N318 Exam 1 Comprehensive Review – Pulmonary, Cardiovascular, Pharmacology & Safety

A comprehensive set of question-and-answer flashcards covering pulmonary ventilation, gas exchange, respiratory patterns, cardiovascular physiology and pathology, pharmacokinetics, medication safety, infection control, thermoregulation, vital signs, wound healing and safety principles for N318 Exam 1 preparation.

What structures make up the upper and lower airway?

The airway includes the nasal passages, mouth, pharynx, larynx, trachea, bronchi and bronchioles.

What are the primary functions of airway structures?

To moisten, warm and filter inspired air before it reaches the lungs.

How many lobes does each lung have?

The right lung has 3 lobes and the left lung has 2 lobes.

Where does gas exchange occur in the lungs?

In the alveoli—tiny air sacs with thin walls surrounded by capillaries.

What is ventilation?

The movement of air into and out of the lungs through inhalation and exhalation.

Which muscle is the major driver of inhalation?

The diaphragm, which contracts and pulls the chest cavity downward creating negative pressure.

During inhalation what happens to the intercostal muscles?

They contract, helping expand the rib cage and chest cavity.

Does normal exhalation require energy?

No; during quiet breathing exhalation is passive as the diaphragm and intercostals relax.

Define respiratory rate and depth.

Rate is how fast a person breathes; depth is how much the lungs expand with each breath.

Differentiate hyperventilation and hypoventilation.

Hyperventilation is rapid, deep breathing that removes excess CO₂; hypoventilation is slow or shallow breathing that retains CO₂.

What is lung elasticity and how does emphysema alter it?

Elasticity is recoil ability; in emphysema lungs inflate easily but have impaired recoil, making deflation difficult.

What is airway resistance and give one example that increases it.

Resistance is opposition to airflow within the airways; asthma narrows bronchioles increasing resistance.

Define external respiration.

Gas exchange between alveoli and pulmonary capillaries where O₂ enters blood and CO₂ leaves it.

What three conditions can slow diffusion across the alveolar-capillary membrane?

Pleural effusion, pneumothorax and asthma (bronchospasm).

What is internal respiration?

Exchange of O₂ and CO₂ between systemic capillaries and body tissue cells.

What term describes low blood-oxygen levels?

Hypoxia.

Which pediatric virus can severely affect lower airways and survive for hours on surfaces?

Respiratory Syncytial Virus (RSV).

List classic symptoms of active tuberculosis.

Fatigue, weight loss, anorexia, night sweats and blood-tinged sputum.

What is atelectasis?

Collapse of alveoli, usually due to reduced ventilation.

Normal adult breathing pattern is called .

Eupnea (12–20 breaths/min).

Define tachypnea.

Fast, shallow breathing > 24 breaths/min.

What are Kussmaul respirations and when do they occur?

Regular, rapid and deep breaths seen in metabolic acidosis to lower blood pH.

Describe Cheyne-Stokes respirations.

A cycle of gradually increasing depth, then decreasing depth, followed by apnea.

What does pulse oximetry measure?

The percentage of hemoglobin saturated with oxygen (SaO₂).

Normal SaO₂ range for healthy adults is _.

Typically 95–100 % (≥ 92 % often accepted clinically).

What does capnography directly measure?

The concentration of CO₂ in exhaled air, reflecting ventilation and PaCO₂ indirectly.

Which ABG value reflects oxygen available to bind hemoglobin?

PaO₂ (partial pressure of oxygen) normally 80–100 mm Hg.

Define hypercarbia and its usual cause.

Elevated PaCO₂ ( > 45 mm Hg) usually from hypoventilation.

How much oxygen is in room air?

Approximately 21 % O₂.

Name at least three common oxygen delivery sources in healthcare.

Wall outlets, portable compressed cylinders, liquid O₂ units, and O₂ concentrators.

What heart structure is the natural pacemaker?

The sinoatrial (SA) node in the right atrium.

Trace the normal cardiac conduction pathway.

SA node → AV node → bundle of His → right and left bundle branches → Purkinje fibers.

What is automaticity?

The heart’s ability to generate electrical impulses without external stimulus.

Which brainstem center controls sympathetic stimulation of the heart?

The vasomotor center.

Baroreceptors respond primarily to changes in .

Blood pressure (stretch).

Chemoreceptors respond to what three blood chemistry changes?

pH, O₂ and CO₂ levels.

Define heart failure.

An inefficient pump unable to meet the body’s metabolic demands.

What is angina pectoris?

Chest pain caused by temporary myocardial ischemia.

Name two oxygen-transport abnormalities.

Anemia (↓RBC/Hgb) and carbon-monoxide poisoning (CO binding to hemoglobin).

Which blood test is currently the most reliable marker of arterial inflammation?

C-reactive protein (CRP).

When is the nursing diagnosis "Decreased Cardiac Output" appropriate?

When the heart cannot pump enough blood to meet metabolic needs.

Pharmacokinetics refers to which four sequential drug processes?

Absorption, distribution, metabolism and excretion.

Define bioavailability.

The proportion of drug that enters circulation to exert an active effect.

How does lipid solubility affect drug absorption?

Lipid-soluble drugs cross cell membranes easily and are absorbed more readily than water-soluble drugs.

What three factors mainly influence drug distribution?

Local blood flow, capillary permeability and protein-binding capacity.

Which organ is the primary drug excretion site?

The kidneys.

Define onset of action.

Time after administration until drug concentration reaches minimum effective level.

What is biological half-life?

Time required for half of the drug to be eliminated from the body.

Differentiate side effects and adverse reactions.

Side effects are predictable, often mild; adverse reactions are harmful and unpredictable at normal doses.

