1
NR 511 MIDTERM ACTUAL FINAL EXAM
QUESTIONS AND ANSWERS
[2025 SET WITH EXPLANATIONS]
An adult has upper respiratory symptoms and cough for the past 14 days. What
should be considered? (Pertussis)
Pertussis should always be considered in adults who present with acute cough of
greater than 5 days’ duration. The incubation period for pertussis is about 7-10
days. Patients present with URI symptoms for 1-2 weeks. The classic paroxysmal
cough usually begins in the second week of the illness. The duration of symptoms
and cough are about 3 months even when treated with antibiotics. This is highly
infectious and is a reportable disease.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be
difficult to diagnose because symptoms can be varied and involve multiple body
systems (extrapulmonary manifestations). Infection with Mycoplasma may
present with a normal white blood cell count, maculopapular rash, GI symptoms,
tender joints and aches, and, though rare, cardiac rhythm disturbances.
Respiratory symptoms may not be pronounced. On chest X-ray there are some
unique findings (peribronchial pattern) with Mycoplasma. These include
thickened bronchial shadow, streaks of interstitial infiltration, and atelectasis.
These are more likely to occur in the lower lobes.
Which medication below is contraindicated in an asthma patient because it may
increase risk of sudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in
combination with an inhaled steroid. Otherwise, using a long-acting
bronchodilator like salmeterol is contraindicated. There is an increased risk of
sudden death with asthma exacerbations when this class is used solo to treat
asthma. The other choices can be used to treat asthma. Choices vary depending
on the patient.
A 75-year-old female with emphysema who has been treated with inhaled
steroids for many years should: (should be screened for osteoporosis)
,2
Older females are at higher risk than others for osteoporosis. This female patient,
who has used inhaled steroids and smokes, has multiple risk factors for
osteoporosis. Additionally, she probably has emphysema because she smoked (or
still smokes). If she is Asian or Caucasian, she has still another risk factor.
Screening for osteoporosis should be considered when managing patients with
multiple risk factors.
A patient received the pneumonia immunization at age 60 years. He is 65 years
old and presents to your clinic today. What recommendation should be made
about the pneumococcal immunization? (He should receive another one today)
This patient should receive another one today because he is 65 years old and at
least 5 years has elapsed since his last one. The CDC does not recommend
immunizing this patient every 5 years. Two immunizations are available, PCV13
and PPSV23. He needs both, but PCV13 should be administered today. PPSV23
should be administered at least 1 year later.
,3
Which of the following medications should be used cautiously in a patient who
has asthma? (Timolol ophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate
bronchoconstriction in patients who have asthma. Even though timolol is being
administered in the eye, it is absorbed through mucous membranes and can exert
systemic effects. Beta blockers should be avoided in patients with asthma and
used cautiously in patients with COPD. The other medications listed have no
specific contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis.
Cough is the most common symptom associated with acute bronchitis. Purulent
sputum is identified in more than 50% of patients with acute bronchitis. The color
imparted to the sputum is usually due to sloughing of epithelial cells, not bacterial
infection. Concurrent upper respiratory symptoms are typical of acute bronchitis.
Pharyngitis is common.
Mild persistent asthma is characterized by: (symptoms occurring more than twice
weekly)
Mild persistent asthma is characterized by symptoms that occur more than twice
weekly but not daily; or 3-4 nocturnal awakenings per month due to asthma. It is
treated with an inhaled steroid daily, and a bronchodilator PRN for
exacerbations. If symptoms occur more than twice weekly, therapy should be
stepped up. Generally, a long-acting bronchodilator is added to the steroid when
therapy is stepped up.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is
assessed if there is concern about the circumference of either the head or the
chest. An exception to this observation can occur in premature infants where the
head grows very rapidly. Normally, the head exceeds the chest circumference by
1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest
circumference should be about equal and by 2 years of age the chest should be
larger than the head. The chest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is
his likely diagnosis? (Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of
, 4
fever and cough, should direct the examiner to consider pneumonia as the
diagnosis. Other common clinical findings with pneumonia include chest pain,
dyspnea, and sputum production. Though not common, some patients with
pneumonia exhibit gastrointestinal symptoms like nausea, vomiting, and
diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature >
101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most
common symptom associated with acute bronchitis. Purulent sputum is
identified in more than 50% of patients with acute bronchitis. The color imparted
to the sputum is usually due to sloughing of epithelial cells, not bacterial
infection. Concurrent upper respiratory symptoms are typical of acute bronchitis.
