Which type of problem narrows the airways by tightening bronchial smooth muscle?
a. Alveoli
b. Emphysema
c. Chronic bronchitis
d. Bronchoconstriction
ANS: D
The alveoli are not airways, they are air sacs. Emphysema is a disease of flabby airways, not of bronchoconstriction. With chronic bronchitis, the airways are narrowed with swollen mucous membranes not by constriction of the muscles in the airways.
Which part of the airway is affected by excessive mucus?
a. Lumen
b. Cartilage
c. Smooth muscle
d. Mucous membrane
ANS: A
The center of the airway, known as the lumen, is partially or completely plugged with excessive mucus (produced by cells in the mucous membranes). Cartilage and smooth muscle do not come into contact with mucus and are not affected by it.
Which part of the respiratory system is most affected by asthma?
a. Alveoli
b. Airway
c. Trachea
d. Cartilage
ANS: B
Asthma is a chronic disease characterized by intermittent changes in the lower and smaller airways, not the alveoli or the cartilage. The trachea, although it is an airway is too large to be affected by asthma.
Which type of asthma problem is helped most by bronchodilator drugs?
a. Thick mucus
b. Mucosal swelling
c. Bronchoconstriction
d. Large, flabby alveoli
ANS: C
Bronchodilators relax bronchiolar smooth muscle and widen the airways. They do nothing to help flabby alveoli and do nothing to reduce inflammation. Inflammation is responsible for mucus production and mucosal swelling.
What is a common side effect of inhaled anti-inflammatory drugs for asthma?
a. Anemia
b. Bronchoconstriction
c. Cutaneous itching
d. Dry mouth
ANS: D
Anti-inflammatory drugs reduce inflammation and dry all mucous membranes including those in the mouth and throat. They would reduce any cutaneous (skin) itching. They do not work on bronchial smooth muscles or the bone marrow (which produces red bl
Which type of asthma problem is helped most directly by anti-inflammatory drugs?
a. Thick mucus
b. Mucosal swelling
c. Bronchoconstriction
d. Large, flabby alveoli
ANS: B
Anti-inflammatory drugs reduce inflammation and do not help bronchoconstriction. They directly inhibit mucosal swelling and, thus indirectly, reduce mucosal production of mucus. They do not affect mucous that has already formed. Flabby alveoli are
Which of these bronchodilators is a cholinergic antagonist?
a. Albuterol
b. Terbutaline
c. Ipratropium
d. Aminophylline
ANS: C
Albuterol and terbutaline are beta2 agonists. Aminophylline is a xanthine.
Which problem is a common side effect of beta-adrenergic agonist types of bronchodilators?
a. Hypertension
b. Urinary retention
c. Increased bleeding
d. Shortness of breath
ANS: A
Although beta-adrenergic agonists relax bronchial smooth muscle, they cause constriction of vascular (blood vessel) smooth muscle. This action increases peripheral resistance and raises blood pressure.
What is the most common route used to deliver short-acting beta-adrenergic agonists?
a. Oral
b. Intravenous
c. Transdermal
d. Inhalation
ANS: D
Short-acting beta-adrenergic agonists work directly on the airways. They are delivered by oral inhalation so that their effects are exerted almost exclusively on the airway tissues.
Which drug is more commonly used as therapy for chronic obstructive pulmonary disease (COPD) than as therapy for asthma?
a. Epoprostenol (Flolan)
b. Warfarin (Coumadin)
c. Guaifenesin (Organidin)
d. Salmeterol (Serevent)
ANS: C
The presence of thick mucus in the respiratory tract is continuous in COPD and intermittent in asthma. It is often necessary to use systemic mucolytic agents or drugs that decrease mucous production in COPD, but is only rarely indicated for asthma.
Drugs from which classes are considered the mainstays of therapy for pulmonary fibrosis?
a. Amiodarone and ambrisentan
b. Nonsteroidal anti-inflammatories and opiates
c. Corticosteroids and immunosuppressants
d. Disease-modifying antirheumatic drugs and a
ANS: C
Pulmonary fibrosis is characterized by increased cell division and formation of fibrous tissue. The goal of therapy is to slow cell division and the progression of the fibrosis. Only the corticosteroids and immunosuppressants work in this way. In f
The use of which drug or drugs is/are associated with later development of pulmonary artery hypertension (PAH)?
a. Amiodarone and ambrisentan
b. Macitentan and cyclophosphamide
c. Fenfluramine/phentermine
d. Disease-modifying antirheumatic drugs
ANS: C
People who took the weight loss drug fenfluramine/phentermine (known as "fen-phen") had a greatly increased incidence of the relatively rare health problem of pulmonary artery hypertension.
Which problem is the main adverse effect of epoprostenol (Flolan)?
a. Impotence
b. Prolonged bleeding
c. Severe hypertension
d. Congestive heart failure
ANS: B
The action of epoprostenol increases the cyclic adenosine monophosphate (cAMP) in blood vessel smooth muscle, which would cause hypotension not hypertension. It does increase the risk for prolonged bleeding. It is not associated with impotence. Con
What is the main way iloprost (Ilomedin) is administered?
a. Oral inhalation
b. Subcutaneous injection
c. Sublingual tablet
d. Continuous intravenous infusion
ANS: A
Iloprost is an inhaled drug used to treat pulmonary artery hypertension.
