N1120 Test Blueprint - KeithRN



RESPIRATORY Test Questions/Blueprint

|Question |Course Objective |Step in the Nursing |Cognitive Level |Difficulty Level|Item |Response |

| | |Process |(Blooms) | |Discrim. | |

|1.Part 1 | |assess |Remember |0.795 |0.3 | |

|What is the major difference in pathophysiology between asthma and COPD? | | | | | | |

|Asthma is a disruption in respiratory diffusion and COPD is disruption in respiratory| | | | | | |

|ventilation | | | | | | |

|Asthma is a disruption in respiratory ventilation and COPD is disruption in | | | | | | |

|respiratory diffusion | | | | | | |

|COPD results in permanent airflow obstruction and asthma is a condition of reversible| | | | | | |

|airflow obstruction. | | | | | | |

|Asthma is the result of an inflammatory process and COPD is a result of | | | | | | |

|hyper-sensitivity of the bronchioles | | | | | | |

|b & c | | | | | | |

|As the home care nurse, you observe oral candidiasis in your patient with severe, | |Assess |Understand |0.692 |0.4 | |

|chronic COPD. What information should you obtain from this client? | |implement |Apply | | | |

|“Do you swish and spit with water after taking your Advair inhaler?” | | | | | | |

|“Do you swish and spit with water after taking your Albuterol inhaler?” | | | | | | |

|“Do you swish and spit with water after taking your Combivent (albuterol/atrovent) | | | | | | |

|inhaler?” | | | | | | |

|“Do you share a toothbrush with any members of your family?” | | | | | | |

|a & b | | | | | | |

|An asthmatic patient who has a new prescription for Advair Diskus (fluticasone and | |implement |Understand |0.872 |0.2 | |

|salmeterol) asks the nurse the purpose of using this inhaler with 2 medications. The | | |apply | | | |

|nurse explains that: | | | | | | |

|Advair is a combination of long-acting and slow-acting bronchodilators. | | | | | | |

|The two drugs work together to block the effects of histamine on the bronchioles. | | | | | | |

|One drug decreases inflammation, and the other is a bronchodilator. | | | | | | |

|The combination of two drugs works more quickly in an acute asthma attack. | | | | | | |

|4, Ms. Anderson, a 72 year old with asthma and emphysema comes into the ER because of| |Assess |Understand |0.718 |0.2 | |

|complaints of fever, chills and increasing shortness of breath. She has had recent | | |Apply | | | |

|productive cough of green phlegm. Her VS: T-101.2 P-110 R-28 BP-140/88 O2 sats 86% on| | |Analyze | | | |

|room air. She has inspiratory as well as expiratory wheezing bilaterally with coarse | | | | | | |

|rhonchi in the LLL. | | | | | | |

|N1120-VI-2 What symptoms of Ms. Anderson are consistent only with pneumonia? | | | | | | |

|Fever/chills | | | | | | |

|Green phlegm | | | | | | |

|Coarse rhonchi | | | | | | |

|Inspiratory/expiratory wheezing | | | | | | |

|a, b, c | | | | | | |

|What is the clinical significance of inspiratory vs. expiratory wheezing in Ms. | |Assess |Understand |0.744 |0.3 | |

|Anderson? | | |Apply | | | |

|There is no clinical significance-they represent the same degree of bronchospasm. | | | | | | |

|Expiratory wheezing reflects a greater degree of bronchoconstriction | | | | | | |

|Inspiratory wheezing reflects a greater degree of bronchoconstriction | | | | | | |

|Crackles are a greater concern with asthmatic exacerbation. | | | | | | |

|The physician orders an Albuterol nebulizer. What is the rationale for this medical | |implement |understand |0.885 |0.3 | |

|treatment? | | | | | | |

|Promotes bronchodilation through stimulating beta 2 receptors on the lungs | | | | | | |

|Promotes bronchodilation through blocking parasympathetic nervous system stimulation | | | | | | |

| | | | | | | |

|Promotes bronchodilation through blocking late reaction to allergens and reduce | | | | | | |

|airway hyperresponsiveness | | | | | | |

|Promotes bronchodilation through inhibiting mast cell activity and decreasing | | | | | | |

|inflammation | | | | | | |

|7. During your initial assessment of Ms. Anderson, what will be your priority to get | |implement |Understand |0.897 |0.2 | |

|done first: | | |Apply | | | |

|Obtain a comprehensive health history to determine the extent of any prior | | | | | | |

