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620 ADULT RESPIRATORY SYSTEM NP
CERTIFICATION FITZGERALD 4TH EDITION
COMPREHENSIVE SCRIPT 2026 COMPLETE
QUESTIONS AND SOLUTIONS GRADED A+
⩥ The family nurse practitioner examines a patient who has sustained a non-work-related injury that interferes with the patient's ability to perform his or her job. The patient does not qualify for medical disability and has a reasonable chance of engaging in a suitable occupation with proper therapy. The nurse practitioner recommends that the patient apply for: (a) Family and Medical Leave Act benefits. (b) home health services. (c) Social Security benefits. (d) vocational rehabilitation services. Answer: (d) vocational rehabilitation services. ⩥ A 45-year-old patient who is an opera singer reports progressive hoarseness for the last four weeks. The hoarseness began after a three- hour opera performance. The patient does not smoke and reports no
weight loss, upper respiratory infection, dysphagia, or shortness of breath. The family nurse practitioner manages this patient by: (a) ordering a computed tomography scan of the head. (b) ordering an immediate lateral neck x-ray. (c) prescribing systemic antibiotics and cool mist inhalations. (d) requesting a referral for evaluation of the larynx. Answer: (d) requesting a referral for evaluation of the larynx. ⩥ A patient who sustained a myocardial infarction comes to the clinic for a refill of atorvastatin (Lipitor). The family nurse practitioner explains that the medication is prescribed for: (a) cancer prevention. (b) primary prevention. (c) secondary prevention. (d) tertiary prevention. Answer: (d) tertiary prevention. ⩥ Which health promotion strategy is most appropriate for adolescents who are obese?
blood pressure is 142/94 mmHg. Which medication does the family nurse practitioner prescribe? (a) Enalapril (Vasotec). (b) Furosemide (Lasix). (c) Hydrochlorothiazide (HydroDIURIL). (d) Propranolol (Inderal). Answer: (a) Enalapril (Vasotec). ⩥ A patient who had a total gastrectomy one year ago complains of a sore mouth, indigestion, and tingling in the lower extremities. Which test is ordered by the family nurse practitioner? (a) Blood urea nitrogen level. (b) Complete blood count. (c) Liver function study. (d) Thyroid function study. Answer: (b) Complete blood count. ⩥ A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and mild euphoria shows symptoms associated with the use of:
(a) benzodiazepine (Alprazolam). (b) cocaine. (c) morphine (MS Contin). (d) oxycodone (OxyContin). Answer: (b) cocaine. ⩥ A 40-year-old patient has had a generalized, nonpruritic skin eruption with intermittent exacerbations over the past 10 years. Currently, a well- circumscribed erythematous plaque appears over the patient's left gluteal fold area. The lesion is covered with scales and has some fissuring. The family nurse practitioner makes a diagnosis of: (a) atopic dermatitis. (b) ichthyosis. (c) psoriasis. (d) tinea corporis. Answer: (c) psoriasis. ⩥ During cardiac auscultation, a soft first heart sound with a holosystolic apical murmur that radiates to the left axilla suggests: (a) aortic stenosis. (b) mitral regurgitation. (c) mitral stenosis. (d) mitral valve prolapse. Answer: (b) mitral regurgitation.
