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Health Assessment Test 3 > Health Assessment Test 3 > Flashcards

Health Assessment Test 3 Flashcards

1
Q

Alveoli

A

functional units of the lung; the thin-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen

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2
Q

Angle of Louis

A

manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib

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3
Q

Apnea

A

Cessation of breathing

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4
Q

Asthma

A

an abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens, characterized by bronchospasm, wheezing, and dyspnea

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5
Q

Atelectasis

A

an abnormal respiratory condition characterized by collapsed, shrunken, deflated section of alveoli

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6
Q

Bradypnea

A

slow breathing,

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7
Q

Bronchiole

A

one of the smaller respiratory passageways into which the segmental bronchi divide

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8
Q

Bronchitis

A

inflammation of the bronchi with partial obstruction of bronchi due to excessive mucus secretion

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9
Q

Bronchophony

A

the spoken voice sound heard through the stethoscope, which sounds soft, muffled, indistinct over normal lung tissue

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10
Q

Bronchovesicular

A

the normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration

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11
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

a functional category of abnormal respiratory conditions characterized by airflow obstruction (ex: emphysema, chronic bronchitis)

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12
Q

Cilia

A

millions of hairlike cells lining the tracheobronchial tree

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13
Q

Consolidation

A

the solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia

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14
Q

Crackles

A

(rales) abnormal, discontinuous, adventitious lung sounds heard on inspiration

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15
Q

Crepitus

A

coarse, crackling sensation palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue

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16
Q

Dead Space

A

passageways that transport air but are not available for gaseous exchange (ex: trachea, bronchi)

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17
Q

Dyspnea

A

difficult, labored breathing

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18
Q

Egophony

A

the voice sound of “eeeeee” heard through the stethoscope

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19
Q

Emphysema

A

the chronic obstructive pulmonary disease characterized by enlargement of alveoli distal to terminal bronchioles

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20
Q

Fissure

A

the narrow crack dividing the lobes of the lungs

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21
Q

Fremitus

A

a palpable vibration from the spoken voice felt over the chest wall

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22
Q

Friction Rub

A

a coarse, grating, adventitous lung sound heard when the pleurae are inflamed

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23
Q

Hypercapnia

A

(hypercarbia) increased levels of carbon dioxide in the blood

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24
Q

Hyperventilation

A

increased rate and depth of breathing

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25
Q

Hypoxemia

A

decreased level of oxygen in the blood

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26
Q

Intercostal Space

A

space between the ribs

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27
Q

Kussmaul Respiration

A

a type of hyperventilation that occurs with diabetic ketoacidosis

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28
Q

Orthopnea

A

ability to breathe easily only in an upright position

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29
Q

Paroxysmal Nocturnal Dyspnea

A

sudden awakening from sleeping with shortness of breath

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30
Q

Percussion

A

striking over the chest wall with short, sharp blows of the fingers to determine the size and density of the underlying organ

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31
Q

Pleural Effusion

A

abnormal fluid between the layers if the pleura

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32
Q

Rhonchi

A

low-pitched, musical, snoring, adventitious lung sound caused by airflow obstruction from secretions

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33
Q

Tachypnea

A

rapid, shallow breathing, >24 breaths per minute

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34
Q

Vesicular

A

the soft, low-pitched, normal breath sounds heard over peripheral lung fields

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35
Q

Vital Capacity

A

the amount of air following maximal inspiration that can be exhaled

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36
Q

Wheeze

A

high-pitched, musical, squeaking adventitious lung sound

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37
Q

Whispered Pectoriloquy

A

a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue

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38
Q

Xiphoid Process

A

sword-shaped lower tip of the sternum

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39
Q

Angina Pectoris

A

acute chest pain that occurs when myocardial demand exceeds its oxygen supply

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40
Q

Aortic Regurgitation

A

(aortic insufficiency) incomplete aortic valve that allows backward flow of blood into left ventricle during diastole

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41
Q

Aortic Stenosis

A

calcification of aortic valve cusps that restricts forward flow of blood during systole

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42
Q

Aortic Valve

A

the left semilunar valve separating the left ventricle and the aorta

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43
Q

Apex of the Heart

A

tip of the heart pointing down toward the 5th left intercostal space

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44
Q

Apical Impulse

A

(point of maximal impulse, PMI) pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th left intercostal space in the midclavicular line

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45
Q

Base of the Heart

A

broader area of heart’s outline located at the 3rd right and left intercostal space

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46
Q

Bell (of the stethoscope)

A

cup-shaped endpiece used for soft, low-pitched heart sounds

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47
Q

Bradycardia

A

slow heart rate, <50 beats per minute in the adult

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48
Q

Clubbing

A

bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions

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49
Q

Coarctation of Aorta

A

severe narrowing of the descending aorta, a congenital heart defect

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50
Q

Cor Pulmonale

A

right ventricular hypertrophy and heart failure due to pulmonary hypertension

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51
Q

Cyanosis

A

dusky blue mottling of the skin and mucous membranes due to excessive amounts of reduced hemoglobin in the blood

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52
Q

Diaphragm (of the stethoscope)

A

flat endpiece of the stethoscope used for hearing relatively high-pitched heart sounds

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53
Q

Diastole

A

the heart’s filling stage

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54
Q

Dyspnea

A

difficult, labored breathing

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55
Q

Edema

A

swelling of legs or dependent body part due to increased interstitial fluid

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56
Q

Erb’s Point

A

traditional auscultory area in the 3rd left intercostal space

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57
Q

First Heart Sound (S1)

A

occurs with closure of the atrioventricular (AV) valves signaling the beginning of systole

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58
Q

Fourth Heart Sound (S4)

A

(S4 gallop; atrial gallop) very soft, low-pitched ventricular filling sound that occurs in late diastole

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59
Q

Gallop Rhythm

A

the addition of a 3rd or a 4th heart sound that makes the rhythm sound like the cadence of a galloping horse

