NR-509-APEA-3P-Exam
NR 509 Advanced physical assessment
,NR-509-APEA-3P-Exam
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
Paradoxical respirations.
the child's febrile state. Correct
the child's age.
an airway obstruction.
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:
standing on the side rather than directly behind the patient.
Correct: having the patient lie supine on the examining table.
carefully palpating any area the patient has reported pain.
using the ball or the ulnar surface of the hand.
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:
ask the patient to cough and note chest expansion.
ask the patient to take a deep breathe and note any delay in expansion
during inhalation.
Correct have the patient hold his breath for 15 seconds then note
chest expansion.
, have the patient exhale forcefully noting expansion on expiration.
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
When trying to differentiate between hemoptysis or blood streaked
material, which one of the following observations is correct?
Hemoptysis is seen frequently in infants, children, and adolescents with
allergic rhinitis.
Blood originating in the stomach is usually brighter than blood
originating from the respiratory tract.
IncorrectHemoptysis is common in children with cystic fibrosis.
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.
NR 509 Advanced physical assessment
,NR-509-APEA-3P-Exam
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
Paradoxical respirations.
the child's febrile state. Correct
the child's age.
an airway obstruction.
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:
standing on the side rather than directly behind the patient.
Correct: having the patient lie supine on the examining table.
carefully palpating any area the patient has reported pain.
using the ball or the ulnar surface of the hand.
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:
ask the patient to cough and note chest expansion.
ask the patient to take a deep breathe and note any delay in expansion
during inhalation.
Correct have the patient hold his breath for 15 seconds then note
chest expansion.
, have the patient exhale forcefully noting expansion on expiration.
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
When trying to differentiate between hemoptysis or blood streaked
material, which one of the following observations is correct?
Hemoptysis is seen frequently in infants, children, and adolescents with
allergic rhinitis.
Blood originating in the stomach is usually brighter than blood
originating from the respiratory tract.
IncorrectHemoptysis is common in children with cystic fibrosis.
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.
