620 Adult - Respiratory System NP Certification, Fitzgerald 4th ed practice questions veri, Exams of Nursing

620 Adult - Respiratory System NP Certification, Fitzgerald 4th ed practice questions verified answers /2024-2025]

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620 Adult - Respiratory System NP Certification,
Fitzgerald 4th ed practice questions verified
answers /2024-2025]
1.c. chronic airway inflammation with superimposed
bronchospasm: which of the following best describes asthma?
a.intermitten airway inflammation with occasional bronchospasm
b.a disease of bronchospasm that leads to airway inflammation
c. chronic airway inflammation with superimposed bronchospasm
d.relatively fixed airway constriction
2.d. hyperresonance on thoracic percussion: the patient you are
evaluating is having a severe asthma flare. You have assessed that his
condition is appropriate for office tx. You expect to find the following
on physical examination:
a.tripod posture
b.inspiratory crackles
c. increased vocal fremitus
d.hyperresonance on thoracic percussion
3.c. spirometry measurement: a 44 y/o man has a long-standing hx
of moderate persistent asthma that is normally well controlled by
fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff
bid, nad the use of albuterol 1-2 times a week prn for wheezing. Three
days ago, he developed a sorethroat, clear nasal discharge, body aches,
and a dry cough. In the past 24 hrs, he has had intermittent wheezing
that necessitated the use of albuterol, two puffs every 3 hrs, which
produced partial relief. Your next most appropriate action is to obtain a:
a.chest x-ray
b.measurement of oxygen saturation (SaO2)
c. spirometry measurement
d.sputum smear for WBCs
4.c. prednisone: You examine Jane, a 24 y/o female who has an acute
asthma flare following a 3 day hx of UPR sxs (clear nasal discharge, dry
cough, no fever). She has a hx of moderate persistent asthma that is in
good control and an acceptable peak expiratory flow (PEF). She is using
budesonide (Pulmicort) and albuterol as directed and continues to have
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620 Adult - Respiratory System NP Certification,

Fitzgerald 4th ed practice questions verified

answers /2024-2025]

  1. c. chronic airway inflammation with superimposed bronchospasm: which of the following best describes asthma? a. intermitten airway inflammation with occasional bronchospasm b.a disease of bronchospasm that leads to airway inflammation c. chronic airway inflammation with superimposed bronchospasm d.relatively fixed airway constriction
  2. d. hyperresonance on thoracic percussion: the patient you are evaluating is having a severe asthma flare. You have assessed that his condition is appropriate for office tx. You expect to find the following on physical examination: a. tripod posture b.inspiratory crackles c. increased vocal fremitus d.hyperresonance on thoracic percussion
  3. c. spirometry measurement: a 44 y/o man has a long-standing hx of moderate persistent asthma that is normally well controlled by fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff bid, nad the use of albuterol 1-2 times a week prn for wheezing. Three days ago, he developed a sorethroat, clear nasal discharge, body aches, and a dry cough. In the past 24 hrs, he has had intermittent wheezing that necessitated the use of albuterol, two puffs every 3 hrs, which produced partial relief. Your next most appropriate action is to obtain a: a. chest x-ray b.measurement of oxygen saturation (SaO2) c. spirometry measurement d.sputum smear for WBCs
  4. c. prednisone: You examine Jane, a 24 y/o female who has an acute asthma flare following a 3 day hx of UPR sxs (clear nasal discharge, dry cough, no fever). She has a hx of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort) and albuterol as directed and continues to have

2 / 20 difficulty with coughing and wheezing. At home her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 sec (FEV1) is 65% of predicted. Her medication regime should be adjusted to include: a. theophylline b.salmeterol (Serevent) c. prednisone d.montelukast (Singulair)

  1. b. provide a convenient method to check lung function at home: Peak expi- ratory 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
  2. a. hyperinflation: which of the following is most likely to appear on a chest x-ray of a person during an acute severe asthma attack? a. hyperinflation b.atelectasis c. consolidation d.Kerley B signs
  3. b. propranolol (beta-blocker): a 36- y/o male with asthma also need antihyper- tensive therapy. Which of the following products should you try to avoid? a. hydrochlorothiazide (thiazide) b.propranolol (beta-blocker) c. amlodipine (calcium channel blocker) d.enalapril (ACEi)
  4. c. morning sputum production: which of the following is INCONSISTENT with the presentation of asthma that is not well controlled? a. troublesome nocturnal cough at least 2 nights per week b.need for albuterol to relieve SOB at least twice a week c. morning sputum production d.two or more exacerbations/year requiring oral corticosteroids
  5. d. inhaled corticosteroids: the cornerstone of moderate persistent asthma drug therapy is the use of: a. oral theophylline b.mast cell stabilizers c. short-acting beta2 agonist (SABA) d.inhaled corticosteroids

