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Advanced Adult health Nursing
Final Exam Blueprint
Test Format:
100 questions: multiple choice, select all that apply, diagram, priority
Medical Surgical
Refence materials: Hinkle, Cheever & Overbaugh (HCO), 15th ed. ATI medical surgical and
Mental health, and PowerPoints posted on blackboard.
Hemoptysis is characteristic of tuberculosis.
Chapter 19- HCO- Chest and lower respiratory tract disorders pg. 571-601. Know sign and
symptoms, diagnostic testing, treatment, nursing management and complications specific to
disorders:
1. Acid-base imbalances
- Ph = 7.35 – 7.45
- PaCO2/CO2 = 35 – 45
- O2 = 80 – 100
- HCO3 = 21 – 28
- SAO2 = 95% – 100%
- Metabolic Acidosis – Ph ↓ - HCo3 ↓
- Metabolic Alkalosis – Ph ↑ - HCo3 ↑
- Respiratory Alkalosis – Ph ↑ - PaCO2 ↓
- Respiratory Acidosis – Ph ↓ - PaCO2 ↑
- Uncompensated – Co2 or HCO3 is normal
- Partially Compensated – Nothing is normal
- Compensated – Ph is normal/neutral
2. ARDS (Hallmark: Refractory Hypoxemia)
- A severe inflammatory process causing diffuse alveolar damage that results in sudden and
progressive pulmonary edema.
- S&S: Rapid onset of severe dyspnea, tachypnea, PaO2 doesn’t respond to supplemental
O2, bilateral infiltrates on CXR, absence of an elevated left atrial pressure.
- PE: Intercostal retractions, crackles
- DX: ABG, CXR, BNP levels, Echocardiography, Pulmonary artery catheterization
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- TX: Tx underlying condition, almost always includes ET intubation & mechanical
ventilation, Supplemental O2, intubation w/ PEEP, hood air (tent w/ humidified air),
prone position (best for oxygenation), enteral feedings preferred, reduce anxiety
(morphine, benzos)
- Meds: NS, Vasopressors (Stimulates the heart and causes dilation): Epinephrine,
Propofol, Morphine, Succinylcholine; VS Q1h/PRN
- Complications: Systemic hypotension, Hypovolemia
3. Respiratory failure (Just Review ATI Ch 26 Pg 161) It’s too much to type
- RF includes ARF, ARDS, and SARS. ARF is caused by failure to adequately ventilate
and/or oxygenate. Criteria for ARF is ABG values.
- Acute Respiratory Failure: Caused by failure to adequately ventilate and/or oxygenate.
- Severe Acute Respiratory Syndrome:
4. Pulmonary embolism
- The obstruction of the pulmonary artery or one of it’s branches by a thrombus (or
thrombi) that originates somewhere in the venous system or in the right side of the heart.
A PE occurs when a substance (solid, gaseous, or liquid) enters venous circulation and
forms a blockage in the pulmonary vasculature.
- S&S: Hallmark – Sudden chest pain, Sudden onset of chest pressure, pain upon
inspiration, chest wall tenderness, dyspnea, air hunger, cough, hemoptysis, SOB, pleural
friction rub, tachycardia, hypotension, tachypnea, crackles, petechiae, JVD, cyanosis,
heart murmur in S3 & S4.
- DX: ABG value (PaCO2 levels are low (NR 35-45)), respiratory alkalosis, D-dimer
(elevated due to clot formation and release of fibrin degradation (NR <0.4mcg/mL)),
Computed Tomography scan (MDCTA) is the criteria for detecting a PE, Ventilation-
perfusion scan (shows circulation of air and blood in the lungs and can detect PE), CXR,
Pulmonary angiography (this is the gold standard when MDCTA is unavailable)
- TX: O2 therapy (to relieve hypoxemia & dyspnea), IV access, high fowler’s position,
assess respiratory status q30m, assess cardiac status, compare BP in both arms, monitor
LOC and mental status. Embolectomy (surgical removal of embolus), Vena cava filter
placement (insertion of a filter in the vena cava to prevent further emboli from reaching
the pulmonary vasculature).
- MEDS: Anticoagulants (Enoxaparin, Warfarin) Used to prevent clots from getting larger
or additional clots from forming. (Monitor PT, INR, aPTT, CBC), Direct factor Xa
inhibitor (Rivaroxaban, Apixaban, Fondaparinux) they bind to Xa factor which inhibits
the production of thrombin. Direct thrombin inhibitor (Dabigatran), Thrombolytic
therapy (Alteplase, Reteplase, Tenecteplase) Used to dissolve blood clots and restore
pulmonary blood flow.
- If taking Warfarin do not increase or decrease the amount of vitamin K foods consumed
(green leafy veggies, cantaloupe) because Vit K can reduce the anticoagulant effects of
Warfarin.
- Complications: Decreased cardiac output and hemorrhage
5. Pulmonary edema
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- An abnormal accumulation of fluid in the lung tissue, the alveolar space, or both.
- S&S: Dyspnea, rales, coughing, pink frothy or blood tinged secretions, advances to
respiratory failure.
