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620 ADULT RESPIRATORY SYSTEM NP
CERTIFICATION FITZGERALD 4TH EDITION
ACTUAL TEST PAPER 2026 QUESTIONS
WITH ANSWERS GRADED A+
⩥ desaturation in oxygen saturation greater than 4% below baseline oxygen saturation. Important for the dx of sleep apnea. Answer: Hyponea ⩥ These are all symptoms of _______________
- Snoring
- witnessed apnea
- restless sleep
- gasping/choking that awakens patient from sleep
- unrested sleep
- daytime hypersomnia
- short-term memory loss
- changes in libido
- Dry mouth during night Should be breathing through nose while sleeping.
- irritability Answer: sleep apnea
⩥ What are the top 5 most common signs of sleep apnea? Answer: Gastroesophageal reflux (uncontrolled) Morning head aches Large neck circumference >17in Systemic hypertension Hypercapnea Narrow or "crowded" airway ⩥ What is the screening test for obstructive sleep apnea? Answer: Screening test: Overnight pulse oximetry: positive test indicates multiple desaturation events 4% below baseline oxygen saturation often with significant nocturnal desaturation*. A Sawtooth pattern (wwwwwwwww) shown on the oxygen saturation tracing is indicative of recurrent obstructive apneas seen in OSA. ( oxygen goes up, down, up, down ect) To qualify for nocturnal oxygen: must have total time below 88% > 5 minutes. ⩥ What testing is required inorder to diffinatively diagnose sleep apnea? Answer: A Polysomnography or sleep study is needed to confirm the diagnosis. Types of sleep studies noted below.
- Gold standard- in lab sleep study, attended, full-night baseline sleep study.
- Home sleep study: good for patient's who cannot leave their home due to children or extenuating circumstances. Will help make the
⩥ What are treatment options for sleep apena? Answer: CPAP BiPAP MAD UPPP ⩥ This treatment of sleep apnea is utilized to shunt open the airway while sleeping to allow for air movement and effective ventilation. 100% effective when titrated to the correct optimal pressure and worn while sleeping. Answer: CPAP- Continuous positive airway pressure ⩥ This type of treatment consists of: Two pressures: inspiratory pressure (IPAP) over Expiratory pressure (EPAP) ie: 18/12 cwp (centimeters of water pressure). When you inhale it is a higher pressure when you exhale the machine drops the pressure so it is easier for you) Works well for patient's intolerant to CPAP due to high optimal pressures (17-20 cwp), patient's with comorbid conditions like CHF, COPD, central sleep apnea hypercapnea, obesity hypoventilation syndrome. Utilize a pressure difference of > 5 cwp when trying to help a patient blow off CO2. ie: 10/5 cwp. Works great for COPD w/Acute
exaccerbation (AE) in hospital when patient is retaining CO2. Answer: Bipap : Bilevel positive airway pressure. ⩥ This treatment for sleep apnea consists of a mouth piece made by a dentist to advance the lower mandible forward to create space in the posterior upper airway. Effective with mild to moderate OSA. Answer: Mandibular airway device ( MAD) ⩥ This treatment for sleep apnea consits of a Common surgical procedure that removes Uvula, part of the soft palate, tonsils and additional tissue in the posterior pharynx. Not 100% effective, more like 50 - 75% a great candidate. Obese patient's with a large neck will not have success and significant weight loss is recommended. Answer: Uvulopalatopharyngoplasty (UPPP)- ⩥ This is an alternative treatment to obstructive sleep apnea. It is a Newer procedure especially to this region. Outpatient procedure, 4- 6 sessions of ablation (scarring) base of the tongue to shrink down the muscle mass in the posterior pharynx. Efficacy is not well proven but anecdotally helps reduce severity or cure mild to moderate OSA. Answer: Radiofrequency tongue ablation ⩥ True or false? Obesity can completely reverse the course of some patient's OSA especially if the architecture of the airway is not crowded. Answer: True
- Endothelin Receptor blocker. ⩥ What do you Not want to give prostaglandin and endothelin receptor blockers to pt who may have an underlying disorder causing the pulmonary hypertension? Answer: Prostoglandin 5 inhibitor and endothelin receptor blockers specifically dilate the Pulmonary artery to stop the hypertension. If this is given to a patient with a secondary underlying disorder causing the PAH and it will KILL them!! ⩥ obstruction of the pulmonary artery or one of its branches by a Thrombus, Fat or Air. In most cases you will see thrombus as the culprit. Answer: Pulmonary embolism ⩥ This causes hypotension, defined as a systolic blood pressure < mmHg or a drop in systolic blood pressure of ≥40 mmHg from baseline for a period >15 minutes. It should be suspected anytime there is hypotension accompanied by an elevated central venous pressure (or neck vein distension), which is not otherwise explained by acute myocardial infarction, tension pneumothorax, pericardial tamponade, or a new arrhythmia Often result in death and found on autopsy. Answer: Massive PE ⩥ All other PE's that don't fit def. of massive PE are classified as - ____________ Answer: sub-massive
⩥ Clot straddles the bifurcation of the main pulmonary artery and either the left or right pulmonary artery. Answer: Saddle embolism ( V/Q scan has a good chance of giving a false neg in a saddle embolism) ⩥ What causes up to 50% of PE? Answer: Greater than 50% are caused by DVT in the lower extremities. May arise from Thrombus formation in upper extremities or right heart. ⩥ deposition of fat into the venous system usually due to long bone fracture (pelvic/femur crush injury) 5 - 10% of total knee and total hip replacements results in this. Answer: fat embolism ⩥ What are the most common causes of a clot? Answer: immobilization Smoking OCPs Factor V leidin Hormone replacement ⩥ Acute onset Dyspnea at rest or with exertion Pleuritic chest pain Cough Orthopnea Calf/leg pain
