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