Question 1

A patient with stable COPD is prescribed a bronchodilator by the provider. Which type of bronchodilator is preferred for this patient? A) A long-acting inhaled $\beta$₂ agonist (LABA) B) An oral $\beta$₂ agonist C) A short-acting $\beta$₂ agonist (SABA) D) An intravenous methylxanthine

Accepted Answer

Long-acting inhaled beta agonists (LABAs) are preferred for stable COPD management due to their prolonged duration of action, which provides better symptom control and improves quality of life.

Question 2

A patient with seasonal and perennial rhinitis requests a prescription for the most effective drug for treating this condition. Which medication will the provider recommend?&#10;A) Pseudoephedrine&#10;B) Fluticasone propionate&#10;C) Loratadine&#10;D) Intranasal cromolyn sodium

Accepted Answer

Fluticasone propionate is a corticosteroid that is highly effective in treating both seasonal and perennial rhinitis by reducing inflammation in the nasal passages, which is a key component of the allergic response.

Question 3

A patient takes oral theophylline twice daily for chronic stable asthma. After developing an infection, the patient went to an after-hours clinic where ciprofloxacin was prescribed. What action will the patient's primary provider take when the patient follows up the next day?

A) Prescribe a different antibiotic.
B) Reduce the theophylline dose.
C) Increase the theophylline dose.
D) Discontinue the theophylline and prescribe a long-acting

\beta

agonist.

Reduce the theophylline dose.

Accepted Answer

Ciprofloxacin inhibits the metabolism of theophylline, increasing its serum concentration and potential for toxicity.

Question 4

A patient with a cold used phenylephrine nasal spray, 2 sprays every 4 hours, for a week. Since then it has become impossible to discontinue the medication because the nasal congestion has increased. What action will the provider take?

A) Prescribe an oral decongestant to replace the intranasal phenylephrine.
B) Order an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
C) Increase the dose of phenylephrine to 4 sprays every 4 hours.
D) Stop the phenylephrine and discuss using an intranasal antihistamine.

Accepted Answer

The patient is likely experiencing rebound congestion from prolonged use of a topical decongestant (phenylephrine). The best approach is to withdraw the phenylephrine and start an intranasal glucocorticoid to manage the congestion without causing rebound symptoms.

Question 5

A patient develops an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast, and a short acting $\beta$ ₂ agonist as needed via metered-dose inhaler (MDI). The patient's respiratory rate is 18 breaths/minute, heart rate is 96 beats/minute, and an oxygen saturation is 95%. The provider auscultates mild expiratory wheezes bilaterally. What action will the provider take first?

A) Prescribe a systemic glucocorticoid.
B) Prescribe a long-acting

\beta

₂ agonist.
C) Evaluate the need for teaching about MDI use.
D) Question the patient about how much albuterol has been used.

Accepted Answer

In the context of an asthma exacerbation, the first step is often to assess the patient's use of their short-acting beta agonist (such as albuterol), which is used for quick relief of asthma symptoms. This helps determine the severity of the exacerbation and whether the patient's current management plan is effective.

Question 6

A child with allergic rhinitis has used budesonide for several years. The parents are concerned that the child's rate of growth has slowed. What action will the provider take to address the parent's concerns?

A) Reassure the parents that this is an expected side effect.
B) Discuss changing to fluticasone with the parents.
C) Advise the parents to administer budesonide only when symptoms are severe.
D) Advise the parents that antihistamines work as well as intranasal glucocorticoids.

Accepted Answer

Changing to a different intranasal corticosteroid, such as fluticasone, may be considered if there are concerns about growth suppression with budesonide. Different corticosteroids can have varying impacts on growth, and a switch might mitigate this concern.

Question 7

A provider prescribes montelukast for a child with asthma. Which statement by the child's parent indicates understanding of this medication?&#10;A) &#34;I may notice mood changes in my child.&#34;&#10;B) &#34;This drug works like albuterol to open up my child's airways.&#34;&#10;C) &#34;I will give my child this drug on days when his peak flow meter results are decreased.&#34;&#10;D) &#34;This drug can alleviate symptoms during an acute attack.&#34;

Accepted Answer

Montelukast is a leukotriene receptor antagonist that can have neuropsychiatric side effects, including mood changes. It is not a rescue medication like albuterol, does not work on an as-needed basis, and is not intended for acute symptom relief.

