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Nursing Exam 3

Fundamentals Test

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