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Text Mode – Text version of the exam 1. In relation to the structure of the larynx, the cricoid cartilage is 2. Which respiratory volume is the maximum volume of air that can be inhaled after maximal expiration? 3. The individual who demonstrates displacement of the sternum is described as having a 4. When the nurse auscultates chest sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together, she records her finding as 5. Which of the following terms is used to describe hemorrhage from the nose? 6. The herpes simplex virus (HSV-1), which produces a cold sore (fever blister), has an incubation period of 7. Another term for clergyman’s sore throat is 8. Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion? 9. When the patient who has undergone laryngectomy suffers wound breakdown, the nurse monitors him very carefully because he is identified as being at high risk for 10. Which of the following terms refers to lung tissue that has become more solid in nature due to a collapse of alveoli or infectious process? 11. Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall? 12. When interpreting the results of a Mantoux test, the nurse explains to the patient that a reaction occurs when the intradermal injection site shows 13. Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? 14. Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally? 15. Which of the following methods is the best method for determining nasogastric tube placement in the stomach? 16. Which of the following types of lung cancer is the most prevalent carcinoma of the lung for both men and women? 17. Emphysema is described as: 18. Which of the following is the most important risk factor for development of Chronic Obstructive Pulmonary Disease? 19. Which type of chest configuration is typical of the patient with COPD? 20. In which stage of COPD is the forced expiratory volume (FEV1) < 30%? 21. Of the following oxygen administration devices, which has the advantage of providing high oxygen concentration? 22. Which of the following ranges identifies the amount of pressure within the endotracheal tube cuff that is believed to prevent both injury and aspiration? 23. When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods? 24. In general, chest drainage tubes are not used for the patient undergoing 25. Which term is used to describe the ability of the heart to initiate an electrical impulse? 26. The nurse auscultates the apex beat at which of the following anatomical locations? 27. Which of the following terms describes the amount of blood ejected per heartbeat? 28. When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the normal adult, the pressures 29. Central venous pressure is measured in which of the following heart chambers? 30. Which of the following ECG characteristics is usually seen when a patient’s serum potassium level is low? 31. Which of the following ECG waveforms characterizes conduction of an electrical impulse through the left ventricle? 32. When the nurse observes that the patient’s heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating 33. Which of the following terms is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? 34. When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? 35. Premature ventricular contractions are considered precursors of ventricular tachycardia when they 36. When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block? 37. Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication? 38. Of the following risk factors, which is considered modifiable? 39. When the patient with known angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing 40. Heparin therapy is usually considered therapeutic when the patient’s activated partial thromboplasin time (aPTT) is how many times normal? 41. When the post-cardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient’s serum electrolytes anticipating which abnormality? 42. In order to be effective, Percutaneous Transluminal Coronary Angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction? 43. Which of the following statements reflect a goal of rehabilitation for the patient with an MI: 44. Which of the following methods to induce hemostasis after sheath removal post Percutaneous Transluminal Coronary Angioplasty is the least effective? 45. A long-term effect of which of the following procedures post acute MI induces angioneogenesis? 46. Which of the following medications are used to reverse the effects of heparin? 47. Which of the following terms refers to leg pain that is brought on walking and caused by arterial insufficiency? 48. When the post-cardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which of the following electrolyte imbalances? 49. When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 ml/hr) with high specific gravity (> 1.025), the nurse suspects: 50. When the valve used in valve replacement surgery is made from the patient’s own heart valve, which of the following terms is used?Practice Mode
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The cricoid cartilage is located below the thyroid cartilage.
The arytenoid cartilages are used in vocal cord movement with the thyroid cartilage.
The thyroid cartilage is the largest of the cartilage structures; part of it forms the Adam’s apple.
The epiglottis is the valve flap of cartilage that covers the opening to the larynx during swallowing.
Inspiratory reserve volume is normally 3000 mL.
Tidal volume is the volume of air inhaled and exhaled with each breath.
Expiratory reserve volume is the maximum volume of air that can be exhaled forcibly after a normal exhalation.
