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NURS 620 ADULT 1 EXAM 2 MARYVILLE
QUESTIONS & ANSWERS
1. Claudication is the classic presenting symptom associated with which of
the following? ANS arterial insufficiency
2. Risk factors for chronic arterial insufficiency?-
ANS tobacco use
3. You are using the CURB 65 clinical tool, for determining which patient dx
with CAP should be hospitalized or treated at home. Mabel's score is 2- what should we do? ANS Short inpatient stay; if she is relatively healthy, she could be closely supervised outpatient
4. S/S of COPD correlate with which of the following?-
ANS Chronic bronchitis with airway obstruction
5. Presents with history of asthma without treatment for a while. She reports
daily but not continual symptoms that last longer than 1 week and present at night. She has been using her rescue inhaler. Her FEV1 is 60-80% predicted- how would you classify her asthma? ANS moderate persistent
6. What is the most common bacterial pathogen in CAP?
ANS Streptococcus PNA
7. Which obstructive lung disease is reversible
ANS asthma
8. George has COPD and a 40% FEV1. How would you classify the severity of
his COPD ANS Stage 3
9. Jason age 62 has Obstructive Sleep Apnea (OSA). Which of these is a
contributing factor? ANS his collar size is 17 inches
10. A patient with CAD should be placed on which of the following as an-
tiplatelet tx (first line) ANS Aspirin
11. What is the desired therapeutic action of inhaled corticosteroids?
ANS reduc- tion in airway inflammation
12. What is the appropriate tx for a pt dx with chronic venous insufficiency-
ANS use of elastic stockings
13. What is the most important measurement in a pulmonary function in a
patient with asthma? ANS FEV forced expiratory volume
14. Healthy 27 yo man, dx with CAP, which one of these is the best choice of
tx? ANS azithromycin- macrolide
15. Salmeterol (Serevent) is an example of which of the following?
ANS long acting beta agonist(LABA)
16. fluticasone & budesonide (pulmocort) are examples of what?
17. Ipratropium (Atrovent) is an example of what?
ANS Short-acting muscarinic-an- tagonist (SAMA)
18. montelukast (Singulair) is an example of what?
ANS NON STEROIDAL PRE- VENTERS
19. Salbutamol (Ventolin) and Albuterol is an example of what?
ANS Short acting beta-2 andrenergic (SABA)
20. tiotropium (Spiriva) is an example of what?
ANS (LAMA) Long-acting mus- carinic-antagonist
21. What is the most important goal of treating HTN
ANS Avoiding disease targeted organ damage
22. indicates severe asthma attack, requiring emergent treatment?
ANS inaudible breath sounds
23. When should a rescue course of prednisolone be issued for a asthma
attack ANS anytime its needed for symptoms
24. What intervention would indicate a patient needs more education for her
asthma? ANS opening a window at night
25. what is usually the earliest sign of coronary artery disease (CAD)
ANS inter- mittent claudication
26. what characteristic is a risk factor for PVD?
ANS male gender
27. An asthmatic patient comes in for a follow up, as you assess his asthma
control. He uses albuterol for wheezing, cough, SOB 1 x week. He has been to the ER once for asthma symptoms and coughs 3x a month at night. He is only prescribed albuterol. What would you add? ANS Inhaled low dose corticosteroid
28. A patient presents with a dry cough, causing chest discomfort x 10 days.
He has a runny nose and fatigue. Nurse notes late expiratory wheeze in the lower lobes and rhinitis in the nasal passages. Denies smoking, fever, wheezing. What do we expect? ANS Acute bronchitis
29. According to JNC 8, a 40 yo with 168/88 with CKD should have treatment
with? ANS Lisinopril (ACE inhibitors)
30. a new 58yo pt has a BP 152/90, first time seeing this patient, what should
you do? ANS Come back for 3 more BP checks
31. What HDL level is considered cardioprotective?
ANS >
32. which of the following is the drug of choice for a African American pt with
HTN and DM? ANS HCTZ (diuretic)
ANS initiate drug therapy with a statin
41. Which diagnostic test would be used for dx of a venous embolism (gold
standard)? ANS Ascending venogram
42. Sam age 78 presents to the clinic with respiratory symptoms. His PFT-
normal, total lung capacity, decreased PaO2, increased PaCO2, on assess- ment crackles and forced expiratory wheezes. What is our DX? ANS Chronic Bronchitis
43. At what LDL level would you start a person on a statin with no risk factors
regardless of comorbidities? ANS >
44. What does this CXR Show?
ANS infiltrates; pneumonia
45. Heart Failure Classification System
ANS I - Asymptomatic; II - Symptoms only with marked exertion; III - Symptoms with moderate exertion; IV - Symptoms at rest
46. What would a diagnosis of HTN w/o further confirmation be based on?-
ANS Initial screening BP of e180/110 mmHg or who presents with hypertensive emer- gency
47. What is the first lifestyle modification to address for someone diagnosed
with HTN ANS Weight reduction
48. African Americans dx with HTN without chronic kidney disease should
use ANS CCBs and thiazides
49. what 2 classes of HTN medication should not be used together?
