Midterm Exam - Adult/Elder

Q: What are the major structures of the upper respiratory tract?

A: Nose, sinuses, pharynx, tonsils, larynx, trachea – function to warm, filter, and humidify air.

Q: What are the major structures of the lower respiratory tract?

A: Lungs, bronchi, bronchioles, alveoli – responsible for gas exchange.

Q: What are the four main functions of the respiratory system?

A: Ventilation, oxygen transport, gas exchange, and neural control (medulla/pons).

Q: What findings are assessed during respiratory inspection?

A: Chest symmetry, shape, accessory muscle use, skin color, respiratory rate and effort.

Q: What do percussion sounds indicate?

A: Resonant = normal; dull = fluid (consolidation); hyperresonant = excess air (emphysema/pneumothorax).

Q: What are the normal breath sounds?

A: Vesicular, bronchial, and bronchovesicular.

Q: What do crackles, wheezes, rhonchi, and pleural rub indicate?

A: Crackles = fluid; wheezes = narrowed airways; rhonchi = mucus; pleural rub = inflamed pleura.

Q: What do ABGs measure?

A: pH, PaCO₂, PaO₂, HCO₃⁻ to assess acid-base and gas exchange.

Q: When should sputum samples be collected?

A: In the morning before eating or drinking.

Q: What is the purpose of a thoracentesis?

A: To remove pleural fluid for diagnostic or therapeutic purposes.

Q: What causes laryngitis and what is the treatment?

A: Viral infection, overuse, or irritants; rest the voice, humidify air, avoid irritants.

Q: What causes tonsillitis and what are key nursing priorities post-tonsillectomy?

A: Group A strep; monitor airway, avoid straws, give cold fluids, watch for bleeding.

Q: What are key symptoms and care for viral rhinitis?

A: Nasal congestion, sore throat, malaise; rest, fluids, decongestants, hand hygiene.

Q: What are differences between viral and bacterial pharyngitis?

A: Viral: mild, self-limiting. Bacterial: exudate, fever, positive strep test → antibiotics.

Q: What are the hallmark signs of asthma?

A: Wheezing, dyspnea, chest tightness, cough.

Q: What are the main prevention measures for hospital-acquired pneumonia (HAP)?

A: Hand hygiene, head of bed 30–45°, oral care, early ambulation.

Q: How do you manage epistaxis?

A: Sit up, lean forward, pinch nostrils 10–15 min, avoid blowing nose/smoking.

Q: What is the normal pathway of cardiac conduction?

A: SA node → AV node → Bundle of His → Purkinje fibers.

Q: Define preload, afterload, and contractility.

A: Preload = stretch before contraction; afterload = resistance; contractility = pumping strength.

Q: What is cardiac output and normal range?

A: CO = HR × SV; normal 4–8 L/min.

Q: What are common symptoms of cardiovascular disease?

A: Chest pain, dyspnea, fatigue, edema, palpitations.

Q: What is an echocardiogram used for?

A: To evaluate ejection fraction, wall motion, and valve function.

Q: What is the difference between a TTE and TEE?

A: TEE provides clearer imaging via the esophagus; requires sedation.

Q: What does BNP indicate?

A: Elevated BNP (>100 pg/mL) = heart failure.

Q: What are normal cholesterol values?

A: Total <200, LDL <100, HDL >40(M)/>50(F), Triglycerides <150 mg/dL.

Q: What are the main risk factors for CAD?

A: HTN, hyperlipidemia, diabetes, smoking, obesity, inactivity, age, family history.

Q: Differentiate stable, unstable, and variant angina.

A: Stable: exertion, relieved by rest; Unstable: unpredictable/rest pain; Variant: coronary spasm.

Q: What is the key teaching for nitroglycerin use?

A: Take 1 tab q5min ×3 for chest pain; if unrelieved → call EMS.

Q: What lifestyle changes help prevent CAD?

A: DASH diet, exercise 30 min/day, quit smoking, weight management.

Q: What are key differences between arterial and venous ulcers?

A: Arterial = deep, punched-out, painful, on toes; Venous = shallow, irregular, around ankles.

Q: What is intermittent claudication?

A: Pain with walking that resolves with rest — hallmark of PAD.

Q: How do you care for a patient with PAD?

A: Promote walking, avoid cold, stop smoking, dangle legs for comfort.

Q: What are triggers and treatment for Raynaud’s phenomenon?

A: Cold/stress; avoid triggers, CCBs, warm protection.

Q: What are signs of DVT?

A: Swelling, warmth, redness, pain in affected leg.

Q: How do you prevent DVT?

A: Early ambulation, compression devices, hydration, avoid immobility.

Q: What is Virchow’s Triad?

A: Venous stasis, endothelial injury, hypercoagulability.

Q: How is chronic venous insufficiency managed?

A: Elevate legs, compression stockings, wound care, prevent infection.

Q: What is the new ACC/AHA definition of hypertension?

A: SBP ≥130 or DBP ≥80 on two or more occasions.

Q: What are the categories of blood pressure per ACC/AHA (2017)?

A: Normal <120/<80; Elevated 120–129/<80; Stage 1: 130–139/80–89; Stage 2: ≥140/≥90.

Q: What are modifiable risk factors for HTN?

A: High sodium diet, obesity, inactivity, smoking, alcohol, stress, poor diet, sleep apnea.

Q: What is the difference between primary and secondary hypertension?

A: Primary = no cause (90–95%); Secondary = due to disease (renal, endocrine, etc.).

