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NSG 211 Exam 4 Questions With
Complete Solutions
Surfactant correct answer: Coats the inside layer of alveoli to reduce surface tension Visceral Pleura correct answer: Inner, medial layer Attached to lung parenchyma Parietal Pleura correct answer: Outer, lateral layer Will adhere the 2 layers for chest and lung expansion Residual Volume correct answer: Volume of air remaining in lungs after the max exhalation Vital Capacity correct answer: The maximal amount of air that can be moved in and out of lungs with breaths Can be altered by lung disease, size of thorax, amount of fluid in lungs Central (Primary Control) correct answer: Chemoreceptors in the brain stem-> —> elevated CO2, elevated H+ in the CSF Hypercapnia is a major stimulus for the healthy CNS respiratory center
Peripheral (Secondary Control) correct answer: Chemoreceptors in carotid artery and aortic body —-> decreased oxygen concentration in blood is major stimulus Oxygen levels must be low (60 torr) for activation Sinusitis correct answer: Bacterial infection secondary to a cold or allergy that obstructs sinus drainage Cause: Strep, Staph, heamophilus Influenza Signs/Sx: Nasal congestion, HA, Low grade fever Laryngotracheobronchitis (Croup) correct answer: Viral infection usually affects children 1-2 years old Cause: parinfluenza virus and adreno virus Signs/Sx: URI (cough, fever, rhinitis) Worse at night Obstruction of airway by inflammation and exudate Barking cough —-> inspiratory stridor especially when active Bronchiolitis (RSV) correct answer: Common infection in young children 2- 12 months Cause: Respiratory syncytial virus, oral droplets Fall/Winter months, Second hand smoke
Cause: Usually viruses, if progress past 10-14 days, may develop bacterial infection Signs/Sx: Nonproductive cough easily triggaered by environment changes, wheezes Influenza (Respiratory Influenza) correct answer: Viral Infection characterized by high fever (>102) and cough Signs/Sx: Sudden high fever, marked fatigue, body aches
- May cause bacterial or viral pneumonia Pneumonia correct answer: Acute infection of lungs -Classified by viral or bacterial agent
- Location: Lobar, RLL, LLL, etc. Classified by CAP and HCAP Pneumococcal Pneumonia (Lobar Pneumonia) correct answer: Cause: Streptococcus pneumoniae, infection is usually localized in one or more lobe Pathology: Inflammation and congestion of the alveolar wall—> exudates interfere with oxygen diffusion—> RBC's and WBC's to accumulate in alveolar exudate forming a solid mass -RBC's exudate will create rusty sputum Signs/Sx: Sudden onset, high fever, chills, marked fatigue, leukocytosis, dyspena, tachypena, tachycardia, pleuritic chest pain, rales, initially, productive cough , rusty sputum, confusion, disorientation
Severe Acute Respiratory Distress Syndrome (SARS) correct answer: Cause: SARS-CoV, transmitted suspected by fecal/oral ——> incubation 2-7 days First stage: Flu-like syndrome, fever, HA, myalgia, chills Second Stage: Marked dyspena, high mortality Pathology: inflammation and alveolar congestion leads to decreased oxygen perfusion, hypoxia, thrombopenia, lymphopenia, elevated C-protein, Elevated liver enzymes Middle Eastern Respiratory Syndroms (MERS) (Camel Flu) correct answer: Cause: MERS-CoV transmitted from camels Transmission: respiratory droplet —-> incubation 2-14 days Pathophysiology and treatment is similar to SARS Tuberculosis (TB) correct answer: Cause: Mycobacterium tuberculosis (acid- fast, aerobic bacteria)
- It invades primarily lung tissue, but can invade other tissues -Resistant to drying and some disinfectants
- Destroyed by UV light, heat, alcohol, glutaraldehyde, Formaldehyde
- Microbe's resistant outer cell membrane protects it from detection and elimination by body's immune system
Systemic signs: weight loss, anemia, fatigue, metastasis (bone pain/fractures) Non-Small Cell Carcinoma (NSCLC) correct answer: Comprise about 80% of all lung cancers further divided into squamous cell, adenocarcinoma, large cell significant genotyping for personalized therapy NeuroEndocrine correct answer: Includes small-cell carcinoma and large neuroendocrine carcinoma
