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NURS 536 Pulmonary exam with correct answers

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NURS 536 Pulmonary exam with correct answers

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NURS 536 Pulmonary exam with |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




correct answers |||\\\




COPD, Group B first choice pharm for stable disease - correct answer✔✔LA anticholinergic
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




(triotropium) or |||\\\ |||\\\




LA B2 agonist (salmeterol)
|||\\\ |||\\\ |||\\\




COPD, Group B second choice pharm for stable disease - correct answer✔✔LA anticholinergic
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




and LA B2 agonist |||\\\ |||\\\ |||\\\




COPD, Group B alternate choice pharm for stable disease - correct answer✔✔SA B2 agonist
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




and/or SA anticholinergic |||\\\ |||\\\




COPD, Group C first choice pharm for stable disease - correct answer✔✔ICS plus LA B2 agonist
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




(salmeterol) or
|||\\\ |||\\\ |||\\\




LA anticholinergic (tiotropium)
|||\\\ |||\\\




COPD, Group C second choice pharm for stable disease - correct answer✔✔LA anticholinergic
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




(tiotropium) and LA B2 agonist |||\\\ |||\\\ |||\\\ |||\\\




SA anticholinergic - correct answer✔✔ipratropium; bronchospasm relief
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




SA B2 agonist (SABA) - correct answer✔✔albuterol; bronchospasm relief
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




LA anticholinergic (LAMA) - correct answer✔✔tiotropium; protracted duration
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




bronchodilation, reduces risk of exacerbation |||\\\ |||\\\ |||\\\ |||\\\

,LA B2 agonist (LABA) - correct answer✔✔salmeterol; protracted duration bronchodilation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




PDE4 inhibitor - correct answer✔✔roflumilast; minimizes risk of exacerbation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Roflumilast cannot be used with - correct answer✔✔theophylline; bronchodilator
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




COPD Group C alternate choice pharm for stable disease - correct answer✔✔PDE-4 inhibitor,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




SA B2 agonist and/or SA anticholinergic, theophylline
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




COPD Group D first choice pharm, stable disease - correct answer✔✔ISC, LA B2 agonist or LA
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




anticholinergic



COPD Group D second choice pharm, stable disease - correct answer✔✔ISC & LA
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




anticholinergic, ICS plus LA B2 agonist and PD4 inhibitor, LA anticholinergic and LA B2 agonist, |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




LA anticholinergic and PDE-4
|||\\\ |||\\\ |||\\\




Causative pathogens COPD exacerbation - correct answer✔✔H. Flu, Haemophilus, Strep
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




pneumonaie, moraxella |||\\\




Abx for mild-mod COPD/bronchitis exacerbation - correct answer✔✔None or if indicated,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




amoxicillian, doxy, TMP-SMX |||\\\ |||\\\




Abx for severe COPD/bronchitis exacerbation - correct answer✔✔Amox-clav, cephalosporin
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




(cefdinir, cefpodoxime etc), Azithro, clarithromycin, Fluoroquinolone x 5-7 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




COPD diagnosis, post bronchodilator FEV1/FVC of ______ confirms the presence of persistent
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




airflow limitation. - correct answer✔✔<0.70 of predicted
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\

,Goals of COPD treatment - correct answer✔✔Symptom relief, reduce impact of symptoms &
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




exacerbations



COPD risk factors - correct answer✔✔Irritants, family history, advancing age
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




COPD diagnosis considered in patients with risk factors above age - correct answer✔✔40
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Population at highest risk of COPD exacerbation & death - correct answer✔✔COPD diagnosis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




and >= 2 exacerbations in last year, FEV1 < 50% of predicted, hospitalization for COPD in past
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




year



Diagnosis of end stage COPD - spirometry - correct answer✔✔FEV1 < 50% |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Steps of COPD diagnosis - correct answer✔✔1. Spirometry, 2. Symptom assessment, 3.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Assessment of exacerbation risk, 4. Assess comorbidities |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Gold 1 - correct answer✔✔Mild disease, FEV1 >80% predicted
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Gold 2 - correct answer✔✔Moderate disease, FEV1 50-80% predicted
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Gold 3 - correct answer✔✔Severe disease, FEV1 30- <50% predicted
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Gold 4 - correct answer✔✔Very severe disease, FEV < 30% predicted
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




COPD assessment test (CAT) scoring - correct answer✔✔Max score 40, lower is better
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




COPD exacerbation risk - correct answer✔✔2 or more in last year - high risk, 1 or more in last
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




year high risk
|||\\\ |||\\\

, Alpha-1 Antitrypsin Deficiency Screening considered - correct answer✔✔COPD in patients of
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




caucasian descent < 45 y/o or strong family history |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




What is Alpha-1 Antitrypsin - correct answer✔✔Enzyme that protects lung lining and alveoli
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




PE findings Emphysema - correct answer✔✔Increased AP diameter, hyperresonance on
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




percussion (air-trapping), normal Hct, no mucous |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




PE findings chronic bronchitis - correct answer✔✔Normal AP diameter, normal percussion,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




increased Hct, copious sputum |||\\\ |||\\\ |||\\\




Hct increased in chronic bronchitis - why? - correct answer✔✔Fluid shifted to interstitial
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




spaces make Hct appear elevated |||\\\ |||\\\ |||\\\ |||\\\




Electrolyte triad of emphysema & bronchitis - correct answer✔✔hypokalemia, hypochloremia,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




increased NaHC03 |||\\\




FVC (forced vital capacity) - correct answer✔✔Volume of gas forcefully expelled from lungs
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




after maximal inspiration over entire course of exhalation
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




FEV1 (forced expiratory volume, peak flow) - correct answer✔✔Volume of gas expelled in the
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




first second of the FV maneuver
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\




FEV1/FVC - correct answer✔✔Comparison of amount of gas expelled in the first second with
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




the total amount of gas expelled
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\




Obstructive COPD, disease states - correct answer✔✔Emphysema, bronchitis |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\

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NURS 536
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