DD Chapter 4

A line drawn down the middle of a lesion with two different halves suggests:

a. A malignant lesion

Body temperature should be taken as part of vital sign assessment:

a. Only for clients who have not been seen by a physician b. For any client who has musculoskeletal pain of unknown origin c. For any client reporting the presence of constitutional symptoms, especially fever or sweats (d.) b and c e. All of the above

During auscultation of an adult client with rheumatoid arthritis, the heart rate gets stronger as she breathes in and decreases as she breathes out. This sign is:

c. A normal finding

When assessing the abdomen, what sequence of physical assessment is best?

c. Inspection, auscultation, percussion, palpation Percussion and palpation can change bowel sounds. Look and listen before you palpate.

Pulse strength graded as 1 means:

c. Pulse diminished, barely palpable

You notice a new client has an unusual (strong) breath odor. How do you assess this?

"I notice an unusual smell on your breath. Do you know what might be causing this?" Bad breath (halitosis) can be a symptom of diabetic ketoacidosis, dental decay, lung abscess, throat or sinus infection, or gastrointestinal disturbance from food intolerance, Helicobacter pylori bacteria, or bowel obstruction. Keep in mind that ethnic foods and alcohol can affect breath and body odor.

Why does postural orthostatic hypotension occur upon standing for the first time in a young adult who has been supine in skeletal traction for 3 weeks?

1) The patient's blood pressure (vasomotor) system is "untuned"; peripheral blood vessels do not constrict properly, so venous pooling may occur. 2) The patient also may be receiving medication(s) that have the potential to reduce blood pressure directly or as an adverse effect of the drug or drugs in combination. 3) Other factors may include dehydration, if the patient has not been on intravenous fluids and has not maintained adequate fluid intake.

How do you plan or modify an exercise program for a client with cancer without the benefit of blood values?

First of all, do you need to? How far out from the first medical diagnosis and final treatment is the client? Is the client still being treated? Without laboratory values, physical assessment becomes much more important. Check vital signs; observe the skin, eyes, and nailbeds, and ask about the presence of associated signs and symptoms.

When would you consider listening for femoral bruits?

The therapist is most likely to assess for bruits when the client or patient is older than 65 years of age and describes problems (i.e., neck, back, abdominal, or flank pain) in the presence of a history of syncopal episodes, a history of cardiovascular disease (CVD), serious risk factors for CVD, or a previous history of aortic aneurysm. Look for other signs of peripheral vascular disease that may account for the client's current symptoms. Symptoms may be described as "throbbing" and may increase with activity and decrease with rest. In the most likely candidate, neck or back pain is not affected by physical therapy intervention. The client is an older adult, a postmenopausal woman, and/or has significant risk factors for CVD or a history of CVD. Bruits are abnormal blowing or swishing sounds heard on auscultation of narrowed or obstructed arteries. Bruits with both systolic and diastolic components suggest the turbulent blood flow of partial arterial occlusion that is possible with aneurysm or vessel constriction.

A 76-year-old man was referred to physical therapy after a total hip replacement (THR). The goal is to increase his functional mobility. Is a health assessment needed since he was examined just before the surgery 2 weeks ago? The physician conducted a systems review and summarized the medical record by saying the client was in excellent health and a good candidate for THR.

Yes. The therapist must be familiar with past medical history and any factors that could put the client at risk for a medical incident of any type. Health status can change for any client within a 2-week period, but especially, the aging adult. Surgery is a major event that is traumatic to the physiologic body, despite the client's previous excellent health.

A 23-year-old female presents with new onset of skin rash and joint pain followed 2 weeks later by GI symptoms of abdominal pain, nausea, and diarrhea. She has a previous history of Crohn's disease, but this condition has been stable for several years. She does not think her current symptoms are related to her Crohn's disease. What kind of screening assessment is needed in this case?

d. No further assessment is needed; there are enough red flags to advise this client to seek medical attention.