NURS 621 Midterm Exam Questions With
Correct Answers 2026
Dx: Acute otitis media - Answer-H&P:
• Ear pain (typical)
• Decreased hearing (typical)
• Fever (sometimes)
• Recent URI or exacerbation of seasonal allergic rhinitis (can be)
• Unilateral (usual)
• Bulging tympanic membrane (needed to distinguish from otitis media with
effusion). Can also be erythematous or opacified. Tympanic membrane can
rupture (feels relief of ear pain, may then have purulent otorrhea)
• Dysequilibrium (not common)
• Conductive hearing loss (usually transient)
• High fever, severe pain behind ear, facial paralysis (unusual complications)
DDx Otitis Media - Answer-• Otitis externa
o More painful, normal-appearing ear drum
• Eustachian tube dysfunction
o Check if recurrent unilateral AOM (>2 over 6 months). Do fiberoptic
nasopharyngoscopy and/or contrast MRI of skull base to rule out malignant
process
• Herpes zoster infection
o Development of dermatomal vesicular rash that evolves into crusted lesions.
Pain may precede rash. Ramsay Hunt syndrome presents with triad of ipsilateral
,facial paralysis, ear pain, and vesicles involving auditory canal and auricle. Can
cause vertigo
COPD H AND P - Answer-H&P:
• *Dyspnea - unpleasant sensation of labored breathing. Progressive and
persistent. Air hunger or gasping for breath
• Current/past tobacco - primary risk factor
• Chronic cough - may be 1st symptom to develop. Initially, intermittent but may
become daily. Rarely occurs only at night
• Chronic sputum production - usually from chronic bronchitis
• History of exposure to dust and chemicals - smoke from cooking and heating
fuels
COPD DDX - Answer-DDx:
• Asthma
• Alpha1-antitrypsin (AAT) deficiency - emphysema onset younger than 45, no
smoking hx, basilar hyperlucency, unexplained liver disease, necrotizing
panniculitis, fam hx
• CHF
• Bronchietasis
• Tuberculosis
COPD LAB DX - Answer-Lab/diagnostics:
• FEV1
o Mild: 80% or > - n abnormal signs, cough +sputum, little or no dyspnea
, o Moderate: 50-80% - breathlessness, cough, variable abnormal signs, hypoxemia
may be present
o Severe: 30-50% - dyspnea with any exertion or rest, wheeze and cough often
prominent
o Very severe: <30% - lung hyperinflation usual, cyanosis, peripheral edema and
poltcythemia in advanced disease, hypoxemia and hypercapnia
• Spirometry
• Arterial blood gases
• Chest x-ray and CT scan
• Theophylline level
• WBC
• Sputum culture
COPD Tx plan: - Answer-Tx plan:
• Oxygen
COPD Follow-up: - Answer-RESOURCES
COPD EDUCATION - Answer-Education:
• Stop smoking - counseling, pharmacotherapy, social support.
o Bupropion SR. Nicotine gum, inhaler, nasal spray, patch. Wellbutrin,
transdermal patch, chantix
• Dyspnea management
• Regular exercise
• Adequate diet and fluid intake
Correct Answers 2026
Dx: Acute otitis media - Answer-H&P:
• Ear pain (typical)
• Decreased hearing (typical)
• Fever (sometimes)
• Recent URI or exacerbation of seasonal allergic rhinitis (can be)
• Unilateral (usual)
• Bulging tympanic membrane (needed to distinguish from otitis media with
effusion). Can also be erythematous or opacified. Tympanic membrane can
rupture (feels relief of ear pain, may then have purulent otorrhea)
• Dysequilibrium (not common)
• Conductive hearing loss (usually transient)
• High fever, severe pain behind ear, facial paralysis (unusual complications)
DDx Otitis Media - Answer-• Otitis externa
o More painful, normal-appearing ear drum
• Eustachian tube dysfunction
o Check if recurrent unilateral AOM (>2 over 6 months). Do fiberoptic
nasopharyngoscopy and/or contrast MRI of skull base to rule out malignant
process
• Herpes zoster infection
o Development of dermatomal vesicular rash that evolves into crusted lesions.
Pain may precede rash. Ramsay Hunt syndrome presents with triad of ipsilateral
,facial paralysis, ear pain, and vesicles involving auditory canal and auricle. Can
cause vertigo
COPD H AND P - Answer-H&P:
• *Dyspnea - unpleasant sensation of labored breathing. Progressive and
persistent. Air hunger or gasping for breath
• Current/past tobacco - primary risk factor
• Chronic cough - may be 1st symptom to develop. Initially, intermittent but may
become daily. Rarely occurs only at night
• Chronic sputum production - usually from chronic bronchitis
• History of exposure to dust and chemicals - smoke from cooking and heating
fuels
COPD DDX - Answer-DDx:
• Asthma
• Alpha1-antitrypsin (AAT) deficiency - emphysema onset younger than 45, no
smoking hx, basilar hyperlucency, unexplained liver disease, necrotizing
panniculitis, fam hx
• CHF
• Bronchietasis
• Tuberculosis
COPD LAB DX - Answer-Lab/diagnostics:
• FEV1
o Mild: 80% or > - n abnormal signs, cough +sputum, little or no dyspnea
, o Moderate: 50-80% - breathlessness, cough, variable abnormal signs, hypoxemia
may be present
o Severe: 30-50% - dyspnea with any exertion or rest, wheeze and cough often
prominent
o Very severe: <30% - lung hyperinflation usual, cyanosis, peripheral edema and
poltcythemia in advanced disease, hypoxemia and hypercapnia
• Spirometry
• Arterial blood gases
• Chest x-ray and CT scan
• Theophylline level
• WBC
• Sputum culture
COPD Tx plan: - Answer-Tx plan:
• Oxygen
COPD Follow-up: - Answer-RESOURCES
COPD EDUCATION - Answer-Education:
• Stop smoking - counseling, pharmacotherapy, social support.
o Bupropion SR. Nicotine gum, inhaler, nasal spray, patch. Wellbutrin,
transdermal patch, chantix
• Dyspnea management
• Regular exercise
• Adequate diet and fluid intake
