Term 2 Reviews

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is cheynes stroke respirations? Periods of hyperpnea alternating with apnea Deep and shallow breaths with periods of apnea (Lect Notes) is biots? Periods of tachypnea (groups of quick shallow) inspirations followed by regular or irregular periods of apnea 3. What is Kussmauls respiration? a. Dyspnea (difficulty beathing), with hyperpnea (increased rate and depth), gasping breaths (air hunger, panting, labored) >20/min 4. What’s the whole point in that? a. Hunger for O2 because there’s a high level of CO2- acidosis 5. Who would most likely do it? a. Kussmauls is a characteristic of diabetic acidosis or other conditions causing acidosis 6. When do u collect sputum specimen? a. In the morning before breakfast 7. If you are explaining the night before, how would you explain the procedure and what would you have the pt to do the night before? a. Push fluids the night before b. Don’t brush teeth in the morning. Just rinse out mouth with water c. Take a warm shower to humidify the lungs d. Instruct the pt to take several deep breaths and then cough deeply to obtain sputum from the lower portion of the lungs e. Always collect sterile sputum before starting antibiotics 8. What is a Mantoux test? a. The most reliable determinant of infection with TB b. PPD (purified Protein Derivative) tuberculin test c. Diagnostic for Tuberculosis d. Cannot differentiate between active versus dormant disease e. Given 0,1 ml Iintrdermal (ID) and checked after 48 – 72 hrs f. Positive PPD i. > 10 mm induration (elevated) ii.>5 mm in HIV infection or in immunocompromised person g. A positive TB does not mean that the active disease is present but indicates exposure to TB of the presence of inactive (dormant) disease h. Once an individual’s skin test is positive, a chest x-ray is necessary to rule out active TB or to detect old, healed lesions i. After the infected individual has received TB medication for 2 -3 weeks, the risk of transimission is greatly reduced 9. What is PPD? a. Purified protein derivative 10.What type of syringe do you use? a. TB 11.Whats the usual dose? a. 0.1 ml 12.angle of injection?

a. 10-15 ° 13.Bevel up or bevel down? a. Bevel up 14.When do you read it? a. 48 – 72 hrs 15.How would you know that it was positive? a. 10 ml or more of induration 16.Your pt has 15 ml of induration (elevation), what does that indicate? a. Already had exposure to TB b. A positive PPD cannot differentiate between active disease and dormant infection 17.What are the greatest risk factors for any respiratory condition? a. Smoking 18.4.57 What are the clinical signs and symptoms for TB? a. May be asymptomatic in primary infection b. Fatigue c. Lethargy d. Anorexia e. Weight loss f. Low-grade fever especially in the afternoon g. Chills h. Night sweats i. Persistent cough and the production of mucoid and mucopurulent sputum, which is occasionally streaked with blood 19.What is pharyngitis? a. Sore throat b. Most common throat inflammation and frequently accompanies a cold c. Untreated may lead to valvular heart disease if it is strep throat d. S/S i. Sore throat and tonsils ii.Enlarged glands iii.Dry cough e. Tx i. No specific treatment if it is viral ii.Antibiotics if bacterial 1. PCN and Erythromycin iii.May have throat culture which shows strep 20.Why is it important to identifiy what sort of bacteria is causing the sore throat? a. Could be strep throat which could lead to heart disease 21.How would you get a culture? a. Swab b. Without touching….. tongue, teeth, …………………

22.Tonsillectomy- look for signs of what? a. Swallowing b. Monitor for post op bleeding such as frequent swallowing

