Pulmonary Sounds and Conditions Quiz

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Questions and Answers

What is another term for fine crackles heard in the lungs?

Wheezes

Rales (correct)

Rhonchi

Stridor

Which condition is associated with early crackles?

Chronic bronchitis (correct)

Pneumonia

Atelectasis

Congestive heart failure

What characterizes a normal sinus rhythm?

Rate of 100 to 140 beats per minute

Rate of 80 to 120 beats per minute

Rate of 50 to 70 beats per minute

Rate of 60 to 100 beats per minute (correct)

What is a possible clinical sign of renal injury post-cardiac surgery?

Decreased urine output Signup and view all the answers

Which of the following is commonly associated with dysrhythmias?

Decreased oxygenation Signup and view all the answers

Which sound is characterized as a crowing sound associated with upper airway issues?

Stridor Signup and view all the answers

What is the normal range for serum creatinine levels in adult females?

0.5 to 1.1 mg/dL Signup and view all the answers

What is a defining characteristic of ventricular tachycardia?

Wide QRS complexes Signup and view all the answers

What is a common adverse effect of calcium channel blockers used in treating variant angina?

Peripheral edema Signup and view all the answers

What symptom distinguishes variant angina from typical angina?

Prolonged pain at the same time daily Signup and view all the answers

What is indicated if a patient's urine output is lower than 30 mL/hr?

Report to the primary health care provider Signup and view all the answers

Which of the following should be avoided by a client taking warfarin sodium?

Aspirin-containing products Signup and view all the answers

What does a therapeutic activated partial thromboplastin time (aPTT) look like for a patient on heparin therapy?

60 to 100 seconds Signup and view all the answers

What physiological response can result from excessive alcohol consumption in a patient taking warfarin sodium?

Enhanced anticoagulant effect Signup and view all the answers

What is a characteristic feature of ventricular fibrillation?

Irregular chaotic undulations Signup and view all the answers

Which position change should clients taking calcium channel blockers be cautious of?

Standing too quickly Signup and view all the answers

What is the primary concern when administering thrombolytic therapy?

Occurrence of hemorrhage Signup and view all the answers

Which of the following conditions may increase the risk of digoxin toxicity?

Hypokalemia Signup and view all the answers

Which medication should be avoided due to the risk of liver abnormalities?

Nicotinic acid Signup and view all the answers

What is the optimal therapeutic range for digoxin?

0.5 to 2.0 ng/mL Signup and view all the answers

Which adverse effects are considered most common with lipid-lowering medications?

Constipation and bloating Signup and view all the answers

What is the most critical monitoring requirement after thrombolytic therapy?

Monitor for bleeding Signup and view all the answers

Which of the following diuretics is sulfa-based and may pose a risk to clients with a sulfa allergy?

Hydrochlorothiazide Signup and view all the answers

What symptom is a typical early manifestation of digoxin toxicity?

Nausea Signup and view all the answers

What is a common symptom experienced by clients with ventricular tachycardia?

Feeling of impending doom Signup and view all the answers

Which of the following can lead to decreased cardiac output in ventricular tachycardia?

Shortened ventricular filling time Signup and view all the answers

What is the initial treatment for ventricular tachycardia if the client is awake?

Cardioversion Signup and view all the answers

What significant change occurs in the rhythm during atrial fibrillation?

Loss of P waves Signup and view all the answers

Which of the following statements about premature ventricular contractions is true?

They can be caused by physiological stressors. Signup and view all the answers

What is the energy level used for all defibrillation attempts with a monophasic defibrillator?

360 joules Signup and view all the answers

What should be checked before using the defibrillator on a patient?

Presence of loose connections on leads Signup and view all the answers

Which condition is NOT associated with loss of cardiac output?

Flat neck veins Signup and view all the answers

What is the normal range for magnesium in mEq/L?

1.8--2.6 Signup and view all the answers

What indicates a progression to pulmonary edema?

Frothy pink sputum Signup and view all the answers

What should be reported to the primary health care provider before initiating thrombolytic therapy?

Results of blood pressure Signup and view all the answers

Which medication is an antidote for warfarin sodium?

Vitamin K Signup and view all the answers

What is a common side effect of bumetanide?

Crackles in the lungs Signup and view all the answers

What should be avoided when taking nicotinic acid for hyperlipidemia?

Alcohol consumption Signup and view all the answers

What indicates worsening heart failure when assessing BNP?

BNP greater than 100 pg/mL Signup and view all the answers

What indicates hepatic dysfunction when observed in stool?

