NSG 511 EXAM 2 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

NSG 511 EXAM 2 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 pathways to airflow limitation in aspathways to airflow limitation in asthma - Answers *airflow limitation in asthma is caused by bronchospasm and/or inflammation* - allergen mast cell reaction inflammatory mediators bronchospasm - allergen mast cell reaction infiltration of inflammatory mediators and inflammatory cells inflammation - bronchial hyperreactivity triggers bronchospasm bronchitis (COPD) pathway to airflow limitation - Answers - continuous irritation from smoke/pollution inflammation bronchial edema/hyper secretion of mucus airway obstruction emphysema (COPD) pathway to airflow limitation - Answers - continuous irritation from smoke/pollution inflammation increased protease activity destruction of alveolar walls airway obstruction considerations for metered dose inhalers (MDIs) - Answers - most commonly prescribed - must coordinate between activation and inhalation - notorious for incorrect use: patient education necessary - more drug reaches lungs with use of spacer (21% vs 9%) considerations for dry powder inhaler (DPIs) - Answers - activated by inhalation (no coordination/spacer necessary) - improved medication delivery to lungs considerations for nebulizers - Answers - fine mist droplets - no coordination necessary - powered equipment (not portable, needs battery or plug) considerations for respimats - Answers - better than other drug inhalation delivery devices - activated by inhalation (no coordination) - fine mist droplets (better delivery to lower respiratory tract) - portable Uses for pulmonary glucocorticoids - Answers asthma and COPD routes for pulmonary glucocorticoids - Answers - oral - parenteral - inhalation mechanism of pulmonary glucocorticoids - Answers - anti-inflammatory - immunosuppressant pulmonary glucocorticoid prototypes (and their routes) - Answers - fluticasone/budesonide (inhalation) - prednisone/prednisolone (oral) - methylprednisolone (IV) indications for pulmonary glucocorticoids - Answers *prophylaxis for obstructive airway diseases* - inhaled - on a fixed schedule - controller medication *temporary use for severe obstructive disease when unable to deliver drug via inhalation* - oral or parenteral - ex: no airway movement during status asthmaticus finch side effects for pulmonary glucocorticoids - Answers - thrush (oral candidiasis): rinse mouth after usage of inhaled agents to prevent this - hyperglycemia - peptic ulcer disease theoretical side effects - immunosuppression - skeletal muscle growth suppression in children - bone loss - adrenal suppression why are side effects of inhaled glucocorticoids rare (other than thrush)? - Answers These side effects are predictable for glucocorticoid use. However, the inhaled dose for asthma patients is typically too low to elicit any of these effects. They may be seen during long term oral use, which is also uncommon for asthma patients. short acting beta agonists (SABA) prototype and route - Answers - albuterol - oral or inhaled long acting beta agonists (LABA) prototype - Answers Salmeterol "-terol" mechanism of action - Answers - beta 2 agonist - epinephrine and "-terols" Short acting beta agonist (SABA) indications - Answers quick relief during asthma (or similar) exacerbation long acting beta agonist (LABA) indications - Answers - long term control of asthma - must be combined with glucocorticoids side effects of -terols - Answers - tachycardia is most common - activation of the sympathetic nervous system (cross over of beta 2 agonists to beta 1 receptors) types of bronchodilators - Answers - beta agonists (-terols) - muscarinic antagonists pulmonary muscarinic antagonist prototypes and route - Answers - ipratropium - tiotropium - both inhaled pulmonary muscarinic antagonist mechanism of action - Answers antagonize muscarinic receptors in the lungs causing: - drying of respiratory secretions (a significant component of bronchitis) - permits the sympathetic nervous system (β2) to dominate resulting in bronchodilation (especially useful in COPD) leukotriene modifiers for asthma prototype drug - Answers - montelukast (singulair) Montelukast mechanism of action - Answers - inhibits leukotrienes, a single mediator of inflammation - leukotrienes trigger bronchospasm and inflammation indications and route for montelukast - Answers - oral - second line therapy as an adjunct for glucocorticoids - NOT for acute attacks montelukast side effects - Answers neuropsychiatric problems: - anxiety - agitation - aggression - suicidal thoughts cromolyn mechanism of action - Answers - blocks mast cells, thus - inhibits the release of inflammatory mediators cromolyn indications and route - Answers - inhaled - regular use can reduce the frequency of chronic asthma attacks - *used prophylactically for exercise-induced asthma* phosphodiesterase inhibitor prototypes - Answers - theophylline (methylxanthines) - roflumilast theophylline mechanism of action - Answers non selectively inhibits phosphodiesterase indications for theophylline - Answers - management of obstructive pulmonary disease (especially COPD) considerations for theophylline - Answers - lots of drug interactions (including coffee) - induction/inhibition of CYP hepatic enzymes - *variable half life* makes dosing problematic - thus is rarely used theophylline drug levels - Answers 20 mcg/mL = therapeutic, no side effects 20 - 25 mcg/mL = GI (n/v/d) and CNS (stimulation) side effects 25 mcg/mL = dysrhythmias, convulsions, death what is the normal half life for theophylline and what causes variability in this number? - Answers - average is 8 hours - half (4 hours) in smokers and youngins - double (16 hours) in adults with heart/liver/kidney disease Roflumilast mechanism of action - Answers - selective phosphodiesterase type 4 (PD4) inhibitor - PD4 normally converts cAMP to AMP - inhibition increases cAMP levels - increased cAMP *reduces inflammation, mucus production, cough, and increases bronchodilation* indications for roflumilast - Answers - management of obstructive pulmonary disease - more selective/targeted than theophylline considerations for roflumilast - Answers much more expensive than theophylline side effects of roflumilast - Answers - headaches - dizziness - insomnia - decreased appetite - nausea - diarrhea - weight loss - back pain - flu-like symptoms how is asthma classified? - Answers - persistent or intermittent - mild, moderate, or severe what are the variables when examining degree of impairment with asthma - Answers - frequency of symptoms - nighttime awakenings - SABA use - normal activity - lung function (FEV1 80%) goals of asthma therapy - Answers - symptoms 2x per week - nighttime awakenings 2x per month - SABA use 2x per week - normal activity not restricted - lung function (FEV1) 80% considerations for asthma treatment - Answers - age dependent - follows a predictable stepwise pattern - progression of medicines is pretty similar regardless of age how often do you evaluate asthma therapy? - Answers every 2-6 weeks until control is achieved a patient requiring oral corticosteroids for asthma is considered: - Answers high risk what is the sole treatment for intermittent asthma? - Answers albuterol what is used for management of an acute asthma attack? - Answers albuterol what drug is used in every step of asthma treatment? - Answers albuterol what is the progression of drugs used for persistent asthma? - Answers 1) progressing doses of inhaled and then systemic corticosteroids (corticosteroids are controllers used on a fixed schedule) 2) addition of LABA 3) addition of alternative drugs (montelukast, cromolyn theophylline, etc) when to step up asthma therapy? - Answers if SABA use is 2x/week when to step down asthma therapy? - Answers asthma is well controlled for at least 3 months what does it mean if asthma is "well controlled"? - Answers - symptoms ≤ 2 days/week - no interference with normal activity - SABA use ≤ 2 days/week - FEV1 80% - asthma exacerbations requiring corticosteroids 0-1x per year (looks like an intermittent asthma patient) true or false a patient with well controlled persistent moderate asthma should stop using inhaled corticosteroids or LABA - Answers false. persistent asthma patients should remain on stepped therapy even if their asthma is well controlled COPD is (more/less?) complex than asthma - Answers less there are (more/less?) treatment options for COPD than asthma - Answers less