1. What is cheynes stroke respirations?

a. Periods of hyperpnea alternating with apnea

b. Deep and shallow breaths with periods of apnea (Lect Notes)
2. What is biots?
a. 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 droplets-
c. 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