Respiratory Pharmacology Exam

Mark, a 52-year-old male, presents to the cardiology clinic with a history of shortness of breath, fatigue, and occasional chest discomfort that has progressively worsened over the past year.
He was diagnosed with pulmonary arterial hypertension (PAH) six months ago after a series of diagnostic tests, including right heart catheterization, confirmed elevated pulmonary artery pressures.
Mark has no significant history of smoking but has a family history of heart disease. His current medications include a diuretic, an angiotensin-converting enzyme (ACE) inhibitor for hypertension, and sildenafil, which was prescribed a month ago.
During the follow-up visit, Mark states, "I know this drug is used for erectile dysfunction, so I’ll take it as needed when I feel my symptoms getting worse."
How should the nurse address Mark’s statement regarding the use of sildenafil for his pulmonary arterial hypertension?

A 54-year-old male with a history of chronic bronchitis visits the outpatient clinic for his routine follow-up.
As the nurse is reviewing his medications, the patient is unsure about the timing of administering the two inhalers.
How should the nurse guide the patient in terms of the sequence and timing of using these medications?

A 29-year-old male has been newly diagnosed with asthma after experiencing recurrent episodes of wheezing and shortness of breath. His primary care provider is starting him on zafirlukast, a leukotriene receptor antagonist (LTRA).
The patient is keen on understanding how the medication works and when he should take it. He also wants to know about any potential side effects.
As the nurse in charge of his education, which of the following two statements would be most appropriate to explain to the patient about his new medication?

Mrs. Johnson is a 42-year-old African-American woman with a known history of severe bronchial asthma. She presents to the emergency department with acute exacerbation of her asthma symptoms, including severe dyspnea, wheezing, and chest tightness.
Mrs. Johnson reports that her symptoms started two days ago and have progressively worsened despite using her prescribed inhalers and medications.
She also mentions a recent upper respiratory tract infection.
Considering Mrs. Johnson's severe bronchial asthma exacerbation, which of the following is the most appropriate treatment option now to help relieve her acute symptoms and improve her oxygenation?

A 55-year-old woman is admitted to the respiratory unit with a diagnosis of bronchitis.
Aware of certain contraindications associated with the prescribed medication, the nurse reviews the patient's medical history.
Which of the following two parameters would raise concern when using this medication?

A 68-year-old woman with a history of moderate persistent asthma presents to the emergency department with shortness of breath. She receives a nebulizer treatment with albuterol.
Following the treatment, she informs the nurse that she feels “shaky,” and upon observation, slight tremors of her hands are noted. 
Based on the patient’s presentation and reaction post-nebulizer treatment, which of the following is the most likely explanation?

A 56-year-old woman with a known history of asthma presents to the emergency department after using her prescribed bronchodilator inhaler. Instead of the expected relief, she complains of worsening shortness of breath and tightness in her chest immediately after the inhalation. 

Complete the diagram below by dragging from the choice below what condition the client is most likely experiencing, two actions the nurse would take to address that condition, and two parameters to monitor to assess the client's condition.

Jacob, a 62-year-old male with a long-standing history of chronic obstructive pulmonary disease (COPD), is being treated for worsening symptoms including chronic cough, difficulty breathing, and frequent exacerbations.
His physician has started him on theophylline as part of his management plan.
During discharge instructions, the nurse explains the importance of monitoring his blood levels. Jacob, looking puzzled, says, "I don’t understand why I need a blood test just for this medicine."
How should the nurse respond to Jacob’s comment regarding the need for blood tests while on theophylline?

A 52-year-old male with a history of chronic obstructive pulmonary disease (COPD) is seen in the outpatient clinic. He reports increased breathlessness over the past month. His current medications include an inhaled corticosteroid and a long-acting beta-agonist.
Given the persistent symptoms, the physician considers adding theophylline to his regimen. During counseling about the medication, the patient inquires about the precautions associated with theophylline use.
Which of the following precautions and considerations should be addressed by the nurse when an HCP is prescribing theophylline? Select all that apply

A 66-year-old female with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with worsening cough and shortness of breath. She reports taking multiple over-the-counter medications to manage her persistent cough, including an antitussive containing codeine that she started 2 days ago. The healthcare team is concerned about her use of codeine in the context of her respiratory history.
Why is caution advised when using antitussives with codeine in patients like her, who have respiratory insufficiency?

A 54-year-old man with a history of chronic bronchitis is being discharged from the hospital. As part of his management plan, he has been prescribed the anticholinergic inhaler ipratropium bromide to help reduce his bronchospasm.
The nurse has been educating him about the proper use and expectations of the medication.
At the end of the session, which statement by the patient would indicate to the nurse that he has understood the instructions related to ipratropium bromide?

