RESPIRATORY Test Questions/Blueprint

Question / Course Objective / Step in the Nursing Process / Cognitive Level
(Blooms) / Difficulty Level / Item
Discrim. / Response
1.Part 1
  1. What is the major difference in pathophysiology between asthma and COPD?
  2. Asthma is a disruption in respiratory diffusion and COPD is disruption in respiratory ventilation
  3. Asthma is a disruption in respiratory ventilation and COPD is disruption in respiratory diffusion
  4. COPD results in permanent airflow obstruction and asthma is a condition of reversible airflow obstruction.
  5. Asthma is the result of an inflammatory process and COPD is a result of hyper-sensitivity of the bronchioles
  6. b & c
/ assess / Remember / 0.795 / 0.3
  1. As the home care nurse, you observe oral candidiasis in your patient with severe, chronic COPD. What information should you obtain from this client?
  2. “Do you swish and spit with water after taking your Advair inhaler?”
  3. “Do you swish and spit with water after taking your Albuterol inhaler?”
  4. “Do you swish and spit with water after taking your Combivent (albuterol/atrovent) inhaler?”
  5. “Do you share a toothbrush with any members of your family?”
  6. a & b
/ Assess
implement / Understand
Apply / 0.692 / 0.4
  1. 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:
  2. Advair is a combination of long-acting and slow-acting bronchodilators.
  3. The two drugs work together to block the effects of histamine on the bronchioles.
  4. One drug decreases inflammation, and the other is a bronchodilator.
  5. The combination of two drugs works more quickly in an acute asthma attack.
/ implement / Understand
apply / 0.872 / 0.2
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.
  1. N1120-VI-2 What symptoms of Ms. Anderson are consistent only with pneumonia?
  2. Fever/chills
  3. Green phlegm
  4. Coarse rhonchi
  5. Inspiratory/expiratory wheezing
  6. a, b, c
/ Assess / Understand
Apply
Analyze / 0.718 / 0.2
  1. What is the clinical significance of inspiratory vs. expiratory wheezing in Ms. Anderson?
  2. There is no clinical significance-they represent the same degree of bronchospasm.
  3. Expiratory wheezing reflects a greater degree of bronchoconstriction
  4. Inspiratory wheezing reflects a greater degree of bronchoconstriction
  5. Crackles are a greater concern with asthmatic exacerbation.
/ Assess / Understand
Apply / 0.744 / 0.3
  1. The physician orders an Albuterol nebulizer. What is the rationale for this medical treatment?
  2. Promotes bronchodilation through stimulating beta 2 receptors on the lungs
  3. Promotes bronchodilation through blocking parasympathetic nervous system stimulation
  4. Promotes bronchodilation through blocking late reaction to allergens and reduce airway hyperresponsiveness
  5. Promotes bronchodilation through inhibiting mast cell activity and decreasing inflammation
/ implement / understand / 0.885 / 0.3
  1. 7. During your initial assessment of Ms. Anderson, what will be your priority to get done first:
  2. Obtain a comprehensive health history to determine the extent of any prior respiratory problems.
  3. Complete a full physical examination to determine the systemic effect of the respiratory distress.
  4. Delay the physical assessment and ask family members about any history of respiratory problems.
  5. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.
/ implement / Understand
Apply / 0.897 / 0.2
  1. Which of the following medications seen in Ms. Anderson would be indicative of severe/end-stage progression of her COPD?
  2. Advair discus MDI bid (Metered Dose Inhaler)
  3. Albuterol MDI tid and prn (Metered Dose Inhaler)
  4. Prednisone po daily
  5. Azmacort MDI bid (Metered Dose Inhaler)
/ assess / Understand / 0.949 / 0.1
  1. Because you are concerned about the risk of Ms. Anderson to develop sepsis, what labs will you be closely monitoring and trending:
  2. Total white blood cell count (WBC)
  3. Neutrophil differential percentage
  4. Serum lactate
  5. a & b
  6. a, b, c
/ assess / Understand
Apply
Analyze
Evaluate / 0.603 / 0.5
  1. 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:
  2. Supplemental oxygen should be used whenever the patient ambulates in the future.
  3. Maintain her on strict bed rest.
  4. The response is normal and the patient should continue at this activity level.
  5. No further ambulation should take place until the disease process is resolved.
/ Assess
implement / Understand
Apply
Analyze
evaluate / 0.731 / 0.1
  1. Ms. Anderson has a right lower-lobe pneumonia and has been treated with intravenous (IV) antibiotics for 2 days, which assessment data obtained by the nurse indicates that the treatment has been effective?
  2. Coarse rhonchi are auscultated at the left lower base.
  3. The patient coughs up large amounts of green mucous.
  4. Current temperature is 98.9 orally
  5. The patient’s current white blood cell (WBC) count is 9000 with a neutrophil differential count of 70%
  6. c & d
/ Assess
implement / Understand
Apply
Analyze
Evaluate / 0.744 / 0.4
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?
  2. Resting pulse oximetry (SpO2) of 85% on room air
  3. Respiratory rate of 28/minute at rest
  4. Crackles in lung bases bilaterally
  5. All of the above
/ assess / Understand
Apply
Analyze / 0.870 / 0.2
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?
  1. Ampicillin/Sulbactam (Unasyn) IV
  2. Acetaminophen (Tylenol) po
  3. Guaifenesin (Robitussin) po
  4. Atenolol 25 mg po (scheduled home medication)
/ Assess
implement / Understand
Apply
Analyze / 0.195 / 0.3 / MODIFY
  1. 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:
  2. White Blood Cells: 14.2
  3. Neutrophils 87%
  4. Bands 14%
  5. a & b
  6. a, b, c
/ assess / Understand
Apply
Analyze
Evaluate / 0.766 / 0.3
  1. The nurse notes new-onset confusion in an 89-year-old patient in a long-term-care facility; the patient is normally alert and oriented. Which action should the nurse take next?
  2. Check the patient’s pulse rate.
  3. Obtain an oxygen saturation.
  4. Notify the health care provider.
  5. Document the change.
/ Assess
implement / Understand
Apply / 0.922 / 0.1
  1. The following signs and symptoms/physical assessment findings are seen if one has an active tuberculosis infection:
  2. Peristent cough with blood tinged sputum
  3. Fever with night sweats
  4. Lungs clear aeration when auscultated bilaterally
  5. a & b
  6. a, b, c
/ assess / Understand
Apply / 0.870 / 0.2
  1. 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:
  2. Wash their hands before entering the room.
  3. Puts on a blue surgical face mask when entering the room
  4. Do not get into an isolation gown when entering the room
  5. Do not apply gloves when entering the room
/ implement / Understand
Apply / 0.416 / 0.3
  1. 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?
  2. Increased hemoglobin and increased hematocrit
  3. Decreased hemoglobin and decreased hematocrit
  4. Decreased hemoglobin and increased hematocrit
  5. Increased hemoglobin and decreased hematocrit
/ assess / Understand
Apply
Analyze
evaluate / 0.883 / 0.3
  1. 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?
  2. Take the iron with dairy products to enhance absorption
  3. Increase the intake of vitamin E to enhance absorption
  4. Iron will cause the stools to become darker or black in color
  5. Limit foods high in fiber due to risk for diarrhea
/ implement / Understand
Apply / 0.779 / 0.4
  1. 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?
  2. Liver and muscle meats
  3. Eggs
  4. Legumes
  5. All of the above
/ implement / Understand
Apply / 0.545 / 0.3
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:
  1. Hemoglobin (Hgb) 7.9 g/dl
  2. platelets 28,000
  3. International Normaized Ration (INR) 3.8
  4. a & b
  5. a, b, c
/ assess / Understand
Apply
Analyze / 0.545 / 0.1 / modify
  1. 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:
  2. Limit the patient’s intake of oral and IV fluids.
  3. Evaluate the effectiveness of opioid analgesics.
  4. Encourage the patient to ambulate as much as tolerated.
  5. Teach the patient about high-protein, high-calorie foods.
/ Implement
evaluate / Understand
Apply
Analyze / 0.896 / 0.0
  1. 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:
  2. Spasms of the blood cells as they change shape.
  3. Deposition of sickled red cells in the bone marrow.
  4. Tissue hypoxia caused by small blood vessel occlusion.
  5. Infectious processes in organs affected by the sickling.
/ implement / Understand
Apply / 0.831 / 0.2

KEY:

Cognitive Level:
Remembering
Understanding
Applying
Analyzing
Evaluating
Creating / 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.

FINAL EXAM

10. ALTERATIONS IN OXYGENATION (RESPIRATORY) (8)
1.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?
  1. Acute respiratory failure.
  2. Fluid volume excess secondary to right-sided heart failure.
  3. Pulmonary edema caused by left-sided heart failure.
  4. Secondary respiratory infection.
/ assess / Understand
apply / 0.924 / -0.1
2.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?
  1. Resting pulse oximetry (SpO2) of 86% on room air
  2. Respiratory rate of 18/minute
  3. Bi-basilar course crackles
  4. a & c
  5. a,b,c
/ assess / Understand
Apply
analyze / 0.949 / 0.1
3.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?
  1. Temperature is 101.5 F
  2. Breath sounds are clear bilaterally
  3. The patient’s current white blood cell (WBC) count is 6000 mm3 with a neutrophil differential count of 68%
  4. b & c
  5. a, b, c
/ assess / Understand
Apply
Analyze
Evaluate / 0.924 / 0.1
4.The physician orders an Albuterol nebulizer for your patient with asthma. What is the rationale for this medical treatment?
  1. Promotes bronchodilation through blocking parasympathetic nervous system stimulation
  2. Promotes bronchodilation through blocking late reaction to allergens and reduce airway hyper-responsiveness
  3. Promotes bronchodilation through inhibiting mast cell activity and decreasing inflammation
  4. Promotes bronchodilation through stimulating beta 2 receptors on the lungs
/ Implement / Understand
apply / 0.722 / 0.4
5.Your patient is on droplet precautions due to tuberculosis. To protect yourself and others from exposure to this pathogen you will:
  1. Wash your hands before entering the room.
  2. Put on a N-95 face mask when entering the room
  3. Apply gown and gloves when entering the room
  4. a & b
  5. a,b,c
/ implement / Understand
Apply / 0.481 / 0.3
6.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?
  1. Liver and muscle meats
  2. Eggs
  3. Dark green leafy vegetables such as spinach
  4. All of the above
/ implement / Understand
Apply
Evaluate / 0.772 / 0.4
7.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:
  1. Hemaglobin (Hgb) 7.2 g/dl
  2. International Normalized Ration (INR) 3.8
  3. Heart rate 118/minute
  4. a & b
  5. a, b, c
/ assess / Understand
Apply
analyze / 0.785 / 0.1
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?
  1. Notify the physician
  2. Stop the transfusion
  3. Remove the patient's intravenous access.
  4. Assess the patient's vital signs.
/ Assess
implement / Understand
Apply
Analyze
Evaluate / 0.987 / 0.1

©2011 Keith Rischer/