Pulmonary

Question 1

When assessing a patient with cor pulmonale, you would anticipate any of the following clinical signs, except:
A. Jugular venous distension
B. Mitral valve murmur
C. Hepatosplenomegaly
D. Pedal edema

Answer 1

B

Cor pulmonale is right sided heart failure resulting from pulmonary artery hypertension. Venous congestion resulting from the right sided heart failure can cause JVD, HSM, and peripheral edema. Right sided heart failure would generally cause tricuspid regurgitation/murmur, but not MVR

Question 2

The most common cause of viral community acquired pneumonia in children is:
A. Streptococcus pneumoniae
B. Influenza
C. Mycoplasma pneumoniae
D. Respiratory syncytial virus

Answer 2

D is correct. CAP results in over 100,000 hospitalizations annually, 66% of which are viral in nature. RSV is the primary offender, as well as parainfluenza, influenza, human rhinovirus, human metapneumovirus, and adenoviruses.

Question 3

A young mom presents to your clinic with her 3 year old child. She reports the child has had a runny nose and barky cough for the past 3 days and she is concerned he’s having a harder time breathing. VS show a temperature of 99.2 (F), HR 140/min, RR 40/min, O2 sats 98%. The child is generally well-appearing with moderate increased work of breathing. Which pulmonary exam finding would you anticipate?
A. Expiratory wheezes
B. Rhales in bilateral lower lobes
C. Inspiratory stridor
D. Diffuse rhonchi throughout all lung fields

Answer 3

C is correct. A barky cough is a hallmark of croup (aka laryngotracheobronchitis), a viral infection that causes inflammation/edema in the subglottic region. This contributes to the characteristic cough, as well as possible inspiratory stridor.

Question 4

The advanced practice nurse is providing education to a patient who has recently been diagnosed with asthma. The nurse knows which of the following is a modifiable risk factor that could be contributing to the patient’s asthma?

A Family history of asthma
B. GERD
C. Rural living
D. Obesity

Answer 4

Obesity is a modifiable risk factor for asthma.

Question 5

A nurse practitioner is caring for a newborn who has just been diagnosed with cystic fibrosis. Which of the following statements would best explain the diagnosis to the parents?

A. “It is an acquired viral or bacterial infection where the air exchange part of the lungs fill with fluid, making it difficult to breathe”
b. “It is a genetic condition that causes the mucus to be thick, which can affect your child’s breathing and digestive tract”
c. “It is an inflammatory lung disease associated with lung immaturity and airway injury”
d. “It is a combination of genetic and environmental factors resulting in reversible airway obstruction and hyperactivity of the pulmonary tract”

Answer 5

B. “It is a genetic condition that causes the mucus to be thick, which can affect your child’s breathing and digestive tract”t is describing cystic fibrosis

Question 6

Melissa is a nurse who is caring for a patient who is scheduled for a total knee replacement surgery the following day. She informs the patient that they cannot eat or drink after midnight prior to their surgery. The patient is confused if they are having surgery on their leg why they cannot eat or drink. Melissa knows that which of the following is the reason for NPO prior to surgery?

a Increased risk for an allergic reaction
b. Do not want GI upset prior to anesthesia
c. Increased risk for aspiration pneumonia
d. Increased risk for a pulmonary embolism

Answer 6

C. General anesthesia increases the risk for aspiration of oral contents, which can lead to infection and pneumonia, among other risks including airway obstruction therefore fasting for a minimum of 8 hours is recommended

Question 7

Which of the following causes of impaired ventilation is not attributable to a restriction of the chest wall?
A. empyema
B. Obesity
C. Kyphoscholiosis
D. Pectus Excavatum

Answer 7

A. empyema– in this type of pleural effusion, pus from an infection course accumulates in the pleural space

Question 8

While assessing a patient admitted w/ CHF exacerbation, the provider notes decreased breath sounds over the left lower lobe with asymmetrical chest expansion. A CXR is ordered, and the image reveals a collection of fluid in the pleural cavity. What are these findings consistent with?
A. Pleural effusion
B. pulmonary edema
C. mediastinal shift
D. atelectasis

