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Nursing Exam 3
Fundamentals Test
| Question | Answer |
|---|---|
| The thorax is made up of ___, sternum and ___; protects heart, ___ and great ___. | ribs, vertebrae, lungs, vessels |
| ___ breath sounds - loud, high-pitched, tubular sounds caused by air moving through trachea | bronchial |
| bronchial breath sounds -___ longer duration than ___ | expiration, inspiration |
| ___ breath sounds - medium-pitched, caused by air moving through bronchi | bronchiovesicular |
| bronchiovesicular breath sounds are best heard where (anterior and posterior locations)? | over 1st and 2nd ICS (anterior) and between scapula (posterior) |
| ___ breath sounds - equal inspiratory and expiratory rates | bronchiovesicular |
| ___ breath sounds - soft, low-pitched, breezy, air moving in smaller airways make these sounds | vesicular |
| vesicular breath sounds are best heard over ___ fields | lung |
| ___ breath sounds have a lengthy inspiratory phase and a short expiratory phase | vesicular |
| wheezing, ronchi, rales are all ___ (or abnormal breath sounds) | adventitious |
| expected respiratory findings - ___ to ___ breaths per minute in adults and ___ to ___ a newborns | 12, 20, 40, 90 |
| AP lateral ratio in adults | 1:2 |
| AP lateral ratio in infants is equal to lateral ___ | diameter |
| COPD AP lateral ratio is ___, barrel chest | increased |
| lateral curvature of spine | scoliosis |
| excessive thoracic curvature of spine | kyphosis |
| sternal and intercostal retractions are seen in ___ or ___ ___ | hypoxia, respiratory distress |
| deviation of trachea may be caused by ___ enlargement or ___ ___ | thyroid, tension pneumothorax |
| term used for air leaking into subQ tissue, may occur around wounds, central IV, chest tubes, tracheostomy | crepitus |
| ___ chest excursion occurs with shallow breathing, restrictive clothing, airway disease | limited |
| ___ chest excursion may result from airway obstruction, pleural effusion, pneumothorax | asymmetrical |
| ___ ___ is diminished if chest wall is very thick or voice very soft, increased respiratory rate e.g. pulmonary edema, decreased or absent w/decreased air movement e.g. emphysema, asthma | tactile fremitus |
| when percussing the chest, dullness is heard when there is ___ or mass in lungs | fluid |
| air trapping that is heard with emphysema is called ___ | hyperresonance |
| normal distance of diaphragmatic excursion is 3 to __ cm | 6 |
| decreased diaphragmatic excursion may indicate ___, paralysis or ___ | atelectasis, COPD |
| name the 2 main networks of blood vessels; ___ and ___ circulation | pulmonary, systemic |
| ___ circulation, oxygen depleted blood - from heart into lungs, where it is oxygenated | pulmonary |
| ___ circulation, coronary circulation, circulates blood through heart itself | systemic |
| always listen to heart in the same… | order |
| ___ is when atria contract (empty), ___ is when ventricles relax (fill) | systole, diastole |
| point of maximal impulse (PMI), is a small pulsation at the ___ ICS | 5th |
| ___ is associated with abnormal blood flow, usually has accompanying murmur | thrill |
| Aunt Polly Takes Meds | aortic, pulmonic, tricuspid, mitral |
| closure of valves between atria and ventricles; S___ | S1 (lub) |
| S1 (lub) is loudest over mitral and ___ areas | tricuspid |
| S1 (lub) marks the beginning of ___ | systole |
| closure of semilunar valves; S___ | S2 (dub) |
| S2 (dub) is loudest at aortic and ___ areas | pulmonic |
| S2 (dub) marks the beginning of ___ | diastole |
| S3 is heard directly after S2 and has a gallop rhythm of KenTUCKy, true or false? | true |
| When is S4 heard and what is the rythm? | immediately before S1 (lub), FLOrida |
| significant distention of jugular vein suggests ___-sided heart failure | right |
| normal venous pressure of jugular vein is <___cm | 3 |
| carotid bruits suggest carotid ___ | stenosis |
| precordium pulsations toward axillary line may indicate left ___ ___ | ventricular hypertrophy |
| precordium pulsations toward the right of sternum may indicate ___ ___ | aortic aneurysm |
| grades of murmurs 1/6 | barely audible |
