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NSG 3280 Exam 2
Module 1: Infectious Skin Disorders & Infestations (Questions 1-20)
1. A nurse is assessing a patient with painful, vesicular lesions localized to a single dermatome on the thoracic trunk. The patient reports a tingling sensation prior to the eruption. This presentation is classic for which condition? a) Herpes Simplex Virus Type 1 b) Contact Dermatitis c) Herpes Zoster (Shingles) (Correct Answer) d) Psoriasis Rationale: Herpes zoster (shingles) is the reactivation of the varicella-zoster virus. It is characterized by a painful, unilateral vesicular eruption along a single dermatome, often preceded by paresthesia or tingling. HSV-1 typically presents as cold sores, contact dermatitis is an irritant reaction, and psoriasis presents as chronic plaques. 2. A patient is diagnosed with tinea pedis. The nurse understands that this is an infection caused by: a) A yeast called Candida albicans b) A dermatophyte fungus (Correct Answer) c) A mite that burrows into the skin d) A Rickettsiae bacterium Rationale: Tinea is a superficial fungal infection caused by dermatophytes (genera: Microsporum , Trichophyton , Epidermophyton ). The term "tinea" is followed by the location (e.g., pedis = foot, corporis = body). 3. A patient presents with an itchy, burrow-like track on the finger webs and wrists. Which infestation is most likely? a) Pediculosis capitis b) Scabies (Correct Answer) c) Bedbugs d) Lyme disease Rationale: Scabies is caused by the mite Sarcoptes scabiei , which burrows into the stratum corneum to lay eggs. The burrows are a hallmark sign, commonly found in finger webs, wrists, and axillae. 4. The nurse is educating a patient with recurrent HSV-1 outbreaks. Which statement by the patient indicates a correct understanding of the condition? a) "Once the sore heals, the virus is completely gone from my body."** b) "I should apply the topical acyclovir as soon as I feel the tingling sensation." (Correct Answer) c) "This is caused by the same virus that causes genital warts."** d) "The lesions are typically painless and require no treatment."**
Rationale: HSV-1 remains latent in the trigeminal nerve ganglia and can reactivate. Antiviral meds manage symptoms, and early treatment at the first sign of a prodrome (tingling) is most effective. HSV- 1 is not the same as HPV (warts) and lesions are usually painful/tender.
5. A child is brought to the clinic with honey-crusted lesions around the nose and mouth. The nurse suspects Impetigo. This condition is most commonly caused by: a) Candida albicans b) Staphylococcus aureus or Streptococcus pyogenes (Correct Answer) c) Borrelia burgdorferi d) Rickettsia rickettsii Rationale: Impetigo is a highly contagious bacterial skin infection common in children, often caused by S. aureus or S. pyogenes. It presents with vesicles that rupture and form characteristic honey- colored crusts. 6. Which skin finding is most characteristic of Lyme disease (Stage 1)? a) A painful, vesicular rash on a red base b) A generalized, dry, scaly patch c) A "bullseye" rash (Erythema migrans) (Correct Answer) d) Petechial lesions on the palms and soles Rationale: Stage 1 Lyme disease (early localized) is classically marked by erythema migrans, a rash that expands outward with a central clearing, often resembling a bullseye. It follows a tick bite infected with Borrelia burgdorferi. 7. Rocky Mountain Spotted Fever (RMSF) is caused by Rickettsia rickettsii transmitted by a tick bite. A key assessment finding the nurse should look for is: a) Bullseye rash b) Honey-crusted lesions c) Petechial rash starting on palms and soles (Correct Answer) d) Burrows in the finger webs Rationale: RMSF is characterized by a maculopapular rash that typically begins on the wrists and ankles (including palms and soles) and then spreads centrally, often becoming petechial. It is a serious, life-threatening infection. 8. A patient with HIV presents with multiple purple-blue lesions on the skin. The nurse suspects this is: a) Basal Cell Carcinoma b) Malignant Melanoma c) Kaposi Sarcoma (Correct Answer) d) Psoriasis vulgaris Rationale: Kaposi Sarcoma is a vascular tumor associated with Human Herpesvirus-8 (HHV-8) and is an AIDS-defining illness. Lesions appear as purple, red, or blue blotches or nodules on the skin, mucous membranes, or viscera. 9. A patient is diagnosed with Pediculosis corporis (body lice). What is the priority nursing intervention regarding transmission? a) Educate the patient on applying topical antifungal cream b) Instruct the patient to wash all clothing and bedding in hot water (Correct Answer)