Answer 8

A. Pleural effusion, fluid collects between the lungs and the pleural sac

Question 9

______ is/are still considered a controversial treatment in PARDS

A. corticosteriods
b. non invasive mechanical ventilation
C. ECMO
D. Invasive mechanical ventilation (intubation)

Answer 9

A. corticosteroids are controversial in PARDS but has been associated with improvements in lung function and survival in some studies

Question 10

Mr. Winter, age 45, was recently diagnosed with emphysema, exhibiting dyspnea and a barrel chest, along with a decreased FEV1 (forced expiratory volume in one second) in his lung function test. He is puzzled as to why he has emphysema, given that he has never smoked and has no exposure to secondhand smoke. Which of the following explanations is correct?

A. You have α1-antitrypsin deficiency, which normally inhibits proteolytic enzymes like elastases from neutrophils. Without this inhibition, unchecked protease activity leads to the destruction of alveolar walls and permanent enlargement of airways, causing obstruction.

B. Your symptoms may be due to left-sided heart disease. When the left ventricle fails, increased pressure can cause fluid to leak into the lungs, resulting in dyspnea.

C. This condition could arise from blood clots in the legs that obstruct pulmonary blood flow, releasing substances that cause vasoconstriction and respiratory issues.

D. This may be related to carcinoma of the true vocal cords that has spread to your lungs.

Answer 10

A. The two most common phenotypes of Chronic Obstructive Pulmonary Disease (COPD) are chronic bronchitis and emphysema. Emphysema is characterized by the abnormal, permanent enlargement of gas-exchange airways, accompanied by the destruction of alveolar walls without significant fibrosis. Both phenotypes are linked to an enhanced chronic inflammatory response in the airways to noxious particles or gases. Emphysema features inflammation, an imbalance between proteases and antiproteases, oxidative stress, and apoptosis of lung structural cells. Nonsmokers with inherited α1-antitrypsin deficiency typically develop COPD at an older age compared to those with the deficiency who smoke. Hepatic fibrosis may also occur. Due to the emergence of effective treatments, some experts now recommend screening all individuals with diagnosed COPD for α1-antitrypsin deficiency. Family screening is advised for those who test positive. Supportive treatment for lung disease associated with α1-antitrypsin deficiency is the same as that for COPD, including keeping influenza, COVID-19, and pneumococcal vaccinations up to date, as well as pharmacologic management based on clinical severity.

Question 11

Which of the following comparisons of signs and symptoms of pulmonary diseases is correctly described?

A. In a communicating pneumothorax, the pressure of air in the pleural space equals barometric pressure, as air drawn in during inspiration is expelled during expiration. In tension pneumothorax, pleural pressure exceeds barometric pressure because air enters during inspiration but cannot escape during expiration.

B. Dyspnea is a feeling of breathlessness, while orthopnea specifically refers to breathlessness when lying flat.

C. Chylothorax is the presence of lymphatic fluid in the pleural space, whereas hemothorax is the presence of blood in the pleural space.

D. Absorption atelectasis is the collapse of alveoli due to the absorption of gases from obstructed alveoli, while compression atelectasis occurs due to external pressure on the alveoli.

Answer 11

A In open (communicating) pneumothorax, air drawn into the pleural space during inspiration is expelled during expiration. In tension pneumothorax, the rupture site acts as a one-way valve, allowing air to enter but preventing its escape, leading to increased pressure and lung compression (p.1159).

Question 12

Which of the following steps describes the development of a specific pulmonary disease?

1) Damage to pulmonary capillary endothelial and alveolar epithelial cells occurs within 72 hours due to direct or indirect injuries, such as pneumonia or COVID-19.

2) This damage activates neutrophils, macrophages, and platelets, leading to the release of inflammatory cytokines and increased capillary permeability.

3) Fluids, proteins, and blood cells leak into the pulmonary interstitium, flooding the alveoli (Exudative phase) and causing significant reduction in alveolar ventilation, resulting in a V/Q mismatch and severe hypoxemia.

