Exam 2: NSG3280 / NSG 3280 (Latest 2026/2027 Update) Pathophysiology for Nurses I | Complete Review | Questions & Verified Answers | 100% Correct | Grade A – Galen

Exam 2: NSG3280 / NSG 3280 (Latest 2026/2027 Update) Pathophysiology for Nurses I | Complete Review | Questions & Verified Answers | 100% Correct | Grade A – Galen When repositioning an immobile patient, the nurse notices redness over the hip bone. What is indicated when a reddened area blanches on fingertip touch? 1. A local skin infection requiring antibiotics 2. Sensitive skin that requires special bed linen 3. A Stage 3 pressure injury needing the appropriate dressing 4. Blanching hyperemia, indicating the attempt by the body to overcome the ischemic episode 4 After surgery the patient with a closed abdominal wound reports a sudden "pop" after coughing. When the nurse examines the surgical wound site, the sutures are open, and small bowel sections are observed at the bottom of the now-opened wound. Which are the priority nursing interventions? (Select all that apply.) 1. Notify the health care provider. 2. Allow the area to be exposed to air until all drainage has stopped. 3. Place several cold packs over the area, protecting the skin around the wound. 4. Cover the area with sterile, saline-soaked towels immediately. 5. Cover the area with sterile gauze and apply an abdominal binder. 1,4 Place the steps when performing wound irrigation of a large open wound in the correct sequence. 1. Use slow, continuous pressure to irrigate wound. 2. Attach 19-gauge angiocatheter to syringe. 3. Fill syringe with irrigation fluid. 4. Place biohazard bag near bed. 5. Position angiocatheter over wound. 4,3,2,5,1 Which skin-care measures are used to manage a patient who is experiencing fecal and/or urinary incontinence? (Select all that apply.) 1. Frequent position changes 2. Keeping the buttocks exposed to air at all times 3. Using a large absorbent diaper, changing when saturated 4. Using an incontinence cleaner 5. Applying a moisture barrier ointment 1,4,5 Which of the following are measures to reduce tissue damage from shear? (Select all that apply.) 1. Use a transfer device (e.g., transfer board). 2. Have head of bed elevated when transferring patient. 3. Have head of bed flat when repositioning patient. 4. Raise head of bed 60 degrees when patient is positioned supine. 5. Raise head of bed 30 degrees when patient is positioned supine. 1,3,5 Which of the following is an indication for a binder to be placed around a surgical patient with a new abdominal wound? (Select all that apply.) 1. Collection of wound drainage 2. Provision of support to abdominal tissues when coughing or walking 3. Reduction of abdominal swelling 4. Reduction of stress on the abdominal incision 5. Stimulation of peristalsis (return of bowel function) from direct pressure 2,4 Medical adhesives, such as tape securing a wound dressing, cause MARSI. Which of the following interventions reduce the risk for MARSI? 1. Gently loosen the ends of the tape and gently pull the outer end parallel with the skin surface toward the wound. 2. Change dressing only when saturated. 3. Apply adhesive remover. 4. Use Montgomery ties to secure the dressing. 5. Immobilize area of wound. 1,3,4 What is the removal of devitalized tissue from a wound called? 1. Debridement 2. Pressure distribution 3. Negative-pressure wound therapy 4. Sanitization 1 Which of the following nursing activities apply to an MDRPI? (Select all that apply.) 1. Assess skin under devices every 2 hours. 2. Cushion at risk areas (e.g., ears, nose with foam or protective dressing). 3. Choose correct size of device. 4. Observe for erythema or irritation that conforms to pattern or shape of device. 5. Observe under casts and splints. 2,3,4,5 The nurse is preparing to perform nasotracheal suctioning on a patient. Arrange the steps in order. 1. Apply suction. 2. Assist patient to semi-Fowler's or high Fowler's position, if able. 3. Advance catheter through nares and into trachea. 4. Have patient take deep breaths. 5. Lubricate catheter with water-soluble lubricant. 6. Apply sterile gloves. 7. Perform hand hygiene. 8. Withdraw catheter. 7,2,6,4,5,3,1 Which skills can the nurse delegate to assistive personnel (AP)? (Select all that apply.) 1. Initiate oxygen therapy via nasal cannula. 2. Perform nasotracheal suctioning of a patient. 3. Educate the patient about the use of an incentive spirometer. 4. Assist with care of an established tracheostomy tube. 5. Reposition a patient with a chest tube. 4,5 The nurse is caring for a patient with pneumonia. On entering the room, the nurse finds the patient lying in bed, coughing, and unable to clear secretions. What should the nurse do first? 1. Start oxygen at 2 L/min via nasal cannula. 2. Elevate the head of the bed to 45 degrees. 3. Encourage the patient to use the incentive spirometer. 4. Notify the health care provider. 2 The nurse is performing discharge teaching for a patient with chronic obstructive pulmonary disease (COPD). What statement, made by the patient, indicates the need for further teaching? 