MSN Exam for Asthma Part 2

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Text Mode – Text version of the exam

1) Which is not a potential side effect of bronchodilator drugs ?

  1. Tremor
  2. Oral thrush
  3. Tachycardia
  4. Anxiety
  5. Headache

2) What should you do when you have an asthma?

  1. Overuse asthma medication
  2. Smoke
  3. To use the medicines as prescribed
  4. Not control diet

3) In which age group of people is asthma the most common disease in?

  1. Children
  2. Teens
  3. Adults
  4. Elderly

4) The following drug cannot cause asthma:

  1. Beta-blocker
  2. Histamine
  3. Ibuprofen
  4. Atropine

5) Which of the following respiratory condition is always considered a medical emergency?

  1. Laryngeotracheobronchitis (LTB)
  2. Epiglottitis
  3. Asthma
  4. Cystic Fibrosis

6) The following bronchodilator is most commonly used when doing a reversibility test:

  1. Salbutamol
  2. Adrenaline
  3. Theophylline anhydrous
  4. Atropine

7) A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

  1. Resonant sounds.
  2. Hyperresonant sounds.
  3. Dull sounds.
  4. Flat sounds.

8) Which contraindication should the nurse assess for prior to giving a child immunization?

  1. Mild cold symptoms
  2. Chronic asthma
  3. Depressed immune system
  4. Allergy to eggs

9) Common signs and symptoms include: Excessive coughing, Wheezing Chest, Tightness Shortness of breath, Waking at night.

  1. True
  2. False

10) Asthma is basically:

  1. An infectious disease
  2. An autoimmune disease
  3. An atopic disease
  4. A malignant disease

11) Use your air conditioner to help filter the air coming into the center.

  1. True
  2. False

12) What is asthma?

  1. Heart failure
  2. A mild ailment
  3. An intestinal illness
  4. A chronic respiratory disease

13) Cockroaches can trigger Asthma attacks.

  1. True
  2. False

14) Dust and dust mites can trigger Asthma too. What are ways to reduce the chances?

  1. Keep classrooms are clean and clutter free as possible.
  2. Dust furniture regularly with a damp cloth and allow sufficient time to dry.
  3. Wash pillows, blankets and stuffed toys often.
  4. All of the above.

15) Inhaled steroids(preventer/controller) will cause major side effects at recommended dosages.

  1. True
  2. False

16) Which of the following is not considered a COPD related disease?

  1. Bronchiectasis
  2. Bronchial asthma
  3. Bronchitis
  4. Bronchial hypotension

17) A 19-year-old patient comes to the ED with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should you take first?

  1. Take a full medical history.
  2. Give a bronchodilator by nebulizer.
  3. Apply a cardiac monitor to the patient.
  4. Provide emotional support for the patient

18) Which answer is a true symptom of Asthma?

  1. Emotional problems.
  2. Clogging-the mucus blocks the airways and thus allows less air to pass through the airways
  3. Swelling of the airways.
  4. B & C are correct

19) The parameter to detect reversibility in airflow obstruction on a spirometry test is:

  1. FEV1
  2. FVC
  3. MVV
  4. RV

20) In those with asthma, which of the following does not contribute to inspiratory muscle weakness ?

  1. Increased use of steroid based medication
  2. Dyspnea
  3. Reduced exercise tolerance
  4. Inflammatory processes

21) True/False: Gastroesophageal reflux should be considered in a patient who has poorly controlled asthma, with a significant nocturnal component.

  1. True
  2. False

22) I cannot participate in physical activities if I have asthma.

  1. True
  2. False

23) Which of the following statements by the family of a child with asthma indicates a need for additional teaching?

  1. “We need to identify what things triggers his attacks”
  2. “He is to use bronchodilator inhaler before steroid inhaler”
  3. “We’ll make sure he avoids exercise to prevent asthma attacks”
  4. “he should increase his fluid intake regularly to thin secretions”

24) The following are helpful in determining the severity of an acute attack except:

  1. Use of accersoy muscles of respiration
  2. Ability to complete sentences
  3. Peak expiratory flow rate
  4. Pedal edema

25) A good inhalation technique can ensure that the medication is delivered to the airways of the lungs.

  1. True
  2. False

26) Symptoms of asthma include wheezing, coughing and breathing difficulty.

  1. True
  2. False

27) A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for CVA?

  1. Caucasian race
  2. Female sex
  3. Obesity
  4. Bronchial asthma

28) Asthma is triggered by allergens such as pollen and animal furs.

  1. True
  2. False

29) Carol Smith is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include:

  1. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures.
  2. tachycardia, headache, dyspnea, temp . 101 F, and wheezing.
  3. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria.
  4. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.

30) What of these is not a characteristic of Allergic asthma?

  1. Starts in childhood or adolescence
  2. Triggered by specific allergens (ie: dust mites and pollen)
  3. Presents with bronchoconstriction and inflammation of the airways
  4. Is a consequence of viral infection

31) Bronchoprovocation tests usually use histamine to challenge the airways. Besides histamine, ____________ can also be used:

  1. Ipratropium bromide
  2. Adrenocorticotrophic hormone
  3. Prednisolone
  4. Metracholine

32) Lisa is newly diagnosed with asthma and is being discharged from the hospital after an episode of status asthmaticus. Discharge teaching should include which of the following:

  1. Limitations in sports that will be imposed by the illness
  2. Specific instructions on staying cal during an attack
  3. The relationship of symptoms and a specific trigger such as physical exercise
  4. Incidence of status asthmaticus in children and teens

33) True/False: If a patient has had coughing or wheezing for over one year, the possiblity of a foreign body is essentially ruled out.

  1. True
  2. False

34) Which of the following is NOT a risk factor for the development of asthma?

  1. Parental history of asthma
  2. Physician diagnosed atopic dermatitis
  3. Peripheral eosinophilia and allergic rhinitis
  4. Wheezing apart from colds and allergic rhinitis
  5. Recurrent otitis media

35) The nurse understands that a good snack for a 2 year old with a diagnosis of acute asthma would be:

  1. Grapes
  2. Apple slices
  3. A glass of milk
  4. A glass of cola

36) Asthma is caused by inflammation of the airways in the lungs.

  1. True
  2. False

37) What can lead to an asthma attack?

  1. Airway Obstruction
  2. Airway Irritability
  3. Inflammation
  4. All of the above

38) Which of the following is true?

  1. A preventer is used to relieve asthma attacks.
  2. A reliever is used to relieve asthma attacks.

39) Crying, laughing hard or yelling can trigger Asthma.

  1. True
  2. False

40) Evidence suggests there are 3 crucial factors in the primary prevention of asthma. These include ..

  1. Avoidance of household pets, obesity and allergen avoidance
  2. Exposure to environmental tobacco smoke, breast feeding during infancy and allergen avoidance
  3. Drug therapy with associated disease, avoidance of sedentary behaviour and exposure to environmental tobacco smoke
  4. Breastfeeding during infancy, residing at least 20 km outside a major city and gaining at least 3 hours of oxygen from outdoors per day

41) Mark, a 7-year-old client is brought to the emergency department. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and has a nonproductive cough. He recently had a cold. Form this history; the client may have which of the following conditions?

  1. Acute asthma
  2. Bronchial pneumonia
  3. Chronic obstructive pulmonary disease (COPD)
  4. Emphysema

42) Which is not a hallmark feature of asthma?

  1. Oedema
  2. Dynamic airway collapse
  3. Bronchospasm
  4. Epithelial Damage

43) Kennedy with acute asthma showing inspiratory and expiratory wheezes and a decreased forced expiratory volume should be treated with which of the following classes of medication right away?

  1. Beta-adrenergic blockers
  2. Bronchodilators
  3. Inhaled steroids
  4. Oral steroids

44) When does nocturnal asthma usually occur?

  1. Early night
  2. Near Dawn
  3. 2am-4am in the middle of the night
  4. It does not exist

45) Perfumes and cleaning products can be an Asthma trigger.

  1. True
  2. False

46) All classroom pets should be banned to prevent Asthma triggers.

  1. True
  2. False

47) Staff who smoke on their personal time cannot harm children with Asthma.

  1. True
  2. False

48) A child has been brought to the emergency room with an asthma attack. What signs and symptoms would the nurse expect to see?

