1. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?
(Points : 3)
A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F
A woman presenting with malaise, lethargy, and copious nasal secretions
A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F
A woman complaining of generalized aches who has a hoarse voice and reddened, painful upper airways
Question 2.2. A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE? (Points : 3)
She was short of breath because ventilation was occurring but perfusion was inadequate.
The combination of normal perfusion but compromised ventilation caused hypoxia.
She developed a transient anatomic shunt resulting in impaired oxygenation.
Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia.
Question 3.3. A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant’s present health problem? (Points : 3)
High inspired oxygen concentration and injury from positive-pressure ventilation
Failure to administer corticosteroids to the infant in utero
Insufficient surfactant production and insufficient surfactant therapy
Insufficient supplemental oxygen therapy
Question 4.4. Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? (Points : 3)
A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration
An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells
An 81-year-old male who has a productive cough and recurrent respiratory infections
An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke
Question 5.5. A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner’s most likely suspicion? (Points : 3)
Question 6.6. A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate? (Points : 3)
“Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it’s important for you to change positions often.”
“You should breathe deeply and cough to help your lungs expand as much as possible while you’re in bed.”
“Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube.”
“I’ll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in.”
Question 7.7. Due to complications, a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which of the following processes would his care team anticipate with relation to his health problem? (Points : 3)
Vasodilation in the alveolar vessels in the affected region of his lung
Increased workload for the left side of the patient’s heart
Increased blood flow to the area of atelectasis
Redirection of blood flow away from the lung regions that are hypoxic
Question 8.8. Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD? (Points : 3)
Audible wheezing on expiration
Diminished expiratory flow rates
Increased respiratory rate with decreased tidal volume
Normal compliance of alveolar tissue
Question 9.9. A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death?
(Points : 3)
Proliferation of natural killer (NK) cells in the alveolar lumen
Large numbers of alveolar macrophages in septal connective tissue
The presence of tubercles in the intra-alveolar spaces
Compensatory regeneration of type I alveolar cells
Question 10.10. A 21-year-old male patient has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition? (Points : 3)
His oropharynx is obstructed.
His epiglottis is covering his larynx
His vocal folds have been compromised.
His tracheobronchial tree is intermittently obstructed.
Question 11.11. A short, nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms? (Points : 3)
Pleuritis related to infection
Question 12.12. Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? (Points : 3)
Intrapleural pressure slightly exceeds that of the inflated lung
The chest wall exerts positive pressure on the lungs that contributes to expiration
The lungs are prevented from collapsing by constant positive intrapulmonary pressure
Negative intrapleural pressure holds the lungs against the chest wall
Question 13.13. The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son’s condition. Which of the following teaching points is most justifiable? (Points : 3)
“Research has shown that viruses may actually be a factor in many children’s asthma.”
“The most reliable indicator that your child is having an asthma attack is audible wheezing.”
“Steroids that your child can inhale will likely be the first line of defense.
“Your son will likely need to limit or avoid exercise and sports.”
Question 14.14. Which of the following phenomena is most likely occurring during a child’s alveolar stage of lung development? (Points : 3)
Terminal alveolar sacs are developing and surfactant production is beginning.
A single-capillary network exists and the lungs are capable of respiration.
The conducting airways are formed, but respiration is not yet possible.
Primitive alveoli are formed and the bronchi and bronchioles become much larger.
Question 15.15. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out? (Points : 3)
Decreased elastic recoil due to alveolar damage
Decreased residual lung volume due to impaired alveolar ventilation
Increased anatomic dead space due to reduced tidal volume
Increased alveolar dead space due to incorrect intrapleural pressure
Question 16.16. A definitive test for cystic fibrosis is (Points : 3)
The sweat test
A sputum culture
A fecal fat test
A Chymex test for pancreatic insufficiency
Question 17.17. A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing? (Points : 3)
Rapid, deep breaths
Short, shallow breaths
Question 18.18. Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli?
(Points : 3)
A patient who is immobilized following orthopedic surgery
A patient who has impaired Cl– and Na+ regulation
A patient who is taking amiodarone for the treatment of a cardiac arrhythmia
A patient who is a smoker and takes oral contraceptives
A patient who is undergoing radiation therapy for the treatment of breast cancer
Question 19.19. Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning? (Points : 3)
To increase the amount of oxygen dissolved in plasma
To increase the production of unbound hemoglobin
To stimulate the release of oxygen at the capillaries
To remove bound CO from hemoglobin
Question 20.20. A nurse practitioner is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year’s vaccine. Which of the following statements by patients best reflects an accurate understanding of the flu virus? (Points : 3)
“I could come down with viral or bacterial pneumonia as a result of a bad flu bug.”
“I know my vaccination is especially important since there aren’t any drugs that can treat the flu once I get sick with it.”
“The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective.”
“Like all vaccines, it is ideal if everyone in a population gets immunized against the flu.”
Question 21.21. A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this patient’s most likely diagnosis? (Points : 3)
Squamous cell carcinoma
Small cell lung cancer
Large cell carcinoma
Question 22.22. As a result of dehydration, a patient’s epithelial cells are producing insufficient amounts of mucus. Consequently, the patient’s mucociliary blanket is compromised. Which of the following changes would a care provider most reasonably anticipate as a direct result of this change? (Points : 3)
Impaired function of the patient’s cilia
Decreased levels of oxygen saturation
Increased amounts of bacteria in the lungs
Increased carbon dioxide levels
Question 23.23. Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma? (Points : 3)
IgG production is heightened as a consequence of exposure to an allergen.
Airway remodeling results in airflow limitations.
Epithelial injury and edema occur along with changes in mucociliary function.
Chemical mediators are released from presensitized mast cells.
Question 24.24. A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her nurse practitioner most appropriately respond to her? (Points : 3)
“I’m sure this is very hard news to hear, but be aware that with aggressive treatment your chances of beating this are quite good.”
“This is very difficult to hear, I’m sure, and we have to observe to see if it spreads because that often happens.”
“I’m very sorry to have to give you this news; I’d like to talk to you about surgical options, however.”
“This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission.”
Question 25.25. About 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually makes a diagnosis of histoplasmosis. Which of the following processes is most likely taking place? (Points : 3)
Toxin production by Histoplasma capsulatum is triggering an immune response.
Antibody production against the offending fungi is delayed by the patient’s age and the virulence of the organism.
Spore inhalation initiates an autoimmune response that produces the associated symptoms.
Macrophages are able to remove the offending fungi from the bloodstream but can’t destroy them.
1. A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states, “I don’t know how this could happen to me, since I’m so careful about eating a healthy diet.” What is the most appropriate response to the man’s statement? (Points : 3)
“Your diet may have played a part in this, but in fact genetics is likely primarily to blame.”
“What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved.”
“You likely don’t need to change your diet, but now that you have stones in one kidney, you’re at very high risk of growing them in the other kidney.”
“Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones.”
Question 2.2. An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? (Points : 3)
Performing a physical examination and history to determine the exact cause and character of the incontinence
Providing patient education focusing on the fact that occasional incontinence is a normal, age-related change
Teaching the resident about protective pads, collection devices, and medications that may be effective
Showing the resident the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone
Question 3.3. A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient’s family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family? (Points : 3)
An inordinate amount of interstitial fluid is accumulating in the patient’s abdomen.
The transcellular component of the intracellular fluid compartment contains far more fluid than normal.
The normally small transcellular fluid compartment, or third space, is becoming enlarged.
Gravity-dependent plasma is accumulating in the patient’s peritoneal cavity.
Question 4.4. A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient’s most likely diagnosis? (Points : 3)
Fluid volume excess
Question 5.5. Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient’s health problem?(Points : 3)
Exchange of Na+ and H+ ions
Selective renal secretion and reabsorption of CO2
Phosphate and ammonia buffer systems in the renal tubules
Excretion of HCO3– by the kidneys
Question 6.6. Which of the following patients would be considered to have a significant risk of developing the prerenal form of acute renal failure?
(Points : 3)
A 22-year-old male who has lost a large amount of blood following a workplace injury
A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis
A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and congestive heart failure
A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug
A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH)
An 80-year-old female who has been admitted for treatment of dehydration, hyponatremia, and malnutrition
Question 7.7. An 81-year-old female has long-standing hypocalcemia secondary to kidney disease and will shortly be moving into an assisted living facility from her own apartment. Which of the following findings should staff at the facility be instructed to observe for? (Points : 3)
Loss of appetite and complaints of nausea
Muscular spasms and complaints of cramps
High fluid intake and urine output
Lethargy and stupor
Question 8.8. A 55-year-old man has made an appointment to see his nurse practitioner because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man’s most likely diagnosis and possible underlying pathophysiologic problem? (Points : 3)
Stress incontinence due to damage to CNS inhibitory pathways
Overactive bladder that may result from both neurogenic and myogenic sources
Overactive bladder due to intravesical pressure exceeding urethral pressure
Overflow incontinence that can result from displacement of the angle between the bladder and the posterior proximal urethra
Question 9.9. A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention? (Points : 3)
Hypertrophy of the bladder muscle and increased bladder wall thickness
Decreased urine production and nitrogenous wasted excretion by the kidneys
Decompensation, bladder stretching, and high residual urine volume
Overflow incontinence and loss of contraction power
Question 10.10. Which of the following individuals is at the highest risk for developing a urinary tract infection (UTI)? (Points : 3)
A 60-year-old man with a history of cardiovascular disease who is recovering in the hospital from a coronary artery bypass graft
A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension
A 38-year-old man with high urine output due to antidiuretic hormone insufficiency
A 30-year-old obese woman with poorly controlled diabetes mellitus
Question 11.11. A nurse educator is orientating new nurses to a renal unit of a hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function? (Points : 3)
“Nephrons are delicate structures that cannot endure the high pressure that exists in capillary beds elsewhere in the body.”
“Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation.”
“Dilation of the afferent arteriole allows more blood into the nephron and increases the glomerular filtration rate.”
“The glomerulus is located between an arteriole and a venule that work together to regulate blood flow.”
Question 12.12. A 51-year-old woman diagnosed with multiple sclerosis (MS) five months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the facts that would underlie the nurse’s response to the patient? (Points : 3)
Neurologic diseases like MS often result in flaccid bladder dysfunction.
She may be unable to sense her bladder filling as a result of her MS.
Lesions of the basal ganglia or extrapyramidal tract associated with MS inhibit detrusor contraction.
Pathologic reductions in bladder volume brought on by MS necessitate frequent micturition.
Question 13.13. A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis? (Points : 3)
Low O2 levels, increased anion gap, base excess
High ammonia levels, decreased anion gap, high potassium
Increased CO2, increased anion gap, base deficit
Decreased CO2, decreased anion gap
Question 14.14. A pediatric unit will be receiving from a rural medical outpost a patient transfer of an 8-day-old infant with a suspected congenital renal disorder. Which of the following possibilities is the care team most likely to be able to rule out early? (Points : 3)
One of the infant’s kidneys may have failed to develop to a normal size.
The kidneys may be misshapen and have cysts.
The upper or lower poles of the two kidneys may be fused.
Renal cell carcinoma may be present.
Question 15.15. A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the care team’s initial differential diagnosis most likely be? (Points : 3)
Systemic lupus erythematosus glomerulonephritis
Henoch-Schonlein purpura nephritis
Immunoglobulin A nephropathy
Question 16.16. Which of the following individuals would be considered to be at risk for the development of edema?
(Points : 3)
An 81-year-old man with right-sided heart failure and hypothyroidism
A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus
A 34-year-old industrial worker who has suffered extensive burns in a job-related accident
A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia
A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa
Question 17.17. A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of her health problem? (Points : 3)
UTIs coupled with an impaired immune response have caused her ADPKD.
She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.
Severe hypertension and portal hypertension are likely precursors.
She has inherited undersized kidneys that are prone to calculi formation.
Question 18.18. A 31-year-old patient with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood gas sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH? (Points : 3)
Conservation or formation of new HCO3– by the kidneys
Low albumin and plasma globulin levels
Transcompartmental exchange of H+ and potassium ions
Renal excretion of HCO3– in the presence of excess base
Question 19.19. Which of the following data would a clinician consider to be most indicative of acute renal failure? (Points : 3)
Alterations in blood pH, peripheral edema
Increased nitrogenous waste levels, decreased glomerular filtration rate (GFR)
Decreased serum creatinine and blood urea nitrogen (BUN), decreased potassium and calcium levels
Decreased urine output, hematuria, increased GFR
Question 20.20. A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her nurse practitioner with complaints of a recent onset of urinary retention. She reveals to her nurse practitioner that she has been taking over-the-counter cold medications at higher than the suggested dose for the past two weeks. Which of the following phenomena will her nurse practitioner most likely suspect is contributing to her urinary retention? (Points : 3)
Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction.
Antihistamine effects inhibit communication between the pons and the thoracolumbar cord.
The anticholinergic effects of the medication are impairing normal bladder function.
Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying.
Question 21.21. Which of the following patients on a medical unit of a hospital is most likely to be experiencing health problems that may be attributable to kidney disease? (Points : 3)
An 81-year-old female patient with osteoporosis and anemia
A 77-year-old patient with urinary retention due to benign prostatic hyperplasia (BPH)
A 55-year-old woman with a recent stroke secondary to long-standing hypertension
A 60-year-old man with a systemic fungal infection requiring intravenous antibiotics
Question 22.22. Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms?
(Points : 3)
Question 23.23. A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?(Points : 3)
She is susceptible to isotonic fluid volume deficit and hypernatremia as a result of water losses.
She is prone to isotonic fluid volume excess due to impaired osmolality from sodium losses.
She could develop third-spacing edema as a result of plasma protein losses.
She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.
Question 24.24. At which of the following locations in the nephron would a nurse practitioner first expect blood to be largely free of plasma proteins? (Points : 3)
Proximal convoluted tubule
Loop of Henle
Question 25.25. Which diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending limb of the loop of Henle? (Points : 3)