4 / 20 b.within 2-8 days c. in about 3-4 weeks d.in about 1-2 months

  1. b. the ability potentially to provide greater bronchodilation with a lower dose: 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
  2. c. assess his level of asthma control and make changes in his tx plan if needed so he can participate: an 18 y/o high school senior presents, asking for a letter stating that he should not participate in gym class because he has asthma. the most appropriate action is to: a. write the note because gym class participation could trigger asthma sxs b.excuse him from outdoor activities only to avoid pollen exposure c. assess his level of asthma control and make changes in his tx plan if needed so he can participate d.write a note excusing him from gym until his f/u exam in 2 months
  3. a. the potential but small risk of delayed growth with ICS is well balanced by their effectivness: which of the following is consistent with the NAEPP comment on the use of inhaled corticosteroids (ICS) for a child with asthma? a. the potential but small risk of delayed growth with ICS is well balanced by their effectivness b.ICS should be used only if leukotriene modifiers fail to control asthma c. permanent growth stunting is consistently noted in children using ICS d.leukotriene modifiers are equal in therapeutic effect to the use of a long-acting beta2-agonist
  4. a. oral candidiasis: a potential adverse effect from ICS is: a. oral candidiasis b.tachycardia c. gastrointestinal upset d.insomnia
  5. c. congested cough that is worse during the day: clinical findings character- istic of asthma include all of the following except: a. recurrent spasmodic cough that is worse at night b.recurrent SOB and chest tightness with exercise

5 / 20 c. congested cough that is worse during the day d.wheezing with and without associated respiratory infections

  1. d. smooth muscle relaxation: which of the following best describes the mech- anism of action of short-acting beta2 agonists? a. reducer of inflammation' b.inhibition of secretions c. modification of leukotrienes d.smooth muscle relaxation
  2. b. use of LABAs is associated with a small increase in risk of asthma death.: regarding the use of long-acting beta2 agonists, which of the following is NOT true? a. LABAs enhance the antiinflammatory action of corticosteroids b.use of LABAs is associated with a small increase in risk of asthma death. c. LABA use reduces the risk of asthma exacerbations d.LABAs can be used as monotherapy to relieve bronchospasms in asthma
  3. c. the oral route is preferred over parenteral therapy: which of the following is TRUE regarding the use of systemic corticosteroids in the tx of asthma? a. frequent short bursts are preferred over daily inhaled corticosteroids b.the oral corticosteroid should be started at day 3-4 of the asthma flare for optimal effect c. the oral route is preferred over parenteral therapy d.the adult dose to tx an asthma flare should not exceed the equivalent of pred- nisone 40mg daily
  4. c. inhibition of muscarinic cholinergic receptors: which of the following is the therapeutic objective of using inhaled Ipratropium bromide? a. as an intiinflammatory b.an increase in vagal tone in the airway c. inhibition of muscarinic cholinergic receptors d.an increase in salivary and mucous secreation
  5. d. should be added to therapy only when ICS use does not provide ad- equate asthma control: compared with short acting beta2 agonists, long acting beta2 agonist: a. are recommended as a first-line therapy in mild intermittent asthma b.have a significantly different pharmacodynamic profile c. have a rapid onset of action across the drug class d.should be added to therapy only when ICS use does not provide

7 / 20 d.mucolytic activity

  1. c. bronchodilation: when used in treating COPD, ipratropium bromide (Atro- vent) is prescribed to achieve which of the following therapeutic effects? a. increase mucociliary clearance b.reduce alveolar volume c. bronchodilation d.mucolytic action
  2. c. receive INactivated influenza virus vaccine: when discussing immuniza- tions with a 67 y/o woman with COPD, you advise that she: a. receive live attenuated influenza virus vaccine b.avoid immunization again influenza because of the risk associated with the vaccine c. receive INactivated influenza virus vaccine d.take an antiviral for the duration of the influenza season
  3. a. FEV1/FVC ratio equal to or less than 0.70 after properly timed SABA use: which is most consistent with the dx of COPD? a. FEV1/FVC ratio equal to or less than 0.70 after properly timed SABA use b.dyspnea on exhalation c. elevated diaphragms noted on x-ray d.polycythemia noted on complete blood cell count
  4. d. avoid exposure to pulmonary irritants such as cigarette smoke: the most effective nonpharmacologic method to prevent exacerbations in patients with COPD is a. st loss for those with a BMI >25kg/m b.avoid exposure to children or day care centers c. brisk walking for at least 5 min 3-5 times a day as tolerated d.avoid exposure to pulmonary irritants such as cigarette smoke
  5. d. at every office visit: when managing patients with COPD who continue to smoke cigarettes, a discussion on the importance of smoking cessation should occur: a. at the initial diagnosis visit b.with each COPD flare c. once inhaled corticosteroid therapy is initiated d.at every office visit
  6. a. short-acting inhaled beta2-agonist: According to the GOLD COPD guide- lines, which of the following medications is indicated for use in all COPD stages?