Residual volume is the volume of air remaining in the lungs after a maximum exhalation.
Pigeon chest may occur with rickets, Marfan’s syndrome, or severe kyphoscoliosis.
A barrel chest is seen in patients with emphysema as a result of over-inflation of the lungs.
A funnel chest occurs when there is a depression in the lower portion of the sternum.
Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine.
A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid.
Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration.
Sonorous wheezes are deep, low-pitched rumbling sounds heard primarily during expiration.
Sibilant wheezes are continuous, musical, high-pitched, whistle-like sounds heard during inspiration and expiration.
Epistaxis is due to rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
Xerostomia refers to dryness of the mouth.
Rhinorrhea refers to drainage of a large amount of fluid from the nose.
Dysphagia refers to difficulties in swallowing.
HSV-1 is transmitted primarily by direct contact with infected secretions.
The time period 0-3 months exceeds the incubation period.
The time period 20-30 days exceeds the incubation period.
The time period 3-6 months exceeds the incubation period.
In clergyman’s sore throat, the pharynx is characterized by numerous swollen lymph follicles.
Aphonia refers to the inability to use one’s voice.
Atrophic pharyngitis is characterized by a membrane that is thin, white, glistening, and at times wrinkled.
Hypertrophic pharyngitis is characterized by general thickening and congestion of the pharyngeal mucous membrane.
Obstructive sleep apnea occurs usually in men, especially those who are older and overweight.
Types of sleep apnea do not include a simple characterization.
Mixed sleep apnea is a combination of central and obstructive apnea with one apneic episode.
In central sleep apnea, the patient demonstrates simultaneous cessation of both airflow and respiratory movements.
The carotid artery lies close to the stoma and may rupture from erosion if the wound does not heal properly.
Pulmonary embolism is associated with immobility.
Dehydration may lead to poor wound healing and breakdown.
Pneumonia is a risk for any postoperative patient.
Consolidation occurs during an infectious process such as pneumonia.
Atelectasis refers to collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression.
Bronchiectasis refers to chronic dilation of a bronchi or bronchi in which the dilated airway becomes saccular and a medium for chronic infection.
Empyema refers to accumulation of purulent material in the pleural space.
Legionnaires’ disease accounts for 15% of community-acquired pneumonias.
Streptococcal pneumonia demonstrates the highest occurrence in winter months.
Mycoplasma pneumonia demonstrates the highest occurrence in fall and early winter.
Viral pneumonia demonstrates the greatest incidence during winter months.
The site is inspected for redness and palpated for hardening.
Drainage at the site does not indicate a reaction to the tubercle bacillus.
Sloughing of tissue at the site of injection does not indicate a reaction to the tubercle bacillus.
Bruising of tissue at the site may occur from the injection, but does not indicate a reaction to the tubercle bacillus.
Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure.
Subcutaneous emphysema is a typical post-operative finding in the patient after chest surgery.
Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted.
Subcutaneous emphysema results from air entering the tissue planes.
Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.
Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and is usually slow-growing.
Adenocarcinoma presents as peripheral masses or nodules and often metastasizes.
Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.
Radiologic identification of tube placement in the stomach is most reliable.
Gastric fluid may be grassy green, brown, clear, or odorless while an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining nasogastric tube placement in the stomach.
Gastric pH values are typically lower or more acidic than that of the intestinal or respiractory tract, but not always.
Placement of external end of tube under water and watching for air bubbles is not a reliable method for determining nasogastric tube placement in the stomach.
Adenocarcinoma presents more peripherally as peripheral masses or nodules and often metastasizes.
Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.
Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures.
Small cell carcinomas arise primarily as proximal lesions, but may arise in any part of the tracheobronchial tree.
Asthma is the disease described.
Bronchitis is the disease described.
Bronchiectasis is the condition described.
Pipe, cigar and other types of tobacco smoking are also risk factors.
While a risk factor, occupational exposure is not the most important risk factor for development of COPD.
Air pollution is a risk factor for development of COPD, but it is not the most important risk factor.
