Download CMN 568 Practice Questions With Complete Solutions and more Exams Nursing in PDF only on Docsity!
CMN 568 Practice Questions With Complete Solutions 10-year-old, waking up 1x/week, increased SABA use to 2x/day, low dose ICS daily, some limitations, daily SOB and cough; what are next steps? Correct Answers add LABA 11-year-old with predicted FEV of 70%, what are they? Correct Answers Moderate persistent, not well controlled, consider short course of systemic corticosteroids and follow-up in 2- 6weeks 12-year-old patient presents to clinic with wheezing, SOB, and feeling of tightness in chest. Which would be best in determining dx? Correct Answers PFTs 2-year-old has been having coughing and wheezing daily. He has been waking up 4x/month during the night. He has limitation when playing with other kids on the playground at daycare. He has never been diagnosed with asthma. What is his asthma severity? What is the treatment plan? Correct Answers Moderate persistent; step 3: start SABA and add medium dose ICS, follow-up in 2-6 weeks 3 consequences of smoke inhalation? Correct Answers Hypoxia, thermal injury to upper airway, and something to the lower airway 3-year-old child using SABA 3x/weeks, waking up 2x/months only reporting a little limitation. What classification? Correct Answers Mild persistent, not well controlled, treat with low dose ICS and SABA
3-year-old with cough and SOB 2-3x/weeks, awakens at night with cough 1-2x/month, not using an inhaler (no current diagnosis), minor limitations. What is the severity of asthma? Treatment? Correct Answers Mild persistent, step 2, SABA and low dose ICS 30yo patient with persistent asthma, what are the essential components of their care plan? (select all that apply) A. Asthma action plan B. Flu and pneumonia vaccine C. Rescue inhaler D. LABA Correct Answers A, B, C 4 components of asthma care in the stepwise approach? Correct Answers Education, control of environmental factors and comorbid conditions, medications, assessing and monitoring 4-year-old not waking up at night, using SABA 1x/week, has had 2 exacerbations over the last year needing corticosteroids. What severity, what are the next steps? Correct Answers Not well controlled, mild persistent, add ICS 4-year-old waking up 1x/month, using SABA multiple times/day. What is classification? Correct Answers Severe persistent, step 3 medium dose ICS, very poor control, might need oral steroids (1-2mg/kg/day) for 3-7days 5yo c/o cough 5d/w, awakens at night 4x/month, utilizes SABA 3d/week. She was previously diagnosed with intermittent asthma. What type of control does she have? What is the
cigarette smoke. What diagnosis is most likely? Correct Answers COPD A bone marrow transplant patient has a TST result of 7mm. How would that be interpreted/ Correct Answers positive A COPD patient has been using albuterol with good relief for SOB. He is using it 3-4x/d x4weeks. How should the NP manage this? Correct Answers Add a LABA. A lung nodule that rapidly grows in size in under 30d is most likely what? Correct Answers infectious A nurse for an assisted living facility has a TST result of 11mm. How would that be interpreted? Correct Answers positive A patient comes to you with the complaint that he cannot stop coughing. He has trouble speaking in sentences but manages to describe a tight feeling in his chest. A physical exam indicates his pulse is 115. The pt explains that he used his albuterol and inhaled budesonide today but is still having symptoms. Of the following, which would be the most appropriate treatment option? a. Add oral prednisone. b. Add an inhaled ipratropium bromide. c. Increase the dosage of albuterol. d. Add a regular dose of salmetero Correct Answers d A patient who worked in construction and building destruction 20 years ago presents to your clinic with unilateral, non- pleuritic chest pain, and dyspnea. What is he at risk for based on
his career history and present symptoms? Correct Answers Mesothelioma A prisoner has a TB skin test with a 10mm induration. What does this tell the NP? Correct Answers Positive result, needs treatment A thin patient w/ a slight build present with constant difficulty breathing and clear mucus. A physical exam also indicates an increased chest anteroposterior diameter and hyperresonance on percussion. Given the most likely diagnosis, which class of medications is best suited for long-term tx? Correct Answers anticholinergics According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD guidelines, which of the following medications is indicated for use in all COPD stages? Correct Answers SABA According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in severe COPD is to: Correct Answers Minimize the risk of repeated exacerbations. According to the GOLD COPD guidelines, which med is indicated for use in all stages? Correct Answers SABA According to the NAEPP guidelines, which of the following is not a risk of asthma death? A. Hospitalization B. Current use of systemic corticosteroids or recent w/d from system corticosteroids
Bronchiectasis typically presents with what symptoms? Correct Answers Foul smelling copious sputum that is typically blood tinged Bronchodilators alter the disease process and decline of COPD? Correct Answers false (Oxygen can alter the disease process and decline COPD) Can IGRAs be used to differentiate between TB and LTBI? Correct Answers Answer: No, IGRAs cannot differentiate between the two Can you do a TST test on a pregnant woman; and when would you do it? Correct Answers Yes, high risk group or showing signs / symptoms Cavitary lung lesions with thick walls are likely what? Correct Answers malignant Common cause of R middle lobe syndrome? Correct Answers foreign body Common symptoms of COPD are: Correct Answers cough, dyspnea, sputum production Common symptoms of COPD are? Correct Answers Cough, dyspnea, sputum production Compared with albuterol, levalbuterol (Xopenex) has: A. A different mechanism of action.
