MSN 621 FINAL EXAM 3 2026 SOLVED
QUESTIONS ANSWERS GRADED A PLUS
EVIDENCE BASED PRACTICE HANDBOOK
◉ Who is at highest risk for asthma?
Answer: genetic predisposition, specifically a personal or family
history of atopy (propensity to allergy, usually seen as eczema, hay
fever, and asthma)
◉ What are some triggers to asthma?
Answer: Viral respiratory tract infections
Exercise
Gastroesophageal reflux disease
Chronic sinusitis
Environmental allergens
Use of aspirin, beta-blockers
Tobacco smoke
Insects, plants, chemical fumes
Obesity
Emotional factors or stress
,◉ Asthma is significantly more common in children. Up to 40% of
children will have a wheeze at some point, which, if reversible by
______, is termed asthma, regardless of lung function tests.
Answer: beta-2 agonists
◉ Describe ages for asthma.
Answer: In childhood, asthma is more common in boys with a male
to female ratio of 2:1 until puberty when the ratio becomes 1:1.
After puberty, the prevalence of asthma is greater in females, and
adult-onset cases after the age of 40 years are mostly females.
Asthma prevalence is greater in extreme of ages due to airway
responsiveness and lower levels of lung function. Of all the asthma
cases, about 66% are diagnosed before the age of 18 years. almost
50% of children with asthma have a decrease in severity or
disappearance of symptoms during early adulthood.
◉ Describe the patho of asthma.
Answer: acute, fully reversible airway inflammation
The pathological process begins with the inhalation of an irritant
(e.g., cold air) or an allergen (e.g., pollen), which then, due to
bronchial hypersensitivity, leads to airway inflammation and an
increase in mucus production. This leads to a significant increase in
airway resistance, which is most pronounced on expiration.
Airway obstruction occurs due to the combination of:
,-Inflammatory cell infiltration.
-Mucus hypersecretion with mucus plug formation.
-Smooth muscle contraction.
These irreversible changes may become irreversible over time due
to
-Basement membrane thickening, collagen deposition, and epithelial
desquamation.
-Airway remodeling occurs in chronic disease with smooth muscle
hypertrophy and hyperplasia.
If not corrected rapidly, asthma may become more difficult to treat,
as the mucus production prevents the inhaled medication from
reaching the mucosa. The inflammation also becomes more
edematous. This process is resolved (in theory complete resolution
is required in asthma, but in practice, this is not checked or tested)
with beta-2 agonists (e.g., salbutamol, salmeterol, albuterol) and can
be aided by muscarinic receptor antagonists (e.g., ipratropium
bromide), which act to reduce the inflammation and relax the
bronchial musculature, as well as reducing mucus production.
◉ Describe the toxicokinetics in asthma.
Answer: The only relevant toxicokinetics in asthma relates to its
management as the absorption and systemic side effects of the beta-
2 agonists must be monitored. Typically these will be removed from
, the body in 2 to 4 hours if salbutamol and albuterol, 18 to 24 hours if
salmeterol, or 48 to 72 hours if clenbuterol, which is no longer used
in the management of asthma.
The side effects of the beta-2 agonists include tachycardia, flushing,
sweating, and other signs of sympathetic system overdrive. There is
also the chance of iatrogenic hypokalaemia, which must be
monitored.
◉ Describe the history and physical of asthma.
Answer: wheeze or a cough, exacerbated by allergies, exercise, and
cold
symptoms are worse at night
may give a history of other forms of atopy, such as eczema and hay
fever. There may be some mild chest pain associated with acute
exacerbations. Many asthmatics have nocturnal coughing spells but
appear normal in the day time.
◉ Describe the s/s of acute asthma exacerbation.
Answer: During an acute exacerbation, there may be a fine tremor in
the hands due to salbutamol use, and mild tachycardia. Patients will
show some respiratory distress, often sitting forward to splint open
their airways. On auscultation, a bilateral, expiratory wheeze will be
heard. In life-threatening asthma, the chest may be silent, as air
cannot enter or leave the lungs, and there may be signs of systemic
hypoxia.
QUESTIONS ANSWERS GRADED A PLUS
EVIDENCE BASED PRACTICE HANDBOOK
◉ Who is at highest risk for asthma?
Answer: genetic predisposition, specifically a personal or family
history of atopy (propensity to allergy, usually seen as eczema, hay
fever, and asthma)
◉ What are some triggers to asthma?
Answer: Viral respiratory tract infections
Exercise
Gastroesophageal reflux disease
Chronic sinusitis
Environmental allergens
Use of aspirin, beta-blockers
Tobacco smoke
Insects, plants, chemical fumes
Obesity
Emotional factors or stress
,◉ Asthma is significantly more common in children. Up to 40% of
children will have a wheeze at some point, which, if reversible by
______, is termed asthma, regardless of lung function tests.
Answer: beta-2 agonists
◉ Describe ages for asthma.
Answer: In childhood, asthma is more common in boys with a male
to female ratio of 2:1 until puberty when the ratio becomes 1:1.
After puberty, the prevalence of asthma is greater in females, and
adult-onset cases after the age of 40 years are mostly females.
Asthma prevalence is greater in extreme of ages due to airway
responsiveness and lower levels of lung function. Of all the asthma
cases, about 66% are diagnosed before the age of 18 years. almost
50% of children with asthma have a decrease in severity or
disappearance of symptoms during early adulthood.
◉ Describe the patho of asthma.
Answer: acute, fully reversible airway inflammation
The pathological process begins with the inhalation of an irritant
(e.g., cold air) or an allergen (e.g., pollen), which then, due to
bronchial hypersensitivity, leads to airway inflammation and an
increase in mucus production. This leads to a significant increase in
airway resistance, which is most pronounced on expiration.
Airway obstruction occurs due to the combination of:
,-Inflammatory cell infiltration.
-Mucus hypersecretion with mucus plug formation.
-Smooth muscle contraction.
These irreversible changes may become irreversible over time due
to
-Basement membrane thickening, collagen deposition, and epithelial
desquamation.
-Airway remodeling occurs in chronic disease with smooth muscle
hypertrophy and hyperplasia.
If not corrected rapidly, asthma may become more difficult to treat,
as the mucus production prevents the inhaled medication from
reaching the mucosa. The inflammation also becomes more
edematous. This process is resolved (in theory complete resolution
is required in asthma, but in practice, this is not checked or tested)
with beta-2 agonists (e.g., salbutamol, salmeterol, albuterol) and can
be aided by muscarinic receptor antagonists (e.g., ipratropium
bromide), which act to reduce the inflammation and relax the
bronchial musculature, as well as reducing mucus production.
◉ Describe the toxicokinetics in asthma.
Answer: The only relevant toxicokinetics in asthma relates to its
management as the absorption and systemic side effects of the beta-
2 agonists must be monitored. Typically these will be removed from
, the body in 2 to 4 hours if salbutamol and albuterol, 18 to 24 hours if
salmeterol, or 48 to 72 hours if clenbuterol, which is no longer used
in the management of asthma.
The side effects of the beta-2 agonists include tachycardia, flushing,
sweating, and other signs of sympathetic system overdrive. There is
also the chance of iatrogenic hypokalaemia, which must be
monitored.
◉ Describe the history and physical of asthma.
Answer: wheeze or a cough, exacerbated by allergies, exercise, and
cold
symptoms are worse at night
may give a history of other forms of atopy, such as eczema and hay
fever. There may be some mild chest pain associated with acute
exacerbations. Many asthmatics have nocturnal coughing spells but
appear normal in the day time.
◉ Describe the s/s of acute asthma exacerbation.
Answer: During an acute exacerbation, there may be a fine tremor in
the hands due to salbutamol use, and mild tachycardia. Patients will
show some respiratory distress, often sitting forward to splint open
their airways. On auscultation, a bilateral, expiratory wheeze will be
heard. In life-threatening asthma, the chest may be silent, as air
cannot enter or leave the lungs, and there may be signs of systemic
hypoxia.
