Galen NUR 242 Exam 3 Respiratory Set With 100% correct answers 2025-2026 already graded A+

What is sleep apnea?

person stops breathing for at least 10 seconds repeatedly during sleep

What is the most common cause of sleep apnea?

obstructive sleep apnea

What is the pathophysiology of obstructive sleep apnea?

airway is restricted as a result of tissue collapse in the airway

How is pharyngeal space decreased during sleep?

muscle in airway relax causing tongue and soft palate to be come displaced

What are the risk factors for obstructive sleep apnea

obesity, large neck circumference, narrowed airway, chronic nasal congestion, allergic rhinitis, smoking, diabetes, family history, asthma, non-white, age 50-59, male, recessed lower jaw

What defines large neck circumference?

Men neck > 17in; Women neck >16 inches

What is the stereotype for obstructive sleep apnea?

obese, middle aged male

Obstructive sleep apnea symptoms at night

snoring, restlessness, nocturia, gasping for air, choking, apneic events(minimum of 10sec), sweating

Obstructive sleep apnea daytime symptoms

exhaustion, irritability, morning headaches, memory loss, dry mouth

Consequences of obstructive sleep apnea

relationship tensions, hypertension, right sided heart failure, pulmonary hypertension, arrhythmias, myocardial infarction, angina, hypoxia, polycythemia Vera

How does obstructive sleep apnea get diagnosed?

formal sleep study

What is the non-surgical treatment of obstructive sleep apnea?

weight loss, avoid alcohol, avoid sedatives, avoid smoking, sleep on side, elevate head of the bed, intra-oral devices, CPAP

What does a CPAP do?

prevents airway collapse by using the continuous pressure to keep bronchioles and alveoli slightly open

What are the surgical treatments for obstructive sleep apnea?

T&A (peds), nasal surgery, UPPP, oral appliance

What does an oral appliance do to treat obstructive sleep apnea?

moves the jaw forward to reduce the narrowing of the airway that exists

What is asthma?

chronic obstructive pulmonary disease of the airway that occurs from inflammation and hyper responsive ness

Is asthma reversible?

Yes, if caught early enough but too much time causes scaring and then it cannot be reversed

What assessment findings would you expect to see in a patient with asthma?

chest tightness, dyspnea, wheezing, cough, accessory muscle use, tachypnea

What are the triggers of asthma?

idiopathic, exercise, infection, GERD, air pollution, allergens, medications

What are the normal symptoms of asthma?

short of breath, increased respiratory rate, coughing, chest tightness, dyspnea, wheezing (esp on exhalation)

What are the alarm symptoms of asthma?

use of accessory muscles, decreased breath sounds, diaphoresis, cough that will not stop, silent chest

What is AERD?

aspirin exacerbated respiratory disease

What are the clinical features of AERD?

asthma, sinus disease, sensitivity to aspirin and other NSAIDS

What are the symptoms of AERD?

nasal congestion, rhinorrhea, sneezing, laryngospasm, cough, wheeze, loss of sense of smell, chest tightness

What treatment is used for AERD?

avoid all NSAIDs and alcohol; some may also need daily inhaled corticosteroids

What are the treatment options for asthma?

short acting beta agonist (SABA), long acting beta agonist (LABA), inhaled corticosteroids, cromolyn, leukotriene receptor agonist (LRA)

What is the only medication to be used in an acute attack or emergent asthma episode?

albuterol

What is the goal of a spacer?

make more medication reach the lungs

Which zone on an peak flow meter indicates a need for emergency care?

Red

What is the nursing care for an acute asthma attack?

airway, high fowler's position, oxygen, SABA, steroids, IV magnesium, continued breath sound assessments

What are the nursing interactions for a health promotion and maintenance for asthma?

education on how to use inhaler, education on triggers, prevention efforts, influenza and pneumonia vaccines, smoking cessation, activity

What is COPD?

chronic obstructive pulmonary disease

What respiratory condition is progressive, non-reversible, obstructive disease that is broken down into emphysema and bronchitis?