1. "Pursed-lip breathing is like exercise for my lungs and will help me strengthen my breathing muscles." 2. "When I am sick, I should limit the amount of fluids I drink so that I don't produce excess mucus." 3. "I will ensure that I receive an influenza vaccine every year, preferably in the fall." 4. "I will look for a smoking-cessation support group in my neighborhood." 2 Which assessment findings indicate that the patient is experiencing an acute disturbance in oxygenation and requires immediate intervention? (Select all that apply.) 1. SpO2 value of 95% 2. Chest retractions 3. Respiratory rate of 28 breaths per minute 4. Nasal flaring 5. Clubbing of fingers 2,3,4 The nurse is caring for a patient with an artificial airway. What are reasons to suction the patient? (Select all that apply.) 1. The patient has visible secretions in the airway. 2. There is a sawtooth pattern on the patient's EtCO2 monitor. 3. The patient has clear breath sounds. 4. It has been 3 hours since the patient was last suctioned. 5. The patient has excessive coughing. 1,2,5 The nurse is caring for a patient with a chest tube for treatment of a right pneumothorax. Which assessment finding necessitates immediate notification of the health care provider? 1. New, vigorous bubbling in the water-seal chamber. 2. Scant amount of sanguineous drainage noted on the dressing. 3. Clear but slightly diminished breath sounds on the right side of the chest. 4. Pain score of 2 one hour after the administration of the prescribed analgesic. 1 The nurse has just witnessed her patient go into cardiac arrest. The family is in the patient's room at the time the cardiac arrest occurs. What priority interventions should the nurse perform at this time? (Select all that apply.) 1. Perform chest compressions. 2. Ask someone to bring the automatic external defibrillator (AED) to the room for immediate defibrillation. 3. Apply oxygen via nasal cannula. 4. Place the patient supine. 5. Educate the family about the need for CPR. 1,2,4 The nurse is performing tracheostomy care on a patient. What finding would indicate that the tracheostomy tube has become dislodged? 1. Clear breath sounds 2. Patient speaking to nurse 3. SpO2 reading of 96% 4. Respiratory rate of 18 breaths/minute 2 A patient is scheduled to have an intravenous pyelogram (IVP) tomorrow morning. Which nursing measures should be implemented before the test? (Select all that apply.) 1. Ask the patient about any allergies and reactions. 2. Instruct the patient that a full bladder is required for the test. 3. Instruct the patient to save all urine in a special container. 4. Ensure that informed consent has been obtained. 5. Instruct the patient that facial flushing can occur when the contrast medium is given. 1,4,5 What is a critical step when inserting an indwelling catheter into a male patient? 1. Slowly inflate the catheter balloon with sterile saline. 2. Secure the catheter drainage tubing to the bedsheets. 3. Advance the catheter to the bifurcation of the drainage and balloon ports. 4. Advance the catheter until urine flows, then insert ¼ inch more. 3 Which instruction should the nurse give the assistive personnel (AP) concerning a patient who has had an indwelling urinary catheter removed that day? 1. Limit oral fluid intake to avoid possible UI. 2. Expect patient complaints of suprapubic fullness and discomfort. 3. Report the time and amount of first voiding. 4. Instruct patient to stay in bed and use a urinal or bedpan. 3 A patient with a three-way indwelling urinary catheter and CBI complains of lower abdominal pain and distention after surgery. What should be the nurse's initial intervention(s)? (Select all that apply.) 1. Increase the rate of the CBI. 2. Assess the patency of the drainage system. 3. Measure urine output. 4. Assess vital signs. 5. Administer ordered pain medication 2,3 After abdominal surgery, the patient is on the surgical unit with an indwelling urinary catheter placed. What aspects of care for this patient can be delegated to the assistive personnel (AP)? (Select all that apply.) 1. Assessing the patient for any postoperative issues with the indwelling catheter 2. Assisting the nurse with patient positioning and maintaining privacy during catheter care 3. Teaching the patient signs and symptoms of a UTI 4. Reporting to the nurse any patient discomfort or fever 5. Reporting any abnormal color, odor, or amount of urine in the drainage bag 2,4,5 What should the nurse teach a young woman with a history of UTIs about UTI prevention? (Select all that apply.) 1. Maintain regular bowel elimination. 2. Limit water intake to 1 to 2 glasses a day. 3. Wear cotton underwear. 4. Cleanse the perineum from front to back. 5. Practice pelvic muscle exercises (Kegel) daily. 1,3,4 Place the following steps for insertion of an indwelling catheter in a female patient in appropriate order. 1. Insert and advance catheter. 2. Lubricate catheter. 3. Inflate catheter balloon. 4. Cleanse urethral meatus with antiseptic solution. 