Book: Adult-Gerontology Acute Care Nurse Practitioner Certification Review: Pulmonology with 100% correct answers + rationales 2026
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1. A 56-year-old white female patient presents to the intensive care unit with some respiratory distress following an elective total hysterectomy. Before the procedure she was in good overall health. The patient received cefotetan 1 g intravenous × 1 dose before her surgery. She had issues during surgery with her respiratory status and required mechanical ventilation at that time. The patient has been on a ventilator for 3 days and the staff now notices increased sputum production, decreased pulmonary function, elevated temperature, and elevated white blood cell count. A chest radiograph was ordered and shows significant left lower lobe infiltrates. She has been diagnosed with health care-associated pneumonia to be treated in the intensive care unit. Which of the following drug regimens would be appropriate for empiric therapy if you determine that she is at risk for multidrug-resistant pathogens?
1. Cefepime (Maxipi
Answer: 1. Cefepime (Maxipime) + Levofloxacin (Levaquin) + Vancomycin.
Rationale: When empiric treatment that includes coverage for methicillin-sensitive Staphylococcus aureus (and not methicillin-resistant S. aureus [MRSA]) is indicated, the guidelines suggest a regimen, including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. If empiric coverage for MRSA is indicated, either vancomycin or linezolid is recommended.1. Cefepime (Maxipime) + levofloxacin (Levaquin) + vancomycin.1. Cefepime (Maxipime) + levofloxacin (Levaquin) + vancomycin.1. Cefepime (Maxipime) + levofloxacin (Levaquin) + vancomycin.
17. How could total lung capacity be described?
1. Forced expiratory volume.
2. Forced vital capacity.
3. Volume of air in the lungs at end of inspiration.
4. Volume of air in the lungs at end of exhalation.
Answer: 3. Volume of air in the lungs at end of inspiration
Rationale: Total lung capacity is the volume of air in the lungs at the end of inspiration.
2. A patient was properly cultured and was found to be growing methicillin-resistant Staphylococcus aureus (MRSA) in the sputum. Which of the following medications would best treat this organism?
1. Amikacin.
2. Gentamicin (Garamycin).
3. Linezolid (Zyvox).
4. Levofloxacin (Levaquin).
Answer: 3. Linezolic (Zyvox)
Rationale: In an effort to minimize patient harm and exposure to unnecessary antibiotics and reduce the development of antibiotic resistance, the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) guidelines recommend that the antibiogram data be used to decrease the unnecessary use of dual gram-negative and empiric methicillin-resistant Staphylococcus aureus (MRSA) antibiotic treatment. If empiric coverage for MRSA is indicated, either vancomycin or linezolid is recommended.
3. Which of the following regimens would be appropriate empiric therapy for a patient with community-acquired pneumonia (CAP) that requires admission to the intensive care unit?
1. Azithromycin (Zithromax) intravenously (IV).
2. Azithromycin IV + ceftriaxone (Rocephin) IV.
3. Azithromycin oral + amoxicillin/clavulanate (Augmentin) oral.
4. Levofloxacin (Levaquin) oral.
Answer: 2. Azithromycin IV + ceftriaxone (Rocephin) IV.
Rationale: Typical bacterial pathogens causing community-acquired pneumonia (CAP) include streptococcal pneumonia (penicillin-sensitive/resistant strains), Haemophilus influenza (ampicillin-sensitive/resistant strains), and Moraxella catarrhalis (all strains penicillin-resistant) and account for about 85% of CAP cases. Aspiration pneumonia is the only form of CAP caused by multiple pathogens (e.g., aerobic/anaerobic oral organisms). Klebsiella pneumoniae CAP occurs primarily in individuals with chronic alcoholism, and Staphylococcus aureus may cause CAP in influenza patients. Pseudomonas aeruginosa is a cause of CAP in patients with bronchiectasis or cystic fibrosis. Empiric therapy for a hospitalized intensive care patient is azithromycin intravenously (IV) + ceftriaxone (Rocephin) IV.
4. You are working in the walk-in clinic today and your first patient is a 62-year-old male patient with chronic diabetes mellitus, hypertension, and hyperlipidemia. He was recently on some antibiotics for a tooth infection this last month. He presents with a mild case of community-acquired pneumonia, and you determine that he is a good candidate for outpatient therapy. Which antibiotics choice would be the most appropriate on which to send him home?
1. A macrolide alone.
2. Doxycycline alone.
3. Fluoroquinolone alone.
4. β-lactam plus a fluoroquinolone.
Answer: 3. Fluoroquinolone alone.
Rationale: If there are comorbidities present (e.g., alcoholism, bronchiectasis/cystic fibrosis, chronic obstructive pulmonary disease, intravenous (IV) drug user, post influenza, asplenia, diabetes mellitus, lung/liver/renal diseases) then use levofloxacin 750 mg by mouth (PO) every 24 hours or moxifloxacin 400 mg PO every 24 hours or a combination of a β-lactam (amoxicillin 1 g PO every 8 hours or amoxicillin-clavulanate 2 g PO every 12 hours or ceftriaxone 1 g IV/intramuscularly every 24 hours or cefuroxime 500 mg PO twice daily) plus a macrolide (azithromycin or clarithromycin).
5. KS had a complicated intensive care unit (ICU) stay. He developed heparin-induced thrombocytopenia, resulting in a pulmonary embolus. He was unable to be extubated. He remains on the ventilator. It is day 8 of his ICU stay. Today you note that he has developed fever and decreasing oxygen saturation. Chest x-ray reveals a right lower lobe infiltrate with a small effusion. What would be the empiric treatment?
1. Cefepime 2 g intravenously (IV) every 12 hours, doxycycline 100 mg twice a day, Zyvox 600 mg twice a day.
2. Azactam 2 g IV every 8 hours and tobramycin 7 mg/kg every 24 hours, vancomycin 1 g every 12 hours.
3. Rocephin 2 g IV every 24 hours, Zithromax 500 mg IV every 24 hours.
4. Tobramycin 7 mg/kg every 24 hours, daptomycin 6 mg/kg every 24 hours.
Answer: 2. Azactam 2 g IV every 8 hours and tobramycin 7 mg/kg every 24 hours, vancomycin 1 g every 12 hours.
Rationale: This patient has ventilator-associated pneumonia and the patient has been in the hospital for several days, so an infection with multidrug-resistant organisms is a possibility. For that reason, Azactam 2 g intravenously every 8 hours and tobramycin 7 mg/kg every 24 hours, and vancomycin 1 g every 12 hours is the best answer.
6. You also sent a sputum culture for this patient. Your results are Acinetobacter baumannii, which is resistant to Primaxin and Zosyn, and intermediate to tobramycin and minocycline. What would be an appropriate antibiotic regimen for this, including the appropriate length of treatment?
1. Continue Azactam and tobramycin for 14 days.
2. Change vancomycin to linezolid.
3. Change tobramycin to amikacin for 14 days.
4. Minocycline with Colistin for 14 days.
Answer: 4. Minocycline with Colistin for 14 days.
Rationale: Extensively drug-resistant Acinetobacter baumannii should be treated with minocycline with Colistin for 14 days based on antibiograms.
