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NURS 511-RESPIRATORY EXAM TEXT QUESTIONS WITH ANSWERS STUDY GUIDE 2022 UPDATE
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NURS 511-RESPIRATORY EXAM TEXT QUESTIONS WITHANSWERS STUDY GUIDE 2022 UPDATE
Which of the following medications should be used cautiously in a patient who has asthma? (Timolol
ophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate bronchoconstriction in patients who
have asthma. Even though timolol is being administered in the eye, it is absorbed through mucous
membranes and can exert systemic effects. Beta blockers should be avoided in patients with asthma
and used cautiously in patients with COPD. The other medications listed have no specific
contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis. Cough is the most
common symptom associated with acute bronchitis. Purulent sputum is identified in more than 50% of
patients with acute bronchitis. The color imparted to the sputum is usually due to sloughing of epithelial
cells, not bacterial infection. Concurrent upper respiratory symptoms are typical of acute bronchitis.
Pharyngitis is common.
Mild persistent asthma is characterized by: (symptoms occurring more than twice weekly)
Mild persistent asthma is characterized by symptoms that occur more than twice weekly but not daily;
or 3-4 nocturnal awakenings per month due to asthma. It is treated with an inhaled steroid daily, and a
bronchodilator PRN for exacerbations. If symptoms occur more than twice weekly, therapy should be
stepped up. Generally, a long-acting bronchodilator is added to the steroid when therapy is stepped up.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is assessed if there is concern
about the circumference of either the head or the chest. An exception to this observation can occur in
premature infants where the head grows very rapidly. Normally, the head exceeds the chest
circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest
circumference should be about equal and by 2 years of age the chest should be larger than the head. The
chest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is his likely diagnosis?
(Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of fever and cough, should
direct the examiner to consider pneumonia as the diagnosis. Other common clinical findings with
pneumonia include chest pain, dyspnea, and sputum production. Though not common, some patients
with pneumonia exhibit gastrointestinal symptoms like nausea, vomiting, and diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature > 101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most common symptom
associated with acute bronchitis. Purulent sputum is identified in more than 50% of patients with acute
bronchitis. The color imparted to the sputum is usually due to sloughing of epithelial cells, not bacterial
infection. Concurrent upper respiratory symptoms are typical of acute bronchitis. Pharyngitis is common
within the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
, NURS 511-RESPIRATORY EXAM TEXT QUESTIONS WITH
ANSWERS STUDY GUIDE 2022 UPDATE
One of the most common causes of cough in adults is asthma. Cough due to asthma is often
accompanied by episodic wheezing or dyspnea, though some patients who have asthma only cough. This
is termed “cough-variant asthma.” The clinical presentation of asthma varies but hyper-responsiveness
of the airways is a typical finding.
The most common cause of atypical pneumonia in adults is: (Mycoplasma pneumonia)
In patients who have atypical pneumonia, Mycoplasma is the most common pathogen. M.
pneumoniae is so named because of its atypical appearance on chest X-ray. This organism is
responsible for “walking pneumonia” that is prevalent in a young adult population. This accounts for
about 15% of pneumonia and is transmitted via respiratory droplet.
Which patient might be expected to have the worst FEV1? (A 65-year-old with emphysema)
FEV 1 stands for “forced expiratory volume in 1 second.” This is the volume of air that is forcefully
exhaled in the first second of exhalation after a deep breath. Patients with emphysema are not able to
do this efficiently because their alveoli are stretched, and mostly contain trapped air. FEV 1 is used to
assess airway obstruction. An asthma patient in the green zone would be expected to have a normal
(compared to himself) FEV1. An FEV1 measurement or pulmonary function tests would not be
performed on a patient with pneumonia or bronchiectasis because he would have diminished
respiratory capacity related to his infection.
A patient who has asthma presents with chest tightness, wheezing, coughing, and fever. He has
wheezing and diminished breath sounds in the upper right lobe. His cough is nonproductive, and he
denies nasal symptoms. Which symptom is not likely related to his asthma? (Fever)
Wheezing is typical of asthma, but one must consider pneumonia in any patient who presents with
diminished breath sounds in only one lobe. Fever is not typical of asthma or an exacerbation.
Ipratropium is very widely used in the treatment of COPD. Which of the following statements about
ipratropium is correct? (It decreases parasympathetic tone and produces bronchodilation)
Ipratropium is the most widely studied anticholinergic medication used to treat patients with COPD. It
produces its helpful effects by reducing cholinergic tone in the lungs. It may be used with a beta agonist
if shortness of breath is present. However, beta agonists increase side effects like tachycardia and
tremor and do not improve efficacy.
, NURS 511-RESPIRATORY EXAM TEXT QUESTIONS WITH
ANSWERS STUDY GUIDE 2022 UPDATE
An 80-year-old has Stage 3 COPD. He is most likely to have concomitant: (anxiety or depression)
About 40% of older patients who have COPD have concomitant anxiety and/or depression. It should
be treated because it affects the overall management of COPD. COPD is characterized by airflow
limitation and dyspnea. This may contribute to feelings of chronic anxiety. Additionally, many chronic
diseases are associated with depression. This is the case with COPD.
