1.

Which of the following statements are true about pleural effusions: (Select all that apply)
a) Heart failure is the most common cause of transudative pleural effusions
b) Exudative pleural effusions are often caused by malignancies
c) Transudative effusions are caused by decreased oncotic or colloidal pressure

2. A patient with COPD has been prescribed home oxygen. How often must the patient wear the
nasal cannula for optimal benefit?
a) 15-18 hours a day

3. Which of the following bacterial organisms is the most common cause of community acquired
pneumonia?
a) S. pneumoniae

4. Women using long-term inhaled glucocorticoids should be advised to :

a) Ensure adequate calcium and vitamin D intake

5. Which of the following drugs can cause interstitial lung disease: (select all that apply)
a) Amiodarone
b) Nitrofurantoin

6. What would you include in your instructions about Spiriva (tiotropium) while prescribing it for
your patient with COPD?
a) Use it once a day

7. The NP suspects community acquired pneumonia in a patient. The NP does not choose a “first
line” agent such as a macrolide and prescribes levofloxacin instead. What are the appropriate
reasons for moving directly to the stronger agent? (Select all that apply)
a) The patient has heart disease, diabetes, and rheumatoid arthritis.
b) The patient has increased risk of having drug resistant Strep pneumonia (DRSP) because
of recent antimicrobial therapy
c) The patient has a risk of having atypical organisms

8. Which of the following treatments are appropriate for patients with moderate to severe COPD?
(Select all that apply)
a) Advair
b) Spiriva
c) Combivent
d) Albuterol

9. A patient taking levofloxacin telephones the office and complaints of pain above the heel while
walking or stretching. The nurse practitioner should instruct the patient to :
a) Stop the drug and do not bear weight on the ankle because of the risk of tendon rupture
10. Buproprion is used for smoking cessation and should not be used if the patient has the following
(Select all that apply)
a) Seizure disorder
b) Recent head trauma
c) Active alcoholism
d) Unstable heart disease
e) Eating disorder

11. A 65 year old patient with a history of 30 pack years is found to have an incidental 9mm nodule
on CT scan. According to the Fleischner Society Recommendations, what is/are the
recommendations ( select all that apply)
a) CT at 3, 9 and 24 months
b) Consider PET scan or biopsy

12. What are some conditions that may increase the risk of spontaneous pneumothorax: ( select all
that apply)
a) Marfan’s syndrome
b) Tall height
c) Male gender

13. According to the USPSTF, screening for lung cancer should occur in individuals between the ages
of 55 – 74 years with a smoking history of at least ____________ pack years?
a) 30

14. The NP chooses an inexpensive antibiotic to treat community acquired pneumonia. Which
macrolide has the most adverse gastrointestinal effects?
a) Erythromycin

15. You are seeing the patient in the office for the first time. She has had recent episodic shortness
of breath and is concerned that she has developed asthma. Which of the following features is
the strongest predisposing factor in the development of asthma:
a) History of atopy

16. Increased tactile fremitus occurs with :

a) Lobar pneumonia

17. Match the drug class with the prototype

LABA -- salmeterol
SAMA -- ipratropium
LAMA -- tiotropium
SABA -- albuterol
18. A 69 year old patient presents with fever, cough, mild SOB and other findings consistent with
pneumonia. The patient also has diabetes and uses oral medications for control. Which agent
would be recommended?
a) Levofloxacin ( Levaquin)

19. The nurse practitioner assesses a PPD on the forearm of a patient being screened for
employment. The induration is 7mm. How should this finding be interpreted?
a) Negative, insignificant

20. Which of the following statements is true regarding x-rays: (select all that apply)
a) Air and fluid are more radiolucent than bone
b) The thicker the structure in the x-ray the brighter it will appear on the x-ray
c) PA view is superior to AP view

21. When educating a patient recently started on inhaled glucocorticoids regarding common side
effects, the nurse practitioner should include:
a) Oral candidiasis and dysphonia

22. What is the desired action of ipratropium bromide (Atrovent) when used in treating COPD?
a) Bronchodilator effect

23. Match the finding on x-ray with the definition or cause

 Lytic lesion - Decreased density of the bone
 Flattening of - Seen with COPD
Diaphragm
 Rib notching - Seen with connective tissue diseases, hyperparathyroidism
 Steeple sign -Seen with subglottal narrowing in children with croup
 Oreo cookie sign - Sign of pericardial effusion seen on lateral x-ray
 Dextrocardia - Congenital anomaly
 Hilar enlargement - Indicates lung cancer or infection
 Kerly B lines - Alveolar opacities seen in heart failure
 Hyperinflation - Increased lucency seen with COPD and asthma exacerbations
 Consolidation - Large dense homogenous opacification involving an entire lung
Lobe
 Silhoutte sign - Loss of normally visible border of an intrathoracic structure
Caused by an adjacent pulmonary density

24. When assessing a patient for adverse reactions to the combination of isoniazid and rifampin, the
nurse practitioner would monitor which laboratory results?
a) Liver enzymes
25. A 36 year old man with asthma also needs antihypertensive therapy. Which agent would you
avoid prescribing?
a) Propranolol