7. A 52-year-old white male patient presenting to the emergency department with shortness of breath. He claims that he has felt a little short of breath over the last few days, but today it became extremely difficult to breathe and he generally feels bloated and uncomfortable. He has had difficulty trying to button his pants, tie his shoes, and noted a 15-lb weight gain over the last week or so. His blood pressure is 138/92 with a heart rate of 98 beats/min. His past medical history includes idiopathic heart failure. His current medications are enalapril, furosemide, digoxin, and carvedilol. Which of the following should be added to his regimen?
1. Bumetanide.
2. Metoprolol XL.
3. Sotalol.
4. Spironolactone.
Answer: 4. Spironolactone
Rationale: Aldactone can be used for congestive heart failure for the management of edema and sodium retention when the patient is only partially responsive to, or is intolerant of, other therapeutic measures. Aldactone is also indicated for patients with congestive heart failure taking digitalis when other therapies are considered inappropriate.
8. A 71-year-old male patient comes to the clinic 2 months ahead of his scheduled appointment with concerns of increasing shortness of breath, which first started a month ago. The shortness of breath appears to have coincided with daily walks with his granddaughter. He has noticed a nonproductive cough but no other associated symptoms. His past medical history includes chronic obstructive pulmonary disease, benign prostatic hypertrophy, and hypertension. He has a 50 pack-year smoking history and continues to smoke his pipe daily. He also admits to two to three beers daily. His current medications are Flomax 0.4 mg daily; Spiriva1 8 mcg, one inhalation daily; and Norvasc 5 mg daily. The patient should have been counseled on which of the following when started on Spiriva?
1. Not to swallow the capsule.
2. A side effect can be a brown coating on the tongue.
3. To call the office if he develops symptoms of depression.
Answer: 1. Do not swallow the capsule.
Rationale: Do not swallow Spiriva capsules. Spiriva capsules should only be used with the Spiriva Handihaler device and inhaled through your mouth (oral inhalation).
9. A 71-year-old male comes to the clinic with complaints of worsening shortness of breath after adding Spiriva to his medication regimen. He has noticed a nonproductive cough but no other associated symptoms. His past medical history includes chronic obstructive pulmonary disease, benign prostatic hypertrophy, and hypertension. He has a 50 pack-year smoking history and continues to smoke his pipe daily. He also admits to two to three beers daily. His current medications are Flomax 0.4 mg daily; Spiriva1 8 mcg, one inhalation daily; and Norvasc 5 mg daily. What medication change should the nurse practitioner make to the patient's therapy?
1. Increase Spiriva dose to 36 mcg daily.
2. Increase Flomax to 2 tablets daily.
3. Add Combivent 2 puffs 4 times a day.
4. Add an albuterol inhaler.
Answer: 4. Add an albuterol inhaler
Rationale: Inhaled short-acting β2 agonists are effective in treating a person whose symptoms are rapidly getting worse (chronic obstructive pulmonary disease [COPD] exacerbation) and improving lung function and shortness of breath in stable COPD.
10. A patient picks up several over-the-counter products when he picks up his prescriptions. Which one of these is cause for concern for patients with chronic obstructive pulmonary disease?
1. Acetaminophen.
2. Multivitamin with iron and zinc.
3. Robitussin DM.
4. Tums.
Answer: 3. Robitussin DM.
Rationale: Robitussin DM is used as an expectorant and will not help these symptoms.
11. A patient who weighs 70 kg is intubated after a motor vehicle accident. He has the following arterial blood gas: pH 7.20, Paco2 60 mmHg, Pao2 89 mmHg, and HCO3 22 mEq/L. The ventilator settings are tidal volume 650 ml, synchronized intermittent mandatory ventilation (SIMV) rate 12, and fraction of inspired oxygen of 0.50. What adjustment needs to be made to the ventilator settings?
1. Administer 1 ampule of NaHCO3 intravenously.
2. Increase the tidal volume.
3. Increase the SIMV rate.
4. Increase the Fio2.
Answer: 1. Administer 1 ampule of NaHCO3 intravenously.
Rationale: The patient is acidotic, so a buffering agent needs to be administered, such as 1 ampule of NaHCO3 intravenously.
12. Which of the following conditions can cause acute hypoxic respiratory failure?
1. Pneumonia.
2. Chronic obstructive pulmonary disease.
3. Congestive heart failure.
4. Obstructive sleep apnea.
Answer: 1. Pneumonia
Rationale: Acute respiratory distress syndrome, characterized by hypoxemic respiratory failure, is associated with a mortality of 30% to 50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation, necessitating intensive care unit admission. The most common precipitant is community-acquired bacterial pneumonia.
13. Alveolar edema can be classified as high-pressure pulmonary edema, low-pressure pulmonary edema, and:
1. Psychogenic pulmonary edema.
2. Neurological pulmonary edema.
3. Adnexa pulmonary edema.
4. High-altitude pulmonary edema.
Answer: 4. High-Altitude Pulmonary Edema
Rationale: High-altitude pulmonary edema, which can be seen with quick assent or descent from high altitudes.
14. High-pressure pulmonary edema can be seen in which diagnosis?
1. Acute respiratory distress syndrome.
2. Inhaling toxic chemicals such as terbutaline.
3. Congestive heart failure.
4. Acute lung injury.
Answer: 3. CHF
Rationale: Congestive heart failure is considered high-pressure pulmonary edema caused by fluid backup.
15. Interpret the following arterial blood gas: Po2 = 45 mmHg, Pco2 = 30 mmHg, HCO3 = 24 mEq/L, and pH is 7.47.
1. Acute respiratory alkalosis.
2. Acute respiratory acidosis.
3. Acute metabolic acidosis.
4. Acute metabolic alkalosis.
15. Answer: 1, Acute Respiratory Alkalosis
Rationale: The slight elevation in Po2 indicates a shunt and the most likely cause is hypoxemia, so this exhibits acute respiratory alkalosis.
16. The classic triad of asthma includes wheezing, dyspnea, and what?
1. Pallor.
2. Cough.
3. Airway hyporesponsiveness.
4. Rash.
Answer: 2. Cough
Rationale: The classic asthma triad is cough, wheezing, and dyspnea.
18. How can the work of breathing be described?
1. Amount of effort needed to inhale and exhale.
2. Tendency of the lungs to return to their original shape.
3. How easy the lungs can inhale and exhale.
4. Stimulation of the chemoreceptors in the brain stem.
Answer: 1. Amount of effort needed to inhale and exhale.
Rationale: The work of breathing is the amount of effort needed to inhale and exhale.
19. In respiratory acidosis, what is the goal?
1. Increase the Pco2.
2. Decrease the Pco2.
3. Increase the Po2.
4. Decrease the Po2.
Answer: 2. Decrease the PCO2
Rationale: The goal of respirator acidosis is to improve alveolar ventilation and increase minute ventilation. This can be done by decreasing the Pco2.
20. In a ventilated patient, peak inspiratory pressures may be seen in what circumstance?
1. Decreased airway resistance.
2. Increased Po2.
3. Metabolic acidosis.
4. Worsening airspace disease.
Answer: 4 worsening airspace disease
Rationale: It is a worsening airspace disease, such as acute respiratory distress syndrome or pneumonia.
21. What allows oxygen to be transported in the blood?
1. Hematocrit.
2. Lymphocytes.
3. Hemoglobin.
4. White blood cells.
Answer: Hemoglobin
Rationale: Hemoglobin allows for blood transport of oxygen.
