NURS 6501 Exam 2
Clinical Presentation of Acute Bronchitis - answer cough (productive or not) is most
likely but fever, muscle aches, and fatigue can also be present. Burning substernal pain
with breathing in. Cough lasts longer than 7 days but shouldn't last more than 3 weeks.
Best Treatment Viral Bronchitis - answermost people improve on their own
antitussives like dextromethorphan or benzonatate helps short term
codeine or hydrocodone if cough is severe
antipyretics, bed rest and increased fluid consuption
classic signs of asthma - answerintermittent dyspnea, wheezing, coughing (worse at
night), SOB, chest tightness. Hx or presence of respiratory sx AND demonstrated
variable expiratory airflow obstruction. Inflammation and bronchial hyper-
responsiveness.
PE: wheezing, eachypnea, tachycardia, prolonged expiratory phase of respiration,
pale/swollen nasal membranes, cobblestone pharyngeal wall, cough, nasal polyps.
Asthma Triggers - answertobacco smoke, beta blockers, aspirin, and NSAIDs
URI are #1
molds, pollen, dust mites, cockroaches, and animal danger
best diagnostic test for asthma - answerFEV1 (spirometry)
mild is 80% or more
moderate is 60-80
severe is less than 60
Rule of 2 for asthma - answersymptoms requiring SABA more than twice a week
nocturnal symptoms more than twice per month
refill of quick relief inhaler more than two times per year
mild asthma - answerSymptoms <2x/week, FEV1 >80% of best
moderate asthma - answerSymptoms >2x/week, FEV1 >60-80%
severe asthma - answerContinuous symptoms, FEV1<60%, frequent nocturnal
symptoms, hospitalizations
stepwise treatment of asthma - answerintermittent: SABA
mild persistent: low dose ICS or leukotriene modifier
moderate persistent: low dose ICS + LABA, med ICS, LAMA +ICS
, severe persistent: med or high ICS + LABA (may add leukotriene modifier, tiotripium,
biologic agent)
black box warning for asthma treatment - answermust prescribe ICS with LABA, never a
LABA alone
criteria for diagnosing asthma with pulmonary function test results - answervariability
testing before and after bronchodilator, from one office visit to another or before after
bronchoprovocation challenge.
Increase FEV of 12% or more, accompanied by an absolute increase in FEV1 of at least
200 mL
hemoptysis - answercoughing up blood
hematemesis - answervomiting blood
epistaxis - answernosebleed
pleural effusion - answerabnormal amount of fluid within the pleural space. The pleura is
a serous membrane covering the lung parenchyma, mediastinum, diaphragm and rib
cage. Two pleural membranes: parietal (lines chest cavity) and visceral (covers both
lungs). Occurs when fluid formation exceeds fluid absorption. CHF is one of most
common causes.
pleural effusion symptoms - answerdyspnea, nonproductive cough, pleuritic chest pain
and activity intolerance. Dyspnea worsens with recumbent positions, cough worsens as
size of effusion increases. Pleuritic pain is sharp, unilateral and localized to affected
area, exacerbated by deep inspiration cough or movement of upper body.
first line of treatment fo community acquire pneumonia for healthy adult - answera
macrolide is first line (Azithromycin, Erythromycin); doxycycline if pt unable to take
macrolide.
first line of treatment of community acquired pneumonia for individuals with
comorbidities - answerfluoroquinolone or a beta lactam plus a macrolide antibiotic is
recommended.
first line of treatment of community acquired pneumonia for pts in ICU - answera beta
lactam (ceftriaxone, cefotaxime or ampicillin-sulbactam) plus either azithromycin and
fluoroquinolone (levofloxacin etc).
bacterial community acquired pneumonia gram positive bacteria - answerS.
pneumoniae, common in individuals with comorbidities like diabetes, COPD, asplenia,
advanced age, cigarette smoking, congestive heart failure, dementia, alcoholism or
immunosuppression
Clinical Presentation of Acute Bronchitis - answer cough (productive or not) is most
likely but fever, muscle aches, and fatigue can also be present. Burning substernal pain
with breathing in. Cough lasts longer than 7 days but shouldn't last more than 3 weeks.
