NUR 4526 MIDTERM EXAM LATEST 2024 ACTUAL
EXAM 160 QUESTIONS AND CORRECT
VERIFIED ANSWERS) |ALREADY GRADED A+
What care is required for patients who require ventilatory support? - ANSWER-- HOB @ min 30
degrees and reposition on either side q1-2h
- Tube feedings
- ROM
- Communication methods
- Cardiopulmonary assessment (I/O, VS, ETCO2, head-to-toe)
What are the common finding that can be found with Ventilation Acquired Pneumonia? - ANSWER--
Pneumonia 48-72 h post-ET intubation
- sputum culture (gram - bacteria; pseudomonas or S.aureus)
- Elevated WBC
- Fever
- Purulent odorous sputum
- crackles
- Pulmonary infiltrates (pus, blood or protein that lingers w/in the parenchyma)
What nursing care can be enacted to prevent VAP? - ANSWER-- Elevate HOB to 45
- Hand hygiene
- Oral care and decontam. with Chlorhexidine
- Readiness to intubate exams q24h
- ET tube with subglottic secretion drainage
- Ensure cuff is inflated
What are the screening assessments for CHD and What are findings that could possibly indicate CHD? -
ANSWER-Pre- and Post-ductal O2 Saturation:
,- right hand (pre-ductal) and either foot (post-ductal) SatO2 are measured; differences of >3-5% b/t pre
and post could indicate CHD
Four-Limb BP:
- Systolic BP difference >10 mmHg b/t upper and lower extremities
- Bounding pulses in arms and reduced pulses in legs
- Low BP in legs compared to arms (sign of CHD); should be the reverse
What are the different classifications and subclassifications of CHD? - ANSWER-Acyanotic:
- Increased Pulmonary Blood flow (Connection b/t the two sides of the heart; ex. left to right shunting,
PDA, VSD, ASD)
- Obstructed Blood flow (ex. CoA)
Cyanotic:
- Decreased Pulmonary Blood Flow (abnormal connection b/t the two sides of the heart; ex. ToF, right to
left shunting)
- Mixed Blood Flow (abnormal heart chamber connections -> opposite flow pattern; ex. hypoplastic
heart syndrome)
What is the difference between murmurs and thrills? - ANSWER-- Murmurs: heart sounds that reflect
flow of blood within the heart (systolic, diastolic or both; during stress or reflect anomalies)
- Thrills: a soft vibration over the heart that reflects the transmitted sound of a heart murmur
What is ASD? What does it cause? Clinical S/S and Treatment? - ANSWER-Atrial Septal Defect:
abnormal opening b/t the atria allowing higher-pressure blood from the left atrium to flow to lower-
pressure right atrium
- Causes increased oxygenated blood to the right side of the heart; stretching such and increasing blood
to the lungs (could lead to Pulmonary HTN)
- S/S: Murmur, Dysrhythmias, Emboli
- Treatment: self-resolves or surgery (patch or occluder; anti-platelets for 6 months post-op)
,What is VSD? What does it cause? Clinical S/S and Treatment? - ANSWER-Ventricular Septal Defect:
abnormal opening b/t the ventricles
- Causes left to right shunting (increasing blood to lungs -> increased pulmonary vascular resistance and
Rt-sided hypertrophy)
- S/S: Murmur, Grunting with feeding, Increased resp efforts
- Treatment: Self-resolves or Surgery (anti-platelets and prophylactic Ax.)
What is PDA? What does it cause? S/S and Treatment? - ANSWER-Patent Ductus Arteriosus: allowing
blood to move from high-pressure aorta -> lower pressure pulmonary artery (Left-to-Right shunting)
- Causes increased blood flow to the lungs
- S/S: Small PDA (asymp.), Large PDA (tachypnea, poor growth, tire easily), loud murmur, Pulmonary HTN
- Treatment: Drugs (indomethacin or prostaglandin inhibitor; shrink it), catheterization (to tye of DA; for
babies not big enough for surgery), surgery (patch)
What is CoA? What does it cause? S/S and Treatment? - ANSWER-Coarctation of the Aorta: localized
narrowing of the descending aorta
- Causes increased pressure proximal to the defect (for upper extremities and head) and decreased
pressure distal to the obstruction (body and lower extremities)
- S/S: HTN and bounding pulses (upper extremities), weak or absent femoral pulses, fatigue, cool lower
extremities, shock
- Risk for ruptured aorta, aneurysm, stroke
- Treatment: Surgery, Ballon angioplasty, stents (if pt. is as stable)
What defects are included in Tetralogy of Fallot? Explain Each. What do these defects cause? -
ANSWER-
1. Ventricular Septal Defect (hole b/t vents)
2. Pulmonic stenosis (narrow pulmonic valve; d/t enlarged valve muscle)
3. Overriding aorta (aorta is misaligned; it sits near the hole b/t the ventricles) 4. Right ventricular
hypertrophy (compensatory mechanism)
, - Causes Right to Left shunting -> decreased blood flow to the lungs (can cause hypercyanotic spells)->
reduced O2 to the heart
What are hypercyanotic spells and the necassary interventions? - ANSWER-turns blue and stats at
