NU 636 Quiz 3 - Week 3 Respiratory Quiz Score 34/40

1. Mom brings in her 2-year-old child describing symptoms over the last couple weeks of an increased cough at night and audible wheeze almost daily with relief for a short period of time from use of a short-acting beta2 agonist. Treatment of these moderate persistent asthma symptoms in this child would include: Adding an oral antihistamine for the cough daily Adding an Advair 100/50 (fluticasone/salmeterol) diskus BID Adding 1.0mg Pulmicort respules (budesonide) via nebulizer BID Adding Atrovent 2.0% (ipratropium bromide) solution via nebulizer TID 2. You are seeing a patient who comes in with a complaint of onset of a cough about 5 days ago. The patient says they a sore throat when they first got sick but that only lasted a couple days. The cough is productive for thick white sputum. After listening to the patient’s lung fields, you make the diagnosis of bronchitis. With this initial treatment which of the following will you not recommend? expectorants antitussives antibiotics anti-inflammatories 3. A 20-year-old female comes into the clinic today and tells you she took a home pregnancy test this morning and it was positive. She has a history of intermittent asthma that is controlled with Albuterol. As her primary care NP which of the following instructions do you provide as a part of your treatment plan? Maintain your current asthma management during the pregnancy Avoid use of your asthma medication during the first trimester Discontinue your asthma medications during your pregnancy Have your OB/GYN manage your asthma now 4. A ten-year-old boy with chronic environmental allergies and intermittent asthma comes in for a visit. Current medications include over-the-counter loratadine (Claritin) 10mg daily and 2 puffs of his Albuterol inhaler as needed. He reports that over the last month he is needing to use his Albuterol inhaler before PE class, so he doesn’t get short of breath. Which of the following medications might be considered for treating his now mild persistent asthma that would also be appropriate treatment for his chronic environmental allergies? Claritin D Singulair Allegra Advair diskus 5. A 16-year-old male patient diagnosed with persistent asthma fails to achieve adequate control on step 2 therapy. What medication regimen would be most appropriate for this patient? Daily low dose inhaled corticosteroid Daily medium dose inhaled corticosteroid and a leukotriene receptor agonist Daily medium dose inhaled corticosteroid and a long-acting beta2 agonist Daily low dose inhaled corticosteroid and a long-acting beta2 agonist 6. You are working with an asthma patient and you wanting to add a drug to help control the inflammatory changes in the lungs. You could select from all the following except: Cromolyn sodium inhaler (Intal) Albuterol inhaler (Proventil) Zafirlukast (Accolate) Budesonide (Pulmicort) 7. A COPD patient who had been stable on his regimen of a short-acting beta2 agonist and a long-acting beta2 agonist has been having repeated exacerbations. Which of the following will you include when revising your patient’s treatment plan? Add an inhaled corticosteroid Replace long-acting beta2 agonist with an anticholinergic Start the patient on oxygen at night Discontinue the short-acting beta2 agonist 8. A 38-year-old patient comes in for follow-up of evaluation of episodes of dyspnea on exertion, increased sputum and a cough. The patient is a non-smoker and does not have a history of exposure to second-hand smoke in his home growing up or presently. The pulmonary functions testing you ordered reveal irreversible obstruction. Which of the following interventions will the advanced practice nurse include in the plan for the management of this patient? Begin treatment with an anticholinergic inhaler Treat the patient empirically for pneumonia Perform an in-office peak flow measurement Order a test for alpha1 trypsin deficiency 9. Oral corticosteroids are appropriately prescribed for asthma management when? For moderate and severe exacerbations As a part of Step 2 management As a part of Step 4 management As a part of Step 3 management 10. Your 69-year-old male patient with COPD, who continues to smoke, complains to you that his ipratropium bromide (Atrovent) is just not working. He complains of feeling short of breath even using his Atrovent 2 puffs QID for the last few months. Understanding the current guidelines for the treatment of COPD you recommend which of the following? Continue his Atrovent and add O2 per nasal cannula Add a corticosteroid inhaler Add 2 puffs of albuterol (Ventolin) to his Atrovent regimen Recommend the addition of a Himalayan salt inhaler 11. You are seeing a 45-year-old paramedic who reports with a fever, malaise, a productive cough, and dyspnea. She reports ongoing symptoms for over 3 weeks. She is frustrated that she is having to wear panty liners because she is coughing so much she is ‘wetting herself’. She has been doing Albuterol treatments in the back of the ambulance about every 4 hours trying to get some relief. The treatments don’t seem to be as effective as they were a week ago. You take a CXR and you note bilateral infiltrates. Which