NURS 620 EXAM 2 REVIEW
250 COMPREHENSIVE CARDIOVASCULAR AND RESPIRATORY
PRACTICE QUESTIONS WITH CORRECT ANSWERS AND
DETAILED RATIONALES|
NURS 620 Adult Gerontology Health Care 1 Exam 2 Prep Test
(Latest!)
1. A 58-year-old with GOLD 2 COPD presents for follow-up. Which of the following are
appropriate management components for this patient?
1) Prescribe SABA for rescue, add LABA or LAMA for maintenance, encourage smoking
cessation at every visit, and recommend annual influenza and pneumococcal vaccines
2) Prescribe roflumilast (Daliresp) as first-line add-on therapy only
3) Prescribe SABA for rescue and roflumilast for maintenance only
4) Encourage smoking cessation only and avoid all pharmacologic therapy
Correct Answer: 1
Rationale: GOLD 2 COPD management follows a comprehensive evidence-based approach.
SABA (short-acting beta-agonist) is the standard rescue therapy for acute symptom relief.
Long-acting bronchodilators (LABA or LAMA) are initiated starting at GOLD 2 for
maintenance to reduce exacerbations and improve quality of life. Smoking cessation is the
single most effective intervention and must be addressed at every visit using the 5 A's
framework. Annual influenza and pneumococcal vaccines are strongly recommended to
reduce infection-related exacerbations. Roflumilast is a PDE4 inhibitor specifically
reserved for GOLD 3-4 patients with chronic bronchitis and frequent exacerbations and is
NOT indicated for GOLD 2 disease. This is a classic trap where roflumilast is
inappropriately included for lower GOLD stages.
[1]
,2. A patient presents with sharp chest pain worse with deep inspiration and lying flat, but
better when leaning forward. The patient reports a viral URI two weeks ago. On exam, a
friction rub is auscultated. What is the most likely diagnosis?
1) Pulmonary embolism
2) Pericarditis
3) Costochondritis
4) Stable angina
Correct Answer: 2
Rationale: This presentation is classic for acute pericarditis. The key features include sharp
pleuritic chest pain that worsens with deep inspiration and lying flat (due to increased
pericardial pressure), but improves with leaning forward (which reduces pressure on the
pericardium). A friction rub is considered pathognomonic for pericarditis and results from
inflamed pericardial layers rubbing together. The preceding viral URI is a common trigger
for viral pericarditis. Pulmonary embolism typically presents with sudden dyspnea,
tachypnea, and pleuritic pain but does NOT improve with leaning forward and would not
produce a friction rub. Costochondritis pain is reproduced by palpation of the
costochondral junctions. Stable angina is exertional and relieved by rest or nitroglycerin,
not positional changes.
3. A 52-year-old smoker has an FEV1/FVC ratio of 58% and an FEV1 of 84% predicted
post-bronchodilator. What is the diagnosis and GOLD stage?
1) Asthma
2) GOLD 1 COPD Mild - FEV1 80% or higher
3) GOLD 2 COPD Moderate
4) Normal - chronic cough does not require diagnosis
[2]
,Correct Answer: 2
Rationale: COPD is confirmed when the post-bronchodilator FEV1/FVC ratio is less than
70%, which is the case here (58%). GOLD staging is determined by the FEV1 percentage of
predicted value. GOLD 1 (Mild) is defined as FEV1 of 80% or higher, which matches the
FEV1 of 84% predicted in this patient. Despite the mild spirometric findings, patients with
GOLD 1 can have significant symptoms including chronic cough and sputum production.
This case highlights the critical distinction: FEV1/FVC ratio DIAGNOSES COPD (must be
under 70%), while FEV1 percentage STAGES COPD. Asthma would show reversibility with
bronchodilator and typically normal FEV1/FVC ratio between exacerbations. A normal
diagnosis would be inappropriate given the obstructive pattern.
