CMN 568 Exam 2- Physical Exam #1
Questions With Complete Solutions
Physical examination CORRECT ANSWERS - Inspection
- Palpation
- Percussion
- Auscultation
Observe pattern of breathing CORRECT ANSWERS - RR (12-14rr/min)
- Rhythm (regular with a sigh every 90 breaths or so)
- Depth of breathing / tidal volume (5ml/kg)
- Relative time spent inspiration and expiration (ratio 2:3)
Inspect for extrapulmonary signs of pulmonary disease CORRECT ANSWERS Use
what you find to perform more detailed exam
Palpate CORRECT ANSWERS - Trachea at suprasternal notch
- Posterior chest wall (gauge fremitus / transmission through lungs of vibrations of
spoken words)
- Anterior chest wall (assess cardiac impulse)
Percussion CORRECT ANSWERS Identifies dull areas or hyperresonant areas
Auscultation CORRECT ANSWERS Lung sounds
Pulmonary Function Tests CORRECT ANSWERS Measures airflow rates, lung
volumes, ability of lung to transfer gas across alveoli-capillary membrane
What would indicate to FNP that patient needs PFT? CORRECT ANSWERS - Assess
type/extent of lung dysfunction
- Dx of causes of dyspnea and cough
- Detect early evidence of lung dysfunction
- Follow-up response to therapy
- Pre- op assessment
- Disability eval
Patient presents with acute asthma exacerbation with mild resp. distress. You want to
perform a PFT to see how well gas exchange is occurring. Is this correct management
for the patient? CORRECT ANSWERS - No
- PFTs are contraindicated in acute severe asthma, resp. distress, angina aggravated
by testing, pneumothorax, ongoing hemoptysis, active TB
, How do you measure your patients PFTs to establish if they are normal or not?
CORRECT ANSWERS - They are measured against predicted values derived from
large studies of healthy subject
- Vary with age, gender, height, weight, ethnicity
Tachypnea CORRECT ANSWERS Increased resp rate and decreased TV
Irregular rhythm CORRECT ANSWERS - Rapid, shallow breathing
- Restrictive lung disease (precursor to resp failure)
Kussmaul resp CORRECT ANSWERS - Rapid large volume breathing leads to intense
stimulation of resp center
- R/T metabolic acidosis
Cheyne-Stokes resp CORRECT ANSWERS - Rhythmic
- Waxing/waning of rate and TV
- Regular periods of apnea
- Seen in end-stage LV failure, neurologic dx, sleeping at high altitude
Extrapulmonary signs of intrinsic pulmonary disease CORRECT ANSWERS - Digital
clubbing
- Cyanosis
- Increased CVP
- BLE edema
Digital clubbing CORRECT ANSWERS - Lung abscess
- Empyema
- Bronchiectasis
- CF
- Idiopathic pulmonary fibrosis
- AV malformations
- Late presentation of concomitant lung cx
Cyanosis CORRECT ANSWERS - Blue or bluish-gray discoloration of skin & mm due to
amounts of unsaturated HgB
in capillary blood
Anemia CORRECT ANSWERS May prevent cyanosis from appearing
Polycythemia CORRECT ANSWERS Cyanosis in mild hypoxemia
Cyanosis not reliable indicator of hypoxemia CORRECT ANSWERS Get arterial PO2 or
HgB saturation measured
Increased CVP CORRECT ANSWERS - Indirectly measures pulmonary HTN (major
complication of chronic lung dx)
Questions With Complete Solutions
Physical examination CORRECT ANSWERS - Inspection
- Palpation
- Percussion
- Auscultation
Observe pattern of breathing CORRECT ANSWERS - RR (12-14rr/min)
- Rhythm (regular with a sigh every 90 breaths or so)
- Depth of breathing / tidal volume (5ml/kg)
- Relative time spent inspiration and expiration (ratio 2:3)
Inspect for extrapulmonary signs of pulmonary disease CORRECT ANSWERS Use
what you find to perform more detailed exam
Palpate CORRECT ANSWERS - Trachea at suprasternal notch
- Posterior chest wall (gauge fremitus / transmission through lungs of vibrations of
spoken words)
- Anterior chest wall (assess cardiac impulse)
Percussion CORRECT ANSWERS Identifies dull areas or hyperresonant areas
Auscultation CORRECT ANSWERS Lung sounds
Pulmonary Function Tests CORRECT ANSWERS Measures airflow rates, lung
volumes, ability of lung to transfer gas across alveoli-capillary membrane
What would indicate to FNP that patient needs PFT? CORRECT ANSWERS - Assess
type/extent of lung dysfunction
- Dx of causes of dyspnea and cough
- Detect early evidence of lung dysfunction
- Follow-up response to therapy
- Pre- op assessment
- Disability eval
Patient presents with acute asthma exacerbation with mild resp. distress. You want to
perform a PFT to see how well gas exchange is occurring. Is this correct management
for the patient? CORRECT ANSWERS - No
- PFTs are contraindicated in acute severe asthma, resp. distress, angina aggravated
by testing, pneumothorax, ongoing hemoptysis, active TB
, How do you measure your patients PFTs to establish if they are normal or not?
CORRECT ANSWERS - They are measured against predicted values derived from
large studies of healthy subject
- Vary with age, gender, height, weight, ethnicity
Tachypnea CORRECT ANSWERS Increased resp rate and decreased TV
Irregular rhythm CORRECT ANSWERS - Rapid, shallow breathing
- Restrictive lung disease (precursor to resp failure)
Kussmaul resp CORRECT ANSWERS - