Examination and Assessment

Question 1

Name the 4 true vitals signs and the “5th” vital sign

Answer 1

1. ) Temp
2. ) Pulse
3. ) Respiration
4. ) BP
5. ) Pain

Question 2

In theory your HR can be higher than your pulse rate if you have moments of electrical activity that do not generate muscular contraction, T or F

Answer 2

True

For individuals who have certain heart conditions, the heart may not push blood efficiently with each contraction. These individuals have a pulse that is lower than their heart rate.

Question 3

What is a 2 on the pulse grading scale?

Answer 3

About half

4=Norm
3= Slightly Diminished
2= About half
1= Barely palpable
0=Absent

Question 4

Strong pressure to carotid artery could do what to the pulse?

Answer 4

Slow it down

Question 5

What is the difference between BP and PR?

Answer 5

PR: Frequency of pressure waves per minute propagated along peripheral aa

BP: Pressure/tension of blood w/in systemic aa, maintained by contraction of the L vent, resistance of capillaries, elasticity of arterial walls, and viscosity/volume of blood.

Question 6

Your patient has diabetes. What do you expect to find when taking BP in the L and the R arm?

Answer 6

A difference of more than 20 mmHg for systolic pressure and more than 10 for diastolic.

• Sign for underlying problem including:
• Peripheral artery disease
• Kidney disease
• Heart defects

Question 7

List things to do/ask pt before taking BP

Answer 7

• ask if they have smoke/drunk alcohol in last 15 min
• have them sit/lie down for 5 min
• remove all clothing from arm
• don’t use arm w/ shunts, IV, paralysis, injury, edema
• ask pt not to talk during it
• flex arm so at heart level
• center of bladder over brachial artery
• no fist clenching, leg crossing, breath holding

Question 8

When completing auscultation of lungs you here a continuous high or low pitch sound that varies in duration. What is this called?

Answer 8

Wheezes / Rhonchi / Stridor

Normally caused by narrowing or obstruction of the airway.

Question 9

Discontinuous sounds like brief bursts of popping bubbles. Most often during inspiration. Can be caused by atelectasis, pulmonary edema, fibrosis, pleural effusion.

Answer 9

Crackles

Question 10

This sound is heard in lower lateral chest, sounds like two pieces of sandpaper together during inspiration and expiration. Indicated pleural inflammation.

Answer 10

Pleural Rub

Question 11

Say the order of ausculatation

Answer 11

0: Upper Left
1: Upper Right
2: Middle Right
3. Middle Left
4. Lower Left
5. Lower Right
6. Costophrenic right angle
7. Costophrenic left angle

Question 12

When do you use the diaphragm part of the stethoscope?

Answer 12

Auscultation to ID high pitched sounds

-Use bell for low-frequency sounds, place lightly

Question 13

This heart sound occurs w/ closure of mitral and tricuspid valves–onset of vent systole–auscultate in apex or tricuspid region

Answer 13

S1 (Lub)

Question 14

This heart sound occurs w/ closure of aortic and pulmonary valves–onset of ventricular diastole–auscultate in aortic or pulmonary region

Answer 14

S2 (dub)

Question 15

What does an S3 heart sound indicate in adults?

Answer 15

Loss of ventricular function/ CHF–low pitched (bell)

*Normal in children

Question 16

What does an S4 heart sound indicate?

Answer 16

Atrial gallop and associated w/ increased resistance to ventricular filing- HTN

Question 17

Name the 3 classifications of murmurs

Answer 17

1. ) High flow rates through normal or abnormal valves
2. ) Flow through stenotic valve or into dilated vessel or chamber
3. ) Regurgitation

Question 18

Normal community ambulation is how fast?

Answer 18

50-80 cm/sec or .5-.8 M/sec

Crossing Intersections: 122 cm/sec or 1.22 M/sec

Question 19

When testing for PVD using a treadmill test, what % drop in ankle systolic BP is considered abnormal?

Answer 19

20% after exercise testing

Question 20

Immediately after a 6 minute walk test what to do need to record?

Answer 20

O2 sat, HR, dyspnea rating

Question 21

What is the difference btw hyperpnea and tachypnea

Answer 21

Hyperpnea: Increased depth
Tachypnea: Increased rate

Question 22

What is Cheyne-Stokes breathing?

Answer 22

Increasing then decreasing depth, w/period of apnea. These pt’s not typically seen in PT

Question 23

Type of breathing with slow rate, shallow depth, irregular rhythm

Answer 23

Biot’s

Question 24

Define Orthopnea

Answer 24

Difficulty breathing unless upright

Question 25

What could a rapid HR in a pt tell you?

Answer 25

• Deconditioning

- Limited SV

Question 26

What could a bradycardiac response tell you?

Answer 26

Pt on cardiac meds or underlying CV disease

Question 27

If pt has an increase in DBP > 10mmHg….what might you be thinking

Answer 27

CAD

Question 28

Functional Class IV can work up to how many mets?

Answer 28

1-2 METS, (walking 1mph, transfers)

Question 29

Functional class III can work up to how many mets?

Answer 29

Up to 5 METs (Walking 4 mph)

Question 30

Functional class II can work up to how many mets?

Answer 30

Up to 7 METs (weightlifting, backpacking)