CHAPTER 06- Respiratory System

Question 1

In a patient in status asthmaticus, the FNP would most likely identify which of the following on a chest radiograph?

1. Atelectasis
2. Effusion
3. Hyperinflation
4. Pleural opacities

Answer 1

3. Hyperinflation

Chest radiography is indicated in patients who have an atypical presentation or in those who do not respond to therapy.

Question 2

Ipratropium is available in a pressurized metered-dose inhaler or solution for nebulization and:

1. Has dose-related adverse effects including nausea, vomiting, seizures, and arrhythmias.
2. Is a short-acting bronchodilator administered four times daily as maintenance therapy for COPD.
3. Can increase the risk of bone mineral density and/or bone fractures.
4. Increases the risk of oral candidiasis, hoarseness, and bruising of the skin.

Answer 2

2. Is a short-acting bronchodilator administered four times daily as maintenance therapy for COPD.

Ipratropium, a SAMA, is as effective or better in improving FEV1 as SABA without tachycardia side effects. SAMAs decrease function residual capacity and residual volume and effectively reduce hyperinflation.

Question 3

Pulmonary tuberculosis is caused by what gram-positive, rod-shaped aerobic bacterium?

1. Lactobacillus
2. Streptococcus
3. Renibacterium
4. Mycobacterium

Answer 3

4. Mycobacterium

The lungs are the major site for Mycobacterium tuberculosis for primary infection and disease.

Question 4

M. tuberculosis is spread by:

1. Body fluids.
2. Airborne droplets.
3. Fomites.
4. Ingestion of bacteria.

Answer 4

2. Airborne droplets.

The bacteria are spread from person to person in tiny microscopic droplets when a TB sufferer coughs, sneezes, speaks, sings, or laughs. Only people with active TB can spread the disease to others.

Question 5

A 53-year-old male with a 45 pack-year smoking history presents to the nurse practitioner’s office for a follow-up visit. This patient had a recent emergency department admission for exertional dyspnea that has progressed to dyspnea at rest and a cough for 1 month. The nurse practitioner received the chest radiograph report, which demonstrates a suspicious nodule in the right hilar region. The nurse practitioner suspects small cell lung cancer and understands that:

1. Small-cell lung cancer differs from non-small-cell lung cancer because small-cell lung cancer grows slowly.
2. Small-cell lung cancer responds well to chemotherapy and radiation therapy.
3. Small-cell lung cancer is generally not associated with distinct paraneoplastic syndromes.
4. Small-cell lung cancer metastasizes slowly.

Answer 5

2. Small-cell lung cancer responds well to chemotherapy and radiation therapy.

Small-cell lung cancer responds well to chemotherapy and radiation therapy. Small-cell lung cancer (also called oat cell cancer) and non-small-cell lung cancer are the two main types of lung cancer. Small-cell lung cancer accounts for approximately 15% of all cases of lung cancer. Small-cell lung cancer grows rapidly and spreads quickly. Small-cell lung cancer is frequently associated with distinct paraneoplastic syndromes.

Question 6

HIV co-infection is the most potent immunosuppressive risk factor for which of the following?

1. Distal acinar emphysema
2. Active TB disease
3. Diabetes mellitus
4. Paraseptal emphysema

Answer 6

2. Active TB disease

People living with HIV are more likely than others to become sick with TB if they are exposed and become infected. According to the Center for Disease Control and Prevention, tuberculosis remains a serious threat in the United States, especially for people living with HIV. People living with HIV are more likely than others to become sick with TB.

Question 7

Screening for latent tuberculosis infection (LTBI) is recommended:

1. In persons at risk of recent infection and patients infected with HIV.
2. Groups with an increased flow of progression to active disease.
3. Persons with nocturnal coughing.
4. In persons whose CD4 cell count increases to counts of > 600 cells/µL.

Answer 7

1. In persons at risk of recent infection and patients infected with HIV.

According to the Center for Disease Control and Prevention, screening for latent tuberculosis infection (LTBI) is recommended for HIV-infected persons and those at risk of recent LTBI infection. The diagnosis of LTBI is based on information gathered from the medical history, a tuberculin skin test (TST) or interferon gamma release assay (IGRA) result, chest radiographs, physical examination, and in certain circumstances, sputum examinations. The presence of TB must be excluded before treatment for LTBI is initiated, because failure to do so may result in inadequate treatment and development of drug resistance. A TST reaction of ³ 5 mm of induration is considered positive in patients with HIV.

Question 8

According to the EPR-3 Guidelines, poor asthma control can increase future risks of asthma, including all of the following EXCEPT:

1. Airway remodeling.
2. Accelerated decrease in lung function.
3. Generally no side effects of treatment.
4. Fatal asthma.

Answer 8

3. Generally no side effects of treatment.

Poor asthma control can increase future risks of asthma, including exacerbation, accelerated decrease in lung function, and side effects of treatment. Increased risk for fatal asthma includes poor asthma control.

Question 9

M. Pneumonia empiric treatment for suspected mycoplasma pneumonia involves which of the following?

1. Five-day course of oral azithromycin (500 mg for the first dose, then 250 mg daily for the next four days)
2. Dexilant 60 mg 1 tablet twice daily for 14 days
3. Treat symptomatically
4. Palivizumab according to weight for 14 days

Answer 9

3. Treat symptomatically

CAP may be treated with monotherapy or combination therapy. Effective monotherapy antibiotics include: combination therapy, which usually consists of ceftriaxone plus doxycycline or azithromycin doxycycline, and respiratory quinolones. Immunocompromised hosts who present with CAP are treated in the same manner as otherwise healthy hosts but may require a longer duration of therapy.

Question 10

Which of the following is considered accurate for Respiratory Syntial Virus (RSV)?

1. Order palivmar 250 mg twice daily for 14 days at the onset of RSV symptoms.
2. RSV is a highly contagious infection, occurring most often during the late spring and summer months.
3. Treat symptoms with Aspirin 100 mg/5 mL. Take 5 mL orally three times daily.
4. Premature infants have the highest risk of RSV.

Answer 10

4. Premature infants have the highest risk of RSV.

RSV is a common cause of severe lower respiratory tract diseases. These include bronchiolitis, pneumonia, and acute repiratory failure. According to Caswell-Dawson & Munchie, this is generally seen in infants and young children.

Question 11

One of the most important initial steps for management of COPD is to:

1. Obtain base-line arterial blood gases.
2. Order supplemental oxygen therapy at 2 pm.
3. Reduce exposure to risk factors, including smoking cessation.
4. Start low-dose prednisone daily for 14 to 21 days to reduce inflammation.

Answer 11

3. Reduce exposure to risk factors, including smoking cessation.

Smoking cessation is relevant especially for individuals with COPD because it is known from multiple studies that patients who quit smoking experience improvement in pulmonary functions, a decreased rate of a normal age-related decline in FEV1, decreased unscheduled medical utilization, and improved survival.

Question 12

For patients with COPD, long-acting bronchodilators are recommended as:

1. Regular maintenance therapy for patients with moderate to severe COPD.
2. Only in combination with inhaled corticosteroid.
3. Reliever therapy for acute exacerbations.
4. An alternative route of administration to treat chronic cough.

Answer 12

1. Regular maintenance therapy for patients with moderate to severe COPD.

Long-acting bronchodilators (LABA) increase FEV1, decrease symptoms, improve lung hyperinflation, increase physical activity, and reduce exacerbations.

Question 13

The nurse practitioner orders a chest radiograph on a 28-year-old Caucasian female who presents to the office for uncontrolled asthma with symptoms of cough, wheezing throughout all lung fields, and shortness of breath. Which clinical finding on the chest radiograph is not suggestive of asthma?

1. Bronchial thickening
2. Nodules
3. Hyperinflation
4. Focal atelectasis

Answer 13

2. Nodules

Hyperinflation, focal atelectasis, and bronchial thickening are clinical findings on chest X-ray of exacerbated asthma. Nodules are diagnostic of cancer.

