NCLEX-PN › Causes and Treatments of Respiratory Conditions
You are a pulmonology nurse taking care of a patient who complains of episodic wheezing. You perform a diagnostic test in which you perform pulmonary function tests on the patient before, and after administering albuterol, a beta-2 adrenergic agonist. You note that the patient's symptoms and FEV1 readings improve drastically with bronchodilator administration. Based upon these findings, the patient most likely has which of the following?
Asthma
Chronic Obstructive Pulmonary Disease
Lung Cancer
Throat Cancer
Sarcoidosis
The correct answer is "Asthma." This answer is correct because asthma is an inflammatory airway condition that is characteristically improved symptomatically and quantitatively (in terms of pulmonary function tests, including FEV1 readings) with bronchodilator administration (e.g. albuterol, the beta-2 adrenergic agonist administered in this patient). In this patient who presented for evaluation of wheezing, a characteristic symptom of asthma, his substantial response to bronchodilator administration makes the likelihood of an asthma diagnosis very high.
Chronic Obstructive Pulmonary Disease (COPD) is an obstructive physiology of the airways often due to chronic tobacco smoking. While bronchodilators may be of some clinical value in these patients, their FEV1 readings characteristically do not correct after bronchodilator administration, as this is a major method in which COPD can be distinguished from asthma and other inflammatory airway conditions.
Sarcoidosis, lung cancer, and throat cancer symptoms would not necessarily improve with bronchodilator administration, nor would pulmonary function test readings in patients with these conditions.
Which of the following best describes the mechanism of albuterol inhalers during an asthma exacerbation?
Beta adrenergic agonist
Beta adrenergic antagonist
Alpha adrenergic agonist
Alpha adrenergic antagonist
None of these
Albuterol is a beta adrenergic agonist. It helps to open up the airways during an asthma exacerbation by activating the beta adrenergic receptors, part of the sympathetic nervous system. Side effects include increased heart rate.
What is the "hygiene hypothesis" in asthma?
Exposing children to pathogens at a young age will decrease their risk for asthma
Keeping children's hands clean will reduce asthma rates
Dirty water is responsible for many cases of asthma in the developing world
Frequent bathing can reduce the severity of asthma attacks
Incidence of asthma is lower in populations exposed to an abundance of microbes from a young age. The "hygiene hypothesis" suggests that early immune stimulation by multiple forms of infectious agents may push a Th1 phenotype, reducing the Th2 (allergic) response.
All of the following are common triggers for asthma except __________.
squatting
emotional stress or excitement
cold air
exercise
The most commonly reported triggers for asthma attacks are cold air, emotional stress or excitement, infection, irritants such as pollen or dust mites, and exercise. Other triggers may include lying down, exposure to cigarette smoke, or acid reflux.
All of the following changes may be seen in chronic asthma except __________.
destruction of alveolar septa and pulmonary capillaries
hypertrophy and hyperplasia of mucus glands
deposition of subepithelial collagen
epithelial desquamation
Chronic asthma can result in a situation referred to as "airway remodeling," typified by the following changes: increased airway vascularity, epithelial desquamation, deposition of subepithelial collagen, and hypertrophy and hyperplasia of mucus glands and of the underlying muscle layer.
Destruction of alveolar septa and pulmonary capillaries is a common finding in emphysema and does not present in asthma.
A 45-year old obese male with a history of obstructive sleep apnea, hypertension, diabetes, and coronary artery disease presents to your primary care clinic for help in managing his fatigue due to his sleep apnea. He is not a candidate for tonsillectomy and adenoidectomy. Which of the following interventions would be the best recommendation to treat his obstructive sleep apnea?
Continuous positive airway pressure mask (CPAP)
Tamsulosin
Metoprolol
Insulin
Metformin
The correct answer is "continuous positive airway pressure mask (CPAP)." This is the correct answer as a CPAP mask helps to force airway into the lungs that is otherwise obstructed by the patient's oropharyngeal anatomy at standard breathing pressures due to obstructive sleep apnea. When wearing a CPAP mask (typically when sleeping), snoring is reduced, and oxygenation is improved, allowing patients to have a more restful sleep and feel less fatigued the following day.
While medications like metoprolol, insulin, and metformin may be beneficial to the patient in treating his conditions co-morbid to obstructive sleep apnea, they do not have a direct effect on treating his sleep apnea or the resultant fatigue.
Tamsulosin is an alpha-adrenergic blocker and can be used to treat benign prostatic hyperplasia among other conditions, but not obstructive sleep apnea.
A patient has been administered isoniazid for the treatment of tuberculosis (TB). Which statement made by the nurse would be the most appropriate when teaching the client about this medication?
"This medication is known to cause peripheral neuropathy and therefore it is necessary to give pyridoxine prophylactically."
"This medication is expensive and may only be taken subcutaneously."
"This medication must be given by DOT – directly observed therapy."
"This medication must be taken twice daily for 9–12 months."
"This medication is associated with color blindness."
Isoniazid is a bactericidal drug that is given for tuberculosis that has several adverse effects including peripheral neuropathy. This drug is usually administered in conjunction to other antitubercular drugs. Pyridoxine (vitamin B6) is recommended to be taken in conjunction with isoniazid to prevent neurotoxicity.
Isoniazid is relatively inexpensive and may be taken orally or intravenously. It is not necessary to be taken under direct observation, and is usually dosed according to type of disease (active versus latent). The typical duration of administration is roughly 26 weeks. Color blindness is not associated with isoniazid treatment.
What is the inspiratory reserve volume?
The amount of air that can be inhaled after normal inhalation
The amount of air that can be exhaled after normal inhalation
The total amount of air the lung can contain
The amount of air available in the lungs after exhalation
The normal amount of air that is inhaled with each breath
The inspiratory reserve volume for the average adult is roughly 3100mL. It is tested using pulmonary function tests. The inspiratory reserve volume is the amount of air able to be inhaled after a regular inhalation. This is in contrast to the expiratory reserve volume, which is the amount of air that can be exhaled after a regular exhalation.
Which of the following side effects would you most likely expect when providing an asthmatic patient with continuous nebulizer therapy?
Tachycardia
Bradycardia
Hyperthermia
Hypothermia
Pinpoint pupils
Asthma is treated with albuterol. This drug is a beta-2 agonist, which works to relax smooth muscle in the lungs, and open up the airways. A consequence of this drug is the beta-2 effects on the heart. Beta-2 on the heart causes an increase in heart rate (tachycardia) and is a common side effect seen in the treatment of asthmatics.
A 45 year old male with COPD presents to the hospital with an exacerbation of his lung condition. He is in respiratory distress and the physician recommends he sit leaning forward. What is the purpose of sitting like this?
To help exhale air
To help inhale air
To prevent falling
To prevent loss of consciousness
To easily cough out secretions
COPD is a chronic lung condition marked by air trapping. Patients with COPD are instructed to sit in the "tripod" position to help them exhale air. Patients sit and lean forward to help maximize air exiting from the lungs.