NURS 621 Midterm Exam Questions With Complete
Solutions
Acute bronchitiIS DDX Correct Answer DDx:
• Common cold/viral URI
• Asthma exacerbation
• Acute exacerbation of chronic bronchitis
• PNA
Acute bronchitis DX HP Correct Answer H&P:
• *Acute infection of lower respiratory tract manifested by
cough with or without sputum that lasts up to 3 weeks
• Risks
o Smoking, malignancy, hx splenectomy, HIV positive
Acute bronchitis labs/dx Correct Answer Lab/diagnostics:
• No dx test to differentiate b/t this and common cold
• Usually caused by virus (90%) - influenza A,B; parainfluenza,
respiratory syncytial viruses
o Bacteria - mycoplasma pneumoniae, chlamydophila
pneumonia, bordatella pertussis
ASTHAM TXT PLAN Correct Answer Tx plan:
• Stepwise - pt is reassessed in 2-6 weeks for effectiveness of
therapy. When pt controlled for 3 months, therapy is step down
o Step 1: intermittent - SABA PRN
o Step 2: mild persistent - low inhaled corticosteroid (ICS)
o Step 3: mod persistent - low ICS + LABA or medium ICS
o Step 4: severe persistent - consult asthma specialist
• Relievers
o SABA
,o Adrenergic agonists - albuterol, advair, serevent diskus
o Anticholinergics - atrovent for acute exacerbations
o Theophylline
o Oral corticosteroids - prednisone or prednisolone
• Controllers
o Cromolyn (intal)
o Leukotrienes (singulair, accolade)
o Inhaled corticosteroids - asmanex, aerobid, aerospan, flovent,
QVAR, pulmicort (neb)
o LABA
o Inhaled NSAIDs
o Methylxanthines
o Anti-IgE therapy (Xolair)
• Combo drugs - ICS/LABA
Fluticasone/salmeterol (Advair)
Budsonide/formoterol (symbicort)
Mometasone/formoterol (Dulera
ASTHMA DDX Correct Answer DDx:
• COPD
• Bronchogenic carcinoma
• Obliteraative bronchiolitis
• Esinophilic bronchitis
• Bronchiectasis
• Vocal cord dysfunction
• Angiotensin-converting enzyme inhibitors
• GERD
• Different forms of asthma:
o Occupational, cough variant, nocturnal, exercise induced
ASTHMA DDX Correct Answer Lab/diagnostics:
, • Spirometry - at initial dx and at least every 1-2 years
• PEFR - used for follow-up, not dx
• Normal FEV1/FVC:
o 8-19y = 85%
o 20-39y = 80%
o 40-59% = 75%
o 60-80y = 70%
ASTHMA EDUCATION Correct Answer Education:
• ICS
o Delayed onset of action, take EVERY DAY, demonstrate
proper technique and teach back, use spacer, rinse and spit after
use, change canister
• Written asthma plan
• Monitoring asthma
• Environmental control
ASTHMA FU Correct Answer RESOURCES
ASTHMA H&P Correct Answer Dx: Asthma
H&P:
• Symptoms: cough, wheezing, SOB.
o Can be perennial/seasonal, episodic/continual, diurnal
• Daytime or nighttime symptoms
o Cough at night or early morning
• Number of times needed quick-relief meds
• Emergency room visits or hospitalization
• Missed days from school or work
• Ability to maintain normal activity levels
• Triggers
Solutions
Acute bronchitiIS DDX Correct Answer DDx:
• Common cold/viral URI
• Asthma exacerbation
• Acute exacerbation of chronic bronchitis
• PNA
Acute bronchitis DX HP Correct Answer H&P:
• *Acute infection of lower respiratory tract manifested by
cough with or without sputum that lasts up to 3 weeks
• Risks
o Smoking, malignancy, hx splenectomy, HIV positive
Acute bronchitis labs/dx Correct Answer Lab/diagnostics:
• No dx test to differentiate b/t this and common cold
• Usually caused by virus (90%) - influenza A,B; parainfluenza,
respiratory syncytial viruses
o Bacteria - mycoplasma pneumoniae, chlamydophila
pneumonia, bordatella pertussis
ASTHAM TXT PLAN Correct Answer Tx plan:
• Stepwise - pt is reassessed in 2-6 weeks for effectiveness of
therapy. When pt controlled for 3 months, therapy is step down
o Step 1: intermittent - SABA PRN
o Step 2: mild persistent - low inhaled corticosteroid (ICS)
o Step 3: mod persistent - low ICS + LABA or medium ICS
o Step 4: severe persistent - consult asthma specialist
• Relievers
o SABA
,o Adrenergic agonists - albuterol, advair, serevent diskus
o Anticholinergics - atrovent for acute exacerbations
o Theophylline
o Oral corticosteroids - prednisone or prednisolone
• Controllers
o Cromolyn (intal)
o Leukotrienes (singulair, accolade)
o Inhaled corticosteroids - asmanex, aerobid, aerospan, flovent,
QVAR, pulmicort (neb)
o LABA
o Inhaled NSAIDs
o Methylxanthines
o Anti-IgE therapy (Xolair)
• Combo drugs - ICS/LABA
Fluticasone/salmeterol (Advair)
Budsonide/formoterol (symbicort)
Mometasone/formoterol (Dulera
ASTHMA DDX Correct Answer DDx:
• COPD
• Bronchogenic carcinoma
• Obliteraative bronchiolitis
• Esinophilic bronchitis
• Bronchiectasis
• Vocal cord dysfunction
• Angiotensin-converting enzyme inhibitors
• GERD
• Different forms of asthma:
o Occupational, cough variant, nocturnal, exercise induced
ASTHMA DDX Correct Answer Lab/diagnostics:
, • Spirometry - at initial dx and at least every 1-2 years
• PEFR - used for follow-up, not dx
• Normal FEV1/FVC:
o 8-19y = 85%
o 20-39y = 80%
o 40-59% = 75%
o 60-80y = 70%
ASTHMA EDUCATION Correct Answer Education:
• ICS
o Delayed onset of action, take EVERY DAY, demonstrate
proper technique and teach back, use spacer, rinse and spit after
use, change canister
• Written asthma plan
• Monitoring asthma
• Environmental control
ASTHMA FU Correct Answer RESOURCES
ASTHMA H&P Correct Answer Dx: Asthma
H&P:
• Symptoms: cough, wheezing, SOB.
o Can be perennial/seasonal, episodic/continual, diurnal
• Daytime or nighttime symptoms
o Cough at night or early morning
• Number of times needed quick-relief meds
• Emergency room visits or hospitalization
• Missed days from school or work
• Ability to maintain normal activity levels
• Triggers