|respiratory problems. | | | | | | |

|Complete a full physical examination to determine the systemic effect of the | | | | | | |

|respiratory distress. | | | | | | |

|Delay the physical assessment and ask family members about any history of respiratory| | | | | | |

|problems. | | | | | | |

|Perform a respiratory system assessment and ask specific questions about this episode| | | | | | |

|of respiratory distress. | | | | | | |

|Which of the following medications seen in Ms. Anderson would be indicative of | |assess |Understand |0.949 |0.1 | |

|severe/end-stage progression of her COPD? | | | | | | |

|Advair discus MDI bid (Metered Dose Inhaler) | | | | | | |

|Albuterol MDI tid and prn (Metered Dose Inhaler) | | | | | | |

|Prednisone po daily | | | | | | |

|Azmacort MDI bid (Metered Dose Inhaler) | | | | | | |

|Because you are concerned about the risk of Ms. Anderson to develop sepsis, what labs| |assess |Understand |0.603 |0.5 | |

|will you be closely monitoring and trending: | | |Apply | | | |

|Total white blood cell count (WBC) | | |Analyze | | | |

|Neutrophil differential percentage | | |Evaluate | | | |

|Serum lactate | | | | | | |

|a & b | | | | | | |

|a, b, c | | | | | | |

|Ms. Anderson has been admitted to the medical floor and while caring for her you note| |Assess |Understand |0.731 |0.1 | |

|that her O2 sats drop from 94% to 85% when she ambulates in the hall. She denies | |implement |Apply | | | |

|SOB. You determine that: | | |Analyze | | | |

|Supplemental oxygen should be used whenever the patient ambulates in the future. | | |evaluate | | | |

|Maintain her on strict bed rest. | | | | | | |

|The response is normal and the patient should continue at this activity level. | | | | | | |

|No further ambulation should take place until the disease process is resolved. | | | | | | |

|Ms. Anderson has a right lower-lobe pneumonia and has been treated with intravenous | |Assess |Understand |0.744 |0.4 | |

|(IV) antibiotics for 2 days, which assessment data obtained by the nurse indicates | |implement |Apply | | | |

|that the treatment has been effective? | | |Analyze | | | |

|Coarse rhonchi are auscultated at the left lower base. | | |Evaluate | | | |

|The patient coughs up large amounts of green mucous. | | | | | | |

|Current temperature is 98.9 orally | | | | | | |

|The patient’s current white blood cell (WBC) count is 9000 with a neutrophil | | | | | | |

|differential count of 70% | | | | | | |

|c & d | | | | | | |

|1. Questions 1-3 refer to the same patient, introduced in Question 1 | |assess |Understand |0.870 |0.2 | |

|Following assessment of your patient, an 86 year old woman with pneumonia, the nurse | | |Apply | | | |

|identifies a nursing diagnosis of impaired gas exchange as the priority problem. | | |Analyze | | | |

|Which nursing assessment data collected supports this diagnosis? | | | | | | |

|Resting pulse oximetry (SpO2) of 85% on room air | | | | | | |

|Respiratory rate of 28/minute at rest | | | | | | |

|Crackles in lung bases bilaterally | | | | | | |

|All of the above | | | | | | |

|MODIFY DONE: 2. 1120-VI-2, 7 This same patient has a temperature of 101.6° F with a | |Assess |Understand |0.195 |0.3 |MODIFY |

|frequent cough and is complaining of chest pain rated 2 on a 10-point scale with deep| |implement |Apply | | | |

|inspiration. Which of these newly ordered medications should the nurse give first? | | |Analyze | | | |

|Ampicillin/Sulbactam (Unasyn) IV | | | | | | |

|Acetaminophen (Tylenol) po | | | | | | |

|Guaifenesin (Robitussin) po | | | | | | |

|Atenolol 25 mg po (scheduled home medication) | | | | | | |

|You obtain her lab results from your Complete Blood Count (CBC) for this same patient| |assess |Understand |0.766 |0.3 | |

|with pneumonia. Which labs are abnormal and relevant to this patient: | | |Apply | | | |

|White Blood Cells: 14.2 | | |Analyze | | | |

|Neutrophils 87% | | |Evaluate | | | |

|Bands 14% | | | | | | |

|a & b | | | | | | |

|a, b, c | | | | | | |

|The nurse notes new-onset confusion in an 89-year-old patient in a long-term-care | |Assess |Understand |0.922 |0.1 | |

