Download N1120 Test Blueprint

RESPIRATORY Test Questions/Blueprint
Question
1.Part 1
1.
What is the major difference in pathophysiology
between asthma and COPD?
a. Asthma is a disruption in respiratory diffusion and
COPD is disruption in respiratory ventilation
b. Asthma is a disruption in respiratory ventilation
and COPD is disruption in respiratory diffusion
c. COPD results in permanent airflow obstruction
and asthma is a condition of reversible airflow
obstruction.
d. Asthma is the result of an inflammatory process
and COPD is a result of hyper-sensitivity of the
bronchioles
e. b & c
2.
As the home care nurse, you observe oral
candidiasis in your patient with severe, chronic
COPD. What information should you obtain from this
client?
a. “Do you swish and spit with water after taking
your Advair inhaler?”
b. “Do you swish and spit with water after taking
your Albuterol inhaler?”
c. “Do you swish and spit with water after taking
your Combivent (albuterol/atrovent) inhaler?”
d. “Do you share a toothbrush with any members of
your family?”
e. a & b
3.
An asthmatic patient who has a new prescription for
Advair Diskus (fluticasone and salmeterol) asks the
nurse the purpose of using this inhaler with 2
medications. The nurse explains that:
a. Advair is a combination of long-acting and slowacting bronchodilators.
b. The two drugs work together to block the effects
©2011 Keith Rischer/www.KeithRN.com
Course
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of histamine on the bronchioles.
c. One drug decreases inflammation, and the other
is a bronchodilator.
d. The combination of two drugs works more quickly
in an acute asthma attack.
4, Ms. Anderson, a 72 year old with asthma and
emphysema comes into the ER because of complaints of
fever, chills and increasing shortness of breath. She has
had recent productive cough of green phlegm. Her VS:
T-101.2 P-110 R-28 BP-140/88 O2 sats 86% on room
air. She has inspiratory as well as expiratory wheezing
bilaterally with coarse rhonchi in the LLL.
4.
5.
6.
N1120-VI-2 What symptoms of Ms. Anderson are
consistent only with pneumonia?
a. Fever/chills
b. Green phlegm
c. Coarse rhonchi
d. Inspiratory/expiratory wheezing
e. a, b, c
What is the clinical significance of inspiratory vs.
expiratory wheezing in Ms. Anderson?
a. There is no clinical significance-they represent
the same degree of bronchospasm.
b. Expiratory wheezing reflects a greater degree of
bronchoconstriction
c. Inspiratory wheezing reflects a greater degree of
bronchoconstriction
d. Crackles are a greater concern with asthmatic
exacerbation.
The physician orders an Albuterol nebulizer. What is
the rationale for this medical treatment?
a. Promotes bronchodilation through stimulating
beta 2 receptors on the lungs
b. Promotes bronchodilation through blocking
parasympathetic nervous system stimulation
c. Promotes bronchodilation through blocking late
reaction to allergens and reduce airway
hyperresponsiveness
d. Promotes bronchodilation through inhibiting mast
©2011 Keith Rischer/www.KeithRN.com
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7.
8.
9.
10.
11.
cell activity and decreasing inflammation
7. During your initial assessment of Ms. Anderson,
what will be your priority to get done first:
a. Obtain a comprehensive health history to
determine the extent of any prior respiratory
problems.
b. Complete a full physical examination to determine
the systemic effect of the respiratory distress.
c. Delay the physical assessment and ask family
members about any history of respiratory
problems.
d. Perform a respiratory system assessment and
ask specific questions about this episode of
respiratory distress.
Which of the following medications seen in Ms.
Anderson would be indicative of severe/end-stage
progression of her COPD?
a. Advair discus MDI bid (Metered Dose Inhaler)
b. Albuterol MDI tid and prn (Metered Dose Inhaler)
c. Prednisone po daily
d. Azmacort MDI bid (Metered Dose Inhaler)
Because you are concerned about the risk of Ms.
Anderson to develop sepsis, what labs will you be
closely monitoring and trending:
a. Total white blood cell count (WBC)
b. Neutrophil differential percentage
c. Serum lactate
d. a & b
e. a, b, c
Ms. Anderson has been admitted to the medical floor
and while caring for her you note that her O2 sats
drop from 94% to 85% when she ambulates in the
hall. She denies SOB. You determine that:
a. Supplemental oxygen should be used whenever
the patient ambulates in the future.
b. Maintain her on strict bed rest.
c. The response is normal and the patient should
continue at this activity level.
d. No further ambulation should take place until the
disease process is resolved.
