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A 45 year old male with COPD presents to the hospital with an exacerbation of his lung condition. He is in respiratory distress and the physician recommends he sit leaning forward. What is the purpose of sitting like this?
COPD is a chronic lung condition marked by air trapping. Patients with COPD are instructed to sit in the "tripod" position to help them exhale air. Patients sit and lean forward to help maximize air exiting from the lungs.
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What is the "hygiene hypothesis" in asthma?
Incidence of asthma is lower in populations exposed to an abundance of microbes from a young age. The "hygiene hypothesis" suggests that early immune stimulation by multiple forms of infectious agents may push a Th1 phenotype, reducing the Th2 (allergic) response.
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All of the following are common triggers for asthma except __________.
The most commonly reported triggers for asthma attacks are cold air, emotional stress or excitement, infection, irritants such as pollen or dust mites, and exercise. Other triggers may include lying down, exposure to cigarette smoke, or acid reflux.
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All of the following changes may be seen in chronic asthma except __________.
Chronic asthma can result in a situation referred to as "airway remodeling," typified by the following changes: increased airway vascularity, epithelial desquamation, deposition of subepithelial collagen, and hypertrophy and hyperplasia of mucus glands and of the underlying muscle layer.
Destruction of alveolar septa and pulmonary capillaries is a common finding in emphysema and does not present in asthma.
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A patient has been administered isoniazid for the treatment of tuberculosis (TB). Which statement made by the nurse would be the most appropriate when teaching the client about this medication?
Isoniazid is a bactericidal drug that is given for tuberculosis that has several adverse effects including peripheral neuropathy. This drug is usually administered in conjunction to other antitubercular drugs. Pyridoxine (vitamin B6) is recommended to be taken in conjunction with isoniazid to prevent neurotoxicity.
Isoniazid is relatively inexpensive and may be taken orally or intravenously. It is not necessary to be taken under direct observation, and is usually dosed according to type of disease (active versus latent). The typical duration of administration is roughly 26 weeks. Color blindness is not associated with isoniazid treatment.
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At what stage are antibiotics effective in treatment of pertussis?
Antibiotics have been shown to have very little effectiveness in treating a pertussis infection older than four weeks. Because of this, treatment with antibiotics to individuals that have been symptomatic for longer than four weeks is not generally recommended.
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A client is admitted to the ICU with acute respiratory distress syndrome (ARDS). The client has a recent history of bacterial pneumonia that has worsened and is at risk for hypoxemia.
All of the following interventions apply to treatment for acute respiratory distress syndrome (ARDS) except __________.
The oxygen concentration should be the lowest possible, due to the risk of oxygen toxicity seen in clients with FIO2 (fraction of inspired oxygen) levels exceeding 60% for more than 48 hours.
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A young male presents to the emergency department after a motor vehicle accident. Upon examination it is found that the client will require a chest tube to re-inflate his collapsed lung.
All of the following correctly describe how a chest tube is placed except which of these?
The correct placement of tubing includes directing a tube apically to remove air from the pleural space, and to direct the tube that will drain fluids in an inferior and posterior orientation.
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Which of the following best describes the mechanism of albuterol inhalers during an asthma exacerbation?
Albuterol is a beta adrenergic agonist. It helps to open up the airways during an asthma exacerbation by activating the beta adrenergic receptors, part of the sympathetic nervous system. Side effects include increased heart rate.
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What is the inspiratory reserve volume?
The inspiratory reserve volume for the average adult is roughly 3100mL. It is tested using pulmonary function tests. The inspiratory reserve volume is the amount of air able to be inhaled after a regular inhalation. This is in contrast to the expiratory reserve volume, which is the amount of air that can be exhaled after a regular exhalation.
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Which of the following side effects would you most likely expect when providing an asthmatic patient with continuous nebulizer therapy?
Asthma is treated with albuterol. This drug is a beta-2 agonist, which works to relax smooth muscle in the lungs, and open up the airways. A consequence of this drug is the beta-2 effects on the heart. Beta-2 on the heart causes an increase in heart rate (tachycardia) and is a common side effect seen in the treatment of asthmatics.
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You are a pulmonology nurse taking care of a patient who complains of episodic wheezing. You perform a diagnostic test in which you perform pulmonary function tests on the patient before, and after administering albuterol, a beta-2 adrenergic agonist. You note that the patient's symptoms and FEV1 readings improve drastically with bronchodilator administration. Based upon these findings, the patient most likely has which of the following?
The correct answer is "Asthma." This answer is correct because asthma is an inflammatory airway condition that is characteristically improved symptomatically and quantitatively (in terms of pulmonary function tests, including FEV1 readings) with bronchodilator administration (e.g. albuterol, the beta-2 adrenergic agonist administered in this patient). In this patient who presented for evaluation of wheezing, a characteristic symptom of asthma, his substantial response to bronchodilator administration makes the likelihood of an asthma diagnosis very high.
Chronic Obstructive Pulmonary Disease (COPD) is an obstructive physiology of the airways often due to chronic tobacco smoking. While bronchodilators may be of some clinical value in these patients, their FEV1 readings characteristically do not correct after bronchodilator administration, as this is a major method in which COPD can be distinguished from asthma and other inflammatory airway conditions.
Sarcoidosis, lung cancer, and throat cancer symptoms would not necessarily improve with bronchodilator administration, nor would pulmonary function test readings in patients with these conditions.
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A 45-year old obese male with a history of obstructive sleep apnea, hypertension, diabetes, and coronary artery disease presents to your primary care clinic for help in managing his fatigue due to his sleep apnea. He is not a candidate for tonsillectomy and adenoidectomy. Which of the following interventions would be the best recommendation to treat his obstructive sleep apnea?
The correct answer is "continuous positive airway pressure mask (CPAP)." This is the correct answer as a CPAP mask helps to force airway into the lungs that is otherwise obstructed by the patient's oropharyngeal anatomy at standard breathing pressures due to obstructive sleep apnea. When wearing a CPAP mask (typically when sleeping), snoring is reduced, and oxygenation is improved, allowing patients to have a more restful sleep and feel less fatigued the following day.
While medications like metoprolol, insulin, and metformin may be beneficial to the patient in treating his conditions co-morbid to obstructive sleep apnea, they do not have a direct effect on treating his sleep apnea or the resultant fatigue.
Tamsulosin is an alpha-adrenergic blocker and can be used to treat benign prostatic hyperplasia among other conditions, but not obstructive sleep apnea.
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A 45 year old male with COPD presents to the hospital with an exacerbation of his lung condition. He is in respiratory distress and the physician recommends he sit leaning forward. What is the purpose of sitting like this?
COPD is a chronic lung condition marked by air trapping. Patients with COPD are instructed to sit in the "tripod" position to help them exhale air. Patients sit and lean forward to help maximize air exiting from the lungs.
Compare your answer with the correct one above
What is the "hygiene hypothesis" in asthma?
Incidence of asthma is lower in populations exposed to an abundance of microbes from a young age. The "hygiene hypothesis" suggests that early immune stimulation by multiple forms of infectious agents may push a Th1 phenotype, reducing the Th2 (allergic) response.
Compare your answer with the correct one above
All of the following are common triggers for asthma except __________.
The most commonly reported triggers for asthma attacks are cold air, emotional stress or excitement, infection, irritants such as pollen or dust mites, and exercise. Other triggers may include lying down, exposure to cigarette smoke, or acid reflux.
Compare your answer with the correct one above
All of the following changes may be seen in chronic asthma except __________.
Chronic asthma can result in a situation referred to as "airway remodeling," typified by the following changes: increased airway vascularity, epithelial desquamation, deposition of subepithelial collagen, and hypertrophy and hyperplasia of mucus glands and of the underlying muscle layer.
Destruction of alveolar septa and pulmonary capillaries is a common finding in emphysema and does not present in asthma.
Compare your answer with the correct one above
A patient has been administered isoniazid for the treatment of tuberculosis (TB). Which statement made by the nurse would be the most appropriate when teaching the client about this medication?
Isoniazid is a bactericidal drug that is given for tuberculosis that has several adverse effects including peripheral neuropathy. This drug is usually administered in conjunction to other antitubercular drugs. Pyridoxine (vitamin B6) is recommended to be taken in conjunction with isoniazid to prevent neurotoxicity.
Isoniazid is relatively inexpensive and may be taken orally or intravenously. It is not necessary to be taken under direct observation, and is usually dosed according to type of disease (active versus latent). The typical duration of administration is roughly 26 weeks. Color blindness is not associated with isoniazid treatment.
Compare your answer with the correct one above
At what stage are antibiotics effective in treatment of pertussis?
Antibiotics have been shown to have very little effectiveness in treating a pertussis infection older than four weeks. Because of this, treatment with antibiotics to individuals that have been symptomatic for longer than four weeks is not generally recommended.
Compare your answer with the correct one above
A client is admitted to the ICU with acute respiratory distress syndrome (ARDS). The client has a recent history of bacterial pneumonia that has worsened and is at risk for hypoxemia.
All of the following interventions apply to treatment for acute respiratory distress syndrome (ARDS) except __________.
The oxygen concentration should be the lowest possible, due to the risk of oxygen toxicity seen in clients with FIO2 (fraction of inspired oxygen) levels exceeding 60% for more than 48 hours.
Compare your answer with the correct one above