NUR 524 exam with correct answers
What |percentage |of |cases |of |bronchitis |are |viral? |- |ANSWER-90%
If |your |patient |presenting |with |bronchitis |symptoms |has |an |elevated |WBC |and |CRP, |what |would |your |
new |diagnosis |be? |- |ANSWER-CAP
Treatment |for |bronchitis |- |ANSWER-cough |suppressants |before |bed |to |promote |sleep, |antihistamines
Mucoterm-46kinetics |only |if |pt |expectorating
Corticosteroids |NOT |recommended
Acute |bronchitis |s/s |- |ANSWER-Cough |with |or |without |sputum
Wheezes, |ronchi/coarse |rales
Reduced |FEV1 |that |improves |with |bronchodilator
Treatment |parameters |for |Covid-19 |- |ANSWER-Pt |> |50 |and |unvaccinated
Any |pt |> |65
Any |patient |at |high |risk |for |severe |disease |(Cormibidities)
How |soon |should |treatment |for |Covid-19 |begin? |- |ANSWER-within |48 |hours |of |symptoms
Treatment |options |for |Covid-19 |- |ANSWER-Paxlovid: |Outpatient, |for |mild |to |moderate |symptoms; |Has
|many |interactions; |Possibility |for |rebound |symptoms |within |5-14 |days |of |stopping; |Renal |adjustment |
needed
Inpatient: |Remdesivir, |dexamethasone, |bronchodilators/ICS, |ASA
What |is |the |#1 |causative |agent |of |PNA? |- |ANSWER-Strep |Pneumoniae
What |are |the |common |PNA |pathogens |for |COPD |patients? |- |ANSWER-H. |Flu, |P. |Aeruginosa, |
Legionella, |S. |pneumoniae, |Maraxella |Catarrhalis |(MCAT), |Chlamydophila |Pneumoniae
What |are |the |common |PNA |pathogens |for |ETOH |users? |- |ANSWER-S. |Pneumoniae, |Oral |anaerobes |
(Aspiration), |Acinetobacter, |Mycobacterium |TB
What |are |the |common |PNA |pathogens |that |form |abcesses? |- |ANSWER-Myobacterium |TB, |MRSA, |
endemic |fungi, |atypical |mycobacterium
What |PNA |pathogens |would |you |find |in |someone |who |resides |in |or |recently |visited |the |Southwest |
US? |- |ANSWER-Coccidiodes |species
What |symptoms |are |more |likely |with |atypical |PNA's? |- |ANSWER-HA |and |sore |throat
What |are |your |first |line |drugs |of |choice |for |treatment |of |CAP |in |a |patient |without |PCN |allergy? |- |
ANSWER-No |comorbids: |Amoxicillin
,With |comorbids: |Augmentin
A |65-year-old |man |is |evaluated |for |a |2-year |history |of |dyspnea |on |exertion. |He |reports |dyspnea |and |
occasional |wheezing |mainly |with |increased |exertion |like |climbing |stairs |or |walking |briskly |up |an |
incline. |He |reports |no |chest |pain. |He |has |a |15-year |history |of |well-controlled |hypertension |and |
hyperlipidemia |treated |with |amlodipine |and |atorvastatin. |He |has |a |30 |pack-year |history |of |smoking. |
On |physical |examination, |his |vital |signs |are |normal. |His |lungs |are |clear |to |auscultation. |His |laboratory |
work |reveals |a |normal |complete |blood |count |and |chemistry |panel. |Spirometry |shows |a |
postbronchodilator |FEV1 |of |80% |and |FEV1/FVC |ratio |of |0.65. |A |chest |radiograph |and |
electrocardiogram |are |both |normal. |What |is |the |most |appropriate |initial |treatment |for |this |patient?
A |Inhaled |corticosteroid |and |long-acting |beta-agonist
B |Long-acting |beta-agonist
C |Long-acting |muscarinic |antagonist
D |Short-acting |beta-agonist |- |ANSWER-D
A |54-year-old |man |with |a |40 |pack-year |smoking |history |presents |to |the |primary |care |office |for |a |
follow-up |for |chronic |cough |that |began |2 |years |ago. |His |recent |spirometry |testing |revealed |a |
postbronchodilator |FEV1/FVC |ratio |of |0.6 |and |an |FEV1 |of |75% |of |predicted |normal. |His |oxygen |
saturation |is |92%. |What |is |the |most |appropriate |initial |pharmacologic |therapy |for |this |patient?
