NUR 221 exam #2 2026 COMPREHENSIVE EXAM QUESTIONS WITH DETAILED VERIFIED AND 100% CORRECT ANSWERS BRAND NEW EXAM ALREADY GRADED A+!!

purpose of the respiratory tract

- carbon dioxide exhaled out of lungs

- oxygen inhaled into lungs

- oxygen to blood

- remove carbon dioxide from blood

lobes of the lungs

Right lung: 3 lobes

Left lung: 2 lobes

organs of the upper respiratory tract + function

-nasal cavity: warms/moistens air, traps foreign material

-nasopharynx: contains tonsils

-oropharynx: passage for air and food, contains epiglottis (protects larynx)

-larynx: two pairs of vocal cords

-trachea: lined w/ ciliated epithelium and has c-shaped cartilage rings

lower respiratory tract organs

-bronchial tree (left and right)

-bronchioles

-alveolar ducts (bundles of grapes)

-alveoli (lined w/ epithelium and surfactant to allow for inflation and reduce tension)

complications w/ insufficient surfactant production

increased surface tension causing:

-alveolar collapse

-decreased lung expansion

-Increased work of breathing (labored)

-Severe O2 / CO exchange abnormalities

What organs/tissues protects the pulmonary system

-Chest Wall: made of skin, ribs and intercostal muscles

-Thoracic Cavity: Encases the lungs and pleura adheres to the lung

-Pleural Space: About 50 mL fluid fills pleural space allowing two layers of the pleura to slide over each other easily, pressure is negative/sub-atmospheric

How does the pulmonary system protect itself from contamination?

-cilia: propels particles to be expectorated (smoking kills)

-alveolar macrophages: eat foreign substances

-irritant receptors in nares/trachea: triggers sneeze/cough

pulmonary circulation purposes

1. Facilitates O2/CO2 gas exchange

2. Delivers nutrients to lung tissue

3. Acts as a reservoir for the left ventricle

4. Filter system removes air and debris from circulation

important pulmonary volumes

*****Vital capacity: max amount of air that can be moved in/out of the lungs with a single forced inspiration and expiration (4600mL)

******Total lung capacity: total air volume in the lungs after max inspiration (5800mL)

Hypercapnia

-excessive carbon dioxide in the blood

-causes increased rate and depth of respirations (hyperventilation)

Hypoxemia

-decreased level of oxygen in the blood

-increased respirations trying to get O2

-common in smokers and COPD pts

basics of the pulmonary gas exchange

inspired air to expired air = low to high O2 and slightly higher CO2 content w/ inspired air

Factors affecting gas exchange

-Partial pressure gradient

-Thickness of respiratory membrane: fluid accumulation in alveoli/interstitial tissue (blood, pneumonia)

-Total surface area for diffusion: alveolar wall destruction, decreased surface area

-Ventilation/Perfusion ratio: Ventilation & perfusion need to match for max gas exchange (PE throws it off bc it blocks blood flow)

Oxygen transport in blood

-About 1% is dissolved in plasma

-Most reversibly bound to hemoglobin

CO2 transport in blood

-Waste product of cellular metabolism

-About 7% dissolved in plasma

-About 20% reversibly bound to hemoglobin

-Most diffuses into RBCs

aging effects on the pulmonary system

-Loss of elastic recoil

-Stiffening of the chest wall

-Alterations in gas exchange

-Increases in flow resistance

-Decreased exercise tolerance

Pulmonary testing

-Spirometry: pulmonary function testing (PFT), measures lung volumes

-ABG analysis

-Oximetry: measures oxygen saturation

-Chest radiographs (CXR)

-Chest CT (most accurate/clear

-Bronchoscopy: biopsy or check for bleeding/lesions

-Culture and sensitivity tests

General manifestations of resp. disease

-sneezing (upper resp)

-coughing (lower resp)

-Hemoptysis: blood-tinged (bright red) frothy sputum, usually associated with pulmonary edema

types of breathing patterns and characteristics

-Eupnea: normal rate

-Kussmaul respirations: deep rapid respirations, typical for acidosis; may follow strenuous exercise

