CNUR 203 MIDTERM EXAM PRACTICE
QUESTIONS WITH COMPLETE
SOLUTIONS
◉ Pursed lip breathing
Answer: involves deep inspiration and prolonged expiration
through pursed lips to prevent alveolar collapse, helps get rid of
CO2
◉ Tripod position
Answer: a position that may be assumed during respiratory
distress to facilitate the use of respiratory accessory muscles and
promote lung expansion
◉ Cardinal Triad of COPD
Answer: Dyspnea
Increased mucous
Cough (productive)
◉ Red Flags in COPD
Answer: Mental status change
Signs of infections
Oxygen saturation lower than 90%
Low PaO2 (hypoxemia)
,High PaCO2 (hypercapnia)
Barrel chested (due to hyperinflation of the lungs)
Clubbing (angle of the nail, flattening of the nail bed)
Check for cyanosis in the mucous membranes with someone who
has a dark skin tone
Check cap refill want it less than 2 seconds
Would hear crackles and wheezing
Would have decreased air entry in the bases of the lungs
◉ Priority Assessments COPD
Answer: 60 second assessment
ABCs/Vital signs
Respiratory
Inspection (use of accessory muscles, cyanosis, fear, shape and
configuration of the thorax, clubbing of the nails)
Palpation: tactile fremitus (could be decreased since there is no
space in the lungs and mucous build up) percussion (would hear a
dull sound due to the mucous build up, could hear hyper-
resonance due to the hyperinflation of the lungs)
Auscultation (would hear crackles and wheezes due to narrowing
of the alveoli and mucous) quality of voice sounds
Cardiovascular
Integumentary
Neurological (decreased LOC can be a sign of hypoxia and
hypercapnia)
,◉ COPD Diagnostics
Answer: Smoking history
Physical exam
Lab Values: polycythemia
ABGs
alpha1-Antitrypsin
Pulmonary function tests
Spirometry (pre and post bronchodilator)
FEV1 (forced expired volume in 1 sec)
FVC (forced vital capacity - total volume of air exhaled after a full
inspiration
Diagnosis FEV1/FVC ratio of less than 70%
Lab Values in COPD:
Pa02 will be lower than 80-100mmHg
Oxygen sat we want greater than 90%
Pa02 will be higher than 35-45 mmHg
◉ Nursing Management and Treatment COPD
Answer: ABCs
Vitals
Positioning
Improving airway clearance/breathing
Monitoring respiratory and lung sounds
, Monitor 02 status
Administration of oxygen as needed
Using medications (bronchodilators)
Monitoring caloric intake and weight
Monitor for signs of infection
Effective coughing, and spitting up the sputum
Breathing exercises
Maximizing respiratory excursion (bronchodilators)
Anticholinergics (used to decrease secretions)
With pursed lip breathing you want them exhaling three times
longer than inhaling
Use of diaphragmatic breathing
◉ COPD Complications
Answer: Cor pulmonale
Acute exacerbation
Pulmonary hypertension
Carbon dioxide necrosis
Respiratory failure/arrest
◉ Asthma
Answer: Primarily affecting the bronchioles
This typically present much younger
Highly hereditary
QUESTIONS WITH COMPLETE
SOLUTIONS
◉ Pursed lip breathing
Answer: involves deep inspiration and prolonged expiration
through pursed lips to prevent alveolar collapse, helps get rid of
CO2
◉ Tripod position
Answer: a position that may be assumed during respiratory
distress to facilitate the use of respiratory accessory muscles and
promote lung expansion
◉ Cardinal Triad of COPD
Answer: Dyspnea
Increased mucous
Cough (productive)
◉ Red Flags in COPD
Answer: Mental status change
Signs of infections
Oxygen saturation lower than 90%
Low PaO2 (hypoxemia)
,High PaCO2 (hypercapnia)
Barrel chested (due to hyperinflation of the lungs)
Clubbing (angle of the nail, flattening of the nail bed)
Check for cyanosis in the mucous membranes with someone who
has a dark skin tone
Check cap refill want it less than 2 seconds
Would hear crackles and wheezing
Would have decreased air entry in the bases of the lungs
◉ Priority Assessments COPD
Answer: 60 second assessment
ABCs/Vital signs
Respiratory
Inspection (use of accessory muscles, cyanosis, fear, shape and
configuration of the thorax, clubbing of the nails)
Palpation: tactile fremitus (could be decreased since there is no
space in the lungs and mucous build up) percussion (would hear a
dull sound due to the mucous build up, could hear hyper-
resonance due to the hyperinflation of the lungs)
Auscultation (would hear crackles and wheezes due to narrowing
of the alveoli and mucous) quality of voice sounds
Cardiovascular
Integumentary
Neurological (decreased LOC can be a sign of hypoxia and
hypercapnia)
,◉ COPD Diagnostics
Answer: Smoking history
Physical exam
Lab Values: polycythemia
ABGs
alpha1-Antitrypsin
Pulmonary function tests
Spirometry (pre and post bronchodilator)
FEV1 (forced expired volume in 1 sec)
FVC (forced vital capacity - total volume of air exhaled after a full
inspiration
Diagnosis FEV1/FVC ratio of less than 70%
Lab Values in COPD:
Pa02 will be lower than 80-100mmHg
Oxygen sat we want greater than 90%
Pa02 will be higher than 35-45 mmHg
◉ Nursing Management and Treatment COPD
Answer: ABCs
Vitals
Positioning
Improving airway clearance/breathing
Monitoring respiratory and lung sounds
, Monitor 02 status
Administration of oxygen as needed
Using medications (bronchodilators)
Monitoring caloric intake and weight
Monitor for signs of infection
Effective coughing, and spitting up the sputum
Breathing exercises
Maximizing respiratory excursion (bronchodilators)
Anticholinergics (used to decrease secretions)
With pursed lip breathing you want them exhaling three times
longer than inhaling
Use of diaphragmatic breathing
◉ COPD Complications
Answer: Cor pulmonale
Acute exacerbation
Pulmonary hypertension
Carbon dioxide necrosis
Respiratory failure/arrest
◉ Asthma
Answer: Primarily affecting the bronchioles
This typically present much younger
Highly hereditary
