NURS 640 EXAMS 1 QUESTIONS AND ANSWERS
SURE A+
✔✔Metabolic acidosis - ✔✔diagnosed when the serum pH is reduced and the serum
bicarbonate concentration is abnormally low (often defined as <22 meq/L, but the
threshold may vary across clinical laboratories).
✔✔Metabolic alkalosis - ✔✔is usually accompanied by hypokalemia, is defined as a
disorder that causes elevations in the serum bicarbonate concentration and arterial pH.
In a patient with an uncomplicated (simple) metabolic alkalosis, both parameters are
above normal. However, this may not be present in patients with mixed acid-base
disorders.
✔✔Venous blood sample - ✔✔o Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
✔✔Vocal fold dysfunction syndrome - ✔✔paradoxical vocal fold adduction, acute and
chronic upper airway obstruction.
✔✔Disorders of the upper airways - ✔✔Acute obstruction include trauma to the larynx
or pharynx, foreign body aspiration, laryngospasm, laryngeal edema from thermal injury
or angioedema, infections (acute epiglottis, Ludwig angina, pharyngeal or
retropharyngeal abscess) and acute allergic laryngitis.
✔✔Chronic obstruction of the upper airway - ✔✔carcinoma of the pharynx or larynx,
laryngeal or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold
paralysis.
Characteristic findings= inspiratory stridor, intercostal retractions on inspiration, palpable
inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on
auscultation.
,✔✔response to bronchodilator therapy, normal spirometry immediately after an attack, -
✔✔Dyspnea, wheezing that may be distinguished from asthma or exercise induced
asthma by the lack of
✔✔Disorders of the lower airways - ✔✔Tracheal obstruction= intrathoracic (below the
suprasternal notch) or extrathoracic.
✔✔Bronchial obstruction - ✔✔pulmonary secretions, aspiration, foreign bodies,
bronchomalcia, bronchogenic carcinoma, masses and tumors metastatic to the airways.
✔✔Intermittent or mild persistent asthma - ✔✔symptoms are worse at night. Circadian
variations in bronchomotor tone and bronchial reactivity reach their nadir between 3am
and 4am, increasing symptoms of bronchoconstriction
ymptoms=breathlessness while walking, talks in sentences, alertness may be agitated.
o Signs= increased respiratory rate, can lie down, usually does not use accessory
muscles, wheeze moderate, often only end expiratory. Pulse less than 100, pulsus
paradoxus absent less 10mmHg
o FEV1 > 70%, PaO2 on room air is normal, PcO2 <42mmHg SaO2on air >95%
✔✔Anaerobic pneumonia and lung absces - ✔✔History of or predisposition to
aspiration= larger amounts of mater include nocturnal asthma, chemical pneumonitis,
mechanical obstruction of airways by particulate matter, bronchiectasis, and
pleuroplumonary infection. Depressed levels of consciousness due to drug alcohol,
seizure, general anesthesia. (think of things that may cause aspiration)
o Indolent symptoms including fever, weight loss, and malaise
o Poor dentition
o Foul smelling purulent sputum
o Infiltrate in dependent lung zone, with single or multiple areas of cavitation or pleural
effusion
· S/S constitutional symptoms= fever, weight loss, malaise, cough with expectoration of
foul smelling purulent sputum. (nonproductive cough does not rule out)
✔✔Anaerobic pneumonia and lung absces - ✔✔· Lab findings
o Expectorated sputum is inappropriate because of the mouth flora contamination.
o Culture can be obtained only by transthoracic aspiration, thoracentesis, or
bronchoscopy with a protected brush.
· Imaging
o Lung abscess appears as a thick walled solitary cavity surrounded by consolidation.
An air fluid level is usually present.
· Treatment
o Clindamycin 600mg IV q 8 until improvement then 300mg orally q6. OR amoxicillin-
clavulanate 875/125 orally q 12.
o Penicillin alone is inadequate treatment.
, ✔✔pulmonary infiltrates in the immunocompromised host - ✔✔Two tools help narrow
the differential diagnosis.
o Knowledge of the underlying immunologic defect
o Time course of infection provides clue to etiology of pneumonia.