14. Candidal vaginitis is often triggered by recent antibiotic use. Why does this occur? a) Antibiotics directly stimulate Candida growth b) Antibiotics suppress the immune system's response to yeast c) Antibiotics kill normal bacterial flora, allowing yeast to overgrow (Correct Answer) d) Antibiotics cause an allergic reaction that weakens the vaginal mucosa Rationale: Broad-spectrum antibiotics disrupt the normal protective bacterial flora (like Lactobacillus) in the vagina. This eliminates competition, allowing Candida albicans , which is normally present in small numbers, to proliferate and cause infection. 15. What is the characteristic feature of psoriasis? a) Vesicles and honey-colored crusts b) Greasy, yellow scales on erythematous skin c) Silvery, scaly plaques on erythematous skin (Correct Answer) d) Burrows and intense itching Rationale: Psoriasis is a chronic autoimmune condition characterized by rapid turnover of keratinocytes. This leads to thick, silvery, scaly plaques (scales) overlying red, inflamed skin (plaques). 16. A patient presents with an itchy rash on their forearm after using a new laundry detergent. This is most consistent with: a) Atopic dermatitis b) Contact dermatitis (irritant) (Correct Answer) c) Psoriasis d) Tinea corporis Rationale: Contact dermatitis is an inflammatory reaction caused by direct contact with an irritant (like chemicals in soaps/detergents) or an allergen (like poison ivy). The rash is typically localized to the area of contact. 17. A patient with a history of asthma and hay fever presents with a dry, itchy, erythematous rash in the antecubital fossa. This is classic for: a) Seborrheic dermatitis b) Atopic dermatitis (eczema) (Correct Answer) c) Contact dermatitis d) Impetigo Rationale: Atopic dermatitis (eczema) is a chronic inflammatory skin condition strongly associated with other atopic diseases like asthma and allergic rhinitis (hay fever). It commonly affects flexural areas like the antecubital and popliteal fossae. 18. When educating a patient with a superficial fungal infection, the nurse should emphasize: a) Stopping medication as soon as the itching stops b) Keeping the area dry and continuing medication for the prescribed duration (Correct Answer) c) Applying topical corticosteroids to reduce inflammation d) Avoiding all contact with family members Rationale: Fungi thrive in moist environments. Treatment involves keeping the area clean and dry and completing the full course of antifungal medication (topical or oral), even if symptoms improve, to ensure the infection is fully eradicated.
19. Which finding is a key differentiator between HSV-1 and HSV-2? a) The presence of a painful prodrome b) The ability to remain latent in nerve ganglia c) The typical location of lesions (above vs. below the waist) (Correct Answer) d) The appearance of vesicles that crust over Rationale: While both viruses can infect either location, HSV-1 is classically associated with oral- facial lesions ("above the waist"), and HSV-2 is classically associated with genital lesions ("below the waist"). Pathophysiologically, they behave very similarly. 20. A child in a daycare center has a suspected case of impetigo. What is the priority action? a) Keep the child home from daycare until lesions are crusted and treated (Correct Answer) b) Send the child home with a note explaining good handwashing c) Clean the lesions with hydrogen peroxide only d) No action is needed as it is not contagious Rationale: Impetigo is highly contagious, especially in settings with close contact like daycare centers. The child should be excluded until at least 24-48 hours after antibiotic treatment has been started and lesions are drying/crusted. **Module 2: Inflammation, Infection Control & HAI (Questions 21-30)
- What is the correct order of the Chain of Transmission that must be broken to prevent infection?** a) Portal of Entry, Reservoir, Portal of Exit, Mode of Transmission, Susceptible Host b) Infectious Agent, Reservoir, Portal of Exit, Mode of Transmission, Portal of Entry, Susceptible Host (Correct Answer) c) Susceptible Host, Infectious Agent, Mode of Transmission, Portal of Exit, Portal of Entry d) Infectious Agent, Mode of Transmission, Reservoir, Portal of Entry, Susceptible Host Rationale: The chain of infection consists of six links: (1) Infectious Agent, (2) Reservoir, (3) Portal of Exit, (4) Mode of Transmission, (5) Portal of Entry, and (6) Susceptible Host. Infection prevention practices aim to break one or more of these links. 22. A patient with suspected bacterial meningitis presents with nuchal rigidity. What type of transmission-based precaution should be initiated? a) Contact b) Airborne c) Droplet (Correct Answer) d) Standard only Rationale: Bacterial meningitis (e.g., Neisseria meningitidis ) is transmitted via large respiratory droplets from the patient's nasopharynx. Droplet precautions (mask, gown, gloves, and face shield for high-contact care) are required for the first 24 hours of effective antibiotic therapy. 23. A patient is placed on Contact Precautions for MRSA. Which personal protective equipment (PPE) is required for entering the room? a) Mask and gloves b) Gown and gloves (Correct Answer)
a) Contact Precautions b) Droplet Precautions c) Airborne Precautions (negative pressure room, N95 respirator) (Correct Answer) d) Standard Precautions Rationale: TB is transmitted via airborne droplet nuclei that can remain suspended in the air for long periods. Patients require Airborne Precautions, including a negative pressure isolation room and healthcare workers wearing N95 or higher-level respirators.
