CMN 568 Unit 3 Exam Questions with Answers Latest Update 2024 Assured Success, Exams of Nursing

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CMN 568 Unit 3 Exam Questions with Answers Latest

Update 2024 Assured Success

1. What are the 3 characteristics of Asthma - Correct Answer Bronchoconstriction Airway Inflammation Reversible airflow limitation
2. Which inhaled anticholinergic is best used for asthma pt. w/an intolerance to beta agonist or w/ bronchospasms due to beta blocker meds? - Correct Answer Ipratropium Bromide
3. What is the primary tx for pt. w/moderate to severe asthma exacerbations who do not respond promptly and completely to SABA? - Correct Answer Systemic Corticosteroids
4. Which bacterial infections predispose exacerbations of asthma - Correct Answer M. Pneumoniae and C. Pneumoniae
5. Is routine use of antimicrobials recommended for acute exacerbations of asthma
   • Correct Answer No, only use when likelihood of acute bacterial respiratory tract infection
6. Name short acting beta agonist - Correct Answer albuterol, levalbuterol, bitolerol, pirbuterol, terbutaline
7. What does a SABA do? - Correct Answer acts directly by relaxing bronchial smooth muscles.
8. What do long-term pharmacologic agents accomplish for asthma pt. - Correct Answer act primarily to attenuate airway inflammation.
9. Why take long-term pharmacologic agents for asthma daily? - Correct Answer to achieve and maintain control of persistent asthma independent of symptoms.
10. What does the NAEPP recommend as the cornerstone of daily treatment of persistent asthma? - Correct Answer daily anti-inflammatory therapy with inhaled corticosteroids
11. Role of corticosteroids with asthma - Correct Answer Reduce inflammation (acute and chronic) = improved airflow, decreased airway hyper-responsiveness and fewer asthma exacerbations, and potentiate the action of beta-adrenergic agonist.

12. 1st. line treatment agent for all pt w/persistent asthma (long term controller) - Correct Answer Inhaled Corticosteroids
13. How often to most patient use inhaled corticosteroids? - Correct Answer Twice daily to provide adequate control.
14. How long can it take to see maximum response of inhaled corticosterioids? - Correct Answer Months
15. What can a patient do to reduce side effects of inhaled corticosteroids? - Correct Answer Rinse mouth after each use
16. A patient has an exacerbation of asthma, what is the most effective treatment to achieve prompt control? - Correct Answer Systemic (oral) corticosteroids
17. Dose of oral corticosteroids for children during exacerbation of asthma - Correct Answer 1-2 mg/kg/day. Can be either a single dose or divided BID. MAX 60 mg/day
18. Dose of oral corticosteroids for adults during exacerbation of asthma - Correct Answer 40-60 mg/day either as a single dose of divided BID
19. Duration of treatment of oral corticosteroids for asthma exacerbation - Correct Answer 3-10 days or until symptoms resolve (no evidence that tapering dose of PO steroids prevents relapse)
20. When treating exacerbation of asthma, what is the preferred treatment plan? - Correct Answer Alternate days rather than daily treatment.
21. What additional medications are required to be given concurrent with systemic corticosteroids to prevent corticosteroid induced bone mineral loss? - Correct Answer Vitamin D and Calcium
22. Should systemic corticosteroids be rapidly discontinued? - Correct Answer No, to prevent adrenal insufficiency
23. Name some mediator inhibitors to treat asthma - Correct Answer Cromolyn sodium and nedocromil
24. What is the mechanism of action of mediator inhibitors? - Correct Answer prevent asthma symptoms, improve airway function in pt w/mild persistent of exercise induce asthma

25. When are mediator inhibitors effective? - Correct Answer Before allergen exposure or exercise Do not relieve asthmatic symptoms once present.
26. Name the Long acting beta 2 agonist (LABA) for asthma - Correct Answer Salmeterol and Formoteol
27. How are LABA's delivered? - Correct Answer dry powder
28. What are LABA's used for - Correct Answer Long term prevention of asthma symptoms Nocturnal symptoms Prevention of exercise induced bronchospasm
29. Should LABA be used as monotherapy - Correct Answer NO linked to fatal asthma when used alone has no anti-inflammatory effects- so use w/a corticosteroid.
30. What does LABA + low or medium dose of corticosteroids given together provide for the patient. - Correct Answer The equivalent to what would be if doubled the inhaled corticosteroid.
31. Name the action of anticholinergic agents, short acting muscarinic agents (SAMA) and long acting muscarinic agents (LAMA) - Correct Answer Reverse vagally medicated bronchospasm but NOT allergen or exercise induced broncospasms
32. Is Ipratropium bromide (SAMA) as effect as a SABA for relief of acute bronchospasm - Correct Answer No
33. What is the benefit to adding Tiotropium to therapy bronchodilator (salmeterol) or inadequately controlled low-dose inhaler. - Correct Answer Improves lung function and reduces frequency of asthma exacerbations.
34. Name the phosphodiesterase inhibitor used for asthma - Correct Answer theophylline
35. What is theophylline used for in a pt w/ asthma? - Correct Answer mild bronchodilation
36. What is the mechanism of action of theophylline for asthma - Correct Answer anti-inflammatory and immunodilator properties which enhance mucociliary clearance and strengthen diaphragmatic contractility.
37. Why are drug levels of Theophylline monitored? - Correct Answer Due to narrow therapeutic ranges.

38. Name the leukotriene modifiers for asthma - Correct Answer Zileutonn, zafirlukast, montelukast
39. use of leukotriene modifiers for asthma? - Correct Answer alternatives to low- dose inhaled corticosteroids in pt. w/mild persistent asthma *as mono-therapy are usually less effective than inhaled corticosteroids
40. Which recombinant antibody that binds IgE w/o activating mast cells can be used to treat SEVERE asthma in 18 yr old and older - Correct Answer Omalizumab and Reslizumab
41. Which vaccinations should the FNP ensure that a pt with asthma receives? - Correct Answer pneumovac and influenze
42. Which patients are oral sustained release beta 2 agonist be reserved for? - Correct Answer pt. with nocturnal asthma or persistent mod-severe asthma who do not respond to other therapies.
43. A patient has a PEF> 80% and minor changes in airway function. What severity of asthma exacerbation does this patient have? - Correct Answer Mild asthma exacerbation
44. The FNP should double the dose of inhaled corticosteroids during an asthma exacerbation, true or false? - Correct Answer False. Doubling the dose of the inhaled corticosteroid is not effective and not recommended.
45. A patient is experiencing mild asthma exacerbation and currently not taking an inhaled corticosteroid, what can the FNP do? - Correct Answer initiate one
46. The FNP expects many pts with mild asthma exacerbation to respond fully and quickly to which treatment? - Correct Answer Inhaled SABA
47. Can the FNP start an oral corticosteroid if the patient is already taking an inhaled corticosteroid? - Correct Answer Yes
48. What is the goal of treating moderate asthma exacerbation? - Correct Answer **Correct hypoxemia! Reverse airflow obstruction reduce likelihood of reoccurrence of obstruction
49. What should the FNP prescribe to correct hypoxemia in a pt with exacerbation of asthma - Correct Answer Oxygen!