50%
EXAM 160 QUESTIONS AND CORRECT
VERIFIED ANSWERS) |ALREADY GRADED A+
What care is required for patients who require ventilatory support? - ANSWER-- HOB @ min 30
degrees and reposition on either side q1-2h
- Tube feedings
- ROM
- Communication methods
- Cardiopulmonary assessment (I/O, VS, ETCO2, head-to-toe)
What are the common finding that can be found with Ventilation Acquired Pneumonia? - ANSWER--
Pneumonia 48-72 h post-ET intubation
- sputum culture (gram - bacteria; pseudomonas or S.aureus)
- Elevated WBC
- Fever
- Purulent odorous sputum
- crackles
- Pulmonary infiltrates (pus, blood or protein that lingers w/in the parenchyma)
What nursing care can be enacted to prevent VAP? - ANSWER-- Elevate HOB to 45
- Hand hygiene
- Oral care and decontam. with Chlorhexidine
- Readiness to intubate exams q24h
- ET tube with subglottic secretion drainage
- Ensure cuff is inflated
What are the screening assessments for CHD and What are findings that could possibly indicate CHD? -
ANSWER-Pre- and Post-ductal O2 Saturation:
,- right hand (pre-ductal) and either foot (post-ductal) SatO2 are measured; differences of >3-5% b/t pre
and post could indicate CHD
Four-Limb BP:
- Systolic BP difference >10 mmHg b/t upper and lower extremities
- Bounding pulses in arms and reduced pulses in legs
- Low BP in legs compared to arms (sign of CHD); should be the reverse
What are the different classifications and subclassifications of CHD? - ANSWER-Acyanotic:
- Increased Pulmonary Blood flow (Connection b/t the two sides of the heart; ex. left to right shunting,
PDA, VSD, ASD)
- Obstructed Blood flow (ex. CoA)
Cyanotic:
- Decreased Pulmonary Blood Flow (abnormal connection b/t the two sides of the heart; ex. ToF, right to
left shunting)
- Mixed Blood Flow (abnormal heart chamber connections -> opposite flow pattern; ex. hypoplastic
heart syndrome)
What is the difference between murmurs and thrills? - ANSWER-- Murmurs: heart sounds that reflect
flow of blood within the heart (systolic, diastolic or both; during stress or reflect anomalies)
- Thrills: a soft vibration over the heart that reflects the transmitted sound of a heart murmur
What is ASD? What does it cause? Clinical S/S and Treatment? - ANSWER-Atrial Septal Defect:
abnormal opening b/t the atria allowing higher-pressure blood from the left atrium to flow to lower-
pressure right atrium
- Causes increased oxygenated blood to the right side of the heart; stretching such and increasing blood
to the lungs (could lead to Pulmonary HTN)
- S/S: Murmur, Dysrhythmias, Emboli
- Treatment: self-resolves or surgery (patch or occluder; anti-platelets for 6 months post-op)
,What is VSD? What does it cause? Clinical S/S and Treatment? - ANSWER-Ventricular Septal Defect:
abnormal opening b/t the ventricles
- Causes left to right shunting (increasing blood to lungs -> increased pulmonary vascular resistance and
Rt-sided hypertrophy)
- S/S: Murmur, Grunting with feeding, Increased resp efforts
- Treatment: Self-resolves or Surgery (anti-platelets and prophylactic Ax.)
What is PDA? What does it cause? S/S and Treatment? - ANSWER-Patent Ductus Arteriosus: allowing
blood to move from high-pressure aorta -> lower pressure pulmonary artery (Left-to-Right shunting)
- Causes increased blood flow to the lungs
- S/S: Small PDA (asymp.), Large PDA (tachypnea, poor growth, tire easily), loud murmur, Pulmonary HTN
- Treatment: Drugs (indomethacin or prostaglandin inhibitor; shrink it), catheterization (to tye of DA; for
babies not big enough for surgery), surgery (patch)
What is CoA? What does it cause? S/S and Treatment? - ANSWER-Coarctation of the Aorta: localized
narrowing of the descending aorta
- Causes increased pressure proximal to the defect (for upper extremities and head) and decreased
pressure distal to the obstruction (body and lower extremities)
- S/S: HTN and bounding pulses (upper extremities), weak or absent femoral pulses, fatigue, cool lower
extremities, shock
- Risk for ruptured aorta, aneurysm, stroke
- Treatment: Surgery, Ballon angioplasty, stents (if pt. is as stable)
What defects are included in Tetralogy of Fallot? Explain Each. What do these defects cause? -
ANSWER-
1. Ventricular Septal Defect (hole b/t vents)
2. Pulmonic stenosis (narrow pulmonic valve; d/t enlarged valve muscle)
3. Overriding aorta (aorta is misaligned; it sits near the hole b/t the ventricles) 4. Right ventricular
hypertrophy (compensatory mechanism)
, - Causes Right to Left shunting -> decreased blood flow to the lungs (can cause hypercyanotic spells)->
reduced O2 to the heart
What are hypercyanotic spells and the necassary interventions? - ANSWER-turns blue and stats at
50%