Ms. Anderson has a right lower-lobe pneumonia and
©2011 Keith Rischer/www.KeithRN.com
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has been treated with intravenous (IV) antibiotics for
2 days, which assessment data obtained by the
nurse indicates that the treatment has been
effective?
a. Coarse rhonchi are auscultated at the left lower
base.
b. The patient coughs up large amounts of green
mucous.
c. Current temperature is 98.9 orally
d. The patient’s current white blood cell (WBC)
count is 9000 with a neutrophil differential count
of 70%
e. c & d
1. Questions 1-3 refer to the same patient, introduced
in Question 1
1. Following assessment of your patient, an 86 year old
woman with pneumonia, the nurse identifies a
nursing diagnosis of impaired gas exchange as the
priority problem. Which nursing assessment data
collected supports this diagnosis?
a. Resting pulse oximetry (SpO2) of 85% on
room air
b. Respiratory rate of 28/minute at rest
c. Crackles in lung bases bilaterally
d. All of the above
MODIFY DONE: 2. 1120-VI-2, 7 This same patient has
a temperature of 101.6° F with a frequent cough and is
complaining of chest pain rated 2 on a 10-point scale
with deep inspiration. Which of these newly ordered
medications should the nurse give first?
e. Ampicillin/Sulbactam (Unasyn) IV
f. Acetaminophen (Tylenol) po
g. Guaifenesin (Robitussin) po
h. Atenolol 25 mg po (scheduled home
medication)
2.
You obtain her lab results from your Complete
Blood Count (CBC) for this same patient with
pneumonia. Which labs are abnormal and relevant to
this patient:
a. White Blood Cells: 14.2
©2011 Keith Rischer/www.KeithRN.com
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MODIFY
3.
4.
5.
6.
b. Neutrophils 87%
c. Bands 14%
d. a & b
e. a, b, c
The nurse notes new-onset confusion in an 89year-old patient in a long-term-care facility; the
patient is normally alert and oriented. Which action
should the nurse take next?
a. Check the patient’s pulse rate.
b. Obtain an oxygen saturation.
c. Notify the health care provider.
d. Document the change.
The following signs and symptoms/physical
assessment findings are seen if one has an active
tuberculosis infection:
a. Peristent cough with blood tinged sputum
b. Fever with night sweats
c. Lungs clear aeration when auscultated
bilaterally
d. a & b
e. a, b, c
When caring for a patient who is hospitalized with
active TB, the nurse observes dietary staff bring a
tray into the room. The nurse will need to immediately
intervene if they:
a. Wash their hands before entering the room.
b. Puts on a blue surgical face mask when
entering the room
c. Do not get into an isolation gown when
entering the room
d. Do not apply gloves when entering the room
Your patient with renal failure has decreased
erythropoetin production. Upon analysis of your
patient’s complete blood cell count (CBC), what
would you expect to see with this patient?
a. Increased hemoglobin and increased
hematocrit
b. Decreased hemoglobin and decreased
hematocrit
c. Decreased hemoglobin and increased
hematocrit
©2011 Keith Rischer/www.KeithRN.com
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d. Increased hemoglobin and decreased
hematocrit
7.
You are providing education to a patient with iron
deficiency anemia who has been prescribed iron
supplements. What will be important to include in
your teaching?
a. Take the iron with dairy products to enhance
absorption
b. Increase the intake of vitamin E to enhance
absorption
c. Iron will cause the stools to become darker or
black in color
d. Limit foods high in fiber due to risk for
diarrhea
8.
You are providing education to a patient with iron
deficiency anemia who needs to increase their
natural intake of iron. What foods will you want to
encourage your patient to increase in their diet?
a. Liver and muscle meats
b. Eggs
c. Legumes
d. All of the above
Modify done 10. A 78 year old female comes into the
ED with complaints of frequent black, tarry stools the
last 2 days, increasing weakness and dizziness when
standing up. Which lab results are abnormal and
relevant to her primary problem:
e. Hemoglobin (Hgb) 7.9 g/dl
f. platelets 28,000
g. International Normaized Ration (INR) 3.8
h. a & b
i. a, b, c
9.
A patient with sickle cell anemia is admitted to the
hospital with a sickle cell crisis. While caring for the
patient during the crisis, it is important for the nurse
to:
a. Limit the patient’s intake of oral and IV fluids.
b. Evaluate the effectiveness of opioid
analgesics.
c. Encourage the patient to ambulate as much
as tolerated.
