18 Oct A 50-year-old female presents complaining of shortness of breath and cough. If present, which of the following features would decrease the probability that the patient’s respiratory symptoms are due to asthma?

A 50-year-old female presents complaining of shortness of breath and cough. If present, which of the following features would decrease the probability that the patient’s respiratory symptoms are due to asthma?

 

Chronic production of sputum

 

Symptoms that are worse at night

 

Symptoms that are worse in the early morning

 

Symptoms vary over time and in intensity

 

Question 2It is recommended that elderly patients with COPD receive the ______________ vaccine to decrease the risk of ischemic heart disease that can develop over time.

 

Pneumococcal

 

Rotavirus

 

Influenza

 

Shingles

 

Question 3A 65-year-old patient that has a history of diabetes, coronary artery disease, and renal insufficiency is post-operative day 3 from a hip replacement. Which of these factors puts the patient at the highest risk for a pulmonary embolism?

 

Diabetes

 

Coronary artery disease

 

Renal insufficiency

 

Hip replacement

 

Question 4 A patient with progressive dyspnea, chronic cough with sputum production, and a history of smoking is being worked up for COPD. What is the most reproducible and objective measurement of air flow limitation?

 

Chest Xray

 

Spirometry measurements

 

Arterial blood gas (ABG)

 

O2 saturation on pulse oximeter

 

Question 5Sildenafil should not be taken with _______________ because it could lead to hypotension due to increased vasodilation.

 

Calcium channel blockers (CCB)

 

Riociguat

 

Nitrates

 

Epoprostenol

 

Question 6The use of bubble studies during echocardiogram (ECHO) are useful in the diagnosis of _________________.

 

Patent foramen ovale (PFO)

 

Pulmonary hypertension (PH)

 

Low ejection fraction (EF)

 

Elevated right sided ventricular pressure (RSVP)

 

Question 7Where do most pulmonary emboli originate?

 

Upper extremities

 

Mesenteric circulation

 

Portal circulation

 

Lower extremities

 

Question 8Which of the following pharmacologic interventions is FDA approved for Chronic Thromboembolic Pulmonary Hypertension (CTEPH)?

 

Calcium channel blockers (CCB)

 

Riociguat

 

Epoprostenol

 

Endothelin receptor antagonist

 

Question 9A patient with a holosystolic murmur has bilateral lower extremity swelling, a pulsatile liver, and on ECG you notice a right axis deviation with a peaked p-wave in lead II. What is the LEADING differential diagnosis for this patient?

 

Left sided Heart Failure (HF)

 

Aortic Stenosis

 

Mitral Regurgitation

 

Pulmonary Hypertension

 

Question 10A patient diagnosed with asthma has uncontrolled symptoms despite good adherence to the prescribed inhaled corticosteroid (ICS) regimen. As the nurse practitioner, what is your next step in the management of this patient?

 

Step-up treatment with a combination low dose ICS and Long-Acting-Beta-Agonist (LABA)

 

Add a combination low dose ICS-formoterol (with budesonide) for both maintenance and symptom reliever

 

Add Short-Acting-Beta-Agonist (SABA) as needed to the maintenance controller treatment

 

Check for common problems such as inhaler technique, persistent allergen exposure, and comorbidities