ADULT-GERONTOLOGY ACUTE CARE NURSE
PRACTITIONER (AGACNP)/PRACTICE TEST 2022/2023
1.You are seeing JR for complaints of shortness of breath. He was seen in urgent care, no medications
were started other than an inhaler, he doesn't know the name and forgot to bring it. You tell him you
are going to order Pulmonary Function tests. He asks you what for? Can't you treat me without doing
that? What is your response?
(correct answers)- Pulmonary function testing is obtained for a few reasons, one of which being
assigning a diagnosis, which guides the course of treatment so we know we are doing the right
interventions. A conversation with your patient may include: You were seen in urgent care and are now
here for shortness of breath, but why are you short of breath? We will find this out by doing pulmonary
function tests, or PFT's. We will then initiate a treatment plan based on your diagnosis and will then use
PFT's to evaluate how well the treatment is working for you and whether we can continue on with that
or change it based on the findings.
*Remember, shortness of breath can indicate a disease process that can include the heart, the lungs and
even a psycosomatic illness. It is important to establish a baseline of lung function. If the patient has had
PFTs in the past, comparison of studies can help you decide your course of action.*
2.You are reviewing PFT results. You determine Marybell has normal lung volumes/flow rates. This
means she has achieved what percentage of predicted values? What percentage of predicted values is
considered severely reduced?
(correct answers)- Marybell has achieved >70% of predicted volumes. Severely reduced predicted values
is <50% of predicted volumes.
3.A decrease in both FEV1 and FEV1/FVC ratio is an obstructive or restrictive disorder? A normal
FEV1/FVC ratio is an obstructive or restrictive disorder?
(correct answers)- A decrease in both FEV1 and FEV1/FVC ratio is seen in obstructive disorders. A normal
FEV1/FVC ratio is seen in restrictive disorders.
(Pay particular attention to what are PFT results for obstructive and restrictive diseases.
Know how to diagnose asthma, medications and patient self monitoring.)
4.What is the mechanism of resistance particularly in infections caused by H. Influenza. How can this be
overcome?
(correct answers)Beta-lactams is the primary mechanism of resistance among H. influenzae and is a
well-known predictor of treatment failure in community acquired respiratory tract infections. This can
be overcome with the use of B-lactamase-stable cephalosporins in part.
,(Make sure you know this. Following up on your patient's culture and sensitivity reports are crucial for
appropriate therapy.)
5.What are common pharmacological therapies for influenza B?
(correct answers)Zanamivir (Relenza) 10 mg (two inhalations BID) or oseltamivir (Tamiflue) 75 mg BID x
5 days. Initiate within 48 hours of symptom onset.
6.What are possible differential diagnoses for a patient with a lower respiratory tract infection?
(correct answers)Pneumonia, post-nasal drip syndrome, GERD, asthma, ACE-I use, HF, pulmonary
embolism (PE), lung cancer
(If pneumonia is high on your differentials, look closely at the CXR and infiltrates to assess for possible
aspiration pneumonia.
If you suspect PE, does the patient have a PMH of DVT? You would want to look for one if you diagnose
a PE.)
7.You are treating a 63 year old male with a long history of smoking, for dyspnea. What diagnostic tests
would you order?
(correct answers)Start with CXR, PA and lateral. Pulmonary Functions studies (complete) is the
diagnostic test of choice, given his history.
*Continued from previous question...
8.The patient does not wish to take any new medications. What non pharmacological treatments would
you suggest?
(correct answers)Smoking cessation - difficult to achieve
Behavioral modification techniques
Nicotine replacement therapy including gum, lozenges and transdermal patches. All are available over
the counter. Pharmacological smoking cessation aids include Bupropion (Zyban) 150 mg daily x 3 days
then BID for 7-12 weeks. Varenicline (Chantix) is available in a starter pack then give 1 mg BID for 8-16
additional weeks.