4. How does COPD cough differ from asthma cough and why?
1) COPD cough is nocturnal due to bronchospasm, similar to asthma
2) COPD chronic bronchitis causes goblet cell hyperplasia and excess mucus - cough is
productive and typically daytime
3) COPD productive cough is caused by viral infections only
4) COPD cough is due to pleural inflammation and is not productive
Correct Answer: 2
Rationale: The COPD cough is characteristically a daytime, productive cough resulting from
chronic bronchitis pathophysiology. Chronic bronchitis involves goblet cell hyperplasia and
hypertrophy in the airways, leading to excessive mucus production that is coughed up
during the day when patients are upright and mobile. This is fundamentally different from
asthma cough, which is typically nocturnal (occurring at night or early morning), dry (non-
productive), and related to bronchospasm and airway hyperresponsiveness. The COPD
cough is not solely caused by viral infections, as it is a chronic inflammatory response to
irritants (primarily smoking). Pleural inflammation causes pleuritic pain rather than
[3]
, productive cough. Understanding this key differentiating feature is essential: COPD cough =
DAYTIME + PRODUCTIVE, while asthma cough = NIGHTTIME + DRY.
5. Which finding indicates VERY SEVERE GOLD 4 COPD on physical examination?
1) Barrel chest with increased AP diameter
2) Productive cough with clear sputum
3) Cyanosis, peripheral edema, and neck vein distension
4) Expiratory wheezing only
Correct Answer: 3
Rationale: Cyanosis, peripheral edema, and neck vein distension (JVD) are signs of cor
pulmonale, which indicates right ventricular failure secondary to chronic hypoxemia and
pulmonary hypertension. These findings represent end-stage (GOLD 4) COPD
complications. Cor pulmonale develops when chronic hypoxemia causes pulmonary
vasoconstriction and increased pulmonary vascular resistance, leading to right heart strain
and failure. Other signs of cor pulmonale include polycythemia (increased RBC production
in response to chronic hypoxia) and hepatomegaly. Barrel chest with increased AP
diameter is characteristic of moderate-to-severe COPD due to hyperinflation but is not
specific to GOLD 4. Productive cough with clear sputum is common in chronic bronchitis
but does not indicate severity. Expiratory wheezing is a general finding in obstructive lung
disease and can occur at any stage.
6. A 61-year-old man presents with 4 days of green sputum, fever of 101.8°F, right-sided
pleuritic chest pain, and right lower lobe consolidation on CXR. CURB-65 score is 0. What is
the appropriate management?
1) Admit and start IV azithromycin
[4]
250 COMPREHENSIVE CARDIOVASCULAR AND RESPIRATORY
PRACTICE QUESTIONS WITH CORRECT ANSWERS AND
DETAILED RATIONALES|
NURS 620 Adult Gerontology Health Care 1 Exam 2 Prep Test
(Latest!)
1. A 58-year-old with GOLD 2 COPD presents for follow-up. Which of the following are
appropriate management components for this patient?
1) Prescribe SABA for rescue, add LABA or LAMA for maintenance, encourage smoking
cessation at every visit, and recommend annual influenza and pneumococcal vaccines
2) Prescribe roflumilast (Daliresp) as first-line add-on therapy only
3) Prescribe SABA for rescue and roflumilast for maintenance only
4) Encourage smoking cessation only and avoid all pharmacologic therapy
Correct Answer: 1
Rationale: GOLD 2 COPD management follows a comprehensive evidence-based approach.
SABA (short-acting beta-agonist) is the standard rescue therapy for acute symptom relief.
Long-acting bronchodilators (LABA or LAMA) are initiated starting at GOLD 2 for
maintenance to reduce exacerbations and improve quality of life. Smoking cessation is the
single most effective intervention and must be addressed at every visit using the 5 A's
framework. Annual influenza and pneumococcal vaccines are strongly recommended to
reduce infection-related exacerbations. Roflumilast is a PDE4 inhibitor specifically
reserved for GOLD 3-4 patients with chronic bronchitis and frequent exacerbations and is
NOT indicated for GOLD 2 disease. This is a classic trap where roflumilast is
inappropriately included for lower GOLD stages.
[1]
,2. A patient presents with sharp chest pain worse with deep inspiration and lying flat, but
better when leaning forward. The patient reports a viral URI two weeks ago. On exam, a
friction rub is auscultated. What is the most likely diagnosis?
