ESTUDYR
NSG 4100 EXAM 3 MOST TESTED QUESTIONS AND
ANSWERS GRADED A+ WITH RATIONALES
Bronchiectasis is best described as:
A. Intermittent bronchospasm without structural change
B. Chronic dilation of bronchi and bronchioles
C. Acute alveolar collapse only
D. Pulmonary vascular remodeling
Rationale: Bronchiectasis is permanent enlargement of airways causing secretion stasis and
infection.
A cardinal symptom of bronchiectasis is:
A. Sudden chest pain only
B. Chronic productive cough with purulent sputum
C. Hemoptysis exclusively in early disease
D. Isolated wheeze with no sputum
Rationale: Persistent, often purulent, sputum production is classic due to recurrent infection.
Which organism is commonly sought with sputum cultures in bronchiectasis?
A. Streptococcus pyogenes
B. Pseudomonas aeruginosa
C. Candida albicans
D. Mycobacterium leprae
Rationale: Pseudomonas frequently colonizes damaged airways, especially in advanced disease
and CF.
The most accurate imaging test to confirm bronchial dilation is:
A. Chest X-ray only
B. Ventilation-perfusion scan
C. High-resolution CT (HRCT) of the chest
D. Pulse oximetry
Rationale: HRCT shows bronchial wall thickening and tram-track sign—gold standard for
bronchiectasis.
Cystic fibrosis (CF) causes lung disease primarily because of:
A. Autoimmune destruction of alveoli
B. Viral infection selectively of bronchioles
C. Thick, tenacious mucus from defective CFTR chloride channels
,ESTUDYR
D. Excess surfactant production
Rationale: CFTR mutation → dehydrated secretions, mucus plugging, recurrent infections.
Primary ciliary dyskinesia usually leads to respiratory problems because:
A. Increased surfactant clearance
B. Impaired mucociliary clearance allowing recurrent infections
C. Excessive mucus thinning
D. Bronchial muscle hypertrophy
Rationale: Defective cilia can't move mucus, causing retention and infection similar to CF.
Which therapy directly thins airway secretions for better clearance?
A. Beta blockers
B. Mucolytics (e.g., acetylcysteine)
C. Systemic anticoagulants
D. Proton pump inhibitors
Rationale: Mucolytics break disulfide bonds in mucus, reducing viscosity.
Chest physiotherapy and postural drainage are used primarily to:
A. Improve alveolar surfactant production
B. Facilitate mobilization and expectoration of secretions
C. Replace inhaled bronchodilators
D. Prevent aspiration of solids
Rationale: Techniques optimize mucus clearance and reduce infection risk.
Atelectasis is defined as:
A. Fluid accumulation within alveoli from heart failure
B. Permanent dilation of bronchi
C. Collapse or loss of volume of alveoli due to obstruction or compression
D. Chronic bronchial inflammation only
Rationale: Obstruction or underinflation leads to alveolar collapse and V/Q mismatch.
A ventilation–perfusion (V/Q) mismatch causes:
A. Perfect gas exchange
B. Hypoxemia due to imbalance between air reaching alveoli and pulmonary blood flow
C. Elevated PaCO₂ only with preserved PaO₂
D. Decreased work of breathing always
Rationale: Areas with poor ventilation or perfusion compromise oxygenation.
The single best bedside tool to continuously monitor oxygenation is:
A. Arterial blood gas every hour
B. Pulse oximetry (SpO₂)
, ESTUDYR
C. Chest CT
D. D-dimer test
Rationale: Pulse oximetry noninvasively trends SpO₂ in real time (though has limitations).
Hemoptysis (coughing up blood) most often indicates:
A. Gastrointestinal bleeding only
B. Heart failure exclusively
C. Airway or lung parenchymal disease requiring prompt evaluation
D. Peripheral vascular disease
Rationale: Hemoptysis can signal infection, bronchiectasis, malignancy, or PE—investigate.
In suspected pulmonary embolism (PE), an elevated D-dimer indicates:
A. Definitive PE diagnosis
B. Fibrin degradation—suggests thrombus but not specific; used to rule out PE when low
pretest probability
C. Pulmonary hypertension
D. Pneumothorax
Rationale: D-dimer is sensitive but not specific—useful to exclude PE if low.
The most definitive imaging to confirm a pulmonary embolus acutely is:
A. Chest X-ray
B. Ventilation scan when normal perfusion
C. CT pulmonary angiography (CTPA)
D. Echocardiogram only
Rationale: CTPA visualizes filling defects in pulmonary arteries and is first-line in many centers.
Immediate life-saving therapy for a massive, hemodynamically unstable PE is:
A. Oral anticoagulation only
B. Systemic thrombolytic therapy or surgical embolectomy if tPA contraindicated
C. High-flow oxygen only
D. Inhaled bronchodilator
Rationale: Thrombolysis rapidly dissolves clot burden to restore perfusion in unstable patients.
Risk factors that increase PE risk include all EXCEPT:
A. Immobilization and recent surgery
B. Oral contraceptives and pregnancy
C. Active cancer
D. Daily moderate exercise
Rationale: Prolonged immobility, estrogen, cancer—exercise reduces, not increases, risk.
