NUR 600 MODULE 4 EXAM – QUESTIONS AND ANSWERS |
UPDATE | 100% CORRECT
1. Salmeterol for Exercise-Induced Asthma
A patient is prescribed salmeterol for prevention of exercise-induced bronchospasm. Which dosing
schedule reflects current expert guideline recommendations?
A. Every 4–6 hours routinely
B. Immediately after exercise
C. 30 minutes before exercise ✅
D. Once daily at bedtime
Rationale:
Salmeterol is a long-acting β2-agonist (LABA) used for prevention, not acute relief. It should be
administered ~30 minutes before exercise to prevent bronchospasm. Routine dosing every 4–6 hours is
inappropriate and increases risk of adverse effects.
2. Teaching for Topical Nasal Decongestants
A patient with sinusitis is prescribed a topical nasal decongestant. Which instruction is most
appropriate?
A. Limit fluids to prevent congestion
B. Increase fluids to about 2 L/day ✅
C. Use continuously for 2 weeks
D. Avoid blowing the nose
Rationale:
Adequate hydration helps thin secretions and improve sinus drainage. Overuse (>3–5 days) of topical
decongestants can cause rebound congestion (rhinitis medicamentosa).
3. Antihistamines in Elderly Patients
A 71-year-old patient with cardiac disease is prescribed an antihistamine. What is the primary concern?
A. Hypoglycemia
B. Renal failure
C. Cardiac arrhythmias ✅
D. Hyperthyroidism
,Rationale:
First-generation antihistamines can cause QT prolongation and arrhythmias, especially in elderly
patients with cardiac disease.
4. Acute Bronchospasm Treatment
Which drug is most effective for rapid relief of acute bronchospasm?
A. Montelukast
B. Cromolyn
C. Theophylline
D. Epinephrine ✅
Rationale:
Epinephrine provides rapid bronchodilation via β2 stimulation and is effective in acute severe
bronchospasm, especially emergencies.
5. Dextromethorphan Interaction
A patient taking dextromethorphan should be monitored for hypotension if also taking:
A. NSAIDs
B. Beta blockers
C. MAO inhibitors ✅
D. Antacids
Rationale:
Combining dextromethorphan with MAO inhibitors can lead to serotonin syndrome and
cardiovascular instability, including hypotension.
6. Ipratropium Allergy Concern
A COPD patient develops distress after first dose of ipratropium. What is the likely cause?
A. Sulfa allergy
B. Soy allergy ✅
C. Lactose intolerance
D. Gluten sensitivity
, Rationale:
Older formulations of ipratropium inhalers contain soy lecithin, which may trigger allergic reactions in
sensitive individuals.
7. Decongestants and Disease Exacerbation
Which condition may be worsened by nasal decongestants?
A. Diabetes
B. Asthma
C. Hypothyroidism ✅
D. Anemia
Rationale:
Decongestants stimulate the sympathetic system and may worsen metabolic imbalance in
hypothyroidism.
8. Nasal Steroid Effect Timeline
A patient reports nasal steroids are not working after 2 days. What is the best response?
A. Stop immediately
B. Switch medication
C. Double the dose
D. Full effect may take up to 2 weeks ✅
Rationale:
Intranasal corticosteroids require consistent use for 1–2 weeks before maximum therapeutic effect is
achieved.
9. Purpose of COPD Medications
A newly diagnosed COPD patient asks about medications. Best response?
A. Cure infection
B. Improve immunity
C. Reduce inflammation and dilate bronchi ✅
D. Increase oxygen production
Rationale:
COPD therapy focuses on bronchodilation and reducing airway inflammation, improving airflow.
UPDATE | 100% CORRECT
1. Salmeterol for Exercise-Induced Asthma
A patient is prescribed salmeterol for prevention of exercise-induced bronchospasm. Which dosing
schedule reflects current expert guideline recommendations?
A. Every 4–6 hours routinely
B. Immediately after exercise
C. 30 minutes before exercise ✅
D. Once daily at bedtime
Rationale:
Salmeterol is a long-acting β2-agonist (LABA) used for prevention, not acute relief. It should be
administered ~30 minutes before exercise to prevent bronchospasm. Routine dosing every 4–6 hours is
inappropriate and increases risk of adverse effects.
2. Teaching for Topical Nasal Decongestants
A patient with sinusitis is prescribed a topical nasal decongestant. Which instruction is most
appropriate?
A. Limit fluids to prevent congestion
B. Increase fluids to about 2 L/day ✅
C. Use continuously for 2 weeks
D. Avoid blowing the nose
Rationale:
Adequate hydration helps thin secretions and improve sinus drainage. Overuse (>3–5 days) of topical
decongestants can cause rebound congestion (rhinitis medicamentosa).
3. Antihistamines in Elderly Patients
A 71-year-old patient with cardiac disease is prescribed an antihistamine. What is the primary concern?
A. Hypoglycemia
B. Renal failure
C. Cardiac arrhythmias ✅
D. Hyperthyroidism
,Rationale:
First-generation antihistamines can cause QT prolongation and arrhythmias, especially in elderly
patients with cardiac disease.
4. Acute Bronchospasm Treatment
Which drug is most effective for rapid relief of acute bronchospasm?
A. Montelukast
B. Cromolyn
C. Theophylline
D. Epinephrine ✅
Rationale:
Epinephrine provides rapid bronchodilation via β2 stimulation and is effective in acute severe
bronchospasm, especially emergencies.
5. Dextromethorphan Interaction
A patient taking dextromethorphan should be monitored for hypotension if also taking:
A. NSAIDs
B. Beta blockers
C. MAO inhibitors ✅
D. Antacids
Rationale:
Combining dextromethorphan with MAO inhibitors can lead to serotonin syndrome and
cardiovascular instability, including hypotension.
6. Ipratropium Allergy Concern
A COPD patient develops distress after first dose of ipratropium. What is the likely cause?
A. Sulfa allergy
B. Soy allergy ✅
C. Lactose intolerance
D. Gluten sensitivity
, Rationale:
Older formulations of ipratropium inhalers contain soy lecithin, which may trigger allergic reactions in
sensitive individuals.
7. Decongestants and Disease Exacerbation
Which condition may be worsened by nasal decongestants?
A. Diabetes
B. Asthma
C. Hypothyroidism ✅
D. Anemia
Rationale:
Decongestants stimulate the sympathetic system and may worsen metabolic imbalance in
hypothyroidism.
8. Nasal Steroid Effect Timeline
A patient reports nasal steroids are not working after 2 days. What is the best response?
A. Stop immediately
B. Switch medication
C. Double the dose
D. Full effect may take up to 2 weeks ✅
Rationale:
Intranasal corticosteroids require consistent use for 1–2 weeks before maximum therapeutic effect is
achieved.
9. Purpose of COPD Medications
A newly diagnosed COPD patient asks about medications. Best response?
A. Cure infection
B. Improve immunity
C. Reduce inflammation and dilate bronchi ✅
D. Increase oxygen production
Rationale:
COPD therapy focuses on bronchodilation and reducing airway inflammation, improving airflow.