29. The SCIP (Surgical Care Improvement Project) protocols aim to prevent: a) Catheter-associated UTIs b) Surgical site infections (SSIs) (Correct Answer) c) Ventilator-associated pneumonia d) Central line infections Rationale: SCIP is a national quality partnership focused on reducing surgical complications. Key measures include appropriate prophylactic antibiotic selection and timing, proper hair removal, and normothermia maintenance to prevent surgical site infections. 30. Which patient is at the highest risk for developing a healthcare-associated infection? a) A patient with a fractured tibia in a cast b) A patient with an indwelling urinary catheter and a central line in the ICU (Correct Answer) c) A patient receiving oral antibiotics for a UTI d) A post-operative day 3 patient with a healing surgical incision Rationale: Risk factors for HAI include invasive devices (catheters, central lines, ventilators), prolonged hospitalization, immunosuppression, and ICU stay. A patient with multiple invasive devices in the ICU has the highest risk profile. **Module 3: Upper Respiratory Disorders (Questions 31-45)
- A patient presents with nasal congestion, clear rhinorrhea, and sneezing. The symptoms began suddenly after the patient was exposed to cat dander. This is most consistent with:** a) Viral rhinitis (common cold) b) Allergic rhinitis (Correct Answer) c) Acute sinusitis d) Pharyngitis Rationale: Allergic rhinitis is an IgE-mediated inflammatory response to an allergen (like cat dander). It presents with sneezing, clear rhinorrhea, nasal congestion, and itchy eyes. Viral rhinitis is caused by a virus and may have associated systemic symptoms like low-grade fever. 32. A patient complains of a severe sore throat, odynophagia (painful swallowing), and fever. On exam, the nurse notes erythematous tonsils with white exudate. This presentation is most suggestive of: a) Viral pharyngitis b) Allergic rhinitis c) Bacterial pharyngitis (e.g., Strep throat) (Correct Answer) d) Laryngitis
Rationale: While viruses are the most common cause of pharyngitis, the presence of high fever, tonsillar exudates, and anterior cervical lymphadenopathy are more indicative of bacterial pharyngitis, most commonly Group A Streptococcus.