26. The CURB is used to:

a) Predict prognosis in CAP and help determine outpatient vs inpatient treatment

27. An 88 year old female who is brought to your office by a neighbor because she feels very ill. She
appears weak, her walk is unsteady, and she seems confused and afraid. Her skin turgor is poor,
her lips are cracked, and her temperature is 100.6. You listen to her lungs and notice an area
where no air appears to be moving. You do a chest x-ray and she has an area of consolidation in
her left lung. You diagnose pneumonia. What’s your next step?
a) Admit her to the hospital for care and treatment of the pneumonia

28. A nurse practitioner counsels a patient using two different types of asthma inhalers: a short –
acting beta2 agonist and a corticosteroid. When the patient questions the purpose of the steroid
inhaler, the nurse practitioner’s best response would be that inhaled glucocorticoids:
a) Are used as prophylaxis for chronic asthma

29. Asthma is diagnosed when the change in the FEV1 from the pre-to post bronchodilation is:
a) 12% greater

30. A patient with asthma is admitted to the emergency department with severe bronchospasm.
The nurse practitioner should prepare to administer first:
a) A nebulized beta2 agonist

31. An 18 year old woman has chief complaint of cough and body aches. You conclude that she has
atypical pneumonia .Assuming she has no other significant history, you prescribe:
a) Azithromycin

32. Which of the following are likely to produce a PFT demonstrating restriction( select all that
apply)
a) TB
b) Pleural effusion
c) Obesity
33. Which drug used to treat TB stimulates the cytochrome P450 system and enhances metabolism
(thereby lowering blood levels and potentially decreasing effectiveness) of many drugs including
warfarin, oral contraceptives, and most HIV drugs?
a) Rifampin
34. It is important for the patient to take a deep breath and hold it in order to have an accurate read
on a chest x-ray. How many posterior ribs should be visible on a PA chest x-ray when a patient
has taken a deep inspiration?
a) 9-10

35. Treatment of latent TB consist of:

a) Isoniazid daily for 9 months

36. The definitive test for sleep apnea is:

a) An overnight polysomnogram

37. Which of the following descriptions are considered a positive TST? (choose all that apply)
a) A 7mm area of induration in an individual with a chest x-ray demonstrating healed TB
disease
b) A patient on entanercept with 7mm area of induration

38. The inspiratory phase of respiration is greater than the expiratory phase with which breath
sound?
a) Vesicular

39. With which voice sound technique do you normally hear a muffled long “eee” through the
stethoscope on auscultating the chest when the client says “eee”?
a) Egophony

40. A patient with a history of asthma has been using her albuterol inhaler 2 times/month. She
would be classified as having:
a) Mild intermittent

41. Which of the following is the most common pathogen implicated in acute bronchitis?
a) Respiratory virus

42. Which of the following can prolong the QT interval? ( Select all that apply)
a) Moxifloxacin(Avelox)
b) Ciprofloxacin(Cipro)
c) Levofloxacin(Levaquin)
d) Clarithromycin(Biaxin)

43. A patient has been smoking 2 packs of cigarettes/day for the past 20 years. In pack years this
would be documented as:
a) 40 packs years
44. Pulmonary hypertension is an uncommon disorder. Which of the following are true in regards to
this condition (select all that apply)
a) Accentuated second heart sound may be heard
b) S3 is common
c) Warfarin, diuretics and PDE5 inhibitors are therapeutics

45. According to the GOLD criteria, a patient with COPD and an acute exacerbation meets the
criteria for treatment with an antibiotic if they have which of the following: (select all that apply)
a) Increased dyspnea
b) Increased sputum volume and purulence

46. According to the GOLD criteria, which of the following medications is indicated for use in all
stages of COPD?
a) SABA

47. Which of the following is considered a “respiratory” fluoroquinolone?

a) Levofloxacin

48. A patient with an FEV1 at 40% of predicted would be classified at stage ______ according to the
GOLD criteria?
a) Stage 3

49. The nurse practitioner prescribes doxycycline for a patient with a respiratory infection. Which
administration would be the most appropriate?
a) 2 hours after a meal containing dairy products

50. Which of the following PFT patterns is obstructive (select all that apply)
a)

Predicted values Measured values % predicted

FVC 6.00 liters 4.00 liters 67 %
FEV1 5.00 liters 2.00 liters 40 %
FEV1/FVC 83 % 50 % 60 %
b)

Predicted values Measured values % predicted

FVC 3.20 liters 3.01 liters 94 %
FEV1 2.51 liters 1.19 liters 47 %
FEV1/FVC 78 % 39 % 50 %
51. This drug is a prodrug that is converted in the liver to morphine and is often used as an
antitussive. Some individuals are “rapid metabolizers” of this drug and have increased blood
levels leading to depressed respirations. The name of the drug is _______?
a) Codeine

52. Which of the following is consistent with the diagnoses of all stages of COPD?
a) FEV1/FVC ratio < .70

53. Which of the following are clinical signs of obstructive sleep apnea? (select all that apply)
a) Daytime somnolence and fatigue
b) Insomnia
c) Snoring, gasping, apnea, and choking
d) Morning headache that lasts for 30 mins

54. What is the gold standard for the diagnosis of asthma?

a) Spirometry

55. Which of the following characteristics are more likely to be an indication of lung cancer (select
all that apply)?
a) Spiculated margins
b) Lobuated lessions