- very aggressive Obstructive Lung Disease correct answer: Airway disease that is worse with expiration -air remains trapped in dysfunctional lung tissue -Increased exhalation phase -Higher Residual Volume
- Lower Vital capacity Signs/Sx: Increased mucus production, plugging, atelectasis, wheezing, coughing, increased risk of infections, permanent lung damage and remodeling Cystic Fibrosis correct answer: Cause: Inherited disorder, autosomal recessive Pathophysiology: A chloride ion cell transport related gene defect, causing high NaCl sweat excretion. -Defect is in the Exocrine glands causing abnormally thick secretions
-Primiarily affects the lungs and pancreas, characterized by obstructions Lung disease, but also affects pancreas and GI tract Asthma correct answer: Chronic lung disorder characterized by periodic episodes of severe, reversible bronchial obstruction in persons with hypersensitive airways. Cardinal Sign: FEV1 measurement Pathophysiology: inflammation of mucosa with edema and increased mucus production -Bronchial hyper-responsiveness
- Concraction of smooth muscle Etiology: family history of eczema, seasonal allergies, asthma. Strong genetic Component. Viral URI's Signs/Sx: Decreased peak flow and spirometry FEV 1 measurements. Hypoxia, Hypoxemia, Status Asthmaticus, Pulsus Paradoxus, Chronic Bronchitis Hypoxia correct answer: Occurs with bothe partial and total obstruction of airway. -Increased need for oxygen dur to stress response furthers hypoxia deficit
- Early tachypena causes respiratory alkalosis, later respiratory acidosis Hypoxemia correct answer: Low blood oxygen induces vasoconstriction of pulmonary vessels, reduces blood flow
Partially irreversible, progressive, and eventually leads to respiratory failure due to hypoxia, hypercapnia, for pulmonale Emphysema correct answer: Pathophysiology: Destruction of alveolar walls and septae
- leads to large, permanently inflated alveolar air sacs (bells/Bullae to increase dead space)
- increased residual volume (air trapping) -Increased AP diameter (barrel-chest)
- Increased Expiratory phase -Chronic Hypercapnia Etiology: smoking, alpha 1 antitrypsin deficiency Signs/Sx: Pink Puffer, dyspena, pursed lip breathing, secondary polycythemia, anorexia, fatigue, weight loss, clubbed fingers, flushed face Chronic Bronchitis correct answer: Pathophysiology: Significant remodeling in bronchi resulting from constant irritation Etiology: Smoking, air pollutants Bronchial Changes: mucosal inflammation and swelling, hypertrophy and hyperplasia of mucosal goblet cells, increasing secretions, thickening of bronchial walls, and loss of ciliary function
Signs/Sx: Blue Bloater, constant productive cough, thick secretions, hypoxia and cyanosis, dyspena, pulmonary hypertension, JVD, peripheral edema Aspiration correct answer: A restrictive disorder, decreased lung expansion, alveoli become inflamed, and gas diffusion is impaired Etiology: decreased LOC, NG tube feedings Complications: inflammation, bronchospasm and lost cilliary function Ateletctasis correct answer: The non-aeration collapse of part of a lung leading to decreased gas exchange and hypoxia Pathophysiology: When the alveoli become airless, they shrivel up as elastic recoil shrinks their shape -Both ventilation and perfusion are affected Etiology: Compression—> tumor—> pleural fluid/effusion Absorption—> hypoventilation from obstruction Surfactant Impairment/Higher surface tension—> ARDS—> Pulm edema Signs/Sx: Dyspena, tachycardia, tachypena, absent breath sounds Pleural Effusion correct answer: Excessive fluid in the pleural cavity
Etiology: pulmonary edema, pulmonary embolus, COPD, and ARDS Mismatch correct answer: Any pulmonary condition that leads to deoxygenated blood passing through pulmonary artery circuit and surviving into the pulmonary vein circuit Pulmonary Edema correct answer: Pathophysiology: Fluid collection in the alveoli and interstitial area of lung. It greatly reduces oxygen diffusion into the blood.