22. What is an example of an airway disease that is restrictive in the extraparenchymal tissue?
1. Cystic fibrosis.
2. Myasthenia gravis.
3. Sarcoidosis.
4. Asthma.
Answer: 2. MG
Rationale: Myasthenia gravis impacts the extraparenchymal tissue.
23. Pulmonary vasculature requires measuring the pulmonary vascular resistance (PVR). The PVR will rise because of what condition?
1. Metabolic alkalosis.
2. Sarcoidosis.
3. Running a 5K.
4. Intraluminal thrombi.
Answer: 4. Intraluminal thrombi
Rationale: Intraluminal thrombi are caused by diminished cross-sectional area from obstruction.
24. What can pulmonary hypertension be caused by?
1. Ankylosing spondylitis.
2. Pneumonia.
3. Interstitial lung disease.
4. 25 pack-year history of smoking.
Answer: 3. Insterstitial lung disease
Rationale: Interstitial lung disease is caused by chronic prolonged hypoxemia.
25. What does the alveolar to arterial gradient measure?
1. The difference between the pH in the alveoli and the pH in the arteries.
2. The difference between the tidal volume in the alveoli and the tidal volume in the arteries.
3. The difference between the partial pressure of carbon dioxide in the alveoli and the arterial partial pressure of carbon dioxide.
4. The difference between the partial pressure of oxygen in the alveoli and the arterial partial pressure of oxygen.
Answer: 4. The difference between the partial pressure of oxygen in the alveoli and the arterial partial pressure of oxygen.
Rationale: The alveolar to arterial gradient measures the difference between the partial pressure of oxygen in the alveoli and the arterial partial pressure of oxygen.
26. What does the diffusion capacity of the lungs for carbon monoxide measure?
1. How much oxygen travels from the blood stream to the alveoli.
2. How much oxygen travels from the alveoli to the blood stream.
3. How much carbon monoxide travels from the blood stream to the alveoli.
4. How much carbon monoxide travels from the alveoli to the blood stream.
Answer: 2. How much oxygen travels from the alveoli to the blood stream.
Rationale: Diffusing capacity of the lungs for carbon monoxide is a medical test that determines how much oxygen travels from the alveoli of the lungs to the blood stream.
27. What is the gold standard used to measure obstructive airway disease?
1. Forced expiratory volume in 1 second.
2. Forced vital capacity.
3. Total lung capacity.
4. Forced expiratory capacity.
Answer: 1. Forced expiratory volume in 1 second.
Rationale: Forced expiratory volume in 1 second is the gold standard for measuring obstructive airway disease.
28. Short-acting β2 agonists are often used in asthma treatment because they focus on which of the following?
1. Increasing forced vital capacity.
2. Increasing total lung capacity.
3. Prohibiting airway inflammation.
4. Relaxing airway smooth muscles.
Answer: 4. Relaxing airway smooth muscles.
Rationale: short-acting β2 agonists work by relaxing airway smooth muscles.
29. What is a common side effect of β2 agonists?
1. Muscle tremors.
2. Dry mouth.
3. Headache.
4. Somnolence.
Answer: 1. Muscle tremors
Rationale: Muscle tremors and palpitations are a common side effect of β2 agonists.
30. Kaden, a 23-year-old male patient, is having an asthma exacerbation. The nurse practitioner would prescribe which of the following medications?
1. Long-acting β2 agonist, metered-dose inhaler, 1 puff twice a day.
2. Short-acting β2 agonist, metered-dose inhaler, 4 to 8 puffs every 20 minutes up to 4 hours.
3. Tapering dose of oral prednisone starting with 10 mg a day and tapering over 1 week.
4. Leukotriene modifier, 1 tablet by mouth daily.
Answer: 2. Short-acting β2 agonist, metered-dose inhaler, 4 to 8 puffs every 20 minutes up to 4 hours.
Rationale: The Global Initiative for Asthma recommends a short-acting β2 agonist, metered-dose inhaler, 4 to 8 puffs every 20 minutes up to 4 hours for mild asthma
31. Jennifer, a 35-year-old female patient, has moderate persistent asthma. The mainstays of treatment require the nurse practitioner to prescribe which of the following?
1. Long-acting β2 agonists (LABAs) and high-dose inhaled corticosteroid and an oral corticosteroid.
2. LABAs and high-dose inhaled corticosteroid.
3. LABAs and low-dose inhaled corticosteroid.
4. Low-dose corticosteroid.
Answer: 3. LABAs and low-dose inhaled corticosteroid.Rationale: Using a stepwise approach, the nurse practitioner would prescribe a long-acting β2 agonist and low-dose inhaled corticosteroid.
32. What is the most common cause of community-acquired pneumonia in adults?
1. Chlamydia pneumoniae.
2. Respiratory syncytial virus.
3. Streptococcus pneumoniae.
4. Aspiration pneumonia.
Answer: 3. Streptococcus pneumoniae.
Rationale: Community-acquired pneumonia (CAP) is one of the most common acute infections requiring admission to the hospital. The main causative pathogens of CAP are Streptococcus pneumoniae, influenza A, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, and the dominant risk factors are age, smoking, and comorbidities.
33. The nurse practitioner is evaluating a patient who complains of a cough for the last several months. He denies fever or shortness of breath. He has worked as an interior house painter for the last 20 years. What test would be ordered first to aid in diagnosis?
1. Arterial blood gas.
2. Chest x-ray.
3. Pulmonary function test.
4. Pulse oximetry.
Answer: 2. A CXR
Rationale: House painters are at risk for asbestosis, silicosis, and alveolitis. A chest x-ray would be the first test to order for this patient because of its specificity.
34. The nurse practitioner has diagnosed John with asbestosis. What would the patient education include?
1. Moving to a dry environment.
2. Using supplemental oxygen.
3. Weight loss.
4. Smoking cessation.
Answer: 4. Smoking cessation
Rationale: In the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED II) study, 94% of patients with pulmonary embolism had one or more of the following risk factors: immobilization, trauma, or surgery. There is no specific treatment for asbestosis, but smoking cessation will prevent further lung damage.
35. Which of the following is not a risk factor for a pulmonary embolism?
1. Recent surgery.
2. Trauma.
3. Coronary artery disease.
4. Immobilization.
Answer: 3. CAD
Rationale: While there are many risk factors for a pulmonary embolism, coronary artery disease is not a risk factor.
36. Which of the following is not part of the Virchow triad?
1. Factor V Leiden.
2. Venous stasis.
3. Endothelial injury.
4. Hypercoagulable state.
Answer: 1. Factor V Leiden.
Rationale: Factor V Leiden is not part of the Virchow triad, which consists of three factors that may predispose a person to the development of venous thrombosis. These factors include hypercoagulability, stasis, and endothelial injury.
37. Most emboli that cause a pulmonary embolus are thought to arise from what vein?
1. Pulmonary.
2. Popliteal.
3. Brachial.
4. Iliac.
Answer: 2. Popliteal
Rationale: Most emboli that cause a pulmonary embolus (PE) arise from veins in the lower extremities. A PE is present in 60% to 80% of patients with deep vein thrombosis, even though more than half of these patients are asymptomatic.
