NP Assessment Lungs & Respiratory System Exam Questions and Answers 100% Solved|
Latest Update Graded A+
Physical exam: Geriatric Considerations Dry mucous membranes
Increased AP diameter and slight hyperresonance of lung fields with percussion
More likely to have atypical sx of pneumonia - altered mental status, decreased
alertness/increased confusion, poor appetite, fatigue, and falls.
Laboratory Considerations ABG, CBC, D-dimer (r/o PE or VTE), Electrolytes, Sputum/Blood
culture, Viral Testing
Lung Function Testing Pulse oximetry - may be inaccurate in smoker or COPD
Peak flow - PEF correlates with airflow limitations
Spirometry - detects volume and capacity of lungs
Decreased FEV1/FVC ratio - obstructive disease (decreased elasticity) such as asthma & COPD
Increased FEV1/FVC ratio - restrictive (noncompliant) fibrotic/pneumonia
Imaging Chest x-ray - A (airway) B (bone) C (cardiomediastinal silhouette) D (diaphragm) E
(expanded lungs/everything else) F (foreign objects)
order for cough, dyspnea, hemoptysis, chest pain
DO NOT ORDER - asymptomatic, low-risk, unremarkable history/physical
CT
Breathing Variations Tachypnea - Abnormally increased RR with shallow breaths -
hypoxemia, hypercapnia, fever --> pneumonia, HF, CNS abnormalities ( tumor salicylate
intoxication)
, Hypernea - increased rate and depth of breathing - exercise, high altitude, anemia, DKA
Bradypnea - slow RR - drug induced depression, hypothyroidism, increased ICP, Gullain-Barre,
ALS
Sighing respiration - normal reaction to emotional states or fatigue --> certain breaths will be
deep leading to hyperventilation
Cheyne-Stokes - periods of progressively deeper breaths (crescendo-descrendo) followed by
periods of no breathing --> dying, CHF, TBI, Carbon monoxide poisoning, hyponatremia, drug
overdose
Biot's Breathing - Regular deep respirations alternating to periods of no breathing due to
damage to the pons casued by CVA, trauma, cerebral ischemia, or hypoxia
Agonal - Occasional reflexive-driven gasps associated with anoxia, cardiac arrest, cerebral
ischemia, or hypoxia
Apnea - absence of breathing
Acute Bronchitis an inflammation of the lower respiratory tract that is usually due to viral
infection.
Sx similar to common cold first few days --> productive cough, dyspnea, nasal congestion,
headache, fever, substernal or chest wall pain while coughing, cough 2-6 weeks
S/s:
Mildly ill, Fever <100, Wheezes or rhonchi that clear with coughing
Important to differentiate from pneumonia --> fever >100
Latest Update Graded A+
Physical exam: Geriatric Considerations Dry mucous membranes
Increased AP diameter and slight hyperresonance of lung fields with percussion
More likely to have atypical sx of pneumonia - altered mental status, decreased
alertness/increased confusion, poor appetite, fatigue, and falls.
Laboratory Considerations ABG, CBC, D-dimer (r/o PE or VTE), Electrolytes, Sputum/Blood
culture, Viral Testing
Lung Function Testing Pulse oximetry - may be inaccurate in smoker or COPD
Peak flow - PEF correlates with airflow limitations
Spirometry - detects volume and capacity of lungs
Decreased FEV1/FVC ratio - obstructive disease (decreased elasticity) such as asthma & COPD
Increased FEV1/FVC ratio - restrictive (noncompliant) fibrotic/pneumonia
Imaging Chest x-ray - A (airway) B (bone) C (cardiomediastinal silhouette) D (diaphragm) E
(expanded lungs/everything else) F (foreign objects)
order for cough, dyspnea, hemoptysis, chest pain
DO NOT ORDER - asymptomatic, low-risk, unremarkable history/physical
CT
Breathing Variations Tachypnea - Abnormally increased RR with shallow breaths -
hypoxemia, hypercapnia, fever --> pneumonia, HF, CNS abnormalities ( tumor salicylate
intoxication)
, Hypernea - increased rate and depth of breathing - exercise, high altitude, anemia, DKA
Bradypnea - slow RR - drug induced depression, hypothyroidism, increased ICP, Gullain-Barre,
ALS
Sighing respiration - normal reaction to emotional states or fatigue --> certain breaths will be
deep leading to hyperventilation
Cheyne-Stokes - periods of progressively deeper breaths (crescendo-descrendo) followed by
periods of no breathing --> dying, CHF, TBI, Carbon monoxide poisoning, hyponatremia, drug
overdose
Biot's Breathing - Regular deep respirations alternating to periods of no breathing due to
damage to the pons casued by CVA, trauma, cerebral ischemia, or hypoxia
Agonal - Occasional reflexive-driven gasps associated with anoxia, cardiac arrest, cerebral
ischemia, or hypoxia
Apnea - absence of breathing
Acute Bronchitis an inflammation of the lower respiratory tract that is usually due to viral
infection.
Sx similar to common cold first few days --> productive cough, dyspnea, nasal congestion,
headache, fever, substernal or chest wall pain while coughing, cough 2-6 weeks
S/s:
Mildly ill, Fever <100, Wheezes or rhonchi that clear with coughing
Important to differentiate from pneumonia --> fever >100
