Exam 2 - MATC NRSAD 102 QUESTIONS WITH 100% VERIFIED CORRECT ANSWERS.

Order for assessment of lungs - correct answers Inspect Palpate Percuss Auscultate Inspection of the thorax (Observe for/Inspect) - correct answers -O: Normal chest movement with inspiration/expiration -O: Bulging of interspaces during expiration -O: Accessory muscle use -I: anterior, posterior and lateral thorax -I: spinal alignment and curvature Which lung has 3 lobes: - correct answers Right lung Types of chest deformities - correct answers Pigeon chest Funnel chest Barrel chest Pigeon chest - correct answers May be caused by rickets Narrow transverse diameter Increased anteroposterior diameter Protruding sternum Funnel chest - correct answers Congenital defect Abnormal pressure on the heart -- altered function Sternum is depressed Narrowing of the anteroposterior diameter Barrel chest - correct answers Ratio of AT:I is 1:1 Seen in clients with thoracic kyphosis & emphysema Thoracic kyphosis - correct answers excessive convex curvature of the thorax spine (hunch back) Lordosis - correct answers excessive curving inward of the lower back Emphysema - correct answers chronic pulmonary condition in which the alveoli are dilated and distended Palpation of the thorax - correct answers For warmth, tenderness, masses Respiratory excursion for symmetry For vocal fremitus Fremitus - correct answers The faintly perceptible vibration felt through the best wall when the client speaks WHERE do you hear vesicular breath sounds? - correct answers Heard over most of lung but best heard at bases HOW does normal vesicular breathing sound? - correct answers soft, low pitched sounds as air moves through bronchioles and alveoli WHERE do you hear bronchovesicular breath sounds? - correct answers Heard between the scapula and the sternum at 1st and 2nd ICS HOW does normal bronchovesicular breathing sound? - correct answers moderate blowing sounds as air moves through bronchi WHERE do you hear bronchial (tubular) breath sounds? - correct answers heard over trachea (not over lung tissue) as air moves through trachea HOW does normal bronchial (tubular) breathing sound? - correct answers Loud, high pitched tubular sounds WHEN do you typically hear vesicular breath sounds? - correct answers best heard on inspiration, which is about 2.5x longer than the expiratory phase (2.5:1 ratio) WHEN do you typically hear bronchovesciular breath sounds? - correct answers Equal inspiratory and expiratory phases (1:1 ratio) WHEN do you typically hear bronchial (tubular) breath sounds? - correct answers Louder than vesicular sounds, short inspiratory phase and long expiratory phase (1:2 ratio) Adventitious lung sounds - correct answers Crackles (rales) Gurgles (rhonchi) Friction rub Wheeze Crackles (rales) - correct answers -high pitched -best heard on inspiration -may not be cleared by coughing -caused by air passing through fluid/mucus in any air passage -heard in the bases of the lower lung lobes Gurgles (rhonchi) - correct answers -low pitched gurgling, harsh, louder sounds with a moaning or SNORING quality -best heard on expiration -may be altered by coughing -caused by air passing through narrowed air passages as a result of secretions, swelling, tumors -heard over most lung areas but mostly over the trachea and bronchi Friction rub - correct answers -superficial grating or creaking sounds -heard on inspiration and expiration -not relieved by coughing -caused by rubbing together of inflamed pleural surfaces -heard most often in areas of greatest thoracic expansion Wheeze - correct answers -continuous high pitched, squeaky musical sounds -heard on expiration -not usually altered by coughing -caused by air passing through a constricted bronchus as a result of secretions, swelling, tumors -heard over all lung fields Lifespan Considerations: Assessing Thorax/Lungs in Infants - correct answers -Thorax is rounded (AP:T diameter is 1:1 and top to base is also 1:1) -To assess remits, place hand over crying infants thorax -Infants tend to breathe using diaphragm so watch abdomen for rise and fall -Sudden onset of cough or respiratory distress could indicate infant has inhaled a foreign object Lifespan Considerations: Assessing Thorax/Lungs in Children - correct answers -by about 6 yo, the AP:T diameter has grown to 1:2 -children begin to breathe thoracically after age 6 -during rapid growth spurts of adolescence, spinal curvature or rotation (scoliosis) may appear so children should be assessed by age 12 -curvature greater than 10% should be referred Lifespan Considerations: Assessing Thorax/Lungs in Older Adults - correct answers -Kyphosis may be accentuated due to osteoporosis and changes in cartilage -kyphosis and osteoporosis after size of thorax cavity as ribs move down and forward -AP diameter widens, giving person a more barrel chested appearance due to loss of skeletal muscle strength -breathing rate normally increases with exercise but may take longer to return to resting state -inspiratory muscles become less powerful and inspiration reserve volume decreases -expiration may require use of accessory muscles -deflation of lung is incomplete -smell airways lose cartilaginous support and elastic recoil -elastic tissue of alveoli loses its stretchability and changes to fibrous tissue -cilia in airway decreases leaving