Question 8

A patient requests medication for insomnia. The provider notes that the patient is restless and anxious with a heart rate of 90 beats/minute, and blood pressure of 130/85 mm Hg. Current medications are the combination product loratadine/pseudoephedrine every 12 hours for allergic rhinitis. What action will the provider take?

A) Discuss changing to an intranasal glucocorticoid and loratadine.
B) Evaluate the patient for acute pseudoephedrine toxicity.
C) Discuss changing to pseudoephedrine without loratadine.
D) Suggest switching to a topical decongestant to minimize systemic symptoms.

Accepted Answer

Pseudoephedrine, a component of the patient's current medication, can cause insomnia, restlessness, anxiety, and increased heart rate and blood pressure. Switching to an intranasal glucocorticoid and loratadine (which does not contain pseudoephedrine) could alleviate these symptoms.

Question 9

A patient with severe, chronic COPD uses an inhaled long-acting inhaled $\beta$ ₂ agonist (LABA)/glucocorticoid but continues to have frequent exacerbation of symptoms. What change in therapy will the provider discuss with the patient?

A) Adding roflumilast
B) Changing to oral theophylline
C) Prescribing oral steroids
D) Using an ipratropium/albuterol combination

Accepted Answer

Adding roflumilast, a phosphodiesterase-4 inhibitor, is an option for patients with severe COPD and chronic bronchitis, especially those with a history of frequent exacerbations, to reduce the risk of exacerbations when their symptoms are not adequately controlled by long-acting bronchodilators and inhaled corticosteroids.

Question 10

A patient with a cough has been advised to use guaifenesin. When the patient asks why this particular drug, what response will the provider provide?&#10;A) &#34;It dries secretions to help suppress coughing so you can rest.&#34;&#10;B) &#34;It stimulates the flow of secretions so they are easier to cough up.&#10;C) &#34;It helps to relieve the chest pain caused by frequent coughing.&#34;&#10;D) &#34;It stimulates the body's natural immune responses.&#34;

Accepted Answer

Guaifenesin is an expectorant that works by thinning and loosening mucus in the airways, making it easier to cough up and clear from the lungs, which is why option B is correct. It does not dry secretions, relieve chest pain directly, or stimulate the immune system.

Question 11

A patient with asthma reports daily symptoms requiring a short-acting $\beta$ ₂-agonist for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV₁) is 75% of predicted values. Which regimen does the provider determine is best for this patient?

A) Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed
B) Daily low-dose inhaled glucocorticoid and a SABA as needed
C) Daily medium-dose inhaled glucocorticoid/LABA combination
D) No daily medications; continue a SABA as needed

Accepted Answer

The answer of A patient with asthma reports daily symptoms...

Question 12

A child with perennial allergic rhinitis has been using an intranasal glucocorticoid. After the child develops frequent nosebleeds, the provider orders montelukast to replace the inhaler. What statement will the provider include when teaching the child's parents about montelukast?

A) "Montelukast is effective for treating allergic and infectious rhinitis."
B) "This drug will help prevent inflammation without causing nosebleeds."
C) "Montelukast will treat both congestion and rhinitis."
D) "Montelukast works best when combined with a topical decongestant."

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Accepted Answer

The answer of A child with perennial allergic rhinitis has...

Question 13

A patient who recently recovered from acute bronchitis reports a lingering dry cough that prevents sleep. Which over-the-counter medication will the provider recommend to best manage the symptoms?&#10;A) Diphenhydramine&#10;B) Fexofenadine/pseudoephedrine&#10;C) Guaifenesin&#10;D) Phenylephrine drops

Accepted Answer

The answer of A patient who recently recovered from acute...

Question 14

Which medication will a provider prescribe for an asthma patient as part of step 1 management? A) Combination inhaled glucocorticoids/long-acting $\beta$₂ agonists B) Inhaled low-dose glucocorticoids C) Long-acting $\beta$₂ agonists D) Short-acting $\beta$₂ agonists

Accepted Answer

The answer of Which medication will a provider prescribe for...

Question 15

Which medication for asthma can a provider prescribe off-label to treat allergic rhinitis?&#10;A) Diphenhydramine&#10;B) Fexofenadine/pseudoephedrine&#10;C) Guaifenesin&#10;D) Omalizumab

Accepted Answer

The answer of Which medication for asthma can a provider...

Deck 15: Respiratory Tract Drugs