NURSE PRACTITIONERS IN PRIMARY CARE
EXAM 4 PROFESSIONAL EXAMPREP 2026
TESTED QUESTIONS AND SOLUTIONS FULL
REVIEW GRADED A+
◉ bronchitis (COPD) pathway to airflow limitation. Answer: -
continuous irritation from smoke/pollution > inflammation >
bronchial edema/hyper secretion of mucus > airway obstruction
◉ emphysema (COPD) pathway to airflow limitation. Answer: -
continuous irritation from smoke/pollution > inflammation >
increased protease activity > destruction of alveolar walls > airway
obstruction
◉ considerations for metered dose inhalers (MDIs). Answer: - 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). Answer: - activated
by inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
,◉ considerations for nebulizers. Answer: - fine mist droplets
- no coordination necessary
- powered equipment (not portable, needs battery or plug)
◉ considerations for respimats. Answer: - 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. Answer: asthma and COPD
◉ routes for pulmonary glucocorticoids. Answer: - oral
- parenteral
- inhalation
◉ mechanism of pulmonary glucocorticoids. Answer: - anti-
inflammatory
- immunosuppressant
,◉ pulmonary glucocorticoid prototypes (and their routes). Answer:
- fluticasone/budesonide (inhalation)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
◉ indications for pulmonary glucocorticoids. Answer: *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. Answer: - 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)?. Answer: 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. Answer: -
albuterol
- oral or inhaled
◉ long acting beta agonists (LABA) prototype. Answer: Salmeterol
◉ "-terol" mechanism of action. Answer: - beta 2 agonist
- epinephrine and "-terols"
◉ Short acting beta agonist (SABA) indications. Answer: quick relief
during asthma (or similar) exacerbation
EXAM 4 PROFESSIONAL EXAMPREP 2026
TESTED QUESTIONS AND SOLUTIONS FULL
REVIEW GRADED A+
◉ bronchitis (COPD) pathway to airflow limitation. Answer: -
continuous irritation from smoke/pollution > inflammation >
bronchial edema/hyper secretion of mucus > airway obstruction
◉ emphysema (COPD) pathway to airflow limitation. Answer: -
continuous irritation from smoke/pollution > inflammation >
increased protease activity > destruction of alveolar walls > airway
obstruction
◉ considerations for metered dose inhalers (MDIs). Answer: - 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). Answer: - activated
by inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
,◉ considerations for nebulizers. Answer: - fine mist droplets
- no coordination necessary
- powered equipment (not portable, needs battery or plug)
◉ considerations for respimats. Answer: - 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. Answer: asthma and COPD
◉ routes for pulmonary glucocorticoids. Answer: - oral
- parenteral
- inhalation
◉ mechanism of pulmonary glucocorticoids. Answer: - anti-
inflammatory
- immunosuppressant
,◉ pulmonary glucocorticoid prototypes (and their routes). Answer:
- fluticasone/budesonide (inhalation)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
◉ indications for pulmonary glucocorticoids. Answer: *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. Answer: - 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)?. Answer: 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. Answer: -
albuterol
- oral or inhaled
◉ long acting beta agonists (LABA) prototype. Answer: Salmeterol
◉ "-terol" mechanism of action. Answer: - beta 2 agonist
- epinephrine and "-terols"
◉ Short acting beta agonist (SABA) indications. Answer: quick relief
during asthma (or similar) exacerbation
