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NURS 550 Midterm Exam Questions And Correct Answers
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NURS 550 Midterm Exam Questions And Correct AnswersThorax and Lungs HPI - ANSWER • Chest pain
-Initial questions should be as open-ended as possible such as, "Do you have any
discomfort or unpleasant feelings in your chest?"
-Ask the patient to point to the location of the pain
-Use OLDCART • Onset and duration • Associated symptoms • Efforts to treat • Other
medications • Recreational drugs (e.g., cocaine)
Chest pain - besides lung conditions, chest pain could be related to cardiac, vascular,
gastrointestinal, musculoskeletal or skin pathology; anxiety also most commonly
presents with a complaint of chest pain.
Lung tissue itself contains no pain fibers. Usually, pain in conditions of the lungs arises
from inflammation of the adjacent parietal pleura
Irritation of parietal pleura may also come from other surrounding structures
• Shortness of breath (Dyspnea)
- Pain-free but uncomfortable awareness of breathing that is inappropriate to the level of
exertion
- Initiate evaluation with open-ended question, for example, "Have you had any difficulty
breathing?"
- Stage dyspnea based on the level of daily activity that produces symptoms
• Dyspnea - Onset - Pattern - Position most comfortable, number of pillows used -
Relation to amount of exercise, specific activities, time of day, meals - Difficulty
inspiration-expiration - Degree - Associated symptoms - Measures to alleviate
• Wheezing
- Wheezes are musical breath sounds that may be heard by the patient and others
Airways obstruction from secretions, inflammation, or foreign body
,• Cough
- A reflex response to stimuli that irritate receptors in the larynx, trachea, or large
bronchi
- Cardiovascular in origin may be left sided failure
Cough Ask patient to describe volume of any sputum and colour, odour, consistency
Onset Nature of cough; dry or produces sputum, or phlegm Sputum production:
frequency and amount in 24 hours Sput
Past Medical History - ANSWER • Thoracic trauma or surgery • Admitting dates for lung
disease • Oxygen and respirator-assisting devices - CPAP or BiPAP • Chronic pulmonary
disorders respiratory conditions • Previous studies peak flow, PFT's, bronchoscopy,
CXR • Immunization against Streptococcus pneumoniae, Influenza
Family History & Personal and Social History - ANSWER • TB • Cystic fibrosis •
Emphysema • Allergy, Asthma, Atopic dermatitis (triad) • Malignancy • Bronchiectasis •
Bronchitis • Clotting disorders risk for pulmonary embolism
• Any of forementioned disorders in family history • Employment/Occupation • Home
environment • Tobacco use • LF exposure to respiratory infections, influenza,
tuberculosis • Nutritional status • Medications including use of herbal or other remedies
• Travel exposures • Hobbies • Use of alcohol/drugs • Exercise tolerance
Special Considerations: History - ANSWER • Pregnant Women • Weeks of gestation •
Presence of multiple fetuses, polyhydramnios, other conditions in which uterus
displaces diaphragm • Exercise type and energy expenditure • Exposure to and
frequency of respiratory infections, annual influenza immunization
• Older Adults • History of exposure to and frequency of respiratory infections -
Vaccination history related to pneumococcal and flu vaccine • Weather's effects on
respiratory effort and incidence of infection • Immobilization and sedentary lifestyle •
Dysphagia • Changes in activity due to respiratory problems ]
• Older Adults - History of tobacco use - Cough - Shortness of breath or dyspnea with
exertion or rest - Fatigue - Unexplained weight loss or gain - Fever and night sweats
Thorax and Lungs
,Physical Examination - ANSWER • Anterior and posterior chest examination in sitting
and supine positon - Proceed in an orderly fashion: inspect, palpate, percuss, and
auscultate - Anteriorally with percussion, the heart normally produces an area of
dullness to the left of the sternum from the 3rd to 5th rib interspaces - Supraclavicular
retraction is often present
