Exam 1 FNP 511 questions and answers graded A+

Exam 1 FNP 511 questions and answers graded A+ 5. 600 A 67-year-old woman with a 30-pack-year history of smoking presents for a routine annual physical examination. She complains of being easily short of breath and is frequently fatigued. Physical examination reveals diminished breath sounds, hyperresonance, and hypertrophied respiratory accessory muscles. Her complete blood count (CBC) results reveal that her hematocrit level is elevated. Her pulmonary function test (PFT) results show increased total lung capacity. Which diagnosis is most likely? A. Bronchogenic carcinoma B. Chronic obstructive pulmonary disease (COPD) C. Chronic bronchitis D. Congestive heart failure Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1210). Springer Publishing Company. Kindle Edition. B) Chronic obstructive pulmonary disease (COPD). COPD is a progressive lung disease that includes emphysema and chronic bronchitis. The most common risk factor for COPD is long-term cigarette smoking (80%-90%). Another cause is alpha-1 antitrypsin deficiency and chronic fume exposure. The three cardinal symptoms of COPD are dyspnea, chronic cough, and sputum production. The lungs are hyperinflated, which changes the shape of the chest and diaphragm, making the mechanics of breathing more difficult. Excess mucus and obstructed airflow from progressive thickening and stiffening of the airways diminish breath sounds. COPD creates a high hematocrit percentage because of chronic hypoxemia. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (pp. ). Springer Publishing Company. Kindle Edition. A middle-aged hypertensive man presents to the public health clinic with complaints of an acute onset of fever, chills, and cough that is productive of rusty-colored sputum. The patient reports episodes of sharp pains on the left side of his back and chest whenever he is coughing. His temperature is 102.2°F, pulse is 100 beats/min, and blood pressure is 130/80 mmHg. The urinalysis does not show leukocytes, nitrites, or blood. These findings are most consistent with: A. Atypical pneumonia B. Upper urinary tract infection C. Bacterial pneumonia D. Acute pyelonephritis Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1214). Springer Publishing Company. Kindle Edition. C) Bacterial pneumonia. The most common cause of bacterial pneumonia is Streptococcus pneumoniae. Haemophilus influenzae, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila are other bacteria that cause pneumonia. Typically, pneumonia comes on very quickly; the patient has high fever/chills, productive cough with yellow or brown sputum, and shortness of breath, and may have chest pain with breathing/coughing. The gold standard for diagnosing bacterial pneumonia is the chest x-ray, which shows infiltrates and/or lobar consolidation. Older people can have confusion or a change in their mental abilities. In patients with bacterial pneumonia, it is important to determine whether bacteria are present in the urine, in order to identify appropriate antibiotics to treat the bacteria. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1258). Springer Publishing Company. Kindle Edition. A patient has been taking albuterol via a metered-dose inhaler for a month and remains in the yellow zone. Which of the following statements is true? A. Medication should be lowered to produce desired effects B. The patient is at 50% to 80% of their personal best C. The patient is at 80% to 100% of their personal best D. Current medication dosage places the patient at risk for hypoxia Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1228). Springer Publishing Company. Kindle Edition. B) The patient is at 50% to 80% of their personal best. Spirometer readings are used to assess a patient's personal best. The green zone is in the range of 80% to 100% expected volume, the yellow zone is in the range of 50% to 80% expected volume, and the red zone is below 50% of expected volume, which would place the patient at risk for hypoxia. The medication would need to be adjusted, but not lowered, to produce desired effects. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1272). Springer Publishing Company. Kindle Edition. What is the priority treatment for a patient who presents with an asthma exacerbation? A. Prescribe albuterol PRN B. Teach patient how to properly use a spacer C. Assess asthma triggers D. Apply nebulizer treatment Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1237). Springer Publishing Company. Kindle Edition. D) Apply nebulizer treatment. The priority treatment for a patient with an asthma exacerbation is a nebulizer treatment every 20 minutes as needed. Additionally, a short course of oral corticosteroids may be prescribed after an exacerbation or, if the patient is not currently prescribed one, a low-dose 635inhaled corticosteroid (ICS) or long-acting beta2-agonist (LABA) such as albuterol. Assessing triggers and providing teaching on the use of a spacer can be completed after the patient has been stabilized. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1281). Springer Publishing Company. Kindle Edition. A middle-aged female patient with a history of rheumatoid arthritis reports to the nurse practitioner that she had been taking ibuprofen twice daily for many years. All of the following organ systems are at risk of damage from chronic nonsteroidal anti-inflammatory drug (NSAID) use, except: A. Cardiovascular system B. Respiratory system C. Gastrointestinal system D. Renal system Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1244). Springer Publishing Company. Kindle Edition. B) Respiratory system. Chronic use of NSAIDs is associated with increased risk of ulcers, perforation, bleeding of the gastrointestinal tract, heart attacks, cardiovascular damage, strokes, acute 638interstitial nephritis and kidney injury, and liver damage. It does not affect the lungs or the pulmonary system. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1288). Springer Publishing Company. Kindle Edition. 12. 645 A 67-year-old female patient complains of progressive dyspnea, minimal cough, and a 10-lb weight loss over the past 3 months. The nurse practitioner notes decreased posterior breath sounds, the use of accessory muscles to breathe, temperature of 98.8°F, and respirations of 24 breaths/minute. The nurse practitioner suspects: A. Emphysema B. Chronic bronchitis C. Respiratory infection D. Pneumonia Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (pp. ). Springer Publishing Company. Kindle Edition. A) Emphysema. Emphysema presents with shortness of breath, minimal cough, and decreased heart and lung sounds. Patients use pursed-lip breathing, and use of accessory muscles is prominent. Chronic bronchitis is characterized by a productive cough, wheezing, and coarse crackles. A respiratory infection and/or pneumonia presents with fever and new onset of symptoms. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1344). Springer Publishing Company. Kindle Edition. Which first-line treatment should be administered when treating a patient with chronic obstructive pulmonary disease (COPD) category C? A. Long-acting muscarinic agonist (LAMA) B. Short-acting beta2-agonist (SABA) C. Long-acting beta2-agonist (LABA) D. Short-acting muscarinic agonist (SAMA) Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1303). Springer Publishing Company. Kindle Edition. A) Long-acting muscarinic agonist (LAMA). LAMA is the first line of treatment for chronic obstructive pulmonary disease (COPD) in category C. For category A, a SABA is recommended. A LABA is used for category B. SAMA only blocks the muscarinic effects. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1347). Springer Publishing Company. Kindle Edition. Which of the following antihypertensive medications should the nurse practitioner avoid when treating patients with emphysema? A. Calcium channel blockers B. Angiotensin-converting enzyme (ACE) inhibitors C. Beta-blockers D. Diuretics C) Beta-blockers. Beta-blockers should be avoided in patients with a history of emphysema. Studies have shown evidence of a reduction in forced expiratory volume in 1 second (FEV1), increased airway hyperresponsiveness, and inhibition of bronchodilator response to beta agonists in patients receiving beta-blockers. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1450). Springer Publishing Company. Kindle Edition. A adult student is seen in the school health clinic with complaints of a hacking nonproductive cough, rhinorrhea, pharyngitis, and malaise for the past 2 weeks. He does not take any medications, denies any allergies, and has no significant medical history. Physical examination reveals a low-grade temperature of 99.9°F, respirations of 16 breaths/min, pulse of 90 beats/min, and scattered rales and wheezing of the lungs. The patient does not appear toxic. The total white blood cell count is 10,500/μL. Which diagnosis is most likely? A. Bacterial pneumonia B. Atypical pneumonia C. Acute bronchitis D. Pertussis Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1431). Springer Publishing Company. Kindle Edition. B) Atypical pneumonia. The most common organism causing community-acquired atypical pneumonia is Mycoplasma pneumoniae, an atypical bacterium. The populations with the highest infection rates are college students, school-age children, and military recruits. Respiratory symptoms (cough) are accompanied by pharyngitis, rhinorrhea, and sometimes ear pain. It is easily spread from aerosol droplets. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1479). Springer Publishing Company. Kindle Edition. A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week. The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner upgrades the patient to the next stage of treatment, which includes: A. Budesonide with formoterol B. Budesonide with montelukast C. Cromolyn or nedocromil D. Fluticasone with salmeterol Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1499). Springer Publishing Company. Kindle Edition. D) Fluticasone with salmeterol. The patient has moved from step 2 to step 3 on the asthma classification scale; therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1551). Springer Publishing Company. Kindle Edition. 142. All of the following pharmacologic agents are used to treat inflammation in the lungs of asthmatic patients, except: A. Nedocromil sodium (Tilade) two sprays QID B. Cromolyn sodium inhaler (Intal) two puffs QID C. Long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours D. Fluticasone inhaler (Flovent) two puffs BID C) Long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours. Theophylline is used to control inflammation of the lungs. Nedocromil sodium (Tilade), cromolyn sodium (Intal), and fluticasone inhaler (Flovent) help to treat inflammation. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1582). Springer Publishing Company. Kindle Edition. A chest radiograph shows an area of consolidation on the lower lobe of the lung. Which of the following conditions is most likely? A. Bacterial pneumonia B. Acute bronchitis C. Chronic obstructive pulmonary disease (COPD) Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1537). Springer Publishing Company. Kindle Edition. A) Bacterial pneumonia. Pneumonia is an inflammatory condition of the lung especially affecting the alveoli. It is associated with fever, chest symptoms, and consolidation on a chest x-ray. Infectious agents include bacteria, viruses, fungi, and parasites. Consolidation is not present in the lungs with bronchitis, COPD, or atypical pneumonia. Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Fourth Edition (p. 1588). Springer Publishing Company. Kindle Edition.