4) The initial increase in respiratory rate causes hypocapnia and respiratory alkalosis.

5) Damage to epithelial cells reduces surfactant production, leading to atelectasis and pulmonary edema, marking the start of the proliferative phase of this disease.

6) The fibrotic stage involves remodeling and fibrosis of lung tissue.

A. Cystic fibrosis
B. Atelectasis
C. ARDS
D. Acute epiglottitis

Answer 12

ARDS - acute respiratory distress syndrome

Question 13

Gastric Esophageal Reflux Disease places a patient at higher risk for:

A. Chronic Cough

B. Aspiration Pneumonia

C. Laryngeal Cancer

D. All of the Above

Answer 13

all of the above are true as patients with GERD

Question 14

All of the following are appropriate interventions to stabilize and treat a 3 year old male with suspected epiglottis except:

A. Obtain chest/soft tissue neck X-ray

B. Administer broad spectrum antibiotics

C. Physical examination of throat

D. Keep the patient calm and undisturbed

Answer 14

Physical examination of throat should be avoided, due to possible “laryngospasm and cause respiratory collapse” (

Question 15

While evaluating a patient for pneumoconiosis, as the provider you know it is most important to ask the patient:

A. Family history

B. Occupational history

C. Smoking history

D. Onset of illness

Answer 15

B— pneumoconiosis is a lung disease that occurs from inhalation of inorganic dusts generally progressing for fibrosis. This is typically seen in coal workers and miners as silicosis and coal workers lung.

Question 16

1 week onset of insult with new or worsening respiratory symptoms, bilateral opacities on imaging not fully explained by other respiratory pathology and respiratory failure not explained by cardiac failure or pulmonary edema are diagnostic criteria to diagnose what disease?

A. COPD

B. ARDS

C. Pulmonary embolism

D. Asthma

Answer 16

B ARDS

Acute respiratory distress syndrome is acute lung inflammation and alveolocapillary injury that is the result of lung injury or systemic process. There are many causes of ARDs like multi trauma and sepsis but they all start with inflammation that progresses to flooding of the alveoli from capillary leaking or exudative phase to the fibrotic stage of remodeling the lungs with fibrinous tissue. This progression to the fibrotic stage permanently damages the lung leading to long term respiratory compromise. (

Question 17

A 14 month old child arrives to the clinic with complaints of rhinorrhea and low grade fever. Upon physical exam the child has a seal-like barking cough and inspiratory stridor and deep retractions with respirations. What is a likely diagnosis for this child?

A. Acute asthma exacerbation

B. Acute epiglottitis

C. Tonsil infection

D. Viral croup

Answer 17

croup

Viral croup is the inflammation of the supraglottic air way. This is often caused by a viral infection in children 6 months to 2 years of age. The inflammation and edema causes an upper airway obstruction resulting in the barking cough and retractions. The negative intrathoracic pressure caused by the obstruction causes further airway collapse and can lead to respiratory failure and hypoxia.Treatment depends on the level of severity. Often humidified oxygen is used and if stridor at rest is present the patient may require inpatient treatment with inhaled epinephrine and corticosteroids.

Question 18

When providing education to a family with a newborn regarding SIDS and Safe sleep practices. What statement indicates further education is required?

A Its ok to have 1 blanket in the crib with baby

B The baby should be placed on their back for sleep

C No one is allowed to smoke in the house or near the baby

D We will learn CPR for emergencies

Answer 18

A. the etiology of SIDs is unknown but we do know risk factors and ways to try to prevent the occurrence of SIDs. Mitigating risk factors include safe sleep practices like having the infant sleep alone on a firm surface with no loose or bulky clothing or blankets. This includes no pillows or toys.

Question 19

A patient is asking about treatments for asthma, and that patient asks which is the most effective for managing their asthma symptoms?