Question 14

A 62-year-old African American male with mild COPD presents to the clinic with a chief complaint of cough. The nurse practitioner understands pharmacological treatment is based upon all EXCEPT:

1. Adherence to medical treatment regimen.
2. The CAT score, breathlessness, and wheezing.
3. Diet.
4. Airflow limitations.

Answer 14

4. Airflow limitations.

Symptoms can be assessed with validated tools such as the CAT. Adherence is important and is improved with an individualized approach. Pharmacological treatment is also based on airflow limitations, symptoms, and exacerbations. Diet may be considered, but other options have a higher ranking.

Question 15

A 3-year-old male presents to the clinic with his mother who complains of coughing, sneezing, rhinorrhea, low-grade fever, and mild sore throat. The nurse practitioner obtained a laboratory diagnosis of RSV that was made by analysis of respiratory secretions. The nurse practitioner understands that:

1. RSV infection usually is a self-limited process, but it is associated with recurrent wheezing in some patients.
2. Infection with respiratory syncytial virus requires direct admission to the emergency department.
3. Adolescents are most severely affected by RSV.
4. Ribavirin is considered to be contraindicated in pregnant women.

Answer 15

1. RSV infection usually is a self-limited process, but it is associated with recurrent wheezing in some patients.

RSV infection usually is a self-limited process, but it is associated with recurrent wheezing in some patients.

Question 16

Vesicular breath sounds:

1. Are soft and high-pitched, and are heard throughout the lung.
2. Are loud, hollow, harsh sounds, and are heard best over the manubrium.
3. Are low-pitched sounds that can be heard over the periphery of both lung fields.
4. Have an expiratory phase that is longer than their inspiratory phase.

Answer 16

3. Are low-pitched sounds that can be heard over the periphery of both lung fields.

Vesicular breath sounds are soft, low-pitched sounds that can be heard over the periphery of both lung fields.

Question 17

The standard short-course anti-TB regimen includes which of the following?

1. Enablex, Myrbetriq, and Ditropan
2. Isoniazid, rifampicin, pyrazinamide, and ethambutol
3. Linezolid and Sutezolid
4. Panobinostat, palbociclib, and lenvatinib.

Answer 17

2. Isoniazid, rifampicin, pyrazinamide, and ethambutol

The standard short-course anti-TB regimen includes Isoniazid, rifampicin, pyrazinamide, and ethambutol.

Question 18

Lower respiratory tract infections cause disease in the alveolar sacs, and may result in which of the following?

1. Emphysema
2. Gastroesophageal reflux disease (GERD)
3. Bronchiectasis
4. Pneumonia

Answer 18

4. Pneumonia

Lower respiratory tract infections cause disease in the alveolar sacs, and the resulting infection is pneumonia. Pneumonia can result from viral or bacterial infections and is associated with acute inflammation of the pulmonary parenchyma and consolidation of the alveoli.

Question 19

Chest radiographs showing new consolidations or infiltrates would suggest which of the following?

1. Emphysema
2. Acute respiratory distress syndrome (ARDS)
3. Interstitial pulmonary edema
4. Pneumonia

Answer 19

4. Pneumonia

Infiltrates consist of fluid/exudate in alveolar spaces, indicating pneumonia. Exudate can consolidate and is the cause of lobar pneumonia.

Question 20

A 48-year-old African American male comes to the FNP’s office for a follow-up visit complaining of shortness of breath, coughing, and dyspnea on exertion. The FNP identifies the findings of COPD as:

1. appearance of Kerley lines on chest X-ray.
2. FEV1/FVC
3. hypotension and tachycardia.
4. low serum glucose level and elevated serum lactate level.

Answer 20

2. FEV1/FVC

Airflow obstruction is determined by spirometry, where the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) after bronchodilation is less than 0.70.