50. When should systemic corticosteroids be given to a pt with asthma exacerbation
    • Correct Answer When peak flow is <70% of baseline
51. To pt. who doesn't respond to several SABA treatments
52. What criteria correlates to the severity of asthma exacerbation? - Correct Answer Improvement of FEVI after 30 minutes
53. A pt presents with (severe) Acute Asthma Exacerbation, what should the patient be treated with? - Correct Answer Immediately- Oxygen, high doses of inhaled SABA, and systemic corticosteroids
54. What goal of oxygen saturation should be expected for a pt. with an acute (severe) asthma exacerbation? - Correct Answer PaO2> 60 mmlHG or maintain sats >90%
55. How often, and how much SABA should patients with acute asthma exacerbation receive - Correct Answer Albuterol inhaler 2-6 puffs every 20 minutes x May need to continue SABA q 3-4 hrs x 24-48 hrs
56. Which inhaled medication helps to reduce the rate of hospitalizations when added to inhaled SABA when that patient has moderate to severe asthma? - Correct Answer Ipratropium bromide
57. Course of oral corticosteroids started when pt has acute asthma exacerbation? - Correct Answer Prednisone, methylprednisolone, or prednisolone- 0.5 mg- 1mg/kg (40-60mg) in either single dose or divided BID x 7 days
58. The patient with an acute asthma exacerbation has a FEVI <25%, what should the FNP expect to give? - Correct Answer IV Magnesium
59. When a pt presents with exacerbations of asthma, what pt. history should the FNP obtain? - Correct Answer daily medication adherence (educate) Vaccination status- pneumococcal and influenza
60. When can a pt. with acute exacerbation of asthma be discharge? - Correct Answer PEF or FEVI has returned to 60% or more of predicted value
61. What type of treatment is contraindicated when a pt. presents with an exacerbation of asthma? - Correct Answer Mucolytic agents - may worsen cough and airflow, anxiolytic and hypnotics- due to resp. depression
62. Doses of Albuterol (SABA) for ALL cases of asthma? - Correct Answer *MDI- 90 mcg/spray *Nebulizer- give 0.05 mg/kg (max 5 mg)

-use either 1 puff of MDI or 1 nebulizer and repeat every 20 min x 3 for acute exacerbation

63. How are pt less than 5 yo diagnosed with asthma - Correct Answer clinical judgement and assessment of symptoms
64. What is FEV1 - Correct Answer forced expiratory volume in 1 second
65. What is FVC? - Correct Answer forced vital capacity
66. What is the FEV1/FVC ratio used for? - Correct Answer it is compared to reference norms for age, weight, and gender. Airflow is indicated by reduced FEV1/FCV
67. What strongly confirms the diagnosis of asthma? - Correct Answer a positive bronchodilator response (increase in FEV1)
68. What does administering a SABA determine when performing PFTs? - Correct Answer if obstruction is reversible.
69. What is a peak expiratory flow (PEF) meter? - Correct Answer A handheld device for personal management (home)
70. When should a pt. with asthma be instructed to use a peak expiratory flow meter at home? - Correct Answer In the AM before taking a bronchodilator and in the afternoon after taking a bronchodilator.
71. A pt. reports that they have a 20% change in PEF. What does this information tell the FNP? - Correct Answer suggests inadequately controlled asthma
72. Is a CXR needed to diagnose someone with asthma? - Correct Answer NO, they are only needed when ruling out pneumonia during an exacerbation
73. What testing is used to identify triggers for an asthma pt.? - Correct Answer allergy testing
74. What needs to be included in the asthma action plan for each pt. - Correct Answer -instructions for daily management -measures to take in response to specific changes in status.
75. Criteria to admit pt. with acute exacerbation of asthma to hospital - Correct Answer -poor response to SABA after 2 tx 20 min. apart -hypoxia- SPO2 < 95% on RA -Marked breathlessness- inability to speak sentences -use of accessory muscles
    • changes in alertness

• *** PEF of <50% personal best

76. Risk factors of TB - Correct Answer Foreign-born minorities, lower socioeconomic status and crowded housing, HIV, multi-drug resistance, close contacts of person known or suspected to have active TB, residents and employees of high-risk congregate settings, health care workers
77. Which factors increase probability of TB transmission? - Correct Answer susceptibility of exposed person infectiousness of person w/TB environmental factors proximity, frequency, and duration of exposure
78. How is M. Tuberculosis spread? - Correct Answer -airborne particles called droplet nuclei r/t coughing, sneezing, shouts or singing. -The uninfected person inhales nuclei through nasal passage or respiratory tract to the bronchi then to the alveoli of the lungs where the tubercle bacilli multiply
79. Where all in the body can TB develop? How does it get to these places? - Correct Answer -brain, larynx, lymph node, lung, spine, bone, kidney

