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Nurse Practitioner:
doi: 10.1097/01.NPR.0000369938.70351.52
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Asthma in pregnancy: Reading between the lines

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INSTRUCTIONS Asthma in pregnancy: Reading between the lines

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Asthma in pregnancy: Reading between the lines

General Purpose: To provide the NP with an overview of the management of asthma during pregnancy. Learning Objectives: After reading the article and taking the following test, you should be able to: 1. Describe the assessment process and findings of asthma during pregnancy. 2. Illustrate the appropriate management and control of asthma during pregnancy and lactation.

1. To confirm the diagnosis of asthma, perform

a. a chest X-ray.

b. a magnetic resonance imaging scan.

c. a PET scan following a nebulized dose of a SABA.

d. pre- and postbronchodilation spirometry.

2. When your pregnant patient has dyspnea,

a. airway obstruction is the usual cause.

b. reduced FEV1 is an expected finding.

c. spirometry is a useful tool to evaluate most patients for asthma.

d. methacholine challenge testing is done if spirometry is normal.

3. For patients classified as mild persistent asthmatics, initiate treatment at step

a. 1.

b. 2.

c. 3.

d. 4.

4. A patient with moderate asthma will have all the following except

a. daily symptoms.

b. 5% reduction in FEV1/FVC.

c. nighttime awakenings.

d. daily use of SABA for symptom control.

5. The preferred medication treatment during step 3 for persistent asthma is

a. low-dose ICS alone.

b. low-dose ICS and LABA.

c. medium-dose ICS and LTRA.

d. high-dose ICS and LABA.

6. During pregnancy, pulmonary function testing and asthma control assessment are recommended every

a. week.

b. month.

c. other month.

d. 3 months.

7. Which is a preferred rescue medication during pregnancy?

a. cromolyn

b. theophylline

c. albuterol

d. budesonide

8. Which statement is accurate about the use of a SABA for rescue therapy?

a. It should not be initiated until there is a 40% decline in peak flow readings.

b. Two to six puffs of an MDI initially, and treatment repeated 20 minutes later if symptoms persist.

c. Lack of adequate response indicates need for a LABA.

d. If symptoms are alleviated, continue SABA hourly for 4 to 6 hours.

9. Which patient report is not an indication for a step-up in asthma therapy?

a. asthma symptoms 1 day per week

b. nighttime awakenings due to asthma more than twice a month

c. use of rescue SABA more than 2 days per week

d. limitations in activities

10. The preferred controller medication for persistent asthma symptoms during pregnancy is

a. zileuton

b. budesonide

c. theophylline

d. omalizumab

11. Which medication carries the pregnancy risk category B?

a. cromolyn

b. theophylline

c. dexamethasone

d. albuterol

12. If not controlled on a medium-dose ICS alone, the next recommended add-on therapy is

a. SABA combined with theophylline.

b. SABA combined with oral corticosteroids.

c. LABA combined with mast cell stabilizers.

d. LABA combined with ICS.

13. Patients may initially treat asthma exacerbations at home with two treatments of

a. LABA, two to six puffs 20 minutes apart.

b. SABA, one to two puffs 60 minutes apart.

c. SABA, two to six puffs 20 minutes apart.

d. LTRA, two to six puffs 30 minutes apart.

14. Which is a criterion for admission to the hospital?

a. Paco2 over 42 mm Hg

b. FEV1 60% of predicted

c. a second dose of SABA is needed

d. a patient with persistent wheezing

15. After hospitalization for an acute asthma exacerbation, medications should include a prn SABA and

a. ICS, two to four puffs every 6 to 8 hours.

b. LTRA.

c. LABA.

d. oral corticosteroids.

16. Which statement is true about labor and delivery for patients with asthma?

a. Discontinue asthma medications 1 week before delivery.

b. Lumbar anesthesia can increase oxygen consumption.

c. Cesarean sections are frequently needed for acute exacerbations.

d. Hydrocortisone during labor and 24 hours afterward is recommended for high-risk patients.

17. Paradoxical central nervous stimulation in breastfeeding infants has been associated with maternal use of

a. prednisone.

b. theophylline.

c. antihistamines.

d. beta2 agonists.

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