  1. A prolonged inspiratory time and a short expiratory time.
  2. Frequent productive coughing of clear, frothy, thin mucus progressing to thick, tenacious mucus heard only on auscultation.
  3. Hypoinflation of the alveoli with resulting poor gas exchange from increasingly shallow inspirations.
  4. Swelling of the bronchial mucosa, with wheezes starting on expiration and spreading to continuous.

49) Asthma has the greatest prevalence in which two populations:

  1. Males aged 25-44 years & females 10-14 years
  2. Males aged 15-19 years & females aged 10-14 years
  3. Males aged 10-14 years & females aged 20-24 years
  4. Males aged 20-24 years & females aged 25-44 years

50) What are the two categories of pharmalogical agents used in the treatment of asthma

  1. B2 adrenoreceptor antagonists and bronchodilators
  2. Anti-inflammatory and glucocorticoids
  3. Inhaled medications and oral medications
  4. Bronchodilators and anti-inflammatory

51) There is no single cause for Asthma and currently, there is no cure for Asthma.

  1. True
  2. False

52) Which answer best describes common outdoor Asthma triggers?

  1. Changes in weather and temperature.
  2. Pollen
  3. Air pollution
  4. All of the above

53) A 5 year old AA male comes in with a history of asthma, but currently is not on any medication. In the history, you find out he uses his Albuterol MDI with spacer once every two weeks during the day. He does wake up 2-3 times per week coughing at night. How would you classify his asthma?

  1. Intermittent
  2. Mild Persistent
  3. Moderate Persistent
  4. Severe Persistent

54) Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation?

  1. Oxygen saturation of 95%
  2. Mild work of breathing
  3. Absence of intercostals or substernal retractions
  4. History of steroid-dependent asthma

55) The characteristic feature of persistent asthma is:

  1. Family history of disease
  2. Airway inflammation
  3. Need for oral steroids
  4. Nocturnal wheezing

56) Which statement is true about Asthma:

  1. Asthma is one of the most common chronic diseases nationwide, impacting the lives and families of over 7 million children.
  2. Asthma is the third-ranking cause of hospitalization among children under 15.
  3. An average of one our of every 10 school-aged children has asthma and 10.5 million school days are missed each year due to Asthmas
  4. All of the above is true

57) The primary physiological alteration in the development of asthma is:

  1. Bronchiolar inflammation and dyspnea
  2. Hypersecretion of abnormally viscous mucus
  3. Infectious processes causing mucosal edema
  4. Spasm of bronchiolar smooth muscle

58) A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

  1. Lips.
  2. Mucous membranes.
  3. Nail beds.
  4. Earlobes.

59) A client with asthma has low pitched wheezes present on the final half of exhalation. One hour later the client has high pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client

  1. Has increased airway obstruction
  2. Has improved airway obstruction
  3. Needs to be suctioned
  4. Exhibits hyperventilation

60) Simple instrument to roughly determine lung function is a:

  1. Barometer
  2. Manometer
  3. Peak flow meter
  4. Sphygmomanometer

61) The nurse is caring for Kenneth experiencing an acute asthma attack. The client stops wheezing and breath sounds aren’t audible. The reason for this change is that:

  1. The attack is over.
  2. The airways are so swollen that no air cannot get through.
  3. The swelling has decreased.
  4. Crackles have replaced wheezes.

62) How can seasonal asthma come about?

  1. Inhlation or exposure to trees, grasses or flowers releasing pollen into the air.
  2. Inhalation of tobacco smoke
  3. Exposure to paint thinners or dust

63) The key role of a physiotherapist in treatment of asthma is to …

  1. Provide education to the patient about the disease and treatment options
  2. Administering and educating the patient about airway clearance techniques
  3. Provide education about exercise and the option of pulmonary rehabilitation classes
  4. All of the above
  5. None of the above

64) Asthma is….

  1. Localised, irreversible dilation of part of the bronchial tree due to destruction of the muscle and elastic tissue
  2. A persistent cough that produces sputum and mucus for at least 3 months of the year, two years in succession
  3. A chronic inflammatory disorder of the airways associated with episodes of wheezing, breathlessness, chest tightness and coughing
  4. Collapse and closure of alveoli resulting in reduced or absent gas exchange affecting all of part of the lung

65) Which of the following tests cannot detect airway inflammation?

