Pre-Board Exam Drill

SITUATION 1: A patient just arrived in the Oncology unit from the Post Anesthesia Care Unit (PACU) following a Left Modified Radical Mastectomy because of Inflammatory Breast Cancer (IBC). She has a pressure dressing over the surgical site and two drains. Assessment shows her vital signs are stable, fully awake and claims that pain is under control. Fortune is the nurse assigned to the patient.
1. From the following data obtained from the chart by Fortune, which is NOT a risk factor which could have predisposed the patient to breast cancer:
a. Age – 55
b. Height 5’2”, weight 160 lbs.
c. Menarche at age 13
d. Mother died of colon cancer
2. Fortune read a literature which says that by the time Inflammatory Breast Cancer (IBC) is diagnosed, 50% - 75% have palpable auxiliary nodes; as many as 30% have gross distant metastasis; and as few as 30% of patients have an underlying breast mass. Which of the following is the APPROPRIATE interpretation of this research findings.
a. Auxiliary nodes were palpated on 20 out of 30 women positive for IBC3
b. Out of the 20 women who were positive for IBC, only 5 have metastasis
c. If there were 10 women diagnosed with IBC, 3 have positive lymph nodes
d. Breast mass was identified on 8 out of 30 women positive for IBC
3. Fortune recognizes that adjuvant chemotherapy for breast cancer may include any of the following EXCEPT:
a. Monoclonal antibody
b. Antibiotics
c. Proton inhibitors – this is a drug for ulcer
d. Antiestrogen – tamoxifen

4. Fortune understands that when the antineoplastic  agent leaks through the peripheral vascular access during chemotherapy procedure, which of the following is expected to be done FIRST?
a. Refer to the physician
b. Stop the chemotherapy infusion
c. Cleanse site with saline solution
d. Call another nurse to check the intravenous site

5. A clinical trial is currently being undertaken to test treatments for Inflammatory Breast Cancer (IBC). The research team leader wishes to include the patient as a participant in the study. As a patient advocate, which of the following will Fortune do FIRST?
a. Obtain informed consent from the patient
b. Explain to the patient the scope of the clinical trial
c. Inquire from the team leader benefits for the patient
d. Read more related literatures
SITUATION 2: During a staff meeting in the Intensive Care Unit, the nurse manager reported a list of procedures that need to be reviewed and updated. One of these procedures is the precautionary measures related to ventilator associated pneumonia.- on mechanical ventilation through an endotracheal or tracheostomy tube for at least 48 hours
6. While brainstorming, the group mentioned the use of evidence-based techniques. Which of the following statements given by the members of the group reflect evidence-based methods?
a. “Let us ask opinions of experts”
b. “The experiences of the nurses must be obtained”
c. “Review of related literature will be very helpful”
d. “We must agree on a common procedure”
7. The nurse manager assigned a group to develop a project intended to improve the existing procedure related to the prevention of ventilator associated pneumonia among ICU patients. A first team leader was selected by the group. Which of the following will the team leader do FIRST?
a. Tell the group to state their objectives
b. Formulate a list of desired outcomes
c. Set a target
d. State actions to be done by each member of the group
8. Which of the following definitions best describes pneumonia?
 A. Inflammation of the large airways
B. Severe infection of the bronchioles
C. Inflammation of the pulmonary parenchyma
D. accumulation of fluids in the lungs
9. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?
        A. Fluid volume deficit
        B. Decreased tissue perfusion.
        C. Impaired gas exchange.
        D. Risk for infection

10. What action should the nurse take in assisting Mr. Ramos in doing deep breathing and coughing exercise?
A. Recognize that the patient is too sick to cough at this time
B. Splint the patient’s chest while he coughs
C. Turn Mr. Ramos to the unaffected side and ask him to cough
D. Encourage her to cough and then give her pain medication as ordered
11. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and  replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be
         A. placing her in a trendeleburg position
         B. putting several warm blankets on her
         C. monitoring her hourly urine output
         D. assessing her VS especially her RR

