chap 30: Asthma & COPD

Question 1

1. Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur:
2. Daily
3. Daily and limit physical activity
4. Less than twice a week
5. More than twice a week and less than once a day

Answer 1

4. More than twice a week and less than once a day

Question 2

2. In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:
3. At nighttime one to two times a month
4. At nighttime three to four times a month
5. Less than twice a week
6. Daily

Answer 2

2. At nighttime three to four times a month

Question 3

3. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is:
4. Ability to use albuterol daily to control symptoms
5. Minimize exacerbations to once a month
6. Keep nighttime symptoms at a maximum of twice a week
7. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms

Answer 3

4. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms

Question 4

4. A stepwise approach to the pharmacologic management of asthma:
5. Begins with determining the severity of asthma and assessing asthma control
6. Is used when asthma is severe and requires daily steroids
7. Allows for each provider to determine their personal approach to the care of asthmatic patients
8. Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma

Answer 4

1. Begins with determining the severity of asthma and assessing asthma control

Question 5

5. Treatment for mild intermittent asthma is:
6. Daily inhaled medium-dose corticosteroids
7. Short-acting beta-2-agonists (albuterol) as needed
8. Long-acting beta-2-agonists every morning as a preventative
9. Montelukast (Singulair) daily

Answer 5

2. Short-acting beta-2-agonists (albuterol) as needed

Question 6

6. The first-line therapy for mild-persistent asthma is:
7. High-dose montelukast
8. Theophylline
9. Low-dose inhaled corticosteroids
10. Long-acting beta-2-agonists

Answer 6

3. Low-dose inhaled corticosteroids

Question 7

7. Monitoring a patient with persistent asthma includes:
8. Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment
9. Monthly in-office spirometry testing
10. Determining if the patient has increased use of his or her long-acting beta-2-agonist due to exacerbations
11. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

Answer 7

4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

Question 8

8. Asthma exacerbations at home are managed by the patient by:
9. Increasing frequency of beta-2-agonists and contacting their provider
10. Doubling inhaled corticosteroid doses
11. Increasing frequency of beta-2-agonists
12. Starting montelukast (Singulair)

Answer 8

1. Increasing frequency of beta-2-agonists and contacting their provider

Question 9

9. Patients who are at risk of a fatal asthma attack include patients:
10. With moderate persistent asthma
11. With a history of requiring intubation or ICU admission for asthma
12. Who are on daily inhaled corticosteroid therapy
13. Who are pregnant

Answer 9

2. With a history of requiring intubation or ICU admission for asthma

Question 10

10. Pregnant patients with asthma may safely use ________ throughout their pregnancy.
11. Oral terbutaline
12. Prednisone
13. Inhaled corticosteroids (budesonide)
14. Montelukast (Singulair)

Answer 10

3. Inhaled corticosteroids (budesonide)

Question 11

11. One goal of asthma management in children is:
12. They independently manage their asthma
13. Participation in school and sports activities
14. No exacerbations
15. Minimal use of inhaled corticosteroids

Answer 11

2. Participation in school and sports activities

Question 12

12. Medications used in the management of patients with chronic obstructive pulmonary disease (COPD) include:
13. Inhaled beta-2-agonists
14. Inhaled anticholinergics (ipratropium)
15. Inhaled corticosteroids
16. All of the above

Answer 12

4. All of the above

Question 13

13. Patients with a COPD exacerbation may require:
14. Doubling of inhaled corticosteroid dose
15. Systemic corticosteroid burst
16. Continuous inhaled beta-2-agonists
17. Leukotriene therapy

Answer 13

2. Systemic corticosteroid burst

Question 14

14. Patients with COPD require monitoring of:
15. Beta-2-agonist use
16. Serum electrolytes
17. Blood pressure
18. Neuropsychiatric effects of montelukast

Answer 14

1. Beta-2-agonist use

Question 15

15. Education of patients with COPD who use inhaled corticosteroids includes:
16. Doubling the dose at the first sign of a URI
17. Using their inhaled corticosteroid first and then their bronchodilator
18. Rinsing their mouth after use
19. Abstaining from smoking for at least 30 minutes after using

Answer 15

3. Rinsing their mouth after use

Question 16

16. Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:
17. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.
18. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.
19. Increase fluid intake to 3 liters per day.
20. Avoid use of aspirin or ibuprofen while using inhaled medications.

Answer 16

2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.