Nursing 106 Fall Final

Question 1

Where can bronchial sounds be heard and how would you describe them?

Answer 1

Heard over the trachea, loud, high pitched, harsh, hollow, tubular sound

Question 2

Where can you hear bronchial-vesicular sounds and how would you describe them?

Answer 2

Heard over the main stem bronchi (middle of the sternum), sound is moderate pitch and amplitude with mixed quality over major bronchi

Question 3

Where can you hear vesicular lung sounds and how would you describe them?

Answer 3

Heard over the lung periphery, low, soft pitched, rustling sound over peripheral lung fields

Question 4

What are fine crackles and why do they occur?

Answer 4

Heard mainly when you inhale, dry high-pitched popping or crackling due to movement of air through fluid in the airways and alveoli. Formerly known as Rales.

Question 5

What are course crackles and why do they occur?

Answer 5

Heard when you exhale, moist, low-pitched gurgling, bubbling. Due to air moving through large bronchi and trachea that are intermittently occluded with secretions.

Question 6

When do you hear a sonorous wheeze and why?

Answer 6

Heard expiratory, continuous. Low pitch, Snoring due to narrowing of large airways from secretions, spasms, tumors, or swelling.

Question 7

When do you hear a sibilant wheeze and why?

Answer 7

Heard expiratory, continuous. High pitched, musical. Due to narrowing of large and small airways.

Question 8

When do you hear pleural friction rub and why?

Answer 8

Heard late expiratory and early inspiratory, continuous. Loud grating or creaking sound. Due to inflamed pleura rubbing against each other.

Question 9

When do you hear stridor and why?

Answer 9

Heard inspiratory, continuous. Crowing, harsh honking wheeze. Due to partially obstructed upper airway.

Question 10

What symptoms in a childs breathing would suggest a problem?

Answer 10

Nasal flaring, accessory muscle use.

Question 11

What is parenchyma?

Answer 11

The essential or functional elements of an organ, as distinguished from its stroma or framework.

Question 12

There is how many ml of deadspace in the respiratory system?

Answer 12

150ml

Question 13

Define mucocillary clearance?

Answer 13

Self clearing mechanisms of the bronchii

Question 14

These four things in the respiratory tree make of the?

Answer 14

Bronchioles, alveolar ducts, alveolar sacs, alveoli

Question 15

What marks the site of tracheal bifurcation?

Answer 15

Manubrium

Question 16

What is the lowest part of the sternum called?

Answer 16

Xyphoid process

Question 17

The top of the scapula is called the?

Answer 17

Acromion process

Question 18

When tipping head forward, the top prominent spinal vertebrae is called what and where is it located?

Answer 18

Vertebral prominens and its located at C7

Question 19

The vertebral prominens is a landmark for IM of the?

Answer 19

deltoid muscle

Question 20

The vertebral prominens is also a landmark for what in the lungs?

Answer 20

Apex

Question 21

What vertebra aligns with the bottom of the lungs?

Answer 21

T10

Question 22

Thoracic reference lines on anterior chest: the line that is in middle of body_____; line that run through nipple area ______; line that runs along side of anterior body _____. On posterior chest: middle line ___; line between middle and edge ____. Lateral chest: line near front of body ____; middle of body ___; back of body ____.

Answer 22

Midsternal line; midclavicular line; anterior axillary line; vertebral line; scapular line; anterior axillary line; midaxillary line; posterior axillary line.

Question 23

The right lung is ___than the left and has ___lobes.

Answer 23

Shorter; three

Question 24

The left lung is ___than the right and has ___lobes.

Answer 24

Narrower; two

Question 25

A/P ratio should be ___as wide as ___.

Answer 25

Twice; deep

Question 26

RR in breaths per min: newborn ___; one year old__ ; 3 years old ___; 6 years old ___; 10 years old ___; 17 and older ___.

Answer 26

Newborn 30-70; 1 yr 20-40; 3 yr 20-30; 6 yr 16-22; 10 yr 16-20; 17 yr + 12-20

Question 27

___ ___ are caused by obstruction of the free inflow of air thus creating increased negative pulmonary pressure.

Answer 27

Intercostal retractions

Question 28

The ___ position allows easier use of ___ muscles when trying to improve breathing.

Answer 28

Tripod; accessory

Question 29

Name at least 5 reasons why there would be asymmetry to the thoracic cavity when breathing.

