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NURS 571 Final Exam 2025 Accredited Questions With Verified Answers A Graded, Exams of Nursing

Mount Carmel College of Nursing (MCCN)Nursing

NURS 571 Final Exam 2025 Accredited Questions With Verified Answers A Graded

Typology: Exams

2024/2025

Available from 01/03/2025

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NURS 571 Final Exam 2025 Accredited
Questions With Verified Answers A Graded
interstitial lung disease
Group of disorders that cause:
- Dyspnea
- Late inspiratory crackles
- Septal thickening, reticulonodular changes on XR
ILD disease process
- Begins w/injury to alveolar epithelial cells, alveolitis
- Scar tissue forms, irreversible fibrosis
- Does not affect airway proximal to respiratory bronchioles
Causes of ILD
- Sarcoidosis
- Pulm alveolar proteinosis
- Idiopathic interstitial PNAs
- Eosinophilic pulm syndromes
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Download NURS 571 Final Exam 2025 Accredited Questions With Verified Answers A Graded and more Exams Nursing in PDF only on Docsity!

NURS 571 Final Exam 2025 Accredited

Questions With Verified Answers A Graded

interstitial lung disease Group of disorders that cause:

  • Dyspnea
  • Late inspiratory crackles
  • Septal thickening, reticulonodular changes on XR ILD disease process
  • Begins w/injury to alveolar epithelial cells, alveolitis
  • Scar tissue forms, irreversible fibrosis
  • Does not affect airway proximal to respiratory bronchioles Causes of ILD
  • Sarcoidosis
  • Pulm alveolar proteinosis
  • Idiopathic interstitial PNAs
  • Eosinophilic pulm syndromes

Pulm alveolar proteinosis Phospholipids accumulate in alveoli --> leads to progressive dyspnea

  • XR showing pulm edema
  • Dx based on bronchial lavage or biopsy, plus 3 S/S of ILD Eosinophilic Pulmonary Syndromes allergic, inflammatory response - usually after expose to medication (Phenytoin, Acetaminophen), or infection w/helminths (worms) Sarcoidosis Systemic disease, inflammation in lung. Insidious onset, may have skin or cardiac involvement
  • Low WBCs, ^ ESR, ^ serum and urine Ca
  • S/S: malaise, fever, dyspnea
  • Tx: PO corticosteroids, immunosuppressants, cyclosporine Idiopathic interstitial PNAs Most common dx in pts w/ILD

Normal vol of pleural space = 5-15mL Types of pleural effusions

  • Transudative: d/t hydrostatic pressure changes, normal process (CHF, cirrhosis, hypoalbumin)
  • Exudative: d/t inflammation, abnormal process (malignancy, RA)
  • Pus (empyema)
  • Blood (hemothorax, trauma, cardiac sx)
  • Chyle (lymph, white fluid)
  • Urine (hydronephrosis) Transudative pleural effusions CHF: #1 cause
  • cirrhosis, atelectasis
  • nephrotic syndrome
  • peritoneal dialysis
  • myxedema coma
  • constrictive pericarditis Exudative pleural effusions Malignancy: #1 cause
  • PE, TB, asbestos
  • RA, lupus
  • Trauma, esophageal perforation
  • Pancreatitis, psuedocyst
  • Meigs syndrome: ascites, pleural effusion, ovarian tumor Pleural effusion S/S
  • May be asymptomatic
  • SOB, DOE, CP, cough (esp w/lying flat)
  • Dullness to percussion, diminished breath sounds
  • Egophany, pleural friction rub
  • Volume of effusion that pt can tolerate is dependent on underlying health (young vs elderly, COPD, etc.) Pulmonary hypertension
  • Constricts vessels, raises BP
  • d/t overproduction of endothelian
  • PA (pulmonary artery) pressure --> typical is 15-30/4-12, p.HTN systolic is 30+, mean pulm pressure is 20+ NY Heart Association classification of pulmonary hypertension
  1. pHTN w/o activity limitation
  • Peripheral cyanosis and/or edema in late stages: eventually will effect bloodflow on R side of heart --> cannot pump blood to lungs, then systemically Pulm HTN workup
  • Start w/echo
  • Dilated RV = cardiac compromise
  • PFTs: is it obstructive or restrictive
  • ANA: Anti-nuclear antibodies: check for autoimmune disease Pulm HTN physical exam/labs S/S: Splitting of S2 d/t increase in pulmonic intensity Peripheral edema, ascites, hepatomegaly when fluid backs up systemically
  • Polycythemia on CBC (^Hgb/Hct) especially w/hypoxemia
  • EKG: R axis deviation
  • CXR: ^size of pulm arteries Pulm HTN Tx
  • Avoid strenuous exercise
  • Treat underlying cause (HF, COPD, OSA, etc)
  • Diuretics: for edema, reduces RV workload
  • Anticoag: ^INR has ^survival in some studies

Pulm arterial HTN Tx

  • CCBs: pts who respond to vasodilators during cardiac cath should be tx w/CCB (<20% pts)
  • Endothelin receptor antagonists (Bosentan, Ambrisentan) - monitor LFTs
  • Phosphodiesterase 5 inhibitors (Sildenafil, Tadalafil) - improves exercise tolerance, do not take w/nitro products
  • Prostacyclins (Ioprost, Epoprostenol, Trprostinil) Light's criteria On exam 100% specificity for dx exudative effusion
  • Pleural fluid protein/serum protein >0.
  • Pleural fluid LDH/serum LDH >0.
  • Pleural fluid LDH more than 2/3 upper limit of normal serum LDH Pleural fluid analysis
  • ^amylase = pancreatitis, esophageal rupture, adenocarcinoma of lung, pancreatic pseudocyst
  • ^triglyceride = disruption of thoracic duct
  • LDH higher in exudative = infection, inflammation. LDH released w/tissue injury
  • Thoracentesis if symptomatic, O2 compromised
  • Consult pulm, onc, CT surg, procedure team, etc. COPD Not fully reversible, progressive. Includes:
  1. Emphysema
  • Permanent enlargement of airspaces, hyperinflation, air trapping. Lose elasticity
  • Causes dyspnea
  1. Chronic bronchitis
  • chronic prod cough for 3 months during 2 successive years
  • S/S: rhonchi, purulent sputum COPD causes #1 cause: SMOKING know this
  • age and FEV1 are most accurate predictors of mortality in COPD
  • If no hx of smoking, may have genetic Alpha 1 antitrypsin deficiency COPD Dx Know this FEV1 = Forced expiratory vol in 1 second

FVC = Forced vital capacity FEV1/FVC < 0.70 (70%), post-bronchodilator = COPD Dx Normal ratio = 0.75-0. Pink puffer vs Blue bloater Know this Pink puffer:

  • emphysema, thin, cachectic, prolonged expiration Blue bloater: chronic bronchitis, cough, DOE, hypercapnic, cyanosis, barrel chested Hyperresonance d/t extra air in lungs COPD CXR Know this
  • Flattened diaphragms d/t air trapping
  • Hyperinflated lungs (^lung vol)
  • Heart may appear smaller r/t lung hyperinflation

