NR 601 MIDTERM EXAM QUESTIONS AND answers
2025-2026 UPDATE THE FIRST ATTEMPT
What are the 3 primary physiological changes of aging? - ANS >>1. Reduced physiological reserve o
most body systems, esp. cardiac, resp, renal.
2. Reduced homeostatic mechanisms that fail to adjust regulatory systems (i.e. temp control, fluid/lyt
balance, etc.).
3. Impaired immunological function (infection risk is greater, autoimmune dz's more prevalent)
What is the preferred amount of exercise for elderly? - ANS >>30min/day 5 days/wk of moderate exercise
If trying to lose wt: 60min/day.
What are PFTs? - ANS >>Group of tests that provide quantifiable measurement of lung function, used t
dx resp abnormalities or assess progression/resolution of lung dz.
What is FEV1? - ANS >>Forced Expiratory Volume in 1 second (80-120%)
What is FVC? - ANS >>Forced Vital Capacity (80-120%)
What is normal FEV1/FVC ratio? - ANS >><0.7 (70%)
What is GOLD 1 criteria? - ANS >>Mild
FEV1 >/= 80% predicted
What is GOLD 2 criteria? - ANS >>Moderate
FEV1 50-79% predicted
What is GOLD 3 criteria? - ANS >>Severe
,FEV1 30-49% predicted
What is GOLD 4 criteria? - ANS >>Very severe
FEV1 <30% predicted
What are the signal symptoms of COPD? - ANS >>Dyspnea
Chronic cough w/sputum
Decreased activity tolerance
Wheezing
What are characteristics of COPD? - ANS >>Common, preventable, treatable.
Characterized by persistent airflow limitation.
Usually progressive, associated with enhanced chronic inflammatory response in airways and lungs t
noxious particles/gases
Airway fibrosis, luminal plugs, airway inflammation, increased airway resistance, small airway dz.
Decreased elastic recoil of alveoli.
What are risk factors for COPD? - ANS >>Smoking (increasing w/number of pack years)
Second hand smoke
Environmental pollution (endotoxins, coal dust, mineral dust)
What is seen on phys exam in COPD? - ANS >>May be normal in early states
As severity progresses: lung hyperinflation, decreased breath sounds, wheezes at bases, distant hea
tones (b/c of hyperinflation, so S1/S2 sounds off in distance), accessory muscle use, pursed lip breathing
increased expiratory phase, neck vein distention.
How is COPD diagnosed? - ANS >>Spirometry is gold standard (pre and post bronchodilator).
Irreversible airflow limitation is hallmark.
How is COPD treated? - ANS >>Bronchodilators: beta agonists (long/short), anticholinergics (long/short
or combo.
,What is the MOA of beta agonists? - ANS >>Stimulates beta-2-adrenergic receptors, increasing cycli
AMP, resulting in relaxing airways.
What is the MOA of anticholinergics? - ANS >>Block the effect of acetylcholine on muscarinic type
receptors, resulting in bronchodilation.
Why are long-acting beta agonists prescribed for COPD? - ANS >>They are for moderate airflow limitation
They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL.
What are some non pulmonary diagnoses that result in COPD-type symptoms? - ANS >>CHF
Hyperventilation syndrome
Panic attacks
Vocal cord dysfunction
Obstructive sleep apnea
Aspergillosis
Chronic fatigue syndrome
What are signal symptoms of asthma? - ANS >>Wheezing
Shortness of breath
Cough (esp at night)
Chest tightness
What is chronic bronchitis? - ANS >>Daily chronic cough w/increased sputum for at least 3 consecutiv
months in at least 2 consecutive years.
Usually worse on wakening.
May or may not be associated with COPD.
What is emphysema? - ANS >>Characterized by obstruction to airflow caused by abnormal airspac
enlargement distal to terminal bronchioles.
Chronic inflammation/remodeling, trapping air, hindering effective O2/CO2 exchange (all due t
inflammatory mediators infiltrating airways).
What are signal symptoms of ischemic heart dz? - ANS >>Chest pain
Chest tightness
, Chest discomfort
What is ischemic heart dz? - ANS >>Imbalance between supply and demand for blood flow to myocardium
What are signal symptoms of lung CA? - ANS >>Cough
Dyspnea
Wt loss
Anorexia
Hemoptysis
What is lung CA? - ANS >>Malignant neoplasm originating in parenchyma of lung/airways
What are signal symptoms of MI? - ANS >>Prolonged CP (>20min duration)
SOB
Confusion
Weakness
Worsening HF
What is an MI? - ANS >>Necrosis of heart tissue caused by lack of blood and O2 supply to the heart
What are signal symptoms of pneumonia? - ANS >>Fever
Chills
Hypothermia
New cough w/or w/out sputum
Chest discomfort or dyspnea
Fatigue
HA
Some older adults will be asymptomatic but may experience falls/confusion
What is community acquired pneumonia? - ANS >>Acute lower resp tract infection of lung parenchyma
Can be bacterial or viral.
Bacterial is most common in older adults.