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60
Q

Inching

A

technique of moving the stethoscope incrementally across the precordium through the auscultory areas while listening to the heart sounds

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61
Q

LVH (Left Ventricular Hypertrophy)

A

increase in thickness of myocardial wall that occurs when the hear pumps against chronic outflow obstruction (ex: aortic stenosis)

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62
Q

MCL (Midclavicular Line)

A

imaginary vertical line bisecting the middle of the clavicle in each hemithorax

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63
Q

Mitral Regurgitation

A

(mitral insufficiency) incompetent mitral valve allows regurgitation of blood back into left atrium during systole

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64
Q

Mitral Stenosis

A

calcified mitral valve impedes forward flow of blood into left ventricle during diastole

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65
Q

Mitral Valve

A

left AV valve separating the left atria and ventricle

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66
Q

Palpitation

A

uncomfortable awareness of rapid or irregular heart rate

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67
Q

Paradoxical Splitting

A

opposite of a normal split S2 so that the split is heard in expiration, and in inspiration the sounds fuse to one sound

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68
Q

Pericardial Friction Rub

A

high-pitched, scratchy extracardiac sound heard when the precordium is inflamed

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69
Q

Physiologic Splitting

A

normal variation in S2 heard as two separate components during inspiration

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70
Q

Precordium

A

area of the chest wall overlying the heart and great vessels

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71
Q

Pulmonic Regurgitation

A

(pulmonic insufficiency) backflow of blood through incompetent pulmonic valve into the right ventricle

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72
Q

Pulmonic Stenosis

A

calcification of pulmonic valve that restricts forward flow of blood during systole

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73
Q

Pulmonic Valve

A

right semilunar valve separating the right ventricle and pulmonary artery

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74
Q

Second Heart Sound (S2)

A

occurs with closure of the semilunar valves, aortic and pulmonic, and signals the end of systole

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75
Q

Summation Gallop

A

abnormal mid-diastolic heart sound heard when both the pathologic S3 and S4 are present

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76
Q

Syncope

A

temporary loss of consciousness due to decreased cerebral blood flow (fainting), caused by ventricular asystole, pronounced bradycardia, or ventricular fibrillation

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77
Q

Systole

A

the heart’s pumping phase

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78
Q

Tachycardia

A

rapid heart rate, >90 beats per minute in the adult

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79
Q

Third Heart Sound (S3)

A

soft, low-pitched ventricular filling sound that occurs in early diastole (S3 gallop) and may be an early sign of heart failure

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80
Q

Thrill

A

palpable vibration on the chest wall accompanying severe heart murmur

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81
Q

Tricuspid Valve

A

right AV valve separating the right atria and ventricle

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82
Q

Allen Test

A

determining the patency of the radial and ulnar arteries by compressing one artery site and observing the return of skin color as evidence of patency of the other artery

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83
Q

Aneurysm

A

defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect

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84
Q

Arrhythmia

A

variation from the heart’s normal rhythm

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85
Q

Arteriosclerosis

A

thickening and loss of elasticity of arterial walls

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86
Q

Atherosclerosis

A

plaques of fatty deposits formed in the inner layer (intima) of the arteries

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87
Q

Bradycardia

A

slow heart rate, <50 beats per minute in the adult

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88
Q

Bruit

A

blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

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89
Q

Cyanosis

A

dusky blue mottling of the skin and mucous membranes due to excessive amounts of reduced hemoglobin in the blood

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90
Q

Diastole

A

the heart’s filling phase

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91
Q

Homan’s Sign

A

calf pain that occurs when the foot is sharply dorsiflexed (pushed up, toward the knee); may occur with deep vein thrombosis, phlebitis, Achilles tendinitis, or muscle injury

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92
Q

Ischemia

A

deficiency of arterial blood to a body part due to constriction or obstruction of a blood vessel

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93
Q

Lymphedema

A

swelling of extremity due to obstructed lymph channel, nonpitting

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94
Q

Lymph Nodes

A

small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels

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95
Q

Pitting Edema

A

indentation left after examiner depresses the skin over swollen edematous tissue

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96
Q

Profile Sign

A

viewing the finger from the side to detect early clubbing

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97
Q

Pulse

A

pressure wave created by each heartbeat, palpable at body sites where the artery lies close to the skin and over a bone

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98
Q

Pulsus Alternans

A

regular rhythm, but force of pulse varies with alternating beats of large and small amplitude

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99
Q

Pulsus Bigeminus

A

irregular rhythm, every other beat is premature; premature beats have weakened amplitude

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100
Q

Pulsus paradoxus

A

beats have weaker amplitude with respiratory inspiration, stronger with expiration

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101
Q

Systole

A

the heart’s pumping phase

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102
Q

Tachycardia

A

rapid heart rate, >90 beats per minute in the adult

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103
Q

Thrombophlebitis

A

inflammation of the vein associated with thrombus formation

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104
Q

Ulcer

A

open skin lesion extending into dermis with sloughing of necrotic inflammatory tissue

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105
Q

Varicose Vein

A

dilated tortuous veins with incompetent valves

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106
Q

Describe the most important points about the health history for the respiratory system

A

frequency of upper respiratory problems and if season affects it. Allergies with medications, pollen, smoke, mold or pet exposure. Characteristics and severity of allergic reactions. Frequency of asthma exacerbations and triggers. History of lower respiratory problems such as asthma, COPD, pneumonia, and TB. History of additional health problems.

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107
Q

Describe the pleura and its function.

A

The thin, slippery pleura are serous membranes that form an envelope between the lungs and the chest wall.

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108
Q

List the structures that compose the respiratory dead space.

A

Trachea and Bronchi

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109
Q

Summarize the mechanics of respiration.

A

1) Supply oxygen to the body for energy production
2) remove CO2 as a waste product of energy reactions
3) maintain homeostasis of arterial blood
4) maintain heat exchange

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110
Q

List the elements included in the inspection of the respiratory system

A

Shape and configuration of chest wall, spinous process should appear in straight line. Thorax is symmetrical, in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine, anteroposterior diameter should be less than the transverse diameter. Ration 1:2 and 5:7. Skin color and condition. Neck and trapezius muscles developed normally for age and occupation. position the person takes to breathe.

111
Q

Discuss the significance of a “barrel chest.”

A

equal anteroposterior-to-transverse diameter. Ribs are horizontal instead of downward slope.

112
Q

List and describe common thoracic deformities

A

Barrel chest: equal anteroposterior-to-transverse diameter. ribs are horizontal instead of downward slope.
Pectus Excavatum: sunken sternum (funnel breast)
Pectus Carinatum: pigeon-breasted - forward protrusion
Scoliosis: lateral S-shaped curvature of thoracic and lumbar spine
Kyphosis: exaggerated posterior curvature of the thoracic spine (hunchback)

113
Q

List and describe 3 types of normal breath sounds

A

bronchial (tracheal): high-pitch, loud, harsh, hollow & tubular, inspiration < expiration

Bronchovesicular: moderate pitch, moderate amplitude. inspiration = expiration

Vesicular: low pitch, soft, rustling, inspiration > expiration.

114
Q

Define 2 types of adventitous breath sounds

A

Crackles (rales): popping sounds not cleared by coughing

Pleural friction rub: grating quality, things rubbing against each other

115
Q

The manubriosternal angle is also called _____? Why is it a useful landmark?

A

angle of louis

useful place to start counting ribs

116
Q

How many degrees is the normal costal angle?

A

90 degrees or less

117
Q

When comparing the anteroposterior diameter of the chest with the transverse diameter, what is the expected ratio? What is the significance of this?

A

1:2. Anteroposterior = transverse diameter or barrel chest. Ribs are horizontal, occurs in chronic emphysema from hyperinflation of the lungs.

118
Q

What is tripod position?

A

Leaning forward with arms branded against their knees, chair or bed. Gives them leverage to aid in expiration.

119
Q

List 3 factors that affect normal intensity of tactile fremitus.

A

1) Relative location of bronchi to the chest wall
2) thickness of the chest wall
3) pitch and intensity

120
Q

During percussion, which sound would you expect to predominate over normal lung tissue?

A

Resonance

121
Q

Normal findings for diaphragmatic excursion are:

A

3-5 cm. in adults

122
Q

List 5 factors that can cause extraneous noise during auscultation

A

1) examiner’s breathing on stethoscope tubing
2) stethoscope tubing bumping together
3) patient shivers
4) patient’s hairy chest
5) rustling of paper gown or paper drapes

123
Q

Describe the 3 types of normal breath sounds

A

bronchial (tracheal) –> trachea and larynx –> harsh, hollow, tubular

bronchovesicular –> over major bronchi, where fewer alveoli are located –> mixed

vesicular –> peripheral lung fields –> rustling

124
Q

Define the apical impulse and describe its normal location, size, and duration.

A

Point of maximal impulse, PMI. It’s the pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th intercostal space in the midclavicular line. It’s normally 1x2 cm, and short (normally the first half of systole)

125
Q

Which normal variations may affect the location of the apical impulse?

A

rolling the person midway to the left

126
Q

Which abnormal conditions may affect the location of the apical impulse?

A

left ventricular dilation due to cardiac enlargement

127
Q

Explain the mechanism producing normal first and second heart sounds.

A

S1: Closure of AV valves (beginning of systole)
S2: closure of semilunar valves (end of systole)

128
Q

Describe the effect of respiration on the heart sounds.

A

During inspiration, intrathoracic pressure is decreased. More blood enters the vena cava, increasing venous return to Right heart, increasing Right ventricular stroke volume. prolongs right ventricular systole and delays pulmonary vavle closure.

129
Q

Describe the characteristics of the first heart sound and its intensity at the apex of the heart and at the base.

A

Mitral component usually precedes the tricuspid component, but usually heard as fused. Can hear all over precordium, but usually loudest at the apex and lower at the base.

130
Q

Which conditions increase the intensity of S1?

A

exercise, anxiety, anemia, fever, pregnancy, thyrotoxicosis

131
Q

Which conditions decrease the intensity of S1?

A

Obesity, COPD

132
Q

Describe the characteristics of the second heart sound and its intensity at the apex of the heart and at the base.

A

aortic component of the second heart sound (A2) slight precedes the pulmonic component (P2). Can hear all over the precordium, but less intense at apex, more intense at base.

133
Q

Which conditions increase the intensity of S2?

A

increased systolic pressure, increased contractility

134
Q

Which conditions decrease the intensity of S2?

A

Lowered systolic pressure, decreased contractility

135
Q

Explain the physiologic mechanism for normal splitting of S2 in the pulmonic valve area.

A

inspiration separates the timing of the two valves’ closure and the aortic valve closes 0.06 seconds before the pulmonic valve.

136
Q

Define the third heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation.

A

Soft, low-pitched ventricular filling sound that occurs in early diastole (S3) and may be an early sign off heart failure. Occurs immediately after S2, when AV valves open and atrial blood first pours into the ventricles. best heard at the apex using the bell.

137
Q

Differentiate a physiologic S3 from a pathologic S3.

A

Physiologic: children & young adults, may persist after 40 (especially in women) usually disappears when sitting up

Pathologic: adults, ventricular gallop. occurs while sitting up. decreased compliance of ventricles

138
Q

Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation.

A

S4 gallop. atrial gallop. very soft, low-pitched ventricular filling sound that occurs in late diastole. heard immediately before S1. Need a good bell to hear. best heard at apex.

139
Q

Explain the position of the valves during each phase of the cardiac cycle.

A

Systole: AV valves shut, semilunar valves open
Diastole: AV valves open, semilunar valves close

140
Q

Define venous pressure and jugular venous pulse.