-labored/prolonged: obstruction of airway

-wheezing/whistling: obstruction of small airways

-stridor: high-pitched noise, upper airway obstruction, common in kids who swallowed coin

types of lung sounds

-rales: crackles, means smaller airways, fluid in lungs (CHF, pneumonia)

-rhonchi: large airways, obstruction or fluid accumulation (COPD, pneumonia)

-stridor

-wheezing (asthma, bronchitis)

dyspnea and s/s

-difficulty breathing

-may be from increased CO2 or hypoxemia

-Often noted on exertion, like climbing stairs

-Severe dyspnea = respiratory distress

-s/s: flaring of nostrils and use of accessory respiratory muscles

orthopnea

-difficulty breathing when lying down

-usually from pulmonary congestion

paroxysmal nocturnal dyspnea

Sudden acute type of dyspnea, common in patients w/ left-sided CHF

pleural pain results from

inflammation or infection of parietal pleura

friction rub

quiet sound produced from rough, inflamed, or scarred pleural moving against each other

upper respiratory disorders

the common cold, acute rhinitis, allergic rhinitis

acute rhinitis

Inflammation of the nasal mucosa with sneezing, tearing, and profuse secretion of watery mucus

allergic rhinitis

hay fever due to pollen or foreign substance

common cold characteristics

-Contagious period: 1-4 days before onset of symptoms and during first 3 days of cold

-Transmission: Touching contaminated surfaces then touching nose or mouth, droplets from sneezing

-Symptoms: Nasal congestion, rhinorrhea, cough, increased mucosal secretions

common cold treatment

Decongestants, Antitussives, Antihistamines, Glucocorticoids

1st gen antihistamines

Diphenhydramine (Benadryl)

-Used for allergic rhinitis, pruritus, urticaria, common cold, sneezing, cough, prevents motion sickness, promotes sleep

-Contraindications/cautions: Severe liver disease, closed-angle glaucoma, urinary retention

-Increases CNS depression with alcohol and other CNS depressants

2nd gen antihistamines

Cetirizine (Zyrtec) and Loratadine (Claritin)

-for allergic rhinitis, pruritus, urticaria, common cold, sneezing, cough

-Side effects: Less sleepiness, dry mucous membranes, dry eyes

-not recommended for pts under 6 or over 65

Intranasal Glucocorticoids

fluticasone, beclomethasone, budesonide

Intranasal Glucocorticoids MOA + side effects

MOA: Anti-inflammatory that decreases rhinorrhea, sneezing, and congestion

-side effects: Headache, blurred vision, epistaxis, Irritated/dry nasal mucosa, pharyngitis, hoarseness, nausea, vomiting, **candidiasis**, insomnia

Types of Nasal Decongestants

pseudoephedrine, phenylephrine, oxymetazoline nasal spray

Pseudoephedrine

-Don't use if HTN or CAD

-controlled d/t methamphetamine production

-vasoconstrictor

Phenylephrine

-alpha 1 agonist

-caution w/ HTN, NO CAD

-vasoconstrictor

-side effects: nervousness, tachycardia, insomnia, rebound congestion

Oxymetazoline Nasal spray

-6yrs and older

-2-3 sprays each nostril Q12 PRN

-vasoconstrictor

-side effects: rebound congestion, nasal irritation/dryness, tachycardia, restlessness, dizziness

Nasal decongestant education

-observe color of bronchial secretions

-proper use of nasal spray

-use it too long = rebound congestion

-drink fluids

what is antitussive therapy?

acts on the cough-control center in medulla to supress cough

-opioid, nonopioid, and combination preparations

Antitussive meds

-opioid: codeine

-nonopioid: benzonatate (calms cough reflex)

-dextromethorphan: OTC cough syrup

what do expectorants do and their side effects?

