1. A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner's most likely suspicion?

Bronchopneumonia

Mycoplasma pneumonia

Legionnaire disease

Pneumococcal pneumonia

Question 2. A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate?

"Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often."

"You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."

"Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube."

"I'll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in."

Question 3. Which of the following situations would be most deserving of a pediatrician's attention?

The mother of an infant 2 days postpartum notes that her baby has intermittent periods of hyperventilation followed by slow respirations or even brief periods of apnea.

A volunteer in the nursery notes that one of the infants, age 2 weeks, appears unable to breathe through his mouth, even when his nose is congested.

A neonate is visibly flaring her nostrils on inspiration.

A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.

Question 4. A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this patient's most likely diagnosis?

Squamous cell carcinoma

Small cell lung cancer

Large cell carcinoma

Adenocarcinoma

Question 5. Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development?

Terminal alveolar sacs are developing and surfactant production is beginning.

A single-capillary network exists and the lungs are capable of respiration.

The conducting airways are formed, but respiration is not yet possible.

Primitive alveoli are formed and the bronchi and bronchioles become much larger.

Question 6. Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration

An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells

An 81-year-old male who has a productive cough and recurrent respiratory infections

An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke

Question 7. Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?

To increase the amount of oxygen dissolved in plasma

To increase the production of unbound hemoglobin

To stimulate the release of oxygen at the capillaries

To remove bound CO from hemoglobin

Question 8. A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death?

Proliferation of natural killer (NK) cells in the alveolar lumen

Large numbers of alveolar macrophages in septal connective tissue

The presence of tubercles in the intra-alveolar spaces

Compensatory regeneration of type I alveolar cells

Question 9. A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE?

She was short of breath because ventilation was occurring but perfusion was inadequate.

The combination of normal perfusion but compromised ventilation caused hypoxia.

She developed a transient anatomic shunt resulting in impaired oxygenation.

Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia.

Question 10. A 21-year-old male patient has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition?

His oropharynx is obstructed.

His epiglottis is covering his larynx

His vocal folds have been compromised.

His tracheobronchial tree is intermittently obstructed.

Question 11. As a consequence of long-standing lung disease, a patient is in a chronic state of hypoxia. Which of the following phenomena would the patient's nurse practitioner be most justified in anticipating? Select all that apply:

Metabolic alkalosis

Increased erythropoietin production

Pulmonary vasodilation

Hyperventilation

A shift to the right of the oxygen-hemoglobin dissociation curve

Personality changes

Question 12. The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable?

"Research has shown that viruses may actually be a factor in many children's asthma."

"The most reliable indicator that your child is having an asthma attack is audible wheezing."

"Steroids that your child can inhale will likely be the first line of defense.

"Your son will likely need to limit or avoid exercise and sports."

Question 13. Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation?

Intrapleural pressure slightly exceeds that of the inflated lung

The chest wall exerts positive pressure on the lungs that contributes to expiration

The lungs are prevented from collapsing by constant positive intrapulmonary pressure

Negative intrapleural pressure holds the lungs against the chest wall

Question 14. A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant's present health problem?

High inspired oxygen concentration and injury from positive-pressure ventilation

Failure to administer corticosteroids to the infant in utero

Insufficient surfactant production and insufficient surfactant therapy

Insufficient supplemental oxygen therapy

Question 15. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F

A woman presenting with malaise, lethargy, and copious nasal secretions

A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F

A woman complaining of generalized aches who has a hoarse voice and reddened, painful upper airways

Question 16. A definitive test for cystic fibrosis is

The sweat test

A sputum culture

A fecal fat test

A Chymex test for pancreatic insufficiency

Question 17. A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing?

Rapid, deep breaths

Wheezing breaths

Short, shallow breaths

Pursed-lip breaths

Question 18. Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli?

A patient who is immobilized following orthopedic surgery

A patient who has impaired Cl- and Na+ regulation

A patient who is taking amiodarone for the treatment of a cardiac arrhythmia

A patient who is a smoker and takes oral contraceptives

A patient who is undergoing radiation therapy for the treatment of breast cancer

Question 19. A female patient is requiring supplementary oxygen by facemask due to her reduced lung compliance. Which of the following pathophysiologic processes is most likely to be a contributor to her low lung compliance?

The woman's lungs have more recoil than a healthy person's.

Her type II alveolar cells are producing a slight excess of surfactant.

Turbulent airflow is taking place in the patient's large airways.

Her thoracic cage is less flexible than when she was healthy.

Question 20. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out?

Decreased elastic recoil due to alveolar damage

Decreased residual lung volume due to impaired alveolar ventilation

Increased anatomic dead space due to reduced tidal volume

Increased alveolar dead space due to incorrect intrapleural pressure

Question 21. As a result of dehydration, a patient's epithelial cells are producing insufficient amounts of mucus. Consequently, the patient's mucociliary blanket is compromised. Which of the following changes would a care provider most reasonably anticipate as a direct result of this change?

Impaired function of the patient's cilia

Decreased levels of oxygen saturation

Increased amounts of bacteria in the lungs

Increased carbon dioxide levels

Question 22. A 3-year-old boy has developed croup following a winter cold. His nurse practitioner would recognize that which of the following causative microorganisms and treatments are most likely?

Respiratory syncytial virus; treatment with intubation

Parainfluenza virus; treatment with a mist tent and oxygen therapy

Haemophilus influenza; treatment with appropriate antibiotics

Staphylococcus aureus; treatment with bronchodilators and a mist tent

Question 23. A short, nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms?

Myocardial infarction

Spontaneous pneumothorax

Pleuritis related to infection

Obstructive atelectasis

Question 24. Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD?

Audible wheezing on expiration

Diminished expiratory flow rates

Increased respiratory rate with decreased tidal volume

Normal compliance of alveolar tissue

Question 25. A nurse practitioner is doing the admission assessment on a patient who has been transferred to the floor after being diagnosed by the emergency room physician with bilateral pleural effusion. Which of the following findings from the nurse practitioner's initial assessment of the patient is incongruent with the patient's diagnosis, and would require further investigation?

The patient complains of sharp pain exacerbated by deep inspiration.

The patient's breath sounds are diminished on auscultation.

Pulse oximetry indicates that the patient is hypoxemic.

The patient complains of dyspnea and increased work of breathing.