· Clinical findings
o Chest radiography is rarely helpful.
o Expectorated sputum is important
✔✔Characteristic Symptoms of Asthma - ✔✔Wheezing
Dyspnea
Coughing
* Prodromal symptoms may precede an attack, with itching under the chin, discomfort
between the scapulae, or inexplicable fear (impending doom).
*Typical signs are inspiratory, and to a greater extent expiratory, rhonchi throughout,
and there may be hyperinflation.
✔✔Lung Function Test Asthma - ✔✔Simple spirometry confirms airflow limitation.
Reduced FEV1, FEV1/FVC ratio, and PEF.
Reversibility is demonstrated by a >12% and 200 ml increase in FEV1 15 mins after an
inhaled short-acting B2-agonist or in some patients by a 2 to 4 wk trial of oral
corticosteroids (prednisone or prednisolone 30-40 mg daily).
Measurements of PEF 2x daily may confirm diurnal variations in airflow obstruction.
Flow-volume loops show reduced peak flow & reduced maximum expiratory flow.
✔✔Airway Responsiveness asthma - ✔✔The increased AHR is normally measured by
methacholine or histamine challenge w/ calculation of the provocative concentration that
reduces FEV1 by 20% (PC20).
Rarely used in clinical practice, but can be used in differential diagnosis of chronic
cough & when the diagnosis is in doubt in the setting of normal PFT.
✔✔Imagings-asthma - ✔✔Chest roentgenography - usually normal but in more severe
patients may show hyperinflated lungs.
In exacerbations, there may be evidence of pneumothorax.
Lung shadowing usually indicates pneumonia or eosinophilic infiltrates in pts w/
bronchopulmonary aspergillosis.
CT - areas of bronchiectasis in pts w/ severe asthma, & thickening of the bronchial
walls, but these changes are not diagnostic of asthma.
✔✔Bronchodilator Therapies - ✔✔act primarily on airway smooth muscle to reverse
bronchoconstriction of asthma. Rapid relief of symptoms, but has little or no effect on
the underlying inflammatory process.
✔✔B2- Agonists - ✔✔Relaxes airway smooth muscle cells of the airways, where they
act as functional antagonists, reversing & preventing contraction of airway smooth
muscle cells by all known bronchoconstrictors.
SURE A+
✔✔Metabolic acidosis - ✔✔diagnosed when the serum pH is reduced and the serum
bicarbonate concentration is abnormally low (often defined as <22 meq/L, but the
threshold may vary across clinical laboratories).
✔✔Metabolic alkalosis - ✔✔is usually accompanied by hypokalemia, is defined as a
disorder that causes elevations in the serum bicarbonate concentration and arterial pH.
In a patient with an uncomplicated (simple) metabolic alkalosis, both parameters are
above normal. However, this may not be present in patients with mixed acid-base
disorders.
✔✔Venous blood sample - ✔✔o Ph 7.31-7.41
o PCo2 41-51
o HCO3 23-29
o PO2 30-40
o SO2 75
✔✔Vocal fold dysfunction syndrome - ✔✔paradoxical vocal fold adduction, acute and
chronic upper airway obstruction.
✔✔Disorders of the upper airways - ✔✔Acute obstruction include trauma to the larynx
or pharynx, foreign body aspiration, laryngospasm, laryngeal edema from thermal injury
or angioedema, infections (acute epiglottis, Ludwig angina, pharyngeal or
retropharyngeal abscess) and acute allergic laryngitis.
✔✔Chronic obstruction of the upper airway - ✔✔carcinoma of the pharynx or larynx,
laryngeal or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold
paralysis.
Characteristic findings= inspiratory stridor, intercostal retractions on inspiration, palpable
inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on
auscultation.
,✔✔response to bronchodilator therapy, normal spirometry immediately after an attack, -
✔✔Dyspnea, wheezing that may be distinguished from asthma or exercise induced
asthma by the lack of
✔✔Disorders of the lower airways - ✔✔Tracheal obstruction= intrathoracic (below the
suprasternal notch) or extrathoracic.
✔✔Bronchial obstruction - ✔✔pulmonary secretions, aspiration, foreign bodies,
bronchomalcia, bronchogenic carcinoma, masses and tumors metastatic to the airways.
