Respiratory Questions

Sarah, age 25, has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following medications ordered for allergic rhinitis would be most appropriate? 1. A decongestant nasal spray. 2. An antihistamine nasal spray. 3. Ipratropium bromide (Atrovent). 4. Omalizumab (Xolair).

1. A decongestant nasal spray. Option 1: For Sarah, who has allergic rhinitis and nasal congestion, a decongestant nasal spray would be indicated. Option 2: For rhinorrhea, an antihistamine nasal spray or ipratropium bromide (Atrovent) would be indicated. Option 3: For rhinorrhea, an antihistamine nasal spray or ipratropium bromide (Atrovent) would be indicated. Option 4: Omalizumab (Xolair) may be necessary for grade 4 allergic rhinitis (severe persistent).

Susie, age 10, has a cough that characteristically occurs all day long but never during sleep. You suspect: 1. A psychogenic cough (or habit). 2. Allergic rhinitis. 3. Pertussis. 4. Postnasal drip.

1. A psychogenic cough (or habit). Option 1: If a cough characteristically occurs all day long but never during sleep, suspect it is a psychogenic cough (or habit). Option 2: Allergic rhinitis results in a cough that is seasonal. Option 3: Pertussis involves a cough that is followed by a "whoop." Option 4: Postnasal drip results in a throat-clearing cough.

The well-established risk factor(s) for nosocomial pneumonia caused by a multidrug-resistant organism is (are): 1. Antibiotic exposure and a hospital stay of more than 1 week. 2. Age greater than 65 and a history of chronic obstructive pulmonary disease (COPD). 3. Outpatient surgery. 4. Allergies to multiple antibiotics.

1. Antibiotic exposure and a hospital stay of more than 1 week. Option 1: Treatment of nosocomial pneumonia is complicated by the frequent involvement of multidrug-resistant organisms. Prior exposure to antibiotics and a hospital stay of more than 1 week are well-established risk factors for infection with these organisms. Option 2: Age and a history of COPD are not related to nosocomial infections caused by multidrug-resistant organisms. Option 3: One advantage of outpatient surgery is that it minimizes patient exposure to infectious organisms in the hospital. Option 4: Antibiotic allergies will limit the number of drug options used to treat infections caused by multidrug-resistant organisms.v

Which of the following conditions is characterized by intermittent episodes of airway obstruction caused by bronchospasm, excessive bronchial secretions, or edema of bronchial mucosa? 1. Asthma. 2. Atelectasis. 3. Acute bronchitis. 4. Emphysema.

1. Asthma. Asthma is characterized by intermittent episodes of airway obstruction caused by bronchospasm, excessive bronchial secretions, or edema of bronchial mucosa.

You are examining the respiratory system of a 65-year-old female client in whom you suspect "impaired gas exchange." This finding may be demonstrated by: 1. Clubbing of the fingers. 2. Nasal flaring. 3. The use of accessory muscles. 4. A cough.

1. Clubbing of the fingers. Option 1: The nursing diagnosis of "impaired gas exchange" may be demonstrated by clubbing of the fingers. Option 2: Nasal flaring is present if the client has a nursing diagnosis of "ineffective airway clearance" or "ineffective breathing pattern." Option 3: The use of accessory muscles to assist breathing may indicate a nursing diagnosis of "ineffective breathing pattern." Option 4: Cough is present if the client has a nursing diagnosis of "ineffective airway clearance" or "ineffective breathing pattern."

Hyperresonance on percussion of the chest occurs with: 1. Emphysema. 2. Pneumonia. 3. Pleural effusion. 4. Lung tumor

1. Emphysema. Option 1: Hyperresonance on percussion of the chest is found when too much air is present, such as occurs with emphysema or a pneumothorax. Option 2: A dull sound on percussion indicates an abnormal density in the lungs, such as occurs with pneumonia, pleural effusion, a lung tumor, or atelectasis. Option 3: A dull sound on percussion indicates an abnormal density in the lungs, such as occurs with pneumonia, pleural effusion, a lung tumor, or atelectasis. Option 4: A dull sound on percussion indicates an abnormal density in the lungs, such as occurs with pneumonia, pleural effusion, a lung tumor, or atelectasis.

You have a patient you are considering starting on bupropion (Wellbutrin) for tobacco cessation and depression. What in the patient's past medical history would prevent you from prescribing this? 1. History of epilepsy. 2. Failure of other antidepressants to treat depression. 3. Obesity. 4. Coronary artery disease.

1. History of epilepsy. Option 1: Bupropion lowers a patient's seizure threshold and is contraindicated in patients with a seizure history. Option 2: Bupropion is generally not first-line treatment for depression, so this would actually lead you toward using this medication. Option 3: Some patients on this medication notice weight loss, so this would also lead you toward using this medication. Option 4: Wellbutrin has no effect on coronary artery disease.

What is the hallmark symptom of sleep apnea? 1. Hypersomnolence. 2. Snoring at night. 3. Impaired memory. 4. Headache.

1. Hypersomnolence. Option 1: Daytime sleepiness is the most common presenting symptom of sleep apnea. Option 2: This is often common in obstructive sleep apnea. Option 3: This is common in sleep apnea but is not the hallmark symptom. Option 4: This is common in the morning with sleep apnea.

Marci, age 15, has been given a diagnosis of step 1 (intermittent) asthma. What long-term control therapy is indicated? 1. None. 2. A single agent with anti-inflammatory activity. 3. An inhaled corticosteroid with the addition of a long-acting bronchodilator if needed. 4. Multiple long-term control medications with oral corticosteroids if needed.

1. None. Option 1: No long-term control therapy is indicated for clients with step 1 (intermittent) asthma, be they children, adolescents, or adults. Clients with step 1 asthma require only quick relief with a beta-2 agonist as needed. Option 2: There is no indication for long-term control until clients approach step 2 (mild persistent) asthma. Option 3: There is no indication for long-term control until clients approach step 2 (mild persistent) asthma. Option 4: There is no indication for long-term control until clients approach step 2 (mild persistent) asthma.

Dennis, age 54, has chronic obstructive pulmonary disease (COPD). He has recently been experiencing difficulty in breathing. His arterial blood gas screening reveals pH 7.3, Pao2 57 mm Hg, Paco2 54 mm Hg, and oxygen saturation 84%. Dennis has: 1. Respiratory acidosis. 2. Respiratory alkalosis. 3. Metabolic acidosis. 4. Metabolic alkalosis.

1. Respiratory acidosis. Option 1: Respiratory acidosis results when the serum Paco2 is more than 45 mm Hg and the serum pH is lower than 7.35. It occurs when there is a reduction in the rate of alveolar ventilation in relation to the rate of carbon dioxide production. The end result is an accumulation of dissolved carbon dioxide, or carbonic acid. Dennis's COPD leads to alveolar hypoventilation with an acute retention of carbon dioxide, resulting in acute respiratory acidosis. Option 2: With respiratory alkalosis, hyperventilation is usually evident, the Paco2 is less than 35 mm Hg, and the pH is higher than 7.45. Option 3: In metabolic acidosis, the Hco3 is less than 22 mEq/L and the pH is lower than 7.35. Option 4: In metabolic alkalosis, the Hco3 is more than 26 mEq/L and the pH is higher than 7.45.

A 23-year-old college student presents to your primary care clinic complaining of the following symptoms: fever for 4 days that is controlled with Tylenol, nonproductive cough, general malaise and fatigue, and minimal rhinorrhea. The patient did not get a flu shot this year and states his girlfriend was diagnosed with the flu 3 days ago. His rapid influenza test is positive. What is the best treatment? 1. Rest and hydration. 2. Oseltamivir. 3. Inpatient hospitalization for supportive care. 4. Azithromycin.

1. Rest and hydration. Option 1: This is the treatment of choice for influenza. At this point, the patient's symptoms have been present too long to give him Tamiflu. Option 2: This can be given as treatment for the flu within the first 48 hours of symptoms only. Option 3: In patients with chronic obstructive pulmonary disease (COPD) or other significant medical comorbidities, hospitalization can be considered. Option 4: The patient has the flu, which is a viral infection.

Which of the following types of lung cancer is most associated with paraneoplastic syndromes? 1. Small cell carcinoma. 2. Adenocarcinoma. 3. Squamous cell carcinoma. 4. Large cell carcinoma.

1. Small cell carcinoma. Option 1: Small cell carcinoma causes paraneoplastic syndromes more than any other type of lung cancer. However, in general, paraneoplastic syndromes occur with lung cancer in only 2% of the population. Option 2: Adenocarcinoma causes paraneoplastic syndromes less than small cell carcinoma. Option 3: Squamous cell carcinoma causes paraneoplastic syndromes less than small cell carcinoma. Option 4: Large cell carcinoma causes paraneoplastic syndromes less than small cell carcinoma.

A 50-year-old male presents to your primary care clinic complaining of fever and cough. The patient's symptoms have been present for 5 days. He complains of mild shortness of breath. Past medical history is positive for hypertension. He takes metoprolol and has no allergies. Vitals show a temperature of 101.5°F, pulse oximetry of 95% on room air, pulse of 101, and blood pressure of 138/90. His chest x-ray shows pulmonary infiltrates in the lower lobes of both lungs. What is the most likely pathogen causing his symptoms? 1. Streptococcus pneumoniae. 2. Legionella pneumophila. 3. Staphylococcus aureus. 4. Mycoplasma pneumoniae.

1. Streptococcus pneumoniae. Option 1: This is the most common etiology of bacterial pneumonia. Option 2: This bacterium most commonly affects older patients. Option 3: This is most commonly seen in hospital-acquired pneumonia or in immunocompromised patients. Option 4: Typically, this is the cause of "walking pneumonia," and symptoms are present for many weeks.

A definitive test for cystic fibrosis (CF) is: 1. The sweat test. 2. A sputum culture. 3. A fecal fat test. 4. A Chymex test for pancreatic insufficiency.

1. The sweat test. Option 1: The definitive tests for CF are the sweat test and DNA analysis. The diagnosis is confirmed by a positive sweat test or by confirming the presence of two of the recognized CF mutations in DNA, one each on the maternally and paternally derived chromosome 7. Sweat testing can be performed at any age. However, newborns in the first few weeks of life may not produce a large enough volume of sweat to analyze, but in those who do, the results will be accurate. Immunoreactive trypsinogen (IRT) levels are elevated in most infants with CF for the first several weeks of life; however, this test has relatively poor specificity because as many as 90% of the positives on the initial screen are false-positives. Early diagnosis of CF improves the poor prognosis for untreated CF. If untreated, most clients die by age 1 to 2 years. With current care, median life expectancy is about 37 years. Option 2: A sputum or throat culture positive for mucoid Pseudomonas aeruginosa is suggestive of CF. Option 3: A fecal fat test, while reliable, is not specific to CF; any condition affected by malabsorption or maldigestion will be associated with increased fecal fat. Option 4: An abnormal Chymex test for pancreatic insufficiency is a supportive laboratory test for diagnosing CF.

In tumor classification, TNM stands for which of the following? 1.Tumor, node, metastasis. 2.Tumor, nodules, metastasis. 3.Tumor, node, medicine. 4.Treat, nodules, metastasis.

1. Tumor, node, metastasis.

What is the most common histologic type of lung cancer? 1. Adenocarcinoma. 2. Squamous cell carcinoma. 3. Small cell carcinoma. 4. Large cell carcinoma.

1.Adenocarcinoma Adenocarcinoma is the most common histology seen in lung cancer.

What is the most common histologic type of lung cancer? 1. Adenocarcinoma. 2.Squamous cell carcinoma. 3.Small cell carcinoma. 4.Large cell carcinoma.

1.Adenocarcinoma.

Hyperresonance on percussion of the chest occurs with: 1.Emphysema. 2.Pneumonia. 3.Pleural effusion. 4.Lung tumor.

1.Emphysema. Hyperresonance on percussion of the chest is found when too much air is present, such as occurs with emphysema or a pneumothorax.

Coughing up blood or sputum that is streaked or tinged with blood is known as: 1.Hemoptysis. 2.Regurgitation. 3.Bloody sputum. 4.Rhinorrhea.

1.Hemoptysis. Hemoptysis is defined as expectoration of blood. The client often reports coughing up blood or sputum that is streaked or tinged with blood. In addition, hemoptysis may be manifested as fresh (bright red) or old blood, or, in the case of bleeding from an infected lung cavity, it may present as slow oozing or frank bleeding. In cases of profuse hemoptysis, blood clots may be expectorated.

Which irregular respiratory pattern has a series of 3 to 4 normal respirations, followed by a period of apnea and is seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis? 1. Cheyne-Stokes respiration. 2. Biot breathing. 3.Kussmaul respiration. 4. Hypoventilation.

2. Biot breathing. Option 1: Cheyne-Stokes respiration is similar except that the pattern is regular. The most common cause of Cheyne-Stokes respiration is severe congestive heart failure, followed by renal failure, meningitis, drug overdose, and increased intracranial pressure. This regular pattern occurs normally in infants and older adults during sleep. Option 2: Biot breathing is the term for an irregular respiratory pattern with a series of 3 to 4 normal respirations, followed by a period of apnea. It is seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis. Option 3: Kussmaul respiration is hyperventilation with an increase in both the rate and depth of the breaths. Option 4: Hypoventilation is a respiratory pattern that causes an increase in carbon dioxide in the bloodstream due to the reduced rate and depth of breathing.

The inspiratory rate equals the expiratory rate with which breath sound? 1. Bronchial. 2. Bronchovesicular. 3. Vesicular. 4. Tracheal.

2. Bronchovesicular. Option 1: With bronchial breath sounds, the inspiratory rate is shorter than the expiratory rate. Option 2: With bronchovesicular breath sounds, the inspiratory rate equals the expiratory rate. Option 3: With vesicular breath sounds, the inspiratory rate is greater than the expiratory rate. Option 4: With tracheal breath sounds, the inspiratory rate is shorter than the expiratory rate.

When trying to differentiate pulmonary from cardiac causes of dyspnea on exertion, it is important to remember that which of the following statements is true? 1. When the cause is pulmonary, recovery of normal respiration is slow, and dyspnea eventually abates after cessation of exercise. 2. Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise. 3. In dyspnea arising from cardiac causes, the heart rate will return to pre-exercise levels within a few minutes after cessation of exercise. 4. Clients with pulmonary dyspnea have minimal dyspnea at rest.

2. Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise Option 1: When the cause is pulmonary, recovery of normal respiration is fast, and dyspnea is gone a few minutes after the cessation of exercise. Option 2: When trying to differentiate pulmonary from cardiac causes of dyspnea on exertion, it is important to remember that clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise. Clients with severe cardiac dyspnea demonstrate a volume of respiration that is greater than normal at every level of exercise, and they experience dyspnea sooner after beginning the exertion. Option 3: In dyspnea arising from cardiac causes, the heart rate takes longer to return to pre-exercise levels. Option 4: Clients with pulmonary dyspnea usually do not have dyspnea at rest.

Which of the following parapharyngeal upper respiratory tract infections occurs most often in children aged 2 to 5 years? 1. Peritonsillar abscess. 2. Epiglottitis. 3. Laryngotracheobronchitis (croup). 4. Bacterial tracheitis.

2. Epiglottitis. The parapharyngeal upper respiratory tract infection that occurs most often in children aged 2 to 5 years is epiglottitis.

Of the following groups, which is at the highest risk of tuberculosis in the United States? 1. People born in the United States. 2. Foreign-born individuals. 3. People in rural populations. 4. Residents of Oklahoma.

2. Foreign-born individuals. Option 1: U.S.-born individuals make up just over 30% of tuberculosis cases. Option 2: Foreign-born individuals represent close to 70% of all cases of tuberculosis in the United States. Option 3: Tuberculosis is more common in urban than rural populations. Option 4: As of a 2016 count by the Centers for Disease Control, the states with the most cases of tuberculosis are California, Florida, New York, and Texas.

A 66-year-old female with a history of diabetes presents to your primary care office complaining of a cough and fever for 6 days. Her vitals are as follows: temperature 101.5°F, oxygen saturation 94 % on room air, respiratory rate (RR) 32 per minute, pulse (P) 110, and blood pressure 145/96. What is the best way to treat this patient for pneumonia? 1. Inpatient admission to the intensive care unit (ICU). 2. Inpatient admission. 3. Outpatient treatment with oral antibiotics. 4. Outpatient treatment with close follow-up until a sputum culture returns.

2. Inpatient admission. Option 1: The patient's CURB-65 score would need to be greater than 3 to admit her to the ICU. Option 2: Based on the CURB-65 criteria, the patient has a score of 2 because of her coexisting diabetes and low oxygen saturation; admission to the hospital is necessary. Option 3: This patient has a CURB-65 score of 2 and has diabetes and low oxygen saturation and should be treated in the hospital. Option 4: The diagnosis of pneumonia is already established in the question. While a sputum culture may help antibiotic therapy selection, outpatient care is not adequate for this patient.

Mr. Tanner, age 67, presents to the clinic with fever, chills, a productive cough with sputum that has changed color from clear to yellow, chest discomfort, fatigue, and myalgias. His wife is concerned because he is confused at times. His blood pressure is 100/54, his pulse rate is 92, and his respirations are 22 per minute. When percussing the chest, you detect dullness over the right lower lobe and suspect that Mr. Tanner has pneumonia. Your plan for Mr. Tanner includes: 1. Outpatient treatment. 2. Inpatient treatment. 3. Macrolide antibiotic therapy. 4. A respiratory fluoroquinolone.

2. Inpatient treatment. Option 1: Mr. Tanner meets 3 of the CURB-65 criteria for hospitalization and therefore should be treated as an inpatient. Option 2: The first step in treatment is to determine the severity of the pneumonia and whether the patient should be hospitalized. The CURB-65 criteria are (1) confusion, (2) uremia (blood urea nitrogen [BUN) 20 mg/dL or higher), (3) respiratory rate more than 30 breaths per minute, (4) systolic blood pressure (BP) less than 90 mm Hg or diastolic BP less than 60 mm Hg, and (5) age 65 or older. If the patient meets less than 2 of the criteria, is able to take oral medication, and is not hypoxic, then he may be treated as an outpatient. If the score is 2 or higher, inpatient treatment is indicated. Mr. Tanner meets 3 of the criteria and therefore should be treated as an inpatient. Option 3: Macrolides are the first choice of antibiotic for previously healthy patients who have not used antimicrobials in the past 3 months. Macrolides are an option for outpatient therapy. Option 4: Respiratory fluoroquinolone therapy is the first choice for patients with comorbidities. A respiratory fluoroquinolone is an option for outpatient therapy.

Michael, age 52, has had a gradual onset of dry cough, dyspnea, chills, fever, general malaise, headache, confusion, anorexia, diarrhea, myalgias, and arthralgias. Which diagnosis do you suspect? 1. Bronchopneumonia. 2. Legionnaires' disease. 3. Primary atypical pneumonia. 4. Pneumocystis jiroveci pneumonia.

2. Legionnaires' disease. Option 1: Bronchopneumonia has a gradual onset with a cough, scattered crackles, minimal dyspnea and respiratory distress, and a low-grade fever. Option 2: If a client has a dry cough, dyspnea, chills, fever, general malaise, headache, confusion, anorexia, diarrhea, myalgias, and arthralgias, suspect Legionnaires' disease. Legionnaires' disease has a gradual onset. Option 3: Primary atypical pneumonia has a gradual onset with a dry, hacking, nonproductive cough; fever; headache; myalgias; and arthralgias. Option 4: P jiroveci pneumonia occurs in clients with AIDS. It has an abrupt onset with a dry cough, tachypnea, shortness of breath, significant respiratory distress, and fever.

Jamie, age 16, has had her asthma well controlled by using only a beta-2 adrenergic metered-dose inhaler. Lately, however, she has had difficulty breathing during the night, and her sleep has been interrupted about 3 times a week. What do you do? 1. Prescribe a short course of steroid therapy. 2. Prescribe an inhaled steroid. 3. Prescribe a longer acting bronchodilator. 4. Prescribe oral theophylline.

2. Prescribe an inhaled steroid. If a client develops moderate asthma, defined as more than 2 episodes per week, an inhaled steroid should be prescribed and used in conjunction with the beta-2 adrenergic metered-dose inhaler.

When you suspect a diagnosis of asthma, which test is the most appropriate to order to confirm the diagnosis? 1. Chest x-ray. 2. Spirometry. 3. Bronchoprovocation. 4. Bronchoscopy.

2. Spirometry. This is the best way to diagnose asthma.

Cough and congestion result when breathing: 1. Carbon monoxide. 2. Sulfur dioxide. 3. Tear gas. 4. Carbon dioxide.

2. Sulfur dioxide. Option 1: Carbon monoxide produces dizziness, headache, and fatigue. Option 2: Cough and congestion result when breathing sulfur dioxide. Option 3: Tear gas irritates the conjunctivae and produces a flow of tears. Option 4: Carbon dioxide produces sleepiness.

A 28-year-old teacher presents to your primary care office in the winter complaining of severe hoarseness for 3 days. It is progressive, and the patient can no longer teach her classes because she can't talk for long periods of time. The patient's vital signs show a temperature of 97.9°F, pulse of 70 beats per minute (BPM), pulse oximetry of 97% on room air, and blood pressure (BP) of 135/82. The patient has erythematous nasal and pharyngeal membranes, no nasal drainage, erythematous tympanic membranes, and a very sore throat. Rapid streptococcal (strep) test is negative, and there is no cervical lymphadenopathy. What is the treatment of choice? 1. Azithromycin. 2. Vocal rest. 3. Oral methylprednisolone. 4. Codeine cough syrup.

2. Vocal rest. Option 1: The patient has laryngitis that is likely viral in origin; no antibiotic is necessary. Option 2: This is the treatment of choice for laryngitis. Option 3: Oral steroids are not the first choice for treatment of laryngitis. Option 4: Cough syrup is supportive in cases of viral cough; the patient has no cough.

Sherri, age 49, has had asthma for several years but has never used a peek expiratory flow (PEF) meter. Should you now recommend it? 1.No, she has been managing fine without it. 2.Yes, she might recognize early signs of a potential respiratory problem. 3.Present the options and let Sherri decide. 4.No, at her age it is not recommended.

2.Yes, she might recognize early signs of a potential respiratory problem. Daily peak flow monitoring has long been recommended for clients with asthma. Guidelines from the National Asthma Education and Prevention Program of the National Heart, Lung, and Blood Institute increase the flexibility of this recommendation and suggest that the use of peak flow measurements be individualized. The guidelines recommend that all clients with persistent asthma assess peak flow each morning. Subsequent assessments are necessary during the day when the morning measurement is less than 80% of the client's personal best PEF measurement. The goal of daily PEF monitoring is to recognize early signs of deterioration in airway function so that corrective steps can be initiated.

Tina, age 49, is on multiple drug therapy for tuberculosis (TB). She asks you how long she needs to take the drugs. You respond: 1. "Six weeks to two months." 2. "Four to six months." 3. "Six to nine months." 4. "One year."

3. "Six to nine months." With the use of multiple drug therapy for tuberculosis, the duration of therapy has shortened from 1 year to a standard of 6 to 9 months. An alternative regimen for persons who cannot take pyrazinamide (PZA), eg, pregnant women, consists of a 9-month regimen of isoniazid (INH) and rifampin (RIF).

Mary, age 69, has chronic obstructive pulmonary disease (COPD). Her oxygen saturation is less than 85%. She is to start on oxygen therapy to relieve her symptoms. How often must she be on oxygen therapy to actually improve her oxygen saturation? 1. On an as needed basis. 2. 6 to 12 hours per day. 3. 15 hours per day. 4. 24 hours per day.

3. 15 hours per day. To decrease mortality in clients with COPD whose oxygen saturations are less than 85%, oxygen must be used at least 15 hours per day to be of more than symptomatic benefit. The oxygen can be either a specific concentration delivered by mask or a flow rate administered through a nasal cannula. It is needed to maintain adequate oxygenation levels during both activity and rest. The goal of therapy is a Pao2 of 60 mm Hg or Sao2 of 90%.

Which of the following patients would you recommend get a low-dose computed tomography (CT) scan for lung cancer screening? 1. A 25-year-old with a 10-pack-year history and asthma. 2. A 75-year-old with a history of pneumonia. 3. A 65-year-old smoker who started smoking at age 12. 4.A 65-year-old smoker who quit 20 years ago but has a previous 50-pack-year history.

3. A 65-year-old smoker who started smoking at age 12. Option 1: The criterion for lung cancer screening is age 55 to 80 with a 30-pack-year history and currently smoking or with a history of quitting within the last 15 years. Option 2: A diagnosis of pneumonia is not associated with cancer. Option 3: The criterion for lung cancer screening is age 55 to 80 with a 30-pack-year history and currently smoking or with a history of quitting within the last 15 years. Option 4: This patient quit smoking greater than 15 years ago and doesn't need screening any longer.

Sharon, who is pregnant, has just been given a diagnosis of tuberculosis. What do you do? 1.Wait until Sharon delivers and then begin therapy immediately. 2.Begin therapy with isoniazid (Nydrazid), rifampin (Rimactane), and pyrazinamide now. 3. Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol) now. 4. Begin therapy with isoniazid now, wait to see how Sharon tolerates it, and then add rifampin, pyrazinamide, or ethambutol.

3. Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol) now. Option 1: Treatment of tuberculosis in pregnant women is essential and should not be delayed; therefore, Sharon's treatment should begin now. Option 2: The teratogenicity of pyrazinamide is undetermined, so it is not wise to use this drug unless resistance to the other drugs is demonstrated or is likely. Option 3: Treatment of tuberculosis in pregnant women is essential and should not be delayed; therefore, Sharon's treatment should begin now. The preferred initial treatment is isoniazid (Nydrazid), rifampin (Rimactane), and ethambutol (Myambutol). Option 4: The teratogenicity of pyrazinamide is undetermined, so it is not wise to use this drug unless resistance to the other drugs is demonstrated or is likely.

Sharon, who is pregnant, has just been given a diagnosis of tuberculosis. What do you do? 1. Wait until Sharon delivers and then begin therapy immediately. 2. Begin therapy with isoniazid (Nydrazid), rifampin (Rimactane), and pyrazinamide now. 3. Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol) now. 4. Begin therapy with isoniazid now, wait to see how Sharon tolerates it, and then add rifampin, pyrazinamide, or ethambutol.

3. Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol) now. Option 1: Treatment of tuberculosis in pregnant women is essential and should not be delayed; therefore, Sharon's treatment should begin now. Option 2: The teratogenicity of pyrazinamide is undetermined, so it is not wise to use this drug unless resistance to the other drugs is demonstrated or is likely. Option 3: Treatment of tuberculosis in pregnant women is essential and should not be delayed; therefore, Sharon's treatment should begin now. The preferred initial treatment is isoniazid (Nydrazid), rifampin (Rimactane), and ethambutol (Myambutol). Option 4: The teratogenicity of pyrazinamide is undetermined, so it is not wise to use this drug unless resistance to the other drugs is demonstrated or is likely.

Sharon, who is pregnant, has just been given a diagnosis of tuberculosis. What do you do? 1.Wait until Sharon delivers and then begin therapy immediately. 2.Begin therapy with isoniazid (Nydrazid), rifampin (Rimactane), and pyrazinamide now. 3.Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol) now. 4.Begin therapy with isoniazid now, wait to see how Sharon tolerates it, and then add rifampin, pyrazinamide, or ethambutol.

3. Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol) now. Treatment of tuberculosis in pregnant women is essential and should not be delayed; therefore, Sharon's treatment should begin now. The preferred initial treatment is isoniazid (Nydrazid), rifampin (Rimactane), and ethambutol (Myambutol).

A 55-year-old male presents to your primary care clinic complaining of a cough for 3 months. He is a diabetic and is currently taking lisinopril, atorvastatin, and metformin. He denies dyspnea, chest pain, and productive cough. He was recently diagnosed with diabetes and has started all 3 of these medications within the last 4 months. The patient's vital signs are within normal limits, and his chest x-ray is negative. What is the etiology of the patient's cough? 1. Upper respiratory infection (URI). 2. Walking pneumonia. 3. Lisinopril. 4. Sinus infection.

3. Lisinopril. Option 1: The patient's symptoms have been present for 3 months; this is not the course taken by a viral URI. Option 2: The patient has no fever or productive cough and has a normal chest x-ray. Option 3: The patient has had a chronic cough for approximately as long as he has been taking his angiotensin-converting enzyme (ACE) inhibitor, so it is likely a side effect of this medication. Option 4: The patient doesn't have facial pain or congestion.

The antibiotic of choice for the treatment of Streptococcus pneumoniae infection is: 1. Dicloxacillin. 2. Erythromycin. 3. Penicillin. 4. Amoxicillin-clavulanate.

3. Penicillin. Option 1: Dicloxacillin is the antibiotic of choice for infections caused by Staphylococcus aureus. Option 2: Erythromycin is the antibiotic of choice for infections caused by Mycoplasma pneumoniae. Option 3: The antibiotic of choice for the treatment of S pneumoniae infection is penicillin. However, the number of penicillin-resistant pneumococcal infections is increasing. These cases require treatment with more powerful antibiotics. Alternative choices are erythromycin and clindamycin. Fever that continues more than 24 hours after initiating therapy usually does not indicate failure of the antibiotic; rather, the usual response to therapy is a gradual reduction in the maximum daily temperature. Option 4: Amoxicillin-clavulanate is the antibiotic of choice for infections caused by Moraxella catarrhalis.

In trying to differentiate between chronic bronchitis and emphysema, you know that chronic bronchitis: 1.Usually occurs after age 50 and has insidious progressive dyspnea. 2.Usually presents with a cough that is mild and with scant, clear sputum, if any. 3.Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note. 4.Results in an increased total lung capacity with a markedly increased residual volume.

3. Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note.

In trying to differentiate between chronic bronchitis and emphysema, you know that chronic bronchitis: 1. Usually occurs after age 50 and has insidious progressive dyspnea. 2. Usually presents with a cough that is mild and with scant, clear sputum, if any. 3. Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note. 4. Results in an increased total lung capacity with a markedly increased residual volume.

3. Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note. Option 1: In a client with emphysema, the onset is usually after age 50. Option 2: In a client with emphysema, there is an insidious progressive dyspnea, and the cough is usually absent or mild with scant, clear sputum, if any. There are also distant or diminished breath sounds and a hyperresonant percussion note. With chronic bronchitis, there is usually copious mucopurulent sputum. Option 3: In trying to differentiate between chronic bronchitis and emphysema, remember that chronic bronchitis presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note. Chronic bronchitis usually occurs after age 35, with recurrent respiratory infections. There is usually a persistent cough productive of copious mucopurulent sputum, and pulmonary function studies show normal or decreased total lung capacity with a moderately increased residual volume. Option 4: In a client with emphysema, pulmonary function studies show an increased total lung capacity with a markedly increased residual volume.

Laura, age 36, has an acute onset of dyspnea. Associated symptoms include chest pain, faintness, tachypnea, peripheral cyanosis, low blood pressure, crackles, and some wheezes. Her history reveals that she is taking birth control pills and that she smokes. What do you suspect? 1. Asthma. 2. Bronchitis. 3. Pulmonary embolism. 4. Pneumothorax.

3. Pulmonary embolism. If a client presents with an acute onset of dyspnea with associated symptoms of chest pain, faintness, tachypnea, peripheral cyanosis, low blood pressure, crackles, and some wheezes and has a history of taking birth control pills and smoking, suspect pulmonary embolism. Other signs and symptoms associated with pulmonary embolism include loss of consciousness and a pleural friction rub. Precipitating and aggravating factors include the use of oral contraceptives and prolonged recumbency.

You have completed a physical exam on Sandra, age 32, who presented to the clinic for a cough that is particularly worse at night. She has been experiencing episodes of recurrent tightness in the chest with wheezing. She tells you that exercise and changes in the weather make her symptoms occur or worsen. Which test is performed to diagnose asthma? 1. Bronchoprovocation with methacholine, histamine, cold air, or exercise challenge. 2. Peak expiratory flow meter monitoring. 3. Spirometry testing. 4. Chest x-ray.

3. Spirometry testing. Option 1: A positive bronchoprovocation test is diagnostic of airway hyperresponsiveness, which may also be present in other conditions. Option 2: Peak flow meters are used for monitoring asthma. Option 3: Spirometry tests are done to diagnose asthma in patients who are 5 years and older. Measurements should include forced expiratory volume in the first second of expiration (FEV1), forced expiratory volume in 6 seconds (FEV6), forced vital capacity (FVC), and FEV1/FVC. These measurements should be performed before and after the patient inhales a short-acting bronchodilator. Bronchoprovocation is done when asthma is suspected but the spirometry testing is normal. Option 4: A chest x-ray is performed to exclude other diseases.

You have completed a physical exam on Sandra, age 32, who presented to the clinic for a cough that is particularly worse at night. She has been experiencing episodes of recurrent tightness in the chest with wheezing. She tells you that exercise and changes in the weather make her symptoms occur or worsen. Which test is performed to diagnose asthma? 1.Bronchoprovocation with methacholine, histamine, cold air, or exercise challenge. 2.Peak expiratory flow meter monitoring. 3.Spirometry testing. 4.Chest x-ray.

3. Spirometry testing. Spirometry tests are done to diagnose asthma in patients who are 5 years and older. Measurements should include forced expiratory volume in the first second of expiration (FEV1), forced expiratory volume in 6 seconds (FEV6), forced vital capacity (FVC), and FEV1/FVC. These measurements should be performed before and after the patient inhales a short-acting bronchodilator. Bronchoprovocation is done when asthma is suspected but the spirometry testing is normal.

What is the gold standard for the diagnosis of asthma? 1. Validated quality-of-life questionnaire. 2. Client's perception of "clogged" airways. 3. Spirometry. 4. Bronchoscopy.

3. Spirometry. Option 1: Routine use of validated quality-of-life questionnaires may detect impairment and severity of the disease. Option 2: The client's perception may be greatly exaggerated. Option 3: Spirometry remains the gold standard for the diagnosis of asthma as well as for periodic monitoring of the condition. Option 4: A bronchoscopy may be necessary to diagnose several conditions, including a chronic cough or infection. If a client is not having an asthma attack, the airways may not appear constricted.

An infant who has periodic breathing with persistent or prolonged apnea (greater than 20 seconds) may have an increased risk of: 1. Pneumonia. 2. Left-sided congestive heart failure. 3. Sudden infant death syndrome (SIDS). 4. Anemia.

3. Sudden infant death syndrome (SIDS). Option 1:Rapid respiratory rates accompany pneumonia, anemia, fever, pain, and heart disease. Option 2: Tachypnea (a very rapid respiratory rate of 50-100 breaths per minute) during sleep may be an early sign of left-sided congestive heart failure. Option 3: An infant who has periodic breathing with persistent or prolonged apnea (greater than 20 seconds) may have an increased risk of SIDS. Option 4: Rapid respiratory rates accompany pneumonia, anemia, fever, pain, and heart disease.

You are teaching Holly, age 14, who has asthma, to use a home peak expiratory flow meter daily to measure gross changes in peak expiratory flow. Which "zone" would rate her expiratory compliance as 50% to 80% of her personal best? 1. White zone. 2. Green zone. 3. Yellow zone. 4. Red zone.

3. Yellow zone. Option 2: A green zone (80%-100% of her personal best) indicates no asthma symptoms are present and she should continue with her normal medication regimen. Option 3: Holly should perform a peak expiratory flow meter reading daily during a 2-week period when she feels well. The highest number recorded during this period is her personal best. A yellow zone (50%-80% of her personal best) indicates asthma symptoms may be starting, and signals caution. Option 4: A red zone (below 50% of her personal best) indicates that an asthma attack is occurring and that Holly should take her inhaled beta-2 agonist and repeat the peak flow assessment.

Which of the following statements regarding sleep apnea is not true? 1.Thirty percent of the male population in the United States has sleep apnea. 2.Unmanaged sleep apnea is associated with worse control of atrial fibrillation. 3.Central sleep apnea is the most common type of sleep apnea. 4.Unmanaged sleep apnea increases a patient's coronary risk.

3.Central sleep apnea is the most common type of sleep apnea. Option 1: This is true; 15% of women have it as well. Option 2: Managed sleep apnea helps manage and control atrial fibrillation. Option 3: This is not true; obstructive sleep apnea is the most common type of sleep apnea. Option 4: This is true; unmanaged sleep apnea is associated with increased risk of a coronary event and arrhythmia.

When teaching a mother who has a child with cystic fibrosis (CF), you emphasize that the most important therapeutic approach for promoting the child's pulmonary function is: 1.Continuously administering low-flow oxygen. 2.Administering bronchodilators on a regular basis. 3.Performing chest physiotherapy with postural drainage, percussion, and vibration. 4.Using maintenance antibiotic prophylactic therapy.

3.Performing chest physiotherapy with postural drainage, percussion, and vibration. Daily performance of chest physiotherapy with postural drainage, percussion, and vibration to remove the abnormally viscous mucus is essential for a client with cystic fibrosis.

Stridor can be heard on auscultation when a client has: 1.Atelectasis. 2.Asthma. 3.Diaphragmatic hernia. 4.Acute epiglottitis.

4. Acute epiglottitis. Stridor, a high-pitched inspiratory crowing sound, can be heard on auscultation when a client has acute epiglottitis or croup.

A cough caused by postnasal drip related to sinusitis is more prevalent at what time of day? 1. Continuously throughout the day. 2. In the early morning. 3. In the afternoon and/or evening. 4. At night.

4. At night. Option 1: A cough associated with an acute illness, such as a respiratory infection, is continuous throughout the day. Option 2: A cough in the early morning is usually caused by chronic bronchial inflammation from habitual smoking. Option 3: A cough in the afternoon and/or evening may reflect exposure to irritants at work. Option 4: Some conditions involve a cough with characteristic timing. A cough caused by postnasal drip related to sinusitis is more prevalent at night.

James, age 12, just moved from Texas. He presents with a headache, cough, fever, rash on the legs and arms, myalgias, and dysuria. His white blood cell count is 12.9 with 8% bands and 7% to 10% eosinophils. Electrolyte levels are normal. Blood cultures are negative. Sputum is not available. A Mantoux skin test so far is negative. What do you suspect? 1.Pulmonary tuberculosis. 2.Lymphoma. 3.Asthma. 4.Coccidioidomycosis.

4. Coccidioidomycosis. Coccidioidomycosis is the leading mycotic (fungal) infection in the southwestern United States. About 40% of people infected with this fungus develop symptoms. Most often they have an influenza-like illness with fever, cough, headaches, rash, and myalgias (muscle pains). Of those people with symptoms, 8% have severe lung disease requiring hospitalization and 7% develop disseminated infection (ie, throughout the body).

James, age 12, just moved from Texas. He presents with a headache, cough, fever, rash on the legs and arms, myalgias, and dysuria. His white blood cell count is 12.9 with 8% bands and 7% to 10% eosinophils. Electrolyte levels are normal. Blood cultures are negative. Sputum is not available. A Mantoux skin test so far is negative. What do you suspect? 1. Pulmonary tuberculosis. 2. Lymphoma. 3. Asthma. 4. Coccidioidomycosis.

4. Coccidioidomycosis. Option 1: Pulmonary tuberculosis is ruled out with the Mantoux test. Option 2: A patient with lymphoma would typically have flu-like symptoms as well as enlarged lymph nodes. Option 3: Asthma is ruled out, as it does not appear that James has any difficulty breathing. Option 4: Coccidioidomycosis is the leading mycotic (fungal) infection in the southwestern United States. About 40% of people infected with this fungus develop symptoms. Most often they have an influenza-like illness with fever, cough, headaches, rash, and myalgias (muscle pains). Of those people with symptoms, 8% have severe lung disease requiring hospitalization and 7% develop disseminated infection (ie, throughout the body).

In children aged 1 to 5 years with a chronic cough, which of the following should be considered part of the differential diagnosis after the more common causes have been ruled out? 1. Allergic rhinitis. 2. Chronic sinusitis. 3. Enlarged adenoids. 4. Cystic fibrosis.

4. Cystic fibrosis. Option 1: Allergic rhinitis is a common cause of chronic cough in children aged 1 to 5 years. Option 2: Chronic sinusitis is a common cause of chronic cough in children aged 1 to 5 years. Option 3: Enlarged adenoids are a common cause of chronic cough in children aged 1 to 5 years. Option 4: After the more common causes—allergic rhinitis, chronic sinusitis, and enlarged adenoids—have been ruled out, a chronic cough in children aged 1 to 5 years should suggest bronchiectasis or cystic fibrosis. Although rare, chronic cough in children younger than age 1 should suggest congenital malformations or neonatal infections, including viral and chlamydial pneumonias. Other relatively rare causes of chronic cough in young infants include recurrent aspiration of milk, saliva, or gastric contents.

Which of the following medications prescribed for asthma acts to prevent binding of IgE receptors on basophils and mast cells? 1. Anti-inflammatory agents. 2. Bronchodilators. 3. Mast cell stabilizers. 4. Immunomodulators.

4. Immunomodulators. Option 1: Anti-inflammatory agents calm inflammation. Option 2: Bronchodilators dilate the bronchi. Option 3: Mast cell stabilizers stabilize mast cells and interfere with chloride channel function. Option 4: Immunomodulators such as omalizumab (Xolair), a monoclonal antibody, prevent binding of IgE receptors on basophils and mast cells.

Keaton, age 6, comes to the clinic with his mother for a 3-month follow-up visit for his asthma. His mother reports he has symptoms 2 days a week but not more than once each day, he has had only 1 episode of nighttime awakening because of his asthma, he is able to play soccer without provoking an attack, and his peak flow personal best is 80% or higher. His current treatment includes a short-acting beta agonist and a leukotriene receptor antagonist. Based on the level of control, your plan for adjusting therapy includes: 1. Considering a short course of oral systemic corticosteroids. 2. Stepping up 1 step. 3. Stepping up 2 steps. 4. Maintaining the current step.

4. Maintaining the current step. Option 1: For very poorly controlled asthma, recommendations include considering a short course of oral systemic corticosteroids and stepping up 1 to 2 steps. Option 2: For asthma that is not well controlled, step up at least 1 step and consider 1 to 2 steps in patients aged 12 and older. Option 3: For asthma that is not well controlled, step up at least 1 step and consider 1 to 2 steps in patients aged 12 and older. Option 4: Keaton's asthma symptoms are well controlled, and he is at step 2. Recommendations for well-controlled asthma include maintaining the current step, following up every 1 to 6 months, and considering a step down if the asthma is well-controlled for at least 3 months.

Which of the following is not a risk factor for the development of asthma? 1. Younger age. 2. African American race. 3. Female gender. 4. Obesity.

4. Obesity. Obesity has no bearing on asthma development.

The diagnosis of tuberculosis does not need to be reported when: 1. The client's Mantoux test shows an induration of 15 mm. 2. A case of tuberculosis is only suspected. 3. An asymptomatic client has a positive chest x-ray for pulmonary tuberculosis. 4. The Mantoux test shows a raised, injected, or red area without induration.

4. The Mantoux test shows a raised, injected, or red area without induration. Option 1: Every potential tuberculosis case must be reported to the local health department; this includes a client with a Mantoux test showing an induration of 15 mm. Option 2: Every potential tuberculosis case must be reported to the local health department, even a case in which tuberculosis is merely suspected. Option 3: Every potential tuberculosis case must be reported to the local health department; this includes an asymptomatic client with a chest x-ray positive for pulmonary tuberculosis. Option 4: In higher risk areas with suspected infection, screening tests that do not have a positive reaction do not need to be reported; these include the appearance of a red area with an induration of less than 10 mm on the first test (less than 5 mm on employees with a yearly screen).

You have been counseling your client about her asthma. You realize she does not understand your suggestions when she tells you she will do which of the following? 1.Cover the mattress and pillows in airtight, dustproof covers. 2.Wash the bedding weekly and dry it on a hot setting for 20 minutes. 3.Avoid sleeping on natural fibers such as wool or down. 4.Open the windows and air out the room daily.

4.Open the windows and air out the room daily. To control the common asthma trigger of dust mites, the following measures are recommended: covering the mattress and pillows in airtight, dustproof covers; washing the bedding weekly and drying it on a hot setting for 20 minutes; avoiding sleeping on natural fibers such as wool or down; removing all carpeting from bedrooms; and reducing indoor humidity to less than 50%. Opening the windows daily would allow allergens to enter.

Which of the following is not a lifestyle modification that can help in the treatment of obstructive sleep apnea? 1. Weight loss. 2. Alcohol abstinence. 3. Positional therapy. 4.Tobacco cessation.

4.Tobacco cessation. Option 1: Weight loss reduces the load on the respiratory system and makes it easier for the body to provide oxygen to the brain while sleeping. Option 2: This will help reduce the severity of obstructive sleep apnea. Option 3: Avoiding sleeping in a supine position will improve sleep apnea. Option 4: Tobacco use is not associated with sleep apnea.

Which of the following workers are at risk for developing "black lung disease?" 1. Farmers. 2. Coal miners. 3. Construction workers. 4. Potters.

Coal miners.

Martin, age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that he should be hospitalized? 1.Inability to take oral medications and multilobar involvement on chest x-ray. 2.Alert and oriented status, slightly high but stable vital signs, and no one to take care of him at home. 3.Sputum with gram-positive organisms. 4.A complete blood count (CBC) showing leukocytosis.

Inability to take oral medications and multilobar involvement on chest x-ray.

Mark, age 72, has been living in a shelter for 4 months. Today he appears at the clinic complaining of productive cough, weight loss, weakness, anorexia, night sweats, and generalized malaise. These have been bothering him for 8 weeks. What would be one of the first tests you order? 1. Mantoux test. 2. Chest x-ray. 3. Complete blood work. 4. Sputum culture.

Mantoux test

Which of the following statements about sarcoidosis is true? 1. It commonly occurs in persons in their 50s. 2. It is more common in whites than in blacks. 3. Many organs may be involved, but the most involved organ is the lung. 4. It occurs more frequently in men than in women.

Many organs may be involved, but the most involved organ is the lung.

Jill, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities, and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Jill in? 1. Intermittent. 2. Mild persistent. 3. Moderate persistent. 4. Severe persistent.

Moderate persistent.

What is a common inhaled allergen in allergic asthma (extrinsic asthma)? 1. Smoke. 2. Cold air. 3. Strong smells. 4. Pet dander.

Pet dander.

An infant who has periodic breathing with persistent or prolonged apnea (greater than 20 seconds) may have an increased risk of: 1. Pneumonia. 2.Left-sided congestive heart failure. 3. Sudden infant death syndrome (SIDS). 4. Anemia.

Sudden infant death syndrome (SIDS).

Which of the following statements regarding the respiratory status of a pregnant woman is true? 1. The thoracic cage may appear wider. 2. The costal angle may feel narrower. 3. Respirations may be shallow. 4. Oxygenation is decreased.

The thoracic cage may appear wider.

Which of the following is considered a therapeutic indication for a bronchoscopy? 1. To evaluate indeterminate lung lesions. 2. To stage cancer preoperatively. 3. To determine the extent of injury secondary to burns, inhalation, or other trauma. 4. To remove a foreign body lodged in the trachea.

To remove a foreign body lodged in the trachea.

What do you include in your teaching about tiotropium (Spiriva) when you initially prescribe it for your client with chronic obstructive pulmonary disease (COPD)? 1. Use it every time you use your beta-2 agonist. 2. Stop taking all your other COPD medications. 3. Use it once per day. 4. Stop taking Spiriva if you develop the adverse effect of dry mouth.

Use it once per day.

What is the greatest risk factor for the development of chronic obstructive pulmonary disease (COPD)? 1. Cigarette smoking. 2. Air pollution. 3. Work exposure. 4. Asthma.

1. Cigarette smoking. Option 1: Smoking is responsible for 80% to 90% of COPD cases. Option 2: This increases your risk of COPD but not as much as smoking. Option 3: Exposure to certain chemicals and gases in work environments increases your risk of COPD but not as much as smoking. Option 4: Asthma doesn't increase the risk of COPD.

When teaching smokers about starting nicotine gum to aid in smoking cessation, tell them to: 1. Chew the gum like regular gum. 2. Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa. 3. Drink a cup of coffee before chewing the gum because it assists the nicotine absorption. 4. Chew 1 piece every 4 hours for the first 6 weeks,

2. Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa. A piece is chewed only long enough to release the nicotine—which produces a peppery taste—and then it is "parked" between the gums and buccal mucosa to allow for nicotine absorption.

Which of the following statements regarding pulmonary tuberculosis is true? 1. Manifestations are usually confined to the respiratory system. 2. Dyspnea is usually present in the early stages. 3. Crackles and bronchial breath sounds are usually present in all phases of the disease. 4. Night sweats are often noted as a manifestation of fever.

4. Night sweats are often noted as a manifestation of fever. In a client with pulmonary tuberculosis, night sweats are often noted as a manifestation of fever.

You have been counseling your client about her asthma. You realize she does not understand your suggestions when she tells you she will do which of the following? 1. Cover the mattress and pillows in airtight, dustproof covers. 2. Wash the bedding weekly and dry it on a hot setting for 20 minutes. 3. Avoid sleeping on natural fibers such as wool or down. 4. Open the windows and air out the room daily.

4. Open the windows and air out the room daily. Option 1: This is a recommended measure to control dust mites, a common asthma trigger. Option 2: This is a recommended measure to control dust mites, a common asthma trigger. Option 3: This is a recommended measure to control dust mites, a common asthma trigger. Option 4: To control the common asthma trigger of dust mites, the following measures are recommended: covering the mattress and pillows in airtight, dustproof covers; washing the bedding weekly and drying it on a hot setting for 20 minutes; avoiding sleeping on natural fibers such as wool or down; removing all carpeting from bedrooms; and reducing indoor humidity to less than 50%. Opening the windows daily would allow allergens to enter.

A 35-year-old nurse presents to your employee health clinic for her annual purified protein derivative (PPD) skin test. Two days later she comes in for the recheck. She has a raised, erythematous lesion at the injection site. What diameter measurement would you consider a positive test? 1.5 mm. 2.8 mm. 3.9 mm. 4.12 mm.

4.12 mm. For a health care worker, a PPD measuring greater than 10 mm is considered positive.