Wilkes University NSG 550 Diagnostic Reasoning Exam 2 (pdf) |
2026/2027 | NP Q&A | Nursing
1. A nurse practitioner is interpreting spirometry results for a patient with
suspected obstructive lung disease. Which finding is most consistent with
obstruction?
A) Decreased FEV1, normal FVC, decreased FEV1/FVC ratio
B) Decreased FEV1, decreased FVC, normal FEV1/FVC ratio
C) Normal FEV1, decreased FVC, increased FEV1/FVC ratio
D) Increased FEV1, normal FVC, normal FEV1/FVC ratio
Correct Answer: Decreased FEV1, normal FVC, decreased FEV1/FVC ratio
Rationale: Obstructive lung disease (e.g., COPD, asthma) is characterized by
a decreased FEV1, normal or slightly decreased FVC, and a decreased
FEV1/FVC ratio (< 0.70). The hallmark is airflow limitation with reduced
expiratory flow rates. Restrictive lung disease shows decreased FVC with
normal or increased FEV1/FVC ratio.
2. A patient's spirometry shows an FEV1/FVC ratio of 0.65 with an FEV1 of
65% predicted. The NP administers a bronchodilator, and the FEV1 improves
by 15%. This finding is most consistent with:
A) Restrictive lung disease
B) COPD
C) Asthma with reversible airway obstruction
D) Pulmonary fibrosis
Correct Answer: Asthma with reversible airway obstruction
Rationale: A significant improvement in FEV1 (≥ 12% and ≥ 200 mL) after
bronchodilator administration indicates reversible airway obstruction, which
,is characteristic of asthma. COPD typically shows less reversibility. Restrictive
lung disease (e.g., pulmonary fibrosis) shows reduced volumes with normal
FEV1/FVC ratio.
3. A nurse practitioner is evaluating a patient with dyspnea and suspects
restrictive lung disease. Which pulmonary function test finding would support
this diagnosis?
A) Decreased FEV1/FVC ratio
B) Decreased FVC with normal or increased FEV1/FVC ratio
C) Increased total lung capacity
D) Decreased DLCO only
Correct Answer: Decreased FVC with normal or increased FEV1/FVC ratio
Rationale: Restrictive lung disease is characterized by reduced lung volumes
(decreased FVC, decreased TLC) with a normal or increased FEV1/FVC ratio.
The FEV1 is also reduced, but the ratio remains normal because both FEV1
and FVC are proportionally decreased. DLCO may be decreased in interstitial
lung diseases.
4. Which of the following is an indication for ordering pulmonary function
tests (PFTs)?
A) Screening for lung disease in asymptomatic low-risk individuals
B) Diagnosing symptomatic lung disease and determining subtype
(obstructive vs. restrictive)
C) Routine annual screening for all patients over 50
D) Evaluating for pulmonary embolism
Correct Answer: Diagnosing symptomatic lung disease and determining
subtype (obstructive vs. restrictive)
,Rationale: PFTs are indicated for diagnosing symptomatic lung disease,
determining the presence and subtype (obstructive vs. restrictive), assessing
severity, monitoring progression or response to treatment, staging COPD,
and assessing preoperative risk. They are not used for routine screening in
asymptomatic individuals or for diagnosing pulmonary embolism.
5. Which of the following is a contraindication to performing spirometry?
A) Age over 65
B) Recent myocardial infarction
C) Mild COPD
D) Obesity
Correct Answer: Recent myocardial infarction
Rationale: Relative contraindications to spirometry include recent myocardial
infarction (within 1 month), pneumothorax, active hemoptysis, pulmonary
embolism, recent surgery, cerebral aneurysm, and respiratory infections.
Age, mild COPD, and obesity are not contraindications.
6. A nurse practitioner is interpreting a DLCO (diffusing capacity of the lungs
for carbon monoxide) test. A decreased DLCO is most consistent with:
A) Asthma
B) Emphysema or interstitial lung disease
C) Obesity
D) Anxiety
Correct Answer: Emphysema or interstitial lung disease
, Rationale: DLCO measures the ability of the lungs to transfer gas from alveoli
to pulmonary capillaries. A decreased DLCO indicates impairment of the
alveolar-capillary membrane, seen in emphysema (loss of alveolar surface
area), interstitial lung disease (thickened alveolar-capillary membrane), and
pulmonary vascular disease.
7. A patient with known COPD has an FEV1 of 45% predicted. According to
GOLD staging, this patient is in which stage?
A) GOLD 1 (Mild)
B) GOLD 2 (Moderate)
C) GOLD 3 (Severe)
D) GOLD 4 (Very Severe)
Correct Answer: GOLD 3 (Severe)
Rationale: GOLD staging of COPD based on FEV1: GOLD 1 (FEV1 ≥ 80%
predicted), GOLD 2 (50-79%), GOLD 3 (30-49%), GOLD 4 (< 30%). An FEV1
of 45% falls into GOLD 3 (Severe). This staging helps guide treatment
decisions.
8. A nurse practitioner is evaluating a patient with suspected sleep apnea.
Which diagnostic test is the gold standard for diagnosing sleep apnea?
