NU 155 EXAM 2 QUESTIONS AND
ANSWERS
Pleurisy/-pleuritis:-inflammation-of-the-pleura---ans-✔✔*causes:*-infection,-medications,-
lupus,-rheumatoid-arthritis
*s/s:*-sharp,-abrupt!-onset,-most-evident-on-inspiration,-shallow-breathing-and-pleural-
friction-rub
*Tx:*-splint-affected-side-during-coughing-for-relief,-intercostal-nerve-block-for-severe-
pleuritic-pain
vesicular-breath-sounds---ans-✔✔-heard-in-the-6th-intercostal-space-over-lung-tissue
-sounds-low-medium-pitched,-soft-whooshing-2-3x-length-of-expiration
Bronchovescular-breath-sounds---ans-✔✔-heard-main-stem-bronchi,-below-clavicles,-
beside-sternum,-posteriorly,-between-scapulae
-sounds-like-moderate-high-pitches-hollow-muffled-
equal-sounds-on-inspiration-and-expiration
Bronchial-breath-sounds---ans-✔✔-heard-over-trachea-above-sternal-notch-(often-
indicate-atelectasis)
-sounds-high-pitched,-loud-harsh-tubular-quality,-inspiration-half-as-long-as-expiration
COPD-(chronic-obstructive-pulmonary-disease):-(PATHO,-Dx,-S/S,-N/I,-pt.-teaching)---
ans-✔✔-combo-of-*chronic-bronchitis,-asthma,-and-emphysema*
-caused-by:-*tobacco-smoke-(90%)*,-occupational-hazards-like-farming,-biomass-fuels,-
firefighters
-*Dx*:-chest-X-ray,-EKG,-labs-like-high-hematocrit,-ABG
-*S/S*:-dyspnea,-barrel-chest,-polycythemia-(high-RBC),-hypercapnia-(high-CO2),-
coughing-up-in-the-morning
-*N/I*-titrate-o2-to-92%,-bronchodilators,-hydrate-uncaffeinated-liquids
-teach-pt:-avoid-over-eating,-smaller-bites,-increase-fluid-and-calcium,-adequate-protein,-
rest-before-eating-and-meds,-and-avoid-lying-down-after
Thyroid-Storm-(thyroid-crisis)---ans-✔✔-*causes*:-drugs-or-dyes-with-iodine,-pregnancy/
child-birth,-M.I.-or-cardiac-emergencies,-severe-emotional-distress,-trauma,-surgery,-
levothyroxine-overdose
-*s/s*:-106ºF-+,-200bpm,-high-b/p,-tachypnea,-HTN,-restlessness,-agitation,-confusion,-if-
*untreated*-delirium-to-coma-to-heart-failure-to-death
, -*Tx*:-MUST-begin-as-soon-as-symptoms-occur!,-reduce-temp.-slow-HR,-sedatives,-
increase-fluid-avoid-dehydration
DKA--VS--HHS---ans-✔✔+DKA-(Type-1):-hyperglycemic-crisis-associated-with-elevated-
ketones!-
+HHS-(Type-2):-hyperglycemic-crisis-without-association-of-ketones!-
-*DKA:*-BS->300mg/dL-*HHS:*-BS->-600mg/dL
*DKA*-Ketonuria-
-*HHS*-Older-adults-at-higher-risk,-and-higher-mortality-r/t-severe-dehydration-and-
extreme-hyperglycemia-(than-DKA)
-*DKA:*-N/V,-abdominal-pain,-rigidity-*HHS:*-NO-GI-NO-KETOACIDOSIS
-*DKA:*-Kussmaul-breathing-*HHS:*-Seizures
-*DKA:*-Acetone-(fruit)-breath-*HHS:*-Confusion-
-*DKA:*-Stupor-or-coma-(late)-*HHS:*-Coma
Chronic-bronchitis-emphysema-sputum-characteristic---ans-✔✔thick,-tenacious,-"ropy"-
and-difficult-to-cough-up!
pneumococcal-pneumonia-sputum-characteristic---ans-✔✔Scant,-sticky,-rust-colored
Pulmonary-edema-sputum-characteristic---ans-✔✔Frothy,-pinkish,-or-blood-tinged
pulmonary-infection-sputum-characteristic---ans-✔✔yellow,-yellow-green,-or-grayish-
yellow-with-foul-odor-or-taste
T.B.,-ulcerated-pulmonary-vessel-or-bronchogenic-carcinoma-sputum-characteristics---
ans-✔✔blood-tinged,-bloody,-or-blood-streaked
Pneumonia-or-Bronchitis-sputum-characteristics---ans-✔✔LARGE-AMOUNTS
Asthma-sputum-characteristics---ans-✔✔Scanty
Inadequate-hydration-sputum-characteristics---ans-✔✔very-THICK-and-viscious
Bronchiectasis-sputum-characteristics---ans-✔✔Large-amounts-of-foamy,-purulent,-foul-
odor
*GOITER*-(Benign-or-malignant)-a-greatly-enlarged-thyroid-gland-caused-by-deficient-
iodine---ans-✔✔-*S/S*-^TSH,-enlargement-of-front-of-neck,-difficulty-swallowing-or-
breathing-indicates-severity
-*N/I*-Give-iodine-through-straw-avoid-teeth-staining
-Adverse-effects:-GI-upset,-metallic-taste,-skin-rash,-allergic-reaction,-epigastric-pain
-Pt.-on-thyroid-supplements-may-have-palpations-or-be-tachycardic
-Inadequate-Tx:-wt.-gain,-dry-skin,-hair-loss
--Pt.-teach:-rich-iodine-diet,-dairy-products,-seafood,-iodized-salt,-regular-follow-ups,-
medication-adherence-vital!-!report-worsening-of-dyspnea!