c. Primary intervention- Hemostatis (is the arrest of bleeding) is of utmost importance d. Notify the physician if bleeding, a persistant earache, or fever occurs 23.What do you do to promote comfort? a. Ice 24.What sorts of foods and fluids? a. Ice cold liquids no straws- using a straw can cause a vacuum in mouth and cause scabs to come off b. No acidic drinks (OJ) apple juice is fine c. Provide clear, cool noncitrus and noncarbonated fluids d. No red or purple drinks (cranberry & grape) e. Avoid milk products initially because they will coat the throat 25.When would you tell the pts to start monitoring for swallowing? a. 7 – 10 days when the scabs start falling off because they could be bleeding again 26.How would you position that pt – 5yrs old that’s just had their tonsils removed? a. Position side lying or prone (face down) to facilitate drainage b. Have suction equipment ready, but do not suction unless there is an airway obstruction 27.What would you do if you notice the child was having an increased amount of swallowing? a. Notify the surgeon 28.Broncoscopy? a. Lighted endioscope is passed through the mouth- pharynx – trachea - bronchi 29.what would you need before the surgery? a. Informed consent before any invasive procedure b. NPO 6 -8 hrs prior c. Mouth care prior d. Remove dentures, note any loose teeth e. Explain procedure f. Throat anesthetized 30.What are they gonna do to the back of the throat? a. Numb it 31.What do you want to monitor after the surgery? a. Gag reflex b. NPO until gag reflex returns c. Assess stridor and dyspnea d. Assess for dysphagia e. Assess for hemoptysis (coughing up blood) f. Aspiration precautions- position in semi-fowlers and side lying 32.What would be normal? a. Pink tinged sputum and… 33.Monitor VS? a. Yes 34.Are they going to be NPO? a. Yes until gag reflex returns 35.Your pt has pneumonia with thick tenacious sputum, what kind of NANDAs would apply to that?

a. Impaired gas exchange b. Ineffective airway clearance c. Impaired breathing pattern 36.Your at a baseball game, one of the kids get hit in the face with a baseball, and has epistaxis, how do you position that kid? a. Sitting down, leaning forward and ice b. Apply pressure to the nose for 10 o 15 minutes 37.For how long ? a. 10 – 15 min 38.What is anaphylaxis? a. an allergic reaction - Life threatening emergency 39.what would you expext to see in an anaphylaxis? a. Tachycardia b. Hypertension c. Tachypnea d. Wheezing 40.What is sleep apnea? a. Airway gets occluded causing them to wake up b. Partial or complete upper airway obstruction during slep c. Causes apnea and hypopnea (episodes of overly shallow breathing or an abnormally low respiratory rate) d. S/S i. Frequent awakening, insomnia, excessive daytime sleeping, apnea, snoring 41.What are factors for laryngeal cancer? a. Smoking b. And excessive abuse of vocal cords- singers- opera c. Primarily men >60 d. Alcohol e. Chronic laryngitis 42.What are the treatments for laryngeal cancer? a. Laryngectomy b. Or radical neck resection with tracheostomy 43.What do you have to do before anyone of those procedures? a. Informed consent b. And establish a means of communication 44.General concept- what do we monitor on any surgery post-op? a. ABCs i. Airway ii.Breathing iii.Circulation – bleeding 45.You go into a room of a pt who has a tracheostomy what would be the best evidence that it needs to be suctioned? a. If it’s gurgling 46.You’re going to suction the tracheostomy, explain the procedure? a. Give them O2 b. Wet catheter before insertion

c. Insert it in till you feel resistance and the pt is coughing 47.What would be the best evidence that the pt is tolerating the suctioning? a. Ability to cough b. Color- and not turning blue or red 48.Your pt has the common cold, based on your assessment, how would you know that the pt was developing complications? a. Fever b. Signs of infections c. Chills d. Productive cough e. Muscle pain f. Headache g. Photophobia h. Burning eyes i. Nasal disharge 49.Chest tubes, why do they put a chest tube in? a. To remove air and fluid b. Chest tubes are placed in the chest cavity and are attached to suction to restore the negative pressure within the chest necessary for reinflation of lungs c. Suction – closed water seal drainage 50.The chest tube consist of 3 parts, what are they? a. Suction b. Drainage c. Water- seal 51.What would you expect to see in the suction chamber? a. Constant bubbling 52.What would you expect to see in the water seal? a. Fluctuation of water b. And intermittent bubbling, it only bubbles when they take a breathe 53.If you are assessing the water seal chamber and you see no bubbling and no fluctuations, what do you check for? a. If the tube is kinked b. Or if the pt is laying on it c. And have the pt take a deep breath and cough because the tube might be up against the wall of the lung 54.You are assessing the water seal and you see constant bubbling, what do you check for? a. Check for an air leak, cuz air is coming in 55.The pt gets out of bed and falls and breaks the pleur-evac, what do you do? a. Put the end in water to make a water seal, which prevents air from backing up into the chest 56.The pt gets out of bed and forgets they are hooked and pulls it right out, what do you do? a. Apply Vaseline gauze to form occlusive seal