12. Ana's postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question?
         A. Put the client in modified Trendelenberg's position.
         B. Administer oxygen at 100
         C. Monitor urine output every hour.
         D. Administer Demerol 50mg IM q4h

13. When assessing Luther for hypovolemic shock, which of the following data indicates that he is in IRREVERSIBLE stage of shock?
a. Restless, anxious and confused
b. Anuria
c. Skin, cool, pale and moist- compensatory stage
d. Pulse rapid and weak – reversible stage
14. The physician ordered colloid solution such as Dextran 40. During the infusion, Luther complained of dyspnea. Upon auscultation, you noted wheezes. Which of the following will you do FIRST?
a. Discontinue the infusion
b. Place Luther on a Fowler’s position..
c. Decrease infusion rate
d. Call the attending physician

15. Luther’s central venous pressure is monitored every hour. When you measure the CVP using a water manometer, you are expected to observe which of the following to ensure accuracy of CVP measurement?
a. Maintain the client on a Fowler’s position
b. Use a one way stopcock to regulate flow of IV fluids to the water manometer
c. Immobilize client’s right arm
d. Keep the zero point of the manometer in level with the client’s right atrium
SITUATION 4: You are caring for Warren, 58 years old, who is diagnosed with Laryngeal cancer
16. Warren, who is scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx, asks you, “How will I talk after the surgery?” as his nurse your BEST response will be:
a. “You will breathe through a permanent opening in your neck, but you will not be able to communicate orally”
b. “You won’t be able to talk right after surgery, but you will be able to speak again once the tracheostomy tube is removed”
c. “You will have a permanent opening in your neck, and you will need to have rehabilitation for some type of voice restoration”
d. “You won’t be able to speak as you used to but there are artificial voice devices that will give you the ability to speak normally”
17. Warren returns from surgery with a tracheostomy tube after a total laryngectomy and radical neck dissection. In caring for Warren during the first 24 hours after surgery, your PRIORITY nursing action is to:
a. Avoid changing tracheostomy ties
b. Monitor for bleeding around stoma
c. Assess the airway patency and breath sounds
d. Clean the inner cannula every 8 hours
18. After doing assessment, one of the nursing diagnosis you identified is “Body image disturbance related to loss of control of personal care.” To evaluate effectiveness of your interventions, the expected outcome for the problem that Warren should demonstrate is that he:
a. Lets his wife provide hygiene and stoma care
b. Wears clothing that minimizes the disfigurement caused by surgery
c. Asks that only family members be allowed to visit
d. Learns to remove and clean the laryngectomy tube independently
19. Warren is scheduled to start radiation therapy. You have just taught Warren all about radiation therapy. Which of the following statements by Warren would indicate that your teaching has been EFFECTIVE?
a. “I can use lotions to moisturize the skin on my throat”
b. “I will need to buy a water bottle to carry with me”
c. “I need to use alcohol-based mouthwashes to help clean oral ulcers”
d. “I may experience diarrhea, I may have diarrhea until radiation is complete”
20. After completing the discharge instructions for Warren, you  determine that ADDITIONAL instruction is needed when he says:
a. “I can participate in most of my prior fitness activities except swimming”
b. “I should wear a Medic Alert Bracelet that identifies me as a neck breather”
c. “I must keep the stoma covered with a loose sterile dressing at all times”
d. “I need to eat nutritious meals even though I can’t smell or taste very well”

Anatomy and Physiology Notes: Gastrointestinal-Hepatobillary System

This is an outlined lecture note on the Anatomy and Physiology of theGastrointestinal-Hepatobillary System. Some information are so compressed that some concepts are not explained in detail. If it is your first time to meet such information please refer to your textbook for further explanation of the concept. This review material requires a student to have a prior knowledge and good foundation of the subject matter for this only emphasizes important/ key information deemed important in understanding advanced concept in Pathophysiology and Medical Surgical Nursing.