5. Drape patient with the sterile square and fenestrated drapes. 6. When urine appears, advance another 2.5 to 5 cm. 7. Prepare sterile field and supplies. 8. Gently pull catheter until resistance is felt. 9. Attach drainage tubing. 5,7,2,4,1,6,3,8,9 Which nursing interventions should a nurse implement when removing an indwelling urinary catheter in an adult patient? (Select all that apply.) 1. Attach a 3-mL syringe to the inflation port. 2. Allow the balloon to drain into the syringe by gravity. 3. Initiate a voiding record/bladder diary. 4. Pull the catheter quickly. 5. Clamp the catheter before removal. 2,3 Which nursing intervention decreases the risk for CAUTI? 1. Cleansing the urinary meatus 3 to 4 times daily with antiseptic solution 2. Hanging the urinary drainage bag below the level of the bladder 3. Emptying the urinary drainage bag daily 4. Irrigating the urinary catheter with sterile water 2 The nurse is inserting a urinary catheter for a female patient, and after the catheter has been inserted 3 inches, no urine is returned. What should the nurse do next? 1. Remove the catheter and start all over with a new kit and catheter. 2. Leave the catheter there and start over with a new catheter. 3. Pull the catheter back and reinsert at a different angle. 4. Ask the patient to bear down and insert the catheter farther. 2 Which nursing actions does the nurse take when placing a bedpan under a patient who is immobilized? (Select all that apply.) 1. Lift the patient's hips off the bed and slide the bedpan under the patient. 2. After positioning the patient on the bedpan, elevate the head of the bed to a 45-degree angle. 3. Adjust the head of the bed so that it is lower than the feet and use gentle but firm pressure to push the bedpan under the patient. 4. Have the patient stand beside the bed, and then have the patient sit on the bedpan on the edge of the bed. 5. Make sure the patient has a nurse call system in reach to notify the nurse when ready to have the bedpan removed. 2,5 During the administration of a warm tap-water enema, a patient starts to have cramping abdominal pain that he rates a 6 out of 10. What nursing action should the nurse take first? 1. Stop the instillation. 2. Ask the patient to take deep breaths to decrease the pain. 3. Tell the patient to bear down as he would when having a bowel movement. 4. Continue the instillation; then administer a pain medication. 1 Which instructions does the nurse include when educating a person with chronic constipation? (Select all that apply.) 1. Increase fiber and fluids in the diet. 2. Use a low-volume enema daily. 3. Avoid gluten in the diet. 4. Take laxatives twice a day. 5. Exercise for 30 minutes every day. 6. Schedule time to use the toilet at the same time every day. 7. Take probiotics 5 times a week. 1,5,6 Which skills does the nurse teach a patient with a new colostomy before discharge from the health care agency? (Select all that apply.) 1. How to change the pouch 2. How to empty the pouch 3. How to open and close the pouch 4. How to irrigate the colostomy 5. How to determine whether the ostomy is healing appropriately 1,2,3,5 Place the steps for an ileostomy pouch change in the correct order. 1. Close the end of the pouch. 2. Measure the stoma. 3. Cut the hole in the wafer to fit around the stoma and not leave skin exposed to the effluent. 4. Press the pouch in place over the stoma. 5. Remove the old pouch. 6. Trace the correct measurement onto the back of the wafer. 7. Assess the stoma and the skin around it. 8. Cleanse and dry the peristomal skin. 5,8,7,2,6,3,4,1 A nurse is teaching a patient about the warning signs of possible colorectal cancer according to the American Cancer Society guidelines. Which statements reflect that the patient understands the teaching? (Select all that apply.) 1. "I need to let my doctor know if my bowel habits start to change." 2. "Blood in the stool is one warning sign I need to look for." 3. "Muscle aches are common in people with colorectal cancer." 4. "It is not normal to see food particles in the stool." 5. "Some people with colorectal cancer have unexplained abdominal or back pain." 1,2,5 A nurse is teaching a patient to obtain a specimen for fecal occult blood testing using fecal immunochemical testing (FIT) at home. How does the nurse instruct the patient to collect the specimen? 1. Get three fecal smears from one bowel movement. 2. Obtain one fecal smear from an early-morning bowel movement. 3. Collect one fecal smear from three separate bowel movements. 4. Get three fecal smears when you see blood in your bowel movement. 3 What should the nurse teach family caregivers when a patient has fecal incontinence because of cognitive impairment? 1. Cleanse the skin with antibacterial soap and apply talcum powder to the buttocks. 2. Initiate a bowel or habit training program to promote continence. 3. Help the patient go to the toilet once every hour. 4. Use sanitary pads in the patient's underwear. 