NUR 550 COMPREHENSIVE QUESTIONS AND
ANSWERS SET A+
✔✔Techniques of Examination - ✔✔• 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 survey (Inspection) of respiration and the thorax - Observe the rate, rhythm,
depth, and effort of breathing - Inspect for any signs of respiratory difficulty o Assess the
patient's color o Listen to the patient's breathing o Inspect the patient's neck - Observe
the shape of the chest
• Observe for peripheral clues may suggest pulmonary or cardiac difficulties: - Breath:
odor - Skin, nails, and lips: cyanosis or pallor - Fingers: clubbing - Lips: pursing -
Nostrils: flaring
• Examination of the posterior chest - Inspection o From a midline position behind the
patient, note the shape of the chest and the way in which it moves
• 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 - ✔✔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 Adventitious (added) sounds: 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
caused by the bronchospasm of asthma (reactive airway disease) or acute or chronic
bronchitis
• Examination of the posterior chest - Auscultation o Adventitious (added) sounds:
Friction Rub • Occurs outside the respiratory tree • Dry, crackly, grating, low-pitched
sound and is heard in both expiration and inspiration • Caused by inflamed, roughened
surfaces rubbing together
o Adventitious (added) sounds: Mediastinal Crunch (Hammam Sign)) • Dry, crackly,
grating, low-pitched sound and is heard in both expiration and inspiration • Caused by
inflamed, roug
✔✔Techniques of Examination: Vocal Resonance - ✔✔• Bronchophony - Greater clarity
and increased loudness of spoken sounds • Pectoriloquy - Extreme bronchophony
where even a whisper can be heard clearly through the stethoscope • Egophony -
Intensity of the spoken voice is increased and there is a nasal quality. - e's become
stuffy broad a's
✔✔Thorax and Lungs
Differential Diagnoses - ✔✔• Asthma (reactive airway disease) - Reversible small
airway obstruction due to inflammation and hyperreactive airways • Atelectasis -
Incomplete expansion of the lung at birth or the collapse of the lung parenchyma at any
age • Bronchitis - Inflammation of the large airways
, • Pleurisy - Inflammatory process involving the visceral and parietal pleura, which
becomes edematous and fibrinous • Pleural effusion - Excessive nonpurulent fluid in the
pleural space • Empyema - Purulent exudative fluid collected in the pleural space
• Lung abscess - Well-defined, circumscribed mass defined by inflammation,
suppuration, and subsequent central necrosis • Pneumonia - Inflammatory response of
the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral)
• Influenza - Viral infection of the lung - Normally an upper respiratory infection, but due
to alterations in the epithelial barrier, the infected host is more susceptible to secondary
bacterial infections. • Tuberculosis - Chronic infectious disease that most often begins in
the lung but may then have widespread manifestations
• Pneumothorax - Presence of air or gas in the pleural cavity • Hemothorax - Presence
of blood in the pleural cavity • Lung cancer - Generally refers to bronchogenic
carcinoma, a malignant tumor that evolves from bronchial epithelial structures
• Cor pulmonale - Acute or chronic condition involving right-sided heart failure •
Pulmonary embolism - Embolic occlusion of pulmonary arteries - Relatively common
condition - Difficult to diagnose
• Older Adults • Chronic obstructive pulmonary disease - COPD is a nonspecific
designation that includes a group of respiratory problems in which cough, chronic and
often excessive sputum production, and dyspnea are prominent features. - Not limited
to older adults, smokers at greatest risk - Emp
✔✔The Cardiovascular System HPI - ✔✔• Chest pain - Onset and duration - Character
- Location - Severity - Associated symptoms - Treatment - Medications: prophylactic
penicillin
• Fatigue - Unusual or persistent - Inability to keep up with peers - Associated symptoms
- Medications: beta-blockers • Cough - Onset and duration - Character - Medications:
ACE inhibitors
• Difficulty breathing (dyspnea, orthopnea) - Aggravated by exertion - On level ground,
climbing stairs - Worsening or remaining stable - Lying down or eased by resting on
pillows • (How many? Or sleep in a recliner?) - Paroxysmal nocturnal dyspnea
• Syncope associated with: - Palpitation - Dysrhythmia - Unusual exertion - Sudden
turning of neck (carotid sinus effect) - Looking upward (vertebral artery occlusion) -
Change in posture
✔✔Past Medical History - ✔✔• Cardiac surgery and hospitalization • Rhythm disorder •
Acute rheumatic fever, unexplained fever, swollen joints, inflammatory rheumatism •
Chronic illness
✔✔Family History & Personal and Social History - ✔✔• Heart disease • Hypertension •
Dyslipidemia • Diabetes • Congenital heart defects • Long QT syndrome • Family
members with cardiac risk factors
• Employment - Physical demands - Environmental hazards • Tobacco use • Nutritional
status • Personality assessment • Relaxation activities • Use of alcohol and/or drugs
ANSWERS SET A+
✔✔Techniques of Examination - ✔✔• 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 survey (Inspection) of respiration and the thorax - Observe the rate, rhythm,
depth, and effort of breathing - Inspect for any signs of respiratory difficulty o Assess the
patient's color o Listen to the patient's breathing o Inspect the patient's neck - Observe
the shape of the chest
• Observe for peripheral clues may suggest pulmonary or cardiac difficulties: - Breath:
odor - Skin, nails, and lips: cyanosis or pallor - Fingers: clubbing - Lips: pursing -
Nostrils: flaring
• Examination of the posterior chest - Inspection o From a midline position behind the
patient, note the shape of the chest and the way in which it moves
• 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 - ✔✔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 Adventitious (added) sounds: 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
caused by the bronchospasm of asthma (reactive airway disease) or acute or chronic
bronchitis
• Examination of the posterior chest - Auscultation o Adventitious (added) sounds:
Friction Rub • Occurs outside the respiratory tree • Dry, crackly, grating, low-pitched
sound and is heard in both expiration and inspiration • Caused by inflamed, roughened
surfaces rubbing together
o Adventitious (added) sounds: Mediastinal Crunch (Hammam Sign)) • Dry, crackly,
grating, low-pitched sound and is heard in both expiration and inspiration • Caused by
inflamed, roug
✔✔Techniques of Examination: Vocal Resonance - ✔✔• Bronchophony - Greater clarity
and increased loudness of spoken sounds • Pectoriloquy - Extreme bronchophony
where even a whisper can be heard clearly through the stethoscope • Egophony -
Intensity of the spoken voice is increased and there is a nasal quality. - e's become
stuffy broad a's
✔✔Thorax and Lungs
Differential Diagnoses - ✔✔• Asthma (reactive airway disease) - Reversible small
airway obstruction due to inflammation and hyperreactive airways • Atelectasis -
Incomplete expansion of the lung at birth or the collapse of the lung parenchyma at any
age • Bronchitis - Inflammation of the large airways
, • Pleurisy - Inflammatory process involving the visceral and parietal pleura, which
becomes edematous and fibrinous • Pleural effusion - Excessive nonpurulent fluid in the
pleural space • Empyema - Purulent exudative fluid collected in the pleural space
• Lung abscess - Well-defined, circumscribed mass defined by inflammation,
suppuration, and subsequent central necrosis • Pneumonia - Inflammatory response of
the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral)
• Influenza - Viral infection of the lung - Normally an upper respiratory infection, but due
to alterations in the epithelial barrier, the infected host is more susceptible to secondary
bacterial infections. • Tuberculosis - Chronic infectious disease that most often begins in
the lung but may then have widespread manifestations
• Pneumothorax - Presence of air or gas in the pleural cavity • Hemothorax - Presence
of blood in the pleural cavity • Lung cancer - Generally refers to bronchogenic
carcinoma, a malignant tumor that evolves from bronchial epithelial structures
• Cor pulmonale - Acute or chronic condition involving right-sided heart failure •
Pulmonary embolism - Embolic occlusion of pulmonary arteries - Relatively common
condition - Difficult to diagnose
• Older Adults • Chronic obstructive pulmonary disease - COPD is a nonspecific
designation that includes a group of respiratory problems in which cough, chronic and
often excessive sputum production, and dyspnea are prominent features. - Not limited
to older adults, smokers at greatest risk - Emp
✔✔The Cardiovascular System HPI - ✔✔• Chest pain - Onset and duration - Character
- Location - Severity - Associated symptoms - Treatment - Medications: prophylactic
penicillin
• Fatigue - Unusual or persistent - Inability to keep up with peers - Associated symptoms
- Medications: beta-blockers • Cough - Onset and duration - Character - Medications:
ACE inhibitors
• Difficulty breathing (dyspnea, orthopnea) - Aggravated by exertion - On level ground,
climbing stairs - Worsening or remaining stable - Lying down or eased by resting on
pillows • (How many? Or sleep in a recliner?) - Paroxysmal nocturnal dyspnea
• Syncope associated with: - Palpitation - Dysrhythmia - Unusual exertion - Sudden
turning of neck (carotid sinus effect) - Looking upward (vertebral artery occlusion) -
Change in posture
✔✔Past Medical History - ✔✔• Cardiac surgery and hospitalization • Rhythm disorder •
Acute rheumatic fever, unexplained fever, swollen joints, inflammatory rheumatism •
Chronic illness
✔✔Family History & Personal and Social History - ✔✔• Heart disease • Hypertension •
Dyslipidemia • Diabetes • Congenital heart defects • Long QT syndrome • Family
members with cardiac risk factors
• Employment - Physical demands - Environmental hazards • Tobacco use • Nutritional
status • Personality assessment • Relaxation activities • Use of alcohol and/or drugs