8 / 20 a. short-acting inhaled beta2-agonist b.inhaled corticosteroid c. long-acting anticholinergic d.long-acting beta2-agonist

  1. a. minimize the risk of repeated exacerbations: According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in stage III or severe COPD is to: a. minimize the risk of repeated exacerbations b.improve cough function c. reverse alveolar hypertrophy d.help mobilize secretions
  2. c. prednisone 15mg: which of the following systemic corticosteroid doses is the most potent? a. methylprednisolone 8mg b.triamcinolone 10mg c. prednisone 15mg d.hydrocortisone 18mg
  3. c. respiratory tract viruses: which of the following pathogens is often implicat- ed in a COPD exacerbation caused by respiratory tract infection? a. legionella species b.streptococcus pyogenes c. respiratory tract viruses d.staphylococcus aureus
  4. d. antimicrobial therapy is usually not indicated: which is the most appropri- ate choice of therapy in the tx of a mild acute COPD exacerbation in a 42 y/o male? a. 5 day course of levofloxacin b. 7 day course of amoxicillin c. 10 day course of doxycycline d.antimicrobial therapy is usually not indicated
  5. d. the role of antimicrobial therapy is debated even for severe disease: - which is the most appropriate statement about therapy for a severe COPD exacer- bation in a 52 y/o male? a. a 5 day course azithromycin should be prescribed b. a 10 day course of amoxicillin/clavulanate is advisable c. A 7 day course of trimethoprim-sulfamethoxazole is recommended d. the role of antimicrobial therapy is debated even for severe disease
  6. d. for at least 15 hrs a day: you see a 67 y/o male with stage IV (very severe) COPD who asks "When should I use my home O2?

10 / 20 office with a man recently dx with active pulmonary TB. Which of the following would be the best plan of care for this woman? a. she should receive TB chemoprophylaxis if her TST result is 5mm or more in induration b. because of her age, TB chemoprophylaxis is contraindicated even in the presence of a positive TST result c. if the TST result is positive but the chest X-ray is normal, no further evaluation or tx is needed d.further evaluation is needed only if the TST results is 15mm or more in induration

  1. d. provides a prediction as to who is at greatest risk for active disease development: compared with TST, potential advantages of the QuantiFERON-TB Gold test (QTF-G) include all of the following EXCEPT: a. ability to have entire testing process complete with one clinical visit b.results are available within 24 hrs c. interpretation of test is not subject to reader bias d.provides a prediction as to who is at greatest risk for active disease development
  2. Yes: a 45 y/o woman with type 2 diabetes mellitis and chest x-ray consistent with previous TB and a 7mm. Does this patient have a reactive TST?
  3. No: a 21 y/o man with no identifiable TB risk factors and a 10mm induration. Does this patient have a reactive TST?
  4. Yes: a 31 y/o male with HIV and a 6mm induration? Does this patient have a reactive TST?
  5. Yes: a 45 y/o female from a country in which TB is endemic who has an 11mm indurantion Does this patient have a reactive TST?
  6. Yes: a 42 y/o woman with RA who is taking etanercept (Enbrel) who has a 7mm induration Does this patient have a reactive TST?
  7. d. male gender: risk factors for development of infection reactivation in patients with latent TB infection include all of the following EXCEPT: a. diabetes mellitus b.immunocompromise c. long-term oral corticosteroid therapy

11 / 20 d.male gender

  1. d. frank hemoptysis: clinical presentation of progressive primary TB most commonly includes all of the following EXCEPT: a. malaise b. fever c. dry cough d. frank hemoptysis
  2. a. azithromycin: According to the American Thoracic Society/Infectious Dis- ease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a 42 y/o male with no comorbidity, no reported drug allergy, and no recent antimicrobial use? a. azithromycin b.cefpodoxime c. trimethoprim- sulfamethoxazole d.ciprofloxacin
  3. c. doxycyline: According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Com- munity-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 46 y/o well female with a hx of a bilateral tubal ligation who is macrolide intolerant? a. clarithromycin b.amoxicillin c. doxycyline d.fosfomycin
  4. b. high-dose amoxicillin with doxycycline: According to the American Tho- racic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guide- lines on the Management of Community- Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 78 y/o female with a hx of COPD, hypertension, and dyslipidemia who is taking lovastatin and a dihydroppyridine calcium channel blocker? clindamycin a.high-dose amoxicillin with doxycycline b.clarithromycin