- OL

  • SABA: Albuterol, levalbuterol
  • LABA: Salmeterol, Formoterol
  • Relaxes smooth muscle Muscarinic antagonists: block bronchoconstriction of smooth muscles Inhaled corticosteroids
  • Fluticasone, Budesonide, Mometasone
  • Group E only!
  • Group E: LABA + LAMA + ICS + SABA PRN Risks for COPD exacerbation
  • Infection (viral or bacterial)
  • Environmental (smoke, air pollution)
  • noncompliance Indications for COPD hospital admission
  • Severe S/S: dyspnea, ^RR, hypoxia, AMS, drowsiness
  • New cyanosis or peripheral edema, at risk for DVTs
  • Hemodynamic instability: ^HR, hypotensive, hypoxic
  • Not responding to outpt tx ICU admission:
  • severe dyspnea not responding to initial tx
  • AMS, confusion, lethargy, coma
  • Hypoxemia (PaO2 <40) or acidosis (pH<7.25)
  • Need for mechanical ventilation, hemodynamically unstable Recommended vaccines for COPD/asthma and CAP pts COPD/asthma:
  • Influenza, COVID, Pneumococcal (can reduce CAP and exacerbations)
  • Tdap (pertussis), Zoster (shingles) CAP prevention:
  • Influenza, COVID, Pneumococcal Asthma S/S and triggers Chronic inflammation of airways, REVERSIBLE
  • S/S: wheezing, SOB, chest tightness, cough
  • Triggers: viral infection, allergens, tobacco smoke, exercise, stress, drugs/meds

Know this

  • CAP: Acquired outside of hospital
  • HAP: Acquired 48+hrs after hospital admission
  • VAP: Acquired 48+hrs after intubation Typical pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Staph aureus, Moraxella catarrhalis PNA risk factors and S/S
  • Comorbidities, asthma
  • Immunosuppression
  • Pts 65+
  • ETOH, smokers S/S: fever, chills, productive cough, dyspnea, pleuritic CP, weakness, lethargy, AMS CURB65 mortality predictor Know this
  • Confusion
  • Urea 20+ (BUN)
  • RR 30+
  • SBP <90, DBP <
  • Age 65+ 1 point each, score of 3-5 = 15-40% risk of death, need ICU ADMIT Risk factors for multidrug resistant PNA
  • Known or prior MRSA/Psuedomonas infection or colonization
  • Recent hospitalization or abx use (esp IV)
  • Recent PNA or empyema
  • Immunosuppression
  • MRSA only: living in nursing home or incarcerated, IVDU CAP tx in outpatient setting No comorbidities or risk factors for MDR: Amoxicillin, Doxycycline, Azithromycin, Clarithromycin Know this With comorbidities (heart, lung, liver, renal disease, DM, malignancy, ETOH use) or at risk for MDR: Monotherapy with respiratory fluoroquinolone --> Levofloxacin 750mg daily CAP tx in inpatient setting

Will need sputum cx or bronchoalveolar lavage (more invasive)

  • 2+ IV therapies for HAP and VAP. Duration dependent on pathogens and risk factors
  • If pt not responding at 72hrs, consider if you are tx the right pathogen, consider ID c/s, bronch. Expanding abx coverage.
  • Common pathogens: Streptococcus pneumoniae, Staphylococcus aureus, Psuedomonas aeruginosa Procalcitonin PCT: marker specific to bacterial infection
  • 0.15-2.0: mild to mod bacterial infection, ESRD, SIRS
  • 2+: bacterial sepsis, severe bacterial infection (PNA, meningitis, peritonitis), major burns, medullary thyroid cancer
  • <0.05: viral infections, autoimmune Tuberculosis: latent vs active
  • Latent: lives but doesn't grow in body. Doesn't make person feel sick or have S/S. Cannot be spread. MUST BE TREATED.
  • Active: pt has S/S, can spread and cause death. Must be treated. Types of stroke
  • Ischemic: blood flow blocked, 89% of strokes
  • Hemorrhagic: bleeding, 11% of strokes Epidural and subdural hemorrhages
  • Subdural more common (MVA, falls)
  • Venous bleed, slow bleed, slower to present symptoms
  • Dura mater: outermost layer that separates brain Frontal lobe
  • Broca's area: expressive aphasia
  • Responsible for motor activity, speech Parietal lobe
  • Wernicke's area: receptive aphasia
  • Sensory input: touch, shape Occipital lobe Visual processing, stroke can cause blindness on opposite side of stroke Basal ganglia