A |Budesonide |nebulizer |2 |mg |four |times |daily
B |Ipratropium |bromide |2 |inhalations |four |times |dailyCorrect |Answer
C |Long-term |supplemental |oxygen |therapy
D |Theophylline |300 |mg |three |times |daily |- |ANSWER-B
A |67-year-old |man |presents |to |the |clinic |for |a |routine |follow-up |visit. |He |was |diagnosed |with |GOLD |
category |B |chronic |obstructive |pulmonary |disease |three |years |ago. |He |has |had |one |mild |exacerbation
|in |the |past |year |but |no |hospitalizations. |His |initial |presenting |symptoms |of |dyspnea |and |productive |
cough |have |improved |significantly |with |daily |use |of |inhaled |tiotropium. |SpO2 |with |ambulation |is |94%.
|The |patient |stopped |smoking |five |years |ago |and |carries |a |35-year |pack |history. |He |received |
pneumococcal |conjugate |vaccine |one |year |ago. |Which |of |the |following |is |the |most |appropriate |
additional |step |in |management?
A |Advise |that |pulmonary |rehabilitation |is |ineffective
B |Order |pneumococcal |polysaccharide |vaccine
C |Prescribe |oxygen |2L/NC |for |use |with |ambulation
D |Repeat |dose |of |pneumococcal |conjugate |vaccine |- |ANSWER-B
A |14-month-old |girl |presents |to |the |office |with |a |three-day |history |of |rhinorrhea |and |low-grade |
temperature. |Today |the |patient |has |developed |a |cough |and |parents |note |some |changes |in |her |
breathing. |She |has |no |history |of |asthma |or |any |other |pulmonary |problems. |On |examination, |there |is |
, diffuse |wheezing, |mild |substernal |retractions, |and |mild |tachypnea. |Which |of |the |following |is |the |most
|likely |diagnosis?
A |Acute |bronchiolitis
B |Asthma |exacerbation
C |Bacterial |pneumonia
D |Croup |- |ANSWER-A |
Bronchiolitis |is |a |common |illness |in |children |under |two |years |of |age |that |affects |the |lower |respiratory
|tract |and |is |noted |as |the |first |episode |of |wheezing |in |otherwise |healthy |children. |The |bronchioles |are
|invaded |by |a |virus, |causing |inflammation |and |obstruction. |Patients |usually |start |with |a |prodrome |of |
upper |respiratory |symptoms, |like |rhinorrhea |or |nasal |congestion, |and |low-grade |fever. |These |
symptoms |typically |last |for |two |to |three |days |and |then |peak |on |days |three |through |five
A |23-year-old |man |with |no |significant |past |medical |history |presents |to |the |clinic |with |an |acute |cough |
for |10 |days. |He |states |that |he |initially |had |rhinorrhea |and |a |sore |throat, |but |these |symptoms |have |
improved. |Vital |signs |are |normal |and |lungs |are |clear |to |auscultation. |Which |of |the |following |is |the |
best |treatment?
A |Amoxicillin
B |Azithromycin
C |Prednisone
D |Supportive |care |- |ANSWER-D
Which |of |the |following |would |be |the |most |appropriate |intervention |for |a |healthy |1-year-old |girl |who |
is |hospitalized |with |her |first |episode |of |bronchiolitis?
A |Administering |an |inhaled |bronchodilator
B |Administering |nebulized |hypertonic |saline
C |Nasal |suctioning
D |Prescribing |oral |glucocorticoids |- |ANSWER-C
Nasal |suctioning |is |a |form |of |supportive |care |routinely |done |for |inpatient |management |of |
bronchiolitis. |This |can |help |with |nasal |obstruction |which |contributes |to |respiratory |and |feeding |
difficulties, |especially |in |infants, |which |can |lead |to |dehydration. |Other |inpatient |treatments |are |used |
depending |on |the |respiratory |needs |of |the |patient |and |include |supplemental |oxygen, |heated |
humidified |high-flow |nasal |cannula, |and |continuous |positive |airway |pressure.