-loosen bronchial secretions so they can be eliminated by coughing

-for the common cold or resp. infection

-side effects: drowsiness, dizziness, HA, N/V/D

OTC expectorants

Guaifenesin

sinusitis and treatment

-inflammation of mucous membranes of sinuses

-treatment: decongestant, acetaminophen, fluids, rest, antibiotics

acute pharyngitis and treatment

-inflammation of throat

-treatment: saline gargles, lozenges, lots of fluids, acetaminophen, antibiotics ONLY IF BACTERIAL (strep throat)

Influenza characteristics and types

-Type A (most common), type B, and C (rare in humans)

-sudden acute fever w/ fatigue, and myalgia, can cause viral pneumonia

Flu prevention

vaccine (IM, IN, ID), masking when sick, handwashing

Flu treatment

-supportive: hydrate, antipyretics, rest

-antiviral drugs: oseltamivir (Tamiflu) 75mg for 5 days, Zanamivir

Bronchiolitis and s/s

-Caused by RSV

-Transmitted by oral droplet

-Virus causes necrosis/inflammation in small bronchi and bronchioles

-s/s: Wheezing and dyspnea, rapid shallow respirations, cough, rales, chest retractions, fever, malaise

Lobar pneumonia

-Bacterial pneumonia

-Community-based, often in healthy young adults

-Usually caused by Streptococcus pneumoniae

-Infection localized in one or more lobes.

-exudate forms in the alveoli and contains fibrin and forms a consolidated mass, exudate produces rusty sputum

-Adjacent pleurae frequently involved

-Infection may spread to pleural cavity (empyema)

Lobar pneumonia s/s

-Sudden onset

-Systemic signs: High fever w/ chills, fatigue, leukocytosis

-Dyspnea, tachypnea, tachycardia

-Pleural pain

-Rales

-Productive cough (typical rusty-colored sputum)

-Confusion and disorientation

Bronchopneumonia

-infection in both lungs

-can be caused by several microorganisms

-exudate forms in alveoli

-insidious: moderate fever, productive cough, rales, yellow/green sputum

-antibacterial treatment

Legionnaires disease

-caused by Legionella pneumophila

-usually nosocomial

-requires special culture medium

Intreated causes severe dry cough and consolidation, necrosis in lungs, and possibly fatal

Primary atypical pneumonia

-caused by Mycoplasma pneumoniae (bacterial)

-Common in older children and young adults

-Transmitted by aerosol-albuterol (Antibiotic therapy)

-Viral form caused by flu A or B, adenoviruses, RSV

-Infection varies greatly in severity

-s/s: Unproductive cough, hoarseness, sore throat, HA, mild fever, malaise

Severe acute respiratory syndrome (SARS)

-caused by SARS-associated coronavirus

-droplet transmission

-first signs: fever, HA, myalgia, chills, anorexia, possibly diarrhea

-Later signs: dry cough, marked dyspnea; areas of interstitial congestion, hypoxia (mechanical ventilation may be needed)

SARS treatment

-antivirals/glucocorticoids

-high fatality rate

-risk factors: travel to endemic/epidemic area & contact w traveler

-active cases require quarantine until clear of infection

Histoplasmosis

-fungal infection

-common opportunistic infection

-1st stage usually asymptomatic

-2nd stage: granuloma formation and necrosis, cough, fatigue, fever, night sweats

-treated w/ antifungals

Anthrax

-bacterial infection by gram+ bacteria

-can be skin (cutaneous), resp (inhalation), or digestive (GI) tract

anthrax S/S - cutaneous

-group of blisters/bumps that may itch

-swelling around sores

-painless open skin sore w/ black center

-sores often on face/neck/hands/arms

Anthrax s/s inhalation

-fever/chills, extreme tiredness, body aches

-chest discomfort, SOB

-confusion, dizziness, HA

-cough, sore throat, pain swallowing, hoarseness

-N/V/D, stomach pain

-sweats (drenching)

