NUR661 FINAL EXAM 2025
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A 40-year-old male patient comes in with a chief complaint of difficulty breathing. His
cardiac function test results are normal. He shows airway hyperresponsiveness to the
methacholine challenge test. His lung spirometry test reveals a lower-than-predicted level of
forced expiratory volume in the first second (FEV1). Based on the most likely diagnosis,
what is the most appropriate first-line therapy for a patient with infrequent episodes of mild
symptoms?
Albuterol alone
, A 78-year-old male presents to the clinic with complaints of a cough that started three days
ago. The cough is associated with sputum, which is scanty in volume and yellow in color. He
also complains of mild headaches and a stuffy nose for the last two days. On further
questioning, he reveals that he has had two similar episodes previously, which subsided
within a week. A detailed medical history reveals that he was diagnosed with diabetes
mellitus twenty years ago and is on metformin. His vital signs show a blood pressure of
100/80 mmHg, a respiratory rate of 14/min, a heart rate of 88/min, and a temperature of 99 F
(37.1 C). Auscultation of the chest was performed, which reveals bilateral coarse rhonchi,
whereas a chest x-ray is normal. What is the most appropriate next step in the management of
his condition?
Abx and antitussives
A 17-year-old male presents with a two-day history of fever, runny nose, and cough
productive of clear sputum. His past medical history is unremarkable, and he takes no
medication. His blood pressure is 110/70 mmHg, respiratory rate 16 breaths per minute, heart
rate 102 beats per minute, temperature 101.8 F (38.8 C), and oxygen saturation 98% on room
air. The lung examination demonstrates clear breath sounds bilaterally. In addition to an
antipyretic, what is the most appropriate treatment for this patient?
Guaifensen
A 28-year-old male patient with a past medical history significant for asthma presents to the
primary care office for complaints of cough, shortness of breath for 24 hours duration. His
symptoms started abruptly and are progressively worsening. He denies fevers or chills and
has had no known exposure to sick contacts. Vital signs are within normal limits. Physical
examination is significant for mild expiratory wheezing. His asthma is well controlled, and he
has not used any inhalers for a few years. What is the next best step in the management of
this patient?
Prescribe albuterol
A 35-year-old female presents to the out-patient department with complaints of cough with
whitish sputum production for the past three months. She mentions that the cough worsens at
night. She has no other complaints. The patient mentions that she has tried chlorpheniramine
for a week, and no improvement was noted. She has a history of gastroesophageal reflux
disease, for which she takes famotidine. She has been smoking a pack of cigarettes a day for
the past seven years and drinks alcohol socially. Vitals show a blood pressure of 133/85 mm
Hg, pulse of 79/min, respiratory rate of 14/min, and temperature of 98.6 F (37 C). Pulmonary
,examination reveals normal breath sounds bilaterally. A chest x-ray is normal. Which of the
following is the best next step in the management of the patient's condition?
Pulm fxn tests
A 20-year-old man presents to the clinic with two months history of cough and right-sided
chest pain. On examination, his chest movement on the right side is diminished, the trachea is
shifted to the left, and a stony dull percussion note is present on the right side. His breath
sounds are impaired, and vocal fremitus is present. Which of the following is the most likely
diagnosis?
Right pleural effusion
A 62-year-old man presents with general malaise, occasional cough, and weight loss of 10 lbs
(4.5 kg) over the last two months. History is significant for prediabetes managed with diet
and cigarette smoking. Physical examination findings include mild edema in the extremities
and clubbing bilaterally. Blood work shows mild anemia and sodium of 122 mg/dL. What
test should be done next?
Chest radiograph
A patient with chronic obstructive pulmonary disease (COPD) and chronic carbon dioxide
retention in a nursing home is wheezing. The oxygen saturation drops from 93 to 90. Which
of the following would be most appropriate?
Albuterol by neb
A middle-aged male presents to the emergency department with an exacerbation of his
chronic obstructive pulmonary disease (COPD). He has been coughing and been moderately
short of breath for the past 2 days. He says that his inhalers do work, but he ran out of
supplies. He complains of general malaise. After examining him, you decide to start him on
antibiotics. However, you first decide to send the sputum for gram stain and culture.
According to the 2015 Global Initiative for Chronic Obstructive Lung Disease report, which
of the following organisms is most likely to be involved in COPD exacerbation?
Moraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive cough for
6 months. He is a current smoker with a 30-pack-year smoking history. His other medical
history includes hypertension and chronic kidney disease. On examination, his blood pressure
is 145/95 mmHg, pulse 88/min, and oxygen saturation of 92% on room air. He does not have
accessory muscle use. On lung auscultation, there is decreased air movement and prolonged
expiration. There are no wheezes detected. No S3 or S4 auscultated. There is no jugular vein
, distention. He has no lower extremity edema and denies chest pain or calf tenderness. Chest
x-ray reveals bilateral hyperinflated lung fields. Which of the following is the next best step
in the diagnosis of this patient's condition?
Spirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing shortness
of breath. His condition has been progressively worsening over the past six months. He is a
smoker and a bird keeper. He has one son and one daughter with asthma. On examination,
there is a wheeze and coarse end-inspiratory crackles in the chest. A chest radiograph reveals
diffuse non-specific changes consistent with lung disease. What investigation is most likely
to yield the diagnosis in this case?
Spirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and
wheezing, particularly at night. He has had asthma. Six months ago, his symptoms were well-
controlled on inhaled fomoterol and low dose budesonide twice a day and occasional use of
an albuterol inhaler as required. However, now he is more short of breath with morning
dipping of his peak flow readings. On examination, he is mildly dyspneic but able to
complete sentences. On auscultation, there are wheezes scattered in his chest. His peak
expiratory flow rate is 70% of predicted. What is the most appropriate next step in the
management of this patient?
Inhaled budesonide dose
A patient with mild, persistent asthma has been well controlled with low-dose inhaled
corticosteroids. He presents for follow up complaining of some limitation with normal
activities and needing albuterol for symptom relief 3 to 4 days per week over the past month.
Which of the following is the preferred next step?
Medium dose inhaled corticosteroid
A 37-year-old woman presents with complaints of intermittent dry cough and chest tightness
since she started a new job as a chambermaid at a hotel 5-weeks ago. Her symptoms are
worst at night. She does not have any rhinitis, postnasal drip, or history of allergic rhinitis.
She has never smoked and doe not take any medicine. On physical examination, the patient
appears comfortable and speaks full sentences without any problem. Oral and nasal mucosa
appears normal. On auscultation of lungs, wheeze is reported in the left lung. The chest x-ray
report comes out normal. Which of the following is the next best step in identifying the cause
of the patient's current symptoms?
LATEST NEWEST UPDATE WITH
ACTUAL QUESTIONS AND
DETAILED VERIFIED ANSWERS
WITH RATIONALES (100%
CORRECT) //BRAND NEW!!
/ALREADY GRADED A+ WITH
GUARANTEED SUCCESS AFTER
DOWNLOAD (ALL YOU NEED TO
PASS YOUR EXAMS
A 40-year-old male patient comes in with a chief complaint of difficulty breathing. His
cardiac function test results are normal. He shows airway hyperresponsiveness to the
methacholine challenge test. His lung spirometry test reveals a lower-than-predicted level of
forced expiratory volume in the first second (FEV1). Based on the most likely diagnosis,
what is the most appropriate first-line therapy for a patient with infrequent episodes of mild
symptoms?
Albuterol alone
, A 78-year-old male presents to the clinic with complaints of a cough that started three days
ago. The cough is associated with sputum, which is scanty in volume and yellow in color. He
also complains of mild headaches and a stuffy nose for the last two days. On further
questioning, he reveals that he has had two similar episodes previously, which subsided
within a week. A detailed medical history reveals that he was diagnosed with diabetes
mellitus twenty years ago and is on metformin. His vital signs show a blood pressure of
100/80 mmHg, a respiratory rate of 14/min, a heart rate of 88/min, and a temperature of 99 F
(37.1 C). Auscultation of the chest was performed, which reveals bilateral coarse rhonchi,
whereas a chest x-ray is normal. What is the most appropriate next step in the management of
his condition?
Abx and antitussives
A 17-year-old male presents with a two-day history of fever, runny nose, and cough
productive of clear sputum. His past medical history is unremarkable, and he takes no
medication. His blood pressure is 110/70 mmHg, respiratory rate 16 breaths per minute, heart
rate 102 beats per minute, temperature 101.8 F (38.8 C), and oxygen saturation 98% on room
air. The lung examination demonstrates clear breath sounds bilaterally. In addition to an
antipyretic, what is the most appropriate treatment for this patient?
Guaifensen
A 28-year-old male patient with a past medical history significant for asthma presents to the
primary care office for complaints of cough, shortness of breath for 24 hours duration. His
symptoms started abruptly and are progressively worsening. He denies fevers or chills and
has had no known exposure to sick contacts. Vital signs are within normal limits. Physical
examination is significant for mild expiratory wheezing. His asthma is well controlled, and he
has not used any inhalers for a few years. What is the next best step in the management of
this patient?