✔✔Intermittent or mild persistent asthma - ✔✔symptoms are worse at night. Circadian
variations in bronchomotor tone and bronchial reactivity reach their nadir between 3am
and 4am, increasing symptoms of bronchoconstriction
ymptoms=breathlessness while walking, talks in sentences, alertness may be agitated.
o Signs= increased respiratory rate, can lie down, usually does not use accessory
muscles, wheeze moderate, often only end expiratory. Pulse less than 100, pulsus
paradoxus absent less 10mmHg
o FEV1 > 70%, PaO2 on room air is normal, PcO2 <42mmHg SaO2on air >95%
✔✔Anaerobic pneumonia and lung absces - ✔✔History of or predisposition to
aspiration= larger amounts of mater include nocturnal asthma, chemical pneumonitis,
mechanical obstruction of airways by particulate matter, bronchiectasis, and
pleuroplumonary infection. Depressed levels of consciousness due to drug alcohol,
seizure, general anesthesia. (think of things that may cause aspiration)
o Indolent symptoms including fever, weight loss, and malaise
o Poor dentition
o Foul smelling purulent sputum
o Infiltrate in dependent lung zone, with single or multiple areas of cavitation or pleural
effusion
· S/S constitutional symptoms= fever, weight loss, malaise, cough with expectoration of
foul smelling purulent sputum. (nonproductive cough does not rule out)
✔✔Anaerobic pneumonia and lung absces - ✔✔· Lab findings
o Expectorated sputum is inappropriate because of the mouth flora contamination.
o Culture can be obtained only by transthoracic aspiration, thoracentesis, or
bronchoscopy with a protected brush.
· Imaging
o Lung abscess appears as a thick walled solitary cavity surrounded by consolidation.
An air fluid level is usually present.
· Treatment
o Clindamycin 600mg IV q 8 until improvement then 300mg orally q6. OR amoxicillin-
clavulanate 875/125 orally q 12.
o Penicillin alone is inadequate treatment.
, ✔✔pulmonary infiltrates in the immunocompromised host - ✔✔Two tools help narrow
the differential diagnosis.
o Knowledge of the underlying immunologic defect
o Time course of infection provides clue to etiology of pneumonia.
· Clinical findings
o Chest radiography is rarely helpful.
o Expectorated sputum is important
✔✔Characteristic Symptoms of Asthma - ✔✔Wheezing
Dyspnea
Coughing
* Prodromal symptoms may precede an attack, with itching under the chin, discomfort
between the scapulae, or inexplicable fear (impending doom).
*Typical signs are inspiratory, and to a greater extent expiratory, rhonchi throughout,
and there may be hyperinflation.
✔✔Lung Function Test Asthma - ✔✔Simple spirometry confirms airflow limitation.
Reduced FEV1, FEV1/FVC ratio, and PEF.
Reversibility is demonstrated by a >12% and 200 ml increase in FEV1 15 mins after an
inhaled short-acting B2-agonist or in some patients by a 2 to 4 wk trial of oral
corticosteroids (prednisone or prednisolone 30-40 mg daily).
Measurements of PEF 2x daily may confirm diurnal variations in airflow obstruction.
Flow-volume loops show reduced peak flow & reduced maximum expiratory flow.
✔✔Airway Responsiveness asthma - ✔✔The increased AHR is normally measured by
methacholine or histamine challenge w/ calculation of the provocative concentration that
reduces FEV1 by 20% (PC20).
Rarely used in clinical practice, but can be used in differential diagnosis of chronic
cough & when the diagnosis is in doubt in the setting of normal PFT.
✔✔Imagings-asthma - ✔✔Chest roentgenography - usually normal but in more severe
patients may show hyperinflated lungs.
In exacerbations, there may be evidence of pneumothorax.
Lung shadowing usually indicates pneumonia or eosinophilic infiltrates in pts w/
bronchopulmonary aspergillosis.
CT - areas of bronchiectasis in pts w/ severe asthma, & thickening of the bronchial
walls, but these changes are not diagnostic of asthma.
✔✔Bronchodilator Therapies - ✔✔act primarily on airway smooth muscle to reverse
bronchoconstriction of asthma. Rapid relief of symptoms, but has little or no effect on
the underlying inflammatory process.
✔✔B2- Agonists - ✔✔Relaxes airway smooth muscle cells of the airways, where they
act as functional antagonists, reversing & preventing contraction of airway smooth
muscle cells by all known bronchoconstrictors.