| grades of murmurs 2/6 | faint but easily audible |
| grades of murmurs 3/6, loud murmur without a ___ ___ | palpable thrill |
| murmur >3/6 is never ___ | innocent |
| grades of murmurs 4/6, loud murmur with a ___ ___ | palpable thrill |
| grades of murmurs 5/6, very loud murmur heard with stethoscope lightly on chest, true or false? | true |
| grades of murmurs ___/6, very loud murmur that can be heard without a stethoscope | 6 |
| signs of pulmonary oxygenation problem are ___, ___, shininess, ___ of nails | pallor, cyanosis, clubbing |
| Allen’s test is used to asses abnormal pulse finds and ___ ___ in hands, pallor resolves in 3-5 seconds | arterial flow |
| ___-___ ___ is used to assess circulatory impairment of feet, abnormal signs are reddish-purple (signs of arterial insufficiency) | ankle-brachial index (ABI) |
| sac of connective tissue encasing heart | pericardium |
| two thin-walled ___ receive blood into heart | atria |
| purpose of ventricles is to pump blood where | out of the heart |
| broadest side of heart is called | base |
| ___ ___ ___ supplies right atrium, right ventricle and inferior surface of the I ventricle and posterior surface of I ventricle, right does 85% of I ventricle | right coronary artery |
| ___ ___ ___ ___ supplies anterior surface of I ventricle, part of lateral surface of I ventricle and most of ___ septum | left anterior descending artery, intraventricular |
| left circumflex artery, a branch of the ___ ___ ___, supplies left atrium part of lateral surface of I ventricle, inferior surface of I ventricle and the posterior surface of I ventricle, does 15% of I ventricle | left coronary artery (LCA) AKA left main coronary artery (LMCA) |
| Which blood, oxygenated or deoxygenated, enters the right atrium via the superior/inferior vena cava | deoxygenated |
| myocardial cells contain ___ ___, mechanical cells, that when electrically stimulated, slide together and myocardial cell contracts | contractile filaments |
| specialized cells of heart’s electrical system, responsible for spontaneously generating and conducting electrical impulses | pacemaker cells |
| action potential cycle has how many phases | 5 |
| action potential phase 0, depolarization, rapid entry of ___ into cell, ___ moves slowly into cell, ___ leaves cell, cell depolarizes, contraction begins, represented by ___ complex | sodium, calcium, potassium, calcium, QRS |
| action potential phase 1, early repolarization, sodium channels partially close, slowing flow of sodium into cell, ___ enters, ___ leaves, results in decreased number of positive electrical charges in cell | chloride, potassium |
| action potential phase 2, plateau phase, calcium slowly enters cell, allows cardiac muscle to sustain an increased period of contraction, responsible for __ segment | ST |
| action potential phase 3, final rapid repolarization, ___ flows quickly out of cell, sodium and calcium channels close (stops entry of sodium and calcium), rapid movement causes inside to become more electrically negative, represented by ___ wave | potassium, T |
| action potential phase 4, resting ___ ___, excess sodium inside cell & excess potassium outside cell, sodium potassium pump activated to move sodium out/potassium in, heart polarized, ready for discharge, cell remains this way until activated by stimulus | membrane potential |
| Deoxygenated blood enters right atrium via ___/___ ___ ___, enters right ventricle via ___ ___, enters left pulmonary artery to left lung. | superior/inferior vena cava, tricuspid valve |
| Oxygenated blood returns to heart via right and left ___ ___ into left atrium, then goes through ___ ___ through left ventricle, then into ___, then enters ___ circulation | pulmonary veins, mitral valve, aorta, systemic |
| cell will not respond to further stimulation and corresponds with onset of QRS complex to peak of T wave during ___ ___ period | absolute refractory |
| vulnerable period, cardiac cells can be stimulated to respond, corresponds with downslope of T wave; ___ ___ period | relative refractory |
| SA node stands for | sinoatrial |
| normal heart beat is result of electrical impulse, begins in SA node that has greatest concentration of ___ cells (have intrinsic rate of 60-100 bpm) | pacemaker |
| Where is the SA node located? | upper posterior part of right atrium |
| atrioventricular junction consists of AV node and non-branching portion of ___ ___ ___ | bundle of HIS |
| rate of atrioventricular junction is ___-___ bpm | 40-60 |
| AV node stands for | atrioventricular |
| group of cells located on floor of right atrium, immediately behind tricuspid valve | AV node |
| ___ node helps regulate number of impulses reaching ventricles | AV |
| after passing through AV node, electrical impulse enters Bundle of HIS, located in upper portion of ___ ___, intrinsic rate of 40-60 bpm | interventricular septum |
| Bundle of HIS conducts electrical impulse to what? | right and left bundle branches |
| RBB innervates ___ ___ | right ventricle |
| RBB and LBB | right bundle branches, left bundle branches |
| LBB spreads electrical impulse to ___ ___ and left ventricle | interventricular septum |
| right and left bundle branches (RBB & LBB) divide into smaller branches known as ___ ___ | purkinje fibers |
| purkinje fibers spread from interventricular septum into ___ ___ | papillary muscle |
| purkinje fibers have pacemaker cells capable of firing ___-___ bpm | 20-40 |
| ECG records electrical activity of large mass of ___ and ___ cells as specific waveforms and complexes | atrial, ventricular |
| ECG electrodes connected to patient, cable goes from electrode to machine, tracing of electrical activity between two electrodes (recording) is called ___ | lead |
| when an ECG is properly calibrated, one millivolt (mV) equals ___mm | 10 |
| ___ wave, atrial depolarization | P |
| Which waveform of cardiac cycle is first? | P wave |
| electrical impulse that originates in SA node, stimulates right atrium, reaches AV node | P wave |
| QRS complex consists of Q, R, S waves, represents spread of electrical impulse through ___ | ventricles |
| ventricular repolarization -___ wave | T |
| ___ segment represents early part of repolarization of right and left ventricles | ST |
| ___ segment - horizontal line between end of P wave and beginning of QRS complex | PR |
| PR segment represents activation of ___ ___, Bundle of HIS, ___ ___ and ___ fibers | AV node, bundle branches, purkinje |
| P wave plus PR segment - PR ___ | interval |
| PR interval reflects depolarization of right and left atria, true or false? | true |
| __ interval represents total ventricular activity (time from ventricular depolarization to repolarization) | QT |
| distortion of ECG tracing, non-cardiac in origin, must assess regularity, rhythm and rate | artifact |
| sinus rhythm - normal heart rhythm ___-100 bpm | 60 |
| sinus ___ - rate slower than normal for patient age (<60 bpm) | bradycardia |
| sinus ___ - rate faster than normal for patient age (101-180 bpm) | tachycardia |
| irregular rhythm, SA node fires irregularly 60-100 bpm - sinus ___ | arrhythmia |
| failure of SA node cells to conduct impulse (atria not activated, appears as single missed beat on ECG) | sinus block |
| sinus arrest (sinus pause) - disorder of property of automaticity, see an absent ___ ___ on strip (missed beat) | PQRST complex |
| PAC (premature atrial complexes) - abnormally shaped P wave, premature heartbeats originating in atria, occur when another region of atria ___ before SA node, triggers premature heartbeat | depolarizes |
| SVT | supraventricular tachycardia |
| SVT includes rhythms that begin in ___ ___, atrial tissue or junction, <180 bpm | SA node |
| ___ ___ - ectopic atrial rhythm, irritable site fires very rapidly and regularly (looks like picket fence) | atrial flutter |
| ___ ___ occurs because of altered automaticity in one or several rapidly firing sites in atria, or reentry involving one or more circuits in atria | atrial fibrillation |
| PVC | premature ventricular contraction |
| arises from irritable site within either ventricle, premature or occurring earlier than next sinus beat | PVC (premature ventricular contraction) |
| ventricular tachycardia exists when 3 or more ___’s occur in a row at a rate of <101-250 bpm | PVC |