ANS ACEIs and ARBs
50. What should be used instead of ACEIs and ARBs in patients over age 75
with impaired kidney function ANS CCBs and thiazides
51. If goal not reached within a month of treatment for HTN what is the next
step? ANS increase the initial dose of drug or add a 2nd agent & reinforce lifestyle changes
52. What level of BUN will increase the CURB 65 score by 1?
ANS greater than 19
53. What factors are considered to calculate CURB 65 score?
ANS age e65, BUN
63. What tests and labs are use to dx PVD?
ANS Ankle-Brachial Index (ABI) & lipid panel
64. Treatment of PVD/PAD consists of what?
ANS drugs to lower lipids, control HTN, antiplatelet agent
65. Risk factors for DVT
ANS genetic clotting issues, immobility, smoking, obesity, age, FH, hormone/BCPs
66. Symptoms of DVT
ANS unilateral LE swelling, pain in calf, leg cramps, erythema, pallor
67. What is a common technique to elicit pain associated with DVT
ANS Homan's sign (dorsiflexion of foot)
68. Common treatment for DVT
ANS anticoagulants, compression stockings, "clot busters"-tPA
69. Treatment goals for DVT
ANS Resolve clot, prevent PE, prevent post phlebitis syndrome or reoccurrence
70. Cardinal Symptoms of asthma?
ANS Cough, wheeze, SOB
71. Differential dx for asthma
ANS COPD, GERD, Esinophilic bronchitis
72. What is the main trigger to asthma?
ANS exposure to agent pt is sensitized to.
73. What is Baylor's Rules of Two with asthma?
ANS More than 2 uses of rescue inhaler/wk, more than 2 night awakenings/month, more than 2 rescue canisters/ year
74. most common finding with mild to moderate persistent asthma?
ANS expira- tory wheezing
75. what physical finding may be seen with severe-persistent asthma?
ANS hy- perinflation of the chest with an increase in the AP diameter
76. What would be considered Intermittent asthma
ANS symptoms <2 D/WK, Awak- ening <2x/MTH, no interference with daily life, Nml FEV1 between episodes, predicted FEV >80%
77. What would be considered Mild-Persistent asthma
ANS Symptoms >2 D/Wk but not daily, Awakening 3-4x/MTH, minor interference with daily life, FEV1 e 80%
78. What would be considered Moderate Persistent Asthma?
ANS Symptoms daily, Awakening >1x weekly but not nightly, some limitation in daily life, FEV1 >60%
79. What would be considered Severe Persistent Asthma?
ANS Symptoms throughout day, Awakening 7x/WK, use of SABA several x/D, extreme limited daily life, FEV1 <60%
87. What is the goal of asthma education
ANS encourage self-managment
88. Patient education for asthma
ANS monitor and log asthma exacerba- tions-when-where-triggers personalized Asthma Plan Medication technique Environmental control
89. What is the cardinal symptom of COPD and primary symptom for seeking
medical care? ANS Dyspnea (progressive and persistent labored breathing and/or Air hunger)
90. Differential dx for COPD?
ANS Asthma, bronchietasis, CHF
91. Classification of COPD severity
ANS I. Mild = FEV1 e80%
II. Moderate = FEV1 50-80%
III.Severe = 30-50%
IV.Very severe = <30%
92. COPD diagnostic testing
ANS Spirometry, ABGs, CXR, WBC, Sputum culture
93. 3 major goals of COPD Management
ANS 1. Maximize functional capacity
2. Prevent and treat secondary medical complications
3. Improve quality of life by reducing respiratory symptoms
94. What is the goal of oxygen therapy in COPD?
ANS Maintain O2 sat of 90% or better
95. Patient Education for COPD
ANS •Smoking cessation counseling
- Dyspnea management
- Importance of regular exercise
- Adequate diet and fluid intake
- Infection prevention
96. When is a cough considered chronic?
ANS last longer than 8 weeks
97. Differential dx of cough
ANS post-nasal drainage acute bronchitis GERD
98. over 90% of acute bronchitis cases are caused by what?
ANS viruses such as flu or RSV
99. Differential Diagnosis of Acute Bronchitis
ANS •Common cold/viral URI
106. 5 P signs of PVD/DVT?
ANS pain pallor pulselessness paralysis paresthesia
107. The nurse practitioner is assessing a patient with increased tactile
fremitus, the nurse practitioner suspects? ANS advanced case of Pneumonia
108. The nurse practitioner is providing lifestyle modifications for a newly
diagnosed hypertensive pt. The nurse practitioner knows this modification has been shown to have the the greatest effect on blood pressure control?- ANS weight reduction
109. A patient presents with cough for 1 weeks and chills/fever of 102.6 today.
On exam the provider notes a productive cough, rhonchi in lower lobes bilat- eral and dullness on percussion. What is the most likely diagnosis? ANS Bacterial pneumonia
110. characteristics of an acute asthma exacerbation
ANS •Peak flow less than 50% predicted normal
- Failure to respond to a beta2-agonist
- Severe coughing or wheezing
- rapid and gasping breathing
111. Goals of Asthma Therapy
ANS •Control symptoms
- Prevent exacerbations
- Maintain normal activity levels
112. Examples of CCBs calcium channel blockers
ANS Amlodipine (Norvasc) Diltiazem (Cardizem, Tiazac, others) Nifedipine (Adalat CC, Procardia) Verapamil
