1. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?
(Points : 3)
A man complaining of general fatigue a headache and facial pain with a temperature of 100.9F
A woman presenting with malaise lethargy and copious nasal secretions
A man with a dry stuffy nasopharynx a sore throat and temperature of 98.9F
A woman complaining of generalized aches who has a hoarse voice and reddened painful upper airways
Question 2.2. A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE? (Points : 3)
She was short of breath because ventilation was occurring but perfusion was inadequate.
The combination of normal perfusion but compromised ventilation caused hypoxia.
She developed a transient anatomic shunt resulting in impaired oxygenation.
Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia.
Question 3.3. A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia low lung compliance and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant’s present health problem? (Points : 3)
High inspired oxygen concentration and injury from positive-pressure ventilation
Failure to administer corticosteroids to the infant in utero
Insufficient surfactant production and insufficient surfactant therapy
Insufficient supplemental oxygen therapy
Question 4.4. Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? (Points : 3)
A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration
An 81-year-old smoker who has increased exercise intolerance a fever and increased white blood cells
An 81-year-old male who has a productive cough and recurrent respiratory infections
An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke
Question 5.5. A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner’s most likely suspicion? (Points : 3)
Question 6.6. A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate? (Points : 3)
Being in bed increases the risk of fluid accumulating between your lungs and their lining so it’s important for you to change positions often.
You should breathe deeply and cough to help your lungs expand as much as possible while you’re in bed.
Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube.
I’ll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in.
Question 7.7. Due to complications a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which of the following processes would his care team anticipate with relation to his health problem? (Points : 3)
Vasodilation in the alveolar vessels in the affected region of his lung
Increased workload for the left side of the patient’s heart
Increased blood flow to the area of atelectasis
Redirection of blood flow away from the lung regions that are hypoxic
Question 8.8. Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD? (Points : 3)
Audible wheezing on expiration
Diminished expiratory flow rates
Increased respiratory rate with decreased tidal volume
Normal compliance of alveolar tissue
Question 9.9. A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death?
(Points : 3)
Proliferation of natural killer (NK) cells in the alveolar lumen
Large numbers of alveolar macrophages in septal connective tissue
The presence of tubercles in the intra-alveolar spaces
Compensatory regeneration of type I alveolar cells
Question 10.10. A 21-year-old male patient has suffered a head injury during a crash on his motorcycle and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition? (Points : 3)
His oropharynx is obstructed.
His epiglottis is covering his larynx
His vocal folds have been compromised.
His tracheobronchial tree is intermittently obstructed.
Question 11.11. A short nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly just after lunch and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal and he is not cyanotic. Which condition is most likely causing his symptoms? (Points : 3)
Pleuritis related to infection
Question 12.12. Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? (Points : 3)
Intrapleural pressure slightly exceeds that of the inflated lung
The chest wall exerts positive pressure on the lungs that contributes to expiration
The lungs are prevented from collapsing by constant positive intrapulmonary pressure
Negative intrapleural pressure holds the lungs against the chest wall
Question 13.13. The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son’s condition. Which of the following teaching points is most justifiable? (Points : 3)
Research has shown that viruses may actually be a factor in many children’s asthma.
The most reliable indicator that your child is having an asthma attack is audible wheezing.
Steroids that your child can inhale will likely be the first line of defense.
Your son will likely need to limit or avoid exercise and sports.
Question 14.14. Which of the following phenomena is most likely occurring during a child’s alveolar stage of lung development? (Points : 3)
Terminal alveolar sacs are developing and surfactant production is beginning.
A single-capillary network exists and the lungs are capable of respiration.
The conducting airways are formed but respiration is not yet possible.
Primitive alveoli are formed and the bronchi and bronchioles become much larger.
Question 15.15. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out? (Points : 3)
Decreased elastic recoil due to alveolar damage
Decreased residual lung volume due to impaired alveolar ventilation
Increased anatomic dead space due to reduced tidal volume
Increased alveolar dead space due to incorrect intrapleural pressure
Question 16.16. A definitive test for cystic fibrosis is (Points : 3)
The sweat test
A sputum culture
A fecal fat test
A Chymex test for pancreatic insufficiency
Question 17.17. A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing? (Points : 3)
Rapid deep breaths
Short shallow breaths
Question 18.18. Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli?