JARVIS WEEK 3

4. While assessing a patient's lung sounds you note bronchial breath sounds in the peripheral lung fields. What could this finding represent?* A. This is a normal finding. B. Pulmonary emboli C. Lung consolidation like with pneumonia D. Pleuritis

C

3. Palpable inguinal lymph nodes are: A normal if small (less than 1 cm), movable, and nontender. B abnormal in adults but common in children and infants. C normal if fixed and tender. D abnormal and indicate the presence of malignant disease.

A Inguinal lymph nodes may be palpable. This is a normal finding if the nodes are small (1 cm or less), movable, and nontender. Lymph nodes may be relatively large in children, and the superficial ones often are palpable even when the child is healthy. Enlarged, tender, or fixed inguinal lymph nodes are an abnormal finding.

9. The jugular venous pressure is an indirect reflection of the: A heart's efficiency as a pump. B cardiac cycle. C conduction effectiveness. D synchronization of mechanical activity.

A Jugular venous pressure is a reflection of the heart's ability to pump blood. If the pressure is elevated, heart failure is suspected.

7. This lung sound is continuous, high-pitched with musical instrument sound that is polyphonic and occurs mainly during expiration but can be present with inspiration as well?* A. Stridor B. Fine crackles C. High-pitched wheeze D. High-pitched crackles

C

12. When auscultating the anterior part of the chest, specifically the apex of the lungs, it is best to auscultate where with the stethoscope?* A. Slightly above the clavicle B. 2nd intercostal space mid-clavicular C. 4th intercostal space mid-clavicular D. 6th intercostal space mid-axillary line

A

8. On auscultation of a patient in respiratory distress, you hear a high-pitched, harsh sound that is monophonic and is present only during inspiration. This is known as:* A. Stridor B. Vesicular C. Rales D. Rhonchi

A

3. A ventricular heave is detected by which assessment technique? A Palpation B Inspection C Auscultation with bell of stethoscope D Auscultation with diaphragm of stethoscope

A A ventricular heave caused by ventricular enlargement is best detected by palpation. The heave may not be apparent visually in an obese patient. Auscultation does not detect heaves.

4. Which of the following is an appropriate position to have the patient assume when auscultating for extra heart sounds or murmurs? A Roll toward the left side B Roll toward the right side C Trendelenburg position D Recumbent position

A After auscultation in the supine position, the nurse should have the patient roll onto the left side; the examiner should listen at the apex with the bell for the presence of any diastolic filling sounds (i.e., S3 or S4) or murmurs that may be heard only in this position. The examiner should have the patient sit up and lean forward; the examiner should auscultate at the base with the diaphragm for a soft, high-pitched, early diastolic murmur of aortic or pulmonic regurgitation.

8. Older adults have: A decreased salivation leading to dry mouth. B increased gastric acid secretion. C increased liver size. D decreased incidence of gallstones.

A Aging results in decreased salivation leading to dry mouth. Aging results in decreased gastric acid secretion. Aging results in decreased liver size. Aging results in increased incidence of gallstone formation

1. What should the nurse inspect when assessing a patient with shortness of breath for evidence of long-standing hypoxemia? A Fingernails B Chest excursion C Spinal curvatures D Respiratory pattern

A Clubbing, a sign of long-standing hypoxemia, is evidenced by an increase in the angle between the base of the nail and fingernail to 180 degrees or more, usually accompanied by an increase in the depth, bulk, and sponginess of the end of the finger.

16. The nurse is obtaining a focused respiratory assessment of a 44-yr-old female patient who is in severe respiratory distress 2 days after abdominal surgery. What is most important for the nurse to assess? A Auscultation of bilateral breath sounds B Percussion of anterior and posterior chest wall C Palpation of the chest bilaterally for tactile fremitus D Inspection for anterior and posterior chest expansion

A Important assessments obtained during a focused respiratory assessment include auscultation of lung (breath) sounds. Assessment of tactile fremitus has limited value in acute respiratory distress. It is not necessary to assess for both anterior and posterior chest expansion. Percussion of the chest wall is not essential in a focused respiratory assessment.

8. In young children, the thymus gland: A produces T lymphocytes. B is small and begins to atrophy. C is not important in immune function. D produces B lymphocytes.

A In young children, the thymus gland is important in developing the T lymphocytes of the immune system. The thymus is large in the fetus and young children and atrophies after puberty. The thymus has no function in adults. The thymus gland does not produce B lymphocytes.

9. The symptoms occurring with lactose intolerance include: A bloating and flatulence. B gray stools. C hematemesis. D anorexia.

A Lactose intolerance produces abdominal pain, bloating, and flatulence when milk products are consumed. Gray stools may occur with hepatitis. Hematemesis occurs with stomach or duodenal ulcers and esophageal varices. Anorexia is a loss of appetite and occurs with gastrointestinal disease, as a side effect of some medications, with pregnancy, or with psychological disorders.

3. Moles on the abdomen: A are common. B are uncommon. C require a biopsy. D are no cause for concern.

A Pigmented nevi (moles) are common on the abdomen. Nevi are circumscribed brown macular or papular areas. Nevi should be observed for unusual color or change in shape; biopsy or removal is indicated if nevi change, which indicates a possible malignancy.

8. Stridor is a high-pitched, inspiratory crowing sound commonly associated with: A upper airway obstruction. B atelectasis. C congestive heart failure. D pneumothorax.

A Stridor is associated with upper airway obstruction from swollen, inflamed tissues or a lodged foreign body.

1. Select the correct description of S2, the second heart sound. A Corresponds to the "dubb" sound B Is pathological if heard as a split sound C Occurs when the mitral and tricuspid valves close D Is low pitched and best heard with the bell of a stethoscope

A The second heart sound, S2, corresponds to the "dubb" sound of the heartbeat: lubb-dubb. It is heard as a split sound during inspiration because of the closure of the aortic and pulmonic valves. It is a high-pitched sound best heard with the diaphragm of the stethoscope.

7. The function of the trachea and bronchi is to: A transport gases between the environment and the lung parenchyma. B condense inspired air for better gas exchange. C moisturize air for optimum respiration. D increase air turbulence and velocity for maximum gas transport.

A The trachea and bronchi transport gases between the environment and the lung parenchyma.

20. When assessing a patient's sleep-rest pattern related to respiratory health, what should the nurse ask the patient (select all that apply.)? A Do you awaken abruptly during the night? B Do you sleep more than 8 hours per night? C Do you need to sleep with the head elevated? D Do you often need to urinate during the night? E Do you toss and turn when trying to fall asleep?

A C E A patient with obstructive sleep apnea may have insomnia, abrupt awakenings, or both. Patients with cardiovascular disease (e.g., heart failure that may affect respiratory health) may need to sleep with the head elevated on several pillows (orthopnea). Sleeping more than 8 hours per night or needing to urinate during the night is not indicative of impaired respiratory health.

13. The right middle lobe is auscultated with the stethoscope where?* A. Posteriorly on the right at the 4th intercostal space B. Anteriorly on the right at the 4th intercostal space C. Anteriorly between C7 to T3 D. Posteriorly between T3 to T10

B

3. These breath sounds are found anteriorly and posteriorly throughout the peripheral lung fields?* A. High-pitched wheezes B. Vesicular C. Discontinuous D. Bronchial

B

8. A bruit heard while auscultating the carotid artery of a 65-year-old patient is caused by: A decreased velocity of blood flow through the carotid artery. B turbulent blood flow through the carotid artery. C rapid blood flow through the carotid artery. D increased viscosity of blood.

B A carotid bruit is a blowing, swishing sound indicating blood flow turbulence. A bruit indicates atherosclerotic narrowing of the vessel.

5. Which of the following voice sounds would be a normal finding? A The voice transmission is distinct and sounds close to the ear. B The "eeeee" sound is clear and sounds like "eeeee." C The whispered sound is transmitted clearly. D Whispered "1-2-3" is audible and distinct.

B A normal finding from voice sounds is egophony—"eeeee" heard through the stethoscope clearly. A normal finding from voice sounds is bronchophony; normal voice transmission is soft, muffled, and indistinct. A normal finding from voice sounds is whispered pectoriloquy—whispered sound is faint, muffled, and almost inaudible.

2. A common clinical manifestation in a patient with chronic obstructive pulmonary disease (COPD) is: A periodic breathing patterns. B pursed-lip breathing. C unequal chest expansion. D hyperventilation.

B A patient with COPD may purse the lips in a whistling position. By exhaling slowly and against a narrow opening, the pressure in the bronchial tree remains positive, and fewer airways collapse. Periodic breathing patterns are Cheyne-Stokes or Biot respirations. Cheyne-Stokes respirations occur in heart failure, renal failure, meningitis, drug overdose, and increased intracranial pressure; this type also normally occurs in infants and older adults during sleep. Biot respirations occur with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis. Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as with pneumonia, or with guarding to avoid postoperative incisional pain or pleurisy pain. Hyperventilation is a normal response to fever, fear, or exercise; respiration rate also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons.

7. The abdomen normally moves with breathing until the age of ____ years. A 4 B 7 C 14 D 75

B Abdominal breathing in children continues until the age of 7 years.

9. Percussion of the chest is: A a useful technique for identifying small lesions in lung tissue. B helpful only in identifying surface alterations of lung tissue. C is not influenced by the overlying chest muscle and fat tissue. D normal if a dull note is elicited.

B An abnormal finding must be 2 to 3 cm wide to yield an abnormal percussion note. Percussion detects only the outer 5 to 7 cm of tissue; it does not penetrate to reveal any change in density deeper than that. Percussion findings (resonant notes) may be modified by a muscular chest wall of an athlete or subcutaneous tissue of an obese person. Resonance is a low-pitched, clear, hollow sound that predominates with percussion of healthy lung tissue.

9. Claudication is caused by: A venous insufficiency. B arterial insufficiency. C varicose veins. D stasis ulcerations.

B Claudication is caused by arterial insufficiency. Varicose veins are venous in origin. Stasis ulcerations are venous in origin.

3. Which of the following cardiac alterations occurs during pregnancy? A An increase in cardiac output and blood pressure B An increase in cardiac volume and a decrease in blood pressure C An increased heart rate and increased blood pressure D An increased stroke volume and decreased cardiac output

B During pregnancy the blood volume increases by 30% to 40%; this creates an increase in stroke volume and cardiac output and an increased pulse rate of 10 to 15 beats per minute. The arterial blood pressure decreases in pregnancy as a result of peripheral vasodilation.

1. Increased tactile fremitus would be evident in an individual who has which of the following conditions? A Emphysema B Pneumonia C Crepitus D Pneumothorax

B Fremitus is a palpable vibration. Increased fremitus occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia). Decreased fremitus occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema). Crepitus is a coarse crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue.

7. A patient with metabolic acidosis is likely to display which type of respiration? A Shallow bradypnea B Rapid deep regular breathing C Grossly irregular breathing with periods of apnea D Deep to shallow breathing to apnea repeated in cycles

B Kussmaul respirations occur with metabolic acidosis. The patient breathes deeply and rapidly as the body blows off carbon dioxide to compensate. Shallow, slow breathing; irregular breathing with apnea (ataxic respirations); and cyclic breathing with apnea (Cheyne Stokes) are not associated with metabolic acidosis.

6. Pyrosis is: A an inflammation of the peritoneum. B a burning sensation in the upper abdomen. C a congenital narrowing of the pyloric sphincter. D an abnormally sunken abdominal wall.

B Pyrosis (heartburn) is a burning sensation in the esophagus and stomach from reflux of gastric acid. Peritonitis is an inflammation of the peritoneum. Pyloric stenosis is a congenital narrowing of the pyloric sphincter. A scaphoid abdomen abnormally caves in or is sunken.

1. The first heart sound (S1) is produced by the: A closure of the semilunar valves. B closure of the AV valves. C opening of the semilunar valves. D opening of the AV valves.

B S1 occurs with closure of the atrioventricular valves. The second heart sound (S2) occurs with closure of the semilunar valves. Normally opening of the semilunar valves is silent, but in aortic or pulmonic stenosis, an ejection click may be heard. An ejection click occurs early in systole at the start of ejection because it results from opening of the semilunar valves. A third heart sound (S3) can be heard when the ventricles are resistant to filling during the early rapid filling phase. S3 is heard when the AV valves open and atrial blood first pours into the ventricles.

6. When does the nurse expect to hear an S4 heart sound? A Just after S2 B Just before S1 C Between S1 and S2 D Only when S3 is present

B S4 is a late diastolic sound that is heard just before S1. It does not occur just after S2 or between S1 and S2. It may be present with S3 or heard without S3.

9. During which segment of the electrical conduction of a heartbeat does ventricular systole occur? A P-R B QRS C ST D T

B The QRS corresponds to the heart's mechanical action of ventricular systole. The P-R interval corresponds to atrial systole. The ST segment and T waves correspond to ventricular diastole.

6. The ability of the heart to contract independently of any signals or stimulation is due to: A depolarization. B automaticity. C conduction. D repolarization.

B The heart can contract by itself, independent of any signals or stimulation from the body; this property is termed automaticity. Depolarization is the reversal of the resting potential in excitable cardiac muscle cell membranes when stimulated. Conduction is the process by which an electrical impulse is transmitted through the heart. Repolarization is the process by which the membrane potential of a cardiac muscle cell is restored to the cell's resting potential.

11. An increase in the transverse diameter of the chest cage in a pregnant woman is due to a(n): A compensatory increase in respiratory parenchyma. B increase in estrogen. C increase in surfactant. D increase in tidal volume.

B The increase in estrogen level during pregnancy relaxes the chest cage ligaments. This allows an increase in the transverse diameter of the chest cage by 2 cm, and the costal angle widens.

4. The organ in the right upper quadrant of the abdomen is the: A spleen. B liver. C cecum. D sigmoid colon.

B The liver is in the right upper quadrant of the abdomen. The spleen is in the left upper quadrant. The cecum is in the right lower quadrant. The sigmoid colon is in the left lower quadrant.

2. The manubriosternal angle (angle of Louis) is continuous with which anatomical landmark? A Clavicle B Second rib C Xiphoid process D Seventh intercostal space

B The manubriosternal angle is continuous with the second rib. The clavicle, xiphoid process, and seventh intercostal space are also anterior landmarks.

5. Which assessment finding of the respiratory system in a 2-month-old infant is considered abnormal? A Sneezing B Grunting C Rounded thorax D Respiratory rate of 50 breaths/min

B Grunting respirations in an infant are a sign of respiratory distress. Sneezing, a respiratory rate between 40 and 60 breaths/min, and a rounded thorax (anteroposterior equals transverse diameter) are normal findings.

21. In assessment of the patient with acute respiratory distress, what should the nurse expect to observe (select all that apply.)? A Cyanosis B Tripod position C Kussmaul respirations D Accessory muscle use E Increased AP diameter

B D Tripod position and accessory muscle use indicate moderate to severe respiratory distress. Cyanosis may be related to anemia, decreased oxygen transfer in the lungs, or decreased cardiac output. Therefore, it is a nonspecific and unreliable indicator of only respiratory distress. Kussmaul respirations occur when the patient is in metabolic acidosis to increase CO2 excretion. Increased AP diameter occurs with lung hyperinflation from chronic obstructive pulmonary disease, cystic fibrosis, or with advanced age.

2. These type of breath sounds are found at the site of the bronchi and are located anteriorly at the 1st and 2nd intercostal space & posteriorly in between the scapulae?* A. Crackles B. Wheezes C. Bronchovesicular D. Vesicular

C

14. When auscultating the posterior part of the chest the upper lobes are found?* A. Between C9 to T10 B. Between T3 to T10 C. Between C7 to T3 D. Directly over the scapulae

C

9. You are auscultating a patient's lung sounds. During your assessment, you note there is a low-pitched harsh, grating sound that sounds like a pleural friction rub. However, you're not sure if this is a pleural friction rub or pericardial friction rub. What do you do next to determine the difference?* A. Have the patient cough and see if the sound clears B. Assess the posterior lower lobe only C. Have the patient hold their breath and note if the sound is still present D. Place the patient in supine position and reassess for the sound

C

6. Which assessment finding suggests a child has epiglottitis? A Salty taste of skin B Harsh, barking cough C Difficulty swallowing D Wheezing respirations

C A child with epiglottitis has an extremely sore throat and is reluctant to swallow. Children with cystic fibrosis have a salty taste to the skin. A harsh barking cough occurs with acute laryngotracheitis or croup. Wheezing occurs with asthma.

5. The nurse hears a pericardial friction rub while listening to heart sounds. Which characteristic is correct about this sound? A Is louder during inspiration B Is best heard with the patient supine C Occurs throughout the heart sound cycle D Will not be heard if the patient holds their breath

C A pericardial friction rub is a scratchy sound heard throughout the heart cycle in patients with pericarditis. The sound is enhanced when the patient holds their breath on expiration while sitting up and leaning forward.

6. A water-hammer or Corrigan pulse is associated with: A hyperkinetic states. B decreased cardiac output. C aortic valve regurgitation. D conduction disturbance.

C A water-hammer (Corrigan) pulse occurs in aortic valve regurgitation. A full, bounding pulse is associated with hyperkinetic states (exercise, anxiety, fever). A weak, thready pulse occurs with decreased cardiac output. Pulsus bigeminus occurs with conduction disturbances.

1. Areas of hyperresonance are percussed over the lung fields in which condition? A Pleurisy B Pneumonia C Emphysema D Pleural effusion

C Areas of trapped air that occur with emphysema cause hyperresonance with percussion. Pleurisy causes a friction rub with auscultation. Pneumonia and pleural effusion are likely to cause areas of dullness.

2. Arteriosclerosis refers to: A a variation from the heart's normal rhythm. B a sac formed by dilation in the arterial wall. C thickening and loss of elasticity of the arterial walls. D deposition of fatty plaques along the intima of the arteries.

C Arteriosclerosis is the thickening and loss of elasticity of the arterial walls. A dysrhythmia is a variation from the heart's normal rhythm. An aneurysm is a sac formed by dilation in the artery wall. Atherosclerosis is the deposition of fatty plaques on the intima of the arteries.

10. A patient has severe bilateral lower extremity edema. The most likely cause is: A an infection of the right great toe. B Raynaud phenomenon. C heart failure. D an aortic aneurysm.

C Bilateral lower extremity edema is a result of a generalized disorder such as heart failure. An infection of only one extremity would lead to unilateral edema. Raynaud phenomenon does not result in bilateral lower extremity edema. Aneurysms do not cause bilateral lower extremity edema.

11. The nurse, when auscultating the lower lungs of the patient, hears these breath sounds. How should the nurse document these sounds? A Stridor B Vesicular C Coarse crackles D Bronchovesicular

C Coarse crackles are a series of long-duration, discontinuous, low-pitched sounds caused by air passing through an airway intermittently occluded by mucus, an unstable bronchial wall, or a fold of mucosa. Coarse crackles are evident on inspiration and at times expiration. Stridor is a continuous crowing sound of constant pitch from partial obstruction of larynx or trachea. Vesicular sounds are relatively soft, low-pitched, gentle, rustling sounds. They are heard over all lung areas except the major bronchi. Bronchovesicular sounds are normal sounds heard anteriorly over the mainstem bronchi on either side of the sternum and posteriorly between the scapulae with a medium pitch and intensity.

15. Which patient is exhibiting an early clinical manifestation of hypoxemia? A A 48-yr-old patient who is intoxicated and acutely disoriented to time and place B A 67-yr-old patient who has dyspnea while resting in the bed or in a reclining chair C A 72-yr-old patient who has four new premature ventricular contractions per minute D A 94-yr-old patient who has renal insufficiency, anemia, and decreased urine output

C Early clinical manifestations of hypoxemia include dysrhythmias (e.g., premature ventricular contractions), unexplained decreased level of consciousness (e.g., disorientation), dyspnea on exertion, and unexplained decreased urine output.

4. Which finding on the patient history is suspicious for pulmonary tuberculosis? A Afebrile B Weight gain C Night sweats D Clear sputum

C Night sweats are associated with pulmonary tuberculosis. Fever, weight loss, and blood-tinged sputum are also associated with pulmonary tuberculosis.

2. Pyloric stenosis is a(n): A abnormal enlargement of the pyloric sphincter. B inflammation of the pyloric sphincter. C congenital narrowing of the pyloric sphincter. D abnormal opening in the pyloric sphincter.

C Pyloric stenosis is a congenital defect causing a narrowing of the pyloric sphincter.

2. Which of the following guidelines may be used to identify which heart sound is S1? A S1 is louder than S2 at the base of the heart. B S1 coincides with the A wave of the jugular venous pulse wave. C S1 coincides with the carotid artery pulse. D S1 coincides with the Q wave of the QRS electrocardiogram complex.

C S1 coincides with the carotid artery pulse. S1 is loudest at the apex of the heart. S1 coincides with the C wave of the jugular venous pulse wave. S1 coincides with the R wave (the upstroke of the QRS complex).

5. The four layers of large, flat abdominal muscles form the: A linea alba. B rectus abdominis. C ventral abdominal wall. D viscera.

C The four layers of large, flat muscles form the ventral abdominal wall. These muscles are joined at the midline by a tendinous seam, the linea alba. One set of abdominal muscles, the rectus abdominis, forms a strip extending the length of the midline. The viscera are all the internal organs inside the abdominal cavity.

6. The gradual loss of intra-alveolar septa and a decreased number of alveoli in the lungs of elderly adults cause: A hyperventilation. B spontaneous atelectasis. C decreased surface area for gas exchange. D decreased dead space.

C The histologic changes result in less surface area for gas exchange.

7. When auscultating the heart of a newborn within 24 hours after birth, the examiner hears a continuous sound that mimics the sound of a machine. This finding most likely indicates: A the presence of congenital heart disease. B a normal sound because of the thinner chest wall of the newborn. C an expected sound caused by nonclosure of the ductus arteriosus. D pathology only when accompanied by an increased heart rate.

C The murmur of a patent ductus arteriosus is a continuous machinery murmur, which disappears by 2 to 3 days.

10. Which of the following pairs correctly expresses the relationship to the lobes of the lungs and their anatomic position? A Upper lobes—lateral chest B Upper lobes—posterior chest C Lower lobes—posterior chest D Lower lobes—anterior chest

C The posterior chest is almost all lower lobe. The anterior chest contains mostly upper and middle lobe with very little lower lobe.

10. The semilunar valves separate the: A atria from the ventricles. B right atria from the left atria. C ventricles from the arteries. D atria from the veins.

C The semilunar valves separate the ventricles from the arteries. The atrioventricular valves separate the atria and ventricles. The atrioventricular valves separate the atria and the ventricles. The septum separates the right atria from the left atria. The vena cava are not separated by a valve from the right atrium; the pulmonary veins are not separated by a valve from the left atrium.

12. The patient is calling the clinic with a cough. What assessment should be made first before the nurse advises the patient? A Frequency, family history, hematemesis B Weight loss, activity tolerance, orthopnea C Cough sound, sputum production, pattern D Smoking status, medications, residence location

C The sound of the cough, sputum production and description, and the pattern of the cough's occurrence (including acute or chronic) and what its occurrence is related to are the first assessments to be made to determine the severity. Frequency of the cough will not provide a lot of information. Family history can help to determine a genetic cause of the cough. Hematemesis is vomiting blood and not as important as hemoptysis. Smoking is an important risk factor for chronic obstructive pulmonary disease, and lung cancer and may cause a cough. Medications may or may not contribute to a cough as does residence location. Weight loss, activity intolerance, and orthopnea may be related to respiratory or cardiac problems, but are not as important when dealing with a cough.

3. Which of the following is not included in the definition of the thoracic cage? A Sternum B Ribs C Costochondral junction D Diaphragm

C The thoracic cage comprises the sternum, ribs, vertebrae, and diaphragm.

5. The leaflets of the tricuspid and mitral valves are anchored by __________________ to the _________________, which are embedded in the ventricular floor. A endocardial ligaments; mediastinal muscles B atrioventricular tendons; pericardial bundles C chordae tendineae; papillary muscles D pericardial cords; ventricular sheaths

C The valves are anchored by collagenous fibers (chordae tendineae) to the papillary muscles, which are embedded in the ventricle floor.

13. During the assessment in the emergency department, the nurse is palpating the patient's chest. Which finding is a medical emergency? A Increased tactile fremitus B Diminished chest movement C Tracheal deviation to the left D Decreased anteroposterior (AP) diameter

C Tracheal deviation is a medical emergency when it is caused by a tension pneumothorax. Tactile fremitus increases with pneumonia or pulmonary edema and decreases in pleural effusion or lung hyperinflation. Diminished chest movement occurs with barrel chest, restrictive disease, and neuromuscular disease

5. Select all of the following that are considered discontinuous breath sounds:* A. High-pitched wheeze B. Stridor C. Pleural friction rub D. Fine crackles E. Low-pitched wheeze F. Coarse Crackles

C D

1. Ascites is defined as: A a bowel obstruction. B a proximal loop of the large intestine. C an abnormal enlargement of the spleen. D an abnormal accumulation of serous fluid within the peritoneal cavity.

D Ascites is free fluid in the peritoneal cavity. A bowel obstruction may result in abdominal distention. The proximal loop of the large intestine is the ascending colon. Splenomegaly is the term to describe an enlarged spleen.

8. In which condition is fluid present in the pleural space? A Crepitus B Pneumonia C Pneumothorax D Pleural effusion

D Fluid is present in the pleural space with a pleural effusion. Crepitus is air in the subcutaneous tissues leaking from the lung area. Pneumonia is a consolidation of alveoli with debris caused by infection. Pneumothorax is air present in the pleural space.

1. Bronchial breath sounds can be auscultated where?* A. Peripheral lung fields B. Sternal area C. Mid-scapulae area D. Tracheal area

D

4. In pulsus paradoxus: A the rhythm is irregular; every other beat is premature. B there is a deficiency of arterial blood to a body part. C the rhythm is regular, but the force of the pulse varies with alternating beats. D beats have weaker amplitude with respiratory inspiration and stronger amplitude with expiration.

D In pulsus paradoxus, beats have weaker amplitude with inspiration and stronger amplitude with expiration. The rhythm is irregular and coupled in pulsus bigeminus; every other beat comes early or premature. A weak, thready pulse may result in a deficiency of arterial blood to a body part. The rhythm is regular in pulsus alternans, but the force varies with alternating beats of large and small amplitude.

5. Lymphedema is: A the indentation left after the examiner depresses the skin over swollen edematous tissue. B a thickening and loss of elasticity of the arterial walls. C an inflammation of the vein associated with thrombus formation. D the swelling of an extremity caused by an obstructed lymph channel.