A) Actigraphy
B) Home sleep apnea testing
C) Polysomnography
D) Pulse oximetry
Correct Answer: Polysomnography
2026/2027 | NP Q&A | Nursing
1. A nurse practitioner is interpreting spirometry results for a patient with
suspected obstructive lung disease. Which finding is most consistent with
obstruction?
A) Decreased FEV1, normal FVC, decreased FEV1/FVC ratio
B) Decreased FEV1, decreased FVC, normal FEV1/FVC ratio
C) Normal FEV1, decreased FVC, increased FEV1/FVC ratio
D) Increased FEV1, normal FVC, normal FEV1/FVC ratio
Correct Answer: Decreased FEV1, normal FVC, decreased FEV1/FVC ratio
Rationale: Obstructive lung disease (e.g., COPD, asthma) is characterized by
a decreased FEV1, normal or slightly decreased FVC, and a decreased
FEV1/FVC ratio (< 0.70). The hallmark is airflow limitation with reduced
expiratory flow rates. Restrictive lung disease shows decreased FVC with
normal or increased FEV1/FVC ratio.
2. A patient's spirometry shows an FEV1/FVC ratio of 0.65 with an FEV1 of
65% predicted. The NP administers a bronchodilator, and the FEV1 improves
by 15%. This finding is most consistent with:
A) Restrictive lung disease
B) COPD
C) Asthma with reversible airway obstruction
D) Pulmonary fibrosis
Correct Answer: Asthma with reversible airway obstruction
Rationale: A significant improvement in FEV1 (≥ 12% and ≥ 200 mL) after
bronchodilator administration indicates reversible airway obstruction, which
,is characteristic of asthma. COPD typically shows less reversibility. Restrictive
lung disease (e.g., pulmonary fibrosis) shows reduced volumes with normal
FEV1/FVC ratio.
3. A nurse practitioner is evaluating a patient with dyspnea and suspects
restrictive lung disease. Which pulmonary function test finding would support
this diagnosis?
A) Decreased FEV1/FVC ratio
B) Decreased FVC with normal or increased FEV1/FVC ratio
C) Increased total lung capacity
D) Decreased DLCO only
Correct Answer: Decreased FVC with normal or increased FEV1/FVC ratio
Rationale: Restrictive lung disease is characterized by reduced lung volumes
(decreased FVC, decreased TLC) with a normal or increased FEV1/FVC ratio.
The FEV1 is also reduced, but the ratio remains normal because both FEV1
and FVC are proportionally decreased. DLCO may be decreased in interstitial
lung diseases.
4. Which of the following is an indication for ordering pulmonary function
tests (PFTs)?
A) Screening for lung disease in asymptomatic low-risk individuals
B) Diagnosing symptomatic lung disease and determining subtype
(obstructive vs. restrictive)
C) Routine annual screening for all patients over 50
D) Evaluating for pulmonary embolism
Correct Answer: Diagnosing symptomatic lung disease and determining
subtype (obstructive vs. restrictive)
,Rationale: PFTs are indicated for diagnosing symptomatic lung disease,
determining the presence and subtype (obstructive vs. restrictive), assessing
severity, monitoring progression or response to treatment, staging COPD,
and assessing preoperative risk. They are not used for routine screening in
asymptomatic individuals or for diagnosing pulmonary embolism.
5. Which of the following is a contraindication to performing spirometry?
A) Age over 65
B) Recent myocardial infarction
C) Mild COPD
D) Obesity
Correct Answer: Recent myocardial infarction
Rationale: Relative contraindications to spirometry include recent myocardial
infarction (within 1 month), pneumothorax, active hemoptysis, pulmonary
embolism, recent surgery, cerebral aneurysm, and respiratory infections.
Age, mild COPD, and obesity are not contraindications.
6. A nurse practitioner is interpreting a DLCO (diffusing capacity of the lungs
for carbon monoxide) test. A decreased DLCO is most consistent with:
A) Asthma
B) Emphysema or interstitial lung disease
C) Obesity
D) Anxiety
Correct Answer: Emphysema or interstitial lung disease
, Rationale: DLCO measures the ability of the lungs to transfer gas from alveoli
to pulmonary capillaries. A decreased DLCO indicates impairment of the
alveolar-capillary membrane, seen in emphysema (loss of alveolar surface
area), interstitial lung disease (thickened alveolar-capillary membrane), and
pulmonary vascular disease.
7. A patient with known COPD has an FEV1 of 45% predicted. According to
GOLD staging, this patient is in which stage?
A) GOLD 1 (Mild)
B) GOLD 2 (Moderate)
C) GOLD 3 (Severe)
D) GOLD 4 (Very Severe)
Correct Answer: GOLD 3 (Severe)
Rationale: GOLD staging of COPD based on FEV1: GOLD 1 (FEV1 ≥ 80%
predicted), GOLD 2 (50-79%), GOLD 3 (30-49%), GOLD 4 (< 30%). An FEV1
of 45% falls into GOLD 3 (Severe). This staging helps guide treatment
decisions.
8. A nurse practitioner is evaluating a patient with suspected sleep apnea.
Which diagnostic test is the gold standard for diagnosing sleep apnea?
A) Actigraphy
B) Home sleep apnea testing
C) Polysomnography
D) Pulse oximetry
Correct Answer: Polysomnography