E-cigarettes - the effectiveness and safety as a smoking cessation is uncertain at present. This patient
has apparently stopped smoking. He will need surveillance to make sure his smoking cessation is
continued
Non-pharmacological therapy provided with heated or cooled aerosols of water in combination with
chest physiotherapy may help thin secretions. While this may be effective, it cannot be done alone. He
will need assistance with:
, Percussion and postural drainage are controversial in the management of COPD but same patients may
benefit
Assess social and family support available to the patient and impact of the disease on their life
Pulmonary Rehab - improves dyspnea, health status and exercise tolerance. It decreases
hospitalizations. Pulmonary rehab should be considered with all diagnoses of COPD
Self-management intervention with a provider decreases ER visits and hospitalizations. Education alone
does not achieve the same result.
Oxygen Therapy - long term administration of oxygen in patients with severe chronic resting hypoxemia
increases survival. Patients with mild COPD will unlikely need oxygen but it is considered a non
pharmacological therapy
9.You are reviewing PFT results of a COPD patient. John has an FEV1 that shows 38% of predicted value.
How would you classify his COPD?
(correct answers)Refer to GOLD Global Initiative for Chronic Lung Disease
GOLD 1: Mild-FEV, 80% or greater of predicted
GOLD II: Moderate-50% or less FEV1, less than 80% predicted
GOLD III: Severe-30% or less FEV1, less than 50% predicted
GOLD IV: Very severe-FEV1 less than 30% predicted
What medications should he be on? (correct answers)Long acting broncho dilators and inhaled
corticosteroids
Describe the treatment plans for a mild, moderate and severe COPD exacerbations. (correct
answers)Mild - treated with short acting bronchodilators only, (SABDs)
Moderate - treated with SABDs plus antibiotics and/or oral corticosteroids
Severe - Patients require hospitalization or ER visit. Severe exacerbations can lead to respiratory failure.
Decision to treat inpatient or outpatient should be based on patient's severity of symptoms and
comorbidities. Refer to corticosteroid section for typical doses given for COPD exacerbations.
What is the treatment plan for a patient with intermittent asthma? (correct answers)Refer to the
Stepwise management of Asthma
PRACTITIONER (AGACNP)/PRACTICE TEST 2022/2023
1.You are seeing JR for complaints of shortness of breath. He was seen in urgent care, no medications
were started other than an inhaler, he doesn't know the name and forgot to bring it. You tell him you
are going to order Pulmonary Function tests. He asks you what for? Can't you treat me without doing
that? What is your response?
(correct answers)- Pulmonary function testing is obtained for a few reasons, one of which being
assigning a diagnosis, which guides the course of treatment so we know we are doing the right
interventions. A conversation with your patient may include: You were seen in urgent care and are now
here for shortness of breath, but why are you short of breath? We will find this out by doing pulmonary
function tests, or PFT's. We will then initiate a treatment plan based on your diagnosis and will then use
PFT's to evaluate how well the treatment is working for you and whether we can continue on with that
or change it based on the findings.
*Remember, shortness of breath can indicate a disease process that can include the heart, the lungs and
even a psycosomatic illness. It is important to establish a baseline of lung function. If the patient has had
PFTs in the past, comparison of studies can help you decide your course of action.*
2.You are reviewing PFT results. You determine Marybell has normal lung volumes/flow rates. This
means she has achieved what percentage of predicted values? What percentage of predicted values is
considered severely reduced?
(correct answers)- Marybell has achieved >70% of predicted volumes. Severely reduced predicted values
is <50% of predicted volumes.
3.A decrease in both FEV1 and FEV1/FVC ratio is an obstructive or restrictive disorder? A normal
FEV1/FVC ratio is an obstructive or restrictive disorder?
(correct answers)- A decrease in both FEV1 and FEV1/FVC ratio is seen in obstructive disorders. A normal
FEV1/FVC ratio is seen in restrictive disorders.
(Pay particular attention to what are PFT results for obstructive and restrictive diseases.
Know how to diagnose asthma, medications and patient self monitoring.)
4.What is the mechanism of resistance particularly in infections caused by H. Influenza. How can this be
overcome?
