N372: EXAM #3 QUESTIONS WITH
ACCURATE ANSWERS
T or F: hypotension is an early sign of hemorrhaegic stroke. - ANSWER FALSE
Cushing's triad - ANSWER r/t ICP (HTN, bradycardia, irritability, sleep, widening
pulse pressure)
T or F: hemorrhagic stroke = hypovolemia - ANSWER Hell no
The nurse uses what material to lubricate the catheter prior to suctioning a
patient's tracheostomy? - ANSWER Sterile water
What is the role of nodes of Ranvier? - ANSWER regeneration and propagation
of action potential
impulse go fast af
89ghguoiwh489`suirheiout - ANSWER sdjkndbjkhetl
What part of the brain is the largest and controls intelligence, creativity, and
memory? - ANSWER The cerebrum
Circulation to the brain originates from what arteries? - ANSWER Carotid +
vertebral
T or F: albumin can cross the blood-brain barrier. - ANSWER FALSE. Too big
What supplies must be kept at the bedside of the patient with a chest tube? -
ANSWER - Dry, sterile gauze to cover & occlude site if tube becomes dislodged.
- Padded clamps at the bedside for use if the drainage system is interrupted.
- Container of sterile water
If a patient's chest tube is entirely dislodged, what kind of dressing should be
applied to the incision site? - ANSWER Dry and sterile gauze - This is the #1
INTERVENTION even before calling an RRT
If a patient's chest tube disconnects from the drainage system (container), what
is the priority nursing intervention? - ANSWER Place the disconnected end of the
chest tube in STERILE water and initiate RRT.
,Chest tube emergencies (where the RN should initiate RRT) - ANSWER -
Tracheal deviation from midline (deviates towards GOOD lung)
- Sudden onset or increased intensity of dyspnea
- O2 saturation below 90%
- Drainage greater than 70mL/hour
- Visible eyelets on chest tube
- Chest tube falls out of patient's chest (first, cover area with dry, sterile gauze,
THEN call RRT)
- Chest tube disconnects from drainage system (first, put end of tube in a
container of sterile water and keep it below the chest, THEN call RRT)
- Drainage in tube stops (in the first 24 hours s/p placement)
Nursing assessment and considerations for the patient with a chest tube -
ANSWER - Ensure dressing on chest around the tube is tight and intact.
- Assess respiratory status for difficulty breathing (RR, WOB, muscle use, etc.)
- Assess pulse ox frequently
- Listen to breath sounds for each lung
- Check alignment of trachea (deviated = emergency)
- Check insertion site for skin condition (palpate for puffiness/crackling which =
subQ emphysema)
- S/s of infection (redness, purulent drainage, excessive bleeding)
- Check to see if tube eyelets are visible (if visible = emergency)
- Assess for pain
- Assist patient to deep breath, cough, perform maximal sustained inhalations,
and use incentive spirometer
- Reposition the patient who complains of "burning" pain in the chest
What should the nurse do if a patient with a chest tube complains of "burning"
chest pain? - ANSWER Panic.
Nah jk reposition them FIRST.
T or F: It is okay to "strip" the chest tube. - ANSWER FALSE.
Use a hand-over-hand "milking" motion if needed.
What may be seen in the chest drainage system if the patient coughs, changes
positions, or sneezes (forceful breathing)? - ANSWER Gentle bubbling may be
seen in the water-seal chamber.
Should the water-seal chamber have constant bubbling? - ANSWER NO this
indicates an AIR LEAK
If a drainage culture or laboratory test is needed for a patient with a chest tube,
how should it be collected? - ANSWER It should be collected right from the chest
tube.
,1. Clean the chest tube
2. Use 20G needle or SMALLER
3. Draw specimen into syringe
4. BLEHHH
Chest tube removal nursing considerations - ANSWER - Pain medication prior
- Performed when drainage is under 180-200ml/day or per provider
- Usually done at bedside
- After removal, it is dressed and sealed with an occlusive dressing and
observed for drainage.
- Q1h respiratory assessments for at least the few hours after removal (to
observe for distress/recurrence)
What is ventilation? - ANSWER The movement of atmospheric air higher in
oxygen into the lungs and the removal of the carbon dioxide produced during
metabolism. = MAJOR FUNCTION OF RESP SYSTEM
What is respiratory diffusion? - ANSWER The movement of gases down their
concentration gradient across the alveolar and capillary membranes.
AKA
- O2 higher in atmospheric air than blood, so when inhaled it diffuses into blood.
- CO2 higher in blood than in alveolar air, so it diffuses into alveoli to be expelled.