Inhaled |bronchodilator |only |recommended |if |history |of |asthma
What |percentage |of |cases |of |bronchitis |are |viral? |- |ANSWER-90%
If |your |patient |presenting |with |bronchitis |symptoms |has |an |elevated |WBC |and |CRP, |what |would |your |
new |diagnosis |be? |- |ANSWER-CAP
Treatment |for |bronchitis |- |ANSWER-cough |suppressants |before |bed |to |promote |sleep, |antihistamines
Mucoterm-46kinetics |only |if |pt |expectorating
Corticosteroids |NOT |recommended
Acute |bronchitis |s/s |- |ANSWER-Cough |with |or |without |sputum
Wheezes, |ronchi/coarse |rales
Reduced |FEV1 |that |improves |with |bronchodilator
Treatment |parameters |for |Covid-19 |- |ANSWER-Pt |> |50 |and |unvaccinated
Any |pt |> |65
Any |patient |at |high |risk |for |severe |disease |(Cormibidities)
How |soon |should |treatment |for |Covid-19 |begin? |- |ANSWER-within |48 |hours |of |symptoms
Treatment |options |for |Covid-19 |- |ANSWER-Paxlovid: |Outpatient, |for |mild |to |moderate |symptoms; |Has
|many |interactions; |Possibility |for |rebound |symptoms |within |5-14 |days |of |stopping; |Renal |adjustment |
needed
Inpatient: |Remdesivir, |dexamethasone, |bronchodilators/ICS, |ASA
What |is |the |#1 |causative |agent |of |PNA? |- |ANSWER-Strep |Pneumoniae
What |are |the |common |PNA |pathogens |for |COPD |patients? |- |ANSWER-H. |Flu, |P. |Aeruginosa, |
Legionella, |S. |pneumoniae, |Maraxella |Catarrhalis |(MCAT), |Chlamydophila |Pneumoniae
What |are |the |common |PNA |pathogens |for |ETOH |users? |- |ANSWER-S. |Pneumoniae, |Oral |anaerobes |
(Aspiration), |Acinetobacter, |Mycobacterium |TB
What |are |the |common |PNA |pathogens |that |form |abcesses? |- |ANSWER-Myobacterium |TB, |MRSA, |
endemic |fungi, |atypical |mycobacterium
What |PNA |pathogens |would |you |find |in |someone |who |resides |in |or |recently |visited |the |Southwest |
US? |- |ANSWER-Coccidiodes |species
What |symptoms |are |more |likely |with |atypical |PNA's? |- |ANSWER-HA |and |sore |throat
What |are |your |first |line |drugs |of |choice |for |treatment |of |CAP |in |a |patient |without |PCN |allergy? |- |
ANSWER-No |comorbids: |Amoxicillin
,With |comorbids: |Augmentin
A |65-year-old |man |is |evaluated |for |a |2-year |history |of |dyspnea |on |exertion. |He |reports |dyspnea |and |
occasional |wheezing |mainly |with |increased |exertion |like |climbing |stairs |or |walking |briskly |up |an |
incline. |He |reports |no |chest |pain. |He |has |a |15-year |history |of |well-controlled |hypertension |and |
hyperlipidemia |treated |with |amlodipine |and |atorvastatin. |He |has |a |30 |pack-year |history |of |smoking. |
On |physical |examination, |his |vital |signs |are |normal. |His |lungs |are |clear |to |auscultation. |His |laboratory |
work |reveals |a |normal |complete |blood |count |and |chemistry |panel. |Spirometry |shows |a |
postbronchodilator |FEV1 |of |80% |and |FEV1/FVC |ratio |of |0.65. |A |chest |radiograph |and |
electrocardiogram |are |both |normal. |What |is |the |most |appropriate |initial |treatment |for |this |patient?
A |Inhaled |corticosteroid |and |long-acting |beta-agonist
B |Long-acting |beta-agonist
C |Long-acting |muscarinic |antagonist
D |Short-acting |beta-agonist |- |ANSWER-D
A |54-year-old |man |with |a |40 |pack-year |smoking |history |presents |to |the |primary |care |office |for |a |
follow-up |for |chronic |cough |that |began |2 |years |ago. |His |recent |spirometry |testing |revealed |a |
postbronchodilator |FEV1/FVC |ratio |of |0.6 |and |an |FEV1 |of |75% |of |predicted |normal. |His |oxygen |
saturation |is |92%. |What |is |the |most |appropriate |initial |pharmacologic |therapy |for |this |patient?
