NSG 300 EXAM QUESTION WITH COMPLETE SOLUTIONS
Genetic attributes of dark-skinned individuals
Protection against skin cancer to melanin. Increased likelihood of skin cancer in whites
Most important environmental risk factor for skin cancer
Exposure to (UV) radiation both from sun and indoor tanning sources → changes genetic
makeup
Increased risk for melanoma r/t
Increased number of sunburns during one's lifetime
Impact of measles
Highly contagious pathogen
Skin assessment subjective data
Past history of skin disease, change in color/moles, excessive dryness/moisture, pruritus
(itching), excessive bruising, rashes/lesions, medications, hair loss, change in nails,
environmental/occupational hazards, pt centered care
Respiratory system 4 major functions
1. Supplies O2 to body for energy production
2. Removes CO2 as a waste product of energy reactions
3. Maintains homeostasis of arterial blood (respiration maintains pH)
4. Maintains heat exchange (less important in humans)
Respiratory system at birth
Not needed until birth
Smoke exposure in infants/children
Increases risk for SIDS, behavioral problems, cognitive issues, adolescent smoking
Pregnancy respiratory change
Decreased vertical diameter of thoracic cage, but breaths are deeper (greater tidal volume)
Aging thorax
Thoraces less mobile
Aging lungs
,Lungs are more rigid and difficult to inflate
Aging adults vital capacity/residual volume
Decreased VC, increased RV
Respiratory risks in older adults
Greater risk for atelectasis/infection from decreased ability to cough, loss of airway reflexes,
increased secretions
Lung cancer
2nd most diagnosed cancer in both genders, leading cause of cancer death in the U.S. →
smoking leading to mutational burden
Tuberculosis (TB)
Affected more than 1/3 of the world's population → "social and migratory" disease. Need to
identify and actively treat
Asthma
Most common chronic disease in childhood
Asthma risk factors
Highest burden seen in those living at/below the federal poverty level. Ethnic and
environmental factors play significant role
Respiratory assessment subjective data
Cough, SOB, chest pain with breathing, history of respiratory infections, smoking history (5 A's),
environmental exposure, patient centered care
Smoking history (5 A's)
ASK about tobacco use status at every visit and record response
ADVISE clear, nonjudgmental, and personalized suggestions for quitting
ASSESS readiness for/interest in quitting
ASSIST with a specific cessation plan
ARRANGE follow-up visits
Respiratory assessment additional history for infants and children
Any frequent or very severe colds? History of allergy in family? Cough or congestion? Noisy
breathing or wheezing? What measures have you taken to child-proof your home and yard? Is
there any possibility of child inhaling or swallowing toxic substances? Has anyone taught you
,emergency care measures in case of accidental choking or a hard-breathing spell? Any smokers
in home or in car with child?
Respiratory assessment additional history for aging adult
Any SOB or fatigue with daily activities? How is your energy level? Do you tire more easily? How
does your illness affect you at home and at work? Any chest pain with breathing? Any chest pain
after a bout of coughing or after a fall? COPD, lung cancer, or tuberculosis- use lung function
questionnaire
Respiratory assessment objective data
Inspect thoracic cage (anterior/posterior), palpate posterior chest, percuss posterior chest,
auscultate anterior/posterior/lateral chest, pulse oximetry
Inspecting thoracic cage
Note shape and configuration of chest wall, ratio of AP to transverse diameter (1:2), position
patient takes to breathe, assess skin color and condition for cyanosis or pallor
Palpate posterior chest
Symmetric expansion (when patient takes deep breath), tactile fr fremitus (patient repeats "99,"
vibration decreases moving down lung field)
Percuss posterior chest
8 locations in zig zag pattern. Sounds are dull over organs, resonant over lungs, flat over bone
Auscultate
5 locations anteriorly, 7 posteriorly, and 2 on each side. Sounds are bronchial over the trachea,
bronchovesicular over major airways, vesicular over lungs
Crackles
Small airways snapping open on inspiration
Rhonchi
Coarse loud sounds caused by constricted larger airways
Wheeze
High-pitched musical sounds caused by constricted smaller airways
Stridor
High-pitched crowing sound caused by partial obstruction of larynx or trachea
, Infant thorax shape
Rounded thorax
Newborn chest vs head size
Chest circumference smaller than head until age 2
Infant breathing type
Obligate nose breathers until 3 months
Infant respiratory rate measurement
Count for full 1 minute, breathing pattern may be irregular
Periodic breathing
Normal in infants, especially premature infants
Infant palpation technique
Encircle thorax with both hands
Pediatric stethoscope placement
Use small diaphragm/bell over interspaces, not ribs
Normal infant respiratory rate
30-40 breaths/min
Pregnancy thoracic cage change
Thoracic cage appears wider
Pregnancy breathing change
Deeper respirations
Pregnancy tidal volume
Increases by about 40%
Aging adult thorax/spine change
Increased AP diameter, kyphosis (outward spinal curvature)
Aging chest expansion