Inspect the chest; anterior and posterior, noting thoracic landmarks, for: • Size and
shape-anteroposterior diameter compared with the lateral diameter • Symmetry • Color •
Superficial venous patterns • Prominence of ribs
Evaluate respirations for: - Rate - Rhythm or pattern Assess chest movement with
breathing for: - Symmetry - Use of accessory muscles Note any audible sounds with
respiration
Auscultate the chest for: - Symmetry - Thoracic expansion - Sensations such as
crepitus, grating vibrations - Tactile fremitus
Percussion: • Chest should be percussed, comparing sides noting the following:
Diaphragmatic excursion Intensity, pitch, duration, and quality of percussion tone
• With the stethoscope diaphragm, auscultate the chest from apex to base, comparing
sides in terms of: Breath sound intensity, pitch, duration, and quality Adventitious
breath sounds Vocal resonance
Techniques of Examination - ANSWER • General techniques - Examine the posterior
thorax and lungs while the patient is sitting - Examine the anterior thorax and lungs with
the patient supine - Compare one side of the thorax and lungs with the other, so the
patient serves as his or her own control - Proceed in an orderly fashion: inspect,
palpate, percuss, and auscultate
Initial examination of respiration and the thorax Inspection Observe rate, rhythm, depth,
and effort of breathing Inspect for signs of respiratory distress o Note the color of the
patient o Auscultate the patient's respiratory sounds o Inspect the neck -Note the
configuration of the chest
• Observe for peripheral clues may indicate respiratory or cardiac problems: Breathing:
odour Skin, nails and lips : cyanosis or pallor Fingers : clubbing Lips: pursing Nostrils:
, flaring
• Inspection of the posterior chest Inspection o From a central position behind the
patient, observe the shape of the chest and the pattern of movement
• Palpation of the thoracic muscles/skeleton - Pulsations - Tenderness -
Bulges/depressions - Masses - Unusual movement/positions - Elasticity of rib cage -
Immovability of sternum - Rigidity of thoracic spine • Position of the trachea (head &
neck exam)
• Percuss chest -Anterior -Lateral -Posterior • Compare tones bilaterally
Examination of the posterior chest - Percussion o Perform from side to side to assess for
asymmetry o Strike using the tip of your tapping finger o Use the lightest percussion
that produces a clear note o Percussion helps establish whether the underlying tissues
(5-7 cm deep) are air-filled, fluid-filled, or solid o Percussion notes Flatness, dullness,
resonance, hyperresonance, tympany
• Percussion tone indicators for lungs -Resonance is normal. -Hyperresonance indicates
hyperinflation. -Dullness indicates diminished air e
Techniques of Examination: Breath Sounds - ANSWER o Characteristics of normal
breath sounds (pg. 303) Vesicular: soft and low pitched, low intensity; usually heard
over most of both lungs Bronchial: louder and higher in pitch and intensity; usually
heard over the manubrium Bronchovesicular: intermediate intensity and pitch; usually
heard over the 1st and 2nd interspaces (major bronchi) Tracheal: very loud and high
pitched, heard over trachea and neck
o Adventitious (added) sounds: Crackles (formerly called rales) • Abnormal respiratory
sound heard more often during inspiration and characterized by discrete discontinuous
sounds • Fine: high pitched, and relatively short in duration • Coarse: low pitched, and
relatively longer in duration
o Adventitious (added) sounds: Rhonchi (sonorous wheezes) • Deeper, more rumbling,
more pronounced during expiration, more likely to be prolonged and continuous, and
less discrete than crackles • Caused by the passage of air through an airway obstructed
by thick secretions, muscular spasm, new growth, or external pressure
o Added sounds (adventitious): Wheezes Sibilant wheeze • Continuous, high pitched,
musical sound (almost a whistle) heard during inspiration or expiration • Caused by a
relatively high-velocity air flow through a narrowed or obstructed airway • May be
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