57.Which respiratory disorder is characterized by an increase in AP (anteroposterior) lateral diameter? a. Emphysema 1:1 (barrel chest)????????????????????????? 58.What is the common term for peripheral tissue hypoxia/anoxia? a. Clubbing of fingers 59.Pt has COPD, complaining of shortness of breath and you are going to start O2, how much do you give the pt? a. 2– 3 L max 60.Why won’t you give them 5 L? a. Because too much oxygen could stop the respiratory drive 61.How do you position any pt with dyspnea? a. High fowlers – to drop diaphragm and increase thoracic cavity 62.What nursing assessment- characteristic would be most indicative of asthma? a. Expiratory Wheezing b. Because they can get it in but they can’t get it out- chest will show hyperinflation 63.What test do they do for a pt with asthma? a. PFT – pulmonary function test (peak flow) b. ABGs c. Chest x-ray will show hyperinflation 64.Which test would you tell that the pt with asthma is getting better? a. PEFM – peak expiratory flow meters- because now the pt can blow more air out of the lungs 65.What kind of things cause asthma? a. Physical and chemical irritants b. Pollens c. Dust mites d. Cockroaches e. Respiratory infection f. Animal dander g. Change in climate h. Exercise and stress 66.How do u differentiate in an assessment a regular pneumotherax from a tension pneumotherax? a. pneumotherax i. collection of air in the pleural space causing lung collapse b. tension pneumotherax i. Tracheal deviation ii.As the trachea deviates there is compression on the heart- causes a decrease in cardiac output(and poor cardiac refill)- decrease in BP → diminished pulses and JVD → cap refill will be prolonged iii.Collapsed lung with asymmetrical chest expansion 67.A child with cystic fibrosis that has developed bronchiectasis and you are to provide chest physiotherapy with postural drainage, how would you do that? 68.How do you position the pt? a. Reverse trendelenburg on their side b. Do one lobe, let it drain, then do the other side

69.When would you do it? a. 2 hrs before or after meals 70.Signs and symptoms of a pulmonary emboli? a. Chest pain b. Dyspnea accompanied by angina and pleuritic pain exacerbated by inspiration c. Hypotension d. Shallow respirations e. Wheezes on auscultation f. Cough g. Blood tinged sputum h. Distended neck veins i. Cyanosis j. Shortness of breathe k. Restlessness l. VS- tachycardia, tachypnea 71.Pneumonia- what signs and symptoms would a pt have if they had bacterial pneumonia? a. Productive cough b. Chills, fever, chest pain, tachypnea, tachycardia, dyspnea, will not have hemoptesis 72.Whats hemoptesis? a. expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs 73.What is a normal SaO2? a. >95% 74.Whats the normal pH of blood? a. 7.35 – 7.45 75.Whats the normal CO2 in blood? a. 35 – 45 76.Whats the normal O2 in blood? a. 80 – 100 77.If you were to look at those 3 thing- which one would give the best evidence that the pt’s hypoxemia (decreased partial pressure of oxygen in blood), has resolved? a. PaO2 78.If the hypoxemia is corrected what else would you expect to see? a. Normal respiration, skin color is pink, lung sounds are clear 79.What is SARS? a. Severe acute respiratory syndrome b. Serious acute respiratory infection spread by dropletsc. Precautions - isolate 80.Acute respiratory failure, what would you expect to see? a. Decreased respiratory rate because the pts lungs are failing- bradypnea b. s/s – altered respirations, hypoxemia, adventitious lung sounds, altered mentation, restlessness- hypoxia-confusion, cardiac dysrhythmias, tachycardia, elevated BP 81.If pts respirations are decreasing are they bringing in enough O2 and getting rid of enough OC2?

