NSG 300 EXAM 3 | COMPREHENSIVE NURSING STUDY GUIDE, PRACTICE
QUESTIONS & ANSWERS 2026/2027
Inspiration - ANS ✔✔Active process stimulated by chemical receptors in the aorta
Expiration - ANS ✔✔Passive process that depends on the elastic recoil properties of the lungs, requiring
little or no muscle work
-Patients with COPD lose the elastic recoil properties of the lungs and thorax
Surfactant - ANS ✔✔Chemical produced in the lungs to maintain the surface tension of the alveoli and
keep them from collapsing
-Patients with decreased surfactant production can sometimes develop atelectasis which is the
collapsing of the alveoli
Tidal volume - ANS ✔✔The amount of air exhaled following a normal inspiration
Residual volume - ANS ✔✔Amount of air left in the alveoli after a full expiration
Forced vital capacity - ANS ✔✔Maximum amount of air that can removed from the lungs during forced
expiration
Stroke volume - ANS ✔✔The volume of blood ejected from the ventricles during systole
-Hemorrhage and dehydration cause a decrease in circulating blood volume which results in a decrease
in stroke volume
Heart sound: S1 - ANS ✔✔During ventricular diastole, the mitral and tricuspid valves open and blood
flows from the atria to the ventricles
As systole begins, ventricular pressure rises, causing the mitral and tricuspid valves to close which results
in S1
Heart sound: S2 - ANS ✔✔During systole, the semilunar (aortic and pulmonary) valves open, and blood
flows from the ventricles into the aorta and pulmonary artery
As the ventricles empty, the ventricular pressure decreases, allowing closure of the aortic and pulmonary
valves which results in S2
-Patients with valvular disease have backflow of blood which can result in a murmur on auscultation
Preload - ANS ✔✔Amount of blood in the left ventricle at the end of diastole
Afterload - ANS ✔✔Resistance to left ventricular ejection
-In hypertension, the afterload increases, making cardiac workload also increase
Myocardial contractility - ANS ✔✔Poor ventricular contraction decreases the amount of blood ejected
Injury to the myocardial muscle (i.e MI) decreases ventricular contraction
The myocardium of the older adult is stiffer with slower ventricular filling rate and prolonged contraction
time
, Anemia - ANS ✔✔-Lower than normal hemoglobin level
-Result of decreased hemoglobin level, increased blood cell destruction, and/or blood loss
Symptoms: Fatigue, decreased activity tolerance, increased breathlessness, increased heart rate, and
pallor (secondary: Oxygenation decreases)
-Response: Increased RBC production (polycythemia)
Hypovalemia - ANS ✔✔Conditions such as severe dehydration and shock cause extracellular fluid loss
and reduced circulating blood flow
Response: Peripheral vasoconstriction and increased heart rate to increase the volume of blood returned
to the heart to then increase stroke volume
Increased metabolic rate - ANS ✔✔-Increased metabolic rate is normal in pregnancy, wound healing, and
exercise
-Fever increases the need for oxygen and as a result CO2 levels increase
-When fever persists, the metabolic rate remains high and the body begins to break down protein stores
which causes muscle wasting an decreased muscle mass including respiratory muscles
Normal arterial carbon dioxide tension - ANS ✔✔35-45 mmHg
Normal arterial oxygen tension - ANS ✔✔80-100 mmHg
Conditions affecting chest wall movement - ANS ✔✔1. Pregnancy: Enlarging uterus pushes abdominal
contents upward towards the diaphragm
2. Obesity: Reduced lung volumes from the heavy lower thorax and abdomen, particularly in the supine
position; reduction in lung and chest volume; obstructive sleep apnea
3. Musculoskeletal abnormalities: Abnormal structural configurations impairing oxygenation include
those affecting the rib cage such as pectus excavatum, kyphosis, lordosis, or scoliosis
4. Trauma: Flail chest, thoracic or abdominal incisions cause shallow breathing, opioids cause respiratory
depression
5. Neuromuscular disease: Myasthenia Gravis (weakness in skeletal muscle) Guillain-Barre Syndrome
(immune system attacks healthy nerve cells which can lead to paralysis), and poliomyelitis
6. Central nervous system alterations: Medulla oblongata issues result in impaired neural regulation of
breathing which results in abnormal breathing patterns; Trauma from C3-C5 usually results in paralysis
below (phrenic nerve) which causes the diaphragm to not be able to descend which reduces inspiratory
lung volume and causes hypoxemia
7. Chronic disease: Barrel chest occurs in patients with emphysema because of overuse of accessory
muscles and air trapping
Hypoventilation - ANS ✔✔-Occurs when alveolar ventilation is inadequate to meet the oxygen demand
of the body or eliminate sufficient amounts of carbon dioxide
-i.e. atelectasis
-Patients with COPD: Peripheral chemoreceptors are sensitive to low oxygen levels, causing increased
ventilation; The stimulus to breathe is a decreased arterial oxygen, oxygen given to these patients that is
greater than 24-28% (1-3L/min) prevents arterial oxygen from falling below 60 mm Hg which destroys
the stimulus to breathe; Hypoventilation occurs and carbon dioxide is retained
-Signs and symptoms: Mental status changes, dysrhythmias, and potential cardiac arrest, dizziness,
headache upon awakening, lethargy, convulsions, coma, and electrolyte imbalances