13 / 20

  1. b. altered mental status: common sxs of CAP in otherwise well adults include all of the following EXCEPT: a. cough b.altered mental status c. dyspnea d.pleuritic chest pain
  2. d. chest x-ray: a dx of pneumonia is confirmed by: a. sputum culture b.sputum gram stain c. bronchoalveolar lavage d.chest x-ray
  3. a. activity against drug-resistant S. pneumoniae (DRSP): which of the follow- ing is a quality of respiratory fluoroquinolones? a. activity against drug-resistant S. pneumoniae (DRSP) b.poor activity against atypical pathogens c. predominatly hepatic route of elimination d.poor activity against beta-lactamase producing organisms
  4. c. alteration in protein-binding sites: the mechanism of resistance of DRSP is through the cell's a. beta-lactamase production b.hypertrophy of cell membrane c. alteration in protein-binding sites d.failure of DNA gyrase reversal
  5. a. beta-lactamase production: the primary mechanism of antimicrobial resis- tance of H. influenzae is through the organism's: a. beta-lactamase production b.hypertrophy of cell membrane c. alteration in protein-binding sites d.failure of DNA gyrase reversal
  6. c. effective against atypical pathogens: which of the following characteristics applies to macrolides? a. consistent activity against DRSP b.contraindicated in pregnancy c. effective against atypical pathogens d.unstable in the presence of beta-lactamase
  7. b. 5-7 days: according to the ATS/IDSA guidelines, what is the usual length of antimicrobial tx for the tx of CAP for outpatients? a. less than 5 days b.5-7 days c. 7-10 days

14 / 20 d.10-14 days

  1. b. Outpatient = score is 1: based on the CURB-65 criteria, indicate which patients should be treated as an inpatient or outpatient? a 47 y/o male with no confusion, BUN=17mg/dL, respiratory rate = 32/min, and blood pressure = 110/ a. Inpatient b.Outpatient
  2. a. Inpatient = score is 2: based on the CURB-65 criteria, indicate which patients should be treated as an inpatient or outpatient? a 56 y/o female with no confusion, BUN=22mg/dL, respiratory rate = 27/min, and blood pressure = 88/ a. Inpatient b.Outpatient
  3. a. Inpatient = score is 3: based on the CURB-65 criteria, indicate which patients should be treated as an inpatient or outpatient? a 72 y/o male with confusion, BUN=18mg/dL, respiratory rate = 35/min, and blood pressure = 102/ a. Inpatient b.Outpatient
  4. c. community residence: risk factors for pneumonia caused by P. aeruginosa include all of the following EXCEPT: a. mechanical ventilation b.cystic fibrosis c. community residence d.chronic tracheostomy
  5. c. sputum analysis is not recommended in the majority of pts with CAP: - which of the following most accurately describes sputum analysis in the evaluation of the person with CAP? a. gram stain is routinely advised b.antimicrobial therapy should not be initiated until sputum specimen for culture has been obtained c. sputum analysis is not recommended in the majority of pts with CAP d.if required, chest physical therapy can be used to facilitate sputum production
  6. b. respiratory droplet: which of the following best describes the mechanism of transmission in an atypical pneumonia pathogen? a. microaspiration b.respiratory droplet c. surface contamination

16 / 20 a. pneumococcal vaccine should be given when antimicrobial therapy has been completed b.pneumococcal vaccine can be given today, and influenza vaccine can be given in 2 wks c.influenza vaccine can be given today, and antipneumococcal vaccine can be given in 2 wks d.influenza and antipneumococcal vaccines should be given today