a. No 82.So what would happen to the O2 level? a. Decrease- hypoxemia 83.Increase in CO2 is called? a. Hypercapnia 84.What is the cause of atelectasis? (partial collapse of the lung tissue )????????????????? a. Local airway obstruction 85.What happens when atelectasis is not resolved? a. Pneumonia 86.What is the LPNs role in the care of a pt with a chest tube? a. Monitor and report the drainage 87.Why is O2 so dangerous? a. Combustible, it supports fire 88.What kinds of things would lead to an inaccurate reading of a pulse ox? a. Nail polish, cold (hypothermia) fingers 89.Pulmonary edema, common symptom? a. Pink frothy (foamy) sputum 90.What kind of treatments? (38:19) a. Lasix, Fluid Restriction, High Fowler’s Position, O2 91.What’s the most common cause of pulmonary edema? a. Heart Failure (Left Side) 92.What is the #1 cause of chronic bronchitis? a. Smoking 93.Your patient is going to have a Thoracentesis. How are you going to position the patient? a. Orthopneic 94.What lab tests would you monitor on a patient who has been exposed to Carbon Monoxide? a. Serum Carboxyhemoglobin 95.You are working in the ER. What kind of assessment data might indicate to you that your patient has a Pneumothorax (air in the lungs that cause it to collapse)? a. Decreased Breath Sounds on one side b. Chest Asymmetry c. Tracheal Deviation 96.What do crackles/rales sound like? a. Fine hair rubbing against each other 97.What are some risk factors for the development of pulmonary emboli? a. Estrogen therapy b. Fracture c. Smoking d. Lack of Exercise (Sedentary Lifestyle) 98.What is the earliest sign of hypoxia? a. Restlessness

99.Your patient has ordered her oxygen. You check the Pulse Ox and it is 90. What other labs would give you information about the patient’s oxygen status so that you can determine how much oxygen to give the patient? a. ABGs b. Hemoglobin (because it carries the oxygen) 100.How is TB spread? a. Droplets 101.A patient has a thoracentesis. What kinds things would be of concern to you after the procedure? a. Dyspnea b. Bleeding c. Hypotension d. Infection e. Fever f. Pain (normal occurrence) 102.Who is at risk for TB? a. Lowered Immunity b. Close contact with someone with infectious TB c. Country of Origin d. Age e. Substance Abuse f. Malnutrition g. Living or working in a residential care facility h. International travel 103.Patient is on Aspirin therapy. What would you assess for if the patient is having an adverse reaction? a. Abdominal pain b. Melena stool 104.If your patient is complaining of abdominal pain because of aspirin therapy, what kinds of questions would you ask the patient? a. “Did you take the aspirin with food?” 105.What’s a normal salicylate level? a. 100-300 mcg 106.What kind of a drug is Colchicine? a. For Acute Gout b. (Allopurinol for prophylactic treatment of Gout) 107.What kind of drug is Rifampin? a. Anti-Tubercular drug b. Causes tears, sweat, urine to be orange colored 108.What is the most characteristic adverse reaction of Isoniazid? a. Peripheral Neuropathy b. (prevented with pyridoxine B6) 109.What kind of a drug is Percocet? a. Narcotic b. No alcohol, no driving, no playing with sharp objects, no walking on ledges

