NR 509 3P Exam Week 8 (Questions, Answers and Explanations) Graded A+

NR 509 3P Exam Week 8 (Questions, Answers and Explanations) Graded A+ Question 1 A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings on exam reveal: temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute. Tachypnea in this child is most likely related to Correct: the child's febrile state. Explanation: In children, heart and respiratory rates will increase with fever. For every degree of fever the respiratory rate will increase 3-4 breaths/minutes and the heart rate will increase 8-10 beats/minute. Question 2 When percussing the lower posterior chest, begin by: Correct: having the patient lie supine on the examining table. Explanation: When percussing the lower posterior chest, stand on the side rather than directly behind the patient. This position allows the ability to place the pleximeter finger more firmly on the chest and the plexor is more effective in making a better percussion note. If the patient is lying supine, the posterior chest will not be able to be percussed. Palpating painful areas is not percussion, so is not correct. Using the bony part of the palm at the base of the fingers or the ulnar surface is a technique used to detect tactile fremitus. Question 3 The palpation technique used to assess respiratory expansion of the chest is placing the hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand medially and grasping a small fold of skin between the thumbs. Then: Correct: have the patient hold his breath for 15 seconds then note chest expansion. Explanation: To assess the respiratory expansion of the chest, the examiner places his hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, slides the hand medially and grasps a small fold of skin between the thumbs then asks the patient to take a deep breath. The thumbs should move evenly away from the vertebrae during inspiration and there should be no delay in expansion. Question 4 NR 509 3P Exam Week 8 (Questions, Answers and Explanations) Graded A+ When trying to differentiate between hemoptysis or blood streaked material, which one of the following observations is correct? Correct: Blood streaked material often originates from the gastrointestinal tract. Explanation: Hemoptysis is rare in infants, children, and adolescents, although common in those with cystic fibrosis. Blood originating in the stomach is usually darker than blood from the respiratory tract and may be mixed with food particles. Blood or blood-streaked material may originate in the mouth, pharynx, or less commonly from the gastrointestinal tract. Question 5 When percussing the chest in a patient who has left sided heart failure, the sound emanated would be: Correct: resonant. Explanation: A patient with left sided heart failure experiences increased pressure in the pulmonary veins causing congestion and interstitial edema. Percussion sounds emitted would most likely be resonant. Consolidation in the lungs produces a dull sound on percussion. Tympany (low-high pitched musical sound) is usually audible when percussing a distended abdomen or when a pneumothorax is present. Chronic obstructive lung disease produces diffusely hyperresonant sound on percussion. Question 6 The line that extends through the inferior angle of the scapula when the arms are at the sides of the body is the: Correct: midclavicular line. Explanation: The line that extends through the inferior angle of the scapula when the arms are at the sides of the body is the scapular line. Question 7 A condition associated with a chronic cough that produces copious amounts of purulent sputum is most Correct: laryngitis. Explanation: An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is tracheobronchitis. An acute, mild illness often associated with viral nasopharyngitis and hoarseness is laryngitis. The initial cough is dry and nonproductive but may become productive over time. A chronic bronchitis cough is characteristically productive with mucoid to purulent sputum and may be blood tinged. Bronchiectasis produces a chronic cough with sputum that is copious and foul-smelling. It may be blood tinged. Question 8 A patient who walked into the examination room, may be observed to be sitting and leaning forward in his chair. Lips were pursed during exhalation and arms are supported on the table. This position could be consistent with patients who have: Correct: asthma. Explanation: People who have chronic obstructive pulmonary disease experience shortness of breath and dyspnea. Breathing with pursed lips and use of abdominal muscles help reduce shortness of breath and dyspnea. Leaning forward while seated and having arms supported on the table facilitate breathing. This position is not characteristic of the other diseases. Question 9 Breath sounds heard over the periphery of the lung fields are: Correct: Incorrectvesicular. Explanation: Bronchial, vesicular, and bronchovesicular breath sounds are considered normal. Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung field. Bronchial breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx. Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase. They are normally heard over the hilar region (center of the lungs near the heart). Question 10 When percussing the posterior chest, which one of the following techniques would be omitted? Correct: If a louder note is needed, apply more pressure with the Explanation: All of the percussion techniques listed are useful when percussing the chest except the areas over the scapulae. These areas are not percussed because the thickness of the muscle and bone alters the percussion notes over the lungs. Question 11 When auscultating breath sounds in a patient who has left sided heart failure, the breath sounds are: Correct: bronchial with late inspiratory crackles over the involved area and dull on percussion. Explanation: A patient with left sided heart failure experiences increased pressure in the pulmonary veins causing congestion and interstitial edema. The breath sounds are vesicular with late inspiratory crackles in the dependent portions of the lungs and are resonant on percussion. Consolidation in the lungs produces bronchial breath sounds with late inspiratory crackles over the involved area and is dull on percussion. A normal lung has vesicular breath sounds without adventitious sounds and is resonant on percussion. Chronic obstructive lung disease produces decreased breath sounds with some audible wheezes and is hyperresonant on percussion. Question 12 Breath sounds consisting of a full inspiratory phase and a shortened and softer expiratory phase normally audible over the hilar region of the chest are termed: Correct: rhonchi. Explanation: Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase. They are normally heard over the hilar region (center of the lungs near the heart). Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung field. Bronchial breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx. Question 13 An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is suggestive of: Correct: chronicbronchitis. Explanation: An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is tracheobronchitis. An acute, mild illness associated with viral nasopharyngitis and hoarseness is laryngitis. The initial cough is dry and nonproductive but may become productive over time. A chronic bronchitis cough is characteristically productive with mucoid to purulent sputum and may be blood tinged. Bronchiectasis produces a chronic cough with sputum that is copious and foul-smelling. It may be blood tinged or bloody. Question 14 One of the anterior thoracic landmarks is the costal angle. It is located: Correct: where the suprasternal notch and the sternum form an angle. Explanation: The right and left costal margins form an angle where they meet at the xiphoid process. This is the costal angle. The angle should be 90 degrees or less. However, the angle increases when the rib cage is chronically over inflated, as in emphysema. Question 15 Atypical respiratory symptoms associated with gastroesophageal disease (GERD) may include all of the following except: Correct: tis. Explanation: Atypical respiratory symptoms associated with gastroesophageal disease may include coughing, wheezing, asthma, and aspiration pneumonia. Rhinitis is rarely associated with GERD.