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NURS 623 : HEALTH ASSESSMENT : MODULE 7 TEST
QUESTIONS WITH CORRECT ANSWERS
what should be suspected when younger patients or nonsmokers develop findings consistent with COPD? -- Answer โโ alpha-1 antitrypsin deficiency COPD is actually made up on what two problems? -- Answer โโ 1. chronic bronchitis
- emphysema what should be used to confirm diagnosis of COPD? -- Answer โโ spirometry how many stages of COPD are there? -- Answer โโ 4 inflammation and consolidation of lung tissue -- Answer โโ pneumonia what do you need to follow up for if a pleural effusion is visualized with pneumonia? -- Answer โโ empyema what is the most common symptoms of bronchitis? -- Answer โโ cough dilation of one or more bronchi -- Answer โโ bronchiectasis
what is the most common symptom associated with pleural effusion -- Answer โโ dyspnea pain at the costosternal cartilage site - it can follow trauma to the chest wall -- Answer โโ costochondritis of the axillary lymph nodes, which ones are most likely to be palpable during physical examination? -- Answer โโ central nodes what are the final common pathway for all of the axillary lymph nodes? -- Answer โโ apical nodes where do you insert the needle for decompression of a tension pneumothorax? -- Answer โโ 2nd intercostal space location for chest tube insertion -- Answer โโ intercostal space between the 4th and 5th ribs lower margin of a well-placed endotracheal tube on a chest x-ray -- Answer โโ level of the 4th rib landmark for thoracentesis -- Answer โโ intercostal space between the 7ths and the 8ths rib, immediately superior to the 8th rib where does the inferior tip of the scapula lie? -- Answer โโ 7th rib or intercostal space an anatomical region in the midaxillary line formed by the lateral border of the pectoralis major muscle anteriorly, lateral border of the latissimus dorsi posteriorly, and the nipple line
what is the most common cause of an acute cough? -- Answer โโ viral upper respiratory infections sputum that is translucent, white, or gray and seen in viral infections and cystic fibrosis -- Answer โโ mucoid sputum sputum that is yellow green and often accompanies bacterial pneumonia -- Answer โโ purulent sputum foul-smelling sputum is present in what? -- Answer โโ anaerobic lung abscess thick tenacious sputum is present in what? -- Answer โโ cystic fibrosis large volumes of purulent sputum are present in what two diseases? -- Answer โโ 1. bronchiectasis
- lung abscess 3 possible causes of chest pain in the myocardium -- Answer โโ 1. Angina Pectoris
- myocardial infarction
- myocarditis possible cause of chest pain in the pericardium -- Answer โโ pericarditis possible cause of chest pain in the aorta -- Answer โโ aortic dissection possible cause of chest pain in the trachea and large bronchi -- Answer โโ bronchitis
6 possible causes of chest pain in the parietal pleura -- Answer โโ 1. pericarditis
- pneumonia
- pneumothorax
- pleural effusion
- pulmonary embolus
- connective tissue disorder 2 possible causes of chest pain in the chest wall (including the skin, musculoskeletal and neurologic systems) -- Answer โโ 1. costochondritis
- herpes zoster 3 possible causes of chest pain in the esophagus -- Answer โโ 1. GERD
- esophageal spasm
- esophageal tear 3 possible causes of chest pain in the extrathoracic structures such as the neck, gallbladder, and stomach -- Answer โโ 1. cervical arthritis
- biliary colic
- gastritis a clenched fist over the sternum -- Answer โโ levine sign what does the levine sign suggest? -- Answer โโ angina pectoris does lung tissue have pain fibers? -- Answer โโ no dullness on percussion of the lungs is indicative of what 2 things? -- Answer โโ 1. pleural effusion
- atelectasis
blind, inflammatory tube-like structures opening onto the skin -- Answer โโ sinus tracts although rare, what do sinus tracts suggest? -- Answer โโ infection of the underlying pleura and lung Examining the range and symmetry of rib cage as it expands and contracts during inspiration -- Answer โโ lung excursion the palpable vibrations that are transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking and is normally symmetric -- Answer โโ fremitus what should you do if a louder note is needed for percussion? -- Answer โโ apply more pressure with the pleximeter finger 5 percussion notes -- Answer โโ 1. flat
- dull
- resonant
- hyperresonant
- tympanitic percussion note heard in healthy lungs -- Answer โโ resonant when does dullness replace resonance during percussion -- Answer โโ when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers pathologic example when you would hear a flat percussive note over the lungs -- Answer โโ large pleural effusion
pathologic example when you would hear a dull percussive note over the lungs -- Answer โโ lobar pneumonia pathologic example when you would hear a resonant percussive note over the lungs -- Answer โโ simple chronic bronchitis 2 pathologic examples when you would hear a hyperressonant percussive note over the lungs -- Answer โโ 1. COPD
