Exam 2 NURS 620 Review of Latest 200
Practice Questions and Correct Verified
Answers/ NURS 620 Adult Gerontology
Health Care 1 Exam 2 Prep Test (Latest!)
SATA: A 58-year-old with GOLD 2 COPD for follow-up. Which are appropriate
management components?
A) Prescribe SABA for rescue
B) Add LABA or LAMA for maintenance
C) Encourage smoking cessation at every visit
D) Prescribe roflumilast (Daliresp) as first-line add-on
E) Recommend annual influenza and pneumococcal vaccines
ANSWER: A, B, C, E.
RATIONALE: GOLD 2 management includes SABA for rescue, LABA or LAMA
for maintenance (started at GOLD 2), smoking cessation at every visit, and
vaccinations.
Roflumilast is reserved for GOLD 3-4 with chronic bronchitis and frequent
exacerbations - NOT GOLD 2.
TIP: Roflumilast (Daliresp) = GOLD 3-4 SEVERE patients only - classic SATA
trap.
A patient has sharp chest pain worse with deep inspiration and lying flat, better
leaning forward, preceded by viral URI 2 weeks ago, and a friction rub on exam.
Most likely diagnosis?
A) Pulmonary embolism
B) Pericarditis
C) Costochondritis
D) Stable angina
1
,ANSWER: B - Pericarditis.
RATIONALE: Classic pericarditis: sharp pleuritic pain WORSE lying flat,
BETTER leaning forward (reduces pericardial pressure), friction rub
(pathognomonic), and post-viral history.
PE does not improve with leaning forward and won't produce a friction rub.
Costochondritis is reproduced by palpation.
TIP: Pericarditis = worse lying flat + better leaning forward + friction rub + post-
viral.
A 52-year-old smoker, FEV1/FVC 58%, FEV1 84% predicted post-bronchodilator.
Diagnosis and GOLD stage?
A) Asthma
B) GOLD 1 COPD Mild - FEV1 80% or higher
C) GOLD 2 COPD Moderate
D) Normal - chronic cough does not require diagnosis
ANSWER: B - GOLD 1 COPD Mild.
RATIONALE: COPD confirmed: FEV1/FVC 58% is less than 70%.
GOLD staging: FEV1 84% = GOLD 1 (80% or higher). Despite mild spirometry,
patient has symptoms. GOLD 1 patients can have chronic cough with near-normal
FEV1.
TIP: FEV1/FVC = DIAGNOSE COPD (must be under 70%). FEV1% = STAGE
COPD. Two separate numbers, two separate jobs.
How does COPD cough differ from asthma cough and why?
A) COPD cough is nocturnal due to bronchospasm, similar to asthma
B) COPD chronic bronchitis causes goblet cell hyperplasia and excess mucus -
cough is productive and typically daytime
C) COPD productive cough is caused by viral infections only
D) COPD cough is due to pleural inflammation and is not productive
ANSWER: B - COPD chronic bronchitis causes goblet cell hyperplasia and excess
mucus causing productive daytime cough.
RATIONALE: Chronic bronchitis involves goblet cell hyperplasia causing
excessive mucus and productive DAYTIME cough.
2
,Asthma cough is NIGHTTIME and DRY.
Key differentiating feature for the exam.
TIP: COPD cough = DAYTIME + PRODUCTIVE. Asthma cough = NIGHTTIME
+ DRY.
Which finding indicates VERY SEVERE GOLD 4 COPD on physical exam?
A) Barrel chest with increased AP diameter
B) Productive cough with clear sputum
C) Cyanosis, peripheral edema, and neck vein distension
D) Expiratory wheezing only
ANSWER: C - Cyanosis, peripheral edema, and neck vein distension.
RATIONALE: These are signs of cor pulmonale (right ventricular failure from
chronic hypoxemia/pulmonary hypertension). Also: polycythemia.
Barrel chest appears in moderate-to-severe disease.
TIP: GOLD 4 = cyanosis + edema + JVD + polycythemia = cor pulmonale.
A 61-year-old man with 4 days of green sputum, fever 101.8°F, right-sided
pleuritic chest pain, right lower lobe consolidation on CXR, CURB-65 score 0.
Management?
A) Admit and start IV azithromycin
B) Outpatient azithromycin or doxycycline
C) Observe 24 hours and recheck CXR
D) Amoxicillin-clavulanate plus levofloxacin
ANSWER: B - Outpatient azithromycin or doxycycline.