Q: Why is HTN called the “silent killer”?

A: Often asymptomatic until target organ damage occurs (heart, kidneys, eyes, brain).

Q: What is the first-line treatment for most adults with HTN?

A: Lifestyle modification (DASH diet, exercise, limit sodium and alcohol).

Q: What are common side effects of ACE inhibitors?

A: Dry cough, hyperkalemia, hypotension.

Q: What are the key nursing concerns with beta-blockers?

A: Check HR and BP before giving; monitor for fatigue, bradycardia, and orthostasis.

Q: What are nursing priorities during a hypertensive emergency?

A: Monitor BP q5–15 min; give IV antihypertensives (nicardipine, labetalol); reduce BP ≤25% in 1 hour.

Q: What physiologic changes cause isolated systolic hypertension in older adults?

A: Arterial stiffening, atherosclerosis, loss of elasticity.

Q: What diagnostic confirms gas exchange efficiency?

A: Arterial blood gases (ABGs).

Q: What ECG finding indicates myocardial injury?

A: Elevated troponin and ST-segment changes.

Q: What intervention prevents venous thromboembolism post-surgery?

A: Early ambulation and compression devices.

Q: What is the first nursing action for chest pain unrelieved by nitroglycerin?

A: Call EMS—possible myocardial infarction.

Q: What are signs of target organ damage from HTN?

A: Retinopathy, LVH, renal impairment, stroke.

A nurse notes dullness to percussion over the patient’s right lower lobe. What does this finding most likely indicate?

B. Pneumonia

Which action should the nurse take before obtaining a sputum culture?

C. Encourage deep coughing into a sterile container before eating or drinking.

A patient’s ABG results show pH 7.32, PaCO₂ 50 mmHg, HCO₃⁻ 26 mEq/L. Which interpretation is correct?

A. Respiratory acidosis

Which findings indicate abnormal respiratory assessment data? (Select all that apply)
a. Symmetrical chest expansion
b. Crackles in lower lobes
c. Trachea deviated to left
d. Use of accessory muscles
e.  Resonant percussion sounds

b, c, d

Which are normal breath sounds? (Select all that apply)
a. Vesicular
b. Bronchial
c. Bronchovesicular
d.  Stridor
e. Pleural rub

a, b, c

A patient presents with sore throat, white exudate on tonsils, and fever. Which nursing intervention is priority?

B. Obtain a throat culture

After a tonsillectomy, a child begins swallowing frequently and appears anxious. What should the nurse do first?

B. Assess for bleeding at the surgical site.

The nurse teaches a patient with laryngitis about home care. Which statement shows correct understanding?

B. “I’ll avoid smoking and use a humidifier.”

Which nursing action helps prevent hospital-acquired pneumonia?

C. Elevating head of bed 30–45°

The nurse teaches a patient with asthma how to prevent attacks. Which points should be included? (Select all that apply)
a. Avoid known allergens and cold air.
b. Take prescribed bronchodilator before exercise.
c.  Limit fluid intake.
d. Use peak flow meter daily.
e. Stop corticosteroid inhaler when symptoms improve.

a, b, d

The nurse hears an S3 heart sound. Which condition might this indicate?

B. Heart failure or fluid overload

Which diagnostic test best evaluates ejection fraction?

B. Echocardiogram

A nurse notes JVD when patient is at 45°. What does this indicate?

C. Right-sided heart failure

Which are components of a focused cardiac assessment? (Select all that apply)
a. Inspect color and jugular veins
b. Palpate peripheral pulses
c. Auscultate heart sounds
d.  Measure urine output only
e. Assess for edema and chest pain

a, b, c, e

Which lipid value requires further teaching?

B. LDL 160 mg/dL

A patient reports chest pain at rest relieved by nitroglycerin. This most likely indicates:

C. Variant (Prinzmetal’s) angina

What is the nurse’s priority if chest pain persists after three doses of nitroglycerin?

C. Notify provider/activate EMS

What are modifiable risk factors for CAD? (Select all that apply)
a. Hypertension
b. Smoking
c. Diabetes
d.  Age
e. Obesity
f. Sedentary lifestyle

a, b, c, e, f

A patient with PAD reports pain in calves while walking that stops with rest. What term describes this?

A. Intermittent claudication

Which assessment finding indicates arterial insufficiency?

B. Cool, pale extremities with weak pulses

A patient has DVT. Which action by the nurse is contraindicated?

C. Massaging the affected leg

What is the best prevention strategy for DVT in a post-op patient?

B. Early ambulation

Which statements are true about Raynaud’s phenomenon? (Select all that apply)
a. Triggered by cold or stress
b. Affects fingers/toes
c. Causes color change white → blue → red
d. Treated with calcium channel blockers
e. Occurs due to infection

a, b, c, d

According to the ACC/AHA (2017), what BP is classified as stage 1 hypertension?

C. 132/84

Which lifestyle change has the most immediate effect in reducing BP?

B. Weight loss and sodium restriction

A patient taking lisinopril reports a persistent cough. What should the nurse do?

C. Notify provider; consider switching to an ARB

Which antihypertensive is contraindicated in pregnancy?

C. ACE inhibitors

Which finding suggests a hypertensive emergency?

B. BP 182/118 with chest pain

Which teaching should be included for a patient with hypertension? (Select all that apply)
a. Monitor BP at home regularly
b. Take medication at the same time daily
c. Do not abruptly stop beta blockers
d. Limit sodium and alcohol
e. Increase potassium intake if not contraindicated

a, b, c, d, e