Answer 29

Mass, musculoskeletal disorders, rib fracture, pneumonia, atelectasis

Question 30

Define tachypnea?

Answer 30

> 24 bpm

Question 31

Define bradypnea

Answer 31

<10 bpm

Question 32

Define hyper and hypo ventilation

Answer 32

Increased rate & depth; decreased rate & depth

Question 33

Define Cheyne -stokes

Answer 33

Alternating deep breaths with periods of apnea

Question 34

Define Agonal breathing

Answer 34

Lasts breaths of life

Question 35

What do the colors of the following sputums indicate? Yellow/green; rust or blood tinged; black; pink - frothy

Answer 35

Bacterial infection, pneumonia, pulmonary infarction, or TB; black lung disease; pulmonary edema

Question 36

Define therapeutic and pharmacologic classifications of drugs and give examples?

Answer 36

Therapeutic is based on WHAT the drug does clinically, ex: antibiotics, anticoagulants; Pharmacologic classifications are based on HOW the drug produces its effect, ex: bacteriostatic, bactericidal.

Question 37

What is a prototype drug?

Answer 37

It serves as a model for a drug class. It is well understood and has known actions and adverse effects. Used to compare other drugs in the same pharm class.

Question 38

What are the pregnancy categories?

Answer 38

A - is no risk per studies
B - is no risk in animals and controlled studies on pregnant women no available
C - is shown evidence of risk so risk vs benefit must be determined
D - is risk proved, only used in life threatening conditions
X - is risk proven and outweighs the good, to be avoided

Question 39

What is bioavailability? How can this effect generic and trade drugs?

Answer 39

The rate and extent to which active ingredients are absorbed and available at the site of action; Can be different between generic and trade so some states don’t allow subs for generic.

Question 40

Controlled substances: what are the 3 main responsibilities when administering? Drugs must be kept under a ___lock. Refills by phone are/are no allowed.

Answer 40

Count and record # of drugs on hand, document amount of drug given, wasted portion must be witnessed and recorded; double; are NOT.

Question 41

Name the schedule categories for controlled substances, and give examples for each?

Answer 41

Schedule I - V, I being highest potential for abuse and V being least potential for abuse. Schedule I: heroin, pot; Schedule II: morphine, amphetamines; Schedule III: codeine; Schedule IV: benzodiazepines; Schedule V: opiod-controlled substances for diarrhea and cough, codeine in cough preparations.

Question 42

Define pharmacokinetics and name the 4 phases?

Answer 42

“medicine action”, the study of drug movement throughout the body and how the body deals with it; absorption, distribution, metabolism, and excretion

Question 43

Hepatic microsomal enzyme system is also known as what? What are the 2 ways it can modify drugs?

Answer 43

P-450 system; it can inactivate it or it can activate it (as it does in pro drugs)

Question 44

Define pharmocodynamics?

Answer 44

What the drug does to the body, knowing this will ensure that drug will provide a safe, effective treatment.

Question 45

Define and describe the 3 different types of multiple drug therapies?

Answer 45

Additive effect: 1 + 1=2
Synergeistic effect: 1 + 1=3
Antagonistic effect: 1+ 1 <1

Question 46

Define median effective dose?

Answer 46

ED50 is the dose needed to produce DESIRED effect in 50% of clients aka “average dose”

Question 47

Define the median lethal dose?

Answer 47

LD50 is lethal to 50% of test subjects

Question 48

What is the therapeutic index and how does it work?

Answer 48

It is the LD50 divided by ED50. Low TI reflects narrow safety margin, high TI is higher safety so the higher the value the safer the drug. So a drug with a low TI has low margins of safety and will likely have plasma levels drawn to monitor.

Question 49

What are peak and trough levels and what do the indicate?

Answer 49

Peak is the highest plasma concentration of drug and indicates the rate of absorption; the trough is the lowest plasma concentration of drug and indicates the rate of elimination.

Question 50

Define Pharmacogenomics?

Answer 50

Newer branch of study looking into genetic factors and hereditary influence since factors can alter metabolism.

Question 51

Define tachyphylaxis?

Answer 51

Acute tolerance of a drug (rapid decrease in response to drug); narcotics prime example

Question 52

Name the four types of parenteral administration?

Answer 52

Intravenous
Subcutaneous
Intradermal
Intramuscular