|facility; the patient is normally alert and oriented. Which action should the nurse | |implement |Apply | | | |

|take next? | | | | | | |

|Check the patient’s pulse rate. | | | | | | |

|Obtain an oxygen saturation. | | | | | | |

|Notify the health care provider. | | | | | | |

|Document the change. | | | | | | |

|The following signs and symptoms/physical assessment findings are seen if one has an | |assess |Understand |0.870 |0.2 | |

|active tuberculosis infection: | | |Apply | | | |

|Peristent cough with blood tinged sputum | | | | | | |

|Fever with night sweats | | | | | | |

|Lungs clear aeration when auscultated bilaterally | | | | | | |

|a & b | | | | | | |

|a, b, c | | | | | | |

|When caring for a patient who is hospitalized with active TB, the nurse observes | |implement |Understand |0.416 |0.3 | |

|dietary staff bring a tray into the room. The nurse will need to immediately | | |Apply | | | |

|intervene if they: | | | | | | |

|Wash their hands before entering the room. | | | | | | |

|Puts on a blue surgical face mask when entering the room | | | | | | |

|Do not get into an isolation gown when entering the room | | | | | | |

|Do not apply gloves when entering the room | | | | | | |

|Your patient with renal failure has decreased erythropoetin production. Upon analysis| |assess |Understand |0.883 |0.3 | |

|of your patient’s complete blood cell count (CBC), what would you expect to see with | | |Apply | | | |

|this patient? | | |Analyze | | | |

|Increased hemoglobin and increased hematocrit | | |evaluate | | | |

|Decreased hemoglobin and decreased hematocrit | | | | | | |

|Decreased hemoglobin and increased hematocrit | | | | | | |

|Increased hemoglobin and decreased hematocrit | | | | | | |

|You are providing education to a patient with iron deficiency anemia who has been | |implement |Understand |0.779 |0.4 | |

|prescribed iron supplements. What will be important to include in your teaching? | | |Apply | | | |

|Take the iron with dairy products to enhance absorption | | | | | | |

|Increase the intake of vitamin E to enhance absorption | | | | | | |

|Iron will cause the stools to become darker or black in color | | | | | | |

|Limit foods high in fiber due to risk for diarrhea | | | | | | |

|You are providing education to a patient with iron deficiency anemia who needs to | |implement |Understand |0.545 |0.3 | |

|increase their natural intake of iron. What foods will you want to encourage your | | |Apply | | | |

|patient to increase in their diet? | | | | | | |

|Liver and muscle meats | | | | | | |

|Eggs | | | | | | |

|Legumes | | | | | | |

|All of the above | | | | | | |

|Modify done 10. A 78 year old female comes into the ED with complaints of frequent | |assess |Understand |0.545 |0.1 |modify |

|black, tarry stools the last 2 days, increasing weakness and dizziness when standing | | |Apply | | | |

|up. Which lab results are abnormal and relevant to her primary problem: | | |Analyze | | | |

|Hemoglobin (Hgb) 7.9 g/dl | | | | | | |

|platelets 28,000 | | | | | | |

|International Normaized Ration (INR) 3.8 | | | | | | |

|a & b | | | | | | |

|a, b, c | | | | | | |

|A patient with sickle cell anemia is admitted to the hospital with a sickle cell | |Implement |Understand |0.896 |0.0 | |

|crisis. While caring for the patient during the crisis, it is important for the | |evaluate |Apply | | | |

|nurse to: | | |Analyze | | | |

|Limit the patient’s intake of oral and IV fluids. | | | | | | |

|Evaluate the effectiveness of opioid analgesics. | | | | | | |

|Encourage the patient to ambulate as much as tolerated. | | | | | | |

|Teach the patient about high-protein, high-calorie foods. | | | | | | |

|A patient who is having a sickle cell crisis asks the nurse why the sickling causes | |implement |Understand |0.831 |0.2 | |

|such pain. The nurse explains that pain of sickling is caused by: | | |Apply | | | |

|Spasms of the blood cells as they change shape. | | | | | | |

|Deposition of sickled red cells in the bone marrow. | | | | | | |

|Tissue hypoxia caused by small blood vessel occlusion. | | | | | | |

|Infectious processes in organs affected by the sickling. | | | | | | |

KEY:

|Cognitive Level: |Item Discrimination = how well an item distinguishes between high and low scoring students. |

|Remembering |0 is OK if it’s info that everyone absolutely needs to know, i.e. key content. |

