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620 ADULT - RESPIRATORY SYSTEM NP CERTIFICATION,
FITZGERALD 4TH ED ACTUAL RETAKE ASESSMENT EXAM
2025 UPDATED QUESTIONS AND 100% CORRECT
REVISED ANSWERS ALREADY GRADED A+
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 - CORRECT ANSWER >>> c. chronic airway inflammation with superimposed bronchospasm 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 - CORRECT ANSWER >>> d. hyperresonance on thoracic percussion 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 - CORRECT ANSWER >>> c. spirometry measurement 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 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) - CORRECT ANSWER >>> c. prednisone 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 ANSWER >>> b. provide a convenient method to check lung function at home 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 - CORRECT ANSWER >>> a. hyperinflation
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 - CORRECT ANSWER >>> b. excessive albuterol use is a risk factor for asthma death 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. current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids c. difficulty perceiving airflow obstruction or its severity d. rural residence - CORRECT ANSWER >>> d. rural residence you see a 34 y/o male with moderate persistent asthma who has a severe asthma flare and a regimen of oral prednisone is being considered. Which of the following is true? a. a taper is needed for prednisone therapy lasting longer than 4 days b. a taper is not needed if the prednisone regimen is for 7 days or less c. a taper is not needed regardless of duration of prednisone therapy d. a taper is needed if the patient is taking concomitant inhaled corticosteroids - CORRECT ANSWER >>> b. a taper is not needed if the prednisone regimen is for 7 days or less after inhaled corticosteroid is initiated, improvement in control is usually seen:
a. on the first day b. within 2-8 days c. in about 3-4 weeks d. in about 1-2 months - CORRECT ANSWER >>> b. within 2-8 days 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 ANSWER >>> b. the ability potentially to provide greater bronchodilation with a lower dose 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 **- CORRECT ANSWER
** c. assess his level of asthma control and make changes in his tx plan if needed so he can participate 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. LABAs can be used as monotherapy to relieve bronchospasms in asthma - CORRECT ANSWER >>> b. use of LABAs is associated with a small increase in risk of asthma death. 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 prednisone 40mg daily - CORRECT ANSWER >>> c. the oral route is preferred over parenteral therapy 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 - CORRECT ANSWER >>> c. inhibition of muscarinic cholinergic receptors 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 adequate asthma control - CORRECT ANSWER >>> d. should be added to therapy only when ICS use does not provide adequate asthma control 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 - CORRECT ANSWER >>> a. its use is recommended for pts with mild persistent asthma to prevent asthma flares 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 **- CORRECT ANSWER
** b. with allergic-based asthma approximately 80% of the dose of an ICS is systemically absorbed True or False - CORRECT ANSWER >>> False little systemic absorption of mast cell stabilizers occurs with inhaled or intranasal use True or False - CORRECT ANSWER >>> True a peak flow meter is used for a. monitoring asthma b. diagnosing asthma - CORRECT ANSWER >>> a. monitoring asthma The NAEPP EPR 3 guidelines recommend achieving and maintaing controll for how long before trying to step down? a. one month b. two months
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 - CORRECT ANSWER >>> a. FEV1/FVC ratio equal to or less than 0.70 after properly timed SABA use 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 - CORRECT ANSWER >>> d. avoid exposure to pulmonary irritants such as cigarette smoke 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 - CORRECT ANSWER >>> d. at every office visit 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 - CORRECT ANSWER >>> a. short-acting inhaled beta2-agonist
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 - CORRECT ANSWER >>> a. minimize the risk of repeated exacerbations which of the following systemic corticosteroid doses is the most potent? a. methylprednisolone 8mg b. triamcinolone 10mg c. prednisone 15mg d. hydrocortisone 18mg - CORRECT ANSWER >>> c. prednisone 15mg which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection? a. legionella species b. streptococcus pyogenes c. respiratory tract viruses d. staphylococcus aureus - CORRECT ANSWER >>> c. respiratory tract viruses which is the most appropriate 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