Question 21

Pulmonary tuberculosis (TB) is a chronic bacterial infection:

1. with high CD4 cell counts that are associated with more severe forms.
2. caused by hMPV and transmitted through aerosolized droplets.
3. and fever associated with it is classically diurnal, with an afebrile period early in the morning, reaching a peak in the late afternoon or evening.
4. and hemoptysis generally decreases in the setting of active tuberculosis.

Answer 21

3. and fever associated with it is classically diurnal, with an afebrile period early in the morning, reaching a peak in the late afternoon or evening.

TB is a chronic bacterial infection, and fever is classically diurnal, with an afebrile period early in the morning, reaching a peak in the late afternoon or evening. Fever is most often low grade at onset and becomes marked with the progression of the disease. Fever is classically diurnal, with an afebrile period early in the morning and a gradually rising temperature throughout the day, reaching a peak in the late afternoon or evening. Night sweats and fever are more common among patients with advanced pulmonary TB.

Question 22

An 18-year-old female presents to a clinic complaining of increased coughing and wheezing once or twice daily the past 3 days. She reports she has had “cold-like” symptoms that started 5 or 6 days ago that she is treating with over-the-counter cough syrup. She has a diagnosis of mild persistent asthma, but is non-adherent to her medical treatment regimen. No nocturnal symptoms. Asthma Control Test score is 18. A spirometry reveals FVC 78%, FEV1 75%, FVC/FEV1 73%, FVC 20%, FEV1 18%, and FVC/FEV1 18% responses to bronchodilator. Upon physical examination, few scattered end-expiratory wheezes are heard throughout all lung fields bilaterally and all were clear bilaterally after nebulized albuterol. The nurse practitioner prescribes:

1. Theophylline 200 mg once daily after the theophylline level is ordered and an asthma education consult.
2. Fluticasone 40 mcg 2 puffs twice daily using an aerochamber, albuterol 2 puffs every 4 to 6 hours as needed, asthma education consult, and follow up in 4 weeks or sooner if needed.
3. Fluticasone/salmeterol 500 mg/50 mcg 1 puff twice daily, albuterol 2 puffs every 4 to 6 hours as needed, asthma education consult, follow up in 1 week.
4. A prednisone burst.

Answer 22

2. Fluticasone 40 mcg 2 puffs twice daily using an aerochamber, albuterol 2 puffs every 4 to 6 hours as needed, asthma education consult, and follow up in 4 weeks or sooner if needed.

Fluticasone 40 mcg 2 puffs twice daily using an aerochamber, albuterol 2 puffs every 4 to 6 hours as needed, asthma education consult, and follow up in 4 weeks or sooner if need. It is imperative to regain asthma control, which is achieved with implementing an inhaled corticosteroid. Albuterol is used to relieve symptoms. An individualized asthma education program is imperative for all patients with asthma. This patient must understand how to use a metered dose inhaler and understand signs and symptoms of worsening asthma. A Prednisone burst is not indicated at this time. Combination therapy would be considered if this patient was adherent on inhaled corticosteroids, with the presence of increased symptoms. Asthma Control Test is 18. Asthma control is 20 or greater. All patients with asthma must have an asthma action plan with appropriate follow-up care.

Question 23

According to the National Asthma Education Prevention Program Expert Panel Report 3, the risk factors for fatal asthma include all but:

1. Two or more hospitalizations in the past year for severe exacerbation requiring admission for asthma into an intensive care unit or intubation.
2. Perceiving an airway obstruction or the severity of worsening.
3. Asthma.
4. Higher income with varying sociodemographic groups.

Answer 23

1. Two or more hospitalizations in the past year for severe exacerbation requiring admission for asthma into an intensive care unit or intubation.

According to the EPR-3, risk factors for asthma-related death include: Previous severe exacerbation, two or more hospitalizations or > 3 ED visits in the past year, use of > 2 canisters of SABA per month, difficulty perceiving airway obstructions or the severity of worsening asthma, low socioeconomic status or inner-city residence, illicit drug use, major psychosocial problems or psychiatric disease, and comorbidities such as cardiovascular disease or other chronic lung disease.