33. A singer develops hoarseness and a dry cough after a weekend of performances. The nurse educates them on the best intervention for laryngitis: a) "Start a course of antibiotics immediately."** b) "Whisper to rest your vocal cords."** c) "Rest your voice and inhale cool steam." (Correct Answer) d) "Take an over-the-counter decongestant."** Rationale: Laryngitis is often caused by vocal strain or viral infection. Whispering actually strains the vocal cords more than normal speech. The primary treatment is voice rest, humidified air, and hydration. Antibiotics are not indicated unless a bacterial infection is confirmed. 34. The nurse is caring for a patient with suspected epiglottitis. What is the priority nursing action? a) Prepare for a throat culture b) Examine the throat with a tongue depressor c) Maintain the patient in an upright position and prepare for emergency airway management (Correct Answer) d) Encourage the patient to drink warm liquids Rationale: Epiglottitis is a life-threatening medical emergency involving inflammation of the epiglottis, which can rapidly progress to complete airway obstruction. Do NOT examine the throat, as this can trigger laryngospasm. Keep the patient upright and calm, and prepare for intubation or tracheostomy. 35. A patient is diagnosed with acute bronchitis. The nurse knows that this condition primarily involves: a) Inflammation of the alveoli b) Inflammation of the bronchi and bronchioles (Correct Answer) c) Inflammation of the larynx and trachea d) Constriction of the bronchial smooth muscle Rationale: Acute bronchitis is an inflammation of the large airways (bronchi and bronchioles), usually viral in origin. It is characterized by a cough that may last for weeks. It does not primarily involve the alveoli (that would be pneumonia) or smooth muscle constriction (that would be asthma). 36. A key difference in the management of viral rhinitis vs. bacterial pharyngitis is: a) Viral rhinitis requires antivirals, while bacterial pharyngitis requires antibiotics b) Viral rhinitis is treated symptomatically, while bacterial pharyngitis may require antibiotics (Correct Answer) c) Viral rhinitis requires isolation, while bacterial pharyngitis does not d) There is no difference; both are treated with antibiotics Rationale: Viral rhinitis (common cold) is self-limiting and treated with supportive care (rest, fluids, OTC symptom relief). Bacterial pharyngitis (strep throat) is treated with antibiotics to prevent complications like rheumatic fever. Overuse of antibiotics for viral illnesses contributes to resistance.
Rationale: The "common cold" can be caused by over 200 different viruses (rhinovirus, adenovirus, coronavirus, etc.). Infection with one confers immunity only to that specific virus, leaving the person susceptible to all the others.
42. A patient with a severe allergy to bee stings should be educated to carry which medication at all times? a) Albuterol inhaler b) Oral diphenhydramine (Benadryl) c) Epinephrine auto-injector (EpiPen) (Correct Answer) d) Topical hydrocortisone cream Rationale: For patients at risk for anaphylaxis, the first-line, life-saving treatment is epinephrine. It rapidly reverses bronchospasm and laryngeal edema and increases blood pressure. Antihistamines are adjunctive but do not replace epinephrine. 43. Which of the following is a known trigger for non-allergic (intrinsic) asthma? a) Pollen b) Pet dander c) Dust mites d) Cold air and exercise (Correct Answer) Rationale: Non-allergic (intrinsic) asthma is triggered by factors that are not allergens. These include respiratory infections, cold air, exercise, stress, smoke, and air pollutants. Allergic asthma (extrinsic) is triggered by inhaled allergens like pollen, dander, and dust mites. 44. The primary difference between acute bronchitis and pneumonia is that pneumonia involves: a) Inflammation of the trachea b) Inflammation of the lung parenchyma and alveoli (Correct Answer) c) A productive cough d) A viral etiology Rationale: Bronchitis is inflammation of the bronchial tubes. Pneumonia is an infection that inflames the air sacs in the lungs (alveoli), which may fill with fluid or pus. This distinction is seen on chest x-ray. Both can cause productive cough and can be viral or bacterial. 45. A patient presents with a sore throat, low-grade fever, and hoarseness. The nurse notes swollen, erythematous vocal cords on indirect laryngoscopy. The patient is diagnosed with: a) Pharyngitis b) Epiglottitis c) Laryngitis (Correct Answer) d) Tonsillitis Rationale: The description of swollen vocal cords with hoarseness points directly to laryngitis, which is inflammation of the larynx and vocal cords. **Module 4: Asthma & Lower Respiratory Disorders (Questions 46-65)
- A nurse is caring for a patient during an acute asthma exacerbation. Auscultation reveals minimal breath sounds in the lower lobes with expiratory wheezing in the upper lobes. The patient is using accessory muscles. What is the priority intervention?**
a) Administer a long-acting beta-agonist (LABA) inhaler b) Reposition the patient to supine position c) Administer a short-acting beta-agonist (SABA) nebulizer treatment (Correct Answer) d) Give the patient a glass of water to drink Rationale: During an acute asthma exacerbation, the priority is to relieve bronchoconstriction immediately. Short-acting beta-agonists (SABAs) like albuterol are the first-line rescue medications. LABAs are used for chronic maintenance, not acute rescue.