COPD

What is the pathophysiology of COPD?

inflammation of airways, bronchoconstriction, airflow limitation, airway obstruction

Risk factors of COPD

smoking, A1AT deficiency(inherited)

COPD symptoms

productive cough, dyspnea on exertion, breathlessness, wheezing, barrel chest, cyanosis, JVD, polycythemia, weight loss

Signs of an acute exacerbation of COPD

worsening of symptoms caused by infection, CHF or air pollution, not responsive to outpatient treatment, hypercapnia, altered mental status, change in sputum characteristics, tachypnea, tachycardia

What testing is reviewed for COPD?

PFT, ABG, CXR, EKG, Echocardiogram, CBC

Why is an echocardiogram used in workup of COPD?

right sided heart impact

What will ABG show in patient with COPD

respiratory acidosis (ex: pH 7.2, PCO2 60)

What medical management can be used for COPD?

supplemental oxygen, albuterol, atrovent, long acting beta agonist, inhaled corticosteroids, smoking cessation, flu and pneumonia vaccine

What nursing interventions are related to airway patency for COPD patients?

suction, upright positioning, assessment and monitoring of SPO2 (acute exacerbation - continuous SPO2 preferred)

What nursing interventions are related to nutrition and hydration for COPD patients?

bronchodilators 30 minutes before meals, easy to chew and no gas forming foods, limit caffeine, high protein, high calorie, >2L of fluids today, 4-6 small meals per day

What nursing interventions are related to education for COPD patients?

smoking cessation, breathing exercises, positioning, effective coughing, oxygen therapy, pulmonary exercise, rest and vaccines

What is the preferred oxygen saturation for patient with COPD?

88-92%; just enough hypoxia to trigger drive to breathe

What benefit does pursed lipped breathing provide?

releases trapped air and creates a slower more effective breathing pattern

What is rhinosinusitis?

inflammation of nasal mucosa and sinus cavity in the skull leading to blockage and build up of fluid and pressure

What are the symptoms of rhinosinusitis?

facial pain, headache, stuffy nose, nasal discharge, tooth pain

What physical exam findings would you expect to see with rhinosinusitis?

tenderness on palpation and motion of head forward causing discomfort

What is the medical management of rhinosinusitis?

symptomatic treatment, if symptoms persist 10 days or worsening before 10 days then antibiotic therapy

What is influenza?

acute viral respiratory infection that can occur at any age

What are the types of influenza

Types A, B, and C (A is most common)

What symptoms are associated with influenza?

high fever, headache, runny nose, sore throat, cough, red eyes, myalgias

What is the most serious complication of influenza?

Pneumonia (usually due to staph aureus)

Symptoms of pneumonia

bloody cough, hypoxemia, elevated WBC, infiltrates on CXR

High risk populations for pneumonia complications

children < 5 years old, pregnant women, adults > 65, American Indians, Alaska Natives, DM, CVD, chronic lung disease, weakened immune systems

How is influenza diagnosed?

rapid test that determines type but not strain

How soon after symptom onset can treatment be started for influenza?

best at 24 hours but no later than 48 hours

What is the preferred treatment option for influenza

oseltamivir

What diagnostic finding is indicative of pneumonia?

Inflitrate on chest x-ray

How often does a patient need a flu vaccine?

once a year

What education is needed for patient trying to prevent flu?

annual vaccine, hand hygiene, covering mouth and nose when coughing or sneezing

What groups should always have a flu vaccine?

adults >50, chronic illness, immunocompromised, healthcare professionals providing direct patient care

What are the three types of pneumonia?

community acquired, hospital acquired, healthcare acquired

Risk factors for community acquired pneumonia

smoker, immunosuppressed, age >60 or <2, never vaccinated

Indicators of hospital acquired pneumonia

onset 48 hours or more after admission to the hospital, usually bacterial (pseudomonas,MRSA)

Risk factors of healthcare acquired pneumonia

spent more than 48 hours in a hospital in the last 90 days, lives in nursing home or assisted living facility, recipient of IV therapy, wound care, or chemotherapy in the last 30 days,

What physical exam findings are associated with pnuemonia?

rales, rhonchi, tachypnea, chest pain, dyspnea

What is the medical management for community acquired pneumonia?

macrolide or fluoroquinolone

What is the treatment for healthcare acquired pneumonia that is anti-pseudomonal?