Functions of the gastrointestinal system
- Process food substances.
- Absorb the products of digestion into the blood.
- Excrete unabsorbed materials.
- Provide an environment for microorganisms to synthesize nutrients, such as vitamin K.

 Mouth
- Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones
- Saliva contains the amylase enzyme (ptyalin) that aids in digestion.

Esophagus
- Collapsible muscular tube about 10 inches long
- Carries food from the pharynx to the stomach


The stomach
- Contains the cardia, fundus, the body, and the pylorus
- Mucous glands are located in the mucosa and prevent autodigestion by providing an alkaline protective covering.
- The lower esophageal (cardiac) sphincter prevents reflux of gastric contents into the esophagus.
- The pyloric sphincter regulates the rate of stomach emptying into the small intestine.
- Hydrochloric acid kills microorganisms, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation.
- Pepsin is the chief coenzyme of gastric juice, which converts proteins into proteases and peptones.
- Intrinsic factor is necessary for the absorption of vitamin B12.
- Gastrin controls gastric acidity.

Small intestine
- The duodenum contains the openings of the bile and pancreatic ducts.
- The jejunum is about 8 feet long.
- The ileum is about 12 feet long.
- The small intestine terminates in the cecum.

Pancreatic intestinal juice enzymes
- Amylase digests starch to maltose.
- Maltase reduces maltose to monosaccharide glucose.
-  Lactase splits lactose into galactose and glucose.
- Sucrase reduces sucrose to fructose and glucose.
- Nucleases split nucleic acids to nucleotides.
-. Enterokinase activates trypsinogen to trypsin.


Large intestine
- About 5 feet long
- Absorbs water and eliminates wastes
- Intestinal bacteria play a vital role in the synthesis of some B vitamins and vitamin K.
- Colon: Includes the ascending, transverse, descending, and sigmoid colons and rectum
- The ileocecal valve prevents contents of the large intestine from entering the ileum.
- The anal sphincters control the anal canal.

Peritoneum: Lines the abdominal cavity and forms the mesentery that supports
the intestines and blood supply

Liver
-The largest gland in the body, weighing 3 to 4 lb.
-Contains Kupffer's cells, which remove bacteria in the portal venous blood
- Removes excess glucose and amino acids from the portal blood
- Synthesizes glucose, amino acids, and fats
- Aids in the digestion of fats, carbohydrates, and proteins
- Stores and filters blood (200 to 400 mL of blood stored)
- Stores vitamins A, D, and B and iron
- The liver secretes bile to emulsify fats (500 to 1000 mL of bile/day).
 Hepatic ducts
a. Deliver bile to the gallbladder via the cystic duct and to the
duodenum via the common bile duct.
b. The common bile duct opens into the duodenum, with the pancreatic duct at the ampulla of Vater.
c. The sphincter prevents the reflux of intestinal contents into the
common bile duct and pancreatic duct.

Gallbladder
-Stores and concentrates bile and contracts to force bile into the duodenum during the digestion of fats
- The cystic duct joins the hepatic duct to form the common bile duct.
- The sphincter of Oddi is located at the entrance to the duodenum.
- The presence of fatty materials in the duodenum stimulates the liberation of cholecystokinin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi.

Pancreas
Exocrine gland
- Secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum
-. Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins.
Endocrine gland
- Secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect
- The islets of Langerhans secrete insulin.
- Insulin is secreted into the bloodstream and is important for carbohydrate metabolism.

“If at first you don't succeed, try, try again. Then quit. No use being a damn fool about it.”  -WC Fields

Anatomy and Physiology Notes: Endocrine System

This is an outlined lecture note on the Anatomy and Physiology of the Endocrine System. Some information are so compressed that some concepts are not explained in detail. If it is your first time to meet such information please refer to your textbook for further explanation of the concept. This review material requires a student to have a prior knowledge and good foundation of the subject matter for this only emphasizes important/ key information deemed important in understanding advanced concept in Pathophysiology and Medical Surgical Nursing.


Functions of Endocrine Glands
- Maintenance and regulation of vital functions
- Response to stress and injury
- Growth and development
- Energy metabolism
- Reproduction
- Fluid, electrolyte, and acid-base balance

Hypothalamus 
- Portion of the diencephalon of the brain, forming the floor and part of the lateral wall of the third ventricle
- Activates, controls, and integrates the peripheral autonomic nervous system, endocrine processes, and many somatic functions, such as body temperature, sleep, and appetite

Pituitary gland 
- The master gland; located at the base of the brain 2. Influenced by the hypothalamus; directly affects the function of the other endocrine glands
- Promotes growth of body tissue, influences water absorption by the kidney, and controls sexual development and function

Adrenal gland
- One adrenal gland is on top of each kidney.
- Regulates sodium and electrolyte balance; affects carbohydrate, fat, and protein metabolism; influences the development of sexual characteristics; and sustains the fight-or-flight response
 Adrenal cortex
- The cortex is the outer shell of the adrenal gland.
-. The cortex synthesizes glucocorticoids and mineralocorticoids and secretes small amounts of sex hormones
Adrenal medulla
- The medulla is the inner core of the adrenal gland.
- The medulla works as part of the sympathetic nervous system and produces epinephrine and norepinephrine.

Thyroid gland
- Located in the anterior part of the neck
- Controls the rate of body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin

Parathyroid glands
- Located on the thyroid gland
- Control calcium and phosphorus metabolism; produce parathyroid hormone

Pancreas
- Located posteriorly to the stomach
- Influences carbohydrate metabolism, indirectly influences fat and protein metabolism, and produces insulin and glucagon

Ovaries and testes
-The ovaries are located in the pelvic cavity and produce estrogen and progesterone.
-The testes are located in the scrotum, control the development of the secondary sex characteristics, and produce testosterone.

Negative feedback loop
-Regulates hormone secretion by the hypothalamus and pituitary gland
-Increased amounts of target gland hormones in the bloodstream decrease secretion of the same hormone and other hormones that stimulate its release.

“Success is getting what you want, happiness is wanting what you get” -Kinsela

Anatomy and Physiology Notes: The Heart

Heart and heart wall layers
1. The heart is located in the left side of the mediastinum.
2. The heart consists of three layers.
a. The epicardium is the outermost layer of the heart.
b. The myocardium is the middle layer and is the
actual contracting muscle of the heart.
c. The endocardium is the innermost layer and lines
the inner chambers and heart valves.


Pericardial sac
1. Encases and protects the heart from trauma and infection
2. Has two layers
a. The parietal pericardium is the tough, fibrous outer membrane that attaches anteriorly to the lower half
of the sternum, posteriorly to the thoracic vertebrae, and inferiorly to the diaphragm.
b. The visceral pericardium is the thin, inner layer that closely adheres to the heart.
3. The pericardial space is between the parietal and visceral layers; it holds 5 to 20 mL of pericardial fluid, lubricates the pericardial surfaces, and cushions the heart.


There are four heart chambers
1. The right atrium receives deoxygenated blood from the body via the superior and inferior vena cava.
2. The right ventricle receives blood from the right atrium and pumps it to the lungs via the pulmonary artery.
3. The left atrium receives oxygenated blood from the lungs via four pulmonary veins.
4. The left ventricle is the largest and most muscular chamber; it receives oxygenated blood from the lungs via the left atrium and pumps blood into the systemic circulation via the aorta.

There are four valves in the heart.
1. There are two atrioventricular valves, the tricuspid and the mitral, which lie between the atria and ventricles.
a. The tricuspid valve is located on the right side of the heart.
b. The bicuspid (mitral) valve is located on the left side of the heart.
c. The atrioventricular valves close at the beginning of ventricular contraction and prevent blood from flowing
back into the atria from the ventricles; these valves open when the ventricle relaxes.

2. There are two semilunar valves, the pulmonic and the aortic.
a. The pulmonic semilunar valve lies between the right ventricle and the pulmonary artery.
b. The aortic semilunar valve lies between the left ventricle and the aorta.
c. The semilunar valves prevent blood from flowing back into the ventricles during relaxation; they open during
ventricular contraction and close when the ventricles begin to relax.