Question 24

Clinical features that suggest malignancy on initial evaluation include:

1. Older age, a current or past history of tobacco abuse, hemoptysis, and the presence of a previous malignancy.
2. Presence of a precious malignancy, cough, and fatigue.
3. Tobacco use, hemoptysis, chest congestion, and shortness of breath.
4. Persistent cough or wheezing with white or pink blood-tinged mucus, and fatigue.

Answer 24

1. Older age, a current or past history of tobacco abuse, hemoptysis, and the presence of a previous malignancy.

Clinical features that suggest malignancy on initial evaluation include older age, current or past history of tobacco abuse, hemoptysis, and the presence of a previous malignancy.

Question 25

Wheezing heard only on inspiration is referred to as stridor and is associated with which of the following? 1. A mechanical obstruction at the level of the trachea/upper airway 2. Focal wheezing 3. COPD 4. Cystic fibrosis

Answer 25

**1.** A mechanical obstruction at the level of the trachea/upper airway ## Footnote Wheezing heard only on inspiration is referred to as stridor and is associated with mechanical obstruction at the level of the trachea/upper airway.

Question 26

The National Asthma Education and Prevention Program, Expert Panel Report 3, highlights the importance of correctly diagnosing asthma, by establishing which of the following? 1. Episodic symptoms of airflow obstruction are present, airflow obstruction or symptoms are at least partially reversible, and exclusion of alternative diagnoses 2. Coughing and wheezing greater than twice a week with a family history of asthma 3. Symptoms of airflow obstruction are present more than twice a week, airflow obstruction or symptoms are reversible, and exclusion of alternative diagnosis 4. Shortness of breath, chest tightness, and chronic productive cough

Answer 26

**1.** Episodic symptoms of airflow obstruction are present, airflow obstruction or symptoms are at least partially reversible, and exclusion of alternative diagnoses ## Footnote According to EPR-3, correctly diagnosing asthma is attained by establishing a history of episodic symptoms of airflow obstruction are present, airflow obstruction or symptoms are at least partially reversible, and the exclusion of alternative diagnoses.

Question 27

Wheezing produced during inspiration and/or expiration: 1. Contributes to the pathological features of gastroesopheal reflux disease 2. Is associated with diffuse processes that affect all lobes of the lung and is often audible in all lung fields. 3. Is seen in severe bronchoconstriction as the inspiratory phase of respiration becomes noticeably prolonged. 4. Contributes to symptoms of post–nasal drainage.

Answer 27

**2.** Is associated with diffuse processes that affect all lobes of the lung and is often audible in all lung fields. ## Footnote Wheezing produced during inspiration and/or expiration is associated with diffuse processes that affect all lobes of the lung and is often audible in all lung fields.

Question 28

A 20-year-old male presents to the clinic with a chief complaint of a productive cough. The nurse practitioner diagnoses acute bronchitis with a treatment plan of which of the following? 1. Augmentin 2. Antiviral therapy 3. Symptomatic treatment including acetaminophen as needed\* 4. Chest X-ray, CBC with differentials

Answer 28

**3.** Symptomatic treatment including acetaminophen as needed\* ## Footnote Symptomatic treatment, including acetaminophen as needed. Symptomatic treatment may include nonsteroidal anti-inflammatory drugs or acetaminophen directed toward presenting symptoms. Bronchodilators can help relieve the cough in people who show evidence of bronchospasm. Other options are not consistent with the initial treatment of acute bronchitis.

Question 29

Which of the following is considered true regarding inhaled corticosteroids in the treatment of asthma? 1. It’s the drug of choice for persistent asthma. 2. It is associated with an increased risk of fatal asthma. 3. It is never used as monotherapy. 4. It inhibits muscarinic cholinergic receptors.

Answer 29

**1.** It’s the drug of choice for persistent asthma. ## Footnote EPR-3 recommends inhaled corticosteroids as the drug of choice in the treatment of persistent asthma.