why are long acting muscarinic antagonists (LAMAs) commonly used to treat COPD? - Answers the anticholinergic effect dries the respiratory secretions of bronchitis AND bronchodilates t/f cough and cold medicines should not be used in children less than 6 years old - Answers true. risks benefits t/f home remedies for upper respiratory symptoms (common cold, viral illness, etc) are less effective than abx or cold and flu medicines - Answers False home remedies for upper respiratory symptoms - Answers - drink lots of water - cool mist vaporizer or saline nasal spray to relieve nasal congestion - ice chips, sore throat spray, lozenges for sore throat - use honey to relieve cough *do not give honey to infants under 1 year old* fun fact: the antidote (BabyBIG) for infant botulism caused by honey costs like $50,000 per dose What is allergic rhinitis? - Answers - inflammation of the nasal mucosa - allergen histamine release mucosal swelling drug treatments for allergic rhinitis - Answers - antihistamines: relieve allergic symptoms. use regularly during allergy season - cromolyn and glucocorticoid (flonase): nasal inhaler blocks mast cells and inhibits inflammation in nasal mucosa - nasal decongestants: use as needed prototype antihistamines - Answers - loratidine - diphenhydramine - fexophenidine (2nd gen) prototype nasal decongestant - Answers pseudoephedrine nasal decongestant mechanism of action - Answers - sympathomimetics - alpha 1 agonist constricts nasal blood vessels - reduces swelling and stuffiness considerations for nasal decongestants - Answers - chronic use of these agents down regulates receptors requiring progressively higher doses for effect - rebound symptoms when withdrawn - *do not use more than 3 days* side effects of pseudoephedrine - Answers - increased HR (and BP) - increased BG - insomnia what are antitussives? - Answers cough suppressants what are used as antitussives? - Answers - opioids (not as much these days) - dextromethorphan (non opioid) what are tussives? - Answers - expectorants: increase respiratory secretions to make phlegm more liquid - mucolytics: literally break up mucus antitussive prototype - Answers dextromethorphan expectorant prototype - Answers Guaifenesin mucolytic prototype - Answers acetylcysteine bonus effect of acetylcysteine - Answers restores glutathione which protects the liver from the adverse effects of acetaminophen and the kidney from the adverse effects of dye what cold/flu meds are prn? - Answers - nasal decongestants - cough meds (?) what cold/flu meds should be taken on a regular schedule? - Answers - antihistamines - flonase what cold/flu meds cause sedation? - Answers - antihistamines - dxm (all antitussives?) what cold/flu meds are stimulants? - Answers - pseudoephedrine pathophysiology of Alzheimer's - Answers - neurons degenerate in the hippocampus and cerebral cortex - hippocampal degeneration impairs memory - cerebral cortex degeneration impairs higher function - advanced disease causes loss of memory, language, self care, and independence - *damaged neurons do not synthesize or respond to acetylcholine. ACh levels are below normal in advanced disease* main theories for neuronal degeneration in AD - Answers - neuritic plaques with central *beta amyloid* core (dead neurons) - neurofibrillary tangles caused by abnormal forms of *tau protein* that destroy the microtubules Drugs to treat Alzheimer's Disease - Answers - cholinesterase inhibitors - donepezil donepezil mechanism of action - Answers - acetylcholinesterase inhibitor - raises levels of ACh - modest improvement of symptoms - lasts a short time considerations for donepezil - Answers - only 1/12 patients benefit from the drug. discontinue if no benefit - predictable side effects of parasympathetic nervous system (rest, digest secrete) - predictable side effects of donepezil - Answers - muscarinic agonist - GI (n/v/d) - cardiovascular (bradycardia, risk of falls) - bronchoconstriction and increased airway secretions pathophysiology for parkinsons disease - Answers - dopamine (DA) and acetylcholine (ACh) are needed in balance for controlled movements - DA producing neurons degenerate and DA and ACh are out of balance - disturbed movements occur parkinsons disease presentation mneumonic - Answers TRAP - *T*remors - *R*igidity - *A*kinesia - *P*ostural instability pharmacological therapy for parkinsons - Answers - dopameinergic agents to increase dopamine levels and restore balance with ACh - *levadopa/carbidopa* t/f levodopa/carbidopa does not cure parkinsons disease or delay disease progression - Answers true Why is carbidopa-levodopa preferred over levodopa alone? - Answers - carbidopa prevents the metabolism of levodopa in the periphery - thus more is available in the CNS what is the efficacy of levodopa/carbidopa? - Answers - very effective - failure to respond to treatment with these drugs suggests an incorrect diagonsis considerations for carbidopa/levodopa therapy - Answers - increase dose as disease progresses - loss of efficacy occurs at the end of the dosing period (give more often) or acutely (on/off effect occurs more frequently as the disease progresses) - levodopa competes with dietary protein for absorption (avoid protein heavy meals) side effects of carbidopa/levodopa - Answers - n/v (take with food) - orthostatic hypertension - dyskinesias - psychosis nociceptive pain - Answers - caused by injury - responsive to opioids and non-opioid analgesics - somatic (bones, muscles, joints) pain may be described as sharp, dull, localized - visceral pain may be described as aching, diffuse neruopathic pain - Answers - caused by nerve pathology - described with sensory terms: shooting, tearing, burning, numb, tingling - like hitting funny bone or "falling asleep" - responsive to adjuvants: antidepressants, anti-seizure drugs who uses DVPRS pain scale? - Answers those who can self report who uses CPOT pain scale? - Answers patients that are not reliable or cannot speak how is the CPOT scale used? - Answers - scale from 0-8 - scored by facial expression, body movements, compliance/vocalization, and muscle tension - score ≥ 3 indicates pain - goal is ≤ 2 considerations for pain interventions - Answers - safety - efficacy - how to take (i.e. with food, etc) - side effects - getting ahead of the pain (i.e. dose 30 minutes before physical therapy) prototype opioid agonist - Answers - morphine - agonizes kappa and mu receptors prototype opioid agonist-antagonist - Answers - pentazocine - agonizes kappa receptors - antagonizes mu receptors Prototype opioid antagonist - Answers - naloxone - reversal agent/antidote for opioid overdose prototype cyclooxygenase (COX) inhibitors - Answers - aspirin - ibuprofen - celecoxib (2nd gen NSAID) - acetaminophen combination analgesic prototype - Answers norco (hydrocodone and acetaminophen) cancer pain adjuvant prototypes - Answers - amitriptyline - gabapentin opioid definition - Answers a natural or synthetic substance that has similar properties to morphine three main types of opioid receptors are: - Answers - *mu*: primary site of action for opioid analgesics - *kappa*: less activation by and a more limited set of responses to opioid analgesics (think tramadol) - *delta*: not typically affected by opioid analgesics; responsive to endogenous opioid peptides important responses to activation of mu receptors - Answers - analgesia - respiratory depression - sedation - euphoria - physical dependance - decreased GI motility important responses to activation of kappa receptors - Answers - analgesia - sedation - decreased GI motility indications for morphine - Answers - moderate to severe pain - cancer related pain - myocardial infarction related pain - dyspnea related to CHF or pulmonary edema - preoperative sedation and anxiety reduction - only indicated for mild pain in cancer patients morphine mechanism of action - Answers - agonist at mu and kappa receptors in the CNS to produce altered pain perception and CNS depression - some side effects d/t action at receptors in the periphery morphine pharmacokinetics/dynamics - Answers - oral, IM, IV, SQ, rectal, epidural, intrathecal formulations - metabolized in liver - excreted in urine - 4-5 hour duration for most routes - first pass effect for oral doses (increase dose) - poor lipid solubility (and thus BBB crossing) - need smaller dose in neonates/infants d/t incomplete development of BBB what to check when reassessing pain after giving morphine? - Answers - respiratory rate - BP - safety (falls) d/t