A

Venous pressure: the pressure exerted on the walls of the veins by the circulating blood

Jugular Venous Pulse: rhythmic expansion of an artery that may be felt with the examiner’s finger over the patient’s jugular vein.

141
Q

Differentiate between the carotid artery pulsation and the jugular vein pulsation.

A

Carotid Artery Pulsation: smooth, rapid upstroke, a summit that is rounded and smooth and a downstroke that is more gradual and has a dicrotic notch caused by closure of the aortic valve.

Jugular Vein Pulsation: results from a backwash, a waveform moving backward caused by events upstream

142
Q

List the areas of questioning to address during the health history of the cardiovascular system.

A

Chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, cardiac history, family cardiac history, personal habits

143
Q

Define bruit, and discuss what it indicates.

A

blowing, swishing sound indicating blood flow turbulence; normally none is present. possible atherosclerotic narrowing.

144
Q

Define heave or lift, and discuss what it indicates.

A

sustained forceful thrusting of the ventricles during systole. It occurs with ventricular hypertrophy as a result of increased workload.

145
Q

State 4 guidelines to distinguish S1 from S2.

A

S1: start of systole, louder at apex, coincides with carotid artery pulse, coincides with R wave

S2: End of systole, louder at base

146
Q

Define pulse deficit, and discuss what it indicates.

A

pulse deficit indicates weak contraction of the ventricles; occurs with atrial fibrillation, premature beats and heart failure. can be checked by auscultating the apical beat while simultaneously palpating the radial pulse.

147
Q

Define preload and afterload.

A

preload: the venous return that builds during diastole
afterload: the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure.

148
Q

List the characteristics to explore when you hear a murmur, including the grading scale of murmurs.

A

timing, loudness, pitch, pattern, quality, location, radiation, posture.

grade I: barely audible
grade II: faint, but audible
grade III: easy to hear
grade IV: loud, thrill palpable on chest
grade V: very loud, one corner of diaphragm off chest
grade VI: loudest, heard without stethoscope touching the chest

149
Q

Discuss the characteristics of an innocent or functional murmur.

A

blowing, swooshing sound that occurs with turbulent blood flow in the heart.

150
Q

Describe the structure and function of arteries and veins.

A

arteries contain elastic fibers which allow the walls to stretch with systole and recoil with diastole. Veins drain deoxygenated blood and its waste products from tissues and return it to the heart.

151
Q

List the pulse sites accessible to examination.

A

temporal, carotid, brachial, ulnar, radial, femoral, popliteal, dorsalis pedis, posterior tibial

152
Q

Describe 3 mechanisms that help return venous blood to the heart.

A

1) contracting skeletal muscles that push blood flow
2) breathing (creates a pressure gradient)
3) intraluminal valves that ensure unidirectional flow.

153
Q

Define the term capacitance vessels, and explain its significance.

A

the distensibility of blood vessels located within the body; it is inversely related to elasticity. Reduce stress on the heart. Can expand & hold more blood when blood volume increases.

154
Q

List the risk factors for venous stasis.

A

elderly, diabetes, obesity, peripheral vascular disease, pregnancy, prolonged standing, inactive lifestyle, smoking, varicose veins, tight clothing

155
Q

Describe the function of the lymphatic system.

A

1) conserve fluid and plasma proteins that leak out of the capillaries
2) form part of the immune system that defends against disease
3) absorb lipids from the intestinal tract

156
Q

Describe the function of lymph nodes.

A

filter fluid before it’s returned to the bloodstream and filter out potentially harmful microbes.

157
Q

Name the related organs in the lymphatic system.

A

spleen, tonsils, thymus

158
Q

List the symptom areas to address during history taking of the peripheral vascular system.

A

leg pain or cramps, skin changes on arms or legs, swelling in arms or legs, lymph node enlargement, medications

159
Q

Fill in the grading scale for assessing the force of an arterial pulse: 0 = ____. 1+ _____. 2+_____. 3+______.

A

0: absent
1+: weak
2+: normal
3+: increased, full, bounding

160
Q

List the steps in performing the modified Allen test.

A

1) firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times
2) ask the person to open hand without hyperextending it, release pressure on the ulnar artery while maintaining pressure on the radial artery.

161
Q

List the skin characteristics expected with arterial insufficiency to the lower legs.

A

thin, shiny skin with loss of hair.

162
Q

Compare the characteristics of leg ulcers associated with arterial insufficiency with ulcers with venous insufficiency.

A

Arterial insufficiency with ulcers: deep muscle pain in the calf or foot, claudication, pain at rest, coolness, pallor

Venous insufficiency: aching pain in the calf or lower leg. worse at the end of the day. firm, brawny edema, coarse, thick skin

163
Q

Fill in the description of the grading scale for pitting edema. 1+____. 2+____. 3+___. 4+____.

A

1+: slight pitting/2 mm, disappears rapidly
2+: somewhat deeper pit/ 4mm. disappears in 10-15 seconds
3+: deep pit/6mm. may last >1 min.
4+: very deep pit/8 mm. lasts 2-5 min.

164
Q

Describe the technique for using the Dopplar ultrasonic stethoscope to detect peripheral pulses.

A

position the person supine, with legs externally rotated so you can reach the medial ankles easily. place a drop of coupling gel on the end of the handheld transducer, place the transducer over the pulse sight, swiveled at 45 degree angle.

165
Q

Raynaud’s phenomenon has associated progressive tricolor changes of the skin from ___ to ____ and then to ____. State the mechanism for each of these color changes.

A

white, blue, red.