A. Avoidance of allergens

B. Short-acting beta-agonists

C. Continuous low-dose inhaled corticosteroids with or without long-acting beta-agonist

D. Formoterol

Answer 19

C

Continuous low-dose inhaled corticosteroids with or without long-acting beta-agonists (correct answer) – using these for even the mildest form of asthma is most effective in managing symptoms (Rogers & Brashers, 2023). Page 1170

Question 20

A patient presents to the emergency room with a pulmonary embolism, what is the primary treatment for a PE?

A. Pneumatic calf compression

B. Anticoagulant therapy

C. Leg elevation

D. Ambulation

Answer 20

B
the primary treatment for PE is anticoagulant therapy; this is the treatment of choice for most individuals with stable oxygenation and hemodynamics

Question 21

An infant is admitted to the emergency room with suspected bronchopulmonary dysplasia, which is considered an infant predisposition risk factor for this infant.

A. Protein oxidation

B. Premature birth <28 weeks

C. Barotrauma

D. Lipid peroxidation

Answer 21

B

Infant predisposition risk factors include premature birth < 28 weeks, male sex, genetic susceptibility, race, altered microbiome, and sepsis (Rogers & Brashers, 2023). Page 1198

Question 22

Ryan is a nursing student who is learning about the pulmonary system. Which of the follow statements would indicate that he understands the pathophysiology of chronic obstructive lung disease exacerbation?

A. Wheezing occurs from persistent bronchial inflammation and bronchoconstriction
B. Hypercapnia occurs when hypertrophied bronchial smooth muscle constricts airways and traps air in the distal portions of the lungs (hyperinflation)
C. Cyanosis occurs when the inflamed and mucus filled airways impair the body’s ability to inhale enough oxygen
D. Polycythermia occurs to increase the number of oxygen carrying cells
E All of the above

Answer 22

ALL

COPD results in progressive damage from inflammation, oxidative stress, extracellular matrix proteolysis, apoptotic and autophagic cell death. Thick mucus and hyperthrophied bronchial smooth muscle constricts airways and leads to obstruction. The expiratory obstruction traps air in the distal portion of the lungs, leading to hypoventilation, hypoxemia, and hypercapnia (Rogers & Brashers, 2023, pp. 1173-1175)

Question 23

Risk factors for surfactant deficiency disorder includes the following, except:

A Prematurity
B Vaginal birth
C Multiple pregnancies
D Perinatal asphyxia

Answer 23

B. Vaginal birth helps to prevent surfactant deficiency disorder due to the lung compression during delivery

Question 24

Which of the following statements are true about cystic fibrosis?

A Cystic fibrosis only involves the respiratory tract
B Cystic fibrosis involves thin copious secretions
C The typical features of cystic fibrosis include mucus plugging, chronic inflammation and chronic infection
D All of the above

Answer 24

C. As a result of the mutations in the cystic fibrosis transmembrane conductance regulator, the typical features of cystic fibrosis include mucus plugging, chronic inflammation and chronic infection (Rogers & Brashers, 2023, p. 1205)

Question 25

Jesse arrives at your clinic reporting continuous asthma exacerbations after being diagnosed with chronic asthma earlier this year. When assessing compliance to therapy, which statement would lead to further evaluation?
A. I made sure to arrive 15 minutes early to each of my allergy shot appointments.
B. I was unsure if the technique for each of my inhaler’s use was the same, so I called the manufacturer to confirm
C. Even though it isn’t peak allergy season for pollen, I still make sure to take my medications every morning
D. My long term inhaler expired, so I’ve been using my short-term inhaler for the last couple weeks

Answer 25

D.
Continuous use of short-acting beta-antagonists has been shown to cause severe asthma exacerbations, and is not as effective as continuous long-acting beta-agonist use for those that are compliant (Rogers & Brashers, 2023, p. 1170). Therefore, it is not beneficial for Jesse to use his short-acting inhaler in place of his long-acting one, and should have it replaced immediately. All the other responses are appropriate with compliance to asthma treatment and control.