  1. d. use of inhaled corticosteroids: risk factors for infection with DRSP include all of the following EXCEPT: a. systemic antimicrobial therapy in the previous 3 months b.exposure to children in day care c. age older than 65 years d.use of inhaled corticosteroids
  2. b. inhalation of aerosolized contaminated water: the mechanism of transmis- sion of Legionella specis is primarily via: a. respiratory droplet b.inhalation of aerosolized contaminated water c. contact with a contaminated surface d.hematogenous spread.
  3. a. Pneumovax: which pneumococcal vaccine offers protection against the greatest number of serotypes? a. Pneumovax b.Prevnar c. PCV d.LSIV
  4. gram positive: identify the following organisms as a gram +, gram -, or a atypical pathogen: Streptococcus pneumoniae
  5. gram negative: identify the following organisms as a gram + or gram -, or atypical pathogen: Haemophilus influenzae
  6. atypicaL: identify the following organisms as a gram + or gram -, or atypical pathogen: Legionella species
  7. Atypical: identify the following organisms as a gram + or gram -, or atypical pathogen: chlAmydophila pneumoniae
  8. atypical: identify the following organisms as a gram + or gram -, or atypical pathogen:

17 / 20 mycoplasma pneumoniae

  1. lung parenchyma, intersitial tissues, and alveolar spaces: pneumonia is an acute lower respiratory tract infection involving
  2. confirm a dx of pneumonia: According to the recommendation of the IDSA/ATS Consensus Guidelines, an abnormal chest xpray and clinical findings are required to
  3. COPD: H. influenzae is a predominant pathogen in CAP patients with
  4. they are not detectable via gram stain, cannot be cultured on standard bacterial media, and clinically do not present with a classic pneumonia presen- tation: why are M. pneumoniae, C. pneumoniae, and Legionella species referred to as atypical?
  5. cough (90%), dyspnea (66%), sputum production (66%) and pleuritic chest pain (50%); although non-respiratory sxs including fatigue and GI upset are commonly reported: pts with pneumonia often present with:
  6. **1. confusion
  7. BUN >19mg/dl
  8. respiratory rate >30/min
  9. BP < than 90/
  10. 65 or older:** CURB-65 Allocates one point for the following five criteria:
  11. levofloxacin (levaquin) gemifloxacin (factive) moxifloxacin (avelox): respiratory fluoroquinolones are:
  12. liver problems and the drug promptly dc if this occurs: healthcare providers should monitor pts taking telithromycin for signs/symptoms of
  13. 23 pneumococcal serotypes and is recommended for adults 65 and older, as well as younger adults at high risk for disease.: Pneumovax is a 23-valent polysaccharide vaccine that protects against
  14. c. three weeks: cough is associated with acute bronchitis can typically last up to: a. one week b.two weeks c. three weeks d. 3 months
  15. d. 90%: approximately of acute bronchitis cases are caused by a viral infection. a. 15%

19 / 20 b.approximately the same number needed to screen to prevent one death c. a higher number needed to screen to prevent one death d.a higher percentage of pts identified where cancer can be prevented

  1. c. 50 yrs: guidelines from the National Comprehensive Cancer Network (NCCN) recommend screening high risk smokers beginning at age: a. 40 yrs b. 45 yrs c. 50 yrs d. 55 yrs
  2. b. low sensitivity: current limitations of screening smokers with CT scan include all of the following EXCEPT: a. a high false-positive rate b.low sensitivity c. radiation exposure from multiple CT scans d.patient anxiety
  3. FEV1>=80% predicted: classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD I is Mild at
  4. 50%<=FEV1<80% predicted: classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD II is Moderate at
  5. 30%<=FEV1<50% predicted: classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD II is Severe at
  6. FEV1<30% predicted: classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD II is Very Severe at
  7. considered the most sensitive indicator of early airflow limitations - the presence of a post-bronchodilator FEV1:FVC <70% confirms airflow obstruc- tion.: the forced expiratory volume in the first second of expiration (FEV1): forced vital capacity (FVC) ratio is
  8. short-acting beta2- agonists (SABA) short-acting

20 / 20 muscarinic agents (SAMA) oral corticosteroids (OCS): which asthma pharmacologic therapies are consid- ered Relievers?

  1. inhaled corticosteroids (ICS) leukotriene modifiers (LTM) inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA): which asthma pharmacologic therapies are considered Controllers?
  2. within 15 minutes and the duration is 4-6 hrs: the onset of action for a SABA is
  3. 30 min and the duration is 4-6 hrs: the onset of action for a SAMA is
  4. iptratropium (Atrovent): a short acting muscarinic agent (SAMA) is
  5. 12 years or older with moderate-severe persistent ALLERGIC asthma uncontrolled on ICS.: Omalizumab (Xolair) is a humanized monoclonal antibody and is indicated for those
  6. **subcutaneous injection and acts by selectively binding to IgE, reducing exacerbations, symptoms, and corticosteroid use. this medication requires specialized evaluation prior to initiation and ongoing monitoring during its use.: Omalizumab (Xolair) is delivered by