seidel's study guide (13)

As the chest of a new- born is examined, bowel sounds are auscultated in the chest. Which of the fol- lowing best describes the significance of this find- ing? a. A normal finding in new- borns b. An abnormal but benign finding in children until 2 years of age c. Abnormal and possibly indicating an enlarged liv- er d. Abnormal and possibly indicating a diaphragmatic hernia Which of the following pa- tients demonstrates the highest risk factor for res- piratory disability? a. A patient with a history of hypertension b. A child who has had a d. Abnormal and possibly indicating a diaphragmatic hernia rationale: diaphragmatic hernia = abnormal open- ing in the diaphragm, mus- cle between the chest and abdomen a patient with paraplegia rationale: paraplegia = Paralysis that affects all or previous respiratory infec- tion c. A patient with paraple- gia d. An extremely thin fe- male patient An adult male patient com- plains of a "persistent cold that will not go away." He is a nonsmoker, and his skin color is normal. Which of the following is most im portant to this patient's his- tory? a. Allergy tests and treat- ment plans b. Expectations for treat- ment and care c. Experiences with diffi- cult breathing d. Previous sports injuries and rehabilitation A health care professional is examining the chest of a 22-year-old woman who part of the trunk, legs, and pelvic organs. b. expectations for treat- ment and care is 8 months pregnant. The patient has a wide thoracic cage. Which of the follow- ing best explains this find- ing? a. She may have lung dis- ease, such as emphyse- ma. b. She may be hypoxic and may require oxygen sup- plementation. c. She may be pregnant with twins, causing ab- dominal contents to be forced up and out. d. This is considered a nor- mal finding with advanced pregnancy. In which of the following conditions should the ex- aminer expect the costal angle to be greater than 90 degrees? a. Chronic obstructive pul- monary disease d. This is considered a nor- mal finding with advanced pregnancy. rationale: thoracic cage widens throughout preg- nancy a. Chronic obstructive pul- monary disease Which of the following find- ings indicates respirato- ry distress in a infant or young child? a. Respiratory rate of 30 breaths/min b. Irregular respiratory pat- tern c. Observation of sternal and supraclavicular retrac- tions with breathing d. Auscultation of bronchovesicular sounds throughout the lung field The examiner notes a di- aphragmatic excursion of 4 cm on the right side and 8 cm on the left side. What do these findings mean? a. The patient may have pleural effusion. c. Observation of sternal and supraclavicular retrac- tions with breathing b. The patient may have a pneumothorax. c. Asym- metric findings are com- mon in well-conditioned adults. d. This is a normal finding because the right lung is larger than the left lung. 8. During percussion, the patient holds his or her arms in front in order to a. expose maximum lung area. b. make the ribs protrude. c. prevent attacks of coughing. d. reduce discomfort. Which of the following ex- amination techniques is not typically done when examining the chest and lungs of a newborn? a. General survey b. Inspection a. The patient may have pleural effusion. a. expose maximum lung area. c. Percussion The patient tells the exam- iner, "I have been cough- ing up a lot of yellowish green phlegm." The exam- iner should suspect a. viral infection. b. tuberculosis. c. pulmonary edema. d. bacterial pneumonia. To best visualize subtle re- tractions on a patient, the examiner should a. place the patient in a supine position. b. stand directly behind the patient. c. ensure that the light source angles toward the patient. d. position the patient di- rectly under a bright exam- ination light. d. bacterial pneumonia. c. ensure that the light source angles toward the patient. 12. Which of the following findings may indicate an intrathoracic infection? a. Malodorous breath b. Protrusion of the clavi- cle c. Clubbing of the nail beds d. Kussmaul respirations 13. Which finding is con- sidered unusual for a new- born? a. Sneezing b. Coughing c. Prominence of the xiphoid process d. Nose breathing In an older adult, which finding can occur in the absence of disease as a result of age-related changes of the chest or lungs? a. Hyperresonance b. Productive cough a. Malodorous breath b. Coughing rationale a. Hyperresonance rationale: thin chest wall A newborn infant has a small chest-to-head size ratio. This finding is usual- ly associated with a. maternal diabetes. b. cocaine use during pregnancy. c. intrauterine growth re- tardation. d. a normal variation of chest-to-head ratio. Hamman sign can best be heard when the patient is a. in a supine position. b. lying on the left side. c. sitting completely up- right. d. positioned with the head elevated 30 degrees. In addition to severe res- piratory distress, which of the following findings may c. intrauterine growth re- tardation. b. lying on the left side. be indicative of a pneu- mothorax with mediastinal shift? a. Hemoptysis b. Pleural friction fremitus c. Vesicular lung sounds over the peripheral lung field d. Tracheal deviation away from midline position A mother tells the examin- er that her 2-year-old child has a cough that "sounds just like a bark." Given this history, what other find- ings should the examiner an- ticipate during respira- tory examination? a. Wheezing and coarse crackles bilaterally b. Labored breathing and inspiratory stridor c. Hyperresonance with percussion d. Productive, d. Tracheal deviation away from midline position Labored breathing and in- spiratory stridor A 4-year-old boy is brought to the emergency department. The examin- er notes Kussmaul respi- rations of 50 per minute. The child has no fever and no cough; good air movement is noted in the lungs with no abnormal breath sounds auscultat- ed. Which of the following questions would be most helpful for the examiner to ask the parents? a. "What is his normal res- piratory rate?" b. "What would you like for me to do for him?" c. "Do you think he may have swallowed a toy?" d. "Where do you keep your medications at home?" d. "Where do you keep your medications at home?" The examiner should ex- pect the ratio of respirato- ry rate to heart rate to be approximately: a. 1 to 2. b. 1 to 4. c. 1 to 6. d. 1 to 8. A patient with long-stand- ing chronic obstructive pulmonary disease has come to the clinic com- plaining that his breathing has been getting more dif- ficult over the past cou- ple of weeks. Which of the following questions would best help the examiner un- derstand the hypoxia this patient is experiencing? a. "Do you think oxygen will help you?" b. "In what way has your activity level been affect- ed?" c. "Do you have a new or b. 1 to 4. b. "In what way has your activity level been affect- ed?" A patient has atelectasis. What finding would lead the examiner to suspect that an undiagnosed tu- mor in the middle lobe of the right lung has caused this problem? a. Low-pitched grating sound heard during inspi- ra- tion and expiration b. Hyperresonance in the right middle lobe c. Diminished or absent breath sounds in the right middle lobe d. Coarse crackles auscul- tated throughout the lung field Which examination finding is consistent with emphy- sema? a. Decreased tactile fremi- c. Diminished or absent breath sounds in the right middle lobe tus b. Dullness with chest per- cussion c. Trachea in midline posi- tion d. An ammonia-like odor to the patient's breath The most important clini- cal signs for pleural effu- sion include which of the following? a. Bronchophony—yellow, frothy sputum b. Paroxysmal dyspnea, decreased breath sounds c. Shallow, rapid respira- tions d. Dullness to percussion, tactile fremitus Which of the following is a normal finding in the assessment of an older adult? a. Loss of elastic recoil b. Decreased chest expan- a. Decreased tactile fremi- tus d. Dullness to percussion, tactile fremitus b. Decreased chest expan- sion