ANSWERS
Pleurisy/-pleuritis:-inflammation-of-the-pleura---ans-✔✔*causes:*-infection,-medications,-
lupus,-rheumatoid-arthritis
*s/s:*-sharp,-abrupt!-onset,-most-evident-on-inspiration,-shallow-breathing-and-pleural-
friction-rub
*Tx:*-splint-affected-side-during-coughing-for-relief,-intercostal-nerve-block-for-severe-
pleuritic-pain
vesicular-breath-sounds---ans-✔✔-heard-in-the-6th-intercostal-space-over-lung-tissue
-sounds-low-medium-pitched,-soft-whooshing-2-3x-length-of-expiration
Bronchovescular-breath-sounds---ans-✔✔-heard-main-stem-bronchi,-below-clavicles,-
beside-sternum,-posteriorly,-between-scapulae
-sounds-like-moderate-high-pitches-hollow-muffled-
equal-sounds-on-inspiration-and-expiration
Bronchial-breath-sounds---ans-✔✔-heard-over-trachea-above-sternal-notch-(often-
indicate-atelectasis)
-sounds-high-pitched,-loud-harsh-tubular-quality,-inspiration-half-as-long-as-expiration
COPD-(chronic-obstructive-pulmonary-disease):-(PATHO,-Dx,-S/S,-N/I,-pt.-teaching)---
ans-✔✔-combo-of-*chronic-bronchitis,-asthma,-and-emphysema*
-caused-by:-*tobacco-smoke-(90%)*,-occupational-hazards-like-farming,-biomass-fuels,-
firefighters
-*Dx*:-chest-X-ray,-EKG,-labs-like-high-hematocrit,-ABG
-*S/S*:-dyspnea,-barrel-chest,-polycythemia-(high-RBC),-hypercapnia-(high-CO2),-
coughing-up-in-the-morning
-*N/I*-titrate-o2-to-92%,-bronchodilators,-hydrate-uncaffeinated-liquids
-teach-pt:-avoid-over-eating,-smaller-bites,-increase-fluid-and-calcium,-adequate-protein,-
rest-before-eating-and-meds,-and-avoid-lying-down-after
Thyroid-Storm-(thyroid-crisis)---ans-✔✔-*causes*:-drugs-or-dyes-with-iodine,-pregnancy/
child-birth,-M.I.-or-cardiac-emergencies,-severe-emotional-distress,-trauma,-surgery,-
levothyroxine-overdose
-*s/s*:-106ºF-+,-200bpm,-high-b/p,-tachypnea,-HTN,-restlessness,-agitation,-confusion,-if-
*untreated*-delirium-to-coma-to-heart-failure-to-death
, -*Tx*:-MUST-begin-as-soon-as-symptoms-occur!,-reduce-temp.-slow-HR,-sedatives,-
increase-fluid-avoid-dehydration
DKA--VS--HHS---ans-✔✔+DKA-(Type-1):-hyperglycemic-crisis-associated-with-elevated-
ketones!-
+HHS-(Type-2):-hyperglycemic-crisis-without-association-of-ketones!-
-*DKA:*-BS->300mg/dL-*HHS:*-BS->-600mg/dL
*DKA*-Ketonuria-
-*HHS*-Older-adults-at-higher-risk,-and-higher-mortality-r/t-severe-dehydration-and-
extreme-hyperglycemia-(than-DKA)
-*DKA:*-N/V,-abdominal-pain,-rigidity-*HHS:*-NO-GI-NO-KETOACIDOSIS
-*DKA:*-Kussmaul-breathing-*HHS:*-Seizures
-*DKA:*-Acetone-(fruit)-breath-*HHS:*-Confusion-
-*DKA:*-Stupor-or-coma-(late)-*HHS:*-Coma
Chronic-bronchitis-emphysema-sputum-characteristic---ans-✔✔thick,-tenacious,-"ropy"-
and-difficult-to-cough-up!
pneumococcal-pneumonia-sputum-characteristic---ans-✔✔Scant,-sticky,-rust-colored
Pulmonary-edema-sputum-characteristic---ans-✔✔Frothy,-pinkish,-or-blood-tinged
pulmonary-infection-sputum-characteristic---ans-✔✔yellow,-yellow-green,-or-grayish-
yellow-with-foul-odor-or-taste
T.B.,-ulcerated-pulmonary-vessel-or-bronchogenic-carcinoma-sputum-characteristics---
ans-✔✔blood-tinged,-bloody,-or-blood-streaked
Pneumonia-or-Bronchitis-sputum-characteristics---ans-✔✔LARGE-AMOUNTS
Asthma-sputum-characteristics---ans-✔✔Scanty
Inadequate-hydration-sputum-characteristics---ans-✔✔very-THICK-and-viscious
Bronchiectasis-sputum-characteristics---ans-✔✔Large-amounts-of-foamy,-purulent,-foul-
odor
*GOITER*-(Benign-or-malignant)-a-greatly-enlarged-thyroid-gland-caused-by-deficient-
iodine---ans-✔✔-*S/S*-^TSH,-enlargement-of-front-of-neck,-difficulty-swallowing-or-
breathing-indicates-severity
-*N/I*-Give-iodine-through-straw-avoid-teeth-staining
-Adverse-effects:-GI-upset,-metallic-taste,-skin-rash,-allergic-reaction,-epigastric-pain
-Pt.-on-thyroid-supplements-may-have-palpations-or-be-tachycardic
-Inadequate-Tx:-wt.-gain,-dry-skin,-hair-loss
--Pt.-teach:-rich-iodine-diet,-dairy-products,-seafood,-iodized-salt,-regular-follow-ups,-
medication-adherence-vital!-!report-worsening-of-dyspnea!