Anthrax treatment

Ciprofloxacin, anthrax antitoxin, vaccines

obstructive lung disease s/s

-dyspnea

-wheezing

-labored breathing

-ventilation-perfusion mismatch

-decreased forced expiratory volume

ventilation perfusion mismatch

occurs when there is a lack of available oxygenated air in the alveoli even though perfusion (blood flow) to the alveoli is adequate or when the alveoli are adequately oxygenated but perfusion to the alveoli is poor or when there is a combination of both poor ventilation and poor perfusion in the alveolar-capillary structures

hypoxia s/s

Early- restless & anxious, combative

Late- cyanosis, confusion, lethargy, coma

Types of O2 administration

-nasal cannula: 0.5-6L, humidified air

-simple mask: 6-10L, nebulizers

-nonrebreather mask: 12-15L

asthma

episodes of breathing difficulty due to narrowed or obstructed airways

-extrinsic: triggered by hypersensitivity rxn

-intrinsic: hyper-responsive tissue in airway initiates attack (resp infections, stress, exposure to cold, exercise)

asthma patho

-Inflammation of the mucosa with edema

-Bronchoconstriction caused by contraction of smooth muscle

-Increased secretion of thick mucus in airways

-Changes create obstructed airways, partial or total.

Asthma triggers

-Viral Respiratory Infections

-Cockroaches, dust mites, mold

-Strong odors: perfume, spray, paints

Pets, pollen

-Smoking, wood stoves

-Weather (Inhaling cold air triggers bronchospasm)

-Exercise (occur during or after)

-Stress

-Food Sensitivity

asthma attack

Beginning of an attack: Chest Congestion/Constriction, wheeze on expiration, nonproductive cough, tachycardia, tachypnea

-Severe Attack: Use of accessory muscles, wheezing on inspiration and expiration

status asthmaticus

-life threatening

-"silent chest:" no audible breathing sounds

-hypoxia

-acidosis (from CO2 retention)

asthma treatment

General measures: Skin tests for allergic reactions, avoiding triggering factors, good ventilation of environment, swimming and walking, maintenance inhalers or drugs

-For acute attacks: Controlled breathing techniques, inhalers (bronchodilators), corticosteroids

COPD diseases

chronic asthma, emphysema, chronic bronchitis

COPD overview

-Abnormal permanent enlargement of the gas-exchange airways

-Accompanied by destruction of alveolar walls without obvious fibrosis

-Lungs lose elastic recoil

-MAJOR CAUSE: SMOKING

emphysema

-a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness

-can trap air due to lack of alveolar recoil

Emphysema Pathophysiology

-Breakdown of alveolar wall results in loss of surface area for gas exchange, loss of pulmonary capillaries, loss of elastic fibers, altered ventilation-perfusion ratio, and decreased support for other structures

-Fibrosis: narrowed airways, weakened walls, interference with passive expiratory airflow

emphysema physical changes

-Progressive difficulty with expiration

-Air trapping and increased residual volume

-Over inflation of the lungs

-Fixation of ribs in a respiratory position, increased anterior-posterior diameter of thorax (barrel chest)

-Flattened diaphragm (on radiographs)

-Adjacent damaged alveoli combine together, forming large air spaces

-Pneumothorax (when pleural membrane surrounding large blebs ruptures)

-Hypercapnia

-hypoxia becomes driving force of respiration

-Frequent infections

-Pulmonary HTN and cor pulmonale (right sided HF) may develop

chronic bronchitis

-Inflammation, obstruction, repeated infection, chronic coughing twice for 3 months or longer in 2 years

-History of cigarette smoking or living in urban or industrial area

-Mucosa inflamed and swollen in bronchi

-Hypertrophy and hyperplasia of mucous glands

-Fibrosis and thickening of bronchial wall

chronic bronchitis s/s

-Constant productive cough

-Tachypnea and SOB

-Hypoxia, cyanosis, hypercapnia

-Severe dyspnea and fatigue

-Pulmonary HTN and cor pulmonale

anti-inflammatory meds

-corticosteroids (budesonide, fluticasone, prednisone)

-foundation of asthma therapy

-taken daily long-term

-best when inhaled

anti-inflammatory corticosteroids

-Decrease synthesis and release of inflammatory mediators

-Reduce infiltration and activity of inflammatory cells

-Decrease edema of the airway mucosa caused by beta2 agonists

-Usually administered by inhalation

-Budesonide (Pulmicort) inhaled

-Fluticasone propionate (Flovent HFA, Flovent diskus) inhaled

-Prednisone oral tablets (for severe asthma or COPD)

corticosteroid medication adverse effects

oral candidiasis and dysphonia

-prednisone: can slow growth in children and teens, promotes bone loss, and increases glaucoma/cataract risk