Sinoatrial (SA) node

1. The main pacemaker that initiates each heartbeat
2. It is located at the junction of the superior vena cava and the right atrium.
3. The sinoatrial node generates electrical impulses at 60 to 100 times per minute and is controlled by the sympathetic and parasympathetic nervous systems.

Atrioventricular (AV) node
1. Located in the lower aspect of the atrial septum
2. Receives electrical impulses from the sinoatrial node
3. If the sinoatrial node fails, the atrioventricular node can initiate
and sustain a heart rate of 40 to 60 beats/min.

The bundle of His
1. A continuation of the AV node; located at the interventricular septum
2. It branches into the right bundle branch, which extends down the right side of the interventricular septum, and the left bundle branch, which extends into the left ventricle.
3. The right and left bundle branches terminate into Purkinje fibers.

Purkinje fibers
1. Purkinje fibers are a diffuse network of conducting strands located beneath the ventricular endocardium.
2. These fibers spread the wave of depolarization through the ventricles.
3. Purkinje fibers can act as the pacemaker with a rate between 20 and 40 beats/min when higher pacemakers fail


Coronary arteries 
1. The coronary arteries supply the capillaries of the myocardium with blood.
2. The right coronary artery supplies the right atrium and ventricle, the inferior portion of the left ventricle, the posterior septal wall, and the sinoatrial and atrioventricular nodes.
3. The left main coronary artery consists of two major branches, the left anterior descending and the circumflex arteries.
4. The left anterior descending artery supplies blood to the anterior wall of the left ventricle, the anterior ventricular septum, and the apex of the left ventricle.
5. The circumflex artery supplies blood to the left atrium and the
lateral and posterior surfaces of the left ventricle.

Notes on Fluid and Electrolytes 3: FLUID VOLUME EXCESS

FLUID VOLUME EXCESS

A. Description
1. Fluid intake or fluid retention exceeds the fluid needs of the body.
2. Fluid volume excess also is called overhydration or fluid overload.
3. The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.

B. Types
1. Isotonic overhydration
a. Known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
b. Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and
intracellular compartments.
c. Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, congestive heart
failure and pulmonary edema can result.

2. Hypertonic overhydration
a. Occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
b. Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.

3. Hypotonic overhydration
a. Hypotonic overhydration is known as water intoxication.
b. The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
c. Electrolyte imbalances occur as a result of dilution.

C. Causes
1. Isotonic overhydration
a. Inadequately controlled IV therapy
b. Renal failure
c. Long-term corticosteroid therapy

2. Hypertonic overhydration
a. Excessive sodium ingestion
b. Rapid infusion of hypertonic saline
c. Excessive sodium bicarbonate therapy

3. Hypotonic overhydration
a. Early renal failure
b. Congestive heart failure
c. Syndrome of inappropriate antidiuretic hormone secretion
d. Inadequately controlled IV therapy
e. Replacement of isotonic fluid loss with hypotonic fluids
f. Irrigation of wounds and body cavities with hypotonic fluids

D. Assessment
1. Cardiovascular
a. Bounding, increased pulse rate
b. Elevated blood pressure
c. Distended neck and hand veins
d. Elevated central venous pressure

2. Respiratory
a. Increased respiratory rate (shallow respirations)
b. Dyspnea
c. Moist crackles on auscultation

3. Neuromuscular
a. Altered level of consciousness
b. Headache
c. Visual disturbances
d. Skeletal muscle weakness
e. Paresthesias

4. Integumentary
a. Pitting edema in dependent areas
b. Skin pale and cool to touch

5. Increased motility in the gastrointestinal tract

6. Isotonic overhydration results in liver enlargement and ascites.

7. Hypotonic overhydration results in the following:
a. Polyuria
b. Diarrhea
c. Nonpitting edema
d. Dysrhythmias
e. Projectile vomiting
8. Laboratory findings
a. Decreased serum osmolality
b. Decreased hematocrit
c. Decreased BUN level
d. Decreased serum sodium level
e. Decreased urine specific gravity

E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid overload, and restore normal fluid balance.
3. Administer diuretics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances.
4. Restrict fluid and sodium intake.
5. Monitor intake and output and weight.
6. Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.