Pharyngitis is common within the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
NR 511 MIDTERM ACTUAL FINAL EXAM
QUESTIONS AND ANSWERS
[2025 SET WITH EXPLANATIONS]
An adult has upper respiratory symptoms and cough for the past 14 days. What
should be considered? (Pertussis)
Pertussis should always be considered in adults who present with acute cough of
greater than 5 days’ duration. The incubation period for pertussis is about 7-10
days. Patients present with URI symptoms for 1-2 weeks. The classic paroxysmal
cough usually begins in the second week of the illness. The duration of symptoms
and cough are about 3 months even when treated with antibiotics. This is highly
infectious and is a reportable disease.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be
difficult to diagnose because symptoms can be varied and involve multiple body
systems (extrapulmonary manifestations). Infection with Mycoplasma may
present with a normal white blood cell count, maculopapular rash, GI symptoms,
tender joints and aches, and, though rare, cardiac rhythm disturbances.
Respiratory symptoms may not be pronounced. On chest X-ray there are some
unique findings (peribronchial pattern) with Mycoplasma. These include
thickened bronchial shadow, streaks of interstitial infiltration, and atelectasis.
These are more likely to occur in the lower lobes.
Which medication below is contraindicated in an asthma patient because it may
increase risk of sudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in
combination with an inhaled steroid. Otherwise, using a long-acting
bronchodilator like salmeterol is contraindicated. There is an increased risk of
sudden death with asthma exacerbations when this class is used solo to treat
asthma. The other choices can be used to treat asthma. Choices vary depending
on the patient.
A 75-year-old female with emphysema who has been treated with inhaled
steroids for many years should: (should be screened for osteoporosis)
,2
Older females are at higher risk than others for osteoporosis. This female patient,
who has used inhaled steroids and smokes, has multiple risk factors for
osteoporosis. Additionally, she probably has emphysema because she smoked (or
still smokes). If she is Asian or Caucasian, she has still another risk factor.
Screening for osteoporosis should be considered when managing patients with
multiple risk factors.
A patient received the pneumonia immunization at age 60 years. He is 65 years
old and presents to your clinic today. What recommendation should be made
about the pneumococcal immunization? (He should receive another one today)
This patient should receive another one today because he is 65 years old and at
least 5 years has elapsed since his last one. The CDC does not recommend
immunizing this patient every 5 years. Two immunizations are available, PCV13
and PPSV23. He needs both, but PCV13 should be administered today. PPSV23
should be administered at least 1 year later.
,3
Which of the following medications should be used cautiously in a patient who
has asthma? (Timolol ophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate
bronchoconstriction in patients who have asthma. Even though timolol is being
administered in the eye, it is absorbed through mucous membranes and can exert
systemic effects. Beta blockers should be avoided in patients with asthma and
used cautiously in patients with COPD. The other medications listed have no
specific contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis.
Cough is the most common symptom associated with acute bronchitis. Purulent
sputum is identified in more than 50% of patients with acute bronchitis. The color
imparted to the sputum is usually due to sloughing of epithelial cells, not bacterial
infection. Concurrent upper respiratory symptoms are typical of acute bronchitis.
Pharyngitis is common.
Mild persistent asthma is characterized by: (symptoms occurring more than twice
weekly)
Mild persistent asthma is characterized by symptoms that occur more than twice
weekly but not daily; or 3-4 nocturnal awakenings per month due to asthma. It is
treated with an inhaled steroid daily, and a bronchodilator PRN for
exacerbations. If symptoms occur more than twice weekly, therapy should be
stepped up. Generally, a long-acting bronchodilator is added to the steroid when
therapy is stepped up.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is
assessed if there is concern about the circumference of either the head or the
chest. An exception to this observation can occur in premature infants where the
head grows very rapidly. Normally, the head exceeds the chest circumference by
1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest
circumference should be about equal and by 2 years of age the chest should be
larger than the head. The chest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is
his likely diagnosis? (Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of
, 4
fever and cough, should direct the examiner to consider pneumonia as the
diagnosis. Other common clinical findings with pneumonia include chest pain,
dyspnea, and sputum production. Though not common, some patients with
pneumonia exhibit gastrointestinal symptoms like nausea, vomiting, and
diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature >
101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most
common symptom associated with acute bronchitis. Purulent sputum is
identified in more than 50% of patients with acute bronchitis. The color imparted
to the sputum is usually due to sloughing of epithelial cells, not bacterial
infection. Concurrent upper respiratory symptoms are typical of acute bronchitis.
Pharyngitis is common within the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