White: deficit in blood supply

blue: slight relaxation
red: return of blood

166
Q

The manubriosternal angle is:

a. the articulation of the manubrium and the body of the sternum.
b. a hollow, U-shaped depression just above the sternum
c. also known as the breastbone
d. a term synonymous with costochondral junction

A

A. the articulation of the manubrium and the body of the sternum

167
Q

Select the correct description of the left lung.

a. narrower than the right lung with three lobes.
b. narrower than the right lung with two lobes.
c. wider than the right lung with two lobes.
d. shorter than the right lung with three lobes.

A

b. narrower than the right lung with two lobes

168
Q

Some conditions have a cough with characteristic timing. The cough associated with chronic bronchitis is best described as:

a. continuous throughout the day.
b. productive cough for at least 3 months of the year for 2 years in a row
c. occurring in the afternoon/evening because of exposure to irritants at work
d. occurring in the early morning

A

b. productive cough for at least 3 months of the year for 2 years in a row

169
Q

Symmetric chest expansion is best confirmed by:

a. placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch up a small fold of skin between the thumbs.
b. inspection of the shape and configuration of the chest wall.
c. placing the palmar surface of the fingers of one hand against the chest and having the person repeat the words “ninety-nine.”
d. percussion of the posterior chest

A

a. placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch up a small fold of skin between the thumbs.

170
Q

Absence of diaphragmatic excursion occurs with:

a. asthma
b. an unusually thick chest wall
c. pleural effusion or atelectasis of the lower lobes.
d. age-related changes in the chest wall.

A

c. pleural effusion or atelectasis of the lower lobes.

171
Q

Auscultation of breath sounds is an important component of respiratory assessment. Select the most accurate description of this part of the examination.

a. hold the bell of the stethoscope against the chest wall; listen to the entire right field and then the entire left field.
b. hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons.
c. listen from the apices to the bases of each lung field using the bell of the stethoscope.
d. select the bell or diaphragm depending upon the quality of sounds heard; listen for one respiration in each location, moving from side to side.

A

b. hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons.

172
Q

Select the best description of bronchovesicular breath sounds:

a. high pitched, of longer duration on inspiration than expiration
b. moderate pitched, inspiration equal to expiration
c. low pitched, inspiration greater than expiration
d. rustling sound, like the wind in the trees.

A

b. moderate pitched, inspiration equal to expiration

173
Q

After examining a patient, you make the following notation: Increased respiratory rate, chest expansion decreased on left side, dull to percussion over left lower lobe, breath sounds louder with fine crackles over left lower lobe. These findings are consistent with a diagnosis of:

a. bronchitis
b. asthma
c. pleural effusion
d. lobar pneumonia

A

d. lobar pneumonia

174
Q

Upon examining a patient’s nails, you note that the angle of the nail base is >160 degrees and that the nail base feels spongy to palpation. These findings are consistent with:

a. adult respiratory distress syndrome.
b. normal findings for the nails.
c. chronic congenital heart disease and COPD
d. atelctasis

A

c. chronic congenital heart disease and COPD

175
Q

Upon examination of a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient complains of pain with breathing. These findings are consistent with:

a. fine crackles
b. wheezes
c. atelectatic crackles
d. pleural friction rub

A

d. pleural friction rub

176
Q

In order to use the technique of egophony, ask the patient to:

a. take several deep breaths and then hold for 5 seconds.
b. say “eeeeee” each time the stethoscope is moved.
c. repeat the phrase, “ninety-nine” each time the stethoscope is moved.
d. whisper a phrase as auscultation is performed.

A

b. say “eeeeee” each time the stethoscope is moved.

177
Q

When examining for tactile fremitus, it is important to:

a. have the patient breathe quickly
b. ask the patient to cough
c. palpate the chest symmetrically
d. use the bell of the stethoscope

A

c. palpate the chest symmetrically

178
Q

The pulse oximeter measures:

a. arterial oxygen saturation
b. venous oxygen saturation
c. combined saturation of arterial and venous blood
d. carboxyhemoglobin levels

A

a. arterial oxygen saturation

179
Q

A pleural friction rub is best detected by:

a. observation
b. palpation
c. auscultation
d. percussion

A

c. auscultation

180
Q

A barrel-shaped chest is characterized by:

a. equal anteroposterior-to-transverse diameter and ribs being horizontal.
b. anteroposterior-to-transverse diameter of 1:2 and an elliptical shape
c. anteroposterior-to-transverse diameter of 2:1 and ribs being elevated
d. anteroposterior-to-transverse diameter of 3:7 and ribs sloping back

A

a. equal anteroposterior-to-transverse diameter and ribs being horizontal.

181
Q

Apex of the lungs (location)

A

3 to 4 cm above the inner third of the clavicles

182
Q

base of the lungs (location)

A

rests on the diaphragm

183
Q

lateral left side of the lungs (location)

A

sixth rib, midclavicular line

184
Q

lateral right side of the lungs (location)

A

fifth intercostal space

185
Q

posterior apex of the lungs (location)

A

C7

186
Q

Description of a normal chest

A

elliptical shape with an anteroposterior-to-transverse diameter in the ratio of 1:2

187
Q

Description of a barrel chest

A

anteroposterior = transverse diameter

188
Q

Description of pectus excavatum

A

sunken sternum and adjacent cartilages

189
Q

Description of pectus carinatum

A

forward protrusion of the sternum with ribs sloping back at either side

190
Q

Description of Scoliosis

A

lateral S-shaped curvature of the thoracic and lumbar spine

191
Q

Description of Kyphosis

A

exaggerated posterior curvature of the thoracic spine

192
Q

The precordium is:

a. a synonym for the mediastinum
b. the area on the chest where the apical impulse is felt
c. the area on the anterior chest overlying the heart and great vessels.
d. a synonym for the area where the superior and inferior venae cavae return unoxygenated venous blood to the right side of the heart.

A

c. the area on the anterior chest overlying the heart and great vessels.

193
Q

Select the best description of the tricuspid valve.

a. left semilunar valve
b. right atrioventricular valve
c. left atrioventricular valve
d. right semilunar valve

A

b. right atrioventricular valve.