Anatomy and Physiology Quiz

I. Fluid and Electrolyte and Acid – Base Balance

1. Approximately 60% of the weight of a typical adult consists of fluid. Body fluid is located in two fluid compartments namely what?
a. Intracellular and intravascular
b. Extracellular and intracellular
c. Intracellular and interstitial
d. Extravascular and intracellular

2. When two different solutions are separated by a membrane that is impermeable to the dissolved substances, fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. This diffusion of water caused by a fluid concentration gradient is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transportation

3. Hydrostatic pressure in the capillaries tends to filter fluid out of the intravascular compartment into the interstitial fluid. Movement of water and solutes occurs from an area of high hydrostatic pressure to an area of low hydrostatic pressure is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transport

4. A patient presented the following signs and symptoms: confusion, muscle cramps and weakness,  dry skin, ↑pulse,  ↓ BP. The patient’s lab result shows ↓ serum and urine sodium and  ↓ urine specific gravity. The doctor told you that the patient is exhibiting hyponatremia. Hyponatremia is having a serum sodium below what? (Smeltzer 2012)
a. 145 mEq/L
b. 108 mEq/L
c. 96.5 mEq/L
d. 135 mEq/L

5. A patient with congestive heart failure is given oral potassium supplements to avoid digoxin toxicity. As a nurse you are aware that the normal serum level for potassium is what? (Smeltzer 2012)
a. 135-145 mEq/L
b. 3.5-5.0 mEq/L
c. 8.5-10.5 mg/dL
d. 1.8-2.7 mg/dL

Evaluate the following arterial blood gas values

6. pH: 7.5   PaCO2: 31   HCO3 : 26

7. pH: 7.38  PaCO2: 32  HCO3: 19

8. pH: 7.24  PaCO2: 60  HCO3: 32

9. pH: 7.41  PaCO2: 30  HCO3 18

10. pH: 7.5  PaCO2: 42  HCO3: 33

II. Respiratory System

11. Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. The rhythm of breathing is controlled by respiratory centers in the brain. The inspiratory and expiratory center is located in the?
a. Medulla Oblongata
b. Hypothalamus
c. Pons
d. Cerebellum

12. The _____ center in the lower pons stimulates the inspiratory medullary center to promote deep, prolonged inspirations.
a. Pneumotaxic
b. Apneustic
c. Chemotaxic
d. Physiotaxic

13. A term that correspond the amount of air inhaled and exhaled with each breath.
a. Residual Volume
b. Inspiratory Reserve Volume
c. Expiratory Reserve Volume
d. Tidal Volume
14. It is the volume of air in the lungs after maximum inhalation
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity

15. The volume of air remaining in the lungs after a normal expiration .
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity

III.  Cardiovascular System

16. It is the ability of the heart to initiate electrical impulse.
a. Excitability
b. Automaticity
c. Conductivity
d. Permeability

17. It is called as the primary pace maker of the heart which fires 60 to 100 impulse per minute
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers

18. The ___  coordinates the incoming electrical impulses from the atria and after a slight delay, allowing the atria time to contract and complete ventricular filling then relays the impulse to the ventricles.
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers

19. This heart sound is created by the closure of the tricuspid and bicuspid valve
a. S1
b. S2
c. S3
d. S4

20. This heart sound is created b the closure of the pulmonic and aortic valves
a. S1
b. S2
c. S3
d. S4

Anatomy and Physiology Notes: Respiratory System

Primary functions of the respiratory system
1. Provides oxygen for metabolism in the tissues
2. Removes carbon dioxide, the waste product of metabolism

Secondary functions of the respiratory system
1. Facilitates sense of smell
2. Produces speech
3. Maintains acid-base balance
4. Maintains body water levels
5. Maintains heat balance

Upper respiratory tract
1. Nose: Humidifies, warms, and filters inspired air

2. Sinuses: Air-filled cavities within the hollow bones that surround the nasal passages and provide resonance during speech

3. Pharynx
a. Passageway for the respiratory and digestive tracts located behind
the oral and nasal cavities
b. Divided into the nasopharynx, oropharynx, and laryngopharynx

4. Larynx
a. Located above the trachea, just below the pharynx at the root of
the tongue; commonly called the voice box
b. Contains two pairs of vocal cords, the false and true cords
c. The opening between the true vocal cords is the glottis.
d. The glottis plays an important role in coughing, which is the most
fundamental defense mechanism of the lungs.

5. Epiglottis
a. Leaf-shaped elastic structure attached along one end to the top of
the larynx
b. Prevents food from entering the tracheobronchial tree by closing
over the glottis during swallowing

Lower respiratory tract
1. Trachea: Located in front of the esophagus; branches into the right
and left main stem bronchi at the carina

2. Main stem bronchi
a. Begin at the carina
b. The right bronchus is slightly wider, shorter, and more vertical than the left bronchus.
c. The mainstem bronchi divide into secondary or lobar bronchi that enter each of the five lobes of the lung.
d. The bronchi are lined with cilia, which propel mucus up and away from the lower airway to the trachea, where it can be expectorated or swallowed.

3. Bronchioles
a. Branch from the secondary bronchi and subdivide into the small terminal and respiratory bronchioles

b. The bronchioles contain no cartilage and depend on the elastic recoil of the lung for patency.
c. The terminal bronchioles contain no cilia and do not participate in gas exchange.

4. Alveolar ducts and alveoli
a. Acinus (plural acini) is a term used to indicate all structures distal to the terminal bronchiole.
b. Alveolar ducts branch from the respiratory bronchioles.
c. Alveolar sacs, which arise from the ducts, contain clusters of alveoli, which are the basic units of gas exchange.
d. Type II alveolar cells in the walls of the alveoli secrete surfactant, a phospholipid protein that reduces the surface tension in the alveoli; without surfactant, the alveoli would collapse.

5. Lungs
a. Located in the pleural cavity in the thorax
b. Extend from just above the clavicles to the diaphragm, the major muscle of inspiration
c. The right lung, which is larger than the left, is divided into three lobes, the upper, middle, and lower lobes.
d. The left lung, which is narrower than the right lung to accommodate the heart, is divided into two lobes.
e. The respiratory structures are innervated by the phrenic nerve, the vagus nerve, and the thoracic nerves.
f. The parietal pleura lines the inside of the thoracic cavity, including the upper surface of the diaphragm.

g. The visceral pleura covers the pulmonary surfaces.
h. A thin fluid layer, which is produced by the cells lining the pleura, lubricates the visceral pleura and the parietal pleura, allowing them to glide smoothly and painlessly during respiration.
i. Blood flows through the lungs via the pulmonary system and
the bronchial system.

6. Accessory muscles of respiration include the scalene muscles, which elevate the first two ribs, the sternocleidomastoid muscles, which raise the sternum, and the trapezius and pectoralis muscles, which fix
the shoulders.


Respiratpry Process
a. The diaphragm descends into the abdominal cavity during inspiration, causing negative pressure in the lungs.
b. The negative pressure draws air from the area of greater pressure, the atmosphere, into the area of lesser pressure, the lungs.
c. In the lungs, air passes through the terminal bronchioles into the alveoli to oxygenate the body tissues.
d. At the end of inspiration, the diaphragm and intercostal muscles relax and the lungs recoil.
e. As the lungs recoil, pressure within the lungs becomes higher than atmospheric pressure, causing the air, which now contains the cellular waste products carbon dioxide and water, to move from the alveoli in the lungs to the atmosphere.
f. Effective gas exchange depends on distribution of gas (ventilation) and blood (perfusion) in all portions of the lungs