38. What causes the impaired gas exchange that results from a pulmonary embolus?
1. Altered alveolar to arterial gradient.
2. Altered pulmonary recoil.
3. Altered ventilation to perfusion ratio.
4. Altered pulmonary elasticity.
Answer: 3. Altered ventilation to perfusion ratio.
Rationale: In an altered ventilation to perfusion ratio, a low pressure of oxygen in venous blood also may contribute to arterial hypoxemia when PE causes right ventricular failure. Low cardiac output leads to increased extraction of oxygen in the tissues, decreasing the partial pressure of oxygen in venous blood below normal levels. Venous blood with an abnormally low Po2 amplifies the effect of a low ventilation to perfusion ratio when it passes through diseased lung gas-exchange units to the systemic circulation.
39. What causes hypotension due to a pulmonary embolus?
1. Increased right ventricular outflow.
2. High venous outflow from the inferior vena cava.
3. Decreased pulmonary vascular resistance.
4. Increased pulmonary vascular resistance.
Answer: 4. Increased pulmonary vascular resistance.
Rationale: Increased pulmonary vascular resistance decreases right ventricular outflow and causes right ventricular dilation and flattening or bowing of the intraventricular septum. Both diminished flow from the right ventricle and right ventricular dilation reduce left ventricular preload, compromising cardiac output.
40. The nurse practitioner is seeing a 40-year-old hemodynamically stable patient in the emergency department with a suspected pulmonary embolus (PE). What does treatment of a PE include?
1. Low-molecular-weight heparin.
2. Oxygen.
3. Inferior vena cava filter.
4. Admission to the hospital
Answer: 1. Low-molecular-weight heparin
Rationale: Treatment options for the initial-phase management of a pulmonary embolism include thrombolytics, parenteral anticoagulants, oral anticoagulants, and nonpharmacological interventions. Because this patient is hemodynamically stable, low-molecular-weight heparin is the best option.
41. According to the Global Initiative for Obstructive Lung Disease (GOLD) criteria, how would a patient with an forced expiratory volume in 1 second (FEV1)/forced vital capacity less than 0.7 and FEV1 less than 30% predicted, be classified?
1. GOLD stage I.
2. GOLD stage II.
3. GOLD stage III.
4. GOLD stage IV.
Answer: 3. GOLD stage III
Rationale: In pulmonary function testing, a postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of less than 0.70 is commonly considered diagnostic for chronic obstructive pulmonary disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) system categorizes airflow limitation into stages. In patients with an FEV1/FVC ratio of less than 0.70, GOLD 3 or severe, FEV1 is less than or equal to 30% of normal value and less than 50% of predicted value.
42. Which of the following criteria suggests a diagnosis of chronic bronchitis?
1. Chronic productive cough for 3 months per year for the last 2 years.
2. Dyspnea that has gotten progressively worse over the last 3 months.
3. Being diagnosed with acute bronchitis more than twice in a 12-month period.
4. Having pneumonia that required hospitalization.
Answer: 1. Chronic productive cough for 3 months per year for the last 2 years.
Rationale: Chronic bronchitis is a clinical diagnosis characterized by a cough productive of sputum for over 3 months' duration during 2 consecutive years and the presence of airflow obstruction. Pulmonary function testing aids in the diagnosis of chronic bronchitis by documenting the extent of reversibility of airflow obstruction.
43. The nurse practitioner is reviewing the chest x-ray of a patient with chronic obstructive pulmonary disease. Which of the findings would not be expected?
1. Hyperinflation of lungs.
2. Pulmonary hypertension.
3. Consolidation in one lung lobe.
4. Flattened diaphragm.
Answer: 3. Consolidation in one lung lobe
Rationale: Although a chest x-ray may not show chronic obstructive pulmonary disease (COPD) until it is severe, the images may show enlarged lungs, air pockets (bullae), or a flattened diaphragm. A chest x-ray also may be used to determine whether another condition may be causing symptoms similar to COPD. Consolidation in one lung lobe suggests an infectious process.
44. Which of the following pulmonary function test findings is not expected in a patient with emphysema?
1. Increased total lung capacity.
2. Increased residual volume.
3. Decreased total lung capacity.
4. Decreased residual volume.
Answer: 2. Increased residual volume.
Rationale: Patients with emphysema have hyperinflated lungs, which can cause increased total lung capacity, but because of decreased recoil the lung can have a decreased capacity. The air gets trapped; thus an increased residual volume would not be expected on pulmonary function testing.
45. The nurse practitioner (NP) is examining Mrs. Jones, a 69-year-old female patient in the intensive care unit for exacerbation of her emphysema. Mrs. Jones is usually very pleasant and talkative. However, today she tells the NP to "get away from her" and then she starts yelling for the police because the NP is "trying to kill me!" The NP notes the change in mental status of Mrs. Jones. What is the next most likely order?
1. Restraints.
2. Arterial blood gas.
3. Pulse oximetry.
4. Intravenous fluids.
Answer: 2. ABG's
Rationale: This patient probably has an acid-base disorder causing her mental status change, and this needs to be evaluated.
46. Which of the following is not part of the criteria for diagnosing acute respiratory distress syndrome?
1. Respiratory symptoms must have begun within 1 week of a known clinical insult.
2. Bilateral opacities must be present on a chest radiograph or computed tomography scan.
3. The patient must be on mechanical ventilation with an Fio2 of at least 0.6 or greater.
4. The patient's respiratory failure must not be fully explained by cardiac failure or fluid overload.
Answer: 3. The patient must be on mechanical ventilation with an Fio2 of at least 0.6 or greater.
Rationale: The patient must be on mechanical ventilation with an Fio2 of at least 0.6 or greater. There is no Fio2 requirement for acute respiratory distress syndrome.
47. The nurse practitioner suspects a patient has acute respiratory distress syndrome. Which diagnostic test should the NP order to confirm or deny this diagnosis?
1. Computed tomography scan of the chest.
2. Chest nuclear medicine study.
3. Pulmonary function test.
4. Chest x-ray.
Answer: 4. A CXR
Rationale: Chest radiograph findings of acute respiratory distress syndrome vary widely depending on the stage of the disease. The most common chest radiograph findings are bilateral, predominantly peripheral, somewhat asymmetrical consolidation with air bronchograms.
48. Which complication is a cause of morbidity and mortality in a patient with acute respiratory distress syndrome?
1. Nosocomial infections.
2. Delirium.
3. Poor nutrition.
4. Myopathies.
Answer: 1. Nosocomial infections.
Rationale: Nosocomial infections, such as ventilator-associated pneumonia, catheter-related infections, or Clostridium difficile, can cause morbidity and mortality in a patient with acute respiratory distress syndrome.
49. The release of which cytokines causes acute respiratory distress syndrome?
1. Cardiotrophin.
2. Tumor necrosis factor.
3. Adiponectin.
4. Apolipoprotein.
Answer: 2. Tumor necrosis syndrome
Rationale: The release of tumor necrosis factor, which goes on to recruit neutrophils to the lungs, which release toxins, causes acute respiratory distress syndrome.
50. What are the three pathological stages that acute respiratory distress syndrome goes through?
1. Reactive stage, proliferative stage, and exudative stage.
2. Injury stage, proliferative stage, and reactive stage.
3. Proliferative stage, the fibrotic stage, and the injury stage.
4. Exudative stage, proliferative stage, and fibrotic stage.
Answer: 4. Exudative stage, proliferative stage, and fibrotic stage.