B. The ability potentially to provide greater bronchodilation with a lower dose. C.An anti-inflammatory effect similar to that of an inhaled corticosteroid. D. A contraindication to use in elderly patients. Correct Answers B COPD patient has been admitted to the hospital for exacerbation once and CAT less than 10, what letter classification are they? Correct Answers E- any hospital admission=E COPD under 40 is likely caused by what? Correct Answers DNA: alpha1 antitrypsin Demographically, which of the following is more likely to present with COPD? A. 57 yo male smoker B. 12 yo girl who never smoked C. 42 yo male with hx of smoking, who's quit D. 82 yo female who never smoked Correct Answers A Diet suggestions for an asthmatic? Correct Answers Avoid sulfite-containing foods (salty) Does every patient with asthma need a SABA? Correct Answers yes Dominique is a 39yo AA female who presents to the office with c/o malaise, fever, and dyspnea with gradual onset. She reports history of peripheral neuropathy, arthritis, and an unidentified skin condition with erythematic/purplish hardened growths on
How much bloody expectorant in a 24hr period is considered "massive" hemoptysis? Correct Answers 200mL/24hrs; 60mL/2hr How should you diagnose a 3yo with asthma? Does this process change with a 9yo being diagnosed? How? Correct Answers 3yo is based on s/s and exam; unable to cooperate with PFT; 9yo diagnosed based on s/s, exam, and PFT In _______ _________ air flow may be so restricted that wheeze may be absent and breath sounds are diminished Correct Answers severe asthma In a severe asthma exacerbation, with FEV1 <40%, what are 3- things (meds, treatments) that must be done/given; and what 2 medications should be avoided because they can worsen the exacerbation? Correct Answers Oxygen, high-dose inhaled SABA, systemic corticosteroids (IV mag sulfate); do not give anxiolytics, benzos, hypnotics or mucolytics In asthma, at what stage can you offer subQ immunotherapy? Correct Answers With suspected allergies starting at stage 2 In cases of asthma, the trachea and bronchi typically become more: Correct Answers responsive In the treatment of asthma, leukotriene receptor antagonists should be used as: Correct Answers Controllers to inhibit inflammatory responses.
Increasing use of SABA greater than how many days/weeks for sx relief generally indicates inadequate control and a need to step up treatment? Correct Answers > Increasing use of SABA or use ________ days a week for symptoms relief generally indicates inadequate control and need to step up treatment. Correct Answers > Is a chest x-ray needed to diagnose COPD? Correct Answers No. Chest x-ray may show hyperinflation, but PFTs are the standard for diagnosis. PFT may be able to diagnose prior to the presentation of symptoms. Is a chest X-ray needed to diagnose COPD? Correct Answers No. CXR may show hyperinflation but PFT are the standard for diagnosis. PFT may be able to diagnose prior to the presentation of symptoms (COPD dx FEV1 < 0.7) Is anaphylaxis mediated by IgE antibodies? Correct Answers No, anaphylatoxins may mediate it Is emphysema or chronic bronchitis typically associated with OSA? Correct Answers chronic bronchitis Is small cell slow or aggressive? And what is the survival rate? Correct Answers Aggressive (so is large cell), survival is 16- 18w Is TST contraindicated in BCG vaccinated people? Correct Answers No but may create a false positive.
Kyle, a 32yo male, is HIV+. When initiating a TB skin test, which result would show the minimal amount of elevation that would indicate he is positive for TB? Correct Answers 5mm LABAs provide bronchodilation for up to how many hours after a single dose. Correct Answers 12 Lung institute says what new treatment shows increased QOL in 84.5% of COPD patients? Correct Answers stem cell Mild persistent asthma is characterized by: Correct Answers Symptoms occurring more than 2x weekly Most common side effects of long-term inhaled steroid use? Correct Answers Bone demineralization (osteopenia) and cataracts Most commonly, COPD exacerbations are precipitated by: Correct Answers bacterial infection Most commonly, COPD exacerbations are precipitated by: Correct Answers VIRAL INFECTION Mrs. Rodriguez has been your patient for 2 months. She has a history of obesity, eczema, atopic dermatitis, and asthma. She states she is having a severe asthma attack. Upon assessment, you hear no wheezing, but you hear reduced breath sounds and note prolonged expiration. Her shoulders are hunched. Based on this information, the NP assumes: Correct Answers She is quite possibly having a severe asthma exacerbation.