47. The pathophysiology of asthma includes all of the following EXCEPT: a) Airway inflammation b) Bronchial hyperresponsiveness c) Permanent destruction of alveolar walls (Correct Answer) d) Airway obstruction (reversible) Rationale: Asthma is characterized by chronic inflammation, airway hyperresponsiveness, and reversible airflow obstruction. Permanent destruction of alveolar walls is a hallmark of emphysema, a form of COPD, not asthma. 48. A patient with asthma is started on a daily inhaled corticosteroid. The nurse explains that this medication works by: a) Quickly dilating constricted bronchioles b) Reducing chronic inflammation in the airways (Correct Answer) c) Blocking the effects of histamine d) Breaking up mucus plugs Rationale: Inhaled corticosteroids are controller medications that reduce airway inflammation over time, decreasing hyperresponsiveness and preventing exacerbations. They do not provide immediate relief (bronchodilation). 49. A patient presents to the ER in severe respiratory distress. They are diaphoretic, unable to speak in full sentences, and have a silent chest on auscultation. This patient is likely experiencing: a) A mild asthma exacerbation b) Acute bronchitis c) Status Asthmaticus (Correct Answer) d) Anaphylaxis Rationale: A "silent chest" is an ominous sign in a severe asthma attack, indicating such severe bronchoconstriction and air trapping that minimal air is moving to allow wheezing. This, along with the inability to speak, points to status asthmaticus, a life-threatening medical emergency. 50. Which of the following is an example of a long-acting bronchodilator used for maintenance therapy in asthma? a) Albuterol (ProAir, Ventolin) b) Levalbuterol (Xopenex) c) Salmeterol (Serevent) (Correct Answer) d) Epinephrine Rationale: Salmeterol and formoterol are long-acting beta-agonists (LABAs) that provide bronchodilation for 12 hours or more. They are used for long-term control and must be combined with an inhaled corticosteroid. Albuterol and levalbuterol are SABAs (short-acting).
Rationale: Theophylline is a bronchodilator with a narrow therapeutic index. Signs of toxicity include tachycardia, cardiac dysrhythmias, nausea, vomiting, and seizures. Serum levels must be monitored closely.
56. During an asthma attack, the release of inflammatory mediators from mast cells leads to: a) Bronchodilation and decreased mucus production b) Bronchoconstriction, mucosal edema, and increased mucus secretion (Correct Answer) c) Alveolar destruction and fibrosis d) Thickening of the pleural lining Rationale: Mast cell degranulation releases histamine, leukotrienes, and prostaglandins. These mediators cause smooth muscle bronchoconstriction, increased vascular permeability leading to mucosal edema, and increased secretion of thick mucus, all of which contribute to airway obstruction. 57. Which of the following is a common trigger for an asthma exacerbation in patients with both allergic and non-allergic asthma? a) Cockroach allergen b) Upper respiratory infection (URI) (Correct Answer) c) Mold spores d) House dust mites Rationale: While allergens are specific triggers for allergic asthma, upper respiratory infections (viral URIs) are a potent trigger for exacerbations in virtually all patients with asthma, regardless of their allergic status. 58. The hallmark symptom of acute bronchitis is: a) High fever and chills b) Cough, which may persist for 1-3 weeks (Correct Answer) c) Sharp, pleuritic chest pain d) Stridor Rationale: The primary symptom of acute bronchitis is a cough. It often starts as a dry cough and becomes productive. The cough can linger for weeks after the initial infection has cleared. 59. A patient with COPD and chronic bronchitis asks how their disease differs from asthma. The nurse's best response is: a) "In asthma, the airway obstruction is fully reversible; in COPD, it is not." (Correct Answer) b) "Asthma is caused by smoking, while COPD is genetic."** c) "COPD involves only the upper airways, while asthma involves the lower airways."** d) "There is no real difference; the treatment is the same."** Rationale: A key pathophysiological difference is reversibility. Asthma is characterized by reversible airway obstruction (though chronic inflammation can lead to remodeling over time). COPD involves progressive, largely irreversible airflow limitation. 60. A patient with suspected influenza (the "flu") presents with which classic triad of symptoms? a) Nasal congestion, sneezing, sore throat b) Gradual onset of runny nose and malaise c) Sudden onset of fever, myalgia (body aches), and cough (Correct Answer) d) Vomiting, diarrhea, and abdominal cramping
Rationale: Influenza is distinguished from the common cold by its sudden onset and systemic symptoms. The classic presentation includes high fever, severe myalgias, headache, and a non-productive cough. GI symptoms are more common in children.