RATIONALE: CURB-65 score 0 = low risk = outpatient management appropriate.
No comorbidities, no prior antibiotics within 3 months = first-line: macrolide
(azithromycin) or doxycycline for 5-7 days.
TIP: CURB-65: 0-1=outpatient; 2=consider hospitalization; 3-4=hospitalize.
Which organism is the MOST COMMON cause of bacterial CAP (25-35% of
cases)?
A) Haemophilus influenzae
B) Mycoplasma pneumoniae
3
, C) Streptococcus pneumoniae
D) Moraxella catarrhalis
ANSWER: C - Streptococcus pneumoniae.
RATIONALE: S. pneumoniae is the most common bacterial cause of CAP
accounting for 25-35% of cases. S. pneumoniae, H. influenzae, and M. catarrhalis
together account for approximately 85% of CAP.
Nosocomial: Pseudomonas and MRSA.
TIP: S. pneumoniae = number 1 bacterial CAP. Explicitly flagged as a board topic.
A CXR shows lobar consolidation with dense homogeneous shadows in the right
lower lobe. What type of pneumonia?
A) Viral pneumonia atypical
B) Bacterial pneumonia
C) Mycoplasmal or chlamydial pneumonia
D) Aspiration pneumonia
ANSWER: B - Bacterial pneumonia.
RATIONALE: Lobar infiltrates with dense homogeneous shadows strongly
suggest bacterial pneumonia.
Diffuse interstitial infiltrates (patchy, bilateral) suggest atypical/viral such as
mycoplasma or chlamydia.
Always order AP AND lateral views.
TIP: LOBAR consolidation = bacterial. DIFFUSE interstitial = atypical/viral.
Which findings indicate higher-risk CAP warranting combination antibiotic
therapy?
A) Antibiotics within past 3 months
B) Diagnosis of COPD
C) History of splenectomy
D) Age 35 with no comorbidities and no prior antibiotics
E) Chronic liver disease
ANSWER: A, B, C, E.
RATIONALE: Higher-risk CAP: prior antibiotics within 3 months, comorbidities
(COPD, DM, CHF, renal/liver disease), post-splenectomy, prior hospitalization
4
Practice Questions and Correct Verified
Answers/ NURS 620 Adult Gerontology
Health Care 1 Exam 2 Prep Test (Latest!)
SATA: A 58-year-old with GOLD 2 COPD for follow-up. Which are appropriate
management components?
A) Prescribe SABA for rescue
B) Add LABA or LAMA for maintenance
C) Encourage smoking cessation at every visit
D) Prescribe roflumilast (Daliresp) as first-line add-on
E) Recommend annual influenza and pneumococcal vaccines
ANSWER: A, B, C, E.
RATIONALE: GOLD 2 management includes SABA for rescue, LABA or LAMA
for maintenance (started at GOLD 2), smoking cessation at every visit, and
vaccinations.
Roflumilast is reserved for GOLD 3-4 with chronic bronchitis and frequent
exacerbations - NOT GOLD 2.
TIP: Roflumilast (Daliresp) = GOLD 3-4 SEVERE patients only - classic SATA
trap.
A patient has sharp chest pain worse with deep inspiration and lying flat, better
leaning forward, preceded by viral URI 2 weeks ago, and a friction rub on exam.
Most likely diagnosis?
A) Pulmonary embolism
B) Pericarditis
C) Costochondritis
D) Stable angina
1
,ANSWER: B - Pericarditis.
RATIONALE: Classic pericarditis: sharp pleuritic pain WORSE lying flat,
BETTER leaning forward (reduces pericardial pressure), friction rub
(pathognomonic), and post-viral history.
PE does not improve with leaning forward and won't produce a friction rub.
Costochondritis is reproduced by palpation.
TIP: Pericarditis = worse lying flat + better leaning forward + friction rub + post-
viral.
A 52-year-old smoker, FEV1/FVC 58%, FEV1 84% predicted post-bronchodilator.
Diagnosis and GOLD stage?
A) Asthma
B) GOLD 1 COPD Mild - FEV1 80% or higher
C) GOLD 2 COPD Moderate
D) Normal - chronic cough does not require diagnosis
ANSWER: B - GOLD 1 COPD Mild.
RATIONALE: COPD confirmed: FEV1/FVC 58% is less than 70%.