Question 26

As a new provider at a respiratory clinic, you would know which initial finding a newly-diagnosed COPD patient would typically indicate they are experiencing emphysema over bronchitis?
A. Presence of barrel chest
B. Cyanosis of the upper extremities
C. Prolonged expirations
D. Productive cough despite negative panels for infection

Answer 26

A

Although it can occur in patients that are experiencing bronchitis, barrel chest is the classis sign of a patient experiencing emphysema with COPD due to air trapping from destruction of the alveolar walls (Rogers & Brashers, 2023, p. 1174). Cyanosis is uncommon in emphysema, and prolonged expirations is common in both of the issues. Productive cough WITH an infection is common in emphysema, but without active infection is normal for those with bronchitis.

Question 27

Timmy, an 8-year-old boy, is brought to your office by his parents with concern that he might have obstructive sleep apnea. While reviewing his history, what finding would raise more concern for possible sleep apnea?
A. Being in the 70th percentile for height and weight at his age
B. Previous tonsillectomy and adenoidectomy at age 7
C Delivered at 40 weeks of pregnancy
D. Both parents being of Irish decent

Answer 27

B

Before considering sleep apnea, it is important to rule out other possible issues, including inflamed tonsils/adenoids for pediatric obstructive sleep apnea. However, since Timmy already had both of them removed, so this is important to note during his assessment (Rogers & Brashers, 2023, p. 1194). All other responses do not put him into a vulnerable population, which includes preterm birth, black/Hispanic descent and obesity.

Question 28

A 78-year-old male is brought to the emergency department due to respiratory failure secondary to severe chronic obstructive pulmonary disease exacerbation. On assessment, it is determined that he is breathing with periods of deep, rapid breathing followed by apnea which lasts for 20-30 seconds.
What abnormal breathing pattern is this patient demonstrating?

A. Labored breathing
B. Kussmaul respirations
C. Cheyne-Stokes respirations
D. Restricted breathing

Answer 28

C

Cheyne-Stokes respirations is when someone demonstrates alternating periods of shallow, deep breathing with periods of apnea that last for longer than 15 seconds (Rogers & Brashers, 2023, p. 1154). These respirations can be caused by neurologic impairment of the brain or reduced blood flow to the patient’s brain and brainstem.

Question 29

A new mother and her newborn come to the clinic for a well-child visit five days after the baby’s delivery. The mother is concerned about sudden infant death syndrome (SIDS), as this occurred with a family friend’s newborn. In regards for educating the new mother on best practices to reduce SIDS, what would be the best recommendation?
A. Allowing the infant to sleep on their stomach to maximize respirations and prevent choking
B. Encouraging co-sleeping with the infant to monitor breathing overnight
C. Having the infant sleep on their back in a crib with a firm mattress
D. Use of soft bedding and pillows for the infant’s comfort to promote sleep

Answer 29

C,

IDS is defined as the sudden death of an infant under the age of 12 months, in which the exact cause of death is unknown, even after autopsy, review of clinical history, and examination of the death scene (Rogers & Brashers, 2023, p. 1207). This almost always occurs overnight, when the baby is least likely to be observed. Risk factors for SIDS includes smoking before and after birth, placing the infant supine, and use of soft or loose bedding.

Question 30

For pediatric patients, tonsillar infections can be severe if not treated and can even lead to upper airway obstruction (UAO), a medical emergency. After assessment and examination, it is determined that the patient has a bacterial tonsillar infection. Which of the following treatment options is typically the first choice for treatment for these infections that are not experiencing UAO?
A Oral antibiotics, such as amoxicillin
B Corticosteroids
C IV or IM antibiotics
D Supportive care with fluids and antipyretics

Answer 30

A Tonsillar infections, as mentioned above, can be severe enough to lead to UAO, so prompt medical care is needed in the form of antibiotics (Rogers & Brashers, 2023, p. 1194). Recurrent infections can lead to possible adenotonsillectomy or tonsillectomy, and corticosteroids should be considered with patients experiencing UAO.