| chaotic rhythm, begins in ventricles, no organized depolarization of ventricles, muscle quivers - ___ ___ | ventricular fibrillation |
| total absence of ventricular electrical activity, no rhythm, no rate, no pulse, no cardiac output - ___ | asystole |
| name 3 blood oxygenation tests | pulse oximetry, capnography, arterial blood gases |
| ECG renders electrical activity of heart, not mechanical activity, and records what nerves are telling heart to do. How many nodes are placed on skin? | 3 to 5 |
| purpose of cardiac monitoring is to identify patient’s baseline ___ and ___, recognize changes in ___ and recognize lethal ___ that require immediate attention. | rhythm, rate, dysrhythmias |
| Which wave represents firing of SA node, conduction of impulse through atria? | P wave |
| What represents ventricular depolarization, leads to ventricular contraction? | QRS complex |
| Which wave represents return of ventricles to electrical rest state, ventricular repolarization? | T wave |
| ___ - abnormal heart rhythms | dysrhythmias |
| tachydysrhythmias, rate | > 100 bpm |
| bradydysrhythmias rate | < 60 bpm |
| ectopy | extra beats |
| junctional – within ___ ___ | AV node |
| air moved in or out of lungs with each breath (normally 500mL) | tidal volume (VT) |
| maximum amount of air than can be inhaled above normal tidal volume (VT), ranges from 2000 to 3000 mL | inspiratory reserve volume (IRV) |
| maximum amount of air that can be forcefully exhaled after normal tidal expiration, ranges from 1000 to 1500 mL | expiratory reserve volume (ERV) |
| air remaining in lungs after forceful expiration, ranges from 1000 to 1500 mL | residual volume (RV) |
| combination of tidal volume and inspiratory reserve volume; Formula (VT) + (IRV), ranges from 2500 to 3500 mL | inspiratory capacity (IC) |
| combination of expiratory reserve volume and residual volume, Formula (ERV)+ (RV), ranges from 2000 to 3000 mL | functional residual capacity (FRC) |
| combination of inspiratory reserve volume and expiratory reserve volume, Formula (IRV)+ (ERV), ranges from 3000 to 4500 mL | vital capacity (VC) |
| contrast dye in veins, serial films taken, test patency of vessels | angiogram |
| evaluates effectiveness of gas exchange | ABG (arterial blood gases) |
| insert endoscope, examine larynx, trache, bronchial tree | bronchoscopy |
| catheter in heart, assess pressure, blood flow, size & patency of chambers | cardiac catheterization |
| anterior/posterior or lateral view of heart/lungs, shows density, evaluates size, masses, fluid | chest x-ray (CXR) |
| MB (myocardial band) isoenzyme present only in heart, high serum of MB band, used to detect MI | creatinin kinase-MB (CK-MB) |
| ultrasound, examines heart function / blood flow | echocardiogram |
| electrodes placed on extremities / chest, illustrates heart rate, rhythm, size, helps evaluate heart damage | electrocardiogram (ECG) |
| serum measurement of oxygen-carrying capacity of blood, may be measured separately or part of CBC | hemoglobin (HgB) |
| continuous ECG tracing, to correlate symptoms and cardiac activity, tracing lasts 48 hrs to 7 days | holter monitor |
| series of test to detect lung volume and capacity | pulmonary monitor |
| microscopic evaluation of sputum | sputum culture |
| Technetium-99m sestamibi injected IV, 90 - 120 min later, heart is scanned, myocardial (hot spots) - damaged areas can be viewed | Techneitium scan |
| large-bore needle through chest wall to obtain fluid specimens, instill meds, or drain accumulations | thoracentisis |
| swap of pharynx or tonsils, assess for pathogens | throat culture |
| evaluates exercise on heart and circulation during exercise using ECG and vital signs monitoring | treadmill test |
| serum protein evaluation, evaluates possible MI, levels elevate up to 7 days after MI | troponin |
| assess for pulmonary embolus, radioactive substance injected, flows to lungs for evaluation, 2nd substance inhaled, maps oxygen distribution | ventilation-perfusion scan |
| what serum measurement assesses for infection | white blood cell (WBC) count |
Created by:
BrandiLynn
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