,NUR 6111 Advanced Practice Nursing I Exam 2 - Actual Questions with
Revised Answers, 100% Verified - William Paterson University
Question 1
A 65-year-old patient with a 40-pack-year smoking history presents with a new persistent
cough. According to USPSTF guidelines, which of the following is the most appropriate next
step?
A) Annual chest x-ray
B) Annual low-dose computed tomography (LDCT)
C) Sputum cytology every 6 months
D) Observation with annual physical exam
Answer: B) Annual low-dose computed tomography (LDCT)
Rationale: The USPSTF recommends annual screening for lung cancer with LDCT in adults aged
50-80 years who have a 20-pack-year smoking history and currently smoke or have quit within
the past 15 years. Chest x-ray is not recommended for screening .
Question 2
Which of the following is the gold standard in assessment and diagnosis of COPD?
A) Chest X-ray
B) CT scan of the chest
C) Post-bronchodilator spirometry
D) Arterial blood gas
Answer: C) Post-bronchodilator spirometry
Rationale: Post-bronchodilator spirometry is the gold standard in the assessment and diagnosis
of COPD. A post-bronchodilator FEV1/FVC ratio <0.70 confirms the diagnosis .
Question 3
A patient with COPD has an FEV1/FVC ratio of 0.65. This finding indicates:
A) Restrictive lung disease
B) Obstructive lung disease
,C) Normal lung function
D) Mixed obstructive-restrictive disease
Answer: B) Obstructive lung disease
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 is diagnostic of airflow
obstruction, which is the hallmark of COPD. Restrictive lung disease typically shows a normal or
increased FEV1/FVC ratio with reduced total lung capacity .
Question 4
A patient is diagnosed with latent tuberculosis infection (LTBI) based on a positive
QuantiFERON-TB Gold test and a normal chest x-ray. Before initiating isoniazid (INH) therapy,
which laboratory test is most important to order?
A) Complete blood count (CBC)
B) Renal function panel
C) Liver function tests (LFTs)
D) Serum electrolytes
Answer: C) Liver function tests (LFTs)
Rationale: Isoniazid (INH) can cause hepatotoxicity. Liver function tests should be obtained
before initiating INH therapy for latent TB and monitored periodically during treatment .
Question 5
A patient with suspected tuberculosis has a positive tuberculin skin test (PPD) with 15 mm
induration. The patient has no risk factors and a normal chest x-ray. What is the most
appropriate next step?
A) Start isoniazid for latent TB
B) Obtain a QuantiFERON-TB Gold test
C) Start four-drug therapy for active TB
D) Repeat the PPD in 6 months
Answer: B) Obtain a QuantiFERON-TB Gold test
Rationale: For patients with a positive PPD but normal chest x-ray and no symptoms,
confirmatory testing with an interferon-gamma release assay (IGRA) such as QuantiFERON-TB
Gold is recommended to rule out false positives, especially in BCG-vaccinated individuals .
, Question 6
A patient with community-acquired pneumonia is treated with azithromycin. Which of the
following is a common adverse effect of macrolide antibiotics?
A) QT prolongation
B) Nephrotoxicity
C) Hepatotoxicity
D) Ototoxicity
Answer: A) QT prolongation
Rationale: Macrolides (azithromycin, clarithromycin) can cause QT prolongation, increasing the
risk of torsade de pointes. This is particularly important in patients with underlying cardiac
disease or those taking other QT-prolonging medications .
Question 7
Which medication is used as a rescue bronchodilator in acute asthma exacerbations?
A) Fluticasone (Flovent)
B) Salmeterol (Serevent)
C) Albuterol (ProAir)
D) Tiotropium (Spiriva)
Answer: C) Albuterol (ProAir)
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid bronchodilation
and is the first-line rescue medication for acute asthma symptoms. Fluticasone is an inhaled
corticosteroid (controller), salmeterol is a long-acting beta-agonist (LABA), and tiotropium is a
long-acting anticholinergic .
Question 8
A patient with COPD has a pulse oximetry reading of 88% on room air. Which of the following is
the most appropriate next action?
