NUR 203 RESPIRATORY + MENTAL HEALTH EXAM B/G QUESTIONS AND ANSWERS NEW UPDATE 2024/2025 AL, Exams of Nursing

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what is coarse crackles - CORRECT ANSWERS a lot of crackles what do crackles/rales sound like, where do we hear them and why? - CORRECT ANSWERS Sounds like rubbing hair. Represents fluid in tissue of lungs, does not clear with cough. Hear 1st at bases posterior because head is up, fluid settles at bases. On a CXR we see a white area on upper L lobe, what is it? - CORRECT ANSWERS NOT fluid, fluid is heavy and will fall- this will be secretions or a mass clinical manifestations of pulmonary edema - CORRECT ANSWERS agitation disorientation increasing respiratory distress, dyspnea, cyanosis tachycardia crackles (rales) cold, clammy skin pink, frothy sputum tachypnea orthopnea What does BMP look at? Why? - CORRECT ANSWERS look at K because diuretics given Why do we get a CBC? - CORRECT ANSWERS H/H to see our O2 carrying capacity Diagnostics/Labs for pulmonary edema - CORRECT ANSWERS CXR ABGs BMP CBC

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BNP

What does a BNP show us - CORRECT ANSWERS Corresponds with left ventricular pressure. Elevated levels correspond with degree of heart failure. Cardiogenic or noncardiogenic noncardiogenic has... - CORRECT ANSWERS normal BNP normal PAWP because not r/t back up If we have a high BNP r/t L ventricular failure, what do we give - CORRECT ANSWERS dobutamine cardiogenic pulmonary edema is related to - CORRECT ANSWERS PAWP- how much fluid volume at pulmonary bed For cardiogenic, we must.. - CORRECT ANSWERS decrease afterload because of resistance, prevent fluid backing up- this does not help non cardiogenic to get rid of pulmonary edema we must.. - CORRECT ANSWERS give diuretics to decrease preload medical management for pulmonary edema - CORRECT ANSWERS correct underlying disorder #1 priority- oxygen Diuretics Morphine Vasodilators Dobutamine Digoxin Milrinone What does morphine do for patients with pulmonary edema?

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What do we critically evaluate when giving it? - CORRECT ANSWERS Afterload and preload reducer, decreases WOB relieve anxiety evaluate RR Nursing management for pulmonary edema - CORRECT ANSWERS assist with intubation administer O elevate HOB- high fowlers: allows for full expansion, fluid lower to optimize upper airway psych support monitor hemodynamics: PAWP, CVP Vital signs- may get every minute strict I/O chemical and physical restraints for intubation - CORRECT ANSWERS Pancuronium Rocuronium Propofol Dexmedetomidine what are the names of the 2 paralytics - CORRECT ANSWERS Pancuronium Rocuronium nursing considerations for paralytic - CORRECT ANSWERS give so they don't extubate themselves and allows patient to relax names of the 2 sedatives - CORRECT ANSWERS propofol- short acting Dexmedetomidine- preferred if weaning from vent, not profound respiratory depressant s/s of pain with patient on paralytic - CORRECT ANSWERS increased bp increased hr

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diaphoretic If area of CXR is whited out - CORRECT ANSWERS something is there (pulmonary edema) and we will hear crackles triggers next breath - CORRECT ANSWERS CO2, lungs expanding with negative pressure rising steady CO2 causes - CORRECT ANSWERS brain becomes desensitized to CO brain senses increased CO2 - CORRECT ANSWERS does not listen, brain listens to decreased O Pink puffer COPD emphysema - CORRECT ANSWERS pink/rosy difficulty decreasing CO can cause pulmonary edema - CORRECT ANSWERS profoundly hypoxic causes because of cell wall permeability decreased pulmonary compliance causes - CORRECT ANSWERS stiff lungs ARDS symptoms - CORRECT ANSWERS Dyspnea decreased surfactant PaO2/FiO2 decreased decreased pulmonary compliance non-cardiac, bilateral pulmonary edema dense pulmonary infiltrates on CXR -ground glass -whited out Fix PaO2 by - CORRECT ANSWERS putting on oxygen

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why do patients need surfactant - CORRECT ANSWERS to keep alveoli expanded what happens to the cell wall with ARDS - CORRECT ANSWERS permeability- fluid shifts where it could not before causes of ARDS - CORRECT ANSWERS direct or indirect injury to the lungs trauma smoke inhalation aspiration infection DIC Shock cardiopulmonary bypass DKA Sepsis Multiple blood transfusions medical management of ARDS - CORRECT ANSWERS identify and treat underlying cause hemodynamic monitoring medications intubation/ventilation nutritional support what medications do we give for ARDS - CORRECT ANSWERS corticosteroids because of inflammatory process surfactant because they don't have enough diuretics- remove fluids from lungs

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intubation/ventilation settings with ARDS - CORRECT ANSWERS PEEP 5-10 cm H2O Small tidal volume have improved outcomes 6cc/kg Goal of intubation/ventilation - CORRECT ANSWERS PaO2 >60 mmHg and/or O2 SAT >90% Nutritional support for ARDS - CORRECT ANSWERS 35-45 kcal/kg/day TPN Enteral feedings successful weaning of ventilator requires - CORRECT ANSWERS adequate nutrition institute within 24-48 hours enteral preferred because it keeps GI tract functioning Parenteral used when we can't use GI tract Nursing management of ARDS - CORRECT ANSWERS monitor and implement medical plan of care Prone patient psych support ventilator considerations benefits of proning patient - CORRECT ANSWERS nothing laying on lungs, better expansion/gas exchange ventilator considerations for patients with ARDS - CORRECT ANSWERS we allow hypercapnia (CO2 of

treat acidosis with Bicarb collection of fluid within pleural space - CORRECT ANSWERS Pleural Effusion Cause of Pleural Effusion - CORRECT ANSWERS Heart failure (pulmonary edema PRIORITY)

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TB

Neoplastic tumors (inflammatory process) pulmonary embolism (inflammatory process) connective tissue diseases why does the inflammatory process occur with neoplastic tumors and PE - CORRECT ANSWERS fluid builds to protect injured area what does the fluid look like with pleural effusion - CORRECT ANSWERS clear bloody purulent transudate vs. exudate most often associated with systemic disease - CORRECT ANSWERS transudate most often associated with pleuritic - CORRECT ANSWERS exudate what do we expect with assessment of pleural effusion - CORRECT ANSWERS percuss- dullness (sounds hollow) absent/diminished breath sounds fluid below lung means it cannot fully expand inspect before auscultated- chest rise and fall R lung rises higher than L what does paradox mean - CORRECT ANSWERS opposite (1 side sinks on expiration) what is pleuritic pain - CORRECT ANSWERS sharp, stabbing pain, cannot take deep breath s/s of pleural effusion - CORRECT ANSWERS decreased chest expansion

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tachypnea pleuritic pain diminished or inaudible breath sounds pleural friction rub egophany (E to A change) dullness to percussion decreased tactile fremitus medical management of pleural effusion - CORRECT ANSWERS airway patent? impede lung expansion? AIRWAY** treat underlying cause medications- antibiotics, corticosteroids thoracentesis chest tube placement pull fluid off pleural space - CORRECT ANSWERS thoracentesis when do we not do a thoracentesis - CORRECT ANSWERS increased INR, PTT hold anticoagulants nursing management of pleural effusion - CORRECT ANSWERS monitor and assess respiratory status administer medications as ordered lung sounds clear - CORRECT ANSWERS pleural effusion higher diminished/absent lung sounds - CORRECT ANSWERS lower pleural effusion

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does not travel - CORRECT ANSWERS thrombus life threatening traveler thrombi that often arises from DVT, the right side of the heart or pelvic area..travels to pulmonary circulation can also be air,fat,amniotic, or foreign object (broken catheter) death can occur within one hour of symptoms - CORRECT ANSWERS pulmonary embolism long bone fracture - CORRECT ANSWERS fat embolism what does smoking cause - CORRECT ANSWERS sludge increased viscosity of blood how can obesity and pregnancy cause a PE - CORRECT ANSWERS pressure on vena cava risk factors for PE - CORRECT ANSWERS immobility smoking obesity pregnancy trauma post-op oral contraceptions history of prior DVT health promotion for PE - CORRECT ANSWERS keep from crossing legs keep them moving ambulation ROM

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SCD

Lovenox Heparin Maintenance of healthy BMI Smoking cessation clinical manifestations for PE - CORRECT ANSWERS restlessness diaphoresis dyspnea tachypnea** low O2 SAT levels feeling of impending doom pleuritic chest pain cough** hemoptysis ** crackles pleural friction rub S3/S4** fever** rhythm when you have a PE - CORRECT ANSWERS PEA- pulseless electrical activity= check carotid and femoral what do we need for adequate breathing - CORRECT ANSWERS perfusion Tell tale sign of PE - CORRECT ANSWERS BP drops because pathway of blood returning to heart is blocked diagnostics for PE - CORRECT ANSWERS ABGs*

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CXR

ECG*

Spiral CT D-Dimer Pulmonary Angiography Ventilation-Perfusion Scan Medical management for PE - CORRECT ANSWERS O ABGs IVF V/Q scan or spiral CT Cardiac monitoring Treat hypotension Medications What do IVF do for PE - CORRECT ANSWERS Optimize cardiac output what medications do we give for PE - CORRECT ANSWERS antiocoagulant thrombolytic surgical management SCD morphine does not do anything to existing PE, just prevents more - CORRECT ANSWERS anticoagulant distengrate existing PE, not candidate if had a recent surgery - CORRECT ANSWERS thrombolytic Nursing management for PE - CORRECT ANSWERS minimize risk

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monitor med therapy pain management anxiety management monitor for complications ROM Lovenox- don't massage and don't engage safety on skin PTT of 246 seconds what should you administer - CORRECT ANSWERS Protamine sulfate Physiological process for successful gas exchange - CORRECT ANSWERS 1) mechanics: chest rise and fall, diaphragm moves up and down

2. vascular movement: blood flow to lungs is adequate abnormal accumulation of fluid in the interstitial spaces and alveoli of the lungs - CORRECT ANSWERS pulmonary edema etiology of pulmonary edema - CORRECT ANSWERS L. ventricular failure (MI, Cardiomyopathy, etc) Renal Failure Mitral Stenosis Rapid administration of IV fluids why does renal failure cause pulmonary edema - CORRECT ANSWERS filters not working, not pulling fluid off why does rapid administration of IV fluids cause pulmonary edema - CORRECT ANSWERS cause baroreceptors in vessels to act up if we hear wheezing, what is it usually related to? EXs? - CORRECT ANSWERS 1. foreign body

2. tightened airway- constriction

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Ex: Asthma, Inhalation burn, PNA with tenacious secretions how do we treat asthma - CORRECT ANSWERS need steroids how do we treat secretions - CORRECT ANSWERS need fluids What does rhonchi sound like and what is it usually related to? - CORRECT ANSWERS musical, junky sounds related to infectious/inflammatory process what do we do for rhochi - CORRECT ANSWERS TCDB, encourage forceful cough what is chest trauma the result of - CORRECT ANSWERS blunt trauma ex: ball to chest at 90 mph sudden compression or positive pressure to the chest wall MVA Steering wheel seat belts falls most common respiratory failure develops over time hemorrhage occurs in and between the alveoli resulting in decreased pulmonary compliance and reduced surface area for gas exchange - CORRECT ANSWERS pulmonary contusion what should we educate our patients on discharge - CORRECT ANSWERS to come back if: SOB can't catch breath

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physical assessment of chest trauma - CORRECT ANSWERS may be asymptomatic and CXR normal initially Hemoptysis Decreased breath sounds crackles or wheezes hazy opacity in the lobes or parenchyma may develop over several days medical management for chest trauma - CORRECT ANSWERS maintenance of ventilation and oxygenation nursing management for chest trauma - CORRECT ANSWERS monitor CVP- low if active bleed monitor response to mechanical ventilation- PEEP caused by rib fractures - CORRECT ANSWERS flail chest most benign, however can be life-threatening due to the risk for intrathoracic injury 5th-9th ribs most common typically heals within 6 weeks - CORRECT ANSWERS rib fractures management for rib fractures - CORRECT ANSWERS instruct patient to splint to reduce pain pain management deep breathing teaching cause of flail chest - CORRECT ANSWERS multiple rib fractures on one side of the chest assessment of rib fractures - CORRECT ANSWERS paradoxical movement of the chest (opposite movement with inspiration and expiration) **inward movement of the thorax with inspiration and outward movement with expiration hypoxemia

