NURS 620 ADULT HEALTH I EXAM 2 2026/2027 | Maryville
University | 100% Verified | AGPCNP Track | Pass Guaranteed
- A+ Graded
SECTION 1: RESPIRATORY DISORDERS - PNEUMONIA, COPD,
ASTHMA & PULMONARY DIAGNOSTICS (Q1-15)
Q1. A 68-year-old male presents with fever, productive cough with rust-colored sputum,
and pleuritic chest pain for 3 days. Chest X-ray shows right lower lobe consolidation.
Vital signs: T 101.8°F, HR 102, RR 24, BP 128/76, SpO2 92% on room air. He has no
recent hospitalization. Which organism is most likely responsible?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae [CORRECT]
C. Staphylococcus aureus
D. Haemophilus influenzae
Correct Answer: B. Streptococcus pneumoniae [CORRECT]
Rationale: Streptococcus pneumoniae is the most common cause of
community-acquired pneumonia (CAP) in adults, especially in older patients with lobar
consolidation. Option A (Pseudomonas) is typical of hospital-acquired pneumonia.
Option C (Staph aureus) is associated with post-influenza pneumonia or
healthcare-associated infections. Option D (H. influenzae) is more common in COPD
patients but less likely than S. pneumoniae in this classic CAP presentation.
Q2. A 72-year-old female is admitted to the hospital for pneumonia and develops fever
on day 5 of hospitalization with worsening oxygenation. She was initially improving on
,ceftriaxone and azithromycin. Which pathogen should the AGPCNP suspect, and what is
the most appropriate empiric antibiotic adjustment?
A. MRSA; add vancomycin only
B. Pseudomonas aeruginosa; switch to piperacillin-tazobactam [CORRECT]
C. Legionella pneumophila; continue current regimen
D. Streptococcus pneumoniae; increase ceftriaxone dose
Correct Answer: B. Pseudomonas aeruginosa; switch to piperacillin-tazobactam
[CORRECT]
Rationale: Hospital-acquired pneumonia (HAP) developing after 48 hours of
hospitalization raises concern for Pseudomonas and MRSA. Pseudomonas coverage
with an anti-pseudomonal beta-lactam (piperacillin-tazobactam) is essential. Option A
misses Pseudomonas coverage. Option C is incorrect as Legionella is a CAP pathogen.
Option D fails to address the changing epidemiology of HAP.
Q3. A 55-year-old male with a 40 pack-year smoking history presents with progressive
dyspnea, chronic cough, and frequent exacerbations. Spirometry shows FEV1/FVC 0.62,
FEV1 45% predicted, with minimal reversibility after bronchodilator. According to GOLD
2024 classification, what is his COPD category, and what is the recommended initial
pharmacotherapy?
A. GOLD 2 (Moderate); LABA monotherapy
B. GOLD 3 (Severe); LAMA monotherapy
C. GOLD 3 (Severe); LABA + LAMA combination [CORRECT]
D. GOLD 4 (Very Severe); triple therapy (ICS/LABA/LAMA)
Correct Answer: C. GOLD 3 (Severe); LABA + LAMA combination [CORRECT]
Rationale: FEV1 30-49% predicted = GOLD 3 (Severe). FEV1/FVC <0.70 confirms
obstruction. Minimal reversibility supports COPD over asthma. GOLD 2024
recommends LABA + LAMA for Group E (frequent exacerbations) or symptomatic GOLD
3 patients. Option A understates severity. Option B is insufficient for symptomatic
,severe COPD. Option D (triple therapy) is reserved for frequent exacerbators despite
dual bronchodilation or eosinophilic phenotype.
Q4. A 62-year-old female with COPD (FEV1 52% predicted) has had two moderate
exacerbations in the past year requiring oral steroids but no hospitalizations. She
reports daily dyspnea and limited activity. What is her GOLD 2024 group classification,
and what is the preferred initial pharmacologic strategy?
A. Group A; short-acting bronchodilator PRN
B. Group B; LAMA or LABA monotherapy
C. Group D; LABA + LAMA [CORRECT]
D. Group C; LAMA monotherapy
Correct Answer: C. Group D; LABA + LAMA [CORRECT]
Rationale: GOLD 2024 classification: mMRC ≥2 or CAT ≥10 = high symptom burden (B or
D). Two moderate exacerbations = high exacerbation risk (C or D). Combined = Group D.
Initial therapy for Group D is LABA + LAMA. Option A and B are for lower-risk groups.
Option D (Group C) is for low symptom burden with high exacerbation risk.