  1. Bronchial mucosal biopsy
  2. Sputum eosinophil counts
  3. Bronchoalveolar lavage
  4. Spirometry

66) Asthma can be life-threatening.

  1. True
  2. False

67) Asthma causes the airways to:

  1. Constrict
  2. Become inflamed
  3. Become lined with a large amount of mucus
  4. All of the above

68) In an acute severe attack of asthma, it is important to get a chest x-ray done to rule out:

  1. A pleural effusion
  2. A pneumothorax
  3. Lung malignancy
  4. COPD

69) If a person suffers from asthma, what are the likely symptoms he/she may have?

  1. Sore, swollen and sensitive airway linings.
  2. Weak breathing
  3. Fast and unsteady pulse
  4. Cancer in the airway

70) An 8-year-old boy with asthma is brought to the clinic for check up. The mother asks the nurse if the treatment given to her son is effective. What would be the appropriate response of the nurse?

  1. I will review first the child’s height on a growth chart to know if the treatment is working
  2. I will review first the child’s weight on a growth chart to know if the treatment is working
  3. I will review first the number of prescriptions refills the child has required over the last 6 months to give you an accurate answer
  4. I will review first the number of times the child has seen the pediatrician during the last 6 months to give you an accurate answer
Answers and Rationales
  1. B. Oral thrush 
  2. C. To use the medicines as prescribed 
  3. A. Children 
  4. D. Atropine 
  5. B. Epiglottitis. Acute and sever inflammation of the epiglottis can cause life threatening airway obstruction, that is why its always treated as a medical emergency. NSG intervention : Prepare tracheostomy set at bed side.LTB, can also cause airway obstruction but its not an emergency. Asthma is also not an emergency . CF is a chronic disease, so its not a medical emergency.
  6. A. Salbutamol 
  7. A. Resonant sounds. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.
  8. C. Depressed immune system . Children who have a depressed immune system related to HIV or chemotherapy should not be given routine immunizations.
  9. A. True
  10. C. An atopic disease 
  11. A. True 
  12. D. A chronic respiratory disease 
  13. A. True 
  14. D. All of the above. 
  15. B. False 
  16. D. Bronchial hypotension 
  17. B. Give a bronchodilator by nebulizer. The patient having an acute asthma attack needs more oxygen delivered to his lungs and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. The patient may not need cardiac monitoring because he’s only 19 years old, unless he has a medical history of cardiac problems.
  18. D. B & C are correct 
  19. A. FEV1 
  20. B. Dyspnea 
  21. A. True . A significant correlation between nocturnal asthma and gastroesophageal reflux has been observed. The patient may not complain of epigastric burning or have reflux symptoms. Cough may be the only symptom.
  22. B. False 
  23. C. “We’ll make sure he avoids exercise to prevent asthma attacks” Asthmatic children don’t have to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator before administering steroids is correct because steroids are just anti-inflammatory and they don’t have effects on the dilation of the bronchioles. OF course letters A and B are obviously correct.
  24. D. Pedal edema
  25. A. True
  26. A. True
  27. C. Obesity. Obesity is a risk factor for CVA. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking, hypercholesterolemia, oral contraceptive use, emotional stress, family history of CVA, and advancing age. The client’s race, sex, and bronchial asthma aren’t risk factors for CVA.
  28. A. True
  29. A. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. Bronchodilators can produce the side effects listed in answer choice for a short time after the patient begins using them.
  30. D. Is a consequence of viral infection 
  31. D. Metracholine 
  32. C. The relationship of symptoms and a specific trigger such as physical exercise. COPD clients have low oxygen and high carbon dioxide levels. Therefore, hypoxia is the main stimulus for ventilation is persons with chronic hypercapnea. Increasing the level of oxygen would decrease the stimulus to breathe.
  33. B. False . The acute cough and/or wheeze caused by a foreign body in the lower respiratory tract may diminish over time only to recur later and present as chronic cough and/or persistent wheezing.
  34. E. Recurrent otitis media 
  35. B. Apple slices. Grapes is inappropriate because of its “skin” that can cause choking. A glass of milk is not a good snack because it’s the most common cause of Iron-deficiency anemia in children (milk contains few iron), A glass of cola is also not appropriate cause it contains complex sugar.
  36. A. True
  37. D. All of the above
  38. B. A reliever is used to relieve asthma attacks. 
  39. A. True 