(d) serve as a handbook to best practice. Answer: (d) serve as a handbook to best practice. ⩥ The family nurse practitioner participates in a hospital-based quality improvement project. The nurse practitioner reviews four charts per month of a nurse practitioner colleague to ensure diabetes protocols are met. This process is a: (a) core competency. (b) force field analysis. (c) peer review. (d) risk analysis. Answer: (c) peer review. ⩥ c. chronic airway inflammation with superimposed bronchospasm Answer: 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 ⩥ d. hyperresonance on thoracic percussion Answer: 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 ⩥ c. spirometry measurement Answer: 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 ⩥ c. prednisone Answer: 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 difficulty with coughing and wheezing. At home her PEF is 55% of personal best. In the office, her forced expiratory volume
⩥ b. propranolol (beta-blocker) Answer: a 36- y/o male with asthma also need antihypertensive 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) ⩥ c. morning sputum production Answer: 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 ⩥ d. inhaled corticosteroids Answer: 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
⩥ b. controllers to inhibit inflammatory responses Answer: in the tx of asthma, leukotriene receptor antagonist should be used as: a. controllers to prevent bronchospasm b. controllers to inhibit inflammatory responses c. relievers to tx acute bronchospasm d. relievers to tx bronchospasm and inflammation ⩥ b. excessive albuterol use is a risk factor for asthma death Answer: Shirley is a 29 y/o with moderate persistent asthma. She is not using prescribed inhaled corticosteroids, but is using albuterol PRN to relieve her cough and wheeze with reported satisfactory clinical effect. Currently she uses about 2 albuterol metered-dose inhalers per month and is requesting a prescription refill. You consider: a. her asthma is well controlled and albuterol use can continue b. excessive albuterol use is a risk factor for asthma death c. her asthma is not well controlled and salmeterol should be added to relieve bronchospasm and reduce her albuterol use d. her asthma has better control with albuterol than inhaled corticosteroids ⩥ d. rural residence Answer: According to the National Asthma Education and Prevention Program Expert Panel Report-3 guidelines, which of the following is NOT a risk for asthma death? a. hospitalization or an emergency department visit for asthma in the past month
⩥ b. the ability potentially to provide greater bronchodilation with a lower dose Answer: 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 ⩥ c. assess his level of asthma control and make changes in his tx plan if needed so he can participate Answer: 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 ⩥ a. the potential but small risk of delayed growth with ICS is well balanced by their effectivness Answer: 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 ⩥ a. oral candidiasis Answer: a potential adverse effect from ICS is: a. oral candidiasis b. tachycardia c. gastrointestinal upset d. insomnia ⩥ c. congested cough that is worse during the day Answer: clinical findings characteristic 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 c. congested cough that is worse during the day d. wheezing with and without associated respiratory infections ⩥ d. smooth muscle relaxation Answer: which of the following best describes the mechanism of action of short-acting beta2 agonists? a. reducer of inflammation'
⩥ c. inhibition of muscarinic cholinergic receptors Answer: 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 ⩥ d. should be added to therapy only when ICS use does not provide adequate asthma control Answer: compared with short acting beta 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 adequate asthma control ⩥ a. its use is recommended for pts with mild persistent asthma to prevent asthma flares Answer: which of the following statement is FALSE regarding the use of omalizumab (Xolair)? a. its use is recommended for pts with mild persistent asthma to prevent asthma flares b. the medication selectively binds to IgE to reduce exacerbations
c. labeled indication is for pts with poorly controlled asthma with frequent exacerbations d. special evaluation is required prior to its use and ongoing monitor is needed during use ⩥ b. with allergic-based asthma Answer: subcutaneous immunotherapy is recommended for use in pts: a. with well-controlled asthma and infrequent exacerbations b. with allergic-based asthma c. with moderate persistent asthma who are intolerant of ICS d. with poorly-controlled asthma who fail therapy with omalizumab ⩥ False Answer: approximately 80% of the dose of an ICS is systemically absorbed True or False ⩥ True Answer: little systemic absorption of mast cell stabilizers occurs with inhaled or intranasal use True or False ⩥ a. monitoring asthma Answer: a peak flow meter is used for a. monitoring asthma b. diagnosing asthma
b. reduce alveolar volume c. bronchodilation d. mucolytic action ⩥ c. receive INactivated influenza virus vaccine Answer: when discussing immunizations 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 ⩥ a. FEV1/FVC ratio equal to or less than 0.70 after properly timed SABA use Answer: 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 ⩥ d. avoid exposure to pulmonary irritants such as cigarette smoke Answer: 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 ⩥ d. at every office visit Answer: 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 ⩥ a. short-acting inhaled beta2-agonist Answer: According to the GOLD COPD guidelines, which of the following medications is indicated for use in all COPD stages? a. short-acting inhaled beta2-agonist b. inhaled corticosteroid c. long-acting anticholinergic d. long-acting beta2-agonist ⩥ a. minimize the risk of repeated exacerbations Answer: According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in stage III or severe COPD is to:
