NSG6420 QUIZ 3
1
.
Question :
Susan P., a 60-year-old woman with a 30 pack year history, presents to
your primary care practice for evaluation of a
... [Show More] persistent, daily cough
with increased sputum production, worse in the morning, occurring over
the past three months. She tells you, “I have the same thing, year after
year.” Which of the following choices would you consider strongly in
your critical thinking process?
Student
Answer: Seasonal allergies
Acute bronchitis
Bronchial asthma
Chronic bronchitis
Instructor
Explanation:
The pulmonary component includes an abnormal inflammatory response to noxious
stimuli, principally tobacco, but also occupational and environmental pollutants. The
hallmark of chronic bronchitis is a daily chronic cough with increased sputum
production lasting for at least 3 consecutive months in at least 2 consecutive years,
usually worse on awakening; this may or may not be
associated with COPD (GOLD, 2011). Emphysema is characterized by
obstruction to airflow caused by abnormal airspace enlargement distal to terminal
bronchioles.
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice
Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
(page 206)
&
Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company,
11/2014. VitalBook file. (page 213)
Points Received: 2 of 2
Comments:
Question
2.
Question :
A patient presents complaining of a 5 day history of upper respiratory
symptoms including nasal congestion and drainage. On the day the
symptoms began he had a low-grade fever that has now resolved. His
nasal congestion persisted and he has had yellow nasal drainage for
three days associated with mild headaches. On exam he is afebrile and
in no distress. Examination of his tympanic membranes and throat are
normal. Examination of his nose is unremarkable although a slight
yellowish-clear drainage is noted. There is tenderness when you lightly
percuss his maxillary sinus. What would your treatment plan for this
patient be?Student Answer:
Observation and reassurance
Treatment with an antibiotic such as amoxicillin
Treatment with an antibiotic such as a fluoroquinoline or
amoxicillin-clavulanate
Combination of a low dose inhaled corticosteroid and a long
acting beta2 agonist inhaler.
Instructor
Explanation:
MedU Card #4. According to the American Academy of Ortolaryngology—Head
and Neck Surgery Foundation guidelines (2007) on sinusitis, making the
distinction between a lingering viral upper respiratory infection that affects the
nose and sinuses (viral rhinosinusitis) or early acute bacterial sinusitis can be
difficult. It is more likely to be a viral rhinosinusitis if the duration of symptoms is
less than ten days and they are not worsening. In this case, you can continue to
observe the patient and reassure him that antibiotics are not necessary at this
time.
Points Received: 2 of 2
Comments:
Question
3.
Question :
Emphysematous changes in the lungs produce the following
characteristic in COPD patients?
Student
Answer: Asymmetric chest expansion
Increased lateral diameter
Increased anterior-posterior diameter
Pectus excavatum
Instructor
Explanation:
In COPD, patients commonly develop a barrel-shaped chest due to
emphysematous changes in the lungs. A barrel shape is due to an increased
anterior-posterior (AP) diameter. In emphysema, there is a 1:1 ratio of AP to lateral
diameter; AP diameter equals the lateral diameter. Normally the AP diameter is
twice the lateral diameter.
Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014.
VitalBook file( page 213-214)
&
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice
Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook
file. (page 206)Points Received: 2 of 2
Comments:
Question
4.
Question :
When palpating the posterior chest, the clinician notes increased tactile
fremitus over the left lower lobe. This can be indicative of pneumonia.
Areas of increased fremitus should raise the suspicion of conditions
resulting in increased solidity or consolidation in the underlying lung
tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the
instance of an extensive bronchial obstruction:
Student
Answer: No palpable vibration is felt
Decreased fremitus is felt
Increased fremitus is felt
Vibration is referred to the non-obstructed lobe
Instructor
Explanation:
Areas of increased fremitus should raise the suspicion of conditions resulting in
increased solidity or consolidation in the underlying lung tissue, such as in
pneumonia, tumor, or pulmonary fibrosis. Conversely, areas of decreased fremitus
raise the suspicion of abnormal fluid- or air-filled spaces, such as occurs with
pleural effusion, pneumothorax, or emphysema. In the instance of an extensive
bronchial obstruction, no palpable vibration is felt in the related field.
Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014.
VitalBook file. (page 209)
&
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice
Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook
file. (page 193)
Points Received: 2 of 2
Comments:
Question
5.
Question :
Your patient presents with complaint of persistent cough. After you
have finished obtaining the History of Present Illness, you realize that
the patient may be having episodes of wheezing, in addition to his
cough. The most common cause of cough with wheezing is asthma.
What of the following physical exam findings will support your tentative
diagnosis of asthma?
Student Answer:
Clear, watery nasal drainage with nasal turbinate swellingPharyngeal exudate and lymphadenopathy
Clubbing, cyanosis and edema.
Diminished lung sounds with rales in both bases
Instructor
Explanation:
MedU Card #9
Points Received: 0 of 2
Comments:
Question
6.
Question :
Which of the following imaging studies should be considered if a
pulmonary malignancy is suspected? [Show Less]