Exam (elaborations)
FULL REVIEW CRT/RRT (NBRC) QUESTIONS AND ANSWERS GRADED A+ 2024/2025
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FULL REVIEW CRT/RRT (NBRC) QUESTIONS AND ANSWERS GRADED A+ 2024/2025
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FULL REVIEW CRT/RRT (NBRC)Ascites - ANSaccumulation of fluid inside the stomach as a result of LIVER FAILURE
Venous distention - ANS-occurs with CHF
-seen with obstructive sufferers (seen in exhalation section)
Capillary replenish - ANS-indication of peripheral movement
-Normal < 3 seconds
Jaundice skin colour - ANS-growth in bilirubin.
-generally in face and trunk
Bradypnea (oligopnea) - ANS-reduced respiratory charge (<12bpm) variable depth and
irregular rhythm
Hyperpnea - ANS-increased rate, depth, with regular rhythm
Cheyne-Stokes - ANS-gradually increasing then decreasing rate and depth in a cycle lasting
from 30 - 180 secs, with apnea up to 60 secs
-increased ICP, meningitis, overdose
Biots - ANS-increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's - ANS-increased rate, depth, irregular rhythm, breathing sounds labored
-Raspy voice
Apneustic - ANSprolonged gasping inspiration followed by extremely short, insufficient
expiration
-respiratory center problems, trauma, tumor
cachectic - ANSmuscle atrophy/loss of muscle tone
retractions - ANS-chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
Character of cough - ANS-dry, non-productive cough may indicate tumor in the lungs or
asthma
-productive cough may indicate infection
,evidence of difficult airway - ANS-short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
pulsus paradoxus - ANS-pulse/blood pressure varies with respiration. May indicate severe
air trapping (status asthmaticus or cardiac tamponade)
tactile fremitus - ANS-vibrations felt by hand on chest wall
-vocal fremitus: voice vibrations on the chest wall
-pleural rub fremitus: grating sensation due to roughened pleural spaces
-Rhonchial fremitus(palpable rhonchi): secretions in airways
Crepitus - ANS-bubbles of air under skin that can be palpated and indicates subcutaneous
emphysema
Resonant percussion - ANS-hollow sound
-normal lungs
Flat percussion - ANS-heard over sternum, muscles, or areas of atelectasis
Dull percussion - ANS-heard over fluid-filled organs such as heart or liver (thudding)
-pleural effusion or pneumonia
Tympanic percussion - ANS-heard over air-filled stomach.
-drum-like sound and when heard over lung = increased volume
Hyperresonant - ANS-found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds - ANSnormal sounds in lungs
bronchial breath sounds - ANS-normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony - ANS-patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy - ANS-increased intensity or transmission of the
spoken voice and indicate CONSOLIDATION or PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales - ANS-crackles
-secretions/fluid
Coarse rales - ANS-rhonchi
-LARGE airway secretions
,-needs suctioning
medium rales - ANS-middle airway secretions
-needs CPT
Fine rales - ANS-fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANS-due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANS-upper airway obstruction
-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub - ANS-coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANS-closure of the mitral and tricuspid valves at the beginning of
ventricular contraction
Heart Sound S₂ - ANS-closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANS-abnormal and may suggest CHF
Heart Sound S₄ - ANS-abnormal and indicative of cardiac abnormality such as myocardial
infarction or cardiomegaly
Heart murmurs - ANS-sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits - ANS-sounds made in an artery or vein when blood flow becomes turbulent or flows
at an abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
Blood pressure - ANS-systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
, -↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANS-angle made by the outer curve of the diaphragm and the chest
wall
-obliterated by pleural effusions and pneumonia
Diaphragm - ANS-dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANS-patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANS-taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANS-tip should be positioned below the vocal chords
and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before CXR is
taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANS-pacemaker should be positioned in the right ventricle
-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein and should
rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANS-viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
Epiglottitis - ANS-bacterial infection
-supraglottic swelling with an enlraged and flattened epiglottis and swollen aryepiglottic folds
-Thumb sign
-Rapid onset
-pediatrics
-provide airway and antibiotics
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