NSG 3160- Exam 3 complete solution update with actual passed questions, Exams of Nursing

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NSG 3160- Exam 3 complete solution update with actual passed questions Right side of the heart pumps to... - >>>>Lungs Left side of heart pumps... - >>>>simutaneously to body Septum - >>>>wall that separates two pumps atrioventricular valves - >>>>separate atria and ventricles heard at apex, located at bottom of heart: 5th rib intercostal space Apical pulse is also called - >>>>Mitral area/PM/Apex Right AV valve = - >>>>tricuspid valve, 5th intercostal space at left sternal border Left AV valve = - >>>>Mitral valve, 5th intercostal space at left midclavicular line Semilunar (SL) valves - >>>>between ventricles and arteries 3 cusps that look like half moons heard at BASE, located at TOP of heart pulmonic valve - >>>>located on right side of heart, 2nd L intercostal space aortic valve - >>>>located on left side of heart, 2nd R intercostal space Diastole phase - >>>>ventricles relax, heart fills with blood 2/3 of cycle AV valves (tricuspid and mitral) are OPEN pressure in atria is higher than in ventricles. 1st filling phase is called early or protodiastolic filling. 2nd filling is called presystole or atrial systole Systole phase - >>>>blood pumped from ventricles and fills pulmonary and systemic arteries 1/3 of cardiac cycle ventricular pressure is now HIGHER than that of atria, causing atria to close. After blood ejection, pressure falls in ventricles. When pressure falls below pressure in aorta, some blood flows backward towards ventricle, causing aortic valve to shut. S1 or Lub - >>>>closer of AV valve S2 or Dub - >>>>closure of semilunar valve S3 heart sound - >>>>↑ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles. VIBRATIONS heard over chest. A gallop. Occurs immediately after S2 (LUB DUB DUB). May be early sign of heart failure. S4 heart sound - >>>>occurs at end of Diastole, at presystole. HEARD BEST AT APEX w/ pt turned to LEFT LATERAL so heart is closer to chest wall. VIBRATION is very soft and low pitch. Occurs jsut before S1 (DUB LUB DUB) ◦Subjective: fatigue, DOE, palpitations, dizziness, fainting, anginal pain ◦Objective Data: Pallor, slow diminished radial pulse, low BP. Thrill in systole over 2nd and 3rd right interspaces and right side of the neck. ◦Murmur: loud, harsh, midsystolic, loudest at 2nd right intercostal space pulmonic stenosis - >>>>calcification of pulmonic valve restricts forward flow of blood. ◦Objective Data: Thrill in systole at 2nd and 3rd interspaces ◦Murmur: Systolic, Medium Pitch, Coarse ◦Best heard: 2nd left interspace mitral regurgitation - >>>>stream of blood regurgitates back into the left atria during systole through an incompetent mitral valve. In diastole, blood passes back into the left ventricle again along with new flow; results in left ventricle dilation and hypertrophy ◦Subjective Data: Fatigue, palpitation, orthopnea ◦Objective: you may palpate a thrill & lift at the left 5th intercostal space midclavicular line ◦Murmur: Pansystolic, often loud, blowing, swishing sound right after S1 ◦Best heard: at the Apex tricuspid regurgitation - >>>>backflow of blood through incompetent tricuspid valve into the right atria ◦Objective: Engorged pulsating neck veins, liver enlarged. ◦Murmur: Pansystolic ◦Best Heard: left lower sternal border mitral stenosis - >>>>Calcified mitral valve does not open properly, impedes forward flow of blood into left ventricle during diastole. Results in left atria enlarged and left atria pressure increased. ◦Subjective: fatigue, palpitations, DOE, orthopnea or pulmonary edema ◦Objective: diminished, often irregular arterial pulse. Lift at Apex, diastolic thrill common at Apex. ◦Murmur: Low-Pitched diastolic rumble ◦Best Heard: at the Apex with the patient in the left lateral position tricuspid stenosis - >>>>Calcification of the Tricuspid Valve that impedes forward flow into right ventricle during diastole. ◦Objective: diminished arterial pulse, jugular venous pulse is prominent ◦Murmur: Diastolic rumble ◦Best Heard: at the Left Lower Sternal Border aortic regurgitation - >>>>Stream of blood regurgitates back through incompetent aortic valve into left ventricle during diastole. Left ventricular dilation and hypertrophy caused by increased left ventricle stroke volume ◦Subjective: only minor symptoms for many years, then rapid deterioration; DOE, PND, angina, dizziness ◦Objective: bounding "water-hammer" pulse in carotid, brachial and femoral arteries. Blood pressure has wide pulse pressure. ◦Murmur: starts almost simultaneously with S2; soft, high pitched, blowing diastolic ◦Best Heard: at 3rd left interspace at base as person sits up and leans forward pulmonic regurgitation - >>>>backflow of blood through incompetent pulmonic valve from pulmonary artery to right ventricle ◦* Murmur has same timing and characteristics as that of aortic regurgitation, and is hard to distinguish on physical examination If a patient suffered from myocardial infarction (MI)... - >>>>the patient may have suffer from inflammation of the precordium, which sounds high-pitched or even scratchy in sound. Heart sounds are normal when client in the supine position, but when they lean forward the abnormal heart sounds are heard. BEST heard in the APEX. Ankle-Brachial Index (ABI) - >>>>Exam with the use of a Doppler stethoscope ◦Highly specific, non-invasive, and readily available way to determine the extent of peripheral arterial disease (PAD) ◦People w/Diabetes (DM), or Chronic Kidney Disease (CKD) may have calcified arteries that are occasionally non-compressible and give a falsely high ankle pressure. Thus the presence or severity of PAD may be underestimated peripheral vascular disease (PVD): Peripheral Artery Disease (PAD) and Venous Disease - >>>>◦With PAD: blood flow cannot match muscle demand during exercise; therefore, people feel muscle fatigue and/or pain when walking (claudication). But only 10% of those with PAD have this classic symptom. ◦Claudication Distance: number of blocks walked or stairs climbed to produce pain ◦Note sudden decrease in claudication distance or pain not relieved by rest- May indicate severe, changing or worsening problem ◦Night Leg Pain is common in aging adults. This may indicate the ischemic rest pain of PAD, severe night muscle cramping (usually in calf), or restless leg syndrome ◦Risk Factors of PVD: Diabetes & Smoking are stronger risk factors for PVD than even heart disease! Coolness occurs, avoid compression stockings b/c further constrict blood flow - >>>>PAD PVD swelling in arms and legs - >>>>◦Edema is BILATERAL when the cause is generalized (Heart Failure). This swelling is usually PITTING & SOFT. Edema is UNILATERAL when the cause is the result of a Local Obstruction, Inflammation or Lymph Node Removal. This swelling is usually NON- PITTING and is FIRM to touch. pulse - >>>>◦Palpate BOTH Radial Pulses. Radial Pulses should be able to be palpated w/light palpation if pulse in Normal. ◦NOTE: Rate, Rhythm, Elasticity of Vessel Wall, and Equal Force. Grade the Force on a 3 point Scale: ◦3+, Increased, Full, Bounding ◦2+, Normal ◦1+, Weak ◦0, Absent ◦Full, Bounding pulse (3+) occurs w/hyperkinetic states (exercise, anxiety, fever), anemia, and hyperparathyroidism ◦Weak "Thready" pulse (1+) occurs w/shock, and PAD S1 coincides with the carotid artery pulse. S1 coincides with the Q wave of the QRS electrocardiogram complex. - >>>>S1 coincides with the carotid artery pulse. S1 coincides with the carotid artery pulse. S1 is loudest at the apex of the heart. S1 coincides with the C wave of the jugular venous pulse wave. S1 coincides with the R wave (the upstroke of the QRS complex). The jugular venous pressure is an indirect reflection of the: heart's efficiency as a pump. cardiac cycle. conduction effectiveness. synchronization of mechanical activity. - >>>>heart's efficiency as a pump. Jugular venous pressure is a reflection of the heart's ability to pump blood. If the pressure is elevated, heart failure is suspected. Which of the following is an appropriate position to have the patient assume when auscultating for extra heart sounds or murmurs? Roll toward the left side Roll toward the right side Trendelenburg position Recumbent position - >>>>roll towards the left side. After auscultation in the supine position, the nurse should have the patient roll onto the left side; the examiner should listen at the apex with the bell for the presence of any diastolic filling sounds (i.e., S3 or S4) or murmurs that may be heard only in this position. The examiner should have the patient sit up and lean forward; the examiner should auscultate at the base with the diaphragm for a soft, high-pitched, early diastolic murmur of aortic or pulmonic regurgitation. The precordium is: a. A synonym for the mediastinum b. The area on the chest where the apical impulse is felt c. The area on the anterior chest overlying the heart and great vessels d. A synonym for the area where the superior and inferior venae cavae return unoxygenated venous blood to the right side of the heart - >>>>c. The area on the anterior chest overlying the heart and great vessels Select the best description of the tricuspid valve. a. Left semilunar valve b. Right atrioventricular valve c. Left atrioventricular valve d. Right semilunar valve - >>>>right atrioventricular valve The function of the pulmonic valve is to: a. Divide the left atrium and left ventricle b. Guard the opening between the right atrium and right ventricle c. Protect the orifice between the right ventricle and the pulmonary artery d. Guard the entrance to the aorta from the left ventricle - >>>>c. Protect the orifice between the right ventricle and the pulmonary artery Atrial systole occurs: a. During ventricular systole b. During ventricular diastole c. Concurrently with ventricular systole d. Independently of ventricular function - >>>>b. During ventricular diastole The second heart sound is the result of: a. Opening of the mitral and tricuspid valves b. Closing of the mitral and tricuspid valves c. Opening of the aortic and pulmonic valves d. Closing of the aortic and pulmonic valves - >>>>d. Closing of the aortic and pulmonic valves The examiner is has estimated the jugular venous pressure. Identify the finding that is abnormal. a. Patient elevated to 30 degrees, internal jugular vein pulsation at 1 cm above sternal angle b. Patient elevated to 30 degrees, internal jugular vein pulsation at 2 cm above sternal angle c. Patient elevated to 40 degrees, internal jugular vein pulsation at 1 cm above sternal angle d. Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle - >>>>d. Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle The examiner is palpating the apical impulse. Which is a normal-sized impulse? a. Less than 1 cm b. Approximately 1 × 2 cm c. 3 cm d. Varies depending on the size of the person - >>>>b. Approximately 1 × 2 cm The nurse auscultates the pulmonic valve area in which region? a. Second right interspace b. Second left interspace c. Left lower sternal border d. Fifth interspace, left midclavicular line - >>>>b. second left interspace When auscultating the heart, your first step is to: a. Identify S1 and S2. b. Listen for S3 and S4. c. Listen for murmurs. with metabolic demand. Using a clenched fist to describe chest pain is characteristic of angina. Other symptoms that may accompany angina are diaphoresis, cold sweats, pallor, grayness, palpitations, dyspnea, nausea, tachycardia, and fatigue. Also, Mr. M symptoms were alleviated with nitroglycerin and cessation of activity Mr. M's risk factors are elevated serum cholesterol elevated blood pressure a history of diabetes obesity cigarette smoking low activity level positive family history of cardiac disease African Americans have a a higher incidence of stroke, higher death rates due to heart disease, increased prevalence of obesity, higher incidence of hypertension, high serom cholesterol levels, and higher incidence of diabetes than other racial groups Sternum - >>>>12 pairs of ribs and 12 thoracic vertebrae. •Floor is the diaphragm, a musculotendinous septum that separates thoracic cavity from abdomen. •First seven ribs attach to sternum by - >>>>costal cartilages. 