• after inhalation, when the immune system cannot keep the tubercle under control, tubercle bacilli enter the bloodstream

80. How does the immune system respond to TB - Correct Answer Macrophages ingest/surround tubercle bacilli which form a barrier shell (granuloma) keeping bacilli contained and under control (LTBI)
81. Most common site of TB - Correct Answer Lungs (usually infectious)
82. What is miliary TB? - Correct Answer when bacilli spreads to all parts of the body. Rare and fatal if untreated.
83. What is the most common presentation of central nervous system TB? - Correct Answer meningitis.
84. Characteristics of extrapulmonary TB (outside the lungs) - Correct Answer usually non infectious unless a person has concomitant pulmonary disease, extra-pulmonary disease of oral cavity or larynx, or with open site (aerosolized fluid)
85. What are the risks of developing TB disease - Correct Answer -Untreated TB -Persons with weak immunity are at risk of progressing to TB disease. - untreated HIV infection is highest risk factor (7-10%) each year. Children <5 yo
86. What is drug resistant TB due to? - Correct Answer organisms resistant to one or more TB drugs.

87. What is multi-drug resistant TB (MDR) - Correct Answer caused by bacteria resistant to best TB drugs- isoniazid and rifampin
88. What is Extensively Drug-resistant TB (XDR) - Correct Answer caused by organisms resistant to isoniazid and rifampin, plus flouroquinolones and >1 of the 3 injectable second-line drugs.
89. How and when can latent TB infection (LTBI) be detected. - Correct Answer 2- weeks after infection by TST or interferon-gamma release assay (IGRA)
90. What is the progression of TB disease? - Correct Answer granulomas break down, bacilli escape, multiply = tb disease.
91. When can TB disease occur - Correct Answer soon after infection or years later
92. How is TB disease diagnosed? - Correct Answer Positive M. tb culture
93. Patient has small amount of TB bacteria in body that are alive but inactive, cannot spread TB to others, does not feel sick, and does not require isolation. What should the FNP suspect? - Correct Answer Latent TB infection. (Infected, not infectious)
94. Patient has large amount of active TB in body, may spread TB to others, symptoms involve cough, fever, weight loss, CXR may be abnormal, sputum smears positive, needs treatment. What should the FNP suspect - Correct Answer TB disease (infectious)
95. Methods for detecting M. tuberculosis infection in the US - Correct Answer Mantoux tuberculin skin test (TST) IGAs- Quantiferon-TB gold in tube (QFT-GIT) and T-spot TB
96. How long does the body take to react to PPD (from a Mantoux Tuberculin Skin Test) - Correct Answer 2-8 wks after exposure and infection for the immune system to react to PPD
97. Should a Mantoux Tuberculin skin test be given to pregnant women? - Correct Answer yes.
98. Patient has a ≥ 5 mm induration TST reaction, what pt will this be considered positive in? - Correct Answer Those with HIV Recent contact of infectious TB person w/fibrotic change on CXR consistent w/prior TB Pt. w/organ transplants and other immunosuppressed pt.

99. Pt has a ≥ 10 mm induration TST reaction , what type of pt will this be considered positive in? - Correct Answer Recent arrival from high-prevalence countries Injection drug users. Residents/employees of high-risk congregate setting Mycobacteriology laboratory personnel pt. w/conditions that increase risk for progressing to TB Child <5 yo, or children and youth exposed to adults high risk
100. ≥ 15 mm induration TST reaction, what type of pt is this considered + in? - Correct Answer persons with no known risk factors.
101. Which persons should receive a BCB Vaccination - Correct Answer Health-care workers who work in settings w/high % of MDR TB, transmission of drug-resistant TB strains & subsequent infections are likely, and comprehensive TB infection-control precautions implemented but not successful.
102. History to obtain when evaluating pt. for TB - Correct Answer symptoms of disease (how long), hx of TB exposure, infection, disease past TB treatment demographic RF for TB Medical conditions that increase risk of TB (HIV, child <5)
103. Symptoms of pulmonary TB - Correct Answer prolonged cough for 3 wks or longer, hemoptysis, CP, loss of appetite, unexplained wt. loss, night sweats, fever, fatigue
104. symptoms of possible extra-pulmonary TB - Correct Answer blood in urine (TB kidney) Headache/confusion (TB meningitis) Back pain (TB spine) Hoarseness (TB larynx) loss of appetite, unexplained wt. loss night sweats, fever, fatigue
105. Can a physical exam confirm or rule out TB disease - Correct Answer No
106. Which tests help to differentiate persons with m. TB infection from those not infected? - Correct Answer TST, IGRAs
107. Does a CXR confirm TB? - Correct Answer No. Can suggest
108. What CXR view is standard for TB - Correct Answer posterior-anterior view