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tachycardia hypotension pain management of flail chest - CORRECT ANSWERS humidified oxygen pain management deep breathing and positioning secretion clearance mechanical ventilation with PEEP ABGs VS monitor fluids (CVP) monitor electrolytes serial CXRs What is a tension pneumothorax? - CORRECT ANSWERS air can enter on affected side in the pleural space but cannot exit what is open pneumothorax? - CORRECT ANSWERS air freely escaping chest injury that allows air to enter the pleural space resulting in a rise in the intrathoracic pressure and the reduction in vital capacity can be either open (pleural cavity exposed) or closed - CORRECT ANSWERS pneumothorax example of causes of open pneumothorax - CORRECT ANSWERS bullet hole stab wound example of closed pneumothorax - CORRECT ANSWERS nothing visible/spontaneous

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Assessment of pneumothorax - CORRECT ANSWERS tachypnea** pleuritic pain asymmetrical chest expansion tracheal deviation- especially with tension decreased breath sounds on ausc.** hyperresonance on percussion** sub-q air why does a tracheal deviation occur - CORRECT ANSWERS air trapped and displaced away from affected side management of pneumothorax - CORRECT ANSWERS CXR for diagnosis ** chest tube rapidly developing life threatening air leak into the pleural space causes complete collapse of the affected lung air accumulates under pressure compressing on the blood vessels and limiting venous return cardiac output is reduced - CORRECT ANSWERS tension pneumothorax causes of pneumothorax - CORRECT ANSWERS primary spontaneous- no identifiable cause blunt trauma PEEP chest tube insertion of central venous cath pneumothorax assessment - CORRECT ANSWERS asymmetrical chest expansion/thorax tracheal deviation

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respiratory distress cyanosis distended neck veins- r/t decreased venous return absent breath sounds on affected side hypertympanic sound with percussion on affected side tachycardia HTN emergency** diagnosis for chest trauma - CORRECT ANSWERS CXR management for chest trauma - CORRECT ANSWERS large bore needle inserted into the 2nd intercostal space at the mid-clavicular line chest tube placement how do we determine chest tube placement - CORRECT ANSWERS go high because air rises and relieves the air with pneumothorax go low with fluid blood loss into the chest cavity - CORRECT ANSWERS hemothorax assessment of hemothorax - CORRECT ANSWERS respiratory distress decreased breath sounds dull sound on percussion blood in pleural space visible on CXR, confirmed by thoracentesis management of hemothorax - CORRECT ANSWERS chest tube open thoracotomy VS monitor chest tube drainage

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IVFs autotransfusion clinical manifestations of hemothorax - CORRECT ANSWERS hypoxemia dyspnea tachypnea hypovolemia cardiac failure medical management of chest trauma - CORRECT ANSWERS establish/secure airway re-establish chest wall integrity with occlusive dressing (3 sides only) at the end of expiration control bleeding nursing management of penetrating chest trauma - CORRECT ANSWERS assessment airway VS skin color assess diagnostics type of traumatic pneumothorax allows air to freely pass in and out rush of air through the hole produces a sucking sound - CORRECT ANSWERS sucking chest wound consequence of sucking chest wound - CORRECT ANSWERS mediastinal flutter what is a mediastinal flutter - CORRECT ANSWERS abnormal motility of the mediastinum during respiration shift 1 side to the other resulting from chest sucking wound

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the voice box - CORRECT ANSWERS larynx can disrupt breathing, eating, facial appearance, self-image, speech and communication is it curable? what happens if untreated? - CORRECT ANSWERS Laryngeal cancer curable if treated early fatal within 2 years of diagnosis if untreated risk factors of head and neck cancers - CORRECT ANSWERS anything that causes tissue irritation and cause constant inflammation asbestos wood dust paint fumes chemicals tar products leather and metals ETOH abuse Tobacco abuse** straining of voice chronic laryngitis nutritional deficiences GERD HPV assessment of head and neck cancers - CORRECT ANSWERS ask about history- tobacco or ETOH abuse: calculate pack years, how much do they drink? laryngitis oral sores