61. The nurse is caring for a patient with a new order for oseltamivir (Tamiflu). The nurse knows this medication is most effective if given: a) Immediately upon diagnosis of bacterial pneumonia b) Within 48 hours of the onset of influenza symptoms (Correct Answer) c) As a daily prophylactic for all healthcare workers d) Only to patients who are already intubated Rationale: Oseltamivir is an antiviral medication that works by inhibiting neuraminidase. It is most effective in reducing the duration and severity of flu symptoms if started within the first 48 hours of symptom onset. 62. Which patient is at the highest risk for developing severe complications from influenza? a) A 25-year-old athlete b) A 70-year-old with heart failure (Correct Answer) c) A 40-year-old with well-controlled hypertension d) A 15-year-old with a broken arm Rationale: High-risk groups for severe influenza complications (like pneumonia, hospitalization, and death) include adults over 65, young children, pregnant women, and individuals of any age with chronic medical conditions (heart disease, lung disease, diabetes, immunosuppression). 63. A patient asks about the difference between the common cold and influenza. The nurse's best response is: a) "The flu has a sudden onset of fever and body aches, while a cold is more gradual with nasal symptoms." (Correct Answer) b) "They are essentially the same illness but caused by different viruses."** c) "A cold is much more severe and dangerous than the flu."** d) "Only the flu is contagious."** Rationale: Symptom onset and presentation are key differentiators. Flu hits suddenly with high fever, severe aches, and fatigue. Colds are usually milder, with a gradual onset focused on nasal congestion and sore throat. 64. A patient with obstructive sleep apnea (OSA) is being educated on treatment options. The nurse explains that Continuous Positive Airway Pressure (CPAP) works by: a) Stimulating the respiratory drive in the brainstem b) Surgically removing the obstructing tissue c) Splinting the airway open with positive pressure during sleep (Correct Answer) d) Delivering extra oxygen during the night Rationale: CPAP provides a pneumatic splint. The continuous positive pressure keeps the soft tissues of the pharynx from collapsing and obstructing the airway during sleep, thereby preventing apnea and hypopnea events. 65. A patient with severe asthma is prescribed a course of systemic corticosteroids. The nurse will monitor for which potential adverse effect? a) Hypoglycemia
Rationale: OSA is characterized by recurrent collapse of the upper airway during sleep. This leads to snoring, apnea episodes, and frequent arousals, resulting in poor sleep quality and excessive daytime sleepiness.
70. The nurse is assessing a patient with a suspected foreign body aspiration. Which finding is most indicative of complete tracheal obstruction? a) Wheezing on expiration b) Audible cough and stridor c) Inability to speak or cough, with universal choking sign (Correct Answer) d) Hoarseness Rationale: Complete airway obstruction means no air is passing the vocal cords. The patient will be unable to speak, breathe, or cough effectively and will often display the universal choking sign (hands clutched to throat). This requires immediate abdominal thrusts. 71. A patient with severe OSA is not improving with CPAP. The nurse anticipates a potential referral for: a) Tracheostomy b) Bariatric surgery c) A tonsillectomy or uvulopalatopharyngoplasty (UPPP) (Correct Answer) d) A permanent pacemaker Rationale: Surgical options for OSA include removal of obstructive tissue (tonsillectomy, adenoidectomy, UPPP) or tracheostomy for severe, life-threatening cases. Bariatric surgery may be considered if obesity is a major contributing factor, but a tonsillectomy/UPPP directly addresses pharyngeal obstruction. 72. A patient with a history of snoring undergoes a sleep study. The results show periods where respiratory effort ceases entirely due to lack of signal from the brainstem. This is known as: a) Obstructive Sleep Apnea b) Central Sleep Apnea (Correct Answer) c) Mixed Sleep Apnea d) Simple snoring Rationale: Central sleep apnea is a neurological disorder where the brain fails to send signals to the respiratory muscles to breathe. There is no respiratory effort during apneic events. In OSA, effort is present but airflow is blocked. 73. A patient with an upper airway obstruction due to anaphylaxis requires immediate medication administration. The nurse prepares to give: a) Diphenhydramine (Benadryl) IV b) Epinephrine IM (intramuscular) (Correct Answer) c) Albuterol nebulizer d) Hydrocortisone IV Rationale: In anaphylaxis-induced airway obstruction, intramuscular epinephrine (into the anterolateral thigh) is the first-line, life-saving treatment. It rapidly causes vasoconstriction (reducing laryngeal edema) and bronchodilation. 74. The nurse is providing dietary education to a patient with sleep apnea. Which recommendation is most important?