2 The patient states, "I have diarrhea and cramping every time I have ice cream. I am sure this is because the food is cold." Based on this assessment data, which health problem does the nurse suspect? 1. A food allergy 2. Irritable bowel syndrome 3. Increased peristalsis 4. Lactose intolerance 4 A patient has been hospitalized with a serious flulike infection and is on bed rest. He is receiving multiple medications through two different IV infusions and is on high-flow oxygen therapy by oxygen mask. Currently the patient's head of bed is elevated to semi Fowler position. The patient initiates little movement and responds only to being shaken. Vitals signs are temperature, 38.6°C (101.6°F); heart rate, 88 beats/min; blood pressure 140/84 mm Hg; and respirations, 20. Which of the following assessment findings suggest that the patient has a risk for an immobility complication? (Select all that apply.) 1. High-flow oxygen therapy by mask 2. Positioned semi-Fowler 3. Temperature 38.6°C (101.6°F) 4. Receiving multiple medications 5. Initiates little movement 6. Reduced conscious response 7. Bed rest 1,3,5,6,7 A nurse is caring for a patient who was in an auto accident and has entered rehab after a 6-day hospitalization. The patient had multiple internal injuries and has nursing diagnoses of Hopelessness and Impaired Mobility at time of discharge. The nurse's assessment revealed the patient asking nurses to let him stay in bed and the patient having limited involvement in hygiene and a loss of appetite. The patient has a cast on his nondominant left hand and has reduced movement in the right lower leg, which is splinted. The health care provider has ordered the patient to ambulate 3 times a day. Which of the following is a priority for the rehab nurse? 1. Providing assistance with meals 2. Teaching patient exercises to strengthen right leg 3. Making preferred hygiene products available to the patient to use 4. Setting times to discuss relationship of hopelessness to injuries 4 A patient has been on bed rest for over 5 days. Which of these findings during the nurse's assessment may indicate a complication of immobility? 1. Decreased peristalsis 2. Decreased heart rate 3. Increased blood pressure 4. Increased urinary output 1 Place the following steps in the correct order for repositioning a patient in the 30-degree lateral side-lying position using two nurses. 1. Using knee and hip for leverage, nurse rolls patient onto side. 2. Nurse facing patient's back places hands under patient's dependent shoulder and brings shoulder blade forward. 3. Place pillows under semiflexed upper leg level at hip from groin to foot. 4. Flex patient's knee that will not be next to mattress, after being turned. Keep foot on mattress. Nurse places one hand on patient's upper bent leg. 5. Place hands under dependent hip and bring hip slightly forward so angle from hip to mattress is approximately 30 degrees. 6. Position patient on side of bed in opposite direction toward which patient is to be turned, then move upper and lower trunk. 7. Lower head of bed completely or as low as patient can tolerate. One nurse on each side of bed. 7,6,4,1,2,5,3 The effects of immobility on the cardiac system include which of the following? (Select all that apply.) 1. Thrombus formation 2. Increased cardiac workload 3. Weak peripheral pulses 4. Irregular heartbeat 5. Orthostatic hypotension 1,2,5 A 46-year-old patient is admitted to the emergency department following an automobile accident. The patient has a pelvic fracture and is ordered on bed rest and placed in an immobilization device to limit further injury until the fracture can safely be repaired. Which measures are appropriate for this patient to prevent complications of bed rest? (Select all that apply.) 1. Administer IV analgesic as ordered. 2. Have patient perform incentive spirometry. 3. Support patient in active assisted ROM exercises of upper extremities. 4. Provide patient a low-calorie diet. 5. Apply SCDs to legs. 2,3,5 A patient has an order for application of compression stockings. Place the following steps for application of the compression stockings in the correct order: 1. Place patient's toes into foot of stocking up to the heel; keep smooth. 2. Use tape measure to measure patient's leg for proper stocking size. 3. Slide stocking up over patient's calf until sock is completely extended. 4. Turn elastic stocking inside out, keeping hand inside holding heel. Take other hand and pull stocking inside out until reaching the heel. 5. Slide remaining portion of stocking over patient's foot, covering toes. Be sure foot fits into toe and heel of stocking. 2,4,1,5,3 An older-adult patient is admitted following a hip fracture and surgical repair. Before ambulating the patient postoperatively on the evening of surgery, which of the following would be most important to assess? (Select all that apply.) 1. Patient's usual exercise pattern at home 2. Time and date of the patient's last bowel movement 3. Preadmission activity tolerance 4. Baseline heart rate and blood pressure 5. Patient's home living situation 3,4 A nurse is helping a patient perform active assisted ROM in the right elbow. Which statement describes the correct technique? 