Q5. A 28-year-old female with asthma presents for follow-up. She uses her albuterol
inhaler 4-5 times per week for rescue and wakes up with nocturnal symptoms 2-3 nights
per month. Her ACT score is 18. She is currently on low-dose ICS monotherapy.
According to GINA 2024 guidelines, what is the next appropriate step in therapy?
A. Continue low-dose ICS; add LABA as needed
B. Step up to medium-dose ICS monotherapy
C. Step up to low-dose ICS-formoterol (maintenance and reliever therapy) [CORRECT]
D. Add LTRA (montelukast) to current ICS
Correct Answer: C. Step up to low-dose ICS-formoterol (maintenance and reliever
therapy) [CORRECT]
, Rationale: ACT score 18 indicates poorly controlled asthma. GINA 2024 Track 1
recommends ICS-formoterol as both maintenance and reliever (MART) for Step 3, which
is preferred over ICS/LABA with SABA reliever. Option A maintains inadequate control.
Option B is less effective than MART. Option D (LTRA) has inferior efficacy and safety
concerns (neuropsychiatric effects).
Q6. A 45-year-old male with asthma is prescribed a new inhaler. The AGPCNP teaches
him proper technique. Which statement by the patient indicates correct understanding
of dry powder inhaler (DPI) use?
A. "I should shake the inhaler vigorously before each use."
B. "I need to breathe out fully, then inhale quickly and deeply through the device."
[CORRECT]
C. "I should use a spacer with this inhaler to improve drug delivery."
D. "I need to hold my breath for 2 seconds after inhaling the medication."
Correct Answer: B. "I need to breathe out fully, then inhale quickly and deeply through
the device." [CORRECT]
Rationale: DPIs require a rapid, forceful inhalation to de-aggregate the powder. Option A
describes MDI technique. Option C (spacer) is for MDIs, not DPIs. Option D is
insufficient; patients should hold their breath for 10 seconds after DPI inhalation.
Q7. A 38-year-old female presents with wheezing, cough, and dyspnea. Spirometry
shows FEV1/FVC 0.68, FEV1 72% predicted. After bronchodilator, FEV1 improves to 84%
predicted (reversibility 16.7%). Which diagnosis is most consistent with these findings?
A. COPD (GOLD 2)
B. Asthma [CORRECT]
C. Restrictive lung disease
D. Mixed obstructive-restrictive disease
Correct Answer: B. Asthma [CORRECT]
University | 100% Verified | AGPCNP Track | Pass Guaranteed
- A+ Graded
SECTION 1: RESPIRATORY DISORDERS - PNEUMONIA, COPD,
ASTHMA & PULMONARY DIAGNOSTICS (Q1-15)
Q1. A 68-year-old male presents with fever, productive cough with rust-colored sputum,
and pleuritic chest pain for 3 days. Chest X-ray shows right lower lobe consolidation.
Vital signs: T 101.8°F, HR 102, RR 24, BP 128/76, SpO2 92% on room air. He has no
recent hospitalization. Which organism is most likely responsible?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae [CORRECT]
C. Staphylococcus aureus
D. Haemophilus influenzae
Correct Answer: B. Streptococcus pneumoniae [CORRECT]
Rationale: Streptococcus pneumoniae is the most common cause of
community-acquired pneumonia (CAP) in adults, especially in older patients with lobar
consolidation. Option A (Pseudomonas) is typical of hospital-acquired pneumonia.
Option C (Staph aureus) is associated with post-influenza pneumonia or
healthcare-associated infections. Option D (H. influenzae) is more common in COPD
patients but less likely than S. pneumoniae in this classic CAP presentation.
Q2. A 72-year-old female is admitted to the hospital for pneumonia and develops fever
on day 5 of hospitalization with worsening oxygenation. She was initially improving on
,ceftriaxone and azithromycin. Which pathogen should the AGPCNP suspect, and what is
the most appropriate empiric antibiotic adjustment?
A. MRSA; add vancomycin only
B. Pseudomonas aeruginosa; switch to piperacillin-tazobactam [CORRECT]
C. Legionella pneumophila; continue current regimen
D. Streptococcus pneumoniae; increase ceftriaxone dose
Correct Answer: B. Pseudomonas aeruginosa; switch to piperacillin-tazobactam
[CORRECT]
Rationale: Hospital-acquired pneumonia (HAP) developing after 48 hours of
hospitalization raises concern for Pseudomonas and MRSA. Pseudomonas coverage
with an anti-pseudomonal beta-lactam (piperacillin-tazobactam) is essential. Option A
misses Pseudomonas coverage. Option C is incorrect as Legionella is a CAP pathogen.
Option D fails to address the changing epidemiology of HAP.