A 42-year-old man is seen at the outpatient pulmonary clinic with symptoms consistent with bronchial asthma. As part of his management, the physician considers prescribing Zafirlukast. The nurse knows that before initiating this medication, a particular laboratory test is often ordered to assess potential risks.
Which of the following laboratory tests is typically ordered before administering Zafirlukast?

Kelly, a 30-year-old woman with allergic asthma, has been prescribed cromolyn sodium to help prevent asthma attacks triggered by allergens. During her follow-up visit, the nurse asks how she's been using the medication. Kelly says, "I use the cromolyn sodium inhaler as soon as I start feeling short of breath, like my rescue inhaler."

Based on Kelly's statement, what further instruction does the nurse need to provide to ensure proper use of cromolyn sodium? Select all that apply

A 72-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) has been hospitalized due to an acute exacerbation. As he prepares for discharge, he is provided with prescriptions for both albuterol and salmeterol to manage his COPD symptoms.
During discharge education, the nurse explains the proper use of both inhalers.
When evaluating the patient's understanding of the education, which statement made by the patient suggests a need for further teaching?

A 3-month-old infant is admitted to the neonatal intensive care unit (NICU) due to respiratory distress. The medical team starts the baby on high-dose oxygen therapy to ensure adequate oxygenation.
The pediatric nurse is discussing the infant's care with a nursing student.
The student is asked to identify the potential complications that might arise from prolonged high-dose oxygen therapy in infants.
What should the student's response be?

A 68-year-old female patient is in the intensive care unit following a severe respiratory failure. She is intubated and on mechanical ventilation. The nurse observes a buildup of secretions in the endotracheal (ET) tube and prepares to suction it out. A nursing student is observing the procedure.
After the nurse completes the suctioning, the student is asked to describe the correct procedure for suctioning through an endotracheal tube.
Which of the following statements by the nursing student indicates a correct understanding of the procedure?

Emily, a 6-year-old girl, presents to the emergency department with stridor and respiratory distress after a viral infection. The healthcare team administers racemic epinephrine to reduce airway swelling. Later, her mother comments, "I’ll make sure she keeps using this medicine at home if she feels sick again."

What should the nurse’s response be to Emily’s mother’s statement?

David, a 55-year-old man with severe COPD, has been experiencing frequent exacerbations, chronic coughing, and worsening shortness of breath despite using bronchodilators and corticosteroids. His pulmonologist has prescribed roflumilast to reduce inflammation and prevent further COPD exacerbations. At his follow-up visit, David says, "I don’t understand how this pill is going to help my breathing since it’s not an inhaler."

Which of the following responses by the nurse best explain how roflumilast works for David's condition? Select all that apply

Mrs. Jenny a 57-year-old female with a history of chronic obstructive pulmonary disease (COPD) has been prescribed revefenacin by her primary care physician. During her nursing consultation, she expresses uncertainty about the medication and asks for further guidance. The nurse decides to highlight the essential precautions associated with revefenacin.
Which of the following precautions should the nurse prioritize when discussing the use of revefenacin with the patient? Select all that apply

A 3-day-old preterm infant is admitted to the neonatal intensive care unit (NICU) with signs of respiratory distress syndrome (RDS). The pediatrician has ordered the administration of poractant alfa as part of the treatment plan. The nurse, aware of the specific considerations associated with the drug, prepares for the administration.
What are the key nursing implications the nurse should consider when administering poractant alfa to this infant? Select all that apply

A young couple with a 20-month-old toddler visits a community health clinic.
Parents express concern about their child's frequent sneezing and watery eyes, especially after playing outside.
They believe these symptoms might be related to allergies and are considering using an over-the-counter (OTC) allergy medication they saw at the local pharmacy.
As a nurse, you want to provide them with general education on the use of OTC allergy medications for children.

What instructions should be appropriate and which ones not in order to teach the parents?

A 47-year-old female patient with severe persistent asthma not well-controlled on high-dose inhaled corticosteroids and long-acting beta-agonists is started on omalizumab therapy. On her follow-up visit after 3 months of treatment, she reported some new symptoms. The nurse knows that some of these might be potential side effects of omalizumab.
Which of the following three symptoms are commonly associated with omalizumab?

A 38-year-old alcoholic woman has recently been diagnosed with tuberculosis and started on a regimen that includes cycloserine, administered orally twice daily.
At her follow-up appointment a week later, the nurse informed her that she would need to have blood drawn to assess the serum concentration of the medication. The patient appears anxious about the upcoming procedure.
The nurse provides instructions about medication administration in relation to the test.

Which of the following is the most appropriate guidance?

A client has been taking rifampin and isoniazid for the treatment of active tuberculosis. Which side effects does the nurse anticipate the client may experience while taking the medication? Select all that apply.