A 6-year-old child who has moderate persistent asthma is diagnosed with pneumonia after chest X-
ray and laboratory studies. He developed a sudden onset of fever with chills. He is in no distress.
What is the preferred treatment for him? (Amoxicillin)
In children who are older than 5 years of age, the most common bacterial pathogen is an atypical
pathogen. Because this child has asthma and uses an inhaled steroid daily, the most likely pathogen is
Streptococcus pneumoniae. An abrupt onset of fever and chills is suggestive of Streptococcal
pneumonia. Amoxicillin is usually chosen first for its efficacy, cost, and tolerability. The higher dose (80-
100 mg/kg/d) is chosen because of the prevalence of resistant Streptococcus pneumoniae. Azithromycin
would be chosen if an atypical pathogen was more likely. Doxycycline is not an appropriate choice
because it has poor Strep coverage and it is contraindicated in children younger than 8 years.
What disease is usually managed with a short-acting or long-acting inhaled anticholinergic
medication? (COPD)
First-line treatment for patients with COPD who have intermittent symptoms of shortness of breath is
an anticholinergic medication because it improves lung function. Alternatively, a short-acting beta
agonist may be used. Anticholinergic medications are not used as a lone agents to manage symptoms of
asthma; inhaled steroids usually are. Bronchitis is a viral infection that is self-limited and usually does
not require an inhaled medication. Bronchiectasis is a disease in which the respiratory tubules are
permanently enlarged. Symptoms include chronic production of purulent mucous.
A patient with pneumonia reports that he has rust-colored sputum. What pathogen should the nurse
practitioner suspect? (Streptococcus pneumonia)
, NURS 511-RESPIRATORY EXAM TEXT QUESTIONS WITH
ANSWERS STUDY GUIDE 2022 UPDATE
Clinical descriptions of mucus do not really help in clinical decision-making regarding pneumonia, but
certain clinical characteristics are associated with specific types of pneumonia. Strep pneumonia, also
known as pneumococcal pneumonia, is associated with rust-colored sputum. Scant or watery sputum is
associated with atypical pathogens like Mycoplasma and Chlamydophila pneumonia. Thick, discolored
sputum may be associated with bacterial pneumonia.
A 44-year-old nonsmoker is diagnosed with pneumonia. He is otherwise healthy and does not need
hospitalization at this time. Which antibiotic can be used for empirical treatment of pneumonia
according to the most recent Infectious Diseases Society of America/American Thoracic Society
guidelines? (Azithromycin)
The guidelines recommend macrolide use or doxycycline for initial treatment of uncomplicated
pneumonia in outpatients who are otherwise healthy and have not had recent antibiotic exposure. The
initial choices can be any of these: azithromycin, clarithromycin, or doxycycline. These agents are
chosen because they cover atypical pathogens, the most likely pathogen in this population.
Fluoroquinolones are commonly used first line in these patients; however, the guidelines strongly
recommend using fluoroquinolones for patients with comorbidities or patients who have recent
antibiotic exposure.
The gold standard for diagnosing pneumonia on chest X-ray is the presence of: (Infiltrates)
The finding of infiltrates on chest X-ray, in conjunction with clinical findings of fever, chest pain,
dyspnea, and sputum production on clinical exam, should direct the examiner to consider pneumonia as
the diagnosis.
An 83-year-old healthy adult is diagnosed with pneumonia. He is febrile but in no distress. What is the
preferred treatment for him? (Levofloxacin)
At age extremes, the most common pathogen is Streptococcus pneumoniae. Because of the age of the
patient and the consequences of potential treatment failure, a respiratory quinolone should be
considered. Quinolone antibiotics can produce QT prolongation and should be used cautiously in older
adults. Azithromycin or doxycycline would be chosen if an atypical pathogen was suspected. This is
unlikely in this patient because of his age.
The pneumococcal immunization in infants has: (shifted the pathogenesis to fewer cases of S.
pneumonia)
The heptavalent pneumococcal conjugate vaccine (PCV13), Prevnar, protects children from 13 types of
pneumococcal bacteria. It has reduced the incidence of ear infections caused by S. pneumo and has
reduced the incidence of recurrent ear infections and tube placement by 10-20%. The pathogenesis of
acute otitis media has shifted to more cases of H. influenzae, but this organism is less likely to become
resistant, as Strep pneumo has.
A 78-year-old adult who has a 50 pack year smoking habit asks the nurse practitioner about the
benefits of quitting “at my age.” What should the nurse practitioner reply? (This will decrease your
risk of all cause mortality 5 years after stopping)
Smoking cessation at any age is beneficial to the person engaging in smoking cessation. Data
demonstrates that after 5 years of smoking cessation, there is a significant decrease in the risk of death
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