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lumps in neck environmental exposures weight loss chronic lung disease clinical manifestations of head and neck cancer - CORRECT ANSWERS hoarseness >2 weeks** lump in throat pain or burning difficulty swallowing color changes in the mouth or tongue oral lesions that do not heal numbness of mouth, lips or face change in fit of dentures persistent sore throat anorexia or weight loss physical assessment of head and neck cancers - CORRECT ANSWERS inspection and palpation laryngeal mirror or fiber optic laryngoscope support system cognitive function family history laryngoscopy biopsy tumor mapping tumor staging TNM (tumor, node, metastasis) radiographic assessment of head and neck cancers - CORRECT ANSWERS CT

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MRI

PET

XRAY

• skull, sinuses, neck and chest Lab assessment of head and neck cancers - CORRECT ANSWERS CBC Bleeding times UA BMP/CMP Liver panel Albumin Glucose Pre-albumin (glucose and albumin show nutritional status) medical management head and neck cancers - CORRECT ANSWERS surgery radiation chemo nursing management for head and neck cancers - CORRECT ANSWERS physical assessment preop education reducing anxiety maintaining patent airway alternative communication adequate nutrition and hydration promoting positive body image and self esteem self care treatment of head and neck cancers - CORRECT ANSWERS radiation therapy (80% cure rate)

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may be the only treatment in conjunction with surgery side effects of radiation - CORRECT ANSWERS hoarseness sore throat reddened, peeling skin Xerostomia- permanent because radiation use saline spray to help nursing management for radiation therapy - CORRECT ANSWERS instruct client to not remove markings use electric razor instruct to use lotions or ointments on dry, broken skin instruct client to stay out of sun do not use petroleum jelly or perfume based used alone, or with radiation and surgery cytotoxic s/e? - CORRECT ANSWERS chemotherapy alopecia N/V mucositis (sores in mouth) anxiety sleep disturbances altered bowel elimination decreased mobility anemia immunosuppression

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thrombocytopenia priority during chemotherapy - CORRECT ANSWERS neutropenic precautions safety r/t infection control nursing management of nausea and vomiting - CORRECT ANSWERS antiemetics alternative therapies- music, relaxation and guided imagery nursing management of alopecia - CORRECT ANSWERS reassure client head coverings- protect from heat loss and sun in the summer nursing management of mucositis - CORRECT ANSWERS oral hygiene salt water gargle vaseline to lips nursing management of bone marrow suppression - CORRECT ANSWERS neutropenic precautions complementary and alternative therapies -echinacea -vitamin C use caution with herbal supplements surgical management of head and neck cancers - CORRECT ANSWERS tumor size and locations determine the type of surgery laryngectomy vocal cord stripping cordectomy laser surgery partial/total laryngectomy

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pre-op education of laryngectomy - CORRECT ANSWERS establish a means of communication suctioning pain control critical care environment- walk through before nutritional support- feeding tube team of healthcare professionals- introduce post-op care of head and neck cancers - CORRECT ANSWERS airway maintenance VS wound flap, and reconstructive tissue care- warm? color? exudate? **pale, cool to touch= not adequate perfusion, will die=necrotic hemodynamic status comfort nutrition speech rehab airway maintenance and ventilation complications of head and neck cancers - CORRECT ANSWERS airway obstruction hemorrhage wound breakdown tumor recurrence surgical incision in the trachea for the purpose of the airway - CORRECT ANSWERS tracheotomy complications of tracheotomy - CORRECT ANSWERS tube obstruction dislodgement accidental decannulation

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pneumothorax SubQ emphysema bleeding infection purpose of trach inflated cuff - CORRECT ANSWERS maintain positive pressure ventilation- keeps patient from speaking RF of lung cancer - CORRECT ANSWERS cigarette smoking inhaled carcinogens- asbestos, nickel, iron, air pollution, arsenic Pulmonary disease- TB, pulmonary fibrosis, bronchiectasis, COPD 10-15% of tumors 99% associated with cigarettes fast growing usually metastatic at time of diagnosis surgery not helpful very aggressive, larger - CORRECT ANSWERS small cell lung cancer 85-90% of tumors large cell carcinoma squamous cell carcinoma adenocarcinoma surgery helpful for stage 1 and 2 use chemo and radiation - CORRECT ANSWERS non-small cell lung cancer lung cancer clinical manifestations - CORRECT ANSWERS persistent cough recurrent pulmonary problems blood-tinged sputum chest pain