- Interferes with lung alveolar expansion -Hypoxemia can induce pulmonary vasoconstriction/shunting/pulmonary HTN Process: fluid shifts from capillaries into alveoli—> hypoxia results from interference in oxygen diffusion—> eventual atelectasis from decreased surfactant and alveolar collapse—> capillary engorgement and rupture can produce pink frothy sputum Etiology: Any inflammation in the lung (ARDS), low pulmonary hypertension, LV heart failure Sighs/Sx: Orthopena, hemoptysis Pulmonary Embolus correct answer: A blood clot or other occlusion that obstructs the pulmonary artery or branch of it. Etiology: Triad of Virchow, immobility, leg trauma, surgery or child birth, a fib, cancer, CHF
Pathophysiology: Ischemia of distal tissue results in V/Q mismatch, hypoxemia, and can lead to lung infarction Signs/Sx: Tachycardia, anxiety, chest pain ARDS correct answer: Pathophysiology: Inflammatory response, increased capillary permeability that will lead to pulmonary edema, decreased oxygen diffusion, hypoxemia Etiology: severe shock or sepsis, inhaled toxins, aspiration pneumonia, lung trauma, pulmonary emboli Signs/Sx: Accesory muscle use, crackles, rales, cyanosis, respiratory failure Dysphagia correct answer: Difficulty Swallowing Neuro deficit (CN V,VII,IX,X,XII) Muscular disorder Obstructive: Mechanical obstruction Risks: Aspiration Hiatal Hernia correct answer: Protrusion of part of the stomach through opening of diaphragm Contributing factors: shortening of esophagus, weakness of diaphragm, and increased abdominal pressure Signs/Sx: GERD, heart burn, dysphagia, mild, persistent chest pain after meals
Dumping Syndrome correct answer: Pathophysiology: Large amounts of ingested food is quickly dumped into the intestines.
- Hypoglycemia Signs/Sx: cramps, nausea, diarrhea, hypovolemia, hypoglycemia Etiology: gastric restriction Jaundice correct answer: Yellowish color of the skin and tissues that results from high levels of serum bilirubin Cholecyst correct answer: Formation of fall stones which are masses of solid material Signs/Sx: often happen by fatty meals, sudden waves of pain that often radiates back to right shoulder, NV, Jaundive Pathophysiology: Eating causes stones. To enter common bile duct Cirrhosis correct answer: Progressive destruction of liver tissue Pathophysiology: extensive diffuse fibrosis and loss of lobular organization Signs/Sx: portal hypertension and low albumin, decreased clotting factors, gynocomastica Acute Pancreatitis correct answer: Inflammation of the pancreas from auto digestion of the tissues
Etiology: premature activation of proenzyme trypsinogen into trypsin Signs/Sx: severe abdominal pain radiating to the back Chronic Inflammatory Bowel Disease (Crohn's Disease and Ulverative Colitis) correct answer: Etiology: genetic and environmental factors appear to be involved Crohn's Disease correct answer: Skip lesions- inflammation begins in intestinal submucosa and spreads in discontinuous pattern Manifestations: soft, semi-formed stools, Marlena, RLQ pain, anemia, fatigue, weight loss Adhesions or fistulas are complications Ulverative Colitis correct answer: Pathophysiology: Inflammation of the mucosa and submucosa at the base of the crypts of liberkuhn, Granular tissue is susceptible to bleeding Sites: starts in the rectum and advances superionly up colon Signs/Sx: Frequent, watery, blood containing diarrhea, abdominal cramping, tense us, rectal bleeding.
- Often requires bowel resection Appendicitis correct answer: Inflammation and infection of the appendix
