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NR 509 APEA 3P Exam Week 8
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
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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
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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:
NR 509 APEA 3P Exam Week 8
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
,2
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
, 3
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:
