NCA 622 exam 2 NRNP 6541 TEST BANK 2026/2027
LATEST SPRING SUMMER ACTUAL EXAM ACTUAL EXAM
Complete Verified Questions And Correct Detailed
Answers| GUARANTEED PASS Graded A+
A 45-year-old woman with asthma presents with severe wheezing and accessory muscle use. She has
used her SABA multiple times with minimal relief. Peak flow is 40% predicted. What is the next best
step?
A. Start inhaled corticosteroid only
B. Give IV magnesium sulfate and systemic steroids
C. Order a chest CT
D. Discharge with increased SABA use
Correct answer: B Rationale: Severe exacerbation (peak flow <50%) warrants systemic steroids and
adjuncts such as IV magnesium.
A 70-year-old man with a history of heart failure presents with dyspnea and orthopnea. CXR shows
bilateral perihilar opacities and Kerley B lines. What is the most likely cause of his symptoms?
A. ARDS
B. Cardiogenic pulmonary edema
C. Bronchiectasis
D. COPD exacerbation
Correct answer: B Rationale: Kerley B lines and perihilar “bat-wing” opacities are classic for cardiogenic
pulmonary edema.
A 58-year-old woman with sepsis develops acute hypoxemia. CXR shows bilateral diffuse alveolar
infiltrates. PAOP is normal. What is the most likely diagnosis?
A. Cardiogenic pulmonary edema
B. ARDS
C. COPD exacerbation
D. Asthma exacerbation
Correct answer: B Rationale: ARDS is characterized by acute onset, bilateral infiltrates, and
non-cardiogenic pulmonary edema (normal PAOP).
A 62-year-old smoker presents with chronic cough and sputum production. PFTs show FEV1/FVC <0.7
and normal DLCO. Which diagnosis is most consistent?
A. Emphysema
B. Chronic bronchitis
C. Interstitial lung disease
D. Asthma
Correct answer: B Rationale: Obstruction with normal DLCO suggests chronic bronchitis rather than
emphysema.
1
,A 50-year-old man presents with pleuritic chest pain and dyspnea. CXR shows a moderate right pleural
effusion. Thoracentesis reveals exudative fluid. Which of the following is most consistent with an
exudate?
A. Pleural protein/serum protein ratio <0.5
B. Pleural LDH/serum LDH ratio <0.6
C. Pleural protein/serum protein ratio >0.5
D. Serum albumin > pleural albumin by >3.1 g/dL
Correct answer: C Rationale: Light’s criteria: exudate if pleural protein/serum protein >0.5, pleural
LDH/serum LDH >0.6, or pleural LDH >2/3 ULN.
A 39-year-old woman with asthma has normal spirometry at baseline but reports episodic wheeze and
cough. Which test best confirms airway hyperresponsiveness?
A. DLCO measurement
B. Methacholine challenge test
C. Chest X-ray
D. Six-minute walk test
Correct answer: B Rationale: Methacholine challenge is used when spirometry is normal but asthma is
suspected.
A 67-year-old man with COPD presents with worsening dyspnea. PFTs show FEV1/FVC 0.55, increased
TLC, and increased RV. DLCO is reduced. Which subtype is most likely?
a. Chronic bronchitis
b. Emphysema-predominant COPD
c. Asthma
d. Restrictive lung disease
Correct answer: B Rationale: Obstruction with hyperinflation and low DLCO is typical of emphysema.
A 72-year-old woman presents with dyspnea and nonproductive cough. CXR shows blunting of the right
costophrenic angle. What is the most appropriate next diagnostic step?
a. High-resolution CT
b. Diagnostic thoracentesis
c. Bronchoscopy
d. Echocardiogram
Correct answer: B Rationale: New pleural effusion of unclear etiology warrants diagnostic thoracentesis.
A 55-year-old man with bronchiectasis reports increased sputum volume and purulence. He is afebrile
but more short of breath. What is the most appropriate initial management?
a. Start inhaled corticosteroids only
b. Begin airway clearance techniques and obtain sputum culture
c. Order a V/Q scan
d. Schedule elective bronchoscopy
Correct answer: B Rationale: Exacerbation of bronchiectasis is managed with airway clearance and
targeted antibiotics guided by sputum culture.
2
,A 60-year-old man with ARDS is on low tidal volume ventilation. Plateau pressures are 32 cm H₂O. What
is the best ventilator adjustment to reduce barotrauma risk?
a. Increase tidal volume
b. Decrease PEEP
c. Decrease tidal volume further
d. Increase respiratory rate
Correct answer: C Rationale: Goal plateau pressure is <30 cm H₂O; reducing tidal volume lowers plateau
pressure and barotrauma risk.
A 48-year-old woman presents with wheezing and chest tightness triggered by exercise. Spirometry
shows obstruction that normalizes after bronchodilator. Which classification best fits her asthma?
a. Intermittent
b. Mild persistent
c. Moderate persistent
d. Severe persistent
Correct answer: A Rationale: Normal lung function between episodes with reversible obstruction and
infrequent symptoms suggests intermittent asthma.
A 69-year-old man with COPD presents with acute confusion and somnolence. ABG: pH 7.25, PaCO₂ 75,
PaO₂ 55 on 2 L NC. What is the most appropriate next step?
a. Increase nasal cannula to 6 L
b. Start noninvasive positive pressure ventilation
c. Order chest CT
d. Immediate bronchoscopy
Correct answer: B Rationale: Acute hypercapnic respiratory failure in COPD is an indication for NIV if no
contraindications.
A 63-year-old woman with a history of rheumatoid arthritis presents with dyspnea. PFTs show normal
FEV1/FVC, reduced TLC, and reduced DLCO. What pattern is this?
a. Obstructive
b. Restrictive
c. Mixed obstructive/restrictive
d. Normal
Correct answer: B Rationale: Reduced TLC with preserved FEV1/FVC indicates a restrictive pattern; low
DLCO suggests parenchymal involvement.
A 52-year-old man presents with fever, weight loss, and chronic productive cough. CXR shows focal
bronchial dilation and thickened bronchial walls in the right lower lobe. What is the most likely
diagnosis?
a. COPD
b. Bronchiectasis
c. ARDS
d. Asthma
3
, Correct answer: B Rationale: Focal bronchial dilation with thickened walls and chronic productive cough
is characteristic of bronchiectasis.
A 59-year-old man with COPD presents with worsening dyspnea. CXR shows hyperlucent lung fields and
flattened diaphragms. ABG: pH 7.36, PaCO₂ 52, PaO₂ 60. What is the most appropriate next step?
A. Increase oxygen to maintain SpO₂ >98%
B. Begin long-acting muscarinic antagonist (LAMA)
C. Start systemic corticosteroids
D. Initiate noninvasive ventilation
Correct Answer: B Rationale: Stable hypercapnia without acidosis suggests chronic COPD; LAMA
improves symptoms and reduces exacerbations.
A 48-year-old woman presents with acute dyspnea. CXR shows a large left pleural effusion. She is
hemodynamically stable. What is the best initial diagnostic test?
A. CT chest with contrast
B. Diagnostic thoracentesis
C. Bronchoscopy
D. V/Q scan
Correct Answer: B Rationale: New pleural effusion of unclear cause requires thoracentesis for fluid
analysis.
A 72-year-old man with pneumonia develops worsening hypoxemia. CXR shows bilateral patchy
infiltrates. PaO₂/FiO₂ ratio is 160. What severity of ARDS does this represent?
A. Mild
B. Moderate
C. Severe
D. Not ARDS
Correct Answer: B Rationale: ARDS severity: mild 200–300, moderate 100–200, severe <100.
A 35-year-old woman with asthma presents with nocturnal symptoms three times per week and uses
her rescue inhaler daily. What is the most appropriate long-term therapy?
A. SABA only
B. Low-dose inhaled corticosteroid
C. Oral corticosteroids
D. Leukotriene receptor antagonist alone
4
LATEST SPRING SUMMER ACTUAL EXAM ACTUAL EXAM
Complete Verified Questions And Correct Detailed
Answers| GUARANTEED PASS Graded A+
A 45-year-old woman with asthma presents with severe wheezing and accessory muscle use. She has
used her SABA multiple times with minimal relief. Peak flow is 40% predicted. What is the next best
step?
A. Start inhaled corticosteroid only
B. Give IV magnesium sulfate and systemic steroids
C. Order a chest CT
D. Discharge with increased SABA use
Correct answer: B Rationale: Severe exacerbation (peak flow <50%) warrants systemic steroids and
adjuncts such as IV magnesium.
A 70-year-old man with a history of heart failure presents with dyspnea and orthopnea. CXR shows
bilateral perihilar opacities and Kerley B lines. What is the most likely cause of his symptoms?
A. ARDS
B. Cardiogenic pulmonary edema
C. Bronchiectasis
D. COPD exacerbation
Correct answer: B Rationale: Kerley B lines and perihilar “bat-wing” opacities are classic for cardiogenic
pulmonary edema.
A 58-year-old woman with sepsis develops acute hypoxemia. CXR shows bilateral diffuse alveolar
infiltrates. PAOP is normal. What is the most likely diagnosis?
A. Cardiogenic pulmonary edema
B. ARDS
C. COPD exacerbation
D. Asthma exacerbation
Correct answer: B Rationale: ARDS is characterized by acute onset, bilateral infiltrates, and
non-cardiogenic pulmonary edema (normal PAOP).
A 62-year-old smoker presents with chronic cough and sputum production. PFTs show FEV1/FVC <0.7
and normal DLCO. Which diagnosis is most consistent?
A. Emphysema
B. Chronic bronchitis
C. Interstitial lung disease
D. Asthma
Correct answer: B Rationale: Obstruction with normal DLCO suggests chronic bronchitis rather than
emphysema.
1
,A 50-year-old man presents with pleuritic chest pain and dyspnea. CXR shows a moderate right pleural
effusion. Thoracentesis reveals exudative fluid. Which of the following is most consistent with an
exudate?
A. Pleural protein/serum protein ratio <0.5
B. Pleural LDH/serum LDH ratio <0.6
C. Pleural protein/serum protein ratio >0.5
D. Serum albumin > pleural albumin by >3.1 g/dL
Correct answer: C Rationale: Light’s criteria: exudate if pleural protein/serum protein >0.5, pleural
LDH/serum LDH >0.6, or pleural LDH >2/3 ULN.
A 39-year-old woman with asthma has normal spirometry at baseline but reports episodic wheeze and
cough. Which test best confirms airway hyperresponsiveness?
A. DLCO measurement
B. Methacholine challenge test
C. Chest X-ray
D. Six-minute walk test
Correct answer: B Rationale: Methacholine challenge is used when spirometry is normal but asthma is
suspected.
A 67-year-old man with COPD presents with worsening dyspnea. PFTs show FEV1/FVC 0.55, increased
TLC, and increased RV. DLCO is reduced. Which subtype is most likely?
a. Chronic bronchitis
b. Emphysema-predominant COPD
c. Asthma
d. Restrictive lung disease
Correct answer: B Rationale: Obstruction with hyperinflation and low DLCO is typical of emphysema.
A 72-year-old woman presents with dyspnea and nonproductive cough. CXR shows blunting of the right
costophrenic angle. What is the most appropriate next diagnostic step?
a. High-resolution CT
b. Diagnostic thoracentesis
c. Bronchoscopy
d. Echocardiogram
Correct answer: B Rationale: New pleural effusion of unclear etiology warrants diagnostic thoracentesis.
A 55-year-old man with bronchiectasis reports increased sputum volume and purulence. He is afebrile
but more short of breath. What is the most appropriate initial management?
a. Start inhaled corticosteroids only
b. Begin airway clearance techniques and obtain sputum culture
c. Order a V/Q scan
d. Schedule elective bronchoscopy
Correct answer: B Rationale: Exacerbation of bronchiectasis is managed with airway clearance and
targeted antibiotics guided by sputum culture.
2
,A 60-year-old man with ARDS is on low tidal volume ventilation. Plateau pressures are 32 cm H₂O. What
is the best ventilator adjustment to reduce barotrauma risk?
a. Increase tidal volume
b. Decrease PEEP
c. Decrease tidal volume further
d. Increase respiratory rate
Correct answer: C Rationale: Goal plateau pressure is <30 cm H₂O; reducing tidal volume lowers plateau
pressure and barotrauma risk.
A 48-year-old woman presents with wheezing and chest tightness triggered by exercise. Spirometry
shows obstruction that normalizes after bronchodilator. Which classification best fits her asthma?
a. Intermittent
b. Mild persistent
c. Moderate persistent
d. Severe persistent
Correct answer: A Rationale: Normal lung function between episodes with reversible obstruction and
infrequent symptoms suggests intermittent asthma.
A 69-year-old man with COPD presents with acute confusion and somnolence. ABG: pH 7.25, PaCO₂ 75,
PaO₂ 55 on 2 L NC. What is the most appropriate next step?
a. Increase nasal cannula to 6 L
b. Start noninvasive positive pressure ventilation
c. Order chest CT
d. Immediate bronchoscopy
Correct answer: B Rationale: Acute hypercapnic respiratory failure in COPD is an indication for NIV if no
contraindications.
A 63-year-old woman with a history of rheumatoid arthritis presents with dyspnea. PFTs show normal
FEV1/FVC, reduced TLC, and reduced DLCO. What pattern is this?
a. Obstructive
b. Restrictive
c. Mixed obstructive/restrictive
d. Normal
Correct answer: B Rationale: Reduced TLC with preserved FEV1/FVC indicates a restrictive pattern; low
DLCO suggests parenchymal involvement.
A 52-year-old man presents with fever, weight loss, and chronic productive cough. CXR shows focal
bronchial dilation and thickened bronchial walls in the right lower lobe. What is the most likely
diagnosis?
a. COPD
b. Bronchiectasis
c. ARDS
d. Asthma
3
, Correct answer: B Rationale: Focal bronchial dilation with thickened walls and chronic productive cough
is characteristic of bronchiectasis.
A 59-year-old man with COPD presents with worsening dyspnea. CXR shows hyperlucent lung fields and
flattened diaphragms. ABG: pH 7.36, PaCO₂ 52, PaO₂ 60. What is the most appropriate next step?
A. Increase oxygen to maintain SpO₂ >98%
B. Begin long-acting muscarinic antagonist (LAMA)
C. Start systemic corticosteroids
D. Initiate noninvasive ventilation
Correct Answer: B Rationale: Stable hypercapnia without acidosis suggests chronic COPD; LAMA
improves symptoms and reduces exacerbations.
A 48-year-old woman presents with acute dyspnea. CXR shows a large left pleural effusion. She is
hemodynamically stable. What is the best initial diagnostic test?
A. CT chest with contrast
B. Diagnostic thoracentesis
C. Bronchoscopy
D. V/Q scan
Correct Answer: B Rationale: New pleural effusion of unclear cause requires thoracentesis for fluid
analysis.
A 72-year-old man with pneumonia develops worsening hypoxemia. CXR shows bilateral patchy
infiltrates. PaO₂/FiO₂ ratio is 160. What severity of ARDS does this represent?
A. Mild
B. Moderate
C. Severe
D. Not ARDS
Correct Answer: B Rationale: ARDS severity: mild 200–300, moderate 100–200, severe <100.
A 35-year-old woman with asthma presents with nocturnal symptoms three times per week and uses
her rescue inhaler daily. What is the most appropriate long-term therapy?
A. SABA only
B. Low-dose inhaled corticosteroid
C. Oral corticosteroids
D. Leukotriene receptor antagonist alone
4