Name 4 of the 8 reasons to refer an asthma patient to pulmonology. Correct Answers Atypical presentation, comorbidities such as smoking and environmental allergies, poor response to therapy, not meeting goals after 6 months, high dose ICS, multiple rounds of prednisone Nick, a 41yo male, non-smoker, who has worked in shipbuilding for the last 20 years, presents with c/o worsening SOB. During your exam, you assess inspiratory crackles, clubbing, and cyanosis. You are concerned he has what? What test do you send him for? Correct Answers Asbestosis, chest CT Non-medication treatment to decrease exercise induced bronchospasm? Correct Answers Longer warm-up Normal FEV1/FVC for 35-year-old patient is? What about 62- year-old? Correct Answers 80%; 70% Patient has a C rating via GOLD, what is the first-choice treatment? Correct Answers ICS and either LABA or LAMA; consider adding PED-4 (roflumilast) Peak expiratory flow meters: A. Should only be used in the presence of a medical professional B. Provide a convenient method to check lung function at home. C. Are as accurate as spirometry. D. Should not be used more than once daily. Correct Answers B Post-bronchodilator FEV1/FVC less than _____ establishes the presence of airflow obstruction? Correct Answers 0.
Should ICS alone every be used as a first line agent for COPD? Correct Answers no Should PZA be offered to treat LTBI? Correct Answers no Signs and symptoms of mesothelioma? Correct Answers Unilateral, non-pleuritic chest pain, dyspnea; mostly on the right side Subcutaneous immunotherapy is recommended for use in patients: Correct Answers with allergic based asthma Suspect _________syndrome if patient has hemoptysis and glomerulonephritis. Correct Answers Goodpasteurs T or F: Apart from acute exacerbations, COPD is not usually responsive to oral corticosteroids? Correct Answers true T or F: Asthma patients and COPD pts both need rescue inhalers? Correct Answers true T or F: Bronchial carcinoid tumors grow slow and rarely metastasize, surgical interventions are often necessary. Correct Answers true T or F: Direct Observed Therapy is recommended for only high- risk populations. Correct Answers False, it is recommended for ALL
T or F: Inhaled corticosteroids are the first line of rescue treatment for acute asthma exacerbations? Correct Answers False, SABA T or F: Inhaled nebulized meds are always more effective than inhaled meds from MDI? Correct Answers False; you can provide a higher dose of the med, but it is more effective for pts who are unable to coordinate inhalation of meds from MDI d/t age, coordination, agitation, or severity of exacerbation (Papadakis p 253, top right-hand side of page) T or F: LTBI radiographs are typically abnormal Correct Answers false T or F: Men over 40 who smoke and have COPD are at risk for lung cancer? Correct Answers true T or F: Patient with a TNM stage B cancer would benefit from surgery? Correct Answers no T or F: Sarcoidosis has an increased calcium level in blood and urine/ Correct Answers true T or F: Solitary pulmonary nodule or "coin lesion" that is less than 5mm in size and is seen with calcification is concerning for lung cancer Correct Answers false; its benign T or F: TB is spread more easily through children than adults? Correct Answers false
Theophylline is the best choice for which population of COPD patient? Correct Answers sleep disorders Treatment of sarcoidosis? Correct Answers Long-term prednisone 0.5-1mg/kg/d Triggers for asthma include which of the following (select all that apply)? a. tobacco smoke b. cold air c. exercise d. rapid changes in barometric pressure e. sedentary lifestyle Correct Answers a, b, c, d Upon diagnosis of a 58 yo male with COPD, you should also screen him for what comorbidity? Correct Answers depression Upon examination, you notice that Alex, an obese 63yo male, has moderate dyspnea and purulent sputum. His lungs are normal upon percussion. Laboratory results reveal an increased hematocrit level. Given the most likely diagnosis, which of the following drugs would you be LEAST likely to prescribe for the patient's condition? A. Ipratropium bromide B. Albuterol C. Budesonide D. Montelukast Correct Answers D. montelukast Upon physical exam of a 19yo female presenting with c/o an asthma exacerbation during exercise, you auscultate her lungs and hear: Correct Answers exp. wheezes
Victor, a stocky 40yo male, presents to the clinic with complaints of difficulty breathing and "endless amounts of gunk whenever he coughs." During the visit, he coughs up a substantial amount of yellow phlegm. A blood test reveals an increased hematocrit level, and a physical exam detects lungs that are normal upon percussion. You order a pulmonary lab for the patient. Given the most likely condition, which of the following findings would you LEAST expect? A. Increased forced expiratory volume in 1 second B. Increased total lung capacity C. Increased functional residual capacity D. Increased residual volume Correct Answers A. (this is an indication of healthy lung functioning) What are 3 immediate treatments for severe asthma exacerbations? Correct Answers Oxygen, high dose SABA, systemic corticosteroids What are advanced symptoms of COPD? Correct Answers Edema, cyanosis, weight loss, decrease muscle strength What are patients considered no longer infectious with TB? Correct Answers 3 consecutive negative sputum cultures; symptoms improving; 2 weeks of adherence to TB treatment regimen What are some diet tips for a patient recently diagnosed with COPD? Correct Answers Limit caffeine, small frequent meals, avoid overeating, avoid gassy foods/ carbonated drinks