Clay-colored stools Signup and view all the answers

Study Notes

Respiratory Sounds

Fine crackles, also known as rales, resemble the sound of wood burning in a fireplace.
Can be heard during both inspiration and expiration, typically at lung bases.
Early crackles are associated with chronic bronchitis; late crackles indicate pneumonia, congestive heart failure, or atelectasis.
Rhonchi and diminished breath sounds are not linked to pulmonary edema.
Stridor is characterized by a crowing sound linked with laryngospasm or upper airway edema.

Cardiovascular Concerns

Dysrhythmias can occur due to decreased oxygenation and severe myocardial damage (>40%).
Classic signs of cardiogenic shock include low blood pressure and tachycardia, with rising central venous pressure due to severe left ventricular failure.
Pulsus paradoxus is associated with cardiac tamponade.

Cardiac Surgery Risks

Clients undergoing cardiac surgery risk renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor treatment.
Decreased urine output and increased BUN and creatinine levels signal renal injury.
Normal reference levels for BUN: 10 to 20 mg/dL (3.6 to 7.1 mmol/L). For creatinine: 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) for males, and 0.5 to 1.1 mg/dL (44 to 97 mcmol/L) for females.
Medications may be needed to improve renal perfusion; dialysis options might be considered.

Heart Rhythm and Dysrhythmias

Normal sinus rhythm is defined as a rate of 60 to 100 beats per minute, with normal PR (0.12 - 0.20 seconds) and QRS measurements (0.04 - 0.10 seconds).
Sudden loss of ECG complexes indicates ventricular asystole or possible electrode displacement; accurate assessment is crucial.
Ventricular tachycardia features absent P waves, wide QRS complexes (>0.12 seconds), and a rate of 140-180 bpm; it is life-threatening and can lead to ventricular fibrillation.
Early signs of ventricular tachycardia include feelings of impending doom and low cardiac output leading to potential ischemia.

Atrial Fibrillation

Characterized by the absence of P waves and the presence of fibrillatory waves.
Loss of atrial contraction, or "atrial kick," increases the risk of low cardiac output.
Clients may experience palpitations, chest pain, hypotension, pulse deficit, dizziness, and distended neck veins.
Hypertension and flat neck veins are not related to decreased cardiac output.

Defibrillation Protocol

CPR is initiated until the defibrillator is ready; ECG checked for ventricular fibrillation or pulseless ventricular tachycardia.
The energy level for defibrillation using a monophasic defibrillator is set at 360 joules.
Normal ranges for activated partial thromboplastin time (aPTT) are 30 to 40 seconds; therapeutic levels should be 1.5 to 2.5 times this reference.

Thrombolytic Therapy and Complications

Aspirin should be avoided during warfarin treatment due to increased bleeding risk.
Alcohol should also be avoided with warfarin to prevent interactions.
Hemorrhage is a risk with thrombolytic medications; clients must be monitored for bleeding.
Normalizing BUN and creatinine levels again signal the need for ongoing assessment for renal function after potential acute kidney injury.

Variant Angina

Also known as Prinzmetal’s angina; characterized by prolonged, severe pain usually at rest due to coronary artery spasm; treated with calcium channel blockers.
Effects of calcium channel blockers can include peripheral edema, hypotension, and bradycardia; grapefruit juice should be avoided.

Digoxin and Its Risks

Digoxin is used for heart failure and arrhythmias; risk of toxicity needs careful monitoring.
Early toxicity signs include gastrointestinal symptoms, while later signs involve vision changes (yellow-green halos), drowsiness, and rhythm abnormalities.
Optimal digoxin levels are 0.5 to 2.0 ng/mL; caution is necessary with conditions like hypercalcemia or hypokalemia.

Diuretic Therapy

Bumetanide is a diuretic; expected outcomes include increased urine output, decreased crackles, and lower body weight.
Common side effects include potassium loss; frothy pink sputum can indicate pulmonary edema.

Interventions for Complications

Antidotes: Protamine sulfate for heparin, vitamin K for warfarin, potassium chloride for deficits, and aminocaproic acid for thrombolytics.
If a client exhibits anaphylaxis during thrombolytic therapy, stop the infusion immediately and notify the rapid response team.
Monitoring for renal failure and psychopathology is important but secondary to immediate interventions like re-evaluating blood pressure in thrombolytic therapy candidates.

Lifestyle Considerations

Encourage clients to manage lifestyle factors that contribute to hyperlipidemia, focusing on dietary adjustments and exercise.
Flushing may occur with nicotinic acid; preemptive aspirin can mitigate this effect.

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Description

Test your knowledge on pulmonary sounds, specifically fine crackles or rales. This quiz covers their characteristics, associated conditions like chronic bronchitis and pneumonia, and their auscultation sites. Perfect for students studying respiratory health or medical professionals seeking a refresher.