2024/2025
NRSG 312 Exam 2 Questions And
Answers Latest Update
Cough ANS✔✔ -OLDCART
-sputum color, amount, odor
-cough: hacking, dry, barking, hoarse, congested, bubbling
-chest or ear pain
Shortness of Breath ANS✔✔ -OLDCART
-orthopnea
-chest pain, cough, cyanosis, wheezing
-environmental exposure
-medications: oxygen, inhalers
-affect of ADLs
Chest Pain ANS✔✔ -OLDCART
-respiratory infection, coughing, or trauma
-fever, deep breathing, unequal chest inflation
-past history: bronchitis, emphysema, asthma, pneumonia, allergies, TB
Smoking ANS✔✔ -OLDCART
-ppd
-second hand
Environmental Exposure ANS✔✔ -chemicals, coal mine, farming, outdoor
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Patient-Centered Care: Lungs ANS✔✔ -TB skin test
-Chest X-ray
-Pneumonia or Influenza immunizations
Aging Adult: Lungs ANS✔✔ -normal physical activity
-change in weight
-change in energy level
-chest pain
Inspection: Posterior Chest ANS✔✔ -thoracic cage: shape, configuration, spine straight, symmetry,
ribs downward sloping at 45 degrees, symmetric scapula, AP to transverse diameter 1:2, normal neck
muscle development
-position, posture, skin color and condition, lesions
Symmetric Expansion ANS✔✔ -Hands at T9-T10, pinch skin with thumbs, ask patient to take a
deep breath
Tactile Fremitus ANS✔✔ -Sounds generated from the larynx moves through bronchi, lung
parenchyma, and to the chest wall
-Use ulnar edge of hands and touch chest, ask patient to say "ninety-nine" or "blue moon"
-start at apices, note symmetry
-generate strong vibrations
-right side may be stronger because of the bronchial bifurcation
-vibrations decrease as you move down, more tissue impedes transmission
-sounds more prominent between scapula and sternum
-loud, low-pitched voice generates more fremitus
-conditions that increase lung density make a better conducting medium, increasing tactile fremitus
-note tenderness, temperature, moisture, lumps, masses, skin lesions
Percussion: Posterior Chest ANS✔✔ -start at apices , percuss side-to-side at 5 cm intervals
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-resonance: low-pitched, clear, hollow sound (healthy tissue)
-percussion only penetrates outer 5-7 cm of tissue, cannot hear anything deeper
-abnormal findings must be 2-3 cm wide to yield abnormal percussion notes
Diaphragmatic Excursion ANS✔✔ -Expiration: percuss down scapular line until sound changes
from resonant to dull
-may be higher on the right because of the liver
-Inhalation: percuss down scapular line until sound changes from resonant to dull
-measure difference (space diaphragm moves during ventilation)
-should be equal bilaterally (3-5 cm in adults; 7-8 cm in well-conditioned people)
Auscultate: Posterior Chest ANS✔✔ -breathe through the mouth, deeper than normal
-use the diaphragm endpiece of stethoscope, listen to full respirations, side-to-side comparison
-minimize extraneous noise: breathing, shivering, hairy chest, gown
-posterior at apices (C7 to bases, T10 laterally from axilla down to 7th or 8th rib)
-bronchial/ tracheal/ tubular- over the trachea (loud amplitude, inspiration shorter, harsh, hollow
tubular)
-bronchovesicular- near sternum/spine (moderate pitch and amplitude, inspiration=expiration,
mixed quality)
-vesicular- lobes of lungs (low pitch, soft amplitude, inspiration longer, rustling sound)
Adventitious Breath Sounds ANS✔✔ -moving air colliding with secretions in tracheobronchial
passageways or popping open of deflated airways
-crackles (rales)- discontinuous popping sounds during inspiration
-wheeze (rhonchi)- continuous musical sounds heard over expiration
-atelectatic crackles- short, popping, crackling sounds, that do not last longer than a few breaths,
heard in the periphery only
Voice Sounds ANS✔✔ -ask to say "ninety-nine" while listening over the chest wall
-normal voice: soft, muffled, indistinct (hear sound but cannot distinguish what is exactly being said)