NBRC Exam Patient Assessment Questions
With Answers Graded A+
What action should be recommended if the APGAR score is 3
Resuscitate
What action should be recommended if the APGAR score is 8?
Monitor routine care
Orthopnea
Difficult breathing except in the upright position (CHF)
General malise
Run down feeling, nausea, weakness. fatigue. headache (check electrolyte imbalance)
Dyspnea
A feeling of shortness of breath or difficulty breathing
Dysphagia
Difficulty swallowing and hoarseness are common symptoms
Peripheral Edema
Fluid in the arms and legs
Recommend a Diuretic
Pathology: Presence of excessive fluid in the tissue as pitting edema caused by CHF and renal failure
Ascites
Accumulation of fluid in the abdomen generally caused by liver failure.
Pathology: Abdominal infection
Clubbing of fingers
Caused by chronic hypoxemia
Pathology: Pulmonary disease COPD, CHF
The thumb and first fingers are affected.
Venous Distention
Increased venous distention, jugular distention (JVD) temporal veins popping out
Pathology: occurs with CHF, seen during exhalation in patients with COPD.
Capillary refill
Indication of peripheral circulation
Pathology: blanching the hand and watch for color return
Color should return within 3 seconds
Diaphoresis
A state of profuse/heavy sweating, heart failure recommend diuretics. positive inotropic agents.
,Pathology: fever infection (recommend antibiotics), anxiety nervousness (recommend sedatives),
tuberculosis/night sweats (recommend antitubular gram stain)
Ashen/pallor
Abnormal
Indicates: anemia, blood loss, (vasoconstriction will cause color change by reducing blood)
Erythema
Redness of the skin
Indicates: due to capillary congestion, inflammation or infection
Cyanosis
Blue or blue-gray dusky discoloration of the skin and mucous membranes.
Indicates: hypoxia from increased amount of reduced hemoglobin
Kyphosis
Convex curvature of the spine (lean forward)
mostly found in osteoporosis more occurred in woman.
Chest configuration Kyphosiscoliosis
Convex curvature of the spine with a lateral curvature of the spine (lean side to side)
- causes a restrictive pattern and reduced lung volumes.
Describe symmetrical chest movement
When both sides of the chest are moving equally at the same time
List five underlying pathologies that can contribute to a patient displaying asymmetrical chest
movement
Post lung resection, post pneumonectomy
Atelectasis (hyperinflation recruitment maneuver
Flail chest
Pneumothorax
Endotracheal tube inserted in right or left mainstem bronchi
Eupnea
Normal respiratory rate, depth and rhythm
Condition: normal respiratory rate for an adult 12-20bpm
Tachypnea
Increased respiratory rate >20bpm
Condition: hypoxia, fever, pain, CNS problem
Bradypnea
Decreased respiratory rate <12bpm
Condition: sleep, drugs, alcohol, metabolic disorder
, Cheyne-Stokes
Gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 secs with periods
of apnea up to 60 secs.
Condition: increased intracranial pressures, brainstem injury, drug overdose
Biot's
Increased respiratory rate and depth with irregular periods of apnea
Condition: CNS depression
Kussmaul's
Increased respiratory rate (usually 20 breaths/min)
Condition: increased depth rhythm, breathing sounds labored metabolic acidosis, renal failure,
diabetic ketoacidosis
What causes hypertrophy of the accessory muscles and what type of patient might this be present in?
Increase in muscle size of accessory muscle occurs with COPD
Describe the four neck pathologies that might complicate endotracheal intubation
Short receding mandible
Enlarged tongue
Bull neck
Limited range of motion
What is the normal range for a patient's heart rate
60-100/min
What term would be used to decribe a heart rate of 160/min? would this indicate
Tachycardia, indicates hypoxemia, anxiety, stress recommended oxygen therapy
What term would be used to describe a pule 52/min? what would this indicate?
Bradycardia, indicates heart failure, shock, code/emergency recommend atropine.
What does paradoxical pulse/pulsus paradoxus indicate
Pulse/blood pressure varies with respiration. May indicate severe air trapping (status asthmaticus,
tension pneumothorax, cardiac tamponade.
Causes of tracheal deviation Pulled to abnormal side (toward pathology) AIR
Pulmonary atelectasis
Pulmonary fibrosis
Pneumoectomy
Diaphrgamatic paralysis
Pushed to normal side (away from pathology) FLUID
Massive pleural effusion
Tension pneumothorax
Neck or thyroid tumors
Large mediastinal mass
With Answers Graded A+
What action should be recommended if the APGAR score is 3
Resuscitate
What action should be recommended if the APGAR score is 8?