- DX: CXR
- TX: Correct cause, O2, respiratory therapy, intubation, diuretics.
6. Pneumothorax (Air between the pleura)
- Occurs when the parietal or visceral pleura is breached and the pleural space is exposed
to positive atmospheric pressure. Normally the pressure in the pleural space is negative or
subatmospheric. The lung or a portion of it collapses. PX is the presence of air or gas in
the pleural space that causes lung collapse.
- S&S: Sudden pain, slight chest discomfort and tachypnea. If the lung completely
collapses acute respiratory distress occurs, dyspnea, anxious, air hunger, increased use of
accessory muscles, central cyanosis from severe hypoxemia, hypotension, tachycardia,
profuse diaphoresis, breath sounds diminished or absent, Percussion of hyperresonant.
- TX: The goal of tx is to evacuate the air or blood from the pleural space. A chest tube is
inserted near the 2nd intercostal space (cause its thinnest part of chest wall), For a
hemothorax a large diameter (32 F) is inserted in the 4th or 5th intercostal space at the
midaxillary line.
7. Lung cancer
- Lung cancer arises from a single transformed epithelial cell in the tracheobronchial
airways, in which the carcinogen binds to and damages the cell’s DNA.
- S&S: Usually develops insidiously and is asymptomatic until it’s in its late stages. Cough
or change in chromic cough (the cough may start as dry and persistent; when obstruction
occurs in the airways, the cough may become productive due to infection.) Dyspnea,
hemoptysis or blood – tinged sputum, chest or shoulder pain, general pain, recurring pain,
hoarseness, dysphagia, head & neck edema, and symptoms of pleural or pericardial
effusion, common sites of metastases includes the lymph nodes, bone, brain, contralateral
lung, adrenal glands and liver. Nonspecific symptoms include weakness, anorexia, and
weight loss.
- DX: CXR (pulmonary density, coin lesion), CT scan (small nodules), Fiberoptic
bronchoscopy (Used to DX lung cancer), bone scans, PET scan, liver ultrasound, CT scan
of the brain, endobronchial ultrasound biopsy of the mediastinal nodes.
- TX: Thoracotomy, Sx, radiation therapy, chemotherapy (used to alter growth tumor
patterns), immunotherapy or a combination of these. Gene therapy using agents that
target specific genetic mutations including EGFR, ALK, ROSI.
- Complications – Respiratory failure, prolonged mechanical ventilation, diminished
cardiopulmonary function, pulmonary fibrosis, pericarditis, myelitis and cor pulmonale.
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Advanced Adult health Nursing
Final Exam Blueprint
Test Format:
100 questions: multiple choice, select all that apply, diagram, priority
Medical Surgical
Refence materials: Hinkle, Cheever & Overbaugh (HCO), 15th ed. ATI medical surgical and
Mental health, and PowerPoints posted on blackboard.
Hemoptysis is characteristic of tuberculosis.
Chapter 19- HCO- Chest and lower respiratory tract disorders pg. 571-601. Know sign and
symptoms, diagnostic testing, treatment, nursing management and complications specific to
disorders:
1. Acid-base imbalances
- Ph = 7.35 – 7.45
- PaCO2/CO2 = 35 – 45
- O2 = 80 – 100
- HCO3 = 21 – 28
- SAO2 = 95% – 100%
- Metabolic Acidosis – Ph ↓ - HCo3 ↓
- Metabolic Alkalosis – Ph ↑ - HCo3 ↑
- Respiratory Alkalosis – Ph ↑ - PaCO2 ↓
- Respiratory Acidosis – Ph ↓ - PaCO2 ↑
- Uncompensated – Co2 or HCO3 is normal
- Partially Compensated – Nothing is normal
- Compensated – Ph is normal/neutral
2. ARDS (Hallmark: Refractory Hypoxemia)
- A severe inflammatory process causing diffuse alveolar damage that results in sudden and
progressive pulmonary edema.
- S&S: Rapid onset of severe dyspnea, tachypnea, PaO2 doesn’t respond to supplemental
O2, bilateral infiltrates on CXR, absence of an elevated left atrial pressure.
- PE: Intercostal retractions, crackles
- DX: ABG, CXR, BNP levels, Echocardiography, Pulmonary artery catheterization
advanced-adult-health-nursing-nur-4324-final-exam-blueprint
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- TX: Tx underlying condition, almost always includes ET intubation & mechanical
ventilation, Supplemental O2, intubation w/ PEEP, hood air (tent w/ humidified air),
prone position (best for oxygenation), enteral feedings preferred, reduce anxiety
(morphine, benzos)
- Meds: NS, Vasopressors (Stimulates the heart and causes dilation): Epinephrine,
Propofol, Morphine, Succinylcholine; VS Q1h/PRN
- Complications: Systemic hypotension, Hypovolemia
3. Respiratory failure (Just Review ATI Ch 26 Pg 161) It’s too much to type
- RF includes ARF, ARDS, and SARS. ARF is caused by failure to adequately ventilate
and/or oxygenate. Criteria for ARF is ABG values.
- Acute Respiratory Failure: Caused by failure to adequately ventilate and/or oxygenate.
