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
... [Show More] 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
Paradoxical respirations.
the child's febrile state. Correct
the child's age.
an airway obstruction.
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:
standing on the side rather than directly behind the patient.
Correct: having the patient lie supine on the examining table.
carefully palpating any area the patient has reported pain.
using the ball or the ulnar surface of the hand.
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
NR 509 APEA 3P EXAM WEEK 8 QUESTIONS AND
ANSWERS ALL CORRECT
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:
ask the patient to cough and note chest expansion.
ask the patient to take a deep breathe and note any delay in expansion during inhalation.
Correct have the patient hold his breath for 15 seconds then note chest expansion.
have the patient exhale forcefully noting expansion on expiration.
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
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
When trying to differentiate between hemoptysis or blood streaked material, which one of the following
observations is correct?
Hemoptysis is seen frequently in infants, children, and adolescents with allergic rhinitis.
Blood originating in the stomach is usually brighter than blood originating from the respiratory tract.
IncorrectHemoptysis is common in children with cystic fibrosis.
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:
resonant. Correct
dulltympany.
Diffusely
hyperresonant. Incorrect
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:
mid vertebral line.
scapular line.
Correct: midclavicular line.
mid-spinal 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
likely:
tracheobronchitis.
chronic bronchitis.
Incorrectbronchiectasis.
Correct: laryngitis.
Explanation:
An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is
tracheobronchitis. An acute, mild illness often associated with viral nasopharyngitis and hoarseness is
laryngitis. The initial cough is dry and nonproductive but may become productive over time. A chronic
bronchitis cough is characteristically productive with mucoid to purulent sputum and may be blood
tinged. Bronchiectasis produces a chronic cough with sputum that is copious and foul-smelling. It may
be blood tinged.
Question 8
A patient who walked into the examination room, may be observed to be sitting and leaning forward in
his chair. Lips were pursed during exhalation and arms are supported on the table. This position could
be consistent with patients who have:
pneumonia.
chronic
obstructive pulmonary disease.
Correct: asthma.
croup.
Explanation:
People who have chronic obstructive pulmonary disease experience shortness of breath and dyspnea.
Breathing with pursed lips and use of abdominal muscles help reduce shortness of breath and dyspnea.
Leaning forward while seated and having arms supported on the table facilitate breathing. This position
is not characteristic of the other diseases.
Question 9
Breath sounds heard over the periphery of the lung fields are:
bronchial.
abnormal.
bronchovesicular.
Incorrectvesicular. Correct
Explanation:
Bronchial, vesicular, and bronchovesicular breath sounds are considered normal. Vesicular breath
sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase.
They are heard over the periphery of the lung field. Bronchial breath sounds consist of a full inspiratory
and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the
trachea and larynx. Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened
and softer expiratory phase. They are normally heard over the hilar region (center of the lungs near the
heart).
Question 10
When percussing the posterior chest, which one of the following techniques would be omitted?
When comparing two areas on the chest, use the same percussion technique in both areas.
Percuss one side of the chest then the other at each level.
Percuss the areas over the scapulae.
Correct: If a louder note is needed, apply more pressure with the
pleximeter finger.
Explanation:
All of the percussion techniques listed are useful when percussing the chest except the areas over the
scapulae. These areas are not percussed because the thickness of the muscle and bone alters the
percussion notes over the lungs.
Question 11
When auscultating breath sounds in a patient who has left sided heart failure, the breath sounds are:
vesicular with late inspiratory crackles in the dependent portions of the lungs and resonant on
percussion.
Correct: bronchial with late inspiratory crackles over the involved area and dull on percussion.
vesicular without adventitious sounds and resonant on percussion.
Incorrect: decreased with some audible wheezes and diffusely
hyperresonant on percussion.
Explanation:
A patient with left sided heart failure experiences increased pressure in the pulmonary veins causing
congestion and interstitial edema. The breath sounds are vesicular with late inspiratory crackles in the
dependent portions of the lungs and are resonant on percussion. Consolidation in the lungs produces
bronchial breath sounds with late inspiratory crackles over the involved area and is dull on percussion. A
normal lung has vesicular breath sounds without adventitious sounds and is resonant on percussion.
