N675 Week 2 Pulmonary Exam Questions and Answers (LATEST)

Week 2 – Pulmonary A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient? Empiric treatment with a macrolide antibiotic A 22 year old tall, thin and athletic man comes into your primary care clinic complaining of pain with breathing and progressively worsening shortness of breath. In order of sequence, what will be your next steps? -Obtain more history, auscultate the lungs and send pt to the ER for a stat CXR and further evaluation. -Obtain more history, and immediately send him to the ER A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient’s symptoms? Infection Patients with pneumonia reports that he has rust-colored sputum. With pathogen should the nurse practitioner suspect? Streptococcus pneumoniae Clinical description of mucus does not really help and clinical decision making regarding pneumonia, but certain clinical characteristics are associated with specific types of pneumonia. Scant or watery sputum is associated with atypical pathogens like mycoplasma and clamydophila. Thick, discolored sputum may be associated with bacterial pneumonia. A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of “not getting enough air.” The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially? Complete blood count A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially? Observe for improvement or worsening for 24 hours Begin treatment with an antiviral medication Administer LAIV influenza vaccine This study source was downloaded by from CourseH on :57:42 GMT -06:00 Perform a nasal swab for RT-PCR assay Which patient might be expected to have the worst FEV1? Patient with bronchiolitis A controlled asthma patient A 65 her old with emphysema A 60-year-old with pneumonia Forced expiratory volume in 1 second (FEV1)is the worst in patients with obstructive disease such as emphysema. An FEV1 should not be performed in patients with pneumonia and bronchiolitis because they would have diminished respiratory capacity related to the infection An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient’s dyspnea? Breathing exercises Anxiolytic drugs Supplemental oxygen Opioid medications Which are causes of pleural effusions? (Select all that apply.) Allergies Bronchiectasis Breast cancer Congestive heart failure Dehydration Pleurisy is not a diagnosis but rather a symptom of many localized and systemic disease that needs further evaluation in order to find the cause of the problem. True False A patient with cough and fever is found to have infiltrates on chest x-ray. Would this is likely diagnosis Tuberculosis Pneumonitis This study source was downloaded by from CourseH on :57:42 GMT -06:00 Pneumonia Acute bronchitis Infiltrates on x-ray in conjunction with clinical findings of fever and cough should direct the NP to consider pneumonia as diagnosis Dyspnea, tachypnea and pleuritic CP are classic presentation of a pulmonary emboli. If your pt is complaining of calf or thigh leg pain, you should suspect compartment syndrome pulmonary embolism (PE) peripheral neuropathy with fracture deep vein thrombosis (DVT) What does peak flow meter measure? Peak flow capacity Oxygen saturation Exercise capacity Expiratory flow A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend’s nitroglycerin during one episode. What is the most likely cause of this chest pain?orrect! Esophageal pain Pleural pain Cardiac pain Aortic dissection pain A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. The patient’s lungs are clear and oxygen saturations are 97% on room air. What will the provider recommend? Empiric antibiotics to treat a possible secondary infection Referral to a specialist for evaluation and treatment Correct! Symptomatic treatment with close follow up in clinic Admission to the hospital for treatment of complications This study source was downloaded by from CourseH on :57:42 GMT -06:00 Hemoptysis can be confuse with other bleeding disorder. To narrow down your differential diagnosis, it is important to evaluate and obtain these pertinent data regarding your patient's history of: (Choose all that apply) sequence of birth number of soda intake per day Correct! occupational and environmental exposures travel history A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient? Admit to the hospital with specialist consultation Prescribe an oral corticosteroid medication Give epinephrine injections and monitor response Administer three more nebulizer treatments and reassess What is the most common complication of influenza? Bacterial pneumonia Cough Bronchitis You Answered Viral pneumonia A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help reduce the duration of symptoms in this patient? Oseltamivir Whoever put this answer its incorrect the correct answer is Azithromycin This study source was downloaded by from CourseH on :57:42 GMT -06:00 The most common cause of bloody expectorant in primary care are due to the following: GERD and esophagitis Acute bronchitis and Pneumonia URI and Asthma AAA and varices Buttaro, Chapter 108 Hemoptysis, pg 471 An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms? Spirometry Allergy testing Peak expiratory flow rate Methacholine challenge test The major laboratory abnormality noted in patients who have pneumococcal pneumonia is: Gram stain positive Leukopenia Eosinophilia Leukocytosis Increased white count is typical in patients with bacterial pneumonia. Eosinophils can be increased in patients but developed pneumonia secondary to irritating substances such as toxic gas. Leukopenia is an ominous finding, especially in older patients, indicating poor prognosis The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this parent? The infant should have an influenza vaccine now with a booster in 1 month. The rest of the family and all close contacts should have the influenza vaccine. The infant should be given prophylactic antiviral medications. The infant should have the live attenuated influenza vaccine (LAIV). When initially treating adults with acute bronchitis, which of the following should the nurse practitioner be least likely to order: Antitussives Expectorants This study source was downloaded by from CourseH on :57:42 GMT -06:00 Antibiotics Bronchodilators Which of the following infections can cause a "barky" cough? Croup Which method of treatment is used for traumatic pneumothorax? 1. Placement of small-bore catheter 2. Needle aspiration of the pneumothorax 3. Observation for spontaneous resolution 4. Tube thoracostomy A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism? 1. CT angiography 2. Electrocardiogram 3. D-dimer 4. Arterial blood gases A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient’s pneumonia. 1. Tuberculosis 2. S. pneumoniae 3. Mycoplasma 4. TrueA virus A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next? 1. Prescribe an antibiotic 2. Recommend an NSAID 3. Order a chest radiograph 4. Refer to a cardiologist This study source was downloaded by from CourseH on :57:42 GMT -06:00 A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend? 1. Taking an oral corticosteroid 2. Administering two more doses of albuterol 3. Going to the emergency department 4. Coming to the clinic for evaluation The following requires immediate intervention and hospitalization (choose all that apply) 1. Primary spontaneous pneumothorax (PSP) 2. Secondary spontaneous pneumothorax 3. PSP with less than 2-3 cm between the lung and chest wall 4. Tension pneumothorax An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient? 1. Isolation if paroxysmal cough develops 2. Symptomatic care only 3. Pertussis vaccine booster 4. Azithromycin daily for 5 days What disease is usually managed with short acting oral long-acting inhaled anticholinergic medications?! COPD Bronchitis Asthma Bronchiectasis Anticholinergics can improve lung function and COPD. Anticholinergics are not to be used as a lone agent to manage symptoms of asthma. Bronchitis is a viral infection and is self-limiting, does not usually require inhalers. The patient has cough, pharyngitis, nasal discharge, and fever. He has been diagnosed with acute bronchitis. Which symptom is least likely in the first 3 days of this illness? Cough This study source was downloaded by from CourseH on :57:42 GMT -06:00 A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings? Hepatic disease Pulmonary infection Pulmonary embolus Congestive heart failure A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient? Blood cultures Spirometry Arterial blood gases Ventilation/perfusion scan Mycoplasma pneumoniae is: Only identifiable on chest x-ray A disease with extrapulmonary manifestations Of diagnosis of exclusion And on common respiratory pathogens Mycoplasma is an atypical pathogen that produces atypical pneumonia. It is often difficult to diagnose because symptoms are varied often involving extrapulmonary symptoms such as GI symptoms, myalgia and arthralgia, rash. Chest x-ray may have some unique findings with mycoplasma but it is not the only way to diagnose it What is the most common cause of pneumonia and people of all ages?Correct! S. pneumoniae Group A Strep S. aureus Mycoplasma sp. Which clinical sign is especially worrisome in a patient with a pulmonary embolism? Abnormal lung sounds Hypotension This study source was downloaded by from CourseH on :57:42 GMT -06:00 Dyspnea Tachycardia You have an elderly patient with a history of a myocardial infarction with residual paresthesia, and dysphagia. Your patient was brought in by his caretaker in the nursing home. The patient presents with one week of fever, productive cough and malaise. Besides his presentation, you suspect pneumonia due to his risk factors. (Choose all that apply) lack of proper housing Diminished gag reflex that can prevent entry of particles, mucus and food debris into the lungs Inadequate nutrition possible compromise airway filtration and humidification from his h/o CVA You see a college student in college health clinic. She complains of abrupt onset of sore throat, nasal congestion, runny nose, and malaise. Vital signs show temperature of 99.8°F, otherwise normal physical exam reveals an erythematous throat, swollen nasal turbinates, and rhinitis. The NP suspect viral URI. Although the following treatments are appropriate except: Pseudoephedrine Saline nasal spray Oral prednisone Ibuprofen