Anti-Inflammatory/Leukotriene Modifiers

Montelukast (Singulair)

-oral

-Suppresses effects of leukotrienes to reduce bronchoconstriction and inflammatory responses (edema and mucous secretion)

montelukast side effects

-Generally well tolerated

-Mood changes and suicidal ideations (Rare)

bronchodilators

Through activation of beta2 receptors in thesmooth muscle of the lung, they promote bronchodilation, relieving bronchospasm

SABA Bronchodilators

-short-acting beta2 agonists

-albuterol

-for asthma and COPD

-PRN or before exercise to prevent attack

albuterol side effects

nervous/jittery, tachycardia, tremors, HA, arrhythmias

LABA bronchodilators

-formoterol, salmeterol

-long-term control for pts w/ frequent attacks

-dosing on fixed schedule

-can treat stable COPD

-can be combined w/ inhaled steroid

Muscarinic antagonists

-Ipratropium (SAMA), inhaled or nebulized

-Prevents bronchoconstriction, therapeutic effects begin w/i 30secs

-Adverse effects: dry mouth and irritation of pharynx

-Tiopropium (LAMA)

-Prevents bronchospasm, therapeutic effects in 30 minutes

-continuously improves bronchodilation, reaching a plateau after eight doses (8 days)

Nebulizer medication admin

1. take deep breath slowly to a volume slightly bigger than normal

2. pause

3. exhale like normal

-DO NOT rinse nebulizer cup w/ tap water

-allow cup to air dry

who is most at risk for TB

-ppl living in crowded conditions

-with an immunodeficiency (HIV, AIDS)

-malnutrition

-alcoholism

-Conditions of war

-Chronic disease

TB drugs

-Isoniazid: latent and active, PO/IM

-Rifampin: latent and active, PO on empty stomach, ORANGE bodily excretions

-Pyrazinamide: active

-Ethambutol: active, PO, affects eyes and color perception

ARDS (adult respiratory distress syndrome)

-from injury to the alveolar wall and capillary membrane

-Causes the release of chemical mediators

-Increases permeability of alveolar capillary membranes

-Increased fluid and protein in interstitial area and alveoli

-Damage to surfactant-producing cells

-necrosis and fibrosis if patient survives

-Multitude of predisposing conditions

**Often associated with multiple organ dysfunction or failure

ARDS s/s

dyspnea, restlessness, rapid shallow breathing, tachycardia, resp and metabolic acidosis

Pulmonary edema

accumulation of fluid in the lungs

-caused by: HF, acute resp distress, inhaling toxic gases, lymph obstruction

-s/s: pink, frothy sputum, dyspnea, labored breathing, hypoxemia

Pulmonary edema treatment

-identify underlying cause

-improve cardiac output

-oxygen therapy

-meds

pulmonary embolus

-Blockage of the pulmonary artery or one of its branches due to a \ clot

-effect depends on size, material, and location of clot

-large emboli may cause sudden death

**90% of PE comes from DVT

PE s/s

-Small emboli: Transient chest pain, cough, dyspnea may occur

-Larger emboli: Chest pain, tachypnea, sudden dyspnea. Later, hemoptysis and fever are present. Also, anxiety and restlessness, pallor, and tachycardia (from hypoxia)

PE diagnosis and prevention

-diagnosis: CT, V/Q scan

-pulmonary angiography

-D-dimer (indicates body is trying to break something down)

-prevention: basically DVT prevention (meds, movement, SCDs)

pleural effusion

-abnormal accumulation of fluid in the pleural space

-increases pressure in pleural cavity

-exudate effusions (watery)

pleural effusion s/s

dyspnea, chest pain, tachypnea, tachycardia, dull to percussion and no breath sounds, tracheal deviation, hypotension