NR511 MIDTERM TEST BANK QUESTIONS
AND ANSWERS WELL RATED AND GRADED
DOWNLOAD TO SCORE A+ (2023/2024)
RESPIRATORY
A patient received the pneumonia immunization at age 60 years. He is 65 years old and
presents to your clinic today. What recommendation should be made about the
pneumococcal immunization? (Heshould receive another one today)
This patient should receive another one today because he is 65 years old and at least 5 years has
elapsedsince his last one. The CDC does not recommend immunizing this patient every 5 years.
Two immunizations are available, PCV13 and PPSV23. He needs both, but PCV13 should be
administered today. PPSV23 should be administered at least 1 year later.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to
diagnose because symptoms can be varied and involve multiple body systems (extrapulmonary
manifestations).Infection with Mycoplasma may present with a normal white blood cell count,
maculopapular rash, GI symptoms, tender joints and aches, and, though rare, cardiac rhythm
disturbances. Respiratory symptoms may not be pronounced. On chest X-ray there are some
unique findings (peribronchial pattern) with Mycoplasma. These include thickened bronchial
shadow, streaks of interstitial infiltration,and atelectasis. These are more likely to occur in the
lower lobes.
An adult has upper respiratory symptoms and cough for the past 14 days. What should be
considered?(Pertussis)
Pertussis should always be considered in adults who present with acute cough of greater than 5
days’ duration. The incubation period for pertussis is about 7-10 days. Patients present with URI
,symptoms for 1-2 weeks. The classic paroxysmal cough usually begins in the second week of the
illness. The duration ofsymptoms and cough are about 3 months even when treated with
antibiotics. This is highly infectious and is a reportable disease.
,Which medication below is contraindicated in an asthma patient because it may increase
risk ofsudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in combination with an
inhaledsteroid. Otherwise, using a long-acting bronchodilator like salmeterol is contraindicated.
There is an increased risk of sudden death with asthma exacerbations when this class is used solo
to treat asthma. The other choices can be used to treat asthma. Choices vary depending on the
patient.
A 75-year-old female with emphysema who has been treated with inhaled steroids for many
yearsshould: (should be screened for osteoporosis)
Older females are at higher risk than others for osteoporosis. This female patient, who has used
inhaledsteroids and smokes, has multiple risk factors for osteoporosis. Additionally, she
probably has emphysema because she smoked (or still smokes). If she is Asian or Caucasian,
she has still another riskfactor. Screening for osteoporosis should be considered when
managing patients with multiple risk factors.
Which of the following medications should be used cautiously in a patient who has asthma?
(Timololophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate bronchoconstriction in
patients who have asthma. Even though timolol is being administered in the eye, it is absorbed
through mucous membranes and can exert systemic effects. Beta blockers should be avoided in
patients with asthma andused cautiously in patients with COPD. The other medications listed
have no specific contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis. Cough is the most
common symptom associated with acute bronchitis. Purulent sputum is identified in more than
50% of patients with acute bronchitis. The color imparted to the sputum is usually due to
sloughing of epithelialcells, not bacterial infection. Concurrent upper respiratory symptoms are
typical of acute bronchitis.
Pharyngitis is common.
, Mild persistent asthma is characterized by: (symptoms occurring more than twice weekly)
Mild persistent asthma is characterized by symptoms that occur more than twice weekly but not
daily; or3-4 nocturnal awakenings per month due to asthma. It is treated with an inhaled steroid
daily, and a bronchodilator PRN for exacerbations. If symptoms occur more than twice weekly,
therapy should be stepped up. Generally, a long-acting bronchodilator is added to the steroid
when therapy is stepped up.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is assessed if there is
concern about the circumference of either the head or the chest. An exception to this observation
can occur in premature infants where the head grows very rapidly. Normally, the head exceeds the
chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and
chest circumference should be about equal and by 2 years of age the chest should be larger than
the head. Thechest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is his likely
diagnosis?(Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of fever and cough,
should direct the examiner to consider pneumonia as the diagnosis. Other common clinical
findings with pneumonia include chest pain, dyspnea, and sputum production. Though not
common, some patientswith pneumonia exhibit gastrointestinal symptoms like nausea, vomiting,
and diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature > 101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most common
symptom associated with acute bronchitis. Purulent sputum is identified in more than 50% of
patients with acute bronchitis. The color imparted to the sputum is usually due to sloughing of
epithelial cells, not bacterial infection. Concurrent upper respiratory symptoms are typical of
acute bronchitis. Pharyngitis is commonwithin the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
AND ANSWERS WELL RATED AND GRADED
DOWNLOAD TO SCORE A+ (2023/2024)
RESPIRATORY
A patient received the pneumonia immunization at age 60 years. He is 65 years old and
presents to your clinic today. What recommendation should be made about the
pneumococcal immunization? (Heshould receive another one today)
This patient should receive another one today because he is 65 years old and at least 5 years has
elapsedsince his last one. The CDC does not recommend immunizing this patient every 5 years.