Rationale: Histopathologically, three phases are recognized during the evolution of acute respiratory distress syndrome: (1) an exudative early phase, which results from diffuse alveolar damage and endothelial injury; (2) a proliferative phase, which ensues about 7 to 14 days after the injury, incorporating repair of the damaged alveolar structure and reestablishment of the barrier function, together with proliferation of fibroblasts; and (3) a fibrotic phase with chronic inflammation and fibrosis of the alveoli, which follows in some patients.
51. What predisposing diagnosis is the most common cause of acute respiratory distress syndrome?
1. Chronic obstructive pulmonary disease.
2. Sepsis.
3. Pneumonia.
4. Transfusion-related acute lung injury.
Answer: 2. Sepsis
Rationale: Sepsis-induced acute respiratory distress syndrome (ARDS) is often caused by indirect injury to the lung. However, pneumonia can directly injure the lung leading to ARDS and can cause sepsis. Pathway sepsis is more likely to work indirectly because this pathway of injury has been shown to be caused by inflammatory mediators. These mediators cause systemic endothelial damage, causing the lung damage that precedes ARDS.
52. Which patient type is at an increased risk of death from acute respiratory distress syndrome?
1. A 20-year-old male patient who was in a motor vehicle accident.
2. A 39-year-old female patient who is pregnant and had an emergency cesarian section.
3. A 60-year-old male patient who has worked in a factory producing weed killer for the last 20 years.
4. An 80-year-old female patient who smoked in her early 20s but has not smoked since.
Answer: 4. An 80-year-old female patient who smoked in her early 20s but has not smoked since.
Rationale: An 80-year-old female patient who smoked in her early 20s but has not smoked since is at an increased risk of death from acute respiratory distress syndrome. Older patients have a 41% higher mortality rate.
53. The nurse practitioner is seeing JR, a 50-year-old male patient, today in the clinic. He was released from the hospital a month ago after being intubated for 6 days for acute respiratory distress syndrome. He asks, "When will my lungs be completely healed from this?" What is the correct answer?
1. Lung function can be compromised for as long as 5 years.
2. Lung function can be compromised for as long as 3 years.
3. Lung function can be compromised for as long as 12 months
Answer: 1. Lung function can be compromised for as long as 5 years.
Rationale: Patients who survived acute respiratory distress syndrome had persistent exercise limitations and a reduced physical quality of life 5 years after their critical illness.
54. Why are sedatives and analgesic medications used in patients with acute respiratory distress syndrome?
1. Decrease the need for restraints.
2. Maximize oxygen consumption.
3. Increase energy expenditure.
4. Decrease the incidence of intensive care unit psychosis.
Answer: 2. Maximize O2 consumption.
Rationale: Maximize oxygen consumption by improving tolerance of mechanical ventilation.
55. What should the initial ventilator settings for a patient with acute respiratory distress syndrome begin with?
1. Low tidal volume ventilation.
2. Synchronous intermittent mandatory ventilation.
3. Pressure controlled ventilation.
4. Pressure support ventilation.
55. Answer: 1
Rationale: The initial ventilator settings for a patient with acute respiratory distress syndrome begin with low tidal volume ventilation, which is also known as lung protective ventilation, 4 to 8 mL/kg predicted body weight.
56. Which of the following is a risk factor for transfusion-related acute lung injury (TRALI)?
1. History of diabetes.
2. History of obesity.
3. History of hypertension.
4. There are no risk factors for TRALI.
56. Answer: 4
Rationale: There are no risk factors for transfusion-related acute lung injury. Risk factors are associated with pretransfusion issues such as sepsis, cancer, or patients who had received multiple transfusions.
57. Which component is involved in the pathogenesis of transfusion-related acute lung injury?
1. Eosinophils.
2. Neutrophils.
3. Lymphocytes.
4. Monocytes.
57. Answer: 2
Rationale: Polymorphonuclear leukocytes (PMNs) are generally considered to be key effector cells in transfusion-related acute lung injury (TRALI). Pulmonary PMN infiltration has been described to occur in multiple animal models of TRALI. Additionally, the abundance of PMNs has been observed in the pulmonary tissue of TRALI patients on autopsy. PMNs are major producers of reactive oxygen species (ROS), and ROS production has been suggested to damage the endothelium in murine antibody-mediated TRALI models and in human pulmonary microvascular endothelial cells in vitro.
58. Transfusion-related acute lung injury presents with a sudden onset of hypoxemia during or shortly after receiving a blood product. Which of the following symptoms will most likely not be present?
1. Fever.
2. Mental status change.
3. Hypotension.
4. Cyanosis.
58. Answer: 2
Rationale: The diagnostic features of transfusion-related acute lung injury (TRALI), as follows: onset within 1 to 6 hours of transfusion, are acute respiratory distress, acute bilateral pulmonary edema (noncardiogenic), severe hypoxemia, hypotension (rarely hypertension), and fever. Mental status change is not associated with TRALI.
59. The nurse practitioner (NP) suspects his patient has transfusion-related acute lung injury. The patient is hypoxic with a room air O2 saturation of 85%. The patient received a unit of whole blood 30 minutes ago. What diagnostic test should the NP order first?
1. Arterial blood gas.
2. Beside pulmonary function test.
3. Chest x-ray.
4. Chest computed tomography scan.
59. Answer: 3
Rationale: The National Heart Lung and Blood Institute Working Group on transfusion-related acute lung injury (TRALI) developed a definition. In patients with no ALI immediately before transfusion, and no other ALI risk factor is present, a diagnosis of TRALI is made by chest x-ray.
60. The nurse practitioner (NP) is called into the intensive care unit for a patient who complains of being short of breath. The patient is a 53-year-old female with triple-negative breast cancer. When the NP arrives, the vital signs are temperature 99.8°F, heart rate 112 beats/min, respiratory rate 14 breaths/min, blood pressure 88/60 mmHg, and oxygen saturation is 89% on room air. The patient is receiving 0.9% normal saline at 25 mL/hr and a unit of packed red blood cells at 75 mL/hr. What should the NP order first?
1. Place the patient on oxygen at 2 L via nasal cannula.
2. Arterial blood gas.
3. Increase the 0.9% normal saline to 100 mL/hr.
4. Stop the blood transfusion.
60. Answer: 4
Rationale: Stop the blood transfusion. The patient is most likely suffering from a transfusion-related acute lung injury.
61. Which of the following is a risk factor for chronic obstructive pulmonary disease?
1. Obesity.
2. Hypertension.
3. Gastroesophageal reflux.
4. Lung cancer.
61. Answer: 3
Rationale: Obesity, lung cancer, and hypertension do not increase a patient's risk of chronic obstructive pulmonary disease. However, gastroesophageal reflux does, but the exact etiology is unclear.
62. Which diagnosis is not considered to be a type of chronic obstructive pulmonary disease?
1. Asthma.
2. Chronic bronchitis.
3. Cystic fibrosis.
4. Emphysema.
62. Answer: 3
Rationale: Cystic fibrosis is not considered a type of chronic obstructive disease (COPD). Although cystic fibrosis impacts the lungs, it also impacts other body systems so it cannot fall under the classification of COPD.