Best Treatment Viral Bronchitis - answermost people improve on their own
antitussives like dextromethorphan or benzonatate helps short term
codeine or hydrocodone if cough is severe
antipyretics, bed rest and increased fluid consuption
classic signs of asthma - answerintermittent dyspnea, wheezing, coughing (worse at
night), SOB, chest tightness. Hx or presence of respiratory sx AND demonstrated
variable expiratory airflow obstruction. Inflammation and bronchial hyper-
responsiveness.
PE: wheezing, eachypnea, tachycardia, prolonged expiratory phase of respiration,
pale/swollen nasal membranes, cobblestone pharyngeal wall, cough, nasal polyps.
Asthma Triggers - answertobacco smoke, beta blockers, aspirin, and NSAIDs
URI are #1
molds, pollen, dust mites, cockroaches, and animal danger
best diagnostic test for asthma - answerFEV1 (spirometry)
mild is 80% or more
moderate is 60-80
severe is less than 60
Rule of 2 for asthma - answersymptoms requiring SABA more than twice a week
nocturnal symptoms more than twice per month
refill of quick relief inhaler more than two times per year
mild asthma - answerSymptoms <2x/week, FEV1 >80% of best
moderate asthma - answerSymptoms >2x/week, FEV1 >60-80%
severe asthma - answerContinuous symptoms, FEV1<60%, frequent nocturnal
symptoms, hospitalizations
stepwise treatment of asthma - answerintermittent: SABA
mild persistent: low dose ICS or leukotriene modifier
moderate persistent: low dose ICS + LABA, med ICS, LAMA +ICS
, severe persistent: med or high ICS + LABA (may add leukotriene modifier, tiotripium,
biologic agent)
black box warning for asthma treatment - answermust prescribe ICS with LABA, never a
LABA alone
criteria for diagnosing asthma with pulmonary function test results - answervariability
testing before and after bronchodilator, from one office visit to another or before after
bronchoprovocation challenge.
Increase FEV of 12% or more, accompanied by an absolute increase in FEV1 of at least
200 mL
hemoptysis - answercoughing up blood
hematemesis - answervomiting blood
epistaxis - answernosebleed
pleural effusion - answerabnormal amount of fluid within the pleural space. The pleura is
a serous membrane covering the lung parenchyma, mediastinum, diaphragm and rib
cage. Two pleural membranes: parietal (lines chest cavity) and visceral (covers both
lungs). Occurs when fluid formation exceeds fluid absorption. CHF is one of most
common causes.
pleural effusion symptoms - answerdyspnea, nonproductive cough, pleuritic chest pain
and activity intolerance. Dyspnea worsens with recumbent positions, cough worsens as
size of effusion increases. Pleuritic pain is sharp, unilateral and localized to affected
area, exacerbated by deep inspiration cough or movement of upper body.
first line of treatment fo community acquire pneumonia for healthy adult - answera
macrolide is first line (Azithromycin, Erythromycin); doxycycline if pt unable to take
macrolide.
first line of treatment of community acquired pneumonia for individuals with
comorbidities - answerfluoroquinolone or a beta lactam plus a macrolide antibiotic is
recommended.
first line of treatment of community acquired pneumonia for pts in ICU - answera beta
lactam (ceftriaxone, cefotaxime or ampicillin-sulbactam) plus either azithromycin and
fluoroquinolone (levofloxacin etc).
bacterial community acquired pneumonia gram positive bacteria - answerS.
pneumoniae, common in individuals with comorbidities like diabetes, COPD, asplenia,
advanced age, cigarette smoking, congestive heart failure, dementia, alcoholism or
immunosuppression