Question 30

Pulsus paradox greater than 25 mmHg reflects which of the following? 1. Controlled asthma 2. Severe airflow obstruction 3. Hypoventilation 4. Hypotension

Answer 30

**2.** Severe airflow obstruction ## Footnote Pulsus paradox is an exaggeration of normal physiology in which the systolic arterial pressure is \> 10 mgHg during inspiration. A drop of \> 25 mmHg reflects severe airflow obstruction.

Question 31

According to the National Asthma Education and Prevention Program Expert Panel Report 3, leukotriene receptor antagonists: 1. Are considered as add-on therapy in mild and moderate persistent asthma. 2. Are alternatives to ICS in moderate persistent asthma. 3. Block the effect of acetylcholine on airways. 4. Reduce vagal tone in the airway.

Answer 31

**1.** Are considered as add-on therapy in mild and moderate persistent asthma. ## Footnote According to EPR-3, the leukotriene receptor antagonist is considered an add-on therapy in mild and moderate persistent asthma.

Question 32

When a normal lung transmits a palpable vibratory sensation to the chest wall, this is known as what? 1. Whispered pectoriloquy 2. Bronchophony 3. Tactile fremitus 4. Egophony

Answer 32

**3.** Tactile fremitus ## Footnote A normal lung transmits a palpable vibratory sensation to the chest wall. This is known as tactile fremitus.

Question 33

Christopher is a 76-year-old Caucasian male who presents to the outpatient clinic for a routine follow-up visit and is complaining of shortness of breath with mild exertion. He was diagnosed with lung cancer 8 months ago and is undergoing treatment. The nurse practitioner understands dyspnea could possibly be contributing to which of the following? 1. Anxiety 2. Cough 3. Lymphangitic tumor spread 4. Costochondritis

Answer 33

**3.** Lymphangitic tumor spread ## Footnote This is a lymphangitic tumor spread. Symptoms of cough, pain, or hemoptysis may be present in patients with hilar involvement, particularly when the metastases adjoin or invade the bronchi.

Question 34

Stephanie is a 47-year-old female with a history of hypertension and cough for the past 3 to 4 weeks. Physical examination findings are unremarkable. The nurse practitioner believes the cough is most likely caused by which of the following? 1. An upper respiratory infection 2. ACE-I 3. Bronchogenic carcinoma 4. A psychogenic cough

Answer 34

**2.** ACE-I ## Footnote ACE-I is a contributing factor to cough. After discontinuing ACE-I, the cough generally resolves within one to four days, but may take up to four weeks.

Question 35

J.R. presents to the clinic with a depression of his sternum. The FNP identifies this finding as which of the following? 1. Flail chest 2. Barrel chest 3. Pectus carinatum 4. Pectus excavatum

Answer 35

**4.** Pectus excavatum ## Footnote Depression of the sternum is known as pectus excavatum (funnel chest).

Question 36

Upon examination of a 55-year-old man, the percussion note is lower-pitched, and is a louder and longer sound heard normally over the lungs during maximum inspiration and is identified as which of the following? 1. Resonance 2. Hyperresonance 3. Dullness 4. Flatness

Answer 36

**2.** Hyperresonance ## Footnote Hyperresonance is described as a lower-pitched, louder and longer sound heard normally over the lungs during maximum inspiration.

Question 37

Emily is a 30-year-old Hispanic female with uncontrolled severe persistent asthma. She requires albuterol at least once or twice daily and has had 3 bursts of oral prednisone the past 12 months. Emily owns a restaurant working 60 hours a week. The FNP would most likely: 1. Refer to a pulmonology or allergy provider requesting an immediate consult, implement a medical treatment regimen according to EPR-3, and give an asthma education consultation. 2. Order a fluticasone 220 mcg 4 puffs twice daily using a valved holding chamber, plus an asthma education consultation. 3. Request an asthma education consult, increase inhaled corticosteroids, and request Emily decrease her workload. 4. Prescribe 60 mg prednisone once daily for 7 days and have Emily return to the clinic in 7 days.