63. Where do the pathological changes of chronic obstructive pulmonary disease occur?
1. Goblet cells.
2. Mast cells.
3. Endothelial cells.
4. Cytoplasmic cells.
63. Answer: 1
Rationale: The pathological changes occur in goblet cells. Goblet cells in the airways are increased in someone with chronic obstructive pulmonary disease (COPD). Chronic bronchitis involves an increase in goblet cell number, enlarged submucosal glands, mucus hypersecretion and plugging of the airways, and chronic cough. Even COPD patients without chronic bronchitis have mucus obstruction of the small airways.
64. Chronic inflammation associated with chronic bronchitis is characterized by which of the following?
1. CD4+ cells.
2. CD8+ cells.
3. CD14+ cells.
4. CD3+ cells.
64. Answer: 2
Rationale: CD8+ (also known as T lymphocytes) lymphocytes may be the predominant cellular element for direct mediation of tissue injuries, but the importance of CD4+ lymphocytes in orchestrating the inflammatory response and facilitating autoimmune humoral responses also appears to be considerable.
65. Bronchial inflammation associated with asthma is characterized by which of the following?
1. CD4+ cells.
2. CD8+ cells.
3. CD14+ cells.
4. CD3+ cells.
65. Answer: 1
Rationale: In asthma, eosinophils, mast cells, and CD4 T lymphocytes represent the predominant cell types in the inflammatory process. In contrast, chronic obstructive pulmonary disease and bronchiectasis demonstrate a greater number of neutrophils, macrophages, and CD8 T lymphocytes.
66. Proximal acinar or centrilobular emphysema is commonly associated with which of the following?
1. Pulmonary hypertension.
2. Working around birds.
3. Cigarette smoking.
4. Traveling to a foreign country.
66. Answer: 3
Rationale: Proximal acinar or centrilobular emphysema are common associated with cigarette smoking. This type of emphysema refers to abnormal dilation or destruction of the respiratory bronchiole, the central portion of the acinus. Centrilobular (proximal acinar) emphysema is the most common type and is commonly associated with smoking. It also can be seen in coal workers pneumoconiosis.
67. Panacinar emphysema is most commonly seen in people with which of the following?
1. Sarcoidosis.
2. Bronchopulmonary dysplasia.
3. Henoch-Schönlein purpura.
4. α1-antitrypsin deficiency.
67. Answer: 4
Rationale: Panacinar emphysema is most commonly seen in people with α1-antitrypsin deficiency, but it also can been seen in a small percentage of smokers. An α1-antitrypsin deficiency is most common in white people, and it most frequently affects the lungs and liver. In the lungs, the most common manifestation is early-onset (patients in their 30s and 40s) panacinar emphysema most pronounced in the lung bases.
68. Which part of the airway is affected in distal acinar, or paraseptal, emphysema?
1. Bronchioles.
2. Pleura.
3. Bronchi.
4. Alveoli.
68. Answer: 4
Rationale: In paraseptal emphysema, the distal respiratory acinus, including alveolar duct and alveoli, is expanded. It occurs primarily adjacent to the pleura and connective tissue septa, especially in the upper lobes. Extensive involvement of the lung is rare. Some cases of spontaneous pneumothorax may be caused by this type of emphysema.
69. What is not a risk factor for developing chronic obstructive pulmonary disease?
1. Exposure to cigarette smoke.
2. Exposure to animals with heavily shed coats.
3. Exposure to fumes.
4. Exposure to organic dusts.
69. Answer: 2
Rationale: Exposure to animals with heavily shed coats or animals with hair has not been shown to be a risk factor for chronic obstructive pulmonary disease.
70. What are the three cardinal symptoms of chronic obstructive pulmonary disease?
1. Dyspnea, chronic cough, and sputum production.
2. Dyspnea, chronic cough, and snoring.
3. Dyspnea, chronic cough, and accessory muscle use when breathing.
4. Dyspnea, chronic cough, and wheezing.
70. Answer: 1
Rationale: The three cardinal symptoms of chronic obstructive pulmonary disease are dyspnea, chronic cough, and sputum production, and the most common early symptom is exertional dyspnea. Less common symptoms include wheezing and chest tightness.
71. Which of the following is an associated symptom of chronic obstructive pulmonary disease?
1. Clubbing of fingers.
2. Weight loss.
3. Depression.
4. Irritability.
71. Answer: 2
Rationale: Weight loss is common due to dyspnea. Clubbing of the digits is not typical in chronic obstructive pulmonary disease (even with associated hypoxemia) and suggests comorbidities such as lung cancer, interstitial lung disease, or bronchiectasis.
72. The Global Initiative for Chronic Obstructive Lung Disease classification for chronic obstructive pulmonary disease is based on which of the following?
1. Pack-year smoking history.
2. Risk of exacerbation.
3. Sputum production in 24 hours.
4. Number of inhalers the patient is prescribed.
72. Answer: 2
Rationale: The assessment of chronic obstructive pulmonary disease proposed by the Global Initiative for Chronic Obstructive Lung Disease has been based on the patient's level of symptoms, future risk of exacerbations, the extent of airflow limitation, the spirometric abnormality, and the identification of comorbidities.
73. The nurse practitioner is seeing a new patient who presents with cough, dyspnea, and sputum production. The patient has a 70 pack-year history of smoking and continues to smoke two packs a day. The patient only gets short of breath with strenuous exercise or when walking uphill. According to the Global Initiative for Chronic Obstructive Lung Disease classification, which class would this patient be in?
1. Class D.
2. Class C.
3. Class B.
4. Class A.
73. Answer: 4
Rationale: The patient's symptoms are mild or infrequent so this would be considered class A.
74. The nurse practitioner (NP) is seeing a new patient who presents with cough, dyspnea, and sputum production. The patient has a 70 pack-year history of smoking and continues to smoke two packs a day. The patient only gets short of breath with strenuous exercise or when walking uphill. What should the NP prescribe for the patient?
1. Short-acting bronchodilator.
2. Long-acting bronchodilator.
3. Oral steroids.
4. Inhaled corticosteroids.
74. Answer: 1
Rationale: The patient should be prescribed a short-acting bronchodilator and is categorized as "A" or low risk.
75. The nurse practitioner (NP) is seeing a patient who presents with cough, dyspnea, and sputum production. The patient has a 70 pack-year history of smoking and continues to smoke two packs a day. The patient was started on a short-acting bronchodilator 2 months ago. The patient reports that the dyspnea is worse, and he must stop to "catch his breath" frequently. What should the NP prescribe for the patient?
1. Short-acting bronchodilator.
2. Long-acting bronchodilator.
3. Oral steroids.
4. Inhaled corticosteroids.
75. Answer: 2
Rationale: The patient should be prescribed a long-acting bronchodilator because the patient's chronic obstructive pulmonary disease is getting worse.
76. What is a radiographic finding suggestive of chronic obstructive pulmonary disease?
1. Cloudiness in lung fields.
2. Flattened diaphragm.
3. Segmented opacities in lower lobes.
4. Lobar consolidation.
76. Answer: 2
Rationale: Flattened diaphragm caused by hyperinflation is the most likely radiographic finding.
77. Which diagnostic test has the best sensitivity and specificity for chronic obstructive pulmonary disease (COPD)?
1. Computed tomography scan.
2. Arterial blood gas.
3. Chest x-ray.
4. Pulmonary function test.
77. Answer: 1
Rationale: The computed tomography scan has greater sensitivity and specificity than standard chest radiography for the detection of emphysema.