Prescribe albuterol
A 35-year-old female presents to the out-patient department with complaints of cough with
whitish sputum production for the past three months. She mentions that the cough worsens at
night. She has no other complaints. The patient mentions that she has tried chlorpheniramine
for a week, and no improvement was noted. She has a history of gastroesophageal reflux
disease, for which she takes famotidine. She has been smoking a pack of cigarettes a day for
the past seven years and drinks alcohol socially. Vitals show a blood pressure of 133/85 mm
Hg, pulse of 79/min, respiratory rate of 14/min, and temperature of 98.6 F (37 C). Pulmonary
,examination reveals normal breath sounds bilaterally. A chest x-ray is normal. Which of the
following is the best next step in the management of the patient's condition?
Pulm fxn tests
A 20-year-old man presents to the clinic with two months history of cough and right-sided
chest pain. On examination, his chest movement on the right side is diminished, the trachea is
shifted to the left, and a stony dull percussion note is present on the right side. His breath
sounds are impaired, and vocal fremitus is present. Which of the following is the most likely
diagnosis?
Right pleural effusion
A 62-year-old man presents with general malaise, occasional cough, and weight loss of 10 lbs
(4.5 kg) over the last two months. History is significant for prediabetes managed with diet
and cigarette smoking. Physical examination findings include mild edema in the extremities
and clubbing bilaterally. Blood work shows mild anemia and sodium of 122 mg/dL. What
test should be done next?
Chest radiograph
A patient with chronic obstructive pulmonary disease (COPD) and chronic carbon dioxide
retention in a nursing home is wheezing. The oxygen saturation drops from 93 to 90. Which
of the following would be most appropriate?
Albuterol by neb
A middle-aged male presents to the emergency department with an exacerbation of his
chronic obstructive pulmonary disease (COPD). He has been coughing and been moderately
short of breath for the past 2 days. He says that his inhalers do work, but he ran out of
supplies. He complains of general malaise. After examining him, you decide to start him on
antibiotics. However, you first decide to send the sputum for gram stain and culture.
According to the 2015 Global Initiative for Chronic Obstructive Lung Disease report, which
of the following organisms is most likely to be involved in COPD exacerbation?
Moraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive cough for
6 months. He is a current smoker with a 30-pack-year smoking history. His other medical
history includes hypertension and chronic kidney disease. On examination, his blood pressure
is 145/95 mmHg, pulse 88/min, and oxygen saturation of 92% on room air. He does not have
accessory muscle use. On lung auscultation, there is decreased air movement and prolonged
expiration. There are no wheezes detected. No S3 or S4 auscultated. There is no jugular vein
, distention. He has no lower extremity edema and denies chest pain or calf tenderness. Chest
x-ray reveals bilateral hyperinflated lung fields. Which of the following is the next best step
in the diagnosis of this patient's condition?
Spirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing shortness
of breath. His condition has been progressively worsening over the past six months. He is a
smoker and a bird keeper. He has one son and one daughter with asthma. On examination,
there is a wheeze and coarse end-inspiratory crackles in the chest. A chest radiograph reveals
diffuse non-specific changes consistent with lung disease. What investigation is most likely
to yield the diagnosis in this case?
Spirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and
wheezing, particularly at night. He has had asthma. Six months ago, his symptoms were well-
controlled on inhaled fomoterol and low dose budesonide twice a day and occasional use of
an albuterol inhaler as required. However, now he is more short of breath with morning
dipping of his peak flow readings. On examination, he is mildly dyspneic but able to
complete sentences. On auscultation, there are wheezes scattered in his chest. His peak
expiratory flow rate is 70% of predicted. What is the most appropriate next step in the
management of this patient?
Inhaled budesonide dose
A patient with mild, persistent asthma has been well controlled with low-dose inhaled
corticosteroids. He presents for follow up complaining of some limitation with normal
activities and needing albuterol for symptom relief 3 to 4 days per week over the past month.
Which of the following is the preferred next step?
Medium dose inhaled corticosteroid
A 37-year-old woman presents with complaints of intermittent dry cough and chest tightness
since she started a new job as a chambermaid at a hotel 5-weeks ago. Her symptoms are
worst at night. She does not have any rhinitis, postnasal drip, or history of allergic rhinitis.
She has never smoked and doe not take any medicine. On physical examination, the patient
appears comfortable and speaks full sentences without any problem. Oral and nasal mucosa
appears normal. On auscultation of lungs, wheeze is reported in the left lung. The chest x-ray
report comes out normal. Which of the following is the next best step in identifying the cause
of the patient's current symptoms?