GOLD staging: FEV1 84% = GOLD 1 (80% or higher). Despite mild spirometry,
patient has symptoms. GOLD 1 patients can have chronic cough with near-normal
FEV1.
TIP: FEV1/FVC = DIAGNOSE COPD (must be under 70%). FEV1% = STAGE
COPD. Two separate numbers, two separate jobs.
How does COPD cough differ from asthma cough and why?
A) COPD cough is nocturnal due to bronchospasm, similar to asthma
B) COPD chronic bronchitis causes goblet cell hyperplasia and excess mucus -
cough is productive and typically daytime
C) COPD productive cough is caused by viral infections only
D) COPD cough is due to pleural inflammation and is not productive
ANSWER: B - COPD chronic bronchitis causes goblet cell hyperplasia and excess
mucus causing productive daytime cough.
RATIONALE: Chronic bronchitis involves goblet cell hyperplasia causing
excessive mucus and productive DAYTIME cough.
2
,Asthma cough is NIGHTTIME and DRY.
Key differentiating feature for the exam.
TIP: COPD cough = DAYTIME + PRODUCTIVE. Asthma cough = NIGHTTIME
+ DRY.
Which finding indicates VERY SEVERE GOLD 4 COPD on physical exam?
A) Barrel chest with increased AP diameter
B) Productive cough with clear sputum
C) Cyanosis, peripheral edema, and neck vein distension
D) Expiratory wheezing only
ANSWER: C - Cyanosis, peripheral edema, and neck vein distension.
RATIONALE: These are signs of cor pulmonale (right ventricular failure from
chronic hypoxemia/pulmonary hypertension). Also: polycythemia.
Barrel chest appears in moderate-to-severe disease.
TIP: GOLD 4 = cyanosis + edema + JVD + polycythemia = cor pulmonale.
A 61-year-old man with 4 days of green sputum, fever 101.8°F, right-sided
pleuritic chest pain, right lower lobe consolidation on CXR, CURB-65 score 0.
Management?
A) Admit and start IV azithromycin
B) Outpatient azithromycin or doxycycline
C) Observe 24 hours and recheck CXR
D) Amoxicillin-clavulanate plus levofloxacin
ANSWER: B - Outpatient azithromycin or doxycycline.
RATIONALE: CURB-65 score 0 = low risk = outpatient management appropriate.
No comorbidities, no prior antibiotics within 3 months = first-line: macrolide
(azithromycin) or doxycycline for 5-7 days.
TIP: CURB-65: 0-1=outpatient; 2=consider hospitalization; 3-4=hospitalize.
Which organism is the MOST COMMON cause of bacterial CAP (25-35% of
cases)?
A) Haemophilus influenzae
B) Mycoplasma pneumoniae
3
, C) Streptococcus pneumoniae
D) Moraxella catarrhalis
ANSWER: C - Streptococcus pneumoniae.
RATIONALE: S. pneumoniae is the most common bacterial cause of CAP
accounting for 25-35% of cases. S. pneumoniae, H. influenzae, and M. catarrhalis
together account for approximately 85% of CAP.
Nosocomial: Pseudomonas and MRSA.
TIP: S. pneumoniae = number 1 bacterial CAP. Explicitly flagged as a board topic.
A CXR shows lobar consolidation with dense homogeneous shadows in the right
lower lobe. What type of pneumonia?
A) Viral pneumonia atypical
B) Bacterial pneumonia
C) Mycoplasmal or chlamydial pneumonia
D) Aspiration pneumonia
ANSWER: B - Bacterial pneumonia.
RATIONALE: Lobar infiltrates with dense homogeneous shadows strongly
suggest bacterial pneumonia.
Diffuse interstitial infiltrates (patchy, bilateral) suggest atypical/viral such as
mycoplasma or chlamydia.
Always order AP AND lateral views.
TIP: LOBAR consolidation = bacterial. DIFFUSE interstitial = atypical/viral.
Which findings indicate higher-risk CAP warranting combination antibiotic
therapy?
A) Antibiotics within past 3 months
B) Diagnosis of COPD
C) History of splenectomy
D) Age 35 with no comorbidities and no prior antibiotics
E) Chronic liver disease
ANSWER: A, B, C, E.
RATIONALE: Higher-risk CAP: prior antibiotics within 3 months, comorbidities
(COPD, DM, CHF, renal/liver disease), post-splenectomy, prior hospitalization
4