elderly more susceptible to pulmonary infections Order for assessment of heart - correct answers Inspect Palpate Auscultate Ape to Man - correct answers Aortic Pulmonic Tricuspid Mitral Normal heart sounds - correct answers S-1 Systole S-2 Diastole Systole - correct answers The period in which the ventricles contract Diastole - correct answers The prior is which the ventricles relax Where is S-1 (lub) BEST heard? - correct answers Mitral Where is S-2 (dub) BEST heard? - correct answers Pulmonic S-1 area - correct answers Mitral and Tricuspid S-2 area - correct answers Pulmonic and Aortic Inspection of PRECORDIUM - correct answers -APTM for visible pulsations, lifts or heaves -Observe for jugular vein distension Palpation of PRECORDIUM - correct answers -APTM areas for pulsations, lifts or heaves -Carotid arteries for fullness/symmetry/thrills Auscultation of PRECORDIUM - correct answers -APETM using diaphragm and bell of stethoscope, listen to S-1 and S-2 -Auscultate carotids and listen for bruits Which part of the stethoscope to use where - correct answers -Use bell for: S-1 and Carotid -Use diaphragm for: S-2 Inspection of PERIPHERAL VASCULAR - correct answers -Varicosities -Signs of thrombophlebitis -Signs of decreased circulation -Signs of inflammation Palpate of PERIPHERAL VASCULAR - correct answers -Pulse volume and symmetry -Tenderness, warmth, edema -Homan's sign Areas of peripheral vascularity - correct answers Temporal Carotid Apical Brachial Radial Femoral Popliteal Posterior tibial Dorsalis pedis What is a bruit? - correct answers A blowing or a swishing sound What is a thrill? - correct answers A vibrating sensation like the purring of a cat or water running through a hose What is a lift or heave? - correct answers Refers to the rising along the sternal border with each heartbeat Where is the precordium? - correct answers The area of the best overlying the heart Where is the base of the heart? - correct answers Superior portion of heart Where is the apex of the heart? - correct answers Inferior portion of heart Can you hear systole or diastole? - correct answers No, they are usually between S-1 & S-2 or S-2 and next S-1 respectively What might bilateral jugular venous distention (JVD) indicate? - correct answers right-sided heart failure Where is the aortic area located? - correct answers right second ICS Where is the pulmonic area located? - correct answers left second ICS Where is the tricuspid area located? - correct answers left fifth ICS Where is the mitral (apical) area located? - correct answers midclavicular and left intercostal space Where is the point of maximal impulse (PMI) located? - correct answers mitral area Lifespan Considerations: Assessing Heart & CV in Infants - correct answers -If splitting of S-2 is heard during normal respirations, it is abnormal and may indicate an atrial-septal defect, pulmonary stenosis or other heart problems -Could normally have sinus arrhythmia (heart rate slows during expiration and increases during inspiration) -Murmurs may be heard in newborns as structures of fetal circulation (esp ductus arteriosus) close Lifespan Considerations: Assessing Heart & CV in Children - correct answers -heart sounds may be louder because of the thinner chest wall -a 3rd hear sounds (S-3) is best heard at the apex and is present in about 1/3 of all children -PMI is higher an more medial in children 8 years of age Lifespan Considerations: Assessing Heart & CV in Older Adults - correct answers -CO and strength of contraction decrease and therefore lessens persons tolerance for increased activity -HR returns more slowly to resting rate then when younger -S-4 heart sounds are considered normal -extra systoles commonly occur (10+ per minute are considered ABNORMAL) -sudden emotional and physical stresses may result in cardiac arrhythmias and HF What is perfusion? - correct answers Blood supply to an area Capillary Refill Test (CRT) involves what? - correct answers -Press at least one nail on each hand and foot between thumb and index finger long enough to cause blanching -Release the pressure and observe how long normal color takes to return What is considered a normal CRT time? - correct answers 2 seconds What does a delayed return of color for CRT indicate? - correct answers Arterial insufficiency Lifespan Considerations: Assessing Peripheral Vascular System in Infants - correct answers -Screen for coarctation of aorta by palpating peripheral pulses and comparing strength of femoral pulses with radial and apical pulses. If femoral pulse is diminished and radial is stronger, coarctation is present What is coarctation? - correct answers Narrowing of the aorta Lifespan Considerations: Assessing Peripheral Vascular System in Children - correct answers -Changes can indicate serious systemic diseases (bruising, petechiae, purpura Lifespan Considerations: Assessing Peripheral Vascular System in Older Adults - correct answers -overall efficiency decreases as smooth muscle cells are replaced by connective tissue -lower extremities more likely to show signs of arterial and venous impairment because of the more distal and dependent position -assessment should always include upper and lower extremities' temp, color, pulses, edema, skin integrity and sensation. Note any differences in symmetry with these PREPARING for assessment