- pneumothorax pathologic example when you would hear a tympanic percussive note over the lungs -- Answer โโ large pneumothorax what does generalized hyperresonance suggest? -- Answer โโ hyperinflated lungs of COPD or asthma Unilateral hyperresonance suggests ________ -- Answer โโ large pneumothorax or an air-filled bulla distance that the diaphragm moves with inhalation -- Answer โโ diaphragmatic excursion before beginning auscultation, what should you ask the patient to do? -- Answer โโ cough once or twice what does a silent gap between inspiratory and expiratory sounds suggest? -- Answer โโ bronchial breath sounds breath sounds that are soft and low pitched, inspiratory sounds last longer -- Answer โโ vesicular
louder, clearer voice sounds heard when auscultating lungs -- Answer โโ bronchophony ______-minute walk test is used to predict clinical outcomes in most patients with COPD -- Answer โโ 6 Patients >60 years with a forced expiratory time of >(#) seconds are four times more likely to have COPD -- Answer โโ 9 2 screening tests for tuberculosis -- Answer โโ 1. TST
- interferon-gamma release assay (IGRA) blood tests what is the primary harm of treatment for tuberculosis? -- Answer โโ hepatotoxicity evaluates how likely a person is to fall asleep during a number of different activities. The person rates each situation on a scale of 0-3 corresponding to the chance of falling asleep (none, slight, moderate, or high). -- Answer โโ Epworth Sleepiness Scale Obstructive Sleep Apnea screening tool. 8 yes or no questions which every "yes" answer is 1 point. less than 3 is low risk for OSA -- Answer โโ STOP-Bang What does STOP-Bang stand for? -- Answer โโ S: Snore T: Tired O: Observed you stop breathing P: high blood Pressure B: Body mass index >35 kg/m A: Age >50 years N: Neck circumference >
G: Gender male what does sighing respiration suggest? -- Answer โโ hyperventilation symptom periods of deep breathing alternating with periods of apnea -- Answer โโ Cheyne- Stokes Breathing periods of apnea alternating irregularly with a series of shallow breaths of equal depth -- Answer โโ Ataxic breathing 3 causes of Biot Breathing -- Answer โโ 1. meningitis
- respiratory depression
- brain injury (typically at medullary level) Note depression in the lower portion of the sternum. Compression of the heart and great vessels may cause murmurs. -- Answer โโ Funnel Chest (Pectus Excavatum) There is an increased AP diameter. This shape is normal during infancy, and often accompanies aging and chronic obstructive pulmonary disease. -- Answer โโ Barrel Chest The sternum is displaced anteriorly, increasing the anteroposterior diameter. The costal cartilages adjacent to the protruding sternum are depressed. -- Answer โโ Pigeon Chest (Pectus Carinatum) Multiple rib fractures may result in paradoxical movements of the thorax. As descent of the diaphragm decreases intrathoracic pressure, on inspiration the injured area caves inward; on expiration, it moves outward. -- Answer โโ Traumatic Flail Chest variant of wheezes but lower in pitch -- Answer โโ Rhonchi
palpation of the breasts is best performed with the patient in what position? -- Answer โโ supine how long does a thorough examination take for each breast? -- Answer โโ 3 minutes what is the currently the best validated technique for detecting breast masses? -- Answer โโ vertical strip pattern what do tender subareolar cords suggest? -- Answer โโ mammary duct ectasia clear, serous, green, black or nonbloody discharges that are multiductal are usually (malignant/ benign) -- Answer โโ benign what is the preferred patient position for examining the axillae -- Answer โโ sitting thickening and darkening of skin near axillary region, A/w Diabetes Type II and gastric carcinoma -- Answer โโ Acanthosis nigricans Breast cancer risk model; Includes personal risk factors, FDR only; Underestimates hereditary risk, ignores paternal fhx/age of onset -- Answer โโ Gail Model three most common breast masses -- Answer โโ 1. fibroadenoma (benign tumor)
- cysts
- breast cancer what is the biggest difference between fibroadenomas and cysts -- Answer โโ cysts are often tender
5 visible signs of breast cancer -- Answer โโ 1. abnormal contours
- skin dimpling
- nipple retraction and deviation
- edema of the skin
- paget disease of the nipple what are the 2 steps of a breast examination? -- Answer โโ 1. inspection
- palpation most common image used for women over 40 in a breast examination -- Answer โโ mammogram a mass that persists throughout a woman's hormonal cycles, is larger and firmer than any other irregularities and differs from the rest of the breast tissue -- Answer โโ dominant breast mass 5 categories of dominant masses of the breast -- Answer โโ 1. fibroadenomas
- cysts
- fibrocystic changes
- fat necrosis
- malignancy what is the triple test recommended for evaluation of a breast mass -- Answer โโ 1. clinical examination
- ultrasound/mammogram
- aspiration and/or biopsy