110.Who should you NOT give Narcan to? a. A Drug Addict 111.What is the best way to prevent drug resistance in a patient who has TB? a. Give them multiple drugs 112.What is the antidote for Tylenol? a. Mucomyst 113.What labs would you monitor on a patient who takes high doses of Tylenol? a. Liver Function tests: AST, ALT b. Tylenol is very very Hepatotoxic 114.Epinephrine: What is it used for? a. Bronchoconstriction, like in anaphylaxis b. Administered via SubQ injection (TB syringe/needle) c. Usual strength of solution: 1:1000 d. Position patient High Fowler’s after injecting Epinephrine e. Side effects: Headache, Tachycardia f. You know it’s working when breathing has improved (no wheezing) 115.What kind of a drug is Albuterol? a. Beta-Adrenergic Agonist b. Side effects: Tachycardia, Insomnia, Restlessness, Jittery, Tremors 116.How do you teach patient to use an MDI (Metered Dose Inhaler)? a. Shake it b. Take the cap off c. Press down on the canister d. Take a deep breath, hold for 10 seconds, then exhale 117.How do you know when you need to get a new MDI? How do you know when it’s almost done? a. See how it floats in the water 118.How do you know the Albuterol has taken effect? a. Breathing is better 119.What kind of lung sounds do asthmatics have? a. Wheezing 120.Gold Compounds??????????? a. Metallic Taste 121.Methotrexate is used for RA. It is autoimmune monitored for pancytopenia (decrease in RBCs, WBCs, platelets). a. Decrease in RBCs= Anemia. Look for Shortness of Breath, Fatigue, Pallor. b. Decrease in WBCs= Leukopenia. Look for signs of Infection: Fever, Chills, SoreThroat, Earache c. Decrease in PLTs= Thrombocytopenia. Look for Petechiae, Purpura, Ecchymosis i. Epistaxis=Nosebleed ii.Hemoptysis=Coughing up blood iii.Hematemesis=Vomiting of blood iv.Hematochezia=Blood in stool (due to bleeding in colon) 122.What would you expect to see doing a post-administration assessment on a patient taking muscle relaxants? a. Drowsiness and Sedation

123.It doesn’t matter if it’s Colchicine, Allopurinol, or Probenecid; How would you administer any Gout medication? a. With lots and lots of water to help flush out the Uric Acid 124.Patient has just been given a RX of Fosamax (Alendronate) 70mg. How would you instruct the patient to take the medication? a. Once a week, Early in the morning, remain in upright position for one hour 125.How often is Boniva taken? a. Once a month 126.Why would aspirin be given to someone with an inflammatory disorder? a. Because it’s an anti-inflammatory?? 127.What medication would you give a 6-year old with a temperature of 101°F? a. Tylenol 128.Difference between a Centrally-Acting Antitussive and a Peripherally-Acting Antitussive? a. Centrally-Acting Antitussives: i. Codeine and Dextromophan ii.Causes dependence b. Peripherally-Acting Antitussives: i. ???? 129.What kind of a drug is streptomycin? a. Aminoglycoside b. Adverse reactions: Ototoxicity (Tinnitus), Nephrotoxicity c. Assess BUN/Creatinine and Urinary Output for Reduced Kidney Function i. Look specifically for Oliguria 130.Do you give Xyloprim (Allopurinol) with or without food? a. WITH Food b. Side effects: Rash, Nausea, Vomiting, Diarrhea 131.What kind of a drug is Flexeril (Cyclobenzaprine HCl)? a. Muscle Relaxant b. Other Muscle Relaxants: Baclofen, Robaxin, Soma 132.Why would you take a Muscle Relaxant? a. To relieve Muscle Spasms 133.What kind of drug is Ethambutol? a. Antibiotic used for TB b. Most common side effect: Colorblindness, Optic Neuritis, Decrease in Color Vision 134.Steroids; Prednisone Therapy: Suppresses the immune system, …infection, …GI Bleed, can cause osteoporosis, etc. Should you ever stop the Drug Immediately? What can happen? a. No. Rebound can take place 135.Would you give Prednisone with Aspirin or an NSAID? a. No. They all cause GI Bleed 136.What kind of drug is Methadone? a. Narcotic used for Heroin Addiction 137.What would you have to assess for before giving Dilaudid (a narcotic)? a. Pain Level, Respiratory

138.What is Theophylline? a. It is a ….? Derivative. It is a Bronchodilator. b. Bradycardia or Tachycardia? c. Bradypnea or Tachypnea? d. Restlessness or Sedation? RESTLESSNESS e. Slowness of movement or Tremors? TREMORS f. Would the BP go up and complain of a Headache? YES 139.What’s the Normal Theophylline Level? a. 10-20 b. If the level is 28, what would you expect the patient to do? ??? 140.How long does someone have to take TB drugs? a. 6 months 141.What kind of drug is Benemid (probenecid)? a. Anti Gout medication b. Monitor Uric Acid Levels