Chronic obstructive lung disease produces decreased breath sounds with some audible wheezes and is
hyperresonant on percussion.
Question 12
Breath sounds consisting of a full inspiratory phase and a shortened and softer expiratory phase
normally audible over the hilar region of the chest are termed:
vesicular.bronchial.bronchovesicular. Correctrhonchi.
Explanation:
Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer
expiratory phase. They are normally heard over the hilar region (center of the lungs near the heart).
Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent
expiratory phase. They are heard over the periphery of the lung field. Bronchial breath sounds consist of
a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally
heard over the trachea and larynx.
Question 13
An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is suggestive
of:
tracheobronchitis.
Correctchronicbronchitis.
bronchiectasis.
laryngitis. Incorrect
Explanation:
An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is
tracheobronchitis. An acute, mild illness associated with viral nasopharyngitis and hoarseness is
laryngitis. The initial cough is dry and nonproductive but may become productive over time. A chronic
bronchitis cough is characteristically productive with mucoid to purulent sputum and may be blood
tinged. Bronchiectasis produces a chronic cough with sputum that is copious and foul-smelling. It may
be blood tinged or bloody.
Question 14
One of the anterior thoracic landmarks is the costal angle. It is located:
where the manubrium and body of the sternum intersect.
where the right and left costal margins form an angle where they meet at the xiphoid process.
Correct: where the suprasternal notch and the sternum form an angle.
Incorrectat the angle where the ninth and tenth ribs are fused.
Explanation:
The right and left costal margins form an angle where they meet at the xiphoid process. This is the costal
angle. The angle should be 90 degrees or less. However, the angle increases when the rib cage is
chronically over inflated, as in emphysema.
Question 15
Atypical respiratory symptoms associated with gastroesophageal disease (GERD) may include all of the
following except:
coughing.wheezing.aspirationpneumonia.rhinitis. Correct
Explanation:
Atypical respiratory symptoms associated with gastroesophageal disease may include coughing,
wheezing, asthma, and aspiration pneumonia. Rhinitis is rarely associated with GERD.
Question 16
On auscultation of the chest, if the patient says "ninety-nine" and it is clearly heard, this is indicative of:
a normal sounding chest. Incorrectlung density in the area. Correctconsolidation or compression in the
area.of inflammation in the area.
Explanation:
Bronchophony indicates density and usually repeating the words ninety-nine produces that sound.
Egophony, saying ee-ee-ee-ee, is more indicative of consolidation or compression in the area.
Whispered pectoriloquy, whispering one-two-three, is more faint than bronchophony, and heard over
areas of small amounts of consolidation. Inflammation would produce more of a wheezing sound in the
chest and is associated with narrowed airways (as heard during asthma exacerbation).
Question 17
Respiratory effort in the neonate is initiated at birth as a result of:
an increase in the PO2 and a decrease in PCO2.
the continued functioning of the foramen ovale.
chemical, thermal, and mechanical factors.
Correctdrying off the infant.
Explanation:
Chemical, thermal, and mechanical factors influence respiration as follows: breathing is initiated by a
lack of oxygen and a high level of carbon dioxide in the blood stream. This stimulates the respiratory
center in the medulla of the brain. Initiation of respiration is aided by the compression of the chest wall
during the birth process, the cool air on the wet face, and the general handling of the body and limbs. A
healthy baby cries almost immediately, but he has to breathe to be able to cry. With the first breath, the
blood vessels in the lung expand. Spontaneous breathing is now established. Pulmonary venous return
to the heart increases. This results in left arterial pressure exceeding right arterial pressure. Right to left
shunting through the foramen ovale is reduced.
Question 18
Adventitious breath sounds, such as crackles, are:
low-pitched, dry, grating sounds heard on inspiration and expiration.continuous, high-pitched, and
musical heard on inspiration and expiration. Incorrectcontinuous, low-pitched and prolonged and heard [Show Less]