of abdomen - correct answers -Make sure bladder is empty -Position pt in supine position -Have knees slightly bent What is located in the Right-Upper Quadrant? - correct answers Liver Galbladder Duodenum Head of pancreas R adrenal gland Upper lobe of R kidney Hepatic flexure of colon Part of ascending and transverse colons What is located in the Left-Upper Quadrant? - correct answers L lobe of the liver Stomach Spleen Upper lobe of L kidney Pancreas L adrenal gland Splenic flexure of colon Part of transverse and descending colons What is located in the Left-Lower Quadrant? - correct answers Lower lobe of L kidney Sigmoid colon Part of descending colon L ovary L fallopian tube L ureter L spermatic cord Part of uterus What is located in the Right-Lower Quadrant? - correct answers Lower lobe of R kidney Cecum Appendix Part of ascending colon R ovary R fallopian tube R ureter R spermatic cord Part of uterus What is another name for the belly button? - correct answers Umbilicus Where is the xiphoid process? - correct answers Base of the sternum Order for assessment of abdomen - correct answers Inspection Auscultation Percussion Palpation Inspection of abdomen - correct answers -Color/scars/striae/veins -Contour/distention -Position of umbilicus -Visible peristalsis Auscultation of abdomen - correct answers Use diaphragm of stethoscope Normal bowl sounds: gurgling every 20 seconds How many areas per quadrant should you listen to? - correct answers 3 areas How long must bowel sounds be absent to indicate an actual absence of BS? - correct answers 5 minutes Tympany indicates what? - correct answers Gas in stomach and intestines Dullness indicates what? - correct answers Non-hollow organ or a full bladder Large dull areas indicate what? - correct answers Possible presence of fluid or a tumor Palpation of the abdomen - correct answers Warm hands Circular motion Light = 1cm with one hand Deep = 4-5cm with two hands Note masses or tenderness Bladder should not be palpable above public symphysis Lifespan Considerations: Assessing Abdomen in Infants - correct answers -Internal organs are large and so abdomens are rounded and tend to protrude -Umbilical hernias may be present at birth -Liver may be palpable 1-2 cm below R costal margin Lifespan Considerations: Assessing Abdomen in Children - correct answers -Potbelly appearance which can persist until age 3 or 4 -Peristaltic waves may be more visible than in adults -Liver can be palpated 1-2 cm blow R costal margin -Use a task that requires concentration if child is ticklish or fearful -Observe facial expressions when determining areas of tenderness Lifespan Considerations: Assessing Abdomen in Adults - correct answers -Rounded abdomens are due to an increase in adipose tissue and decrease in muscle tone -Abdominal wall is thinner and slacker, making palpation easier and more accurate -Muscle wasting and loss of fibroconnective tissue occur -Pain threshold is high in adults and issues can go undetected -GI pain needs to be differentiated from cardiac pain -Stool passes through GI at slower rate -Fecal incontinence can occur with adults who are confused or have a neurologic impairment -Symptoms of colon cancer include: change in bowel function, rectal bleeding, weight loss -Decreased absorption of oral meds occurs -Impaired metabolism of some drugs may occur with aging Assessment of Musculoskeletal System - correct answers Inspection Palpation Inspection of MS System - correct answers Muscle size/symmetry Presence of contracture Tremors/Spasms Joint swelling/deformities Limitations in ROM Palpation of MS System - correct answers Muscle tone/atony Muscle strength bilaterally Joint tenderness Joint crepitation Smoothness of motion What is a tremor? - correct answers an involuntary trembling of a limb or body part involving small bundles or large groups of muscle fibers What is an intention tremor? - correct answers involuntary trembling when a person attempts a voluntary movement What is a resting tremor? - correct answers involuntary trembling when a person is relaxed and dimities with activity What is a fasciculation? - correct answers an abnormal contraction of a bundle of muscle fibers that appears as a twitch What is crepitation? - correct answers A crackling, grating sound Grading muscle strength - correct answers 0: 0% - complete paralysis 1: 10% of normal strength; no movement; contraction of muscle is palpable or visible 2: 25% of normal strength; full muscle movement against gravity, with support 3: 50% of normal strength; normal movement against gravity 4: 75% of normal strength; normal full movement against gravity and against minimal resistance 5: 100% of normal strength; normal full movement against gravity and against full resistance What does atrophy mean? - correct answers A decrease in size What does hypertrophy mean? - correct answers An increase in size Lifespan Considerations: Assessing MS System in Infants - correct answers -palpate clavicles of newborns. A mass and crepitus may indicate a fx experienced during vaginal delivery -should be able to bear weight on legs if normal muscle strength is present -check for dev dysplasia of the hip by examining for asymmetric gluteal folds, abduction of legs or apparent shortening of the femur -should be able to site without support by 8 months, crawl by 7-1