109. What is the gold standard for diagnosing TB - Correct Answer sputum culture
110. Who should be treated for LTBI even with negative TB results when they have been exposed to TB - Correct Answer young children <5yo Immunosuppressed others at risk for rapid progression to tb disease once infected.
111. What drugs are used to treat LTBI - Correct Answer Isoniazid (INH), Isoniazid-Rifapenitine, Rifampin (RIF)
112. How long is isoniazid given for LTBI? - Correct Answer 9 months daily. (270 doses w/in 12 mo) or 6 months ( 180 doses in 9 mo)
113. What type of observation is recommended for patients taking TB medications - Correct Answer DOT- Directly observed therapy.
114. Isoniazid-rifapentine regimine is given for how long to treat LTBI? - Correct Answer 12 doses once a week under DOT
115. How long is rifampin given to treat LTBI - Correct Answer 4 months daily. -given as an alternative to isoniazid, but cannot be given to HIV. pt receiving ART
116. What are the adverse reactions of isoniazid - Correct Answer -peripheral neuropathy (give B6 if high risk or s/s develop) -fatal hepatitis- (pregnant/postpartum increase risk) -elevated liver enzymes- (discontinue if liver enzyme exceed 3 x normal w/symptoms or 5x upper limit of normal no symptoms)
117. What is the LBTI treatment for pregnant and breast feeding women? - Correct Answer -9 mo. of isoniazid QD or twice weekly, give w/vit B If cannot take INH- consult TB expert -12-dose INH-RPT regimen not recommended for pregnant women -women at high risk for progression to tb disease, esp. HIV-infected or diabetic, should not delay -breast-feeding not contraindicated.
118. What are the characteristics of sarcoidosis - Correct Answer granulomatous inflammation of the lung (90% of pts)
119. Who has the highest prevalence of sarcoidosis. - Correct Answer American blacks (women more than men), northern European whites

120. Pt. is presenting to clinic after CXR shows bilateral hilar and right paratracheal adenopathy. What should the FNP suspect? - Correct Answer Sarcoidosis
121. Patient symptoms in sarcoidosis and why they may seek treatment - Correct Answer -Insidious onset- malaise, fever, dyspnea
122. -erythema nodosum, lupus pernio (skin), iritis, peripheral neuropathy, arthritis, cardiomyopathy, parotid gland enlargement, hepatosplenomegaly and lymphadenopathy
123. Lab findings for sarcoidosis - Correct Answer leukopenia, elevated ESR, hypercalcemia (5%) or hypercalcemuria (20%) angiotensin-converting enzymes (ACE) levels- elevated in 40-80% of pt w/active disease. PFTs-obstructive airflow Skin test anergy- present in 70% of pts. ECG- conduction disturbances and dysthymias
124. What can an FNP expect to see stage 1 of sarcoidosis on CXR - Correct Answer Stage 1- bilateral hilar adenopathy alone
125. What can an FNP expect to see stage II of sarcoidosis on CXR - Correct Answer Stage 2- hilar adenopathy and parenchymal involvement
126. What can a FNP expect to see stage III of sarcoidosis on CXR - Correct Answer parenchymal involvement alone manifested by reticular infiltrates (may also see focal infiltrates, acinar shadows, nodules, and cavitation)
127. What can a FNP expect to see stage IV of sarcoidosis on CXR - Correct Answer advanced fibrotic changes in upper lobes principally
128. How is sarcoidosis diagnosed? - Correct Answer biopsy- requires histologic demonstration of noncaseating granulomas in biopsies from pt w/other typical associated manifestations (necessary when alternative diagnosis like lymphoma, ALL pt. must complete ophthalmologic eval) BAL fluid
129. What is BAL fluid - Correct Answer characterized by increase in lymphocytes and a high CD4/CD8 cell ratio (does not diagnose but useful in following the activity of sarcoidosis in select pt.)
130. Prognosis of sarcoidosis? - Correct Answer -long term follow up -annual physical exam, PFTs, chemistry panel, ophthalmologic eval, CXR, ECG -20% have irreversible lung damage