1. Support elbow by holding distal part of extremity. 2. Grasp joint with fingers to provide support. 3. Have patient move joint independently. 4. Move the joint past the point of resistance. 5. Perform the exercise three times during the session, and gradually build up to more. 1 A middle-aged adult patient has limited mobility following a total knee arthroplasty. During assessment, the nurse notes that the patient is having difficulty breathing while lying supine. Which assessment data support a pulmonary issue related to immobility? (Select all that apply.) 1. Oxygen saturation of 89% 2. Irregular radial pulse 3. Diminished breath sounds in bilateral bases of lungs 4. Blood pressure 132/84 mm Hg 5. Pain reported at 3 on scale of 0 to 10 following medication 6. Respiratory rate of 26 1,3,6 Epidermis in the elderly Generalized thinning except some sun spots that are thicker Where are prickle cells located? In the epidermis What is located in the dermis? Contains blood vessels, nerves, hair follicles, and sebaceous glands Dermal elastic in responsible for? The skin! Collagen and elastin make up what? The dermis Elastosis Caused by sunlight and provides a weather beaten/tanned appearance. Caused by collagen bundles becoming thicker Dermal skin and aging Aging causes a decrease in the vascularity of the dermal skin AEB by a decrease in the number of epithelial cells and blood vessels What produces thick, course facial hair in white women? The adrenal androgens Sweat glands and aging Decrease in size, number, and function Eccrine glands and aging The secretory epithelial cells become even in size and lipofuscin in the cytoplasm Apocrine glands and aging Don't decrease in number or size but they do decrease in function. Lipofuscin accumulates Intertriginous Skin folds. Warm and moist Acral Pertains to the distal extremities, ears, and nose Verrucae Warts. Benign papilloma is caused by the papillomavirus. The stratum corneum is irregularly thickened Bronze skin is an indicator of Addisons disease The secretory cells of the eccrine glands in aging The secretory cells of the eccrine glands are replaced by fibrous tissue which decreases the ability to sweat HSV Tingling/burning sensation are signs Treat it with antivirals and acyclovir to decrease the spread Where to HSV lie dormant? In the trigeminal nerve and other ganglia Herpes Zoster Acute, localized inflammatory disease of he dermatomal segments of the skin Herpes Zoster infections Follow a unilateral dermatomal distribution on the thorax, trunk, or even the face What is post-herpatic neuralgia? Most common complication of hepres zoster in the elderly. It's a recurrent pain AFTER the HZ rash has gone away Tinea Manis Hand Tinea Cruris Groin Tinea Unguium Toenail Tinea Corpus Trunk Tinea Barbae Beard Tinea Faciei Face Impetigo bacterial inflammatory skin disease characterized by vesicles, pustules, and crusted-over lesions. Caused by staph or strep Syphilis 3 stages. 1-Single chance on genitalia 2-Disseminated rash 3-Permenant cardiac and CNS damage TX-PCN Leprosy A skin and nerve disease that causes open sores on the body. Chronic infectious disease caused by intracellular mycobacterium leprae Lupus Discoid-Scaly red plaques with scarring Systemic-Butterfly shaped rash Psoriasis Silvery papules and plaques Lichen Planus Chronic, pruritic disease involving inflammations, papular eruption of the skin and mucous membranes. Acne Vulgaris Disease of the pilosebaceous unit. Happens when sludging of the sebaceous oils and deposition of loose endothelial cells cause an obstruction of the follicular canal. Build up of oil on the skin and clogs the follicle. Atopic dermatitis AKA atopic eczema Genetic defect in the epidermal barrier protein called filaggrin which causes the disease. Kids can "grow out of it" Atopic dermatitis cause Has to deal with an allergy, hx of allergic rhinitis, or eczematous dermatitis. Thickens the skin. IgE mediated hypersensitivity. Erythema in kids and pruritis and dry skin are symptoms. Older kids and adults have litchenification, dry scaling, and papules Contact Dermitis Cell mediated type of hypersensitivity response brought on by a sensitization to an alleren such as a toxin like poison ivy. Can cause Rhus dermatitis. Linear pattern, produces vesicles Pediculosis Lice infestation Blood flukes Found in freshwater lakes. Invasion of duck worms Rocky Mountain Spotted Fever Rickettsia rickettsii Initial site is a papule/macule with or without a central punctate area. Dioxycycline is TX of choice Lyme Disease Caused by spirochete from borrelia burgdorferi found in deer and mice. 3 stages Scleroderma Autoimmune disease of connective tissue characterized by excessive collagen disposition in the kin and internal organs like the lungs, GI tract, heart, and kidneys Localized scleroderma Single or multiple violet colored, firm, inelastic macules and plaques that enlarge slowly Scleroderma key feature Saber