78. The nurse practitioner (NP) is seeing a patient in the emergency department (ED) for exacerbation of chronic obstructive pulmonary disease (COPD). This patient was in the ED 6 weeks ago for the same diagnosis. The patient continues to smoke two to three packs a day and works in a popcorn factory. Her vital signs are temperature 99.9°F, heart rate 101 beats/min, respiratory rate 20 breaths/min, blood pressure 102/86 mmHg, and oxygen saturation of 90% on room air. The patient appears comfortable. The patient asks the NP "for an antibiotic this time so I won't end up here 6 weeks from now." The NP knows that prescribing antibiotics for COPD exacerbation is which of the following?
1. The standard of care for a patient with worsening COPD and fever.
2. Based on the results of a sputum culture.
3. Based on the clinical severity of the disease.
4. Not indicated at this time because the patient is stable.
78. Answer: 3
Rationale: Using clinical indicators (dyspnea, sputum purulence, sputum volume) and severity of illness (advanced airflow limitation, presence of comorbidities, need for mechanical ventilation) can help identify patients who may benefit most from antibiotics; laboratory data (sputum culture, C-reactive protein, procalcitonin) alone should not be used to guide initiation of antibiotics.
79. The nurse practitioner (NP) is seeing a patient in the emergency department (ED) for exacerbation of chronic obstructive pulmonary disease (COPD). This patient was in the ED 6 weeks ago for the same diagnosis. The patient continues to smoke two to three packs a day and works in a popcorn factory. Her vital signs are temperature 99.9°F, heart rate 101 beats/min, respiratory rate 20 breaths/min, blood pressure 102/86 mmHg, and oxygen saturation of 90% on room air. The patient appears comfortable. The patient asks the NP, "for some prednisone to help me breathe, like the other doctors always give me." The NP knows which of the following is not true when prescribing prednisone for COPD exacerbation?
1. 7 to 10 days of corticosteroid therapy is associated with fewer treatment failures.
2. 7 to 10 days of corticosteroid therapy is the standard of care for hemodynamically stable patients with a COPD exacerbation.
3. The
79. Answer: 2
Rationale: 7 to 10 days of corticosteroid therapy is the standard of care for hemodynamically stable patients. Systemic corticosteroids are efficacious in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and considered a standard of care for patients experiencing an AECOPD. Therefore systemic corticosteroids should be administered to all patients experiencing AECOPD severe enough to seek emergent medical care. The lowest effective dose and shortest duration of therapy is the standard.
80. The nurse practitioner is seeing a patient who was just admitted to the intensive care unit for exacerbation of chronic obstructive pulmonary disease. What would the recommended ventilator settings include?
1. Pressure support mode.
2. High tidal volumes.
3. Low tidal volumes.
4. High positive end-expiratory pressures.
80. Answer: 3
Rationale: Low tidal volumes will help to prevent dynamic hyperinflation of the lungs.
81. The nurse practitioner (NP) is seeing a patient who was just admitted to the intensive care unit for exacerbation of chronic obstructive pulmonary disease. The patient's arterial blood gas shows pH 7.34, Pao2 85, Paco2 58, and HCO3 28. The NP is considering noninvasive ventilation support for this patient. The NP knows that noninvasive ventilatory support is
1. Not indicated in this patient.
2. Only used in patients who have exacerbation of asthma.
3. Can only be used on patients for 48 hours.
4. Indicated in patients with progressing hypercapnia.
81. Answer: 4
Rationale: Noninvasive ventilation is considered the standard of care in the management of acute hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease. It can be delivered safely in any dedicated setting.
82. Which of the following is an indication for a pneumonectomy?
1. Lung cancer.
2. Well-controlled chronic obstructive pulmonary disease.
3. Asthma.
4. Chronic bronchitis.
82. Answer: 1
Rationale: Lung cancer in an indication for pneumonectomy. Traditional/standard pneumonectomy is removal of the entire lung. Extrapleural pneumonectomy is removal of the entire lung, as well as a part of the membrane that covers the heart (pericardium), part of the diaphragm, and the membrane, which lines the inside of the chest (pleura).
83. The nurse practitioner (NP) is performing a preoperative assessment for Joe, a 70-year-old patient with lung cancer, who is scheduled to undergo a right middle lobe lobectomy. The NP is reviewing Joe's pulmonary function test. The predicted postoperative value for the diffusing capacity of the lung for carbon monoxide is 38%. What does this value mean to the NP?
1. Joe needs to repeat the test because this is an incorrect value.
2. Joe is at a low to medium risk for postoperative morbidity.
3. Joe is at no increased risk for postoperative morbidity.
4. Joe is at a moderate-to-high risk for postoperative morbidity.
83. Answer: 4
Rationale: The patient is at a moderate-to-high risk for postoperative morbidity. Diffusing capacity is an independent predictor of morbidity after major lung resection. Diffusing capacity is an important predictor of postoperative morbidity after lung resection, even in patients with normal spirometry.
84. The nurse practitioner is performing a preoperative assessment for Joe, a 70-year-old patient with lung cancer, who is scheduled to undergo a right middle lobe lobectomy. Which diagnostic test is not part of the preoperative assessment?
1. Pulmonary function test.
2. Evaluation of tuberculosis status.
3. Chest x-ray.
4. Cardiac risk assessment.
84. Answer: 2
Rationale: Evaluation of tuberculosis status is not part of preoperative assessment.
85. Pulmonary function testing (PFT) is an important part of the preoperative assessment for a patient undergoing lung surgery. The diffusing capacity of the lung for carbon monoxide and what other measurement from the PFT provide the best estimate of postoperative morbidity and mortality?
1. Tidal volume.
2. Functional residual capacity.
3. Forced expiratory volume in 1 second.
4. Total lung capacity.
85. Answer: 3
Rationale: Forced expiratory volume in 1 second and the diffusion capacity of the lungs for carbon monoxide are the best predictors of morbidity and mortality.
86. The nurse practitioner is performing a preoperative assessment for Joe, a 70-year-old patient with lung cancer, who is scheduled to undergo a right pneumonectomy. The nurse practitioner knows that Joe has a 10% to 20% chance of going into which cardiac arrhythmia?
1. Sinus tachycardia.
2. Sick sinus syndrome.
3. Bradycardia.
4. Atrial fibrillation.
86. Answer: 4
Rationale: Cardiac complications are the second most common cause of morbidity and mortality in patients subjected to thoracic surgery after respiratory complications. Postoperative arrhythmia is one of the most common cardiac complications in these patients. Atrial fibrillation is the most common arrhythmia seen after pneumonectomy. The pathophysiology involved in the development of postoperative atrial fibrillation is multifactorial, and it involves a complex interaction between "triggering" stimuli and "sustaining" processes acting on a myocardial substrate that may be predisposed to developing tachyarrhythmia.
87. The nurse practitioner is performing a preoperative assessment for Joe, a 70-year-old patient with lung cancer, who is scheduled to undergo a right pneumonectomy. The nurse practitioner knows that cardiac arrhythmias can occur in 10% to 20% of patients and if they do occur, they usually happen during which postoperative time frame?
1. 1 to 2 days postoperatively.
2. 2 to 4 days postoperatively.
