NR 603 Week 2 Case Discussion Pulmonary
- Part 2 Follow up Visit Complete Solution
Section 1: Asthma Management & Follow-Up
1. A patient returns for a follow-up visit after an asthma exacerbation. They report using their
albuterol inhaler 4 times daily for the past week. Which classification of asthma severity does
this indicate?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
[CORRECT] C. Moderate persistent
[RATIONALE] Moderate persistent asthma is characterized by daily symptoms, use of a
short-acting beta-agonist (SABA) daily, and nighttime awakenings more than once a week but
not nightly. Using albuterol 4 times daily indicates daily symptoms requiring daily SABA use.
2. Which of the following is the preferred controller medication for a patient with moderate
persistent asthma?
A. Montelukast
B. Low-dose inhaled corticosteroid (ICS)
C. Medium-dose ICS + Long-acting beta-agonist (LABA)
D. Oral prednisone
[CORRECT] C. Medium-dose ICS + Long-acting beta-agonist (LABA)
[RATIONALE] For moderate persistent asthma, guidelines recommend a medium-dose ICS
plus a LABA as the preferred controller therapy to achieve symptom control and reduce
exacerbation risk.
3. A patient with asthma states they feel fine and have stopped taking their inhaled
corticosteroid. What is the most important teaching point?
A. "You can stop it if you have no symptoms."
B. "You should only take it when you have an attack."
C. "This medication reduces airway inflammation even when you feel well."
D. "You should switch to an oral medication instead."
[CORRECT] C. "This medication reduces airway inflammation even when you feel well."
[RATIONALE] ICS are controller medications that reduce underlying airway inflammation.
,They must be taken daily, even when asymptomatic, to prevent exacerbations and maintain
control.
4. Which finding on spirometry confirms a diagnosis of asthma?
A. FEV1/FVC ratio > 0.70
B. Reversibility of FEV1 by ≥12% and ≥200 mL after SABA
C. Decreased total lung capacity
D. Increased DLCO
[CORRECT] B. Reversibility of FEV1 by ≥12% and ≥200 mL after SABA
[RATIONALE] A key diagnostic feature of asthma is reversible airflow obstruction,
demonstrated by an improvement in FEV1 of at least 12% and 200 mL after administration of a
short-acting bronchodilator.
5. A patient with asthma is prescribed a LABA. Which warning is essential to include in patient
education?
A. "This medication should be used as a rescue inhaler."
B. "Never use this medication alone without an ICS."
C. "This medication can cause hyperglycemia."
D. "You can use this medication as often as needed."
[CORRECT] B. "Never use this medication alone without an ICS."
[RATIONALE] LABAs must not be used as monotherapy in asthma due to an increased risk of
severe asthma-related events, including death. They must always be combined with an ICS.
6. Which of the following is a common trigger for asthma exacerbations?
A. Beta-blockers
B. NSAIDs
C. Cold air
D. All of the above
[CORRECT] D. All of the above
[RATIONALE] Asthma triggers are varied and include pharmacological agents (beta-blockers,
NSAIDs), environmental factors (cold air, allergens, smoke), and emotional stress.
7. A patient presents with an acute asthma exacerbation. They are speaking in full sentences
and have an oxygen saturation of 94%. What is the initial treatment of choice?
A. Oral corticosteroids
B. Inhaled SABA
C. Intravenous magnesium
D. Non-invasive positive pressure ventilation
[CORRECT] B. Inhaled SABA
, [RATIONALE] The cornerstone of acute asthma exacerbation treatment is repeated
administration of an inhaled short-acting beta-agonist (SABA) like albuterol, often combined
with ipratropium.
8. Which of the following patients with asthma should be considered for a referral to a
pulmonologist?
A. A patient who needs a SABA once a week
B. A patient with well-controlled symptoms on low-dose ICS
C. A patient who has had two or more exacerbations requiring oral steroids in a year
D. A patient who has mild intermittent asthma
[CORRECT] C. A patient who has had two or more exacerbations requiring oral steroids in
a year
[RATIONALE] Referral to a specialist is indicated for patients with poor control, frequent
exacerbations, or those requiring step 4 or higher therapy.
9. A patient with asthma has a peak flow reading in the yellow zone. What does this indicate?
A. Asthma is well controlled.
B. Caution: asthma is getting worse.
C. Medical alert: severe exacerbation.
D. The reading is invalid.
[CORRECT] B. Caution: asthma is getting worse.
[RATIONALE] The yellow zone on a peak flow meter (50-79% of personal best) indicates a
deterioration in asthma control and a need to follow the action plan, which may include
increased medication.
10. Which medication is a leukotriene receptor antagonist used in asthma?
A. Albuterol
B. Montelukast
C. Fluticasone
D. Tiotropium
[CORRECT] B. Montelukast
[RATIONALE] Montelukast is a leukotriene receptor antagonist (LTRA) used as an alternative
or add-on controller medication for asthma.
11. SATA: Which of the following are goals of asthma management? (Select all that apply.)
A. Reduce impairment
B. Reduce risk of exacerbations
C. Achieve normal lung function
D. Eliminate the need for all medications
, [CORRECT] A. Reduce impairment
[CORRECT] B. Reduce risk of exacerbations
[CORRECT] C. Achieve normal lung function
[RATIONALE] The goals of asthma management are to reduce impairment (symptoms,
nighttime awakenings, use of SABA, maintain normal activity) and reduce risk (prevent
exacerbations, prevent loss of lung function, minimize medication side effects). Eliminating all
medications is not a goal.
12. A patient with asthma is started on a high-dose ICS. Which side effect should the nurse
practitioner monitor for?
A. Hypoglycemia
B. Oral candidiasis
C. Hypertension
D. Bradycardia
[CORRECT] B. Oral candidiasis
[RATIONALE] Inhaled corticosteroids can lead to local side effects such as oral candidiasis
(thrush) and dysphonia. Patients should rinse their mouth after use.
13. A patient with asthma reports using their albuterol inhaler before exercise. This is an
example of:
A. Poor asthma control
B. Exercise-induced bronchoconstriction (EIB)
C. Medication overuse
D. A need for oral steroids
[CORRECT] B. Exercise-induced bronchoconstriction (EIB)
[RATIONALE] Pre-treatment with a SABA before exercise is a standard strategy for
preventing exercise-induced bronchoconstriction, a common asthma phenotype.
14. Which of the following is a long-acting muscarinic antagonist (LAMA) used in asthma?
A. Ipratropium
B. Tiotropium
C. Salmeterol
D. Formoterol
[CORRECT] B. Tiotropium
[RATIONALE] Tiotropium is a long-acting muscarinic antagonist (LAMA) that can be used as
an add-on therapy for asthma. Ipratropium is a short-acting muscarinic antagonist (SAMA).
15. A patient's asthma is not controlled on medium-dose ICS + LABA. What is the next
recommended step?
- Part 2 Follow up Visit Complete Solution
Section 1: Asthma Management & Follow-Up
1. A patient returns for a follow-up visit after an asthma exacerbation. They report using their
albuterol inhaler 4 times daily for the past week. Which classification of asthma severity does
this indicate?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
[CORRECT] C. Moderate persistent
[RATIONALE] Moderate persistent asthma is characterized by daily symptoms, use of a
short-acting beta-agonist (SABA) daily, and nighttime awakenings more than once a week but
not nightly. Using albuterol 4 times daily indicates daily symptoms requiring daily SABA use.
2. Which of the following is the preferred controller medication for a patient with moderate
persistent asthma?
A. Montelukast
B. Low-dose inhaled corticosteroid (ICS)
C. Medium-dose ICS + Long-acting beta-agonist (LABA)
D. Oral prednisone
[CORRECT] C. Medium-dose ICS + Long-acting beta-agonist (LABA)
[RATIONALE] For moderate persistent asthma, guidelines recommend a medium-dose ICS
plus a LABA as the preferred controller therapy to achieve symptom control and reduce
exacerbation risk.
3. A patient with asthma states they feel fine and have stopped taking their inhaled
corticosteroid. What is the most important teaching point?
A. "You can stop it if you have no symptoms."
B. "You should only take it when you have an attack."
C. "This medication reduces airway inflammation even when you feel well."
D. "You should switch to an oral medication instead."
[CORRECT] C. "This medication reduces airway inflammation even when you feel well."
[RATIONALE] ICS are controller medications that reduce underlying airway inflammation.
,They must be taken daily, even when asymptomatic, to prevent exacerbations and maintain
control.
4. Which finding on spirometry confirms a diagnosis of asthma?
A. FEV1/FVC ratio > 0.70
B. Reversibility of FEV1 by ≥12% and ≥200 mL after SABA
C. Decreased total lung capacity
D. Increased DLCO
[CORRECT] B. Reversibility of FEV1 by ≥12% and ≥200 mL after SABA
[RATIONALE] A key diagnostic feature of asthma is reversible airflow obstruction,
demonstrated by an improvement in FEV1 of at least 12% and 200 mL after administration of a
short-acting bronchodilator.
5. A patient with asthma is prescribed a LABA. Which warning is essential to include in patient
education?
A. "This medication should be used as a rescue inhaler."
B. "Never use this medication alone without an ICS."
C. "This medication can cause hyperglycemia."
D. "You can use this medication as often as needed."
[CORRECT] B. "Never use this medication alone without an ICS."
[RATIONALE] LABAs must not be used as monotherapy in asthma due to an increased risk of
severe asthma-related events, including death. They must always be combined with an ICS.
6. Which of the following is a common trigger for asthma exacerbations?
A. Beta-blockers
B. NSAIDs
C. Cold air
D. All of the above
[CORRECT] D. All of the above
[RATIONALE] Asthma triggers are varied and include pharmacological agents (beta-blockers,
NSAIDs), environmental factors (cold air, allergens, smoke), and emotional stress.
7. A patient presents with an acute asthma exacerbation. They are speaking in full sentences
and have an oxygen saturation of 94%. What is the initial treatment of choice?
A. Oral corticosteroids
B. Inhaled SABA
C. Intravenous magnesium
D. Non-invasive positive pressure ventilation
[CORRECT] B. Inhaled SABA
, [RATIONALE] The cornerstone of acute asthma exacerbation treatment is repeated
administration of an inhaled short-acting beta-agonist (SABA) like albuterol, often combined
with ipratropium.
8. Which of the following patients with asthma should be considered for a referral to a
pulmonologist?
A. A patient who needs a SABA once a week
B. A patient with well-controlled symptoms on low-dose ICS
C. A patient who has had two or more exacerbations requiring oral steroids in a year
D. A patient who has mild intermittent asthma
[CORRECT] C. A patient who has had two or more exacerbations requiring oral steroids in
a year
[RATIONALE] Referral to a specialist is indicated for patients with poor control, frequent
exacerbations, or those requiring step 4 or higher therapy.
9. A patient with asthma has a peak flow reading in the yellow zone. What does this indicate?
A. Asthma is well controlled.
B. Caution: asthma is getting worse.
C. Medical alert: severe exacerbation.
D. The reading is invalid.
[CORRECT] B. Caution: asthma is getting worse.
[RATIONALE] The yellow zone on a peak flow meter (50-79% of personal best) indicates a
deterioration in asthma control and a need to follow the action plan, which may include
increased medication.
10. Which medication is a leukotriene receptor antagonist used in asthma?
A. Albuterol
B. Montelukast
C. Fluticasone
D. Tiotropium
[CORRECT] B. Montelukast
[RATIONALE] Montelukast is a leukotriene receptor antagonist (LTRA) used as an alternative
or add-on controller medication for asthma.
11. SATA: Which of the following are goals of asthma management? (Select all that apply.)
A. Reduce impairment
B. Reduce risk of exacerbations
C. Achieve normal lung function
D. Eliminate the need for all medications
, [CORRECT] A. Reduce impairment
[CORRECT] B. Reduce risk of exacerbations
[CORRECT] C. Achieve normal lung function
[RATIONALE] The goals of asthma management are to reduce impairment (symptoms,
nighttime awakenings, use of SABA, maintain normal activity) and reduce risk (prevent
exacerbations, prevent loss of lung function, minimize medication side effects). Eliminating all
medications is not a goal.
12. A patient with asthma is started on a high-dose ICS. Which side effect should the nurse
practitioner monitor for?
A. Hypoglycemia
B. Oral candidiasis
C. Hypertension
D. Bradycardia
[CORRECT] B. Oral candidiasis
[RATIONALE] Inhaled corticosteroids can lead to local side effects such as oral candidiasis
(thrush) and dysphonia. Patients should rinse their mouth after use.
13. A patient with asthma reports using their albuterol inhaler before exercise. This is an
example of:
A. Poor asthma control
B. Exercise-induced bronchoconstriction (EIB)
C. Medication overuse
D. A need for oral steroids
[CORRECT] B. Exercise-induced bronchoconstriction (EIB)
[RATIONALE] Pre-treatment with a SABA before exercise is a standard strategy for
preventing exercise-induced bronchoconstriction, a common asthma phenotype.
14. Which of the following is a long-acting muscarinic antagonist (LAMA) used in asthma?
A. Ipratropium
B. Tiotropium
C. Salmeterol
D. Formoterol
[CORRECT] B. Tiotropium
[RATIONALE] Tiotropium is a long-acting muscarinic antagonist (LAMA) that can be used as
an add-on therapy for asthma. Ipratropium is a short-acting muscarinic antagonist (SAMA).
15. A patient's asthma is not controlled on medium-dose ICS + LABA. What is the next
recommended step?