Monitor routine care
Orthopnea
Difficult breathing except in the upright position (CHF)
General malise
Run down feeling, nausea, weakness. fatigue. headache (check electrolyte imbalance)
Dyspnea
A feeling of shortness of breath or difficulty breathing
Dysphagia
Difficulty swallowing and hoarseness are common symptoms
Peripheral Edema
Fluid in the arms and legs
Recommend a Diuretic
Pathology: Presence of excessive fluid in the tissue as pitting edema caused by CHF and renal failure
Ascites
Accumulation of fluid in the abdomen generally caused by liver failure.
Pathology: Abdominal infection
Clubbing of fingers
Caused by chronic hypoxemia
Pathology: Pulmonary disease COPD, CHF
The thumb and first fingers are affected.
Venous Distention
Increased venous distention, jugular distention (JVD) temporal veins popping out
Pathology: occurs with CHF, seen during exhalation in patients with COPD.
Capillary refill
Indication of peripheral circulation
Pathology: blanching the hand and watch for color return
Color should return within 3 seconds
Diaphoresis
A state of profuse/heavy sweating, heart failure recommend diuretics. positive inotropic agents.
,Pathology: fever infection (recommend antibiotics), anxiety nervousness (recommend sedatives),
tuberculosis/night sweats (recommend antitubular gram stain)
Ashen/pallor
Abnormal
Indicates: anemia, blood loss, (vasoconstriction will cause color change by reducing blood)
Erythema
Redness of the skin
Indicates: due to capillary congestion, inflammation or infection
Cyanosis
Blue or blue-gray dusky discoloration of the skin and mucous membranes.
Indicates: hypoxia from increased amount of reduced hemoglobin
Kyphosis
Convex curvature of the spine (lean forward)
mostly found in osteoporosis more occurred in woman.
Chest configuration Kyphosiscoliosis
Convex curvature of the spine with a lateral curvature of the spine (lean side to side)
- causes a restrictive pattern and reduced lung volumes.
Describe symmetrical chest movement
When both sides of the chest are moving equally at the same time
List five underlying pathologies that can contribute to a patient displaying asymmetrical chest
movement
Post lung resection, post pneumonectomy
Atelectasis (hyperinflation recruitment maneuver
Flail chest
Pneumothorax
Endotracheal tube inserted in right or left mainstem bronchi
Eupnea
Normal respiratory rate, depth and rhythm
Condition: normal respiratory rate for an adult 12-20bpm
Tachypnea
Increased respiratory rate >20bpm
Condition: hypoxia, fever, pain, CNS problem
Bradypnea
Decreased respiratory rate <12bpm
Condition: sleep, drugs, alcohol, metabolic disorder
, Cheyne-Stokes
Gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 secs with periods
of apnea up to 60 secs.
Condition: increased intracranial pressures, brainstem injury, drug overdose
Biot's
Increased respiratory rate and depth with irregular periods of apnea
Condition: CNS depression
Kussmaul's
Increased respiratory rate (usually 20 breaths/min)
Condition: increased depth rhythm, breathing sounds labored metabolic acidosis, renal failure,
diabetic ketoacidosis
What causes hypertrophy of the accessory muscles and what type of patient might this be present in?
Increase in muscle size of accessory muscle occurs with COPD
Describe the four neck pathologies that might complicate endotracheal intubation
Short receding mandible
Enlarged tongue
Bull neck
Limited range of motion
What is the normal range for a patient's heart rate
60-100/min
What term would be used to decribe a heart rate of 160/min? would this indicate
Tachycardia, indicates hypoxemia, anxiety, stress recommended oxygen therapy
What term would be used to describe a pule 52/min? what would this indicate?
Bradycardia, indicates heart failure, shock, code/emergency recommend atropine.
What does paradoxical pulse/pulsus paradoxus indicate
Pulse/blood pressure varies with respiration. May indicate severe air trapping (status asthmaticus,
tension pneumothorax, cardiac tamponade.
Causes of tracheal deviation Pulled to abnormal side (toward pathology) AIR
Pulmonary atelectasis
Pulmonary fibrosis
Pneumoectomy
Diaphrgamatic paralysis
Pushed to normal side (away from pathology) FLUID
Massive pleural effusion
Tension pneumothorax
Neck or thyroid tumors
Large mediastinal mass
