used as an additional bronchodilator in pts w/ asthma that is not controlled by
ICS & LABA combinations.
High doses may be given by nebulizer in treating acute severe asthma, but should only
be given following B2-agonists, because they have slower onset of bronchodilation.
✔✔Theophylline - ✔✔It has now fallen out of favor because side effects are common &
inhaled B2-agonists are much more effective bronchodilators.
Nausea, vomiting & headaches are the most common side effects due to
phosphodiesterase inhibition. Diuresis & palpitations may also occur, at high
concentrations, cardiac arrhythmias, epileptic seizures, & death may occur due to
adenosine A1-receptor antagonism.
✔✔Inhaled Corticosteroids - ✔✔Most effective anti-inflammatory agents used in asthma
therapy and are beneficial in treating asthma of any severity and age.
Usually given 2x daily, but some may be effective once daily in mildly symptomatic pts.
Now given as first-line therapy for patients with persistent asthma, but if they don't
control symptoms at low doses, it is usual to add a LABA as the next step.
Side effects include hoarseness (dysphonia) and oral candidiasis, which may be
reduced with the use of large-volume spacer device.
✔✔Systemic Corticosteroids - ✔✔Used IV for the treatment of acute severe asthma,
although several studies now show that OCS (usually prednisone or prednisolone 30-45
mg once daily for 5-10 days) is used to treat acute exacerbations of asthma. No
tapering of the dose is needed.
✔✔Antileukotrienes - ✔✔E.g. Montelukast - provide modest clinical benefit in asthma.
Less effective than ICS in controlling asthma and have less effect on airway
inflammation, but are useful as an add-on therapy in some pts not controlled w/ low
doses of ICS, although less effective than LABA.
Given once or twice daily
✔✔Anti-IgE - ✔✔Omalizumab
Reduce number of exacerbations in pts w/ severe asthma and may improve asthma
control.
Very expensive and is only suitable for highly selected pts who are not controlled on
maximal doses of inhaler therapy and have circulating IgE within a specified range.
Given a 3-4 month trial of therapy.
Given subq every 3-4 weeks and appears not to have significant side effects.
✔✔Acute Severe Asthma Management - ✔✔High concentration of oxygen by face mask
yo achieve O2sat >90%.
Mainstay of treatment are high doses of SABA given either by nebulizer or metered-
dose inhaler w/ a spacer.
In severely ill patients with impending respiratory failure, IV B2-agonists may be given.
, A nebulized anticholinergic may be added if there is not a satisfactory response to B2-
agonists alone, as there are additive effects.
In patients who are refractory to inhaled therapies, a slow infusion of aminophylline may
be effective, but it is important to monitor to monitor blood levels, especially of patients
have already been treated w/ oral theophylline.
Magnesium sulfate given IV or by nebulizer is effective when added to inhaled B2-
agonists, and is relatively well-tolerated but is not routinely recommended.
Prophylactic intubation may be indicated for impending resp failure, when PCO2 is
normal or rises.
For pts w/ resp failure, it is necessary to intubate and institute ventilation.
✔✔CAP - ✔✔Essentials of diagnosis include:
-Fever, tachypnea, cough with or w/o sputum, dyspnea, chest discomfort, sweats or
rigors
-Bronchial breath sounds or inspiratory crackles
- Parenchymal opacity on CXR
-Occurs outside the hospital OR within 28 hours of hospital admission in a patient not
residing in long term care facility
- Remember: Patient outcomes improve when initial antibiotic choice is appropriate for
the infecting organism, and improves antibiotic coverage, reduces unnecessary
hospitalization, and improves 30 day survival.
Pathogenesis: Bacteria more common than viruses, with S pneumoniae accounting for
⅔ of bacterial isolates.
✔✔CAP patho, S&S - ✔✔Pathogenesis: Bacteria more common than viruses, with S
pneumoniae accounting for ⅔ of bacterial isolates.
Clinical Findings: Most patients experience acute or subacute onset of fever, cough with
or w/o sputum production and dyspnea. Other symptoms include sweats, chills, rigors,
chest discomfort, pleurisy, hemoptysis, myalgias, headache, abdominal pain.
Physical Findings: Fever or hypothermia, tachypnea, tachycardia, arterial oxygen
desaturation. Patients appear acutely ill, inspiratory crackles and bronchial breath
sounds heard.
✔✔CAP diagnosis - ✔✔A chest radiograph is essential to eval of suspected CAP
Diagnostic testing: In addition to CXR, sputum gram stain, urine antigen test for s.
Pneumoniae and legionella, and rapid antigen detection test for influenza may be used.
Blood cultures should be obtained prior to administration of antibiotics, other labs to be
drawn include CBC, chem panel, and ABG samples
Pulmonary opacity on CXR required for diagnosis of CAP; Chest CT more sensitive.
Findings range from patchy airspace opacities to lobar consolidation with air
bronchograms to diffuse aleveolar or interstitial opacities. Other findings can include
pleural effusions and cavitation. Patients with cavitary opacities should have sputum
fungal and myobacterial cultures
AND ANSWERS SURE A+
✔✔Bronchodilator Therapies - ✔✔act primarily on airway smooth muscle to reverse
bronchoconstriction of asthma. Rapid relief of symptoms, but has little or no effect on
the underlying inflammatory process.
✔✔B2- Agonists - ✔✔Relaxes airway smooth muscle cells of the airways, where they
act as functional antagonists, reversing & preventing contraction of airway smooth
muscle cells by all known bronchoconstrictors.
Given by inhalation to reduce side effects.
SABAs such as albuterol & terbutaline have a duration of action of 3-6 hrs. They have
rapid onset of bronchodilation, therefore used as needed for symptom relief. Increased
use of SABAs indicates that asthma is not controlled.
