Nursing Board Exam Reviewer Part 2 of 5

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111. Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall?

a)      Legionnaires’ disease
Legionnaires’ disease accounts for 15% of community-acquired pneumonias.

b)      Streptococcal (pneumococcal) pneumonia
Streptococcal pneumonia demonstrates the highest occurrence in winter months.

c)      Mycoplasma pneumonia
Mycoplasma pneumonia demonstrates the highest occurrence in fall and early winter.

d)      Viral pneumonia
Viral pneumonia demonstrates the greatest incidence during winter months.

112. When interpreting the results of a Mantoux test, the nurse explains to the patient that a reaction occurs when the intradermal injection site shows

a)      redness and induration.
The site is inspected for redness and palpated for hardening.

b)      drainage.
Drainage at the site does not indicate a reaction to the tubercle bacillus.

c)      tissue sloughing.
Sloughing of tissue at the site of injection does not indicate a reaction to the tubercle bacillus.

d)      bruising.
Bruising of tissue at the site may occur from the injection, but does not indicate a reaction to the tubercle bacillus.

113. Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery?

a)      Record the observation.
Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure.

b)      Apply a compression dressing to the area.
Subcutaneous emphysema is a typical post-operative finding in the patient after chest surgery.

c)      Measure the patient’s pulse oximetry.
Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted.

d)      Report the finding to the physician immediately.
Subcutaneous emphysema results from air entering the tissue planes.

114. Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally?

a)      Large cell carcinoma
Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.

b)      Bronchioalveolar carcinoma
Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and is usually slow-growing.

c)      Adenocarcinoma
Adenocarcinoma presents as peripheral masses or nodules and often metastasizes.

d)      Squamous cell carcinoma
Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.

115. Which of the following methods is the best method for determining nasogastric tube placement in the stomach?

a)      X-ray
Radiologic identification of tube placement in the stomach is most reliable.

b)      Observation of gastric aspirate
Gastric fluid may be grassy green, brown, clear, or odorless while an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining nasogastric tube placement in the stomach.

c)      Testing of pH of gastric aspirate
Gastric pH values are typically lower or more acidic than that of the intestinal or respiractory tract, but not always.

d)      Placement of external end of tube under water
Placement of external end of tube under water and watching for air bubbles is not a reliable method for determining nasogastric tube placement in the stomach.

116. Which of the following types of lung cancer is the most prevalent carcinoma of the lung for both men and women?

a)      Adenocarcinoma
Adenocarcinoma presents more peripherally as peripheral masses or nodules and often metastasizes.

b)      Large cell carcinoma
Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.

c)      Squamous cell carcinoma
Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures.

d)      Small cell carcinoma
Small cell carcinomas arise primarily as proximal lesions, but may arise in any part of the tracheobronchial tree.

117. Emphysema is described as:

a)      A disease of the airways characterized by destruction of the walls of overdistended alveoli. Emphysema is a category of COPD.

b)      A disease that results in a common clinical outcome of reversible airflow obstruction.
Asthma is the disease described.

c)      The presence of cough and sputum production for at least a combined total of two or three months in each of two consecutive years.
Bronchitis is the disease described.

d)      Chronic dilatation of a bronchus or bronchi
Bronchiectasis is the condition described.

118. Which of the following is the most important risk factor for development of Chronic Obstructive Pulmonary Disease?

a)      Cigarette smoking
Pipe, cigar and other types of tobacco smoking are also risk factors.

b)      Occupational exposure
While a risk factor, occupational exposure is not the most important risk factor for development of COPD.

c)      Air pollution
Air pollution is a risk factor for development of COPD, but it is not the most important risk factor.

d)      Genetic abnormalities
A deficiency of alpha-antitrypsin is a risk factor for development of COPD, but it is not the most important risk factor.

119. Which type of chest configuration is typical of the patient with COPD?

a)      Barrel chest
“Barrel chest” results from fixation of the ribs in the inspiratory position.

b)      Pigeon chest
Pigeon chest results from a displaced sternum.

c)      Flail chest
Flail chest results when the ribs are fractured.

d)      Funnel chest
Funnel chest occurs when there is a depression in the lower portion of the sternum and is associated with Mafan’s syndrome or rickets.

120. In which stage of COPD is the forced expiratory volume (FEV1) < 30%?

a)      III
Stage III patients demonstrate FEV1 < 30% with respiratory failure or clinical signs of right heart failure

b)      II
Stage II patients demonstrate FEV1 between > 30% and 80%

c)      I
Stage I is mild COPD with FEV1 < 70%.

d)      O
Stage O is characterized by normal spirometry

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