QUESTIONS & ANSWERS 2026/2027
Inspiration - ANS ✔✔Active process stimulated by chemical receptors in the aorta
Expiration - ANS ✔✔Passive process that depends on the elastic recoil properties of the lungs, requiring
little or no muscle work
-Patients with COPD lose the elastic recoil properties of the lungs and thorax
Surfactant - ANS ✔✔Chemical produced in the lungs to maintain the surface tension of the alveoli and
keep them from collapsing
-Patients with decreased surfactant production can sometimes develop atelectasis which is the
collapsing of the alveoli
Tidal volume - ANS ✔✔The amount of air exhaled following a normal inspiration
Residual volume - ANS ✔✔Amount of air left in the alveoli after a full expiration
Forced vital capacity - ANS ✔✔Maximum amount of air that can removed from the lungs during forced
expiration
Stroke volume - ANS ✔✔The volume of blood ejected from the ventricles during systole
-Hemorrhage and dehydration cause a decrease in circulating blood volume which results in a decrease
in stroke volume
Heart sound: S1 - ANS ✔✔During ventricular diastole, the mitral and tricuspid valves open and blood
flows from the atria to the ventricles
As systole begins, ventricular pressure rises, causing the mitral and tricuspid valves to close which results
in S1
Heart sound: S2 - ANS ✔✔During systole, the semilunar (aortic and pulmonary) valves open, and blood
flows from the ventricles into the aorta and pulmonary artery
As the ventricles empty, the ventricular pressure decreases, allowing closure of the aortic and pulmonary
valves which results in S2
-Patients with valvular disease have backflow of blood which can result in a murmur on auscultation
Preload - ANS ✔✔Amount of blood in the left ventricle at the end of diastole
Afterload - ANS ✔✔Resistance to left ventricular ejection
-In hypertension, the afterload increases, making cardiac workload also increase
Myocardial contractility - ANS ✔✔Poor ventricular contraction decreases the amount of blood ejected
Injury to the myocardial muscle (i.e MI) decreases ventricular contraction
The myocardium of the older adult is stiffer with slower ventricular filling rate and prolonged contraction
time
, Anemia - ANS ✔✔-Lower than normal hemoglobin level
-Result of decreased hemoglobin level, increased blood cell destruction, and/or blood loss
Symptoms: Fatigue, decreased activity tolerance, increased breathlessness, increased heart rate, and
pallor (secondary: Oxygenation decreases)
-Response: Increased RBC production (polycythemia)
Hypovalemia - ANS ✔✔Conditions such as severe dehydration and shock cause extracellular fluid loss
and reduced circulating blood flow
Response: Peripheral vasoconstriction and increased heart rate to increase the volume of blood returned
to the heart to then increase stroke volume
Increased metabolic rate - ANS ✔✔-Increased metabolic rate is normal in pregnancy, wound healing, and
exercise
-Fever increases the need for oxygen and as a result CO2 levels increase
-When fever persists, the metabolic rate remains high and the body begins to break down protein stores
which causes muscle wasting an decreased muscle mass including respiratory muscles
Normal arterial carbon dioxide tension - ANS ✔✔35-45 mmHg
Normal arterial oxygen tension - ANS ✔✔80-100 mmHg
Conditions affecting chest wall movement - ANS ✔✔1. Pregnancy: Enlarging uterus pushes abdominal
contents upward towards the diaphragm
2. Obesity: Reduced lung volumes from the heavy lower thorax and abdomen, particularly in the supine
position; reduction in lung and chest volume; obstructive sleep apnea
3. Musculoskeletal abnormalities: Abnormal structural configurations impairing oxygenation include
those affecting the rib cage such as pectus excavatum, kyphosis, lordosis, or scoliosis
4. Trauma: Flail chest, thoracic or abdominal incisions cause shallow breathing, opioids cause respiratory
depression
5. Neuromuscular disease: Myasthenia Gravis (weakness in skeletal muscle) Guillain-Barre Syndrome
(immune system attacks healthy nerve cells which can lead to paralysis), and poliomyelitis
6. Central nervous system alterations: Medulla oblongata issues result in impaired neural regulation of
breathing which results in abnormal breathing patterns; Trauma from C3-C5 usually results in paralysis
below (phrenic nerve) which causes the diaphragm to not be able to descend which reduces inspiratory
lung volume and causes hypoxemia
7. Chronic disease: Barrel chest occurs in patients with emphysema because of overuse of accessory
muscles and air trapping
Hypoventilation - ANS ✔✔-Occurs when alveolar ventilation is inadequate to meet the oxygen demand
of the body or eliminate sufficient amounts of carbon dioxide
-i.e. atelectasis
-Patients with COPD: Peripheral chemoreceptors are sensitive to low oxygen levels, causing increased
ventilation; The stimulus to breathe is a decreased arterial oxygen, oxygen given to these patients that is
greater than 24-28% (1-3L/min) prevents arterial oxygen from falling below 60 mm Hg which destroys
the stimulus to breathe; Hypoventilation occurs and carbon dioxide is retained
-Signs and symptoms: Mental status changes, dysrhythmias, and potential cardiac arrest, dizziness,
headache upon awakening, lethargy, convulsions, coma, and electrolyte imbalances
