NP Respiratory Management Mastery Exam
– 150 Clinical Questions & Answers (1–150)
2025/2026
1. A 45-year-old patient presents with acute shortness of b
reath, wheezing, and chest tightness. Peak flow is 55% of personal
best. What is the most appropriate next step?
• Increase inhaled corticosteroid dose
• Administer a short-acting bronchodilator immediately
• Start leukotriene receptor antagonist
• Order a chest X-ray
Rationale: Peak flow <60% indicates moderate to severe
exacerbation requiring rapid bronchodilation with a SABA.
2. A patient with COPD has chronic sputum production and a chronic
productive cough for 3 consecutive months over 2 years. What COPD
phenotype is most consistent?
• Emphysema
• Chronic bronchitis
• Mixed COPD
• Asthma-COPD overlap
Rationale: Chronic bronchitis is defined by chronic productive
cough for ≥3 months in 2 consecutive years.
,3. Which diagnostic test confirms asthma when spirometry is
nondiagnostic?
• Chest CT
• FeNO test
• Chest X-ray
• Methacholine challenge
Rationale: Methacholine challenge tests airway
hyperresponsiveness and is used when spirometry results are
borderline or normal.
4. A COPD patient’s FEV1/FVC ratio is <0.70 post-bronchodilator.
What does this finding indicate?
• Restrictive lung disease
• Normal lung function
• Asthma only
• Airflow limitation consistent with COPD
Rationale: Post-bronchodilator FEV1/FVC <0.70 confirms
persistent airflow obstruction characteristic of COPD.
5. First-line controller therapy for persistent asthma in adults is:
• SABA alone
• LAMA
• Low-dose inhaled corticosteroid
, • Oral prednisone
Rationale: ICS are the cornerstone of persistent asthma
management.
6. A smoker presents with digital clubbing and bibasilar crackles.
What condition is most likely?
• Acute bronchitis
• Asthma
• Interstitial lung disease
• Chronic sinusitis
Rationale: ILD commonly presents with clubbing and fine
inspiratory crackles.
7. A patient with pneumonia has rusty-colored sputum. What
organism is most likely?
• Mycoplasma pneumoniae
• Legionella
• Streptococcus pneumoniae
• Klebsiella pneumoniae
Rationale: Rust-colored sputum is classically associated with S.
pneumoniae.
8. What is the first-line treatment for community-acquired pneumonia
in a healthy adult with no comorbidities?
• Clindamycin
, • Amoxicillin or doxycycline
• Ceftriaxone alone
• Vancomycin
Rationale: Guidelines recommend amoxicillin or doxycycline for
low-risk CAP in healthy adults.
9. Which COPD stage corresponds to FEV1 <50% predicted?
• GOLD 1
• GOLD 2
• GOLD 3
• GOLD 4
Rationale: GOLD 3 = severe airflow limitation with FEV1 30–49%
predicted.
10. A patient reports nighttime asthma symptoms 3–4 times per
week. What severity classification applies?
• Mild intermittent
• Moderate persistent
• Severe persistent
• Mild persistent
Rationale: Nighttime symptoms >1×/week but not nightly
suggest moderate persistent asthma.
– 150 Clinical Questions & Answers (1–150)
2025/2026
1. A 45-year-old patient presents with acute shortness of b
reath, wheezing, and chest tightness. Peak flow is 55% of personal
best. What is the most appropriate next step?
• Increase inhaled corticosteroid dose
• Administer a short-acting bronchodilator immediately
• Start leukotriene receptor antagonist
• Order a chest X-ray
Rationale: Peak flow <60% indicates moderate to severe
exacerbation requiring rapid bronchodilation with a SABA.
2. A patient with COPD has chronic sputum production and a chronic
productive cough for 3 consecutive months over 2 years. What COPD
phenotype is most consistent?
• Emphysema
• Chronic bronchitis
• Mixed COPD
• Asthma-COPD overlap
Rationale: Chronic bronchitis is defined by chronic productive
cough for ≥3 months in 2 consecutive years.
,3. Which diagnostic test confirms asthma when spirometry is
nondiagnostic?
• Chest CT
• FeNO test
• Chest X-ray
• Methacholine challenge
Rationale: Methacholine challenge tests airway
hyperresponsiveness and is used when spirometry results are
borderline or normal.
4. A COPD patient’s FEV1/FVC ratio is <0.70 post-bronchodilator.
What does this finding indicate?
• Restrictive lung disease
• Normal lung function
• Asthma only
• Airflow limitation consistent with COPD
Rationale: Post-bronchodilator FEV1/FVC <0.70 confirms
persistent airflow obstruction characteristic of COPD.
5. First-line controller therapy for persistent asthma in adults is:
• SABA alone
• LAMA
• Low-dose inhaled corticosteroid
, • Oral prednisone
Rationale: ICS are the cornerstone of persistent asthma
management.
6. A smoker presents with digital clubbing and bibasilar crackles.
What condition is most likely?
• Acute bronchitis
• Asthma
• Interstitial lung disease
• Chronic sinusitis
Rationale: ILD commonly presents with clubbing and fine
inspiratory crackles.
7. A patient with pneumonia has rusty-colored sputum. What
organism is most likely?
• Mycoplasma pneumoniae
• Legionella
• Streptococcus pneumoniae
• Klebsiella pneumoniae
Rationale: Rust-colored sputum is classically associated with S.
pneumoniae.
8. What is the first-line treatment for community-acquired pneumonia
in a healthy adult with no comorbidities?
• Clindamycin
, • Amoxicillin or doxycycline
• Ceftriaxone alone
• Vancomycin
Rationale: Guidelines recommend amoxicillin or doxycycline for
low-risk CAP in healthy adults.
9. Which COPD stage corresponds to FEV1 <50% predicted?
• GOLD 1
• GOLD 2
• GOLD 3
• GOLD 4
Rationale: GOLD 3 = severe airflow limitation with FEV1 30–49%
predicted.
10. A patient reports nighttime asthma symptoms 3–4 times per
week. What severity classification applies?
• Mild intermittent
• Moderate persistent
• Severe persistent
• Mild persistent
Rationale: Nighttime symptoms >1×/week but not nightly
suggest moderate persistent asthma.