⩥ What kind of CT is used for Dx of a pulmonary embolism? Answer: Spiral (helical) CT with contrast. AKA: CTA chest or CT pulmonary angiogram. Provides a good image of the clot burden. ⩥ What is the gold standard for dx of a pulmonary embolism? Answer: Pulmonary Angiography is the Gold Standard for diagnosis. There is a difference between the above CTA chest. Dye is injected into the pulmonary artery via catheter (femoral) and visualized on Fluoroscopy. Not used in unstable patient's and frankly not used that much. ⩥ What is a pulmonary infarction? Answer: Pulmonary infarction- where the tissue dies and needs to be reabsorbed by the body. ⩥ What is the treatment for a pulmonary embolism? Answer: Anticoagulation is the hallmark. LMWH (lovenox 1mg/kg SC Q 12 hours) Heparin drip titrate to therapeutic PTT Outpatient: Coumadin titrate to PT/INR 2.0-3. Xarelto (Rivaroxaban) 15mg BID x 21 days, then 20mg daily (new med without reversal agent) blocks factor Xa
⩥ How does vitamin K affect Coumadin? Answer: Vitamin K works against Coumadin have patient eat the same amount of vit K daily and then you can titrate the dose up to meet the required INR. To stop a bleed due to a hypercoaguable state and are bleeding because of to much coumadin you can do IV vit K and plasmaphoresis. If they are taking Xarelto there is nothing to reverse it you just have to wait it out. Not many use it for this reason. ⩥ In severe cases where you have to break a clot down stat what is used as treatment? Answer: Thrombolytic therapy ⩥ How long will you do anti-coagulation for the following cases: DVT caused by car ride: Inherited disease: Etiology unknown: Answer: Know cause ie. DVT from long car ride: 6- 9 months unless physician desires longer for some reason Inherited disease or multiple PE : lifelong Etiology unknown at least 12 months ⩥ This is the most common life-shortening autosomal recessive disease among Caucasian Answer: CF
⩥ Chronic inflammation causes lung damage that ultimately advances to the stage of irreversible bronchiectasis and progressive respiratory failure. The result is congested lung parenchyma filled with purulent mucous Answer: CF ⩥ How do you dx CF? Answer: Sweat chloride test : abnormal test (>60meq/L) on two occasions. Normal test rules out CF in 99% of patients Intermediate test: retest and get gene mutation test Gene Mutation: CFTR ⩥ Pt presents with rash, veg chest discomfort, whispy infiltrates over the lungs ... What is wrong and how do you treat? Answer: Mycoplasm pneumonia ( you get a rash) veg chest discomfort whispy infiltrates over the lungs ( treat with doxy or azithromycin) ⩥ In the early stages of iron deficient anemias, blood studies show: (a) macrocytic normochromic (b) microcytic hypochromic (c) normochromic normocytic (d) pancytopenic hypocytic Answer: (a) normochromic normocytic
⩥ A 14-year-old, male patient has some general concerns about eczema, as his twin brother was recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: (a) asthma (b) bee allergy (c) otitis media (d) psoriasis Answer: (a) asthma ⩥ A patient has hyperactive reflexes of the lower extremities. The adult- gerontology primary care nurse practitioner assesses for ankle clonus by: (a) firmly applying a low-pitched tuning fork to the lateral malleolus. (b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer. Answer: (c) sharply
⩥ The adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? (a) Comorbidities and length of exposure. (b) Location and event intensity. (c) Mode of transmission and incubation. (d) Premorbid conditions and surveillance rates. Answer: (c) Mode of transmission and incubation. ⩥ When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: (a) concludes that the study proves the hypothesis. (b) excludes the discussion section, because the conclusion contains this information. (c) recommends incorporating the results directly into clinical practice.
(d) uses the methodology section to support the validity of the study. Answer: (d) uses the methodology section to support the validity of the study. ⩥ A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: (a) asks the child to provide a copy of the patient's advance directive document. (b) assures the child that the nurse practitioner can disclose requested information. (c) informs the child that he or she must come to the clinic to discuss the parent's case. (d) tells the child that the nurse practitioner can discuss the information only with the patient. Answer: (d) tells the child that the nurse practitioner can discuss the information only with the patient. ⩥ The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to:
⩥ One effect of using electronic health record applications, such as telemedicine and portable monitoring systems, has been to: (a) create stand-alone clinics. (b) decrease billable visits. (c) increase risks to patients. (d) open access to care. Answer: (d) open access to care. ⩥ The adult-gerontology primary care nurse practitioner evaluates an 80 - year-old patient with cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole- trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing the medication, the nurse practitioner: (a) contacts the patient's adult child. (b) queries the other staff members. (c) relies on the patient's self-report. (d) waits until the patient's chart is available. Answer: (a) contacts the patient's adult child.
⩥ The adult-gerontology primary care nurse practitioner conducts a small group class on weight management. The nurse practitioner anticipates that the patient who may have the greatest difficulty implementing the counseling is the: (a) extroverted patient raising his or her grandchildren. (b) introverted patient who does not speak in the group. (c) personable patient who lives with his or her children. (d) worried patient whose son is serving in military conflict. Answer: (d) worried patient whose son is serving in military conflict. ⩥ The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse practitioner's most appropriate approach is to treat the cold symptoms and: (a) advise the patient to stop smoking. (b) prescribe bupropion (Zyban).