  40. B. Exposure to environmental tobacco smoke, breast feeding during infancy and allergen avoidance
  41. A. Acute asthma . Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed (COPD) and emphysema.
  42. B. Dynamic airway collapse
  43. B. Bronchodilators . Bronchodilators are the first line of treatment for asthma because broncho-constriction is the cause of reduced airflow. Beta adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled oral steroids may be given to reduce the inflammation but aren’t used for emergency relief.
  44. C. 2am-4am in the middle of the night 
  45. A. True . Try not to wear perfumes to school. Limit the use of scented aerosols in the center. Try to use non-aerosol cleaners while Asthmatic children are present.
  46. B. False . Proteins in animal’s skin flakes, urine, feces, saliva and hair can trigger asthma. Dogs, cats, rodents (including hamsters and guinea pigs) and other warm-blooded mammals can trigger Asthma in individuals with an allergy to animal dander. SO, load your class with the Asthma friendliest pets of all-FISH!
  47. B. False . Secondhand smoke can be present on your clothing therefore exposing children to it. Never smoke in clothing you wear to work.
  48. D. Swelling of the bronchial mucosa, with wheezes starting on expiration and spreading to continuous. Bronchi normally expand and lengthen during inspiration and shorten during expiration. Asthma causes spasm of the smooth muscles in the bronchi and bronchioles, resulting in an even tighter airway on exhalation and prolonged exhalation. Inspirations increase in rate in an effort to relieve hypoxia. At the beginning of the attack, the cough is nonproductive and results from bronchial edema. Then the mucus becomes profuse and rattly, with a cough producing frothy, clear sputum. Gas trapping is the central feature of asthma. It is caused by allowing more air to enter alveoli than can escape from them through the narrowed airways. Gas trapping also causes an increased depth and rate of respirations. The wheeze starts during the expiratory phase because of the extreme narrowing of the bronchus on exhalation. As obstruction increases, wheezes become more high pitched and continuous.
  49. C. Males aged 10-14 years & females aged 20-24 years 
  50. D. Bronchodilators and anti-inflammatory 
  51. A. True 
  52. D. All of the above 
  53. C. Moderate Persistent . Moderate persistent, great than one night per week of symptoms bumps him to Moderate persistent
  54. D. History of steroid-dependent asthma . A history of steroid-dependent asthma, a contributing factor to this client’s high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. An oxygen saturation of 95%, mild work of breathing, and absence of intercostals or substernal retractions are all normal findings.
  55. B. Airway inflammation 
  56. D. All of the above is true 
  57. D. Spasm of bronchiolar smooth muscle. Asthma is the presence of bronchiolar spasms. This spasm can be brought on by allergies or anxiety. Answer A is incorrect because the primary physiological alteration is not inflammation. Answer B is incorrect because there is the production of abnormally viscous mucus, not a primary alteration. Answer C is incorrect because infection is not primary to asthma.
  58. B. Mucous membranes. Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.
  59. A. Has increased airway obstruction . The higher pitched a sound is, the more narrow the airway. Therefore, the obstruction has increased or worsened. With no evidence of secretions no support exists to indicate the need for suctioning.
  60. C. Peak flow meter 
  61. B. The airways are so swollen that no air cannot get through. During an acute attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can’t get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles do not replace wheezes during an acute asthma attack.
  62. A. Inhlation or exposure to trees, grasses or flowers releasing pollen into the air.
  63. D. All of the above 
  64. C. A chronic inflammatory disorder of the airways associated with episodes of wheezing, breathlessness, chest tightness and coughing 
  65. D. Spirometry 
  66. A. True 
  67. D. All of the above 
  68. B. A pneunothorax 
  69. A. Sore, swollen and sensitive airway linings.
  70. C. I will review first the number of prescriptions refills the child has required over the last 6 months to give you an accurate answer. Reviewing the number of prescription refills the child has required over the last 6 months would be the best indicator of how well controlled and thus how effective the child’s asthma treatment is. Breakthrough wheezing, shortness of breath, and upper respiratory infections would require that the child take additional medication. This would be reflected in the number of prescription refills.