A deficiency of alpha-antitrypsin is a risk factor for development of COPD, but it is not the most important risk factor.
“Barrel chest” results from fixation of the ribs in the inspiratory position.
Pigeon chest results from a displaced sternum.
Flail chest results when the ribs are fractured.
Funnel chest occurs when there is a depression in the lower portion of the sternum and is associated with Mafan’s syndrome or rickets.
Stage III patients demonstrate FEV1 < 30% with respiratory failure or clinical signs of right heart failure
Stage II patients demonstrate FEV1 between > 30% and 80%
Stage I is mild COPD with FEV1 < 70%.
Stage O is characterized by normal spirometry
The non-rebreather mask provides high oxygen concentration but is usually poor fitting.
The Venturi mask provides low levels of supplemental oxygen.
The catheter is an inexpensive device that provides a variable fraction of inspired oxygen and may cause gastric distention.
A face tent provides a fairly accurate fraction of inspired oxygen, but is bulky and uncomfortable. It would not be the device of choice to provide high oxygen concentration.
Usually the pressure is maintained at less than 25 cm water pressure to prevent injury and at more than 20 cm water pressure to prevent aspiration.
A measure of 10–15 mm Hg water pressure would indicate that the cuff is underinflated.
A measure of 30–35 mm Hg water pressure would indicate that the cuff is overinflated.
A measure of 0-5 mm Hg water pressure would indicate that the cuff is underinflated.
In general, the nurse should apply suction no longer than 10-15 seconds because hypoxia and dysrhythmias may develop, leading to cardiac arrest.
Applying suction for 30-35 seconds is hazardous and may result in the patient’s developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest.
Applying suction for 20-25 seconds is hazardous and may result in the patient’s developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest.
Applying suction for 0-5 seconds would provide too little time for effective suctioning of secretions.
Usually, no drains are used for the pneumonectomy patient because the accumulation of fluid in the empty hemithorax prevents mediastinal shift.
With lobectomy, two chest tubes are usually inserted for drainage, the upper for air and the lower for fluid
With wedge resection, the pleural cavity usually is drained because of the possibility of an air or blood leak
With segmentectomy, drains are usually used because of the possibility of an air or blood leak.
Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse.
Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse.
Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another.
Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.
The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space.
The right ventricle lies anteriorly, just beneath the sternum.
Use of inches to identify the location of the apex beat is inappropriate based upon variations in human anatomy.
Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the apex beat of the heart.
Stroke volume is determined by preload, afterload, and contractility.
Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed by multiplying the stroke volume of the heart by the heart rate.
Ejection Fraction is the percentage of the end-diastolic volume that is ejected with each stroke, measured at 42–50% in the normal heart.
Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during systole and is one of the determinants of stroke volume.
Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures.
The pressures in each arm do not have to be equal in order to be considered normal.
Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding.
The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.
The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart.
The left atrium receives oxygenated blood from the pulmonary circulation.
The left ventricle receives oxygenated blood from the left atrium.
The right ventricle is not the central collecting chamber of venous circulation.
The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient’s serum potassium level is low.
The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or “peaked” if a patient’s serum potassium level is high.
The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria.
The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.
The QRS complex represents ventricular depolarization
The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria.
The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node.
The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.
Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm.
Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway.
Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate.
Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
PAT is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia.
Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
Atrial flutter occurs in the atrium and creates an atrial rate between 250-400 times per minute.
Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature.
Ventricular bigeminy is a rhythm in which every other complex is a PVC.
Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.
When PVCs occur at a rate of more than six per minute they indicate increasing ventricular irritability and are considered forerunners of ventricular tachycardia (VT).
PVCs are dangerous when they occur on the T wave.
PVCs are dangerous when they are multifocal (have different shapes).
A PVC that is paired with a normal beat is termed bigeminy.
In third degree heart block, two impulses stimulate the heart—one stimulates the ventricles and one stimulates the atria.
In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal.
In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles.
In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.
Angina pectoris is a symptom of myocardial ischemia.
Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens.
Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial vessels.
Ischemia is insufficient tissue oxygenation and may occur in any part of the body.