©2011 Keith Rischer/www.KeithRN.com
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modify
d. Teach the patient about high-protein, highcalorie foods.
10.
A patient who is having a sickle cell crisis asks
the nurse why the sickling causes such pain. The
nurse explains that pain of sickling is caused by:
a. Spasms of the blood cells as they change
shape.
b. Deposition of sickled red cells in the bone
marrow.
c. Tissue hypoxia caused by small blood vessel
occlusion.
d. Infectious processes in organs affected by the
sickling.
KEY:
Cognitive Level:
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Item Discrimination = how well an item distinguishes between high and low scoring students.
 0 is OK if it’s info that everyone absolutely needs to know, i.e. key content.
 .2 to .3 is desirable for most
 .4 or higher is OK for just a few questions. If all were .4, most of our students would fail the test.
 Negative discrimination means a problem, like a poorly written question, mis-speaking in lecture, not fully clarifying a
topic, or an error on the answer key.
Add the item analysis statistics to the blueprint after you administer the test. Use these stats for improving you test items.
©2011 Keith Rischer/www.KeithRN.com
FINAL EXAM
10. ALTERATIONS IN OXYGENATION
(RESPIRATORY) (8)
1.
2.
3.
4.
The patient has severe emphysema. During
assessment the nurse notes jugular vein distention
and pedal edema. The nurse recognizes that these
findings are indicative of which complication of
COPD?
a.
Acute respiratory failure.
b.
Fluid volume excess secondary to right-sided
heart failure.
c.
Pulmonary edema caused by left-sided heart
failure.
d.
Secondary respiratory infection.
Following assessment of your patient, an 86 year
old woman with pneumonia, the nurse identifies a
nursing diagnosis of impaired gas exchange as the
priority problem. Which nursing assessment data
collected supports this diagnosis?
a.
Resting pulse oximetry (SpO2) of 86% on
room air
b.
Respiratory rate of 18/minute
c.
Bi-basilar course crackles
d.
a&c
e.
a,b,c
Your patient with a right lower-lobe pneumonia has
been treated with intravenous (IV) antibiotics for 2
days, which assessment data indicates that the
treatment has been effective?
a.
Temperature is 101.5 F
b.
Breath sounds are clear bilaterally
c.
The patient’s current white blood cell (WBC)
count is 6000 mm3 with a neutrophil
differential count of 68%
d.
b&c
e.
a, b, c
The physician orders an Albuterol nebulizer for your
©2011 Keith Rischer/www.KeithRN.com
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5.
6.
7.
patient with asthma. What is the rationale for this
medical treatment?
a.
Promotes bronchodilation through blocking
parasympathetic nervous system stimulation
b.
Promotes bronchodilation through blocking
late reaction to allergens and reduce airway
hyper-responsiveness
c.
Promotes bronchodilation through inhibiting
mast cell activity and decreasing inflammation
d.
Promotes bronchodilation through stimulating
beta 2 receptors on the lungs
Your patient is on droplet precautions due to
tuberculosis. To protect yourself and others from
exposure to this pathogen you will:
a.
Wash your hands before entering the room.
b.
Put on a N-95 face mask when entering the
room
c.
Apply gown and gloves when entering the
room
d.
a&b
e.
a,b,c
You are providing education to a patient with iron
deficiency anemia who needs to increase her
natural intake of iron before iron supplements are
considered. What foods will you want to encourage
your patient to increase in their diet?
a.
Liver and muscle meats
b.
Eggs
c.
Dark green leafy vegetables such as spinach
d.
All of the above
A 72 year old male comes into the ED with
complaints of several black, tarry stools the last 24
hours, increasing weakness and dizziness
especially when standing up. Which data collected
by the nurse are abnormal and relevant to the
primary problem:
a.
Hemaglobin (Hgb) 7.2 g/dl
b.
International Normalized Ration (INR) 3.8
c.
Heart rate 118/minute
d.
a&b
e.
a, b, c
©2011 Keith Rischer/www.KeithRN.com
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8.
The nurse caring for a patient receiving a
transfusion notes that 15 minutes after the infusion
of packed red blood cells (RBCs) has begun, the
patient is having a systemic raised rash and
complaining of itching. What is the most appropriate
initial action for the nurse to take?
a.
Notify the physician
b.
Stop the transfusion
c.
Remove the patient's intravenous access.
d.
Assess the patient's vital signs.
©2011 Keith Rischer/www.KeithRN.com
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