3. 4 to 6 days postoperatively.
4. 6 to 8 days postoperatively.
87. Answer: 2
Rationale: Arrhythmias most often occur 2 to 4 days postoperatively. Postoperative atrial fibrillation (POAF) is a common and potentially morbid complication following cardiac surgery. POAF occurs in around 35% of cardiac surgery cases and has a peak incidence on between postoperative days 2 and 4.
88. The nurse practitioner (NP) has just admitted Joe, a 70-year-old patient with lung cancer, who just underwent a right pneumonectomy. The NP knows that cardiac arrhythmias can occur postoperatively, so which serum electrolyte is ordered to be checked every morning?
1. Magnesium.
2. Potassium.
3. Sodium.
4. Chloride.
88. Answer: 1
Rationale: Keeping serum magnesium levels normal can decrease the likelihood of a postoperative arrhythmia. Magnesium plays an essential role in many fundamental biological reactions because it is involved in more than 300 metabolic reactions. Deficiency of magnesium may result in many disorders, including cardiac arrhythmias.
89. Which of the following is not a potential complication after a pneumonectomy?
1. Chronic obstructive pulmonary disease.
2. Pulmonary edema.
3. Postpneumonectomy syndrome.
4. Intraoperative spillage.
89. Answer: 1
Rationale: Chronic obstructive pulmonary disease is not a potential postoperative complication of a pneumonectomy.
90. Which of the following is not a potential complication of the pleural space after a pneumonectomy?
1. Empyema.
2. Chylothorax.
3. Cardiopleural fistula.
4. Bronchopleural fistula.
90. Answer: 3
Rationale: Cardiopleural fistula is not a complication of the pleural space after a pneumonectomy. A true fistula of the circulatory system is characterized by a clearly ectatic vascular segment that exhibits fistulous flow and connects two vascular territories governed by widely variant hemodynamic environments.
91. Which of the following is an indication for one-lung ventilation?
1. Pulmonary resection.
2. Staphylococcus aureus pneumonia infection.
3. Open heart surgery.
4. Acute respiratory distress syndrome.
91. Answer: 1
Rationale: Pulmonary resection, including pneumonectomy, lobectomy, and wedge resection are indications for one-lung ventilation.
92. Which three factors are taken into consideration when determining treatment for lung cancer?
1. Tumor histology, extent of disease, and gender of patient.
2. Tumor histology, comorbidity, and which lung lobe is involved.
3. Tumor histology, extent of disease, and comorbidity.
4. Tumor histology, smoking history, and comorbidity.
92. Answer: 3
Rationale: Tumor histology, extent of disease, and comorbidity are considered when determining treatment for lung cancer. These 3 factors have the most impact on treatment.
93. The nurse practitioner (NP) is reviewing a chest x-ray of a patient in status asthmaticus. What finding would the NP expect to see?
1. Expanded diaphragm.
2. Pulmonary nodules.
3. Consolidation.
4. Hyperinflation.
93. Answer: 4
Rationale: Plain chest radiographs can be normal in up to 75% of patients with asthma. Reported features with asthma include pulmonary hyperinflation bronchial wall thickening, peribronchial cuffing (nonspecific finding but may be present in ~48% of cases with asthma), pulmonary edema (rare), and/or pulmonary edema caused asthma (usually occurs with acute asthma).
94. Ipratropium bromide (Atrovent) is used in the treatment of asthma and has shown to increase the forced expiratory volume in 1 second. What other statement is true about Atrovent?
1. It is only available as a metered-dose inhaler.
2. It is a short-acting muscarinic agent used in the treatment of chronic asthma.
3. There are no side effects.
4. Patients must be educated about storing the medication in an area that is less than 40°F.
94. Answer: 2
Rationale: It is a short-acting muscarinic agent used in the treatment of chronic asthma.
95. What is tuberculosis of the lung caused by?
1. Gram-negative, rod-shaped aerobic bacteria.
2. Gram-negative, spherical-shaped anaerobic bacteria.
3. Gram-positive, spherical-shaped anaerobic bacteria.
4. Gram-positive, rod-shaped aerobic bacteria.
95. Answer: 4
Rationale: Mycobacterium tuberculosis is a gram-positive, rod-shaped aerobic bacteria.
96. Tuberculosis of the lung is caused by what bacteria?
1. Streptococcus.
2. Acinetobacter.
3. Mycobacterium.
4. Bifidobacterium
96. Answer: 3
Rationale: Mycobacterium is the cause of pulmonary tuberculosis.
97. Sally has just been diagnosed with Mycobacterium tuberculosis. The nurse practitioner (NP) is educating Sally on how M. tuberculosis is spread. The NP knows that Sally has understood the education when Sally says which of the following?
1. "Tuberculosis can be spread when I cough or sneeze and don't cover my mouth."
2. "Tuberculosis can be spread when someone hugs me or shakes my hand."
3. "Tuberculosis can be spread when I have sex with my boyfriend."
4. "Tuberculosis can be spread if someone drinks from the same cup as me."
97. Answer: 1
Rationale: "Tuberculosis can be spread when I cough or sneeze and don't cover my mouth." Tuberculosis is spread by airborne droplets and can be spread when someone speaks or sings.
98. The nurse practitioner (NP) is performing a preoperative assessment for Joe, a 70-year-old patient with small cell lung cancer, who is scheduled to start chemotherapy. Joe asks the NP if chemotherapy is the best treatment for this disease. What does the NP explains to Joe about the disease?
1. "There is no 'best' treatment. All treatments have the same probably outcome."
2. "Chemotherapy has been shown to increase survival compared with best supportive care."
3. "Your insurance will only pay for chemotherapy so that is why you're going to get chemotherapy."
4. "Chemotherapy is only going to shrink the cancer. You'll need radiation too."
98. Answer: 2
Rationale: Chemotherapy is the primary treatment for small-cell lung cancer because it spreads quickly. The most used chemotherapy regimen is etoposide (available as a generic drug) or irinotecan (Camptosar) plus a platinum-based drug such as cisplatin (available as a generic drug) or carboplatin (available as a generic drug).
99. The nurse practitioner is seeing a new patient, Fred, in the pulmonary clinic. The NP sees the diagnosis of "latent tuberculosis (TB)" in the past medical history section of the patient's chart. What does latent TB mean?
1. The person had a history of TB, but he is now cured.
2. The patient shared a home with someone with a history of TB.
3. The patient has TB that is silent but can be reactivated to active disease.
4. The patient has active TB and is contagious.
99. Answer: 3
Rationale: Persons with latent tuberculosis (TB) infection do not feel sick and do not have any symptoms. They are infected with Mycobacterium tuberculosis but do not have TB disease. The only sign of TB infection is a positive reaction to the tuberculin skin test or a TB blood test.
100. The nurse practitioner (NP) is seeing Celia, a 39-year-old patient with a history of low-grade fever that has been present for the last 2 weeks. A chest x-ray is ordered. Celia suspects tuberculosis. If this suspicion is correct, what will the NP see on the chest x-ray?
1. Hyperinflation.
2. Hilar adenopathy.
3. Pleural effusions.
4. Pulmonary infiltrates.
100. Answer: 2
Rationale: Hilar adenopathy is the most common finding; changes were visible as early as 1 week after skin test conversion, and within 2 months in all cases.