194
Q

The function of the pulmonic valve is to:

a. divide the left atrium and the left ventricle.
b. guard the opening between the right atrium and the right ventricle.
c. protect the orifice between the right ventricle and the pulmonary artery.
d. guard the entrance to the aorta from the left ventricle.

A

c. protect the orifice between the right ventricle and the pulmonary artery.

195
Q

Atrial systole occurs:

a. during ventricular systole
b. during ventricular diastole
c. concurrently with ventricular systole
d. independently of ventricular function.

A

b. during ventricular diastole.

196
Q

The second heart sound is the result of:

a. opening of the mitral and tricuspid valves
b. closing of the mitral and tricuspid valves
c. opening of the aortic and pulmonic valves
d. closing of the aortic and pulmonic valves

A

d. closing of the aortic and pulmonic valves.

197
Q

The examiner has estimated the jugular venous pressure. Identify the finding that is abnormal.

a. Patient elevated to 30 degrees, internal jugular vein pulsation at 1 cm above sternal angle
b. Patient elevated to 30 degrees, internal jugular vein pulsation at 2 cm above sternal angle
c. Patient elevated to 40 degrees, internal jugular vein pulsation at 1 cm above sternal angle
d. Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle

A

d. Patient elevated to 45 degrees, internal jugular vein pulsation at 4 cm above sternal angle.

198
Q

The examiner is palpating the apical impulse. The normal size of this impulse:

a. is less than 1 cm
b. is about 2 cm
c. is 3 cm
d. varies on the size of the person

A

b. is about 2 cm.

199
Q

The examiner wishes to listen in the pulmonic valve area. To do this, the stethoscope would be placed at the:

a. second right interspace
b. second left interspace
c. left lower sternal border
d. fifth interspace, left midclavicular line

A

b. second left interspace.

200
Q

Select the statement that best differentiates a split S2 from S3.

a. S3 is lower pitched and is heard at the apex
b. S2 is heard at the left lower sternal border
c. The timing of S2 varies with respirations
d. S3 is heard at the base; timing varies with respirations

A

a. S3 is lower pitched and is heard at the apex.

201
Q

The examiner wishes to listen for a pericardial friction rub. Select the best method of listening.

a. with the diaphragm, patient sitting up and leaning forward, breath held in expiration
b. using the bell with the patient leaning froward
c. at the base during norma respiration
d. with the diaphragm, patient turned to the left side

A

a. with the diaphragm, patient sitting up and leaning forward, breath held in expiration.

202
Q

When auscultating the heart, your first step is to:

a. identify S1 and S2
b. listen for S3 and S4
c. listen for murmurs
d. identify all four sounds on the first round

A

a. identify S1 and S2

203
Q

You’ll hear a split S2 most clearly in what area?

a. apical
b. pulmonic’
c. tricuspid
d. aortic

A

b. pulmonic

204
Q

The stethoscope bell should be pressed lightly against the skin so that:

a. chest hair doesn’t simulate crackles
b. high-pitched sounds can be heard better
c. it doesn’t act as a diaphragm
d. It doesn’ interfere with amplification of heart sounds

A

c. it doesn’t act as a diaphragm

205
Q

A murmur heard after S1 and before S2 is classified as:

a. diastolic ( possibly benign)
b. diastole ( always pathologic)
c. systolic ( possibly benign)
d. systolic ( always pathologic)

A

c. systolic (possibly benign)

206
Q

When assessing the carotid artery, the examiner should palpate:

a. bilaterally at the same time, while standing behind the patient
b. medial to the sternomastoid muscle, one side at a time
c. for a bruit while asking the patient to hold his or her breath briefly
d. for unilateral distention while turning the patient’s head to one side.

A

b. medial to the sternomastoid muscle, one side at a time

207
Q

Fill in the following blanks.

S1 is best heard at the ___ of the heart, whereas S2 is loudest at the ___ of the heart. S1 coincides with the pulse in the ______ and coincides with _____ wave if the patient is on an ECG monitor.

A

Apex, base, carotid artery, R

208
Q

Tough, fibrous, double-walled sac that surrounds and protects the heart

A

pericardium

209
Q

thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

A

endocardium

210
Q

reservoir for holding blood

A

atrium

211
Q

ensures smooth, friction-free movement of the heart muscle

A

pericardial fluid

212
Q

muscular pumping chamber

A

ventricle

213
Q

muscular wall of the heart

A

myocardium

214
Q

Briefly relate the route of a blood cell from the liver to tissue in the body.

A

liver to right atrium via inferior vena cava, through tricuspid valve to right ventricle, through the pulmonic valve to the pulmonary artery, picks up oxygen in the lungs, returns to left atrium, to left ventricle via mitral valve, through aortic valve to aorta, and out to the body.

215
Q

List the major risk factors for heart disease and stroke identified in the text.

A

hypertension, smoking, high cholesterol levels, obesity, and diabetes. Physical inactivity, family history of heart disease, and age are other risk factors.

216
Q

A function of the venous system is:

a. to hold more blood when blood volume increases
b. to conserve fluid and plasma proteins that leak out of the capillaries
c. to form a major part of the immune system that defends the body against disease
d. to absorb lipids from the intestinal tract.

A

a. to hold more blood when blood volume increases

217
Q

The organs that aid the lymphatic system are:

a. liver, lymph nodes and stomach
b. pancreas, small intestine, and thymus
c. spleen, tonsils, and thymus
d. pancreas, spleen, and tonsils

A

c. spleen, tonsils, and thymus

218
Q

Ms T has come for a prenatal visit. She complains of dependent edema, varicosities in the legs, and hemorrhoids. The best response is:

a. “If these symptoms persist, we will perform an amniocentesis.”
b. “If these symptoms persist, we will discuss having you hospitalized.”
c. “The symptoms are caused by the pressure of the growing uterus on the veins. They are usual conditions of pregnancy.”
d. “At this time, the symptoms are a minor inconvenience. You should learn to accept them.”

