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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