CCBC NURN155 EVALUATION EXAMS ANSWERS
AND QUESTIONS SET A+
✔✔Alterations in the Cardiovascular System - ✔✔-Dysrhythmia or arrhythmia
-Myocardial ischemia
-Angina
-Myocardial infarction
-Heart failure
✔✔Factors affecting cardiopulmonary functioning and oxygenation - ✔✔Level of health
Developmental considerations
Medication considerations
Lifestyle considerations
Environmental considerations
Psychological health considerations
✔✔Respiratory Activity in the Infant - ✔✔* Respiratory rate is rapid and respiratory
activity is primarily abdominal.
* Synthetic surfactant can be given to the infant to reopen alveoli.
* Crackles heard at the end of deep respiration are normal.
✔✔Respiratory Activity in the Child - ✔✔Some subcutaneous fat is deposited on the
chest wall, making landmarks less prominent.
Eustachian tubes, bronchi, and bronchioles are elongated and less angular.
The average number of routine colds and infections decreases until children enter
daycare or school.
Good hand hygiene and tissue etiquette are encouraged.
By the end of late childhood, the immune system protects from most infections.
✔✔Respiratory Functioning in the Older Adult - ✔✔Bony landmarks are more prominent
due to loss of subcutaneous fat.
Kyphosis contributes to appearance of leaning forward.
Barrel chest deformity may result in increased anteroposterior diameter.
Tissues and airways become more rigid; diaphragm moves less efficiently.
Older adults have an increased risk for disease, especially pneumonia.
, ✔✔breath sounds - ✔✔vesicular, bronchovesicular, bronchial
✔✔Abnormal lung sounds - ✔✔wheezing, crackles and silent chest
✔✔Nursing interventions for adequate respiratory function - ✔✔Teaching about a
pollution-free environment
Promoting optimal function
Promoting comfort
Promoting proper breathing
Managing chest tubes
Promoting and controlling coughing
Suctioning the airway
Meeting oxygenation needs with medications
✔✔Promoting Proper Breathing - ✔✔-Deep breathing
-Incentive spirometer
-Pursed-Lip breathing
-Abdominal or Diaphragmatic breathing
✔✔Physical Assessment Techniques - ✔✔Inspection
Palpation
Percussion
Auscultation
✔✔bedside shift report - ✔✔examine IVs, patient and receive report at the patient's
bedside to fill gaps in knowledge before the off-going nurse leaves
* be aware of HIPAA when the pt. has a roommate
✔✔Change of shift report - ✔✔-given at the conclusion of each shift by the nurse
leaving to the nurse assuming responsibility for the client
-can be given face-to-face, audiotaped, or presented during rounds
-should include significant objective info, given in logical order, free of gossip and
personal opinions, and relate recent changes in meds, treatments/procedures, or
discharge plan
✔✔Charting by exception (CBE) - ✔✔shorthand method for documenting patient data
that is based on well-defined standards of practice; only exceptions to these standards
are documented in narrative notes
✔✔consultation - ✔✔process in which two or more individuals with varying degrees of
experience and expertise deliberate about a problem and its solution
AND QUESTIONS SET A+
✔✔Alterations in the Cardiovascular System - ✔✔-Dysrhythmia or arrhythmia
-Myocardial ischemia
-Angina
-Myocardial infarction
-Heart failure
✔✔Factors affecting cardiopulmonary functioning and oxygenation - ✔✔Level of health
Developmental considerations
Medication considerations
Lifestyle considerations
Environmental considerations
Psychological health considerations
✔✔Respiratory Activity in the Infant - ✔✔* Respiratory rate is rapid and respiratory
activity is primarily abdominal.
* Synthetic surfactant can be given to the infant to reopen alveoli.
* Crackles heard at the end of deep respiration are normal.
✔✔Respiratory Activity in the Child - ✔✔Some subcutaneous fat is deposited on the
chest wall, making landmarks less prominent.
Eustachian tubes, bronchi, and bronchioles are elongated and less angular.
The average number of routine colds and infections decreases until children enter
daycare or school.
Good hand hygiene and tissue etiquette are encouraged.
By the end of late childhood, the immune system protects from most infections.
✔✔Respiratory Functioning in the Older Adult - ✔✔Bony landmarks are more prominent
due to loss of subcutaneous fat.
Kyphosis contributes to appearance of leaning forward.
Barrel chest deformity may result in increased anteroposterior diameter.
Tissues and airways become more rigid; diaphragm moves less efficiently.
Older adults have an increased risk for disease, especially pneumonia.
, ✔✔breath sounds - ✔✔vesicular, bronchovesicular, bronchial
✔✔Abnormal lung sounds - ✔✔wheezing, crackles and silent chest
✔✔Nursing interventions for adequate respiratory function - ✔✔Teaching about a
pollution-free environment
Promoting optimal function
Promoting comfort
Promoting proper breathing
Managing chest tubes
Promoting and controlling coughing
Suctioning the airway
Meeting oxygenation needs with medications
✔✔Promoting Proper Breathing - ✔✔-Deep breathing
-Incentive spirometer
-Pursed-Lip breathing
-Abdominal or Diaphragmatic breathing
✔✔Physical Assessment Techniques - ✔✔Inspection
Palpation
Percussion
Auscultation
✔✔bedside shift report - ✔✔examine IVs, patient and receive report at the patient's
bedside to fill gaps in knowledge before the off-going nurse leaves
* be aware of HIPAA when the pt. has a roommate
✔✔Change of shift report - ✔✔-given at the conclusion of each shift by the nurse
leaving to the nurse assuming responsibility for the client
-can be given face-to-face, audiotaped, or presented during rounds
-should include significant objective info, given in logical order, free of gossip and
personal opinions, and relate recent changes in meds, treatments/procedures, or
discharge plan
✔✔Charting by exception (CBE) - ✔✔shorthand method for documenting patient data
that is based on well-defined standards of practice; only exceptions to these standards
are documented in narrative notes
✔✔consultation - ✔✔process in which two or more individuals with varying degrees of
experience and expertise deliberate about a problem and its solution