Slightly decreased but still symmetric
Genetic attributes of dark-skinned individuals
Protection against skin cancer to melanin. Increased likelihood of skin cancer in whites
Most important environmental risk factor for skin cancer
Exposure to (UV) radiation both from sun and indoor tanning sources → changes genetic
makeup
Increased risk for melanoma r/t
Increased number of sunburns during one's lifetime
Impact of measles
Highly contagious pathogen
Skin assessment subjective data
Past history of skin disease, change in color/moles, excessive dryness/moisture, pruritus
(itching), excessive bruising, rashes/lesions, medications, hair loss, change in nails,
environmental/occupational hazards, pt centered care
Respiratory system 4 major functions
1. Supplies O2 to body for energy production
2. Removes CO2 as a waste product of energy reactions
3. Maintains homeostasis of arterial blood (respiration maintains pH)
4. Maintains heat exchange (less important in humans)
Respiratory system at birth
Not needed until birth
Smoke exposure in infants/children
Increases risk for SIDS, behavioral problems, cognitive issues, adolescent smoking
Pregnancy respiratory change
Decreased vertical diameter of thoracic cage, but breaths are deeper (greater tidal volume)
Aging thorax
Thoraces less mobile
Aging lungs
,Lungs are more rigid and difficult to inflate
Aging adults vital capacity/residual volume
Decreased VC, increased RV
Respiratory risks in older adults
Greater risk for atelectasis/infection from decreased ability to cough, loss of airway reflexes,
increased secretions
Lung cancer
2nd most diagnosed cancer in both genders, leading cause of cancer death in the U.S. →
smoking leading to mutational burden
Tuberculosis (TB)
Affected more than 1/3 of the world's population → "social and migratory" disease. Need to
identify and actively treat
Asthma
Most common chronic disease in childhood
Asthma risk factors
Highest burden seen in those living at/below the federal poverty level. Ethnic and
environmental factors play significant role
Respiratory assessment subjective data
Cough, SOB, chest pain with breathing, history of respiratory infections, smoking history (5 A's),
environmental exposure, patient centered care
Smoking history (5 A's)
ASK about tobacco use status at every visit and record response
ADVISE clear, nonjudgmental, and personalized suggestions for quitting
ASSESS readiness for/interest in quitting
ASSIST with a specific cessation plan
ARRANGE follow-up visits
Respiratory assessment additional history for infants and children
Any frequent or very severe colds? History of allergy in family? Cough or congestion? Noisy
breathing or wheezing? What measures have you taken to child-proof your home and yard? Is
there any possibility of child inhaling or swallowing toxic substances? Has anyone taught you
,emergency care measures in case of accidental choking or a hard-breathing spell? Any smokers
in home or in car with child?
Respiratory assessment additional history for aging adult
Any SOB or fatigue with daily activities? How is your energy level? Do you tire more easily? How
does your illness affect you at home and at work? Any chest pain with breathing? Any chest pain
after a bout of coughing or after a fall? COPD, lung cancer, or tuberculosis- use lung function
questionnaire
Respiratory assessment objective data
Inspect thoracic cage (anterior/posterior), palpate posterior chest, percuss posterior chest,
auscultate anterior/posterior/lateral chest, pulse oximetry
Inspecting thoracic cage
Note shape and configuration of chest wall, ratio of AP to transverse diameter (1:2), position
patient takes to breathe, assess skin color and condition for cyanosis or pallor
Palpate posterior chest
Symmetric expansion (when patient takes deep breath), tactile fr fremitus (patient repeats "99,"
vibration decreases moving down lung field)
Percuss posterior chest
8 locations in zig zag pattern. Sounds are dull over organs, resonant over lungs, flat over bone
Auscultate
5 locations anteriorly, 7 posteriorly, and 2 on each side. Sounds are bronchial over the trachea,
bronchovesicular over major airways, vesicular over lungs
Crackles
Small airways snapping open on inspiration
Rhonchi
Coarse loud sounds caused by constricted larger airways
Wheeze
High-pitched musical sounds caused by constricted smaller airways
Stridor
High-pitched crowing sound caused by partial obstruction of larynx or trachea
, Infant thorax shape
Rounded thorax
Newborn chest vs head size
Chest circumference smaller than head until age 2
Infant breathing type
Obligate nose breathers until 3 months
Infant respiratory rate measurement
Count for full 1 minute, breathing pattern may be irregular
Periodic breathing
Normal in infants, especially premature infants
Infant palpation technique
Encircle thorax with both hands
Pediatric stethoscope placement
Use small diaphragm/bell over interspaces, not ribs
Normal infant respiratory rate
30-40 breaths/min
Pregnancy thoracic cage change
Thoracic cage appears wider
Pregnancy breathing change
Deeper respirations
Pregnancy tidal volume
Increases by about 40%
Aging adult thorax/spine change
Increased AP diameter, kyphosis (outward spinal curvature)
Aging chest expansion
Slightly decreased but still symmetric