A

c. “The symptoms are caused by the pressure of the growing uterus on the veins. They are usual conditions of pregnancy.”

219
Q

A pulse with an amplitude of 3+ would be considered:

a. irregular, with 3 premature beats
b. increased, full
c. normal
d. weak

A

b. increased, full

220
Q

Inspection of a person’s right hand reveals a red, swollen are. To further assess for infection, you would palpate the:

a. cervical node
b. axillary node
c. epitrochlear node
d. inguinal node

A

c. epitrochlear node

221
Q

In order to screen for deep vein thrombosis, you would:

a. measure the circumference of the ankle
b. check the temperature with the palm of the hand
c. compress the dorsalis pedis pulse, looking for blood return
d. measure the widest point with a tape measure.

A

d. measure the widest point with a tape measure.

222
Q

During the examination of the lower extremities, you are unable to palpate the popliteal pulse, you should:

a. proceed with the examination. It is often impossible to palpate this pulse
b. refer the patient to a vascular surgeon for further evaluation
c. schedule the patient for venogram
d. schedule the patient for an arteriogram

A

a. proceed with the examination. It is often impossible to palpate this pulse

223
Q

While reviewing a medical record, a notation of 4+ edema of the right leg is noted. The best description of they type of edema is:

a. mild pitting, no perceptible swelling of the leg
b. moderate pitting, indentation subsides rapidly
c. deep pitting, leg looks swollen
d. very deep pitting, indentation lasts a long time

A

d. very deep pitting, indentation lasts a long time

224
Q

The examiner wishes to asses for arterial deficit in the lower extremities. After raising the legs 12 inches off the table and than having the person sit up and dangle the leg, the color should return in:

a. 5 seconds or less
b. 10 seconds or less
c. 15 seconds
d. 30 seconds

A

b. 10 seconds or less

225
Q

A 54 year old woman with five children has varicose veins of the lower extremities. Her most characteristic sign is:

a. reduced arterial circulation
b. blanching, deathlike appearance of the extremities on elevation
c. loss of hair on feet and toes
d. dilated, tortuous superficial bluish vessels.

A

d. dilated, tortuous superficial bluish vessels.

226
Q

Atrophic skin changes that occur with peripheral arterial insufficiency include:

a. thin, shiny skin with loss of hair
b. brown discoloration
c. thick, leathery skin
d. slow-healing blisters on the skin

A

a. thin, shiny skin with loss of hair

227
Q

Intermittent claudication is:

a. muscular pain relieved by exercise
b. neurologic pain relieved by exercise
c. muscular pain brought on by exercise
d. neurologic pain brought on by exercise

A

c. muscular pain brought on by exercise

228
Q

A known risk factor for venous ulcer development is:

a. obesity
b. male gender
c. history of hypertension
d. daily aspirin therapy

A

a. obesity

229
Q

Brawny edema is:

a. acute in onset
b. soft
c. nonpitting
d. associated with diminished pulses

A

c. nonpitting

230
Q

Arteriosclerosis is the:

a. deposition of fatty plaques on the intima of arteries
b. loss of elasticity of the walls of blood vessels
c. loss of lymphatic tissue that occurs in the aging process
d. progressive enlargement of the intramuscular calf veins

A

b. loss of elasticity of the walls of blood vessels

231
Q

To assess the thorax, what should you do?

A

Assess areas side to side to compare.

231
Q

Raynaud’s phenomenon occurs:

a. when the patient’s extremities are exposed to heat and compression
b. in hands and feet as a result of exposure to cold, vibration, and stress
c. after removal of lymph nodes or damage to lymph nodes and channels.
d. as a result of leg cramps due to excessive walking or climbing stairs

A

b. in hands and feet as a result of exposure to cold, vibration, and stress

232
Q

When assessing lung sounds, you should

A. Use the bell of the stethoscope
B. Have the patient breathe quickly
C. Move the stethoscope after complete exhalation
D. Listen through clothing so you don’t embarrass the patient

A

Move the stethoscope after complete exhalation

233
Q

When assessing thoracic expansion:

A. You should auscultate an “aa” sound when they say “ee”
B. The diaphragm should drop 5-7 cm with deep inspiration
C. Your thumbs will move 3-5 cm during inspiration
D. You will percuss for a change from hyper resonance to dullness with deep inspiration.

A

C. Your thumbs will move 3-5 cm during inspiration

234
Q

When comparing the size of the thoracic cavity, the AP diameter is usually 2:1 in a healthy adult.

A. True
B. False

A

A. True.

235
Q

Bronchial breath sounds are high pitched sounds typically auscultated over the trachea.

A. True
B. False

A

A. True

236
Q

Vesicular breath sounds are low pitched soft sounds typically auscultated over the peripheral lung fields.

A. True
B. False

A

A. True

237
Q

Rhonchi are high pitched wheezing sounds.

A. True
B. False

A

B. False

238
Q

Tactile fremitus is:

A. Using the ulnar or palmar aspect of your hand to palate vibrations when the patient says 99
B. Auscultating when the patient speaks 99
C. Inspecting for symmetry with deep inspiration
D. Percussing the intercostal spaces for resonant sounds

A

A. Using the ulnar or palmar aspect of your hand to palpate vibrations when the patient says 99

239
Q

When you auscultate while the patient says 99, it is called:

A. Whispered pectoriloquy
B. Bronchophony
C. Egophony
D. Tactile fremitus

A

B. Bronchophony

241
Q

A pleural friction rub is when:

A. There is inflammation of the pleural lining
B. You auscultate a loud inspiratory wheeze
C. There is atelectasis in the right lower lobe
D. Breath sounds are very diminished or absent

A

A. There is inflammation of the pleural lining.

242
Q

HYPERRESONANCE NOTED WITH PERCUSSION IS TYPICALLY FOUND WITH COPD

a. true
b. false

A

a. true

243
Q

Adventitious sounds include:

a. Absent breath sounds
b. Wheezing
c. Normal breath sounds
d. Christmas bells

A

b. wheezing

244
Q

Tactile fremitus is:

a. Increased vibrations palpated with normal lungs
b. Increased vibrations palpated in a patient with pneumonia
c. Increased vibrations palpated in a patient with emphysema
d. Are greater on the right side of the thorax than on the left side

A

b. Increased vibrations palpated in a patient with pneumonia

245
Q

There are 3 lobes on the left side and 2 on the right.

