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NR 509 APEA 3P EXAM WEEK 8-WITH 100%VERIFIED ANSWERS WITH RATIONALES
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NR 509 APEA 3P EXAM WEEK 8-WITH100%VERIFIED ANSWERS WITH RATIONALES
2023-2024
Question 1
A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings on exam
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
respiratoryrate 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 ismore effective in making a better percussion note. If the patient is lying supine, the
posterior chest willnot be able to be percussed. Palpating painful areas is not percussion, so is not
correct. Using the bonypart of the palm at the base of the fingers or the ulnar surface is a technique
used to detect tactile fremitus.
Question 3
,The palpation technique used to assess respiratory expansion of the chest is placing the hands on
theeight 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
followingobservations 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 lesscommonly 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.
IncorrectExplanation:
A patient with left sided heart failure experiences increased pressure in the pulmonary veins
causingcongestion 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
mostlikely:
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
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