A) Administer oxygen at 2 L/min via nasal cannula
B) Obtain an arterial blood gas (ABG)
Revised Answers, 100% Verified - William Paterson University
Question 1
A 65-year-old patient with a 40-pack-year smoking history presents with a new persistent
cough. According to USPSTF guidelines, which of the following is the most appropriate next
step?
A) Annual chest x-ray
B) Annual low-dose computed tomography (LDCT)
C) Sputum cytology every 6 months
D) Observation with annual physical exam
Answer: B) Annual low-dose computed tomography (LDCT)
Rationale: The USPSTF recommends annual screening for lung cancer with LDCT in adults aged
50-80 years who have a 20-pack-year smoking history and currently smoke or have quit within
the past 15 years. Chest x-ray is not recommended for screening .
Question 2
Which of the following is the gold standard in assessment and diagnosis of COPD?
A) Chest X-ray
B) CT scan of the chest
C) Post-bronchodilator spirometry
D) Arterial blood gas
Answer: C) Post-bronchodilator spirometry
Rationale: Post-bronchodilator spirometry is the gold standard in the assessment and diagnosis
of COPD. A post-bronchodilator FEV1/FVC ratio <0.70 confirms the diagnosis .
Question 3
A patient with COPD has an FEV1/FVC ratio of 0.65. This finding indicates:
A) Restrictive lung disease
B) Obstructive lung disease
,C) Normal lung function
D) Mixed obstructive-restrictive disease
Answer: B) Obstructive lung disease
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 is diagnostic of airflow
obstruction, which is the hallmark of COPD. Restrictive lung disease typically shows a normal or
increased FEV1/FVC ratio with reduced total lung capacity .
Question 4
A patient is diagnosed with latent tuberculosis infection (LTBI) based on a positive
QuantiFERON-TB Gold test and a normal chest x-ray. Before initiating isoniazid (INH) therapy,
which laboratory test is most important to order?
A) Complete blood count (CBC)
B) Renal function panel
C) Liver function tests (LFTs)
D) Serum electrolytes
Answer: C) Liver function tests (LFTs)
Rationale: Isoniazid (INH) can cause hepatotoxicity. Liver function tests should be obtained
before initiating INH therapy for latent TB and monitored periodically during treatment .
Question 5
A patient with suspected tuberculosis has a positive tuberculin skin test (PPD) with 15 mm
induration. The patient has no risk factors and a normal chest x-ray. What is the most
appropriate next step?
A) Start isoniazid for latent TB
B) Obtain a QuantiFERON-TB Gold test
C) Start four-drug therapy for active TB
D) Repeat the PPD in 6 months
Answer: B) Obtain a QuantiFERON-TB Gold test
Rationale: For patients with a positive PPD but normal chest x-ray and no symptoms,
confirmatory testing with an interferon-gamma release assay (IGRA) such as QuantiFERON-TB
Gold is recommended to rule out false positives, especially in BCG-vaccinated individuals .
, Question 6
A patient with community-acquired pneumonia is treated with azithromycin. Which of the
following is a common adverse effect of macrolide antibiotics?
A) QT prolongation
B) Nephrotoxicity
C) Hepatotoxicity
D) Ototoxicity
Answer: A) QT prolongation
Rationale: Macrolides (azithromycin, clarithromycin) can cause QT prolongation, increasing the
risk of torsade de pointes. This is particularly important in patients with underlying cardiac
disease or those taking other QT-prolonging medications .
Question 7
Which medication is used as a rescue bronchodilator in acute asthma exacerbations?
A) Fluticasone (Flovent)
B) Salmeterol (Serevent)
C) Albuterol (ProAir)
D) Tiotropium (Spiriva)
Answer: C) Albuterol (ProAir)
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid bronchodilation
and is the first-line rescue medication for acute asthma symptoms. Fluticasone is an inhaled
corticosteroid (controller), salmeterol is a long-acting beta-agonist (LABA), and tiotropium is a
long-acting anticholinergic .
Question 8
A patient with COPD has a pulse oximetry reading of 88% on room air. Which of the following is
the most appropriate next action?
A) Administer oxygen at 2 L/min via nasal cannula
B) Obtain an arterial blood gas (ABG)