131. A patient with sarcoidosis has the following symptoms how should they be treated? iritis, hypercalcemia, uveitis, arthritis, CNS involvement, cardiac involvement, hepatitis, cutaneous lesions other than erythema nodosum and progressive pulmonary lesions - Correct Answer Oral corticosteroids 0.5- mg/kg/day
132. What can pt who cannot tolerate corticosteroids take for sarcoidosis? - Correct Answer methotrexate - immunosuppressive medications
133. Patient has a spread of extrapulmonary malignant tumor through vascular or lymphatic channels or by direct extension, what should the FNP suspect? - Correct Answer Pulmonary metastases.
134. How are pulmonary metastases seen on CXR - Correct Answer multiple nodules or masses
135. risk factors for pulmonary metastases - Correct Answer -Carcinoma of kidney, breast, rectum, colon, cervix, and malignant melanoma -Head, neck cancer w/extensive or lower cervical nodule involvement (30% risk for distant metastasis, w/1% in lung) -Lymphangitic carcinomatosis -Most mets to lungs are intraparenchmal.
136. Signs and symptoms of advanced cases of pulmonary metastases - Correct Answer dyspnea and hypoxemia
137. Which lung cancer is the leading cause of cancer deaths in both women and men? - Correct Answer bronchiogenic carcinoma
138. Risk factors for bronchiogenic carcinoma - Correct Answer smoking (85- 90%) environmental factors, family history of lung cancer diseases such as pulmonary fibrosis, copd, sarcoidosis.
139. Signs and symptoms of bronchiogenic carcinoma - Correct Answer anorexia, wt. loss, asthenia new cough, change in chronic cough SOB, hemoptysis Non-specific CP
140. How is brochiogenic carcinoma diagnosed? - Correct Answer cytologic or histologic findings of lung ca in sputum, pleural fluid, or biopsy specimen
141. Patient has a distant history of exposure to asbestos (more than 20 yrs earlier), what should the FNP suspect? - Correct Answer Mesothelioma

142. What are mesotheliomas? - Correct Answer primary tumors arising from surface lining of pleura or peritoneum.
143. risk factors for mesotheliomas - Correct Answer 10%-lifetime risk if worked in asbestos (latent period 20-40 years)
144. Signs and symptoms of mesotheliomas - Correct Answer insindious onset of SOB Nonpleuritic CP and wt. loss dullness to percussion, diminished breath sounds, digital clubbing
145. lab findings for mesothelioma - Correct Answer VATS biopsy pleural fluid is exudative and hemorrhagic (usually negative)
146. Which lung disorder is related to inhaling products of combustion causing serious acute respiratory complications - Correct Answer Smoke Inhalation
147. What are the three consequences of smoke inhalation that must be assessed - Correct Answer Impaired tissue oxygenation Thermal Injury to upper airway thermal injury to lower airway and lung parenchyma
148. How long must O2 be given to a patient with smoke inhalation - Correct Answer until the measured carboxyhemoglobin level falls <10% and concomitant metabolic acidosis resolves
149. What time frame does thermal injury to upper airway occur following smoke inhalation and what symptoms will the patient have? - Correct Answer 18-24 hrs
150. mucosal edema, upper airway obstruction, impaired ability to clear oral secretions, inspiratory stridor which can lead to respiratory failure.
151. Early management of thermal injury to upper airway includes? - Correct Answer high-humidity face mask w/supplemental O2, gentle suctioning, elevated HOB 30º, topical epi (reduces edema of oropharyngeal mucous membrane)
152. How can helium-gas mixture treat patients with upper airway thermal injury? - Correct Answer can reduce labored breathing due to critical upper airway narrowing
153. Daily progression of thermal injury to upper airway and lung parenchyma - Correct Answer day 1-2 = develop ARDs day 2-3 = sloughing of bronchiolar mucosa » airway obstruction, atelectasis, worsening hypoxemia day 5-7 = bacterial colonization & pneumonia