cut! On scalp or on side of the face/body. Rare to relapse Diffuse scleroderma Hardens like hide and is 50% fatal Diffuse scleroderma s/s Thick skin with decreased elasticity. Permanent hair loss, "stone face" due to restrictive movement What causes sunburn and what can sunburn cause? Caused by short UV wavelengths. can cause malignant melanoma Congenital ichthyosis Excessive growth of keratinocytes and keratin. Causes fish like scales What causes corns and callouses? Hyperkeratosis What causes moles? Melanocytes What causes squamous papillomas? Keratinocytes Kaposi sarcoma Opportunistic disease from a decreased immune system. Purplish macules Melanoma= Fatal Opportunistic infection Microbe that causes disease in humans who are immunocompromised. Endotoxin Toxin that's present inside a bacterial cell and is released when it disintegrates. Exotoxin Toxin released by a living bacteria cell into the surrounding area Gram - Pink/red Have a mesh membrane but a strong protective shell. More resistant, more mortality Gram + Purple Thicl, mesh like membrane Infection State of cellular tissue or organ destruction resulting from invasion by microorganisms B & T cells Lymphocytes, helper cells. Respond to viral infections but can take days to weeks to respond Pathogen characteristics Adheres and invades Bacterial endotoxin Bacterial exotoxins and enzymes Evasion of immune cells Forms endospores Resistant to antimicrobials Virulence Potential pf the microorganisms to cause disease in the host Anaerobic Without oxygen Aerobic With oxygen Viruses Smallest infective agent that's made up of a DNA/RNA shell. Replicates themselves. What is the first step for the virus? Attachment to the target cell How are viruses released? They do NOT manufacture an envelope. They are released by lysing the cell and then destroying the host cell What kind of virus is covid? Retro virus Fungi Mycotic infection Obstructive asthma Harder to get air OUT. Longer exhale Traps air in the lungs so lung volume increases FEV 1 Forced expiratory volume in one second. If it's less than 0.7, its and obstructive respiratory disease FVC Forced vital capacity. Measures the amount of air a person can forcibly and quickly exhale after taking a deep breath Obstructive asthma classification Obstructive from conditions in the wall of the lumen like asthma or bronchitis. Also seen as increased pressure around the outside of the airway lumen like in emphysema Asthma A chronic inflammatory condition of the smaller airways. Usually reversible Asthma S/S Diffuse wheezing, dyspnea, and coughing due to spasmodic contractions --Are the largest players in inflammatory cell infiltration Eosinophils! Atopy Genetic tendency to develop allergic diseases like asthma, atopic dermatitis, etc. Atopic triad Asthma Allergic rhinitis Atopic dermatitis Response to allergens What causes narrowing in the airways? Contracted airways muscles Airway walls swell Excess mucous These all cause hyperinflation of the lungs. Watch for resp acidosis Intrinsic asthma Non allergic, adult onset. Caused by RTI or virus IgE Plasma cells are activated when we come across an allergen Extrinsic asthma increases what levels? Also increases eosinophils as well as IgE What happens during extrinsic asthma? Normal resp epithelium is replaced by goblet cells, resulting in edema, bronchoconstriction, and an increase in microvascular permeability What do golblet cells do? Responsible for mucous production Triggers for extrinsic asthma Roaches, pollen, dander, mold, grass, foods, etc Exercise induced asthma Bronchospasms that occur within 3 minutes after the end of exercise. Caused by running, jogging, and tennis. Common in kids and adolescents Exercise induced asthma causes what? Heat loss Water loss Increased osmolarity of the lower respiratory tract Occupational asthma S/S get progressively worsen after each exposure. Conduct a challenge test by inhaling the suspected dust If not experiencing symptoms, a chest x-ray will be negative Drug induced asthma Can produce S/S from mild rhinorrhea all the way to resp arrest. Avoid NSAID's Samplers Triad Asthma ASA sensitivity Nasal polyps ASA shunts arachidic acid to prostaglandins. ASA causes bronchoconstriction In the samplers triad, what is released by mast cells? Leukotrienes What causes wheezing? Caused by a vibration of narrowed airways Inspiratory wheezing reflects airway constriction Tachycardia is a sign of Hypoxemia Prolonged expiration Can't get air out Status asthmaticus X-ray May show hyperinflation of the lungs with flattening of the diaphragm Status asthmaticus labs CBC: Increase in WBC, increase in eosinophils. Increased PCo2 means resp acidosis Status asthmaticus tx Beta 2 agonists like albuterol Corticosteroids Leukotriene modifiers Mast cell inhibitors If severe, epi and nebulizer Restrictive lung disease Harder to get air IN Decreases lung volume Caused by long term inhalation of particles such as coal miners FVC levels 0.7 Restrictive 0.7 Obstructive Restrictive lung disease S/S Productive cough that worsens, dyspnea