- Severe Acute Respiratory Syndrome:
4. Pulmonary embolism
- The obstruction of the pulmonary artery or one of it’s branches by a thrombus (or
thrombi) that originates somewhere in the venous system or in the right side of the heart.
A PE occurs when a substance (solid, gaseous, or liquid) enters venous circulation and
forms a blockage in the pulmonary vasculature.
- S&S: Hallmark – Sudden chest pain, Sudden onset of chest pressure, pain upon
inspiration, chest wall tenderness, dyspnea, air hunger, cough, hemoptysis, SOB, pleural
friction rub, tachycardia, hypotension, tachypnea, crackles, petechiae, JVD, cyanosis,
heart murmur in S3 & S4.
- DX: ABG value (PaCO2 levels are low (NR 35-45)), respiratory alkalosis, D-dimer
(elevated due to clot formation and release of fibrin degradation (NR <0.4mcg/mL)),
Computed Tomography scan (MDCTA) is the criteria for detecting a PE, Ventilation-
perfusion scan (shows circulation of air and blood in the lungs and can detect PE), CXR,
Pulmonary angiography (this is the gold standard when MDCTA is unavailable)
- TX: O2 therapy (to relieve hypoxemia & dyspnea), IV access, high fowler’s position,
assess respiratory status q30m, assess cardiac status, compare BP in both arms, monitor
LOC and mental status. Embolectomy (surgical removal of embolus), Vena cava filter
placement (insertion of a filter in the vena cava to prevent further emboli from reaching
the pulmonary vasculature).
- MEDS: Anticoagulants (Enoxaparin, Warfarin) Used to prevent clots from getting larger
or additional clots from forming. (Monitor PT, INR, aPTT, CBC), Direct factor Xa
inhibitor (Rivaroxaban, Apixaban, Fondaparinux) they bind to Xa factor which inhibits
the production of thrombin. Direct thrombin inhibitor (Dabigatran), Thrombolytic
therapy (Alteplase, Reteplase, Tenecteplase) Used to dissolve blood clots and restore
pulmonary blood flow.
- If taking Warfarin do not increase or decrease the amount of vitamin K foods consumed
(green leafy veggies, cantaloupe) because Vit K can reduce the anticoagulant effects of
Warfarin.
- Complications: Decreased cardiac output and hemorrhage
5. Pulmonary edema
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- An abnormal accumulation of fluid in the lung tissue, the alveolar space, or both.
- S&S: Dyspnea, rales, coughing, pink frothy or blood tinged secretions, advances to
respiratory failure.
- DX: CXR
- TX: Correct cause, O2, respiratory therapy, intubation, diuretics.
6. Pneumothorax (Air between the pleura)
- Occurs when the parietal or visceral pleura is breached and the pleural space is exposed
to positive atmospheric pressure. Normally the pressure in the pleural space is negative or
subatmospheric. The lung or a portion of it collapses. PX is the presence of air or gas in
the pleural space that causes lung collapse.
- S&S: Sudden pain, slight chest discomfort and tachypnea. If the lung completely
collapses acute respiratory distress occurs, dyspnea, anxious, air hunger, increased use of
accessory muscles, central cyanosis from severe hypoxemia, hypotension, tachycardia,
profuse diaphoresis, breath sounds diminished or absent, Percussion of hyperresonant.
- TX: The goal of tx is to evacuate the air or blood from the pleural space. A chest tube is
inserted near the 2nd intercostal space (cause its thinnest part of chest wall), For a
hemothorax a large diameter (32 F) is inserted in the 4th or 5th intercostal space at the
midaxillary line.
7. Lung cancer
- Lung cancer arises from a single transformed epithelial cell in the tracheobronchial
airways, in which the carcinogen binds to and damages the cell’s DNA.
- S&S: Usually develops insidiously and is asymptomatic until it’s in its late stages. Cough
or change in chromic cough (the cough may start as dry and persistent; when obstruction
occurs in the airways, the cough may become productive due to infection.) Dyspnea,
hemoptysis or blood – tinged sputum, chest or shoulder pain, general pain, recurring pain,
hoarseness, dysphagia, head & neck edema, and symptoms of pleural or pericardial
effusion, common sites of metastases includes the lymph nodes, bone, brain, contralateral
lung, adrenal glands and liver. Nonspecific symptoms include weakness, anorexia, and
weight loss.
- DX: CXR (pulmonary density, coin lesion), CT scan (small nodules), Fiberoptic
bronchoscopy (Used to DX lung cancer), bone scans, PET scan, liver ultrasound, CT scan
of the brain, endobronchial ultrasound biopsy of the mediastinal nodes.
- TX: Thoracotomy, Sx, radiation therapy, chemotherapy (used to alter growth tumor
patterns), immunotherapy or a combination of these. Gene therapy using agents that
target specific genetic mutations including EGFR, ALK, ROSI.
- Complications – Respiratory failure, prolonged mechanical ventilation, diminished
cardiopulmonary function, pulmonary fibrosis, pericarditis, myelitis and cor pulmonale.
advanced-adult-health-nursing-nur-4324-final-exam-blueprint
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