Med Surg NCLEX Questions with Correct
Answers
Emphysema
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Reduced gas exchange surface area, increased air trapping, decreased capillary network,
increased work, increased O2 consumption
Cigarette smoking, environmental and or occupational exposure, genetic
Pink puffers, barrel chest, pursed lip breathing, distant, quiet breath sounds, wheezes,
pulmonary blebs on radiograph
Monitor S/SX of fluid overload, maintain PaO2 between 55 and 60, Baseline ABGs, Teach
purse lip breathing and diaphragmatic breathing, teach tripod position
Asthma
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Narrowing or closure of the airway due to a variety of stimulants
Mucosal edema, V/Q abnormalities, increased work of breathing, beta blockers, respiratory
infection, allergic reaction, emotional stress, exercise, environmental or occupational
exposure, reflux esophagitis
Dyspnea, wheezing, chest tightness, assess precipitating factors, medication history
,Administer bronchodilators, administer fluids and humidification, education, ABGs,
ventilatory patterns
Chronic Bronchitis
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Chronic sputum with cough production on a daily basis for a minimum of 3 months per year;
chronic hypoxemia, cor pulmonale; increase in mucus, cilia production; increase in bronchial
wall thickness, reduced responsiveness of respiratory center to hypoxemic stimuli.
Higher incidence in smokers
Generalized cyanosis, blue boaters, right sided heart failure, distended neck veins, crackles,
expiratory wheezes; Monitor for S/SX of fluid overload; Maintain PaO2 between 55 and 60;
baseline ABGs; Teach pursed lip breathing and diaphragmatic breathing; Teach tripod
position
Normal ABG Values
pH: 7.35-7.45
PCO2: 35-45mm Hg
PO2: 80 to 100 mm Hg
HCO3: 21-28 mEq/L
What is a pink puffer?
Barrel chest, which is indicative of emphysema and is caused by use of accessory muscles to
breathe. The person works harder to breathe. The person works harder to breathe, but the
amount of O2 taken in is adequate to oxygenate the tissues
,What is a blue bloater?
Insufficient oxygenation occurs with chronic bronchitis and leads to generalized cyanosis and
often right sided heart failure (cor pulmonale)
Tracheal Sunctioning
Suction when adventitious breath sounds are heard, when secretions are present at
endotracheal tube, and when gurgling sounds are noted.
Use aseptic technique throughout procedure
Wear mask and goggles
Advance catheter until resistance is felt
Apply suction only when withdrawing catheter
Never suction for more than 10 to 15 seconds, and pass the catheter only 3 fewer times
Oxygenate with 100% O2 for 1 to 2 minutes before and after suctioning to prevent hypoxia
Oxygen Administration
Nasal Cannula: low O2 flow for low O2 concentrations
Simple face mask: low flow, but effectively delivers high O2 concentrations; cannot deliver
<40% O2
Nonrebreather mask: low flow, but delivers high O2 concentrations (60%-90%)
Partial rebreather mask: low flow O2 reservoir bad attached; can deliver high O2
concentrations
Venturi mask: high flow system; can deliver exact O2 concentration
Pulse Oximetry
Easy measurement of O2 sat
Should be >90%, ideally above 95%
, No nail polish
Can attach to ear, toe, finer
Must have good peripheral perfusion to be accurate
Respiratory Isolation Technique
Mask is required for anyone entering room
Private room with negative air pressure
Client must wear mask when leaving room
Tuberculosis
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Communicable lung disease cause by infection from Mycobacterium tuberculosis bacteria;
transmission is airborne, after initial exposure, the bacteria encapsulates into Ghon lesions,
bacteria remain dormant until a later time, where clinical symptoms occurs
Fever with night sweats, anorexia, malaise, fatigue, cough, hemopytisis, dyspnea, pleuritic
chest pain with inspiration, cavitation or calcification as evidenced on chest radiograph,
positive sputum culture
A positive TB skin test is exhibited by an induration 100mm or greater in diameter 48 hours
after the skin test. Anyone who has received a BCG vaccine will have a positive skin test.