Q3. A 55-year-old male with a 40 pack-year smoking history presents with progressive
dyspnea, chronic cough, and frequent exacerbations. Spirometry shows FEV1/FVC 0.62,
FEV1 45% predicted, with minimal reversibility after bronchodilator. According to GOLD
2024 classification, what is his COPD category, and what is the recommended initial
pharmacotherapy?
A. GOLD 2 (Moderate); LABA monotherapy
B. GOLD 3 (Severe); LAMA monotherapy
C. GOLD 3 (Severe); LABA + LAMA combination [CORRECT]
D. GOLD 4 (Very Severe); triple therapy (ICS/LABA/LAMA)
Correct Answer: C. GOLD 3 (Severe); LABA + LAMA combination [CORRECT]
Rationale: FEV1 30-49% predicted = GOLD 3 (Severe). FEV1/FVC <0.70 confirms
obstruction. Minimal reversibility supports COPD over asthma. GOLD 2024
recommends LABA + LAMA for Group E (frequent exacerbations) or symptomatic GOLD
3 patients. Option A understates severity. Option B is insufficient for symptomatic
,severe COPD. Option D (triple therapy) is reserved for frequent exacerbators despite
dual bronchodilation or eosinophilic phenotype.
Q4. A 62-year-old female with COPD (FEV1 52% predicted) has had two moderate
exacerbations in the past year requiring oral steroids but no hospitalizations. She
reports daily dyspnea and limited activity. What is her GOLD 2024 group classification,
and what is the preferred initial pharmacologic strategy?
A. Group A; short-acting bronchodilator PRN
B. Group B; LAMA or LABA monotherapy
C. Group D; LABA + LAMA [CORRECT]
D. Group C; LAMA monotherapy
Correct Answer: C. Group D; LABA + LAMA [CORRECT]
Rationale: GOLD 2024 classification: mMRC ≥2 or CAT ≥10 = high symptom burden (B or
D). Two moderate exacerbations = high exacerbation risk (C or D). Combined = Group D.
Initial therapy for Group D is LABA + LAMA. Option A and B are for lower-risk groups.
Option D (Group C) is for low symptom burden with high exacerbation risk.
Q5. A 28-year-old female with asthma presents for follow-up. She uses her albuterol
inhaler 4-5 times per week for rescue and wakes up with nocturnal symptoms 2-3 nights
per month. Her ACT score is 18. She is currently on low-dose ICS monotherapy.
According to GINA 2024 guidelines, what is the next appropriate step in therapy?
A. Continue low-dose ICS; add LABA as needed
B. Step up to medium-dose ICS monotherapy
C. Step up to low-dose ICS-formoterol (maintenance and reliever therapy) [CORRECT]
D. Add LTRA (montelukast) to current ICS
Correct Answer: C. Step up to low-dose ICS-formoterol (maintenance and reliever
therapy) [CORRECT]
, Rationale: ACT score 18 indicates poorly controlled asthma. GINA 2024 Track 1
recommends ICS-formoterol as both maintenance and reliever (MART) for Step 3, which
is preferred over ICS/LABA with SABA reliever. Option A maintains inadequate control.
Option B is less effective than MART. Option D (LTRA) has inferior efficacy and safety
concerns (neuropsychiatric effects).
Q6. A 45-year-old male with asthma is prescribed a new inhaler. The AGPCNP teaches
him proper technique. Which statement by the patient indicates correct understanding
of dry powder inhaler (DPI) use?
A. "I should shake the inhaler vigorously before each use."
B. "I need to breathe out fully, then inhale quickly and deeply through the device."
[CORRECT]
C. "I should use a spacer with this inhaler to improve drug delivery."
D. "I need to hold my breath for 2 seconds after inhaling the medication."
Correct Answer: B. "I need to breathe out fully, then inhale quickly and deeply through
the device." [CORRECT]
Rationale: DPIs require a rapid, forceful inhalation to de-aggregate the powder. Option A
describes MDI technique. Option C (spacer) is for MDIs, not DPIs. Option D is
insufficient; patients should hold their breath for 10 seconds after DPI inhalation.
Q7. A 38-year-old female presents with wheezing, cough, and dyspnea. Spirometry
shows FEV1/FVC 0.68, FEV1 72% predicted. After bronchodilator, FEV1 improves to 84%
predicted (reversibility 16.7%). Which diagnosis is most consistent with these findings?
A. COPD (GOLD 2)
B. Asthma [CORRECT]
C. Restrictive lung disease
D. Mixed obstructive-restrictive disease
Correct Answer: B. Asthma [CORRECT]
