NURS 640 UPDATED EXAM PAPER QUESTIONS AND
ANSWERS SURE A+
✔✔ABG abnormalities associated with COPD, asthma and pneumonia
Asthma: - ✔✔ABG may be normal during mild exacerbation, but respiratory alkalosis
and increase in alveolar-arterial oxygen difference (A-a-DO2) common. During severe
exacerbations, hypoxemia develops and PaCO2 returns to normal. The combination of
an increased PACO2 and respiratory acidosis may indicate impending respiratory
failure
✔✔COPD - ✔✔No abnormalities early in COPD other than increased A-a-DO2.
Hypoxemia occurs in advanced disease, particularly when chronic bronchitis
predominates. Compensated respiratory acidosis occurs in patients with chronic
respiratory failure, particularly in chronic bronchitis, with worsening of acidemia during
acute exacerbations
✔✔Asthma - ✔✔Findings are usually normal, may show hyperinflation. Other findings
may include bronchial wall thickening and diminished peripheral lung vascular shadows
✔✔COPD - ✔✔Xrays show non-specific peribronchial and perivascular markings, plain
radiographs show hyperinflation with flattening of the diaphragm or peripheral arterial
deficiency
✔✔Pneumonia - ✔✔Pulmonary opacity required to establish diagnosis of CAP, findings
range from patchy airspace opacities to lobar consolidation with air bronchograms to
diffuse alveolar or interstitial opacities. Additional findings can include pleural effusions
and cavitation
✔✔Diabetic retinopathy - ✔✔35% of all diabetic patients and 20% DM Type II
Leading cause of blindness in ages 20-65
Maculopathy: mac edema, exudates, or ischemia
Non-proliferative
Dilation of veins
, Microaneurysms
Retinal hemorrhages and edema
Hard exudates
Pre-proliferative
Vascular abnormalities and retinal hemorrhages
Proliferative retinopathy
Neovascularization, arising from optic disk or the major vascular arcades
Vitreous hemorrhage which may lead to retinal detachment
Diagnosis
Complete opth exam for diabetics yearly
Treatment (Optimize blood sugar, blood pressure, renal function, lipids (more
prevention than tx)
Medications
Fenofibrates (antilipemics)
Intravitreal steroids
Thromolytic
Vascular endothelial growth factor
Procedures
Laser photocoagulation or vitrectomy
Panretinal laser photocoagulation
Vitrectomy
✔✔Hypertensive retinochoroidopathy - ✔✔Occurs in young pts with abrupt elevations of
BP which can occur in
Pheochromocytoma
Malignant HTN
Preeclampsia and eclampsia
Surrogate marker for current or future non-ocular end-organ damage
Chronic HTN
Diagnosis
Acute elevation of BP
Fundal abnormalities
Choroid (VC and ischemia)
Treatment
Control BP is key however, precipitous reductions may exacerbate retinal, choroid, or
optic nerve damage
✔✔Corneal Abrasion - ✔✔Severe pain and photophobia
Hx of trauma
Visual acuity, cornea and conjunctiva are examined with a light and loupe to r/o FB
Sterile fluorescein instilled abrasion will stain darker green
Bacitracin-polymyxin oint, mydriatic, analgesics, topical or oral non-steroidal anti
inflammatory
Heal slower in smokers
ANSWERS SURE A+
✔✔ABG abnormalities associated with COPD, asthma and pneumonia
Asthma: - ✔✔ABG may be normal during mild exacerbation, but respiratory alkalosis
and increase in alveolar-arterial oxygen difference (A-a-DO2) common. During severe
exacerbations, hypoxemia develops and PaCO2 returns to normal. The combination of
an increased PACO2 and respiratory acidosis may indicate impending respiratory
failure
✔✔COPD - ✔✔No abnormalities early in COPD other than increased A-a-DO2.
Hypoxemia occurs in advanced disease, particularly when chronic bronchitis
predominates. Compensated respiratory acidosis occurs in patients with chronic
respiratory failure, particularly in chronic bronchitis, with worsening of acidemia during
acute exacerbations
✔✔Asthma - ✔✔Findings are usually normal, may show hyperinflation. Other findings
may include bronchial wall thickening and diminished peripheral lung vascular shadows
✔✔COPD - ✔✔Xrays show non-specific peribronchial and perivascular markings, plain
radiographs show hyperinflation with flattening of the diaphragm or peripheral arterial
deficiency
✔✔Pneumonia - ✔✔Pulmonary opacity required to establish diagnosis of CAP, findings
range from patchy airspace opacities to lobar consolidation with air bronchograms to
diffuse alveolar or interstitial opacities. Additional findings can include pleural effusions
and cavitation
✔✔Diabetic retinopathy - ✔✔35% of all diabetic patients and 20% DM Type II
Leading cause of blindness in ages 20-65
Maculopathy: mac edema, exudates, or ischemia
Non-proliferative
Dilation of veins
, Microaneurysms
Retinal hemorrhages and edema
Hard exudates
Pre-proliferative
Vascular abnormalities and retinal hemorrhages
Proliferative retinopathy
Neovascularization, arising from optic disk or the major vascular arcades
Vitreous hemorrhage which may lead to retinal detachment
Diagnosis
Complete opth exam for diabetics yearly
Treatment (Optimize blood sugar, blood pressure, renal function, lipids (more
prevention than tx)
Medications
Fenofibrates (antilipemics)
Intravitreal steroids
Thromolytic
Vascular endothelial growth factor
Procedures
Laser photocoagulation or vitrectomy
Panretinal laser photocoagulation
Vitrectomy
✔✔Hypertensive retinochoroidopathy - ✔✔Occurs in young pts with abrupt elevations of
BP which can occur in
Pheochromocytoma
Malignant HTN
Preeclampsia and eclampsia
Surrogate marker for current or future non-ocular end-organ damage
Chronic HTN
Diagnosis
Acute elevation of BP
Fundal abnormalities
Choroid (VC and ischemia)
Treatment
Control BP is key however, precipitous reductions may exacerbate retinal, choroid, or
optic nerve damage
✔✔Corneal Abrasion - ✔✔Severe pain and photophobia
Hx of trauma
Visual acuity, cornea and conjunctiva are examined with a light and loupe to r/o FB
Sterile fluorescein instilled abrasion will stain darker green
Bacitracin-polymyxin oint, mydriatic, analgesics, topical or oral non-steroidal anti
inflammatory
Heal slower in smokers