(correct answers)Beta-lactams is the primary mechanism of resistance among H. influenzae and is a
well-known predictor of treatment failure in community acquired respiratory tract infections. This can
be overcome with the use of B-lactamase-stable cephalosporins in part.
,(Make sure you know this. Following up on your patient's culture and sensitivity reports are crucial for
appropriate therapy.)
5.What are common pharmacological therapies for influenza B?
(correct answers)Zanamivir (Relenza) 10 mg (two inhalations BID) or oseltamivir (Tamiflue) 75 mg BID x
5 days. Initiate within 48 hours of symptom onset.
6.What are possible differential diagnoses for a patient with a lower respiratory tract infection?
(correct answers)Pneumonia, post-nasal drip syndrome, GERD, asthma, ACE-I use, HF, pulmonary
embolism (PE), lung cancer
(If pneumonia is high on your differentials, look closely at the CXR and infiltrates to assess for possible
aspiration pneumonia.
If you suspect PE, does the patient have a PMH of DVT? You would want to look for one if you diagnose
a PE.)
7.You are treating a 63 year old male with a long history of smoking, for dyspnea. What diagnostic tests
would you order?
(correct answers)Start with CXR, PA and lateral. Pulmonary Functions studies (complete) is the
diagnostic test of choice, given his history.
*Continued from previous question...
8.The patient does not wish to take any new medications. What non pharmacological treatments would
you suggest?
(correct answers)Smoking cessation - difficult to achieve
Behavioral modification techniques
Nicotine replacement therapy including gum, lozenges and transdermal patches. All are available over
the counter. Pharmacological smoking cessation aids include Bupropion (Zyban) 150 mg daily x 3 days
then BID for 7-12 weeks. Varenicline (Chantix) is available in a starter pack then give 1 mg BID for 8-16
additional weeks.
E-cigarettes - the effectiveness and safety as a smoking cessation is uncertain at present. This patient
has apparently stopped smoking. He will need surveillance to make sure his smoking cessation is
continued
Non-pharmacological therapy provided with heated or cooled aerosols of water in combination with
chest physiotherapy may help thin secretions. While this may be effective, it cannot be done alone. He
will need assistance with:
, Percussion and postural drainage are controversial in the management of COPD but same patients may
benefit
Assess social and family support available to the patient and impact of the disease on their life
Pulmonary Rehab - improves dyspnea, health status and exercise tolerance. It decreases
hospitalizations. Pulmonary rehab should be considered with all diagnoses of COPD
Self-management intervention with a provider decreases ER visits and hospitalizations. Education alone
does not achieve the same result.
Oxygen Therapy - long term administration of oxygen in patients with severe chronic resting hypoxemia
increases survival. Patients with mild COPD will unlikely need oxygen but it is considered a non
pharmacological therapy
9.You are reviewing PFT results of a COPD patient. John has an FEV1 that shows 38% of predicted value.
How would you classify his COPD?
(correct answers)Refer to GOLD Global Initiative for Chronic Lung Disease
GOLD 1: Mild-FEV, 80% or greater of predicted
GOLD II: Moderate-50% or less FEV1, less than 80% predicted
GOLD III: Severe-30% or less FEV1, less than 50% predicted
GOLD IV: Very severe-FEV1 less than 30% predicted
What medications should he be on? (correct answers)Long acting broncho dilators and inhaled
corticosteroids
Describe the treatment plans for a mild, moderate and severe COPD exacerbations. (correct
answers)Mild - treated with short acting bronchodilators only, (SABDs)
Moderate - treated with SABDs plus antibiotics and/or oral corticosteroids
Severe - Patients require hospitalization or ER visit. Severe exacerbations can lead to respiratory failure.
Decision to treat inpatient or outpatient should be based on patient's severity of symptoms and
comorbidities. Refer to corticosteroid section for typical doses given for COPD exacerbations.
What is the treatment plan for a patient with intermittent asthma? (correct answers)Refer to the
Stepwise management of Asthma