What are signal symptoms of a PE? - ANS >>Dyspnea
CP on inspiration
2025-2026 UPDATE THE FIRST ATTEMPT
What are the 3 primary physiological changes of aging? - ANS >>1. Reduced physiological reserve o
most body systems, esp. cardiac, resp, renal.
2. Reduced homeostatic mechanisms that fail to adjust regulatory systems (i.e. temp control, fluid/lyt
balance, etc.).
3. Impaired immunological function (infection risk is greater, autoimmune dz's more prevalent)
What is the preferred amount of exercise for elderly? - ANS >>30min/day 5 days/wk of moderate exercise
If trying to lose wt: 60min/day.
What are PFTs? - ANS >>Group of tests that provide quantifiable measurement of lung function, used t
dx resp abnormalities or assess progression/resolution of lung dz.
What is FEV1? - ANS >>Forced Expiratory Volume in 1 second (80-120%)
What is FVC? - ANS >>Forced Vital Capacity (80-120%)
What is normal FEV1/FVC ratio? - ANS >><0.7 (70%)
What is GOLD 1 criteria? - ANS >>Mild
FEV1 >/= 80% predicted
What is GOLD 2 criteria? - ANS >>Moderate
FEV1 50-79% predicted
What is GOLD 3 criteria? - ANS >>Severe
,FEV1 30-49% predicted
What is GOLD 4 criteria? - ANS >>Very severe
FEV1 <30% predicted
What are the signal symptoms of COPD? - ANS >>Dyspnea
Chronic cough w/sputum
Decreased activity tolerance
Wheezing
What are characteristics of COPD? - ANS >>Common, preventable, treatable.
Characterized by persistent airflow limitation.
Usually progressive, associated with enhanced chronic inflammatory response in airways and lungs t
noxious particles/gases
Airway fibrosis, luminal plugs, airway inflammation, increased airway resistance, small airway dz.
Decreased elastic recoil of alveoli.
What are risk factors for COPD? - ANS >>Smoking (increasing w/number of pack years)
Second hand smoke
Environmental pollution (endotoxins, coal dust, mineral dust)
What is seen on phys exam in COPD? - ANS >>May be normal in early states
As severity progresses: lung hyperinflation, decreased breath sounds, wheezes at bases, distant hea
tones (b/c of hyperinflation, so S1/S2 sounds off in distance), accessory muscle use, pursed lip breathing
increased expiratory phase, neck vein distention.
How is COPD diagnosed? - ANS >>Spirometry is gold standard (pre and post bronchodilator).
Irreversible airflow limitation is hallmark.
How is COPD treated? - ANS >>Bronchodilators: beta agonists (long/short), anticholinergics (long/short
or combo.
,What is the MOA of beta agonists? - ANS >>Stimulates beta-2-adrenergic receptors, increasing cycli
AMP, resulting in relaxing airways.
What is the MOA of anticholinergics? - ANS >>Block the effect of acetylcholine on muscarinic type
receptors, resulting in bronchodilation.
Why are long-acting beta agonists prescribed for COPD? - ANS >>They are for moderate airflow limitation
They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL.
What are some non pulmonary diagnoses that result in COPD-type symptoms? - ANS >>CHF
Hyperventilation syndrome
Panic attacks
Vocal cord dysfunction
Obstructive sleep apnea
Aspergillosis
Chronic fatigue syndrome
What are signal symptoms of asthma? - ANS >>Wheezing
Shortness of breath
Cough (esp at night)
Chest tightness
What is chronic bronchitis? - ANS >>Daily chronic cough w/increased sputum for at least 3 consecutiv
months in at least 2 consecutive years.
Usually worse on wakening.
May or may not be associated with COPD.
What is emphysema? - ANS >>Characterized by obstruction to airflow caused by abnormal airspac
enlargement distal to terminal bronchioles.
Chronic inflammation/remodeling, trapping air, hindering effective O2/CO2 exchange (all due t
inflammatory mediators infiltrating airways).
What are signal symptoms of ischemic heart dz? - ANS >>Chest pain
Chest tightness
, Chest discomfort
What is ischemic heart dz? - ANS >>Imbalance between supply and demand for blood flow to myocardium
What are signal symptoms of lung CA? - ANS >>Cough
Dyspnea
Wt loss
Anorexia
Hemoptysis
What is lung CA? - ANS >>Malignant neoplasm originating in parenchyma of lung/airways
What are signal symptoms of MI? - ANS >>Prolonged CP (>20min duration)
SOB
Confusion
Weakness
Worsening HF
What is an MI? - ANS >>Necrosis of heart tissue caused by lack of blood and O2 supply to the heart
What are signal symptoms of pneumonia? - ANS >>Fever
Chills
Hypothermia
New cough w/or w/out sputum
Chest discomfort or dyspnea
Fatigue
HA
Some older adults will be asymptomatic but may experience falls/confusion
What is community acquired pneumonia? - ANS >>Acute lower resp tract infection of lung parenchyma
Can be bacterial or viral.
Bacterial is most common in older adults.
What are signal symptoms of a PE? - ANS >>Dyspnea
CP on inspiration