Answer 37

**1.** Refer to a pulmonology or allergy provider requesting an immediate consult, implement a medical treatment regimen according to EPR-3, and give an asthma education consultation. ## Footnote According to the EPR-3 guidelines, this patient should be referred to a pulmonary or allergy service for an immediate consult. In the interim, the FNP should prescribe a medical treatment regimen according to EPR-3 and begin an asthma education consult.

Question 38

Upon physical examination, the FNP assesses dullness on percussion, increased tactile fremitus, and whispered pectoriloquy is heard clearly. These findings are consistent with which of the following? 1. Asthma 2. Atelectasis 3. Consolidation 4. Pneumothorax

Answer 38

**3.** Consolidation ## Footnote Clinical findings of dullness on percussion, increased tactile fremitus, and whispered pectoriloquy being heard clearly is consistent with consolidation.

Question 39

Which of the following drugs does pharmacodynamic criteria suggest are more potent against S. pneumoniae? 1. Rifapentine and Moxifloxacin 2. Doxycycline and omalizumab 3. Levofloxacin and adriamycin 4. Moxifloxacin and gemifloxacin

Answer 39

**4.** Moxifloxacin and gemifloxacin ## Footnote Moxifloxacin and gemifloxacin are more potent against S. pneumoniae.

Question 40

The nurse practitioner understands chronic cough is a multifactorial symptom and may require: 1. Antitussive treatment. 2. Prednisone 40 mg once daily for 5 days to reduce the inflammatory response from cough. 3. Referral to allergy and asthma, pulmonology, and/or gastrointestinal specialists. 4. ACE-I.

Answer 40

**3.** Referral to allergy and asthma, pulmonology, and/or gastrointestinal specialists. ## Footnote Causes of chronic cough include post-nasal drip, GERD, and other issues. Referral for evaluation may be needed to further evaluate the patient and reduce/eliminate the cough.

Question 41

The United States Preventative Services Task Force (USPSTF) recommends annual screening for lung cancer. Which of the following is NOT recommended? 1. Low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history 2. Screen all persons that are current smokers or who have quit within the past 15 years. 3. Screening should be discontinued once a person has not smoked for 5 years. 4. Patients who develop a health problem that substantially limits life expectancy

Answer 41

**3.** Screening should be discontinued once a person has not smoked for 5 years. ## Footnote According to the United States Preventative Services Task Force, annual screening for lung cancer is recommended using low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history, currently smoke or have quit within the past 15 years, and patients who develop a health problem that substantially limits life expectancy.

Question 42

The FNP understands N2 is defined as: 1. Metastasis in ipsilateral peribronchial and/or ipsilateral hilar nodes and intrapulmonary nodes, including involvement by extension. 2. Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene node, or supraclavicular node. 3. Distant metastasis. 4. Metastasis in ipsilateral mediastinal and/or subcarinal node.

Answer 42

**4.** Metastasis in ipsilateral mediastinal and/or subcarinal node. ## Footnote According to the American Joint Committee on Cancer, N2 is classified as metastasis in ipsilateral, mediastinal, and/or subcarinal lymph node(s); NX Regional lymph nodes cannot be assessed; N0 no regional lymph node metastases; N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension; N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s).

Question 43

IgE is the antibody responsible for activation of allergic reactions and is: 1. Important to the development and persistence of inflammation. 2. A critical component of lung function. 3. Important for selecting inhaled corticosteroid dosages. 4. A tool for determining airway remodeling.

Answer 43

**1.** Important to the development and persistence of inflammation. ## Footnote When IgE receptors are activated with an antigen, they release mediators that initiate acute bronchospasms and release pro-inflamatory cytokines affecting underlying airway inflammation.

Question 44

Measurements of fractional exhaled NO (FeNO) are: 1. Useful for monitoring responses to asthma treatment because of the association between FeNO and the presence of inflammation in asthma. 2. Identified as a pathogenesis of allergic diseases. 3. Responsible for activation of allergic reactions. 4. Important in promoting Th1 cytokines to avoid asthma exacerbations.