What is the difference between VENTILATION, respiratory DIFFUSION, and
PERFUSION? - ANSWER Ventilation = actual movement of air in and out of the
lungs
Diffusion = movement of gases from high concentrations to low concentrations
Perfusion = blood flow throughout the arteries of the body that DELIVERS
oxygenated blood (2ndary diffusion then allows gas exchange)
What is perfusion? - ANSWER The arterial blood flow through the tissues
(peripheral perfusion) and blood that is pumped by the heart (central perfusion).
Pharynx - ANSWER throat
Larynx - ANSWER voice box LALALLAL
T or F: the trachea is in front of the esophagus and branches into the right and
left mainstem bronchi at the carina junction. - ANSWER True
T or F: Because the right bronchus is slightly wider, shorter, and more vertical
than the left, it can be accidentally intubated when an endotracheal tube is
placed. - ANSWER TRUE.
, On top of this, when a foreign object is aspirated from the throat, it usually
enters the right bronchus.
This is bad because the ET tubes should stay in the trachea, not advance into
either of the bronchi.
What is the pleura? - ANSWER A continuous smooth membrane with TWO
surfaces that totally enclose the lungs.
Parietal - lines chest cavity and upper surface of diaphragm (wall)
Visceral - covers the actual lung surfaces (organ)
The alveolar walls have cells called ________ that secrete the fatty protein
surfactant, which helps prevent atelectasis. - ANSWER Type II pneumocytes
Why are the terminal bronchioles more prone to collapse than are the other
airways? Select all that apply.
A. The cartilage is an incomplete C-shape rather than a true ring.
B. The mucous membrane lining contains minimal active cilia.
C. Lung elastic recoil is the only force that keeps them patent.
D. Their walls are too thick to permit gas exchange.
E. They are surrounded by capillaries.
F. The lumens have a small diameter.
G. Their walls contain no cartilage. - ANSWER C. Lung elastic recoil is the only
force that keeps them patent.
F. The lumens have a small diameter.
G. Their walls contain no cartilage.
Kyphosis - ANSWER Hunchback (exaggerated thoracic curvature)
ex: older adults
T or F: The sedentary older adult often feels breathless during exercise. -
ANSWER True
Age-Related Changes in the Respiratory System (Older Adult) - ANSWER -
Alveolar surface area decreases
- Diffusion capacity decreases
- Elastic recoil decreases
- Bronchioles and alveolar ducts dilate
- Ability to cough decreases
ACCURATE ANSWERS
T or F: hypotension is an early sign of hemorrhaegic stroke. - ANSWER FALSE
Cushing's triad - ANSWER r/t ICP (HTN, bradycardia, irritability, sleep, widening
pulse pressure)
T or F: hemorrhagic stroke = hypovolemia - ANSWER Hell no
The nurse uses what material to lubricate the catheter prior to suctioning a
patient's tracheostomy? - ANSWER Sterile water
What is the role of nodes of Ranvier? - ANSWER regeneration and propagation
of action potential
impulse go fast af
89ghguoiwh489`suirheiout - ANSWER sdjkndbjkhetl
What part of the brain is the largest and controls intelligence, creativity, and
memory? - ANSWER The cerebrum
Circulation to the brain originates from what arteries? - ANSWER Carotid +
vertebral
T or F: albumin can cross the blood-brain barrier. - ANSWER FALSE. Too big
What supplies must be kept at the bedside of the patient with a chest tube? -
ANSWER - Dry, sterile gauze to cover & occlude site if tube becomes dislodged.
- Padded clamps at the bedside for use if the drainage system is interrupted.
- Container of sterile water
If a patient's chest tube is entirely dislodged, what kind of dressing should be
applied to the incision site? - ANSWER Dry and sterile gauze - This is the #1
INTERVENTION even before calling an RRT
If a patient's chest tube disconnects from the drainage system (container), what
is the priority nursing intervention? - ANSWER Place the disconnected end of the
chest tube in STERILE water and initiate RRT.
,Chest tube emergencies (where the RN should initiate RRT) - ANSWER -
Tracheal deviation from midline (deviates towards GOOD lung)
- Sudden onset or increased intensity of dyspnea
- O2 saturation below 90%
- Drainage greater than 70mL/hour
- Visible eyelets on chest tube
- Chest tube falls out of patient's chest (first, cover area with dry, sterile gauze,
THEN call RRT)
- Chest tube disconnects from drainage system (first, put end of tube in a
container of sterile water and keep it below the chest, THEN call RRT)
- Drainage in tube stops (in the first 24 hours s/p placement)
Nursing assessment and considerations for the patient with a chest tube -
ANSWER - Ensure dressing on chest around the tube is tight and intact.
- Assess respiratory status for difficulty breathing (RR, WOB, muscle use, etc.)