D Lymphedema is swelling of the limb caused by surgical removal of lymph nodes or damage to lymph nodes and vessels. Pretibial edema (pitting) occurs if an indentation is left after the examiner depresses skin over the tibia or the medial malleolus for 5 seconds. Arteriosclerosis is the thickening and loss of elasticity of the arterial walls. In deep vein thrombosis, a deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema

3. Which breath sounds, heard in the posterior bases, suggest atelectasis? A Stridor B Vesicular sounds C Bronchial sounds D Diminished breath sounds

D Patients with atelectasis, in which alveoli are collapsed, have diminished or absent breath sounds in the bases. Stridor is crowing heard with upper airway obstruction. Vesicular sounds are normal sounds heard in the bases posteriorly. Bronchial sounds are normally heard over the trachea.

10. Methods to enhance abdominal wall relaxation during examination include: a cool environment. having the patient place arms above the head. examining painful areas first. positioning the patient with the knees bent.

D Position the patient supine, with the head on a pillow, knees bent or on a pillow, and arms at the side. Keep the room warm to avoid chilling and tensing of muscles. Avoid having arms above the head; this increases abdominal wall tension. Painful areas should be examined last to avoid muscle guarding.

9. During a history, a client tells the nurse he has smoked 2 packs of cigarettes per day for 10 years and 1 pack per day for the past 15 years. The cigarette use is reported as how many pack-years? _______ A 24 B 8 C 60 D 35

D Smoking history is reported in pack-years, which is determined by the number of packs smoked per day multiplied by the number of years smoked. The client smoked 2 packs X 10 years (20) plus 1 pack X 15 years (15) for a total of 35 pack-years.

7. The cervical nodes drain the: A upper arm and breast. B hand and lower arm. C external genitalia. D head and neck.

D The cervical nodes drain the head and neck. Axillary nodes drain the breast and upper arm. The epitrochlear node drains the hand and lower arm. Inguinal nodes drain most of the lymph from the lower extremity, the external genitalia, and the anterior abdominal wall.

1. One of the leg's deep veins is the: A great saphenous. B small saphenous. C tibial. D popliteal.

D The femoral and popliteal veins are the deep veins in the leg. The superficial veins are the great and small saphenous veins. The superficial veins are the great and small saphenous veins. The anterior tibial veins extend downward from the popliteal veins.

4. Inspiration is primarily facilitated by which of the following muscles? A Diaphragm and rectus abdominis B Trapezius and sternomastoids C Internal intercostal and abdominis D Diaphragm and intercostal

D The major muscle responsible for inspiration is the diaphragm. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal; this increases the anteroposterior diameter.

2. A patient has a holosystolic murmur. Which statement is correct about this murmur? A The sound is very loud. B The sound is a summation gallop C The sound is heard between S2 and S1. D The sound is heard with mitral regurgitation.

D The murmur is associated with mitral regurgitation when the mitral valve does not fully close with systole. The loudness depends on many factors and is described in grades. A summation gallop is a combination of all four heart sounds (S1, S2, S3, S4). A systolic murmur is heard during systole (between S1 and S2).

7. Where is the point of maximum impact heard in most normal adult patients? A Lower left sternal border B Left second intercostal space C Right second intercostal space D Fifth intercostal space midclavicular line

D The point of maximum impact is heard or palpated most commonly in the fifth intercostal space midclavicular line, the mitral valve area. The point of maximal impulse is not located along the left sternal border or in the left or right second intercostal spaces.

4. What effect on the radial pulse is a usual finding for a client with atrial fibrillation? A The rhythm is a regular irregularity. B The pulse rate is over 100 beats/min. C The radial pulse rate is greater than the apical pulse rate. D There is a fluctuation in strength and quality of the pulse.

D The pulse is inconsistent in quality because different amounts of blood are expelled with ventricular contraction because of the inconsistent filling of the ventricles. The radial pulse is irregular because there is no consistency in the rhythm. The rate of atrial fibrillation may be slower or faster than 100 beats/min. The apical pulse should be greater than the radial because all of the beats heard at the heart may not be perfused peripherally.

6. True or False: Low-pitched wheezes are polyphonic sounds that can be cleared when coughing.*

FALSE