NSG 4100 EXAM 3 MOST TESTED QUESTIONS AND
ANSWERS GRADED A+ WITH RATIONALES
Bronchiectasis is best described as:
A. Intermittent bronchospasm without structural change
B. Chronic dilation of bronchi and bronchioles
C. Acute alveolar collapse only
D. Pulmonary vascular remodeling
Rationale: Bronchiectasis is permanent enlargement of airways causing secretion stasis and
infection.
A cardinal symptom of bronchiectasis is:
A. Sudden chest pain only
B. Chronic productive cough with purulent sputum
C. Hemoptysis exclusively in early disease
D. Isolated wheeze with no sputum
Rationale: Persistent, often purulent, sputum production is classic due to recurrent infection.
Which organism is commonly sought with sputum cultures in bronchiectasis?
A. Streptococcus pyogenes
B. Pseudomonas aeruginosa
C. Candida albicans
D. Mycobacterium leprae
Rationale: Pseudomonas frequently colonizes damaged airways, especially in advanced disease
and CF.
The most accurate imaging test to confirm bronchial dilation is:
A. Chest X-ray only
B. Ventilation-perfusion scan
C. High-resolution CT (HRCT) of the chest
D. Pulse oximetry
Rationale: HRCT shows bronchial wall thickening and tram-track sign—gold standard for
bronchiectasis.
Cystic fibrosis (CF) causes lung disease primarily because of:
A. Autoimmune destruction of alveoli
B. Viral infection selectively of bronchioles
C. Thick, tenacious mucus from defective CFTR chloride channels
,ESTUDYR
D. Excess surfactant production
Rationale: CFTR mutation → dehydrated secretions, mucus plugging, recurrent infections.
Primary ciliary dyskinesia usually leads to respiratory problems because:
A. Increased surfactant clearance
B. Impaired mucociliary clearance allowing recurrent infections
C. Excessive mucus thinning
D. Bronchial muscle hypertrophy
Rationale: Defective cilia can't move mucus, causing retention and infection similar to CF.
Which therapy directly thins airway secretions for better clearance?
A. Beta blockers
B. Mucolytics (e.g., acetylcysteine)
C. Systemic anticoagulants
D. Proton pump inhibitors
Rationale: Mucolytics break disulfide bonds in mucus, reducing viscosity.
Chest physiotherapy and postural drainage are used primarily to:
A. Improve alveolar surfactant production
B. Facilitate mobilization and expectoration of secretions
C. Replace inhaled bronchodilators
D. Prevent aspiration of solids
Rationale: Techniques optimize mucus clearance and reduce infection risk.
Atelectasis is defined as:
A. Fluid accumulation within alveoli from heart failure
B. Permanent dilation of bronchi
C. Collapse or loss of volume of alveoli due to obstruction or compression
D. Chronic bronchial inflammation only
Rationale: Obstruction or underinflation leads to alveolar collapse and V/Q mismatch.
A ventilation–perfusion (V/Q) mismatch causes:
A. Perfect gas exchange
B. Hypoxemia due to imbalance between air reaching alveoli and pulmonary blood flow
C. Elevated PaCO₂ only with preserved PaO₂
D. Decreased work of breathing always
Rationale: Areas with poor ventilation or perfusion compromise oxygenation.
The single best bedside tool to continuously monitor oxygenation is:
A. Arterial blood gas every hour
B. Pulse oximetry (SpO₂)
, ESTUDYR
C. Chest CT
D. D-dimer test
Rationale: Pulse oximetry noninvasively trends SpO₂ in real time (though has limitations).
Hemoptysis (coughing up blood) most often indicates:
A. Gastrointestinal bleeding only
B. Heart failure exclusively
C. Airway or lung parenchymal disease requiring prompt evaluation
D. Peripheral vascular disease
Rationale: Hemoptysis can signal infection, bronchiectasis, malignancy, or PE—investigate.
In suspected pulmonary embolism (PE), an elevated D-dimer indicates:
A. Definitive PE diagnosis
B. Fibrin degradation—suggests thrombus but not specific; used to rule out PE when low
pretest probability
C. Pulmonary hypertension
D. Pneumothorax
Rationale: D-dimer is sensitive but not specific—useful to exclude PE if low.
The most definitive imaging to confirm a pulmonary embolus acutely is:
A. Chest X-ray
B. Ventilation scan when normal perfusion
C. CT pulmonary angiography (CTPA)
D. Echocardiogram only
Rationale: CTPA visualizes filling defects in pulmonary arteries and is first-line in many centers.
Immediate life-saving therapy for a massive, hemodynamically unstable PE is:
A. Oral anticoagulation only
B. Systemic thrombolytic therapy or surgical embolectomy if tPA contraindicated
C. High-flow oxygen only
D. Inhaled bronchodilator
Rationale: Thrombolysis rapidly dissolves clot burden to restore perfusion in unstable patients.
Risk factors that increase PE risk include all EXCEPT:
A. Immobilization and recent surgery
B. Oral contraceptives and pregnancy
C. Active cancer
D. Daily moderate exercise
Rationale: Prolonged immobility, estrogen, cancer—exercise reduces, not increases, risk.