a. indicated in moderate to very severe COPD b. use limited by narrow therapeutic profile and drug-drug interaction potential c. a potent bronchodilator d. available only in parenteral form - CORRECT ANSWER >>> b. use limited by narrow therapeutic profile and drug-drug interaction potential all of the following are consistent with the GOLD COPD recommendation for pulmonary rehabilitation except: a. reserved for very severe COPD b. goals include improvement in overall well-being c. an underused therapeutic option d. components aimed at reducing the deconditioning common in COPD **- CORRECT ANSWER
** a. reserved for very severe COPD you examine a 28 y/o female who has emigrated from a country where TB is endemic. She has documentation of receiving Bacille CalmetteGuerin (BCG) vaccine as a child. with this information, you consider that: a. she will always have a positive TB skin test (TST) result b. biannual chest x-rays are needed to assess her health status accurately c. a TST finding of 10mm or more induration shuld be considered a positive result d. isoniazid therapy should be given for 6 months before TSTS is undertaken - CORRECT ANSWER >>> c. a TST finding of 10mm or more induration shuld be considered a positive result a 33 y/o female works in a small 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 - CORRECT ANSWER >>> a. she should receive TB chemoprophylaxis if her TST result is 5mm or more in induration 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 - CORRECT ANSWER >>> d. provides a prediction as to who is at greatest risk for active disease development 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? - CORRECT ANSWER >>> Yes a 21 y/o man with no identifiable TB risk factors and a 10mm induration. Does this patient have a reactive TST? - CORRECT ANSWER >>> No a 31 y/o male with HIV and a 6mm induration? Does this patient have a reactive TST? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Yes a 42 y/o woman with RA who is taking etanercept (Enbrel) who has a 7mm induration
According to the American Thoracic Society/Infectious Disease 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: 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 - CORRECT ANSWER >>> c. doxycyline According to the American Thoracic Society/Infectious Disease 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: 78 y/o female with a hx of COPD, hypertension, and dyslipidemia who is taking lovastatin and a dihydroppyridine calcium channel blocker? a. clindamycin b. high-dose amoxicillin with doxycycline c. clarithromycin d. ceftriaxone - CORRECT ANSWER >>> b. high-dose amoxicillin with doxycycline According to the American Thoracic Society/Infectious Disease 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: 69 y/o male with heart failure, prior MI, and type 2 diabetes? a. respiratory fluoroquinolone b. amoxicillin with a beta-lactamase inhibitor c. cephalosporin d. beta-lactam plus macrolide - CORRECT ANSWER >>> a. respiratory fluoroquinolone
According to the American Thoracic Society/Infectious Disease 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: 28 y/o female with a severe beta-lactam allergy who has a dry cough, headache, malaise, no recent antimicrobial use, and no comorbidity who takes no medication? a. clarithromycin b. amoxicillin c. levofloxacin d. ceftriaxone - CORRECT ANSWER >>> a. clarithromycin According to the American Thoracic Society/Infectious Disease 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: 47 y/o female who was recently tx within the past 2 months with a beta-lactam for acute bacterial sinusitis? a. amoxicillin-clavulanate b. high-dose amoxicillin c. clarithromycin d. moxifloxacin - CORRECT ANSWER >>> d. moxifloxacin criteria to distinguish if pneumonia is CAP include all of the following EXCEPT: a. lives in the community b. not a resident of a long-term care facility c. no prior antimicrobial use in the previous 3 months d. no recent hospitalization - CORRECT ANSWER >>> c. no prior antimicrobial use in the previous 3 months common sxs of CAP in otherwise well adults include all of the following EXCEPT:
b. hypertrophy of cell membrane c. alteration in protein-binding sites d. failure of DNA gyrase reversal - CORRECT ANSWER >>> a. beta-lactamase production 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 - CORRECT ANSWER >>> c. effective against atypical pathogens 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 d. 10-14 days - CORRECT ANSWER >>> b. 5-7 days 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 - CORRECT ANSWER >>> b. Outpatient = score is 1 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 - CORRECT ANSWER >>> a. Inpatient = score is 2 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 - CORRECT ANSWER >>> a. Inpatient = score is 3 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 - CORRECT ANSWER >>> c. community residence 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 - CORRECT ANSWER >>> c. sputum analysis is not recommended in the majority of pts with CAP