154. What are the 1st signs of thermal injury to lower airways - Correct Answer bronchorrhea and bronchospasm + dyspnea, tachypnea, tachycardia. Leads to labored breathing and cyanosis
155. Overall treatment of smoke inhalation - Correct Answer O2, bronchodilators, suction, chest PT, adequate humidification of inspired gases
156. Should corticosteroids be used for smoke inhalation - Correct Answer No, no benefit and can be harmful
157. Which condition is a pulmonary response to acute aspiration of gastric contents - Correct Answer Acute Aspiration of Gastric Contents (Mendelson syndrome)
158. does more acidic or more alkaline GI aspirated contents cause chemical pneumonitis - Correct Answer More acidic
159. What is the result of aspirating pure gastric contents with a pH<2.5? - Correct Answer extensive desquamation of bronchial epithelium bronchiolitis hemorrhage pulmonary edema (most common cause of ARDs)
160. What symptoms and physical findings can the FNP expect to see when a patient has aspirated gastric contents - Correct Answer abrupt onset of respiratory distress and cough wheezing, fever, tachypnea crackles at base of lungs, hypoxemia immediately after event occurs
161. What is a common complication of gastric content aspiration - Correct Answer infection 2-3 days post aspiration
162. What disorders are linked to GERD + chronic aspiration - Correct Answer asthma, chronic cough, bronchiectasis, pulmonary fibrosis
163. What is pneumoconiosis - Correct Answer chronic fibrotic lung disease cause by inhalation of inorganic dust (coal, silica, asbestos)
164. Does smoking increase prevalence of coal-workers pneumonconiosis? - Correct Answer No, but it may have detrimental effects on ventilatory status
165. When a patient has asbestosis, what is their risk factor if they also smoke?

- **Correct Answer** Markedly increased incidence of lung carcinoma, can interfere w/clearance of short asbestos fibers from lung. 

-increased prevalence of radiographic pleural and parenchymal changes.

166. What will the CXR show in pt. with advanced asbestosis - Correct Answer Honeycomb changes
167. Silo-filler disease - Correct Answer acute toxic high permeability pulmonary edema caused by inhalation of nitrogen dioxide in recent filled silos- FATAL if extensive exposure
168. What is toxic lung injury - Correct Answer r/t inhaled irritant gases. (nitrogen dioxide, diacetyl)
169. What 2 randomized controlled trials are used for lung cancer screening (pulmonary neoplasm) - Correct Answer PLCO- Prostate, Lung, Colorectal and Ovarian ca screening. NLST- National Lung Screening Trial
170. What has been referred to as a "coin lesion," is < 3 cm isolated, rounded opacity on CXR outlined by normal lung and NOT associated w/infiltrate, atelectasis, or adenopathy - Correct Answer Solitary Pulmonary Nodule
171. Are solitary pulmonary nodules usually malignant? - Correct Answer Yes, high probability of malignancy >30yo. larger tumor increases risk of malignancy. -spiculated margins and peripheral halo seen on CT are highly associated with malignancy. -cavitary lesions w/thick walls (>16mm) much more likely to be malignant -PET (negative) usually correctly excludes cancer
172. What could the FNP expect if a patient is coughing up blood - Correct Answer pneumonia, pulmonary embolism, lung ca
173. What history should the FNP obtain if a pt is coughing up blood - Correct Answer Quantify the amount of bleeding (tsp, cups)? (massive hemoptysis is >200 cc/24 hr) Nosebleeds, GERD, N/V, medications (blood thinners), smoking, drugs, weight loss, fever, malaise? How long and color of blood?
174. What is the 4th leading cause of death in the US - Correct Answer COPD