1) Pulmonary embolism
2) Pericarditis
3) Costochondritis
4) Stable angina
Correct Answer: 2
Rationale: This presentation is classic for acute pericarditis. The key features include sharp
pleuritic chest pain that worsens with deep inspiration and lying flat (due to increased
pericardial pressure), but improves with leaning forward (which reduces pressure on the
pericardium). A friction rub is considered pathognomonic for pericarditis and results from
inflamed pericardial layers rubbing together. The preceding viral URI is a common trigger
for viral pericarditis. Pulmonary embolism typically presents with sudden dyspnea,
tachypnea, and pleuritic pain but does NOT improve with leaning forward and would not
produce a friction rub. Costochondritis pain is reproduced by palpation of the
costochondral junctions. Stable angina is exertional and relieved by rest or nitroglycerin,
not positional changes.
3. A 52-year-old smoker has an FEV1/FVC ratio of 58% and an FEV1 of 84% predicted
post-bronchodilator. What is the diagnosis and GOLD stage?
1) Asthma
2) GOLD 1 COPD Mild - FEV1 80% or higher
3) GOLD 2 COPD Moderate
4) Normal - chronic cough does not require diagnosis
[2]
,Correct Answer: 2
Rationale: COPD is confirmed when the post-bronchodilator FEV1/FVC ratio is less than
70%, which is the case here (58%). GOLD staging is determined by the FEV1 percentage of
predicted value. GOLD 1 (Mild) is defined as FEV1 of 80% or higher, which matches the
FEV1 of 84% predicted in this patient. Despite the mild spirometric findings, patients with
GOLD 1 can have significant symptoms including chronic cough and sputum production.
This case highlights the critical distinction: FEV1/FVC ratio DIAGNOSES COPD (must be
under 70%), while FEV1 percentage STAGES COPD. Asthma would show reversibility with
bronchodilator and typically normal FEV1/FVC ratio between exacerbations. A normal
diagnosis would be inappropriate given the obstructive pattern.
4. How does COPD cough differ from asthma cough and why?
1) COPD cough is nocturnal due to bronchospasm, similar to asthma
2) COPD chronic bronchitis causes goblet cell hyperplasia and excess mucus - cough is
productive and typically daytime
3) COPD productive cough is caused by viral infections only
4) COPD cough is due to pleural inflammation and is not productive
Correct Answer: 2
Rationale: The COPD cough is characteristically a daytime, productive cough resulting from
chronic bronchitis pathophysiology. Chronic bronchitis involves goblet cell hyperplasia and
hypertrophy in the airways, leading to excessive mucus production that is coughed up
during the day when patients are upright and mobile. This is fundamentally different from
asthma cough, which is typically nocturnal (occurring at night or early morning), dry (non-
productive), and related to bronchospasm and airway hyperresponsiveness. The COPD
cough is not solely caused by viral infections, as it is a chronic inflammatory response to
irritants (primarily smoking). Pleural inflammation causes pleuritic pain rather than
[3]
, productive cough. Understanding this key differentiating feature is essential: COPD cough =
DAYTIME + PRODUCTIVE, while asthma cough = NIGHTTIME + DRY.
5. Which finding indicates VERY SEVERE GOLD 4 COPD on physical examination?
1) Barrel chest with increased AP diameter
2) Productive cough with clear sputum
3) Cyanosis, peripheral edema, and neck vein distension
4) Expiratory wheezing only
Correct Answer: 3
Rationale: Cyanosis, peripheral edema, and neck vein distension (JVD) are signs of cor
pulmonale, which indicates right ventricular failure secondary to chronic hypoxemia and
pulmonary hypertension. These findings represent end-stage (GOLD 4) COPD
complications. Cor pulmonale develops when chronic hypoxemia causes pulmonary
vasoconstriction and increased pulmonary vascular resistance, leading to right heart strain
and failure. Other signs of cor pulmonale include polycythemia (increased RBC production
in response to chronic hypoxia) and hepatomegaly. Barrel chest with increased AP
diameter is characteristic of moderate-to-severe COPD due to hyperinflation but is not
specific to GOLD 4. Productive cough with clear sputum is common in chronic bronchitis
but does not indicate severity. Expiratory wheezing is a general finding in obstructive lung
disease and can occur at any stage.
6. A 61-year-old man presents with 4 days of green sputum, fever of 101.8°F, right-sided
pleuritic chest pain, and right lower lobe consolidation on CXR. CURB-65 score is 0. What is
the appropriate management?
1) Admit and start IV azithromycin
[4]