While diabetes mellitus cannot be cured, blood sugars and symptomatology can be managed through healthy heart living.
Gender is considered a non-modifiable risk factor.
Race is considered a non-modifiable risk factor.
Increasing age is considered a non-modifiable risk factor.
Unstable angina is also called crescendo or pre-infarction angina and indicates the need for a change in treatment.
Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm.
Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to any alteration of dosage.
The patient’s aPTT value would have to be greater than .5 to 1 times normal to be considered therapeutic.
An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic.
Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves).
Hypercalcemia would likely be demonstrated by asystole.
Hypomagenesemia would likely be demonstrated by hypotension, lethargy, and vasodilation.
Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T wave formation.
The sixty minute interval is known as “door to balloon time” for performance of PTCA on a diagnosed MI patient.
The thirty minute interval is known as “door to needle” time for administration of thrombolytics post MI.
The time frame of nine (9) days refers to the time for onset of vasculitis after administration of Streptokinase for thrombolysis in an acute MI patient.
The six to twelve month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.
Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.
An immediate objective of rehabilitation of the MI patient is to limit the effects and progression of atherosclerosis.
An immediate objective of rehabilitation of the MI patient is to return the patient to work and a pre illness lifestyle.
An immediate objective of rehabilitation of the MI patient is to prevent another cardiac event.
Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding.
Application of a vascular closure device has been demonstrated to be very effective.
Direct manual pressure to the sheath introduction site has been demonstrated to be effective and was the first method used to induce hemostasis post PTCA.
Application of a pneumatic compression device post PTCA has been demonstrated to be effective.
TNR procedures usually involves making 20 to 40 channels in ventricular muscle. It is thought that some blood flows into the channels, decreasing the ischemia directly. Within the next few days to months, the channels close as a result of the body’s inflammatory process of healing a wound and new blood vessels form as a result of the inflammatory process.
Brachytherapy involves the delivery of gamma or beta radiation by placing a radioisotope close to the lesion and has been shown to be effective in reducing the recurrence of obstruction, preventing vessell restenosis by inhibiting smooth muscle cell proliferation.
Atherectomy is an invasive interventional procedure that involves the removal of the atheroma, or plaque, from a coronary artery.
A stent is a woven stainless steel mesh that provides structural support to a vessel at risk of acute closure. Eventually, endothelium covers the stent and it is incorporated into the vessel wall. Because of the risk of thrombus formation in the stent, the patient receives antiplatelet medications (e.g., clopidigrel [Plavix]) therapy for 2 weeks and lifetime use of aspirin).
Protamine sulfate is known as the antagonist to heparin.
Streptokinase is a thrombolytic agent.
Clopidigrel (Plavix) is an antiplatelet medication that is given to reduce the risk of thrombus formation post coronary stent placement.
The antiplatelet effect of aspirin does not reverse the effects of heparin.
Intermittent claudication is leg pain that is brought on by exercise and relieved by rest.
Dyspnea is the patient’s subjective statement of difficulty breathing.
Orthopnea is the inability of the patient to breathe except in the upright (sitting) position.
Thomroangitis obliterans is a peripheral vascular disease also known as Burger’s disease.
Untreated hypomagnesemia may result in coma, apnea, cardiac arrest.
Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves).
Signs of hyperkalemia include: mental confusion, restlessness, nausea, weakness, paresthesias of extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged QT interval).
Signs and symptoms of hypomagnesemia include: paresthesias, carpopedal spasm, muscle cramps, tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT intervals, broad flat T waves), disorientation, depression, and hypotension.
Urine output of less than 25 ml/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume.
Indices of normal glomerular filtration are output of 25 ml or greater per hour and specific gravity between 1.010 and 1.025.
Overhydration is manifested by high urine output with low specific gravity.
The anuric patient does not produce urine.
An example of autograft is found when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement.
Allograft refers to replacement using human tissue and is a synonym for homograft.
Homograft refers to replacement using human tissue and is a synonym for allograft.
Medical-Surgical Nursing Exam 13
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