Question 31

Which of the following best describes hypersensitivity pneumonitis?
A. A condition caused by immediate allergic reactions to pollen and dust mites.
B. An inflammatory response in the lungs triggered by inhaled organic dust, molds, or bird droppings.
C. A chronic airway condition characterized by wheezing and shortness of breath due to airway obstruction.
D. A viral infection that primarily affects the alveoli and leads to pneumonia

Answer 31

B.

An inflammatory response in the lungs triggered by inhaled organic dust, molds, or bird droppings.

Question 32

Which of the following statements best describes pulmonary vascular disease?
A. A respiratory condition characterized by the obstruction of airflow due to inflammation and mucus production in the airways.
B. A group of disorders affecting the pulmonary arteries and veins, often leading to increased blood pressure in the lungs.
C. A disease caused by a viral infection that primarily targets the alveoli and leads to pneumonia.
D. A condition characterized by the accumulation of fluid in the alveoli, primarily resulting from heart failure.

Answer 32

B) A group of disorders affecting the pulmonary arteries and veins, often leading to increased blood pressure in the lungs. This accurately captures the essence of pulmonary vascular disease, which includes conditions such as pulmonary hypertension and pulmonary embolism. These disorders specifically impact the blood vessels in the lungs, causing complications that can result in elevated pressure and impaired blood flow.

Question 33

Which of the following statements best describes surfactant deficiency disorder?
A. A lung condition characterized by obstructed airflow due to inflammation and increased mucus production.
B. A disorder primarily affecting neonates, resulting from inadequate surfactant production, leading to collapsed alveoli and impaired gas exchange.
C. A disease caused by a viral infection that primarily attacks the respiratory epithelium and leads to bronchitis.
D. A condition where fluid accumulates in the lung interstitium, primarily due to heart failure.

Answer 33

B.

A disorder primarily affecting neonates, resulting from inadequate surfactant production, leading to collapsed alveoli and impaired gas exchange. This statement accurately describes surfactant deficiency disorder, specifically neonatal respiratory distress syndrome (NRDS). In this condition, the lack of surfactant leads to alveolar collapse, making it difficult for the lungs to expand and exchange gases effectively.

Question 34

A female presented to the emergency room 7 times in the last 2 months due to uncontrolled asthma, with minimal relief with her short-acting inhaler. The NP reviews the patient’s medication list and finds a possible cause. Which medication can possibly be the cause?
A. Enalapril 10 mg daily
B. Montelukast 10 mg once daily
C. Ventolin as needed every 4 hours
D. Folic Acid 1 mg daily

Answer 34

Enalapril 10 mg daily

Rationale: An ACE inhibitor is used for hypertension by inhibiting angiotensin 1 to convert to angiotensin 2. This medication is notable for a dry, non-productive cough, that has no treatment for the symptom (Herman et al., 2023)

Question 35

A postpartum patient with a delivery course notable for 36 hours of labor had a C-section for fetal distress. As the patient is getting out of bed to the bathroom, she reports chest pain and is getting anxious. Upon exam, the NP notices the patient is short of breath, and vitals are BP 98/60, T- 98, P- 120 bpm, RR- 26 bpm. The Np’s initial thought should be:
A. Cor Pulmonale
B. Tuberculosis
C. Pulmonary embolism
D. Acute Bronchitis

Answer 35

Pulmonary embolism

Rationale Pulmonary embolism can be caused by immobilization and venous stasis of the lower extremities. As the patient walks to the bathroom, a lower extremity clot travels to the lung and presents the classic symptoms of PE mentioned above. (McCance & Huether, 2024, p. 1179).

Question 36

A patient presents to the clinic with respiratory symptoms. The medical history is remarkable for Cystic Fibrosis. The NP understands that the patient will NOT show with which symptom?
A. Wheezing
b. Persistent cough
c. Decreased sputum production
d. Recurrent pneumonia

Answer 36

Decreased sputum production.

Rationale: Cystic fibrosis causes thick, dehydrated mucous secretions due to chloride and water transportation dysfunction across the epithelial membranes. This causes increased sputum production. (McCance & Huether, 2024, p 1205-06)