NURS 5335 RESPIRATORY EXAM 2026/2027 |
100% Correct Answers with Complete Solutions |
Graduate Nursing Advanced Assessment | Pass
Guaranteed - A+ Graded
Domain 1: Upper Respiratory Tract Disorders (12 Questions)
Q1: A 28-year-old female presents with sneezing, clear rhinorrhea, nasal congestion, and
itchy eyes every spring when pollen counts are high. She has no fever. Physical exam
reveals clear nasal discharge, boggy nasal turbinates, and conjunctival injection. Which
is the most appropriate initial pharmacotherapy?
A. Oral pseudoephedrine 60 mg every 4-6 hours
B. Intranasal ipratropium bromide 0.06% nasal spray
C. Intranasal fluticasone propionate 1-2 sprays per nostril daily
D. Oral amoxicillin 875 mg twice daily for 10 days
Correct Answer: C
,Rationale: This patient has seasonal allergic rhinitis (intermittent symptoms triggered by
pollen, classic allergic symptoms with itchy eyes and sneezing). Intranasal
corticosteroids (fluticasone) are first-line therapy for moderate-to-severe or persistent
allergic rhinitis per ARIA guidelines. They are most effective for nasal congestion and
provide relief within hours, with maximum benefit in 1-2 weeks.
● Option A is incorrect—Oral decongestants provide temporary relief but do not
address underlying inflammation; they are not first-line and have
cardiovascular/CNS side effects.
● Option B is incorrect—Ipratropium nasal spray is used for rhinorrhea-predominant
symptoms (particularly non-allergic rhinitis), not as first-line for allergic rhinitis
with congestion.
● Option D is incorrect—Antibiotics are inappropriate; there are no signs of
bacterial infection (no fever, purulent discharge, facial pain, or symptom duration
>10 days without improvement).
Q2: A 45-year-old male reports chronic nasal congestion, rhinorrhea, and postnasal drip
for 6 months. He denies seasonal pattern, sneezing, or itchy eyes. He uses
oxymetazoline nasal spray daily for 3 months. Physical exam reveals erythematous
nasal mucosa without polyps. Which diagnosis is most likely?
A. Seasonal allergic rhinitis
B. Rhinitis medicamentosa
C. Acute bacterial sinusitis
D. Vasomotor rhinitis
,Correct Answer: B
Rationale: Rhinitis medicamentosa is rebound nasal congestion caused by prolonged
use (>3-5 days) of topical decongestants (oxymetazoline, phenylephrine). The patient
has used oxymetazoline for 3 months, far exceeding the recommended duration. The
nasal mucosa appears erythematous (characteristic "beefy red" appearance).
● Option A is incorrect—Allergic rhinitis would have triggers, sneezing, and itchy
eyes; this is perennial without allergic symptoms.
● Option C is incorrect—Acute bacterial sinusitis requires purulent discharge, facial
pain/pressure, or symptoms >10 days without improvement; this is chronic
congestion.
● Option D is incorrect—While vasomotor rhinitis is non-allergic and could cause
these symptoms, the history of prolonged decongestant use makes rhinitis
medicamentosa the primary diagnosis.
Q3: A 32-year-old female presents with 8 days of nasal congestion, purulent nasal
discharge, facial pressure over the maxillary sinuses, and decreased sense of smell.
She had a viral URI 10 days ago that initially improved but then worsened. She has no
fever. Which management is most appropriate?
A. Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
B. Amoxicillin 500 mg three times daily for 10 days
C. Supportive care with saline irrigation and intranasal corticosteroids
D. Levofloxacin 750 mg daily for 5 days
, Correct Answer: A
Rationale: This patient has acute bacterial rhinosinusitis (ABRS) meeting
IDSA/AAO-HNSF criteria: symptoms >10 days without improvement, or
"double-sickening" (worsening after initial improvement). Amoxicillin-clavulanate is
first-line for adults due to S. pneumoniae and H. influenzae coverage, including
beta-lactamase producing organisms. Duration is 5-7 days for uncomplicated cases in
adults (shorter courses are effective).
● Option B is incorrect—Amoxicillin alone has high failure rates due to
beta-lactamase producing H. influenzae and M. catarrhalis; clavulanate is
necessary.
● Option C is incorrect—While supportive care helps, antibiotics are indicated for
confirmed bacterial sinusitis with "double-sickening" pattern.
● Option D is incorrect—Fluoroquinolones are not first-line for sinusitis due to
safety concerns (tendon rupture, neuropathy, QT prolongation); reserve for
beta-lactam allergy or treatment failure.
Q4: A 16-year-old presents with sore throat, fever 38.8°C (101.8°F), tender anterior
cervical lymphadenopathy, and tonsillar exudates. No cough is present. Rapid antigen
detection test (RADT) is negative. Which is the most appropriate next step?