with exercise, finger clubbing, cor pulmonale (R sided HF), hypercapnia Extrinsic asthma AKA atopic asthma related to allergies. It's genetic Extrinsic asthma patho Collagen disposition beneath basement membranes, edema, mast cell production Extrinsic asthma S/S Genetic disposition to atopy, structural disposition due to smaller airways An infectious disease that is common in a community is termed: a) endemic b) epidemic c) pandemic d) partdemic a The most common method of disease transmission is: a) airborne b) droplet c) vector d) inoculant b Immune function is likely to be most effective in a a) newborn b) 7-month-old infant c) 30-year-old d) 70-year-old c A characteristic of some bacteria a) is intracellular parasite b) is composed of RNA or DNA c) contains cell wall endotoxin d) cannot replicate extracellularly c The term used to describe fungal infections is a) sepsis b) mycoses c) amebiasis d) Chlamydia b Drug resistance of microbes occurs secondary to a) patient allergy to a drug b) mutation of the microbe c) enhance pathogenicity of the microbe d) using high doses of drugs b dietary zinc is an important defense against infections, because it maintains (select all that apply) a) natural killer cell function b) lymphocyte activity c) antioxidant activity d) neutrophil activity e) complement activity a, b, d, e Characteristics of immunization include which of the following? (select all that apply) a) giving injections of preformed antibodies provides immediate immunity b)Immunization provides life-long immunity c) Immunization with killed vaccines may lead to infection from the agent d) Herd immunity controls disease without immunizing everyone in the population e) lack of immunization may lead to an epidemic A, D, E Risk of infection is increased in (select all that apply) a) Use of corticosteroids b) Diabetes mellitus c) Spleen removal d) Stomach removal e) Stress A, B, C, E Atopic dermatitis (eczema) is caused by a) parasitic infestation of the skin b) superficial staphylococcal infection c) Superficial fungal infection d) contact with skin allergens d Itchy linear burrows on the hands and wrists are associated with a) tick bites b) Rocky Mountain Spotted Fever c) Scabies d) Contact dermatitis c It is true that vitiligo a) occurs as a result of a genetic lack of melanin production b) is a depigmented patch of skin c) occurs most commonly in light-skinned individuals d) Is a warning sign for malignant melanoma b Deep pressure ulcers usually a) appear first as reddened areas that do not blanch b) begin in the dermal and epidermal skin layers c) result from thrombosis of deep vessels d) are an unavoidable consequence of immobility c The cancer considered to be the most malignant is a) hyperkeratosis b) basal cell carcinoma c) squamous cell carcinoma d) melanoma d The presence of a widely distributed pruritic maculopapular rash and erythema is commonly associated with a) psoriasis b) drug reaction c) scleroderms d) bedbug bites B At puberty when sebaceous gland secretion increases, follicle obstruction and infection may occur, resulting in a) psoriasis b) eczema c) acne vulgaris d) pemphigus c Acute, painful inflammation with vesicles along the distribution of a spinal nerve (dermatome) is a characteristic of a) herpes zoster b) herpes simplex c) HPV d) tinea A A topical therapy that would tend to dry the skin because it is an astringent is a) lotion b) gel c) cream d) ointment B Corticosteroids are commonly administered for the management of skin disorders because they a) are analgesics b) prevent infection c) enhance collage production d) reduce inflammation d A 4-year-old is brought to the clinic for evaluation of dry, scaly, itchy patches on the face, antecubital areas, and behind the ears and knees. The skin is dry overall, and there is evidence of scratching. This is likely a case of a) impetigo b) atopic dermatitis c) psoriasis d) scabies B Which finding indicates a need for further evaluation of a nevus mole? a) The presence of light pigmentation b) variations in color within the nevus c) very dark coloration of the mole d) diameter less than 2 mm b Manifestations of herpes zoster include a) multiple fluid-filled vesicles on the lips, tongue, and hands b) generalized painful maculopapular rash C) red itchy palms & soles of feet d) dermal distribution of lesions and pain d Impetigo is a skin infection caused by a) Fungus b) Yeast c) bacteria d) parasite c Scleroderma is characterized by a) large weeping open sores b) thickening and decreased elasticity of the skin c) butterfly rash on face d) Hair loss and ulcer formation on the extremities b Which type of dermatitis is associated with cradle cap in newborns a) irritant b) seborrheic c) atopic d) status B What is the most common benign form of skin cancer a) Basal b) squamous c) melanoma d) actinic keratosis a What is the most deadliest form of skin cancer? a) Basal b) squamous c) melanoma d) actinic keratosis C Shingles is caused by the same virus that causes a) Measles b) mumps c) chickenpox d) rubella