A |Budesonide |nebulizer |2 |mg |four |times |daily
B |Ipratropium |bromide |2 |inhalations |four |times |dailyCorrect |Answer
C |Long-term |supplemental |oxygen |therapy
D |Theophylline |300 |mg |three |times |daily |- |ANSWER-B
A |67-year-old |man |presents |to |the |clinic |for |a |routine |follow-up |visit. |He |was |diagnosed |with |GOLD |
category |B |chronic |obstructive |pulmonary |disease |three |years |ago. |He |has |had |one |mild |exacerbation
|in |the |past |year |but |no |hospitalizations. |His |initial |presenting |symptoms |of |dyspnea |and |productive |
cough |have |improved |significantly |with |daily |use |of |inhaled |tiotropium. |SpO2 |with |ambulation |is |94%.
|The |patient |stopped |smoking |five |years |ago |and |carries |a |35-year |pack |history. |He |received |
pneumococcal |conjugate |vaccine |one |year |ago. |Which |of |the |following |is |the |most |appropriate |
additional |step |in |management?
A |Advise |that |pulmonary |rehabilitation |is |ineffective
B |Order |pneumococcal |polysaccharide |vaccine
C |Prescribe |oxygen |2L/NC |for |use |with |ambulation
D |Repeat |dose |of |pneumococcal |conjugate |vaccine |- |ANSWER-B
A |14-month-old |girl |presents |to |the |office |with |a |three-day |history |of |rhinorrhea |and |low-grade |
temperature. |Today |the |patient |has |developed |a |cough |and |parents |note |some |changes |in |her |
breathing. |She |has |no |history |of |asthma |or |any |other |pulmonary |problems. |On |examination, |there |is |
, diffuse |wheezing, |mild |substernal |retractions, |and |mild |tachypnea. |Which |of |the |following |is |the |most
|likely |diagnosis?
A |Acute |bronchiolitis
B |Asthma |exacerbation
C |Bacterial |pneumonia
D |Croup |- |ANSWER-A |
Bronchiolitis |is |a |common |illness |in |children |under |two |years |of |age |that |affects |the |lower |respiratory
|tract |and |is |noted |as |the |first |episode |of |wheezing |in |otherwise |healthy |children. |The |bronchioles |are
|invaded |by |a |virus, |causing |inflammation |and |obstruction. |Patients |usually |start |with |a |prodrome |of |
upper |respiratory |symptoms, |like |rhinorrhea |or |nasal |congestion, |and |low-grade |fever. |These |
symptoms |typically |last |for |two |to |three |days |and |then |peak |on |days |three |through |five
A |23-year-old |man |with |no |significant |past |medical |history |presents |to |the |clinic |with |an |acute |cough |
for |10 |days. |He |states |that |he |initially |had |rhinorrhea |and |a |sore |throat, |but |these |symptoms |have |
improved. |Vital |signs |are |normal |and |lungs |are |clear |to |auscultation. |Which |of |the |following |is |the |
best |treatment?
A |Amoxicillin
B |Azithromycin
C |Prednisone
D |Supportive |care |- |ANSWER-D
Which |of |the |following |would |be |the |most |appropriate |intervention |for |a |healthy |1-year-old |girl |who |
is |hospitalized |with |her |first |episode |of |bronchiolitis?
A |Administering |an |inhaled |bronchodilator
B |Administering |nebulized |hypertonic |saline
C |Nasal |suctioning
D |Prescribing |oral |glucocorticoids |- |ANSWER-C
Nasal |suctioning |is |a |form |of |supportive |care |routinely |done |for |inpatient |management |of |
bronchiolitis. |This |can |help |with |nasal |obstruction |which |contributes |to |respiratory |and |feeding |
difficulties, |especially |in |infants, |which |can |lead |to |dehydration. |Other |inpatient |treatments |are |used |
depending |on |the |respiratory |needs |of |the |patient |and |include |supplemental |oxygen, |heated |
humidified |high-flow |nasal |cannula, |and |continuous |positive |airway |pressure.
Inhaled |bronchodilator |only |recommended |if |history |of |asthma