What is an idiosyncratic drug reaction?

An unexpected, abnormal or paradoxical response unique to an individual.

State the Three Checks of safe medication administration.

1) Before preparing/pouring, 2) After preparing, 3) At bedside before administration.

List the original Six Rights of medication administration.

Right drug, patient, dose, route, time and documentation.

What IV method delivers medication fastest to circulation?

IV push (bolus) directly into the vein.

Give two reasons for using a central venous access device (CVAD).

Long-term IV therapy, total parenteral nutrition, frequent blood draws, or difficult peripheral access.

Differentiate tunneled and non-tunneled central catheters.

Tunneled catheters are surgically inserted and run subcutaneously to a central vein; non-tunneled enter directly near the destination vein (e.g., jugular, subclavian).

Describe the six-link chain of infection.

Infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host.

What is the difference between transient and resident flora?

Transient flora are temporary microbes acquired by contact; resident flora are permanent skin inhabitants.

Define medical asepsis.

Clean technique that reduces the number and spread of microorganisms.

How long should routine handwashing last under medical asepsis?

At least 15 seconds (longer if visibly soiled).

What distinguishes surgical asepsis from medical asepsis?

Surgical asepsis (sterile technique) eliminates all microorganisms; medical asepsis only reduces them.

What is the Institute of Medicine’s stance on patient safety?

Patients should never be harmed by the healthcare system; safety requires leadership, team function and continuous learning.

Which age group is at highest risk for strength without wisdom, influencing safety?

Adolescents.

Name three common household safety hazards.

Poisoning, fires/burns, and carbon monoxide exposure (others: firearms, suffocation).

What tool quickly screens hospitalized patients for fall risk?

The Morse Fall Scale.

Define a "Never Event" (Serious Reportable Event).

A preventable, clearly identifiable healthcare-acquired complication that causes serious harm or death.

Thermoregulation is controlled by which brain region?

The hypothalamus.

What body response occurs when core temperature rises?

Peripheral vasodilation and sweating to promote heat loss.

Define stroke volume.

The amount of blood ejected from the left ventricle with each contraction.

Cardiac output formula is _.

Cardiac output = stroke volume × heart (pulse) rate.

What pulse quality grade indicates a bounding pulse?

3 (easily felt, not easily obliterated).

Dyspnea means .

Labored or difficult breathing.

Name the four most common adventitious breath sounds.

Wheezes, rhonchi, crackles and stridor (plus stertor).

Define systolic and diastolic blood pressure.

Systolic: peak arterial pressure during ventricular contraction; diastolic: minimum pressure during ventricular rest.

What factors strongly influence blood pressure?

Age, sex, genetics, lifestyle (exercise, stress), body position, medications, and diseases.

List three key nutrients that maintain skin integrity.

Protein, vitamin C and adequate calories/fluids (plus cholesterol, minerals).

Differentiate primary, secondary, and tertiary wound healing intention.

Primary: edges approximated, minimal tissue loss; secondary: extensive tissue loss, edges not closed; tertiary: delayed primary closure after granulation.

What are the three phases of wound healing?

Inflammatory (hemostasis & inflammation), proliferative (granulation), maturation (remodeling).

Describe serosanguineous exudate.

Thin, watery drainage that is tinged pink or light red from small amounts of blood.

What wound complication involves internal organs protruding through an open incision?

Evisceration.

What does the Braden Scale assess?

Risk for pressure injury based on sensory perception, moisture, activity, mobility, nutrition, friction & shear.

Describe a Stage 2 pressure injury.

Shallow, open ulcer with a red-pink wound bed; partial-thickness skin loss without slough.

When is a pressure injury considered unstageable?

When the wound base is covered by slough or eschar, obscuring depth assessment.

Explain sharp (surgical) debridement.

Use of sterile scalpels/scissors to quickly remove devitalized tissue, preserving healthy tissue.

How does autolytic debridement work?

Moisture-retentive dressing allows the body’s own enzymes to liquefy necrotic tissue.

Which dressing is best for wounds with moderate to heavy drainage and tunneling?

Alginate dressings.

Why irrigate a wound from least to most contaminated area?

To prevent introducing microorganisms into cleaner tissue areas.

What is cumulative drug effect?

Increased response due to drug accumulation when rate of administration exceeds metabolism/excretion.

What immediate actions are required after a medication error?

Assess the patient’s vital signs/condition, then notify provider and follow reporting policies.

What additional three patient rights are often included beyond the original six?

Right reason, right to know (education) and right to refuse.

Define hypocarbia.

Low PaCO₂ caused by hyperventilation.

Which infection defense involves phagocytes, complement cascade, inflammation and fever?

Secondary (nonspecific) defenses.

What is bacteremia versus septicemia?

Bacteremia: presence of bacteria in blood; septicemia: symptomatic systemic infection spreading via blood.

Describe standard precautions.

First-tier safety measures applied to the care of all patients to prevent infection transmission.

What is piloerection and when does it occur?

Hair standing on end ("goose-bumps"), a heat-conserving response to cold via sympathetic stimulation.

Which ABG component indicates metabolic acid–base status?

HCO₃⁻ (bicarbonate).

Describe an intermittent IV infusion ("saline lock").

Medication given through a capped IV port when continuous fluids are not required.

Why weigh dressings before and after application?

To accurately quantify wound drainage volume by weight difference.

What two visual skin signs indicate compromised peripheral circulation?

Pallor (pale skin) and cyanosis (bluish-gray discoloration).

Define orthopnea.

Inability to breathe comfortably while lying flat; relieved by sitting or standing.

How does CO poisoning impair oxygen transport?

CO binds hemoglobin with high affinity, preventing O₂ attachment.