A. true
B. false

A

B. false

246
Q

You can easily auscultate the right middle lobe posteriorly.

A. True
B. False

A

B. False

247
Q

A normal respiratory rate for a newborn is:

a. 10-20 bpm
b. 50-60 bpm
c. 30-40 bpm
d. 20-30 bpm

A

c. 30-40 bpm

248
Q

Course crackles are high pitched adventitious sounds auscultated on expirations.

A. True
B. False

A

B. False - auscultated on inspirations.

Nice couple of pages in the book. 444-445. tells you all about wave forms – NEED TO KNOW THEM!!!! Course crackles are low pitched!

249
Q

Atelectasis is a condition when the alveolar collapse; it sounds like fine crackles on inspiration.

A. True
B. False

A

A. True

250
Q

Pleural friction rub is heard equally on inspiration and expiration.

A. True
B. False

A

A. True

251
Q

Wheezes are only heard on inspiration.

A. True
B. False

A

B. False

252
Q

The aortic valve is auscultated at the:

a. 3rd ICS, RLSB
b. 5th ICS, MCL
c. 2nd ICS, LUSB
d. 2nd ICS, RUSB

A

D. 2nd ICS, RUSB

5th ICS, MCL: mitral valve. Think m for mitral.

ALL PEOPLE EAT TURKEY MEAT
Aortic, Pulmonic, Erbs, Tricuspid, Mitral

253
Q

A systolic murmur is a whoosing sound heard:

a. Best with the patient taking a deep breath
b. Between the S1 and S2 heart sounds

A

b. between the S1 and S2 heart sounds

254
Q

An S3 heart sound:

a. Is noted after the S2 heart sound
b. Is noted before the S1 heart sound
c. Sounds like “tennessee”
d. Is best heard with the diaphragm

A

a. Is noted after the S2 heart sound

255
Q

The S1 heart sound is:

a. Auscultated loudest at the apex
b. Caused by closing of the semilunar valves
c. Heard best with the bell
d. Auscultated loudest at the base

A

a. Auscultated loudest at the apex

256
Q

The S2 heart sound is:

a. Best auscultated with the bell
b. Can be normally split during inspiration
c. Loudest at the base
d. Caused by the closing of the mitral valve

A

b and c. can be normally split during inspiration, and is loudest at the base.

257
Q

A normal apical pulse area is 1cmx2cm in size.

A. True
B. False

A

A. True

258
Q

The mitral valve is assessed at the:

a. 4th ICS
b. 3rd ICS
c. 2nd ICS
d. 5th ICS, MCL

A

d. 5th ICS, MCL

259
Q

You should always listen for the S1 and S2 heart sounds first when assessing heart sounds.

A. True
B. False

A

A. True

260
Q

The valves that can be best heard at the apex of the heart are the pulmonic and aortic valves.

A. True
B. False

A

B. False

261
Q

When assessing the carotid arteries, you should always palpate both sides simultaneously to compare them.

A. True
B. False

A

B. False

262
Q

To check for a blood clot in the leg, you would do a:

a. Check of the patients radial pulse
b. Homans sign
c. Allens test
d. Ankle Branchial Index

A

b. homans sign

263
Q

Arteries are thicker than veins with elastic properties, allowing them to withstand increases in pressure.

A. True
B. False

A

A. True

264
Q

Intermittent claudication is:

a. When a patient experiences leg pain with exercise
b. A blood clot in the vein of the leg
c. Assessed using the homans sign
d. A blockage caused by an arterial plaque

A

a. When a patient experiences leg pain with exercise

265
Q

S1 is heard loudest at:

a. 3rd ICS LSB
b. 2nd ICS LSB
c. 2nd ICS RSB
d. 5th ICS MCL

A

d. 5th ICS MCL (mitral valve)

266
Q

Which statement is NOT true about S2?

a. It is heard loudest at the base of the heart
b. It is caused by the closure of the semilunar valves
c. It is best heard with the bell
d. It is at the end of systole

A

c. it is best heard with the bell

267
Q

Heart sounds are the same thing as murmurs.

A. True
B. False

A

B. false

268
Q

All of the following regarding S3 are true except:

a. Sounds like Kentucky
b. Is often a sign of heart failure
c. Is caused by resistance to ventricular filling
d. Is best heard with the diaphragm

A

d. it is best heard with the diaphragm

269
Q

All of the following are true about S4 except:

a. Occurs during diastole
b. Occurs right before the S1
c. Is heard best with the bell
d. Is always an abnormal finding

A

d. is always an abnormal finding

270
Q

Diastolic murmurs are always pathologic.

A. True
B. False

A

A. True

271
Q

Systolic murmurs occur between S2 and S1.

A. True
B. False

A

B. False

272
Q

Which statement is not true?

a. Kyphosis is a flexion deformity
b. The tripod position may indicate resp distress
c. Normal thorax a/p ratios is 1:1
d. Clubbing of the nails may indicate resp disease

A

c. Normal thorax a/p ratios is 1:1

273
Q

What is not true about lung auscultation?

a. In bronchial breath sounds; I>E
b. The pt must breathe deeply in and out of their mouth
c. Wheezes can be caused by acute bronchites
d. Crackles can be fine or coarse

A

a. In bronchial breath sounds; I > E

Health Assessment Test 3 (1 decks)

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