a) Increase caffeine intake to stay alert during the day b) Eat a large meal right before bedtime to promote sleep c) Weight loss through a healthy diet and exercise (Correct Answer) d) Increase fluid intake to thin secretions Rationale: Obesity is a major risk factor for OSA. Excess fatty tissue in the neck can narrow the airway. Weight loss is a key component of long-term management and can significantly reduce the severity of apnea.
75. A patient post-thyroidectomy reports difficulty breathing and a sensation of pressure on the trachea. The nurse observes neck swelling. This is likely due to: a) Laryngospasm b) Hematoma formation causing tracheal compression (Correct Answer) c) Vocal cord paralysis d) Pneumothorax Rationale: A post-thyroidectomy hematoma is a surgical emergency. Bleeding in the closed neck space can rapidly expand, compressing the trachea and causing airway obstruction. Immediate surgical evacuation is required. **Comprehensive Integrated Questions (Questions 76-85)
- A patient with a history of asthma is admitted with pneumonia. The nurse knows that the presence of pneumonia will likely:** a) Have no effect on the patient's asthma b) Improve asthma symptoms by triggering an immune response c) Exacerbate the patient's asthma due to increased inflammation (Correct Answer) d) Require a decrease in the patient's usual asthma medications Rationale: Respiratory infections like pneumonia cause significant inflammation in the airways, which is a potent trigger for asthma exacerbations. The patient's asthma will likely worsen, and they may require increased use of bronchodilators and corticosteroids. 77. A nurse is caring for four patients. Which patient is at the greatest risk for impaired gas exchange related to a problem with ventilation (air movement)? a) A patient with anemia b) A patient with a pulmonary embolism c) A patient in status asthmaticus (Correct Answer) d) A patient with carbon monoxide poisoning Rationale: Status asthmaticus causes severe bronchoconstriction and air trapping, which physically prevents air from moving in and out of the lungs (a ventilation problem). Anemia and CO poisoning are gas transport problems. A pulmonary embolism is a perfusion problem. 78. A patient presents with a sudden onset of severe dyspnea, pleuritic chest pain, and hypoxemia. A V/Q scan indicates a pulmonary embolism. What is the underlying pathophysiological cause of the hypoxemia? a) Bronchoconstriction of the small airways b) Alveoli that are ventilated but not perfused (increased dead space) (Correct Answer)
83. A patient with COPD and chronic bronchitis has a persistent cough. The nurse understands that the cough in chronic bronchitis is primarily due to: a) Bronchospasm triggered by an allergen b) Hypertrophy of mucus glands and excessive mucus production (Correct Answer) c) Destruction of alveolar walls d) Fibrosis of the lung parenchyma Rationale: Chronic bronchitis is clinically defined by a chronic productive cough for at least 3 months in 2 consecutive years. The underlying pathophysiology is hypertrophy and hyperplasia of the mucus glands in the bronchi, leading to excessive mucus secretion. 84. A patient is diagnosed with exercise-induced bronchoconstriction (EIB). When should the nurse instruct the patient to use their prescribed albuterol inhaler? a) At the first sign of an asthma attack during exercise b) Every 12 hours, morning and night c) 15-20 minutes before starting exercise (Correct Answer) d) Immediately after finishing exercise Rationale: For EIB, using a SABA (like albuterol) 15-20 minutes prior to exercise is highly effective in preventing or minimizing bronchoconstriction during physical activity. 85. A patient with a 40-pack-year smoking history is diagnosed with laryngeal cancer. Which initial symptom is most common? a) Dysphagia b) Persistent hoarseness (Correct Answer) c) Hemoptysis d) Stridor Rationale: Hoarseness that persists for more than 2-3 weeks is the most common and often earliest presenting sign of laryngeal cancer, especially when the tumor involves the vocal cords.