8,9,10 attached to costal cartilage, ribs 11 and 12 are "floating" with free palpable tips suprasternal notch - >>>>U-shaped depression just above the sternum, between the clavicles Sternum - >>>>breastbone: manubrium, the body and xiphoid process sternal angle - >>>>"Angle of Louis" - articulation of the manubrium and body of the sternum. Continuous with the second rib. costal angle - >>>>the right and left costal margins form an angle where they meet at the xiphoid process. Normal=90 degree or less angle vertebra prominens - >>>>•start here when you count ribs & intercostal spaces on the back. Have patient flex head & feel for the most bony prominent spur protruding at the base of the neck. This is the spinous process of C7. If 2 bumps are seen equally prominent, C7 is the upper one & T1 is the lower one spinous process - >>>>•felt as knobs on the vertebrae, which stack together to form the spinal column. Note that the spinous processes align w/their same numbered ribs only down to T4. After T4, the spinous processes angle downward and overlie the vertebral body and rib below. inferior border of scapula - >>>>•scapulae located symmetrically in each hemithorax. The lower tip is usually at the 7th or 8th rib. 12th rib - >>>>palpate midway b/w the spine & the patient's side to identify the free tip Right lung - >>>>3 lobes, shorter than L lung b/c of underlying liver L lung - >>>>2 lobes, narrower than R lung b/c of heart aging adult - >>>>costal cartilage more calcified = thorax less mobile. •Respiratory muscle strength DECLINES •DECREASE in elastic properties equals less distensible & lessening the tendency to collapse & recoil •Aging lung is a more rigid structure that is harder to inflate •Lung bases become less ventilated as a result of closing off of a number of airways, which increases risk of dyspnea w/exertion beyond normal workload •Increased risk for post-operative pulmonary complications- atelectasis & infection from decreased ability to cough, a loss of protective airway reflexes & increased secretions •Decreased vital capacity: - >>>>maximum amount of air that a person can expel from the lungs after first filling the lungs to the maximum •age related changes result in an increase in small airway closure. increased residual volume - >>>>•the amount of air remaining in the lungs even after the most forceful expiration gas exchange - >>>>•With gradual loss of intra-alveolar septa & decreased number of alveoli; therefore, less surface area for gas exchange Tuberculosis - >>>>. •Airborne disease that has infected 1/3 of world's population •Rampant in crowded living conditions w/limited physical space b/w persons •Declined steadily in US, with incidence stable among Caucasians & Asians, and has decreased in all other racial/ethnic groups •68% of US cases occur among foreign born persons •90% of these cases are attributable to reactivation of latent TB •Others at risk for TB include: HIV co-infection, homeless population, those living in group settings, such as: shelters, prison, & long-term care facilities Asthma - >>>>•8.4% in children < 18 years, making it the most common chronic disease in childhood •Highest burden is among those living at or below the federal poverty line white or clear sputum - >>>>colds, bronchitis, viral infections Yellow or green sputum - >>>>bacterial infection rust sputum - >>>>TB or pneumococcal pneumonia abnormal chest findings - >>>>-increased chest size/altered contour >90 degrees -unequal chest expansion -abnormal breathing pattern -use of accessory muscle to breathe (tripod stance) -nasal flaring -greater or lower than 12-20 respirations per minute -clubbing of distal phalanx occurs with COPD or chronic hypoxia pectus excavatum - >>>>sunken sternum and adjacent cartilages barrel chest - >>>>associated w/normal aging & chronic emphysema & asthma as result of hyperinflation pectus carinatum - >>>>forward protrusion of the sternum Scoliosis - >>>>lateral curvature of the spine kyphosis - >>>>excessive outward curvature of the spine, causing hunching of the back. sigh - >>>>Occasional sighs are a normal finding; purposeful to expand alveoli. Frequent sighs are indicative of emotional dysfunction >>> hyperventilation and dizziness. Tachypnea - >>>>rapid breathing. •Increased rate, > 24 per minutes. Normal in fever, fear or exercise. Rate also increases w/respiratory insufficiency, PNA, alkalosis, pleurisy and lesions in the pons bradypnea - >>>>•slow breathing- decreased, but regular rate (<10 per minute), as in increased intracranial pressure and diabetic coma. Hyperventilation - >>>>•increase in both rate & depth. Normally occurs with: fear, anxiety, or extreme exertion. Also occurs w/DKA (Kussmul respirations), etc. Hyperventilation blows off CO2, causing a decrease level in blood (alkalosis). hypoventilation - >>>>•irregular shallow pattern by an overdose of narcotics or anesthetics. Cheybe-Stokes respiration - >>>>•regular cycle in which respirations alternate between shallow-deep- shallow breathing pattern followed by periods of apnea lasting longer than 30 seconds or longer. Most common cause: heart failure, renal failure, etc. Biot's respirations - >>>>•similar to Cheyne-Stokes respiration, except pattern is irregular. A series of normal respirations (3 to 4) is followed by period of apnea. Cycle length is variable, lasting anywhere from 10 seconds to 1 minute. Seen with: head trauma, brain abscess, spinal meningitis, encephalitis. chronic obstructive breathing - >>>>normal inspiration & prolonged expiration to overcome increased airway resistance. increased tactile fremitus - >>>>•occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium for vibrations (e.g. compression or consolidation such as PNA) decreased tactile fremitus - >>>>•Occurs when anything obstructs transmission of vibrations (e.g. obstructed bronchus, pleural effusion, pneumothorax, & emphysema). The barrier gets in the way of the sound and your palpating hand decreases fremitus. rhonchal fremitus - >>>>•vibration felt when inhaled air passes through thick secretion in the larger bronchi. This may decrease with coughing. pleural friction - >>>>produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid. The opposing surfaces make a coarse grating sound when rubbed together during breathing. Best detected by auscultation. It may be palpable and feels like two pieces of leather grating together. It is synchronous with respiratory excursion. Also called a palpable friction rub. Clinical example: Pleuritis pleural friction rub - >>>>•Description: superficial sound that is coarse and low pitched; grating quality as if 2 pieces of leather being rubbed together. Sound is inspiratory & expiratory. •Clinical Example: Pleuritis, accompanied by pain w/breathing Wheeze (high pitched) - >>>>•Description: High-Pitched, Musical, Squeaking sounds. •Clinical Example: diffuse airway obstruction fro acute asthma or chronic emphysema Wheeze- low pitched - >>>>•Description: Low-Pitched; Monophonic, Single Note, Snoring, Moaning sound •Clinical Example: Bronchitis, single bronchus obstruction from tumor stridor - >>>>•Description: High-Pitched, Monophonic, Crowing sound. Louder in neck than over chest wall. •Clinical Example: Croup and Acute Epiglottis in children and foreign inhalation; obstructed airway may be life-threatening Egophony - >>>>•Technique: auscultate the chest while the person phones a long "ee-ee-ee" sound •Normal Findings: should hear "eeeeee" •Abnormal Findings: over areas of consolidation or compression the spoken "eeee" sound changes to a bleating long "aaaa" sound Brochophony - >>>>•Technique: ask patient to repeat "ninety-nine" while you listen w/stethoscope over posterior chest •Normal Finding: soft, muffled & indistinct; you can hear through stethoscope, but cannot distinguish exactly what is being said •Abnormal Finding: pathology that increases lung density enhances transmission of voice sounds- essentially words are more distinct sound closet to your ear; you auscultate a clear "ninety-nine" whispered pectoriloquy - >>>>•Technique: ask the patient to whisper a phrase such as: "one-two-three" as you auscultate