|Understanding |.2 to .3 is desirable for most |

|Applying |.4 or higher is OK for just a few questions. If all were .4, most of our students would fail the test. |

|Analyzing |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. |

|Evaluating | |

|Creating | |

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) | |assess |Understand |0.924 |-0.1 |

|The patient has severe emphysema. During assessment the nurse notes jugular vein | | |apply | | |

|distention and pedal edema. The nurse recognizes that these findings are indicative of| | | | | |

|which complication of COPD? | | | | | |

|Acute respiratory failure. | | | | | |

|Fluid volume excess secondary to right-sided heart failure. | | | | | |

|Pulmonary edema caused by left-sided heart failure. | | | | | |

|Secondary respiratory infection. | | | | | |

|Following assessment of your patient, an 86 year old woman with pneumonia, the nurse | |assess |Understand |0.949 |0.1 |

|identifies a nursing diagnosis of impaired gas exchange as the priority problem. Which | | |Apply | | |

|nursing assessment data collected supports this diagnosis? | | |analyze | | |

|Resting pulse oximetry (SpO2) of 86% on room air | | | | | |

|Respiratory rate of 18/minute | | | | | |

|Bi-basilar course crackles | | | | | |

|a & c | | | | | |

|a,b,c | | | | | |

|Your patient with a right lower-lobe pneumonia has been treated with intravenous (IV) | |assess |Understand |0.924 |0.1 |

|antibiotics for 2 days, which assessment data indicates that the treatment has been | | |Apply | | |

|effective? | | |Analyze | | |

|Temperature is 101.5 F | | |Evaluate | | |

|Breath sounds are clear bilaterally | | | | | |

|The patient’s current white blood cell (WBC) count is 6000 mm3 with a neutrophil | | | | | |

|differential count of 68% | | | | | |

|b & c | | | | | |

|a, b, c | | | | | |

|The physician orders an Albuterol nebulizer for your patient with asthma. What is the | |Implement |Understand |0.722 |0.4 |

|rationale for this medical treatment? | | |apply | | |

|Promotes bronchodilation through blocking parasympathetic nervous system stimulation | | | | | |

|Promotes bronchodilation through blocking late reaction to allergens and reduce airway | | | | | |

|hyper-responsiveness | | | | | |

|Promotes bronchodilation through inhibiting mast cell activity and decreasing | | | | | |

|inflammation | | | | | |

|Promotes bronchodilation through stimulating beta 2 receptors on the lungs | | | | | |

|Your patient is on droplet precautions due to tuberculosis. To protect yourself and | |implement |Understand |0.481 |0.3 |

|others from exposure to this pathogen you will: | | |Apply | | |

|Wash your hands before entering the room. | | | | | |

|Put on a N-95 face mask when entering the room | | | | | |

|Apply gown and gloves when entering the room | | | | | |

|a & b | | | | | |

|a,b,c | | | | | |

|You are providing education to a patient with iron deficiency anemia who needs to | |implement |Understand |0.772 |0.4 |

|increase her natural intake of iron before iron supplements are considered. What foods | | |Apply | | |

|will you want to encourage your patient to increase in their diet? | | |Evaluate | | |

|Liver and muscle meats | | | | | |

|Eggs | | | | | |

|Dark green leafy vegetables such as spinach | | | | | |

|All of the above | | | | | |

|A 72 year old male comes into the ED with complaints of several black, tarry stools the| |assess |Understand |0.785 |0.1 |

|last 24 hours, increasing weakness and dizziness especially when standing up. Which | | |Apply | | |

|data collected by the nurse are abnormal and relevant to the primary problem: | | |analyze | | |

|Hemaglobin (Hgb) 7.2 g/dl | | | | | |

|International Normalized Ration (INR) 3.8 | | | | | |

|Heart rate 118/minute | | | | | |

|a & b | | | | | |

|a, b, c | | | | | |

|The nurse caring for a patient receiving a transfusion notes that 15 minutes after the | |Assess |Understand |0.987 |0.1 |

|infusion of packed red blood cells (RBCs) has begun, the patient is having a systemic | |implement |Apply | | |

|raised rash and complaining of itching. What is the most appropriate initial action for| | |Analyze | | |

|the nurse to take? | | |Evaluate | | |

|Notify the physician | | | | | |

|Stop the transfusion | | | | | |

|Remove the patient's intravenous access. | | | | | |

|Assess the patient's vital signs. | | | | | |

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