Which statement about the pathology of asthma is true?
a. Breath sounds are normal between attacks.
b. Mucous plugs are the major cause of airway obstruction.
c. Eventually the alveoli are destroyed and gas exchange is limited.
d. During an attack, arteri
ANS: A
The two causes of reversible and intermittent airway obstruction with asthma are bronchoconstriction and inflammation. Between asthma attacks the airways are open and normal breath sounds are heard. Mucous plugs can make the airway obstruction wors
Why are long-acting beta-adrenergic agonists not useful during an actual acute asthma attack?
a. They are likely to cause allergies.
b. They need time to build up an effect.
c. They take too long to be absorbed by the intestinal tract.
d. They reduce infl
ANS: B
Long-acting beta2-adrenergic agonists (LABAs) work in the same way as SABAs but need time to build up an effect. Therefore LABAs are used to prevent an asthma attack because their effects last longer but have no value during an acute attack.
Which responses are possible side effects of inhaled beta2-adrenergic agonists? (select all that apply)
a. Bad taste in the mouth
b. Increased salivation
c. Difficulty sleeping
d. Rapid heart rate
e. Hypotension
f. Diarrhea
ANS: A, C, D
Beta2-adrenergic agonists have actions similar to the sympathetic division of the autonomic nervous system. When these drugs are used heavily, they can have systemic effects, which include rapid heart rate, increased blood pressure, a feeling
Which drugs are useful in the management of pulmonary artery hypertension (PAH)? (select all that apply)
a. Anoro Ellipta
b. Bosentan (Tracleer)
c. Cyclophosphamide (Cytoxan)
d. Guaifenesin (Naldecon)
e. Macitentan (Opsumit)
f. Prednisone
g. Riociguat (Ad
ANS: B, E, G
PAH is managed using anticoagulants, guanylate cyclase stimulators, prostacyclin agents, and endothelin-receptor antagonists. Bosentan and macitentan are endothelin-receptor antagonists and riociguat is a guanylate cyclase stimulator.
Which side effects should you monitor for after a patient receives ipratropium (Atrovent)? (select all that apply)
a. Headache
b. Increased urine output
c. Blurred vision
d. Nausea
e. Decreased heart rate
f. Eye pain
g. Muscle aches
ANS: A, C, D, F
Ipratropium (Atrovent) is a cholinergic antagonist drug. Cholinergic antagonists can cause some specific side effects if they reach the bloodstream. These effects include urinary retention, blurred vision, eye pain, nausea, and headache.
A patient has been medicated during an asthma attack. Which assessment finding indicates that the therapy is ineffective?
a. Trachea is at the midline.
b. Oxygen saturation is 96%.
c. Respiratory rate is 22 breaths/min.
d. Peak expiratory flow is 40% belo
ANS: D
A peak expiratory flow rate of 40% below the patient's personal best indicates that the patient is still having difficulty moving air into the respiratory passages because of airway narrowing. The asthma is not responding sufficiently to the drug.
A patient with asthma is prescribed albuterol (Proventil) as needed and salmeterol (Serevent) every 12 hours. When the patient asks why two inhaler drugs are needed, what is your best response?
a. "Albuterol opens your airways and salmeterol decreases the
ANS: C
Even though both drugs are beta2 agonists, they are both normally prescribed for the patient with asthma. Short-acting (rapid-acting) beta2 agonists (albuterol) are used to reduce the severity or stop an asthma attack. Long-acting beta2 agonists (s
A patient newly diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed inhaled pirbuterol (Maxair) every 6 hours. You should instruct the patient to take additional drug doses during which specific times or conditions?
a. At bedtime
b.
ANS: C
Unlike for asthma, short-acting beta2-adrenergic agonists are often prescribed on a schedule and as an additional rescue drug for the patient with COPD. Extra doses may be needed to open the airways whenever the patient feels especially breathless.
A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is your best instruction to the patient?
a. Use the albuterol (Proventil) inhaler instead.
b. Wait at least one full minute between puffs.
c. Attach the space
ANS: A
Salmeterol is a long-acting beta2 agonist. This type of drug needs time to build up an effect and is useful in preventing asthma attacks. The effects of this drug are longer lasting, but are not of value during an acute asthma attack.
A patient with chronic obstructive pulmonary disease (COPD) who is prescribed a short-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug can't be taken as a pill. What is the nurse's best response?
a. "Inhaled drugs work more sl
ANS: D
When used as prescribed, inhaled drugs go more to the site where the intended responses are needed (the airways) and less drug is absorbed systemically. Thus inhaled drugs have fewer (but still have some) side effects. Oral drugs always have system
A patient with asthma asks why he must take regularly scheduled systemic drugs when he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta agonist inhaler. What is your best response?
a. "Frequent asth
ANS: A
Because damage can occur with any asthma attack, the main focus of therapy should be on attack prevention rather than just on symptom management.