Answer 44

**1.** Useful for monitoring responses to asthma treatment because of the association between FeNO and the presence of inflammation in asthma. ## Footnote Measurements of fractional exhaled NO (FeNO) is very useful for monitoring the response to asthma treatment because of the association between FeNO and the presence of inflammation in asthma. Many insurance companies pay for this tool, which is helpful in evaluating the current treatment regimen, response to treatment over a period of time, and possibly adherence.

Question 45

In patients with asthma, the nurse practitioner understands that: 1. Beta-blockers can cause increased bronchial obstruction, airway reactivity, and resistance to the effects of inhaler or oral beta receptor agonists. 2. Topical ophthalmic administration of nonselective beta-blockers are in patients with COPD and not asthma. 3. Pulmonary function tests must be performed every 3 to 4 weeks for patients with asthma who are prescribed a beta-blocker. 4. Significant respiratory symptoms occur only in patients with moderate and severe persistent asthma who are prescribed a beta-blocker.

Answer 45

**1.** Beta-blockers can cause increased bronchial obstruction, airway reactivity, and resistance to the effects of inhaler or oral beta receptor agonists. ## Footnote Beta-blockers can cause increased bronchial obstruction, airway reactivity, and resistance to the effects of inhaled or oral beta receptor agonists in patients with asthma. Topical ophthalmic administration of nonselective beta-blockers for the treatment of glaucoma can lead to exacerbated asthma but not exacerbated COPD. Pulmonary function testing is not indicated every 3 to 4 weeks in patients taking beta-blockers. Adverse reactions can occur in intermittent asthma, mild persistent, moderate persistent asthma, and severe persistent asthma.

Question 46

Patients with chronic bronchitis tend to have complications of which of the following? 1. Chronic hypoxemia and hypocapnia 2. Peripheral edema from cor pulmonale 3. Ocular swelling and post–nasal drainage 4. Muscle wasting and chronic, productive cough with large amounts of sputum

Answer 46

**2.** Peripheral edema from cor pulmonale ## Footnote Patients with chronic bronchitis may be obese, cough frequently and expectoration are typical, accesory muscles of repiration is common. These patients usually have signs of right heart failure, such as edema and cyanosis.

Question 47

Ausculatory findings characterized as low-pitched, loud, generally heard on inspiration, and often cleared with cough is known as what? 1. Wheezing 2. Crackles 3. Vesicular 4. Rhonchi

Answer 47

**4.** Rhonchi ## Footnote Rhonchi is described as low-pitched and loud, generally heard on inspiration, and often cleared with cough. It is important to ask the patient to cough and then repeat auscultation of the lungs.

Question 48

The therapeutic action of ipratropium bromide is: 1. Activation of β1 receptors that degrades cycle monophosphate. 2. the bronchodilatory effect due to activation of β1 receptors. 3. inducing positive inotropic, chronotropic output of the cardiac muscle. 4. that it promotes the degradation of cyclic guanosine monophosphate and the activation of beta2-adrenergic receptors on airway smooth muscle.

Answer 48

**4.** that it promotes the degradation of cyclic guanosine monophosphate and the activation of beta2-adrenergic receptors on airway smooth muscle. ## Footnote Ipratropium bromide promotes the degradation of cyclic guanosine monophosphate and activation of beta2-adrenergic receptors on airway smooth muscle.

Question 49

Systemic manifestations of comorbid diseases have a significant influence on the management of asthma. The FNP understands comorbidities should be considered, especially with uncontrolled asthma, and that it includes all except which of the following? 1. Gastroesophageal reflux disease 2. Diabetes mellitus 3. Allergic rhinitis 4. Vocal cord dysfunction

Answer 49

**4.** Vocal cord dysfunction ## Footnote Several comorbidities of asthma include gastroesophageal reflux disease, diabetes mellitus, and allergic rhinitis. Vocal cord dysfunction can mimic asthma.