Two immunizations are available, PCV13 and PPSV23. He needs both, but PCV13 should be
administered today. PPSV23 should be administered at least 1 year later.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to
diagnose because symptoms can be varied and involve multiple body systems (extrapulmonary
manifestations).Infection with Mycoplasma may present with a normal white blood cell count,
maculopapular rash, GI symptoms, tender joints and aches, and, though rare, cardiac rhythm
disturbances. Respiratory symptoms may not be pronounced. On chest X-ray there are some
unique findings (peribronchial pattern) with Mycoplasma. These include thickened bronchial
shadow, streaks of interstitial infiltration,and atelectasis. These are more likely to occur in the
lower lobes.
An adult has upper respiratory symptoms and cough for the past 14 days. What should be
considered?(Pertussis)
Pertussis should always be considered in adults who present with acute cough of greater than 5
days’ duration. The incubation period for pertussis is about 7-10 days. Patients present with URI
,symptoms for 1-2 weeks. The classic paroxysmal cough usually begins in the second week of the
illness. The duration ofsymptoms and cough are about 3 months even when treated with
antibiotics. This is highly infectious and is a reportable disease.
,Which medication below is contraindicated in an asthma patient because it may increase
risk ofsudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in combination with an
inhaledsteroid. Otherwise, using a long-acting bronchodilator like salmeterol is contraindicated.
There is an increased risk of sudden death with asthma exacerbations when this class is used solo
to treat asthma. The other choices can be used to treat asthma. Choices vary depending on the
patient.
A 75-year-old female with emphysema who has been treated with inhaled steroids for many
yearsshould: (should be screened for osteoporosis)
Older females are at higher risk than others for osteoporosis. This female patient, who has used
inhaledsteroids and smokes, has multiple risk factors for osteoporosis. Additionally, she
probably has emphysema because she smoked (or still smokes). If she is Asian or Caucasian,
she has still another riskfactor. Screening for osteoporosis should be considered when
managing patients with multiple risk factors.
Which of the following medications should be used cautiously in a patient who has asthma?
(Timololophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate bronchoconstriction in
patients who have asthma. Even though timolol is being administered in the eye, it is absorbed
through mucous membranes and can exert systemic effects. Beta blockers should be avoided in
patients with asthma andused cautiously in patients with COPD. The other medications listed
have no specific contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis. Cough is the most
common symptom associated with acute bronchitis. Purulent sputum is identified in more than
50% of patients with acute bronchitis. The color imparted to the sputum is usually due to
sloughing of epithelialcells, not bacterial infection. Concurrent upper respiratory symptoms are
typical of acute bronchitis.
Pharyngitis is common.
, Mild persistent asthma is characterized by: (symptoms occurring more than twice weekly)
Mild persistent asthma is characterized by symptoms that occur more than twice weekly but not
daily; or3-4 nocturnal awakenings per month due to asthma. It is treated with an inhaled steroid
daily, and a bronchodilator PRN for exacerbations. If symptoms occur more than twice weekly,
therapy should be stepped up. Generally, a long-acting bronchodilator is added to the steroid
when therapy is stepped up.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is assessed if there is
concern about the circumference of either the head or the chest. An exception to this observation
can occur in premature infants where the head grows very rapidly. Normally, the head exceeds the
chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and
chest circumference should be about equal and by 2 years of age the chest should be larger than
the head. Thechest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is his likely
diagnosis?(Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of fever and cough,
should direct the examiner to consider pneumonia as the diagnosis. Other common clinical
findings with pneumonia include chest pain, dyspnea, and sputum production. Though not
common, some patientswith pneumonia exhibit gastrointestinal symptoms like nausea, vomiting,
and diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature > 101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most common
symptom associated with acute bronchitis. Purulent sputum is identified in more than 50% of
patients with acute bronchitis. The color imparted to the sputum is usually due to sloughing of
epithelial cells, not bacterial infection. Concurrent upper respiratory symptoms are typical of
acute bronchitis. Pharyngitis is commonwithin the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