possible orthostasis - bowel activity morphine adverse effects - Answers - constipation - urinary retention - miosis - biliary colic - euphoria/dysphoria - respiratory depression - orthostatic hypotension - birth defects and newborn withdrawal - sedation - cough suppression (use IS) - emesis - neurotoxicity - elevated ICP Cumber obscene considerations for morphine - Answers - patients will build a tolerance - opioid naive vs chronic use/abuse - age - kidney function (renal dosing) - liver function - polypharmacy/drug interactions - timing and breakthrough dosage What opioid effects do patients build a tolerance to? - Answers tolerance develops for: - analgesia - sedation - euphoria - respiratory depression tolerance DOES NOT develop for: - constipation - miosis discuss physical dependence of morphine (opioids) - Answers - develops after 20 days - abstinence syndrome (née withdrawal) develops if drug is acutely discontinued - taper off over 3 days to avoid abstinence syndrome in therapeutic users - taper off over 7-10 days to avoid abstinence syndrome in abuse situations abstinence syndrome symptoms - Answers - yawning, rhinorrhea, diaphoresis (10 hours after last dose) - severe weakness, n/v, cramping, kicking (7-10 days after last dose) - irritability, tremor, goosebumps (cold turkey) substance abuse disorder (as opposed to addiction) - Answers continued substance craving and use despite significant life disruption and/or physical risk pentazocine - Answers - opioid agonist-antagonist - agonizes kappa - antagonizes mu - not interchangeable with a pure opioid agonist - provides mild to moderate pain relief - low abuse potential - *never give to a cancer patient, immediately puts them into withdrawal* nalaxone (narcan) - Answers - opioid antagonist - reversal agent for opioid overdoses - IV, IM, SQ, nasal spray formulations - competitive antagonist to mu and kappa receptors - duration of action is shorter than many opioids, so multiple doses may be required - intended to reverse respiratory depression/arrest - no side effects stomach cox isoform, response, and effects of inhibition - Answers - cox-1 - gastric protection (increased secretion, mucus production, etc) - gastric ulceration platelet cox isoform, response, and effects of inhibition - Answers - cox-1 - platelet aggregation - platelet aggregation inhibition/MI prophylaxis blood vessels cox isoform, response, and effects of inhibition - Answers - cox-2 - vasodilation - vasoconstriction kidney cox isoform, response, and effects of inhibition - Answers - cox-1 and cox-2 - maintenance of renal function; renal vasodilation; maintained renal perfusion - renal impairment injured tissue cox isoform, response, and effects of inhibition - Answers - cox-2 - inflammation; pain - reduced inflammation; analgesia brain cox isoform, response, and effects of inhibition - Answers - cox-2 - fever; pain - reduced fever; analgesia colon/rectum cox isoform, response, and effects of inhibition - Answers - cox-2 - colorectal cancer promotion - colorectal cancer protection cox inhibitors - Answers - NSAIDs - acetaminophen first generation NSAIDs - Answers - COX-1 and COX-2 inhibitors - aspirin - ibuprophen - naproxen second generation NSAIDs - Answers - selective cox-2 inhibitors - celecoxib non anti-inflammatory Cox inhibitor - Answers acetaminophen aspirin mechanism of action - Answers non-selective irreversible COX (1 and 2) inhibitor aspirin indications - Answers - antiplatelet (primary and secondary protection for acute myocardial event or CVA) - antipyretic - anti-inflammatory - dysmenorrhea - headache side effects/adverse reactions of aspirin - Answers - gastric ulceration - renal impairment - bleeding - salicylism (tinnitus) - Reye's syndrome (fatty liver and encephalopathy. Increased risk in children with influenza or chicken pox) nursing considerations for aspirin - Answers - give with food/water - give with proton pump inhibitor (protonix) if high dose is required - know the indication and approximate dose - higher dose = increased risk of side effects - discontinue high dose at least 1 week prior to invasive procedures - overdose can be fatal (treat with base (acid ionizes in base) to limit absorption) - hypersensitivity reactions are rare, but fatal