Provide teaching, collect sputum culture, place client in respiratory isolation, administer anti
TB meds
Lung Cancer
Pathophysiology
Answers
Emphysema
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Reduced gas exchange surface area, increased air trapping, decreased capillary network,
increased work, increased O2 consumption
Cigarette smoking, environmental and or occupational exposure, genetic
Pink puffers, barrel chest, pursed lip breathing, distant, quiet breath sounds, wheezes,
pulmonary blebs on radiograph
Monitor S/SX of fluid overload, maintain PaO2 between 55 and 60, Baseline ABGs, Teach
purse lip breathing and diaphragmatic breathing, teach tripod position
Asthma
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Narrowing or closure of the airway due to a variety of stimulants
Mucosal edema, V/Q abnormalities, increased work of breathing, beta blockers, respiratory
infection, allergic reaction, emotional stress, exercise, environmental or occupational
exposure, reflux esophagitis
Dyspnea, wheezing, chest tightness, assess precipitating factors, medication history
,Administer bronchodilators, administer fluids and humidification, education, ABGs,
ventilatory patterns
Chronic Bronchitis
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Chronic sputum with cough production on a daily basis for a minimum of 3 months per year;
chronic hypoxemia, cor pulmonale; increase in mucus, cilia production; increase in bronchial
wall thickness, reduced responsiveness of respiratory center to hypoxemic stimuli.
Higher incidence in smokers
Generalized cyanosis, blue boaters, right sided heart failure, distended neck veins, crackles,
expiratory wheezes; Monitor for S/SX of fluid overload; Maintain PaO2 between 55 and 60;
baseline ABGs; Teach pursed lip breathing and diaphragmatic breathing; Teach tripod
position
Normal ABG Values
pH: 7.35-7.45
PCO2: 35-45mm Hg
PO2: 80 to 100 mm Hg
HCO3: 21-28 mEq/L
What is a pink puffer?
Barrel chest, which is indicative of emphysema and is caused by use of accessory muscles to
breathe. The person works harder to breathe. The person works harder to breathe, but the
amount of O2 taken in is adequate to oxygenate the tissues
,What is a blue bloater?
Insufficient oxygenation occurs with chronic bronchitis and leads to generalized cyanosis and
often right sided heart failure (cor pulmonale)
Tracheal Sunctioning
Suction when adventitious breath sounds are heard, when secretions are present at
endotracheal tube, and when gurgling sounds are noted.
Use aseptic technique throughout procedure
Wear mask and goggles
Advance catheter until resistance is felt
Apply suction only when withdrawing catheter
Never suction for more than 10 to 15 seconds, and pass the catheter only 3 fewer times
Oxygenate with 100% O2 for 1 to 2 minutes before and after suctioning to prevent hypoxia
Oxygen Administration
Nasal Cannula: low O2 flow for low O2 concentrations
Simple face mask: low flow, but effectively delivers high O2 concentrations; cannot deliver
<40% O2
Nonrebreather mask: low flow, but delivers high O2 concentrations (60%-90%)
Partial rebreather mask: low flow O2 reservoir bad attached; can deliver high O2
concentrations
Venturi mask: high flow system; can deliver exact O2 concentration
Pulse Oximetry
Easy measurement of O2 sat
Should be >90%, ideally above 95%
, No nail polish
Can attach to ear, toe, finer
Must have good peripheral perfusion to be accurate
Respiratory Isolation Technique
Mask is required for anyone entering room
Private room with negative air pressure
Client must wear mask when leaving room
Tuberculosis
Pathophysiology
Precipitating Factors
Assessment
Nursing Intervention
Communicable lung disease cause by infection from Mycobacterium tuberculosis bacteria;
transmission is airborne, after initial exposure, the bacteria encapsulates into Ghon lesions,
bacteria remain dormant until a later time, where clinical symptoms occurs
Fever with night sweats, anorexia, malaise, fatigue, cough, hemopytisis, dyspnea, pleuritic
chest pain with inspiration, cavitation or calcification as evidenced on chest radiograph,
positive sputum culture
A positive TB skin test is exhibited by an induration 100mm or greater in diameter 48 hours
after the skin test. Anyone who has received a BCG vaccine will have a positive skin test.
Provide teaching, collect sputum culture, place client in respiratory isolation, administer anti
TB meds
Lung Cancer
Pathophysiology