+ Asthma Combined 

175. Mortality and morbidity in a pt with COPD is increased by? - Correct Answer significant concomitant chronic disease

176. Characteristics of COPD - Correct Answer presence of airflow obstruction due to chronic bronchitis and emphysema, may be accompanied by airway hyper reactivity and may be partially reversible.
177. What is the most important cause of COPD - Correct Answer cigarette smoking - nearly all smokers suffer an accelerated decline in lung function that is dose and duration dependent.
178. What lung disease should the FNP suspect if the patient has excessive cough, sputum production and chronic/progressive dyspnea (approx 10 yrs) - Correct Answer COPD
179. Pink puffers are predominately? - Correct Answer emphysema older, thin, severe dyspnea, quiet chest, hyper-inflated lung, flattened diaphragm on CXR, cough rare, PaCO2 normal.
180. Blue bloaters are predominately? - Correct Answer Chronic bronchitis Overweight due to activity intolerance, elevated hemoglobin, peripheral edema r/t right HF, rhonchi, wheezing, chronic productive cough, PaCO2 elevated
181. What is the hallmark of COPD - Correct Answer the periodic exacerbation of symptoms beyond normal day to day variations which includes increased dyspnea, increased cough severity, increased sputum, and changes in sputum character -exacerbations usually precipitated by infection
182. Results of PFT in COPD - Correct Answer -Increase in total lung capacity -increase in residual volume -decrease FEV1 & FVC » air trapping (emphysema) -FEV1 <40%:hypoxemia or hypercapnia (clinical signs of right HF)
183. What is required to make a diagnosis of COPD - Correct Answer spirometry presence of post-bronchodilator FEV1/FVC <70 confirms presence of persistent airflow limitation = positive COPD
184. Definition of chronic bronchitis - Correct Answer excessive secretion of bronchial mucus, daily productive cough for 3 months or more for 2 consecutive years
185. When to refer pt with COPD - Correct Answer onset < 40 yo exacerbations (2 + despite tx) severe or rapid progression of symptoms need for long term O2 therapy onset of co-morbid illness

186. What is the most important intervention of COPD - Correct Answer Smoking cessation
187. What vaccines should the FNP ensure that a pt with COPD receives or has received. - Correct Answer Influenza, PPSV23, PPDV13, covid, tdap, zoster
188. Is theophylline recommended for COPD patients? - Correct Answer No. Only if long-term bronchodilators are unavailable or unaffordable
189. Are PO bronchodilators preferred over inhaled bronchodilators for a patient w/COPD - Correct Answer NO
190. If a patient has been hospitalized with COPD and is only taking one bronchodilator, what should the FNP expect to do? - Correct Answer Increase treatment to 2 bronchodilators.
191. Is long-term therapy of corticosteroids recommended for pts with COPD - Correct Answer NO
192. What can be considered for former smokers with exacerbations despite appropriate therapy - Correct Answer Macrolides (Azithromycin)
193. What medications should be prescribed for immediate symptom relief of COPD - Correct Answer Short-acting bronchodilators.
194. Medications that may help a patient with COPD stop smoking - Correct Answer bupropion varenicline (neuropsych SE) cysteine
195. Indications that a patient with COPD may need antibiotics - Correct Answer Acute exacerbation Acute bronchitis prevent acute exacerbation of chronic bronchitis **most benefited- pt. w/exacerbation w/increase sputum purulence accompanied by dyspnea or an increase in quantity of sputum.
196. How long should abx therapy be for exacerbation of COPD - Correct Answer 3-7 days depending on response to therapy.
197. What is the benefit of pulmonary rehabilitation - Correct Answer improves exercise capacity, decreased hospitalizations and enhances quality of life.