of the following antibiotics is best as the first line anti-microbial agent for community acquired pneumonia on an outpatient basis? Amoxicillin Ciprofloxacin Azithromycin Keflex 12. You are seeing a 7-year-old patient with asthma. The patient has been categorized as having intermittent asthma previously. Now dad and the patient report the patient is waking up once a week with a cough. The presence of these nighttime awakening symptoms moves your patient out of a diagnosis of intermittent asthma to a diagnosis of mild persistent asthma. To date your patient had been managed with a short-acting beta2 agonist (Ventolin) only. Understanding step therapy, you will choose any of the following agents except: Montelukast (Singular) Budesonide turbuhaler (Pulmicort Turbuhaler) Ipratropium bromide inhaler (Atrovent) Cromolyn inhaler (Intal) 13. Mom brings in her 5-year-old for evaluation of possible sinusitis. Mom reports both she and the child have environmental allergy problems. You observe the child with copious amounts of thick, green nasal drainage. Mom reports the child has not been playing much or eating well for the last several days and has been running a fever the last two days. The temperature reading obtained in your office 102. Mom’s presumptive diagnosis is supported with your evaluation. Mom reports the child has a drug allergy to amoxicillin having broken out seven days after taking it and had the rash for over a week and was miserable. Which of the following antibiotics is the appropriate treatment for this child’s acute bacterial sinusitis? Augmentin Bactrim Levofloxacin Ceftin 14. A patient reports that despite the use of an Albuterol inhaler she is still experiencing some ‘troubles breathing’ and has a lot of clear mucus. A Spirometry test performed last week indicated an FEV/FVC = 70% and her FEV1 = 39% of expected. Based on these findings you know that she is in Stage II (moderate) COPD. Which of the following medications is best added next to her short-acting beta2 agonist for long-term treatment? An anti-diabetic medication An anticholinergic inhaler A leukotriene receptor agonist A short-acting beta2 adrenergic agonist 15. For your adult patient with acute, uncomplicated bacterial sinusitis how many days would the Amoxicillin be prescribed for? 21 days 7 days 14 days 10 days 16. You are educating a patient newly diagnosed with intermittent asthma about their use of their Albuterol inhaler. Which of the following patient education statements is most appropriate? The frequency you use your inhaler for symptom control is not important Use of your inhaler <2 times a week indicates control of your asthma It is important to minimize your activity when using your inhaler Use of your inhaler >6 times a week indicates control of your asthma 17. One of your well-managed hypertensive patients comes in because their blood pressure has been elevated for the last five days. During your evaluation of the patient you do a medication review that does not reveal any new medications. You notice that your patient is ‘sniffling’ quite a bit during the interview. You explore that symptom with the patient who reports they have been having cold symptoms for the last week. Which of the following over-the-counter medication categories do you suspect the patient may be taking for managing their cold symptoms? Guaifenesin (Mucinex) Dextromethorphan (Delsym) Pseudoephedrine (Sudafed) Naproxen sodium (Aleve) 18. Theophylline has been used in the treatment of COPD for seven decades. With the advent of better tolerated medications with less side effects it fell out of favor. However, it is still utilized with appropriate patients with COPD. As you consider the addition of Theophylline for your COPD patient you take into consideration that Theophylline (Theo-24) can interact with all the following drugs except: Phenytoin sodium (Dilantin) Cimetidine (Tagamet) Erythromycin (EryTab) Montelukast (Singulair) 19. Your 21-year-old college athlete comes in complaining of having cold symptoms for the last ten days or so. Now they report experiencing sinus pressure, facial pain, ‘bad breath’ and a cough. They are blowing out green purulent nasal discharge. The patient has been using over-the-counter nasal sprays, antihistamines and anti-inflammatories to manage the symptoms. These approaches have not resulted in resolution of the symptoms which seem to be getting worse. Based on the presentation of symptoms and your exam findings you diagnose the patient with acute bacterial sinusitis you could consider waiting a few more days before adding an antibiotic. Which of the following would the advanced practice nurse anticipate would be prescribed for a patient with no known drug allergies? Azithromycin Ciprofloxacin Amoxicillin Erythromycin 20. You are seeing a 15-year-old with a diagnosis of intermittent asthma who reports she uses her Ventolin inhaler (short-acting beta2 agonist) maybe a couple times a month. Understanding stepwise asthma management, which of the following should be added for daily long-term therapy? A low dose inhaled corticosteroid No long-term management is needed Montelukast (Singulair) daily A long-acting beta2 agonist