LABAs include salmeterol & formoterol, have duration of action over 12 hrs & are given
2x daily. Indacaterol is given once daily. LABAs have replaced the regular use of
SABAs, but LABAs should not be given in the absence of ICS therapy because they
don't control the underlying inflammation. They improve asthma control and reduce
exacerbations when given w/ ICS, which allows asthma to be controlled at lower doses
of corticosteroids.
Most common side effects are tremors and palpitations.
✔✔Anticholinergics - ✔✔Muscarinic receptor antagonists such as ipratropium bromide
prevent cholinergic nerve-induced bronchoconstriction & mucus secretion.
,Less effective than B2 agonists.
May be used as an additional bronchodilator in pts w/ asthma that is not controlled by
ICS & LABA combinations.
High doses may be given by nebulizer in treating acute severe asthma, but should only
be given following B2-agonists, because they have slower onset of bronchodilation.
✔✔Theophylline - ✔✔It has now fallen out of favor because side effects are common &
inhaled B2-agonists are much more effective bronchodilators.
Nausea, vomiting & headaches are the most common side effects due to
phosphodiesterase inhibition. Diuresis & palpitations may also occur, at high
concentrations, cardiac arrhythmias, epileptic seizures, & death may occur due to
adenosine A1-receptor antagonism.
✔✔Inhaled Corticosteroids - ✔✔Most effective anti-inflammatory agents used in asthma
therapy and are beneficial in treating asthma of any severity and age.
Usually given 2x daily, but some may be effective once daily in mildly symptomatic pts.
Now given as first-line therapy for patients with persistent asthma, but if they don't
control symptoms at low doses, it is usual to add a LABA as the next step.
Side effects include hoarseness (dysphonia) and oral candidiasis, which may be
reduced with the use of large-volume spacer device.
✔✔Systemic Corticosteroids - ✔✔Used IV for the treatment of acute severe asthma,
although several studies now show that OCS (usually prednisone or prednisolone 30-45
mg once daily for 5-10 days) is used to treat acute exacerbations of asthma. No
tapering of the dose is needed.
✔✔Antileukotrienes - ✔✔E.g. Montelukast - provide modest clinical benefit in asthma.
Less effective than ICS in controlling asthma and have less effect on airway
inflammation, but are useful as an add-on therapy in some pts not controlled w/ low
doses of ICS, although less effective than LABA.
Given once or twice daily
✔✔Anti-IgE - ✔✔Omalizumab
Reduce number of exacerbations in pts w/ severe asthma and may improve asthma
control.
Very expensive and is only suitable for highly selected pts who are not controlled on
maximal doses of inhaler therapy and have circulating IgE within a specified range.
Given a 3-4 month trial of therapy.
Given subq every 3-4 weeks and appears not to have significant side effects.
✔✔Acute Severe Asthma Management - ✔✔High concentration of oxygen by face mask
yo achieve O2sat >90%.
Mainstay of treatment are high doses of SABA given either by nebulizer or metered-
dose inhaler w/ a spacer.
In severely ill patients with impending respiratory failure, IV B2-agonists may be given.
, A nebulized anticholinergic may be added if there is not a satisfactory response to B2-
agonists alone, as there are additive effects.
In patients who are refractory to inhaled therapies, a slow infusion of aminophylline may
be effective, but it is important to monitor to monitor blood levels, especially of patients
have already been treated w/ oral theophylline.
Magnesium sulfate given IV or by nebulizer is effective when added to inhaled B2-
agonists, and is relatively well-tolerated but is not routinely recommended.
Prophylactic intubation may be indicated for impending resp failure, when PCO2 is
normal or rises.
For pts w/ resp failure, it is necessary to intubate and institute ventilation.
✔✔CAP - ✔✔Essentials of diagnosis include:
-Fever, tachypnea, cough with or w/o sputum, dyspnea, chest discomfort, sweats or
rigors
-Bronchial breath sounds or inspiratory crackles
- Parenchymal opacity on CXR
-Occurs outside the hospital OR within 28 hours of hospital admission in a patient not
residing in long term care facility
- Remember: Patient outcomes improve when initial antibiotic choice is appropriate for
the infecting organism, and improves antibiotic coverage, reduces unnecessary
hospitalization, and improves 30 day survival.
Pathogenesis: Bacteria more common than viruses, with S pneumoniae accounting for
⅔ of bacterial isolates.
✔✔CAP patho, S&S - ✔✔Pathogenesis: Bacteria more common than viruses, with S
pneumoniae accounting for ⅔ of bacterial isolates.
Clinical Findings: Most patients experience acute or subacute onset of fever, cough with
or w/o sputum production and dyspnea. Other symptoms include sweats, chills, rigors,
chest discomfort, pleurisy, hemoptysis, myalgias, headache, abdominal pain.
Physical Findings: Fever or hypothermia, tachypnea, tachycardia, arterial oxygen
desaturation. Patients appear acutely ill, inspiratory crackles and bronchial breath
sounds heard.
✔✔CAP diagnosis - ✔✔A chest radiograph is essential to eval of suspected CAP
Diagnostic testing: In addition to CXR, sputum gram stain, urine antigen test for s.
Pneumoniae and legionella, and rapid antigen detection test for influenza may be used.
Blood cultures should be obtained prior to administration of antibiotics, other labs to be
drawn include CBC, chem panel, and ABG samples
Pulmonary opacity on CXR required for diagnosis of CAP; Chest CT more sensitive.
Findings range from patchy airspace opacities to lobar consolidation with air
bronchograms to diffuse aleveolar or interstitial opacities. Other findings can include
pleural effusions and cavitation. Patients with cavitary opacities should have sputum
fungal and myobacterial cultures