- Assess pulse ox frequently
- Listen to breath sounds for each lung
- Check alignment of trachea (deviated = emergency)
- Check insertion site for skin condition (palpate for puffiness/crackling which =
subQ emphysema)
- S/s of infection (redness, purulent drainage, excessive bleeding)
- Check to see if tube eyelets are visible (if visible = emergency)
- Assess for pain
- Assist patient to deep breath, cough, perform maximal sustained inhalations,
and use incentive spirometer
- Reposition the patient who complains of "burning" pain in the chest
What should the nurse do if a patient with a chest tube complains of "burning"
chest pain? - ANSWER Panic.
Nah jk reposition them FIRST.
T or F: It is okay to "strip" the chest tube. - ANSWER FALSE.
Use a hand-over-hand "milking" motion if needed.
What may be seen in the chest drainage system if the patient coughs, changes
positions, or sneezes (forceful breathing)? - ANSWER Gentle bubbling may be
seen in the water-seal chamber.
Should the water-seal chamber have constant bubbling? - ANSWER NO this
indicates an AIR LEAK
If a drainage culture or laboratory test is needed for a patient with a chest tube,
how should it be collected? - ANSWER It should be collected right from the chest
tube.
,1. Clean the chest tube
2. Use 20G needle or SMALLER
3. Draw specimen into syringe
4. BLEHHH
Chest tube removal nursing considerations - ANSWER - Pain medication prior
- Performed when drainage is under 180-200ml/day or per provider
- Usually done at bedside
- After removal, it is dressed and sealed with an occlusive dressing and
observed for drainage.
- Q1h respiratory assessments for at least the few hours after removal (to
observe for distress/recurrence)
What is ventilation? - ANSWER The movement of atmospheric air higher in
oxygen into the lungs and the removal of the carbon dioxide produced during
metabolism. = MAJOR FUNCTION OF RESP SYSTEM
What is respiratory diffusion? - ANSWER The movement of gases down their
concentration gradient across the alveolar and capillary membranes.
AKA
- O2 higher in atmospheric air than blood, so when inhaled it diffuses into blood.
- CO2 higher in blood than in alveolar air, so it diffuses into alveoli to be expelled.
What is the difference between VENTILATION, respiratory DIFFUSION, and
PERFUSION? - ANSWER Ventilation = actual movement of air in and out of the
lungs
Diffusion = movement of gases from high concentrations to low concentrations
Perfusion = blood flow throughout the arteries of the body that DELIVERS
oxygenated blood (2ndary diffusion then allows gas exchange)
What is perfusion? - ANSWER The arterial blood flow through the tissues
(peripheral perfusion) and blood that is pumped by the heart (central perfusion).
Pharynx - ANSWER throat
Larynx - ANSWER voice box LALALLAL
T or F: the trachea is in front of the esophagus and branches into the right and
left mainstem bronchi at the carina junction. - ANSWER True
T or F: Because the right bronchus is slightly wider, shorter, and more vertical
than the left, it can be accidentally intubated when an endotracheal tube is
placed. - ANSWER TRUE.
, On top of this, when a foreign object is aspirated from the throat, it usually
enters the right bronchus.
This is bad because the ET tubes should stay in the trachea, not advance into
either of the bronchi.
What is the pleura? - ANSWER A continuous smooth membrane with TWO
surfaces that totally enclose the lungs.
Parietal - lines chest cavity and upper surface of diaphragm (wall)
Visceral - covers the actual lung surfaces (organ)
The alveolar walls have cells called ________ that secrete the fatty protein
surfactant, which helps prevent atelectasis. - ANSWER Type II pneumocytes
Why are the terminal bronchioles more prone to collapse than are the other
airways? Select all that apply.
A. The cartilage is an incomplete C-shape rather than a true ring.
B. The mucous membrane lining contains minimal active cilia.
C. Lung elastic recoil is the only force that keeps them patent.
D. Their walls are too thick to permit gas exchange.
E. They are surrounded by capillaries.
F. The lumens have a small diameter.
G. Their walls contain no cartilage. - ANSWER C. Lung elastic recoil is the only
force that keeps them patent.
F. The lumens have a small diameter.
G. Their walls contain no cartilage.
Kyphosis - ANSWER Hunchback (exaggerated thoracic curvature)
ex: older adults
T or F: The sedentary older adult often feels breathless during exercise. -
ANSWER True
Age-Related Changes in the Respiratory System (Older Adult) - ANSWER -
Alveolar surface area decreases
- Diffusion capacity decreases
- Elastic recoil decreases
- Bronchioles and alveolar ducts dilate
- Ability to cough decreases