c which finding is a characteristic of oral candidiasis a) silvery plaques on the skin b) itching oozing rash c) thickened discolored nails d) Whitish coating on tongue d Post-infective painful neuralgia can complication of a) shingles b) herpes simplex c) impetigo d) verrucae a A major difference between a vesicle and a wheal is that vesicles a) a contain fluid but wheals are edematous b) are palpable, but a wheal is not c) are larger than wheals d) are smaller than wheals a A difference between chickenpox and measles is that chickenpox a) is caused by a virus, whereas measles is caused by a bacterium b) causes a widespread rash, whereas measles causes a macular rash c) is a childhood infection but measles can involve into shingles as adults d) causes vesicles that scab, whereas measles remain as a macular rash d Psoriasis is characterized by a) a silvery scale on the skin b) itchy oozing rash c) thickened discolored nails d) white-ish coating on tongue a Conditions caused by a virus include a) athletes foot b) boils c) warts d) impetigo c Onycholysis is characterized by a) a silvery scale on the skin b) itchy oozing rash c) destruction of nails d) white-ish coating on the tongue c SELECT ALL herpes simplex 1 infection a) causes both oral and genital infections b) burning tingling sensation c) reactivates with stress, sun exposure, and menses d) is painless e) remains latent in spinal ganglia between outbreak B, C, E Allergic (extrinsic) asthma is associated with a) hyporesponsiveness of airways. b) unknown precipitating factors. c) IgE-mediated airway inflammation. d) irreversible airway obstruction. c All obstructive pulmonary disorders are characterized by a. resistance to airflow. b. hyperresponsiveness. c. decreased residual volumes. d. decreased lung compliance. a Asthma is categorized as a(n) a) restrictive pulmonary disorder. b) infective pulmonary disorder. c)obstructive pulmonary disorder. d) type of acute tracheobronchial obstruction. c Which pulmonary function test result is consistent with a diagnosis of asthma? a)Reduced forced expiratory volume in 1 second (FEV1) b)Decreased functional residual capacity c) Increased FEV1 d) reduced total lung volume a After evaluation, a child's asthma is characterized as "extrinsic." This means that the asthma is a) of unknown pathogenesis. b) associated with specific allergic triggers. c) associated with respiratory infections. d) induced by psychological factors (stress). b Obstructive disorders are associated with a) low residual volumes. b) low expiratory flow rates. c) increased expiratory reserve volume. d) decreased total lung capacity. b When exposed to inhaled allergens, a patient with asthma produces large quantities of a. IgG. b. IgE. c. IgA. d. IgM. b In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event? a- Loss of alveolar elastin and premature closure of airways b- Pulmonary edema and decreased alveolar compliance c- Mast cell degranulation that causes decreased surfactant d- Inflammation, mucosal edema, and bronchoconstriction d Which complication of asthma is life threatening? a) Exercise-induced asthma b) Late phase response c) Status asthmaticus d) Mast cell degranulation c he increased anterior-posterior chest diameter associated with obstructive lung disease is caused by a) increased pulmonary blood flow. b) increased expiratory flow rates c) increased residual lung volumes d) decreased chest wall compliance c The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment? a) The child probably has consolidated pneumonia; oxygen should be started immediately. b) Since there is not wheezing, asthma is the problem, but oxygen should be started immediately anyway. c) The signs and symptoms are consistent with asthma; start oxygen and then check to see that your stethoscope is working properly. d) The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately. d An acute asthma attack is associated with (Select all that apply.) a) bronchoconstriction. b) bronchial mucosal edema. c) hypersecretion of mucus. d) alveolar collapse. e) hypoxemia. A, B, C, E When assessing an individual during an acute asthma episode, you should expect to find (Select all that apply.) a) use of accessory breathing muscles. b) expiratory wheezing. c) foul-smelling sputum. d) coughing. e) feeling of chest tightness A, B, D, E Characteristics of asthma include (Select all that apply.) a) chronic inflammatory disorder. b) airway hyperresponsiveness. c) alveolar collapse. d) genetic susceptibility. e) airway remodeling. A, B, D, E A restrictive respiratory disorder is characterized by a) increased total lung capacity. b) decreased residual volume. c) inspiratory wheezing. d) expiratory wheezing. B Chronic occupational lung disease is characterized by (Select all that apply.) a) causation from long-term inhalation of inorganic material. b) a latent period before symptoms occur. c) hyperactive respiratory macrophages. d) a progressive cough and dyspnea with exercise. e) possible negative chest x-ray when symptom-free. A, B, D, E