Vancomycin with or without a fluroquinolone

How does a patient properly perform incentive spirometry?

1. Put mouth around mouthpiece

2. Breathe in as deep as able

3. Hold breath for 1-2 seconds

4. Turn head and cough

What is a good reading for a young healthy patient doing incentive spirometry?

2000-3000

What non-medical treatment can be used for pneumonia?

incentive spirometry, activity, supplemental oxygen, SPO2 monitoring, hydration

What diagnostic test is important for pneumonia?

daily chest x-ray

What are the guidelines for pneumonia vaccine?

patient over 65: prevnar 13 followed by pneumovax 1 year later

patient 19-64: chronic illness (heart, liver, kidney disease, lung disease) DM, alcoholism, immunosupression, smoker); prevnar 13 followed by pneumovax 1 year later

What is tuberculosis?

contagious disease that generally affects the lungs but may affect other parts of body

What pathogen causes tuberculosis?

Mycobacterium tuberculosis

How is tuberculosis transmitted?

Inhalation of infected respiratory droplets

What groups are at greatest risk for TB?

alcoholics, immigrants, healthcare workers, nursing home patients, HIV/AIDS, homeless

What are the symptoms of TB?

fever, sputum production, productive cough, anorexia, fatigue, malaise, weight loss, drenching night sweats

What hospital precautions should be taken for TB?

negative pressure room, N95 mask, Powered Air Purifying Respirator, door closed, limit visitors when possible and anyone visiting needs N95

How many people can be suffering from active TB at one time?

15 million

How is TB diagnosed?

PPD skin testing; Chest x-ray most useful in emergency department, active TB usually presents with parenchymal infiltrates; Sputum culture for AFB

What are the 4 drugs used to treat TB?

INH

Rifampin

Ethambutal

Pyrazidamide

What drugs are a part of phase 1 TB treatment

INH

Rifampin

Ethambutal

Pyrazidamide

What drugs are part of phase 2 TB treatment

INH

Rifampin

What tests are needed to determine TB is no longer active?

Sputum culture and CXR

What induration determines a positive PPD?

> or equal to 5mm in immunocompromised patient

> 10mm in patient who recently immigrated or exposed to high risk region

> 15mm in any person

What do you measure to determine positive TB skin test?

Induration (hardness of wheel) *not the redness*

What are the important patient teachings in trach care?

clean procedure in home setting, wear a shower shield, increase home humidity or use a humidifier, wear filter cover to filter air

What is needed for tracheal suctioning?

12-14 FR suction catheter, suction set to 80-120 mmHg, Preoxygenate with 100% O2 for 30 sec- 3min, ensure sterile technique

Tracheal Suctioning Process

Apply suction only when withdrawing

Withdraw catheter applying continuous suction and using a twirling motion

Suction applied for no > 10-15 sec

May repeat for a total of 3 passes

Hyperoxygenate after suctioning until the patient's HR and RR return to baseline

Purpose of Thoracentesis

Used for fluid removal from the lung and assist with lung re-expansion

Clinical considerations of thoracentesis

Position patient leaned over bedside table and prevent them from falling

MD should remove no more than 1000cc at a time

STAT post procedure CXR to rule out pneumothorax

Deep breathing following thoracentesis to help lung expansion

What complication can occur after thoracentesis?

pneumonthorax

What are the signs of pnemothroax?

Pain with inhalation, increased HR, increased RR, Air hunger, new onset nagging cough