A. Send throat culture and treat empirically with penicillin V
B. Send throat culture and await results before treating
C. Treat with azithromycin empirically
100% Correct Answers with Complete Solutions |
Graduate Nursing Advanced Assessment | Pass
Guaranteed - A+ Graded
Domain 1: Upper Respiratory Tract Disorders (12 Questions)
Q1: A 28-year-old female presents with sneezing, clear rhinorrhea, nasal congestion, and
itchy eyes every spring when pollen counts are high. She has no fever. Physical exam
reveals clear nasal discharge, boggy nasal turbinates, and conjunctival injection. Which
is the most appropriate initial pharmacotherapy?
A. Oral pseudoephedrine 60 mg every 4-6 hours
B. Intranasal ipratropium bromide 0.06% nasal spray
C. Intranasal fluticasone propionate 1-2 sprays per nostril daily
D. Oral amoxicillin 875 mg twice daily for 10 days
Correct Answer: C
,Rationale: This patient has seasonal allergic rhinitis (intermittent symptoms triggered by
pollen, classic allergic symptoms with itchy eyes and sneezing). Intranasal
corticosteroids (fluticasone) are first-line therapy for moderate-to-severe or persistent
allergic rhinitis per ARIA guidelines. They are most effective for nasal congestion and
provide relief within hours, with maximum benefit in 1-2 weeks.
● Option A is incorrect—Oral decongestants provide temporary relief but do not
address underlying inflammation; they are not first-line and have
cardiovascular/CNS side effects.
● Option B is incorrect—Ipratropium nasal spray is used for rhinorrhea-predominant
symptoms (particularly non-allergic rhinitis), not as first-line for allergic rhinitis
with congestion.
● Option D is incorrect—Antibiotics are inappropriate; there are no signs of
bacterial infection (no fever, purulent discharge, facial pain, or symptom duration
>10 days without improvement).
Q2: A 45-year-old male reports chronic nasal congestion, rhinorrhea, and postnasal drip
for 6 months. He denies seasonal pattern, sneezing, or itchy eyes. He uses
oxymetazoline nasal spray daily for 3 months. Physical exam reveals erythematous
nasal mucosa without polyps. Which diagnosis is most likely?
A. Seasonal allergic rhinitis
B. Rhinitis medicamentosa
C. Acute bacterial sinusitis
D. Vasomotor rhinitis
,Correct Answer: B
Rationale: Rhinitis medicamentosa is rebound nasal congestion caused by prolonged
use (>3-5 days) of topical decongestants (oxymetazoline, phenylephrine). The patient
has used oxymetazoline for 3 months, far exceeding the recommended duration. The
nasal mucosa appears erythematous (characteristic "beefy red" appearance).
● Option A is incorrect—Allergic rhinitis would have triggers, sneezing, and itchy
eyes; this is perennial without allergic symptoms.
● Option C is incorrect—Acute bacterial sinusitis requires purulent discharge, facial
pain/pressure, or symptoms >10 days without improvement; this is chronic
congestion.
● Option D is incorrect—While vasomotor rhinitis is non-allergic and could cause
these symptoms, the history of prolonged decongestant use makes rhinitis
medicamentosa the primary diagnosis.
Q3: A 32-year-old female presents with 8 days of nasal congestion, purulent nasal
discharge, facial pressure over the maxillary sinuses, and decreased sense of smell.
She had a viral URI 10 days ago that initially improved but then worsened. She has no
fever. Which management is most appropriate?
A. Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
B. Amoxicillin 500 mg three times daily for 10 days
C. Supportive care with saline irrigation and intranasal corticosteroids
D. Levofloxacin 750 mg daily for 5 days
, Correct Answer: A
Rationale: This patient has acute bacterial rhinosinusitis (ABRS) meeting
IDSA/AAO-HNSF criteria: symptoms >10 days without improvement, or
"double-sickening" (worsening after initial improvement). Amoxicillin-clavulanate is
first-line for adults due to S. pneumoniae and H. influenzae coverage, including
beta-lactamase producing organisms. Duration is 5-7 days for uncomplicated cases in
adults (shorter courses are effective).
● Option B is incorrect—Amoxicillin alone has high failure rates due to
beta-lactamase producing H. influenzae and M. catarrhalis; clavulanate is
necessary.
● Option C is incorrect—While supportive care helps, antibiotics are indicated for
confirmed bacterial sinusitis with "double-sickening" pattern.
● Option D is incorrect—Fluoroquinolones are not first-line for sinusitis due to
safety concerns (tendon rupture, neuropathy, QT prolongation); reserve for
beta-lactam allergy or treatment failure.
Q4: A 16-year-old presents with sore throat, fever 38.8°C (101.8°F), tender anterior
cervical lymphadenopathy, and tonsillar exudates. No cough is present. Rapid antigen
detection test (RADT) is negative. Which is the most appropriate next step?
A. Send throat culture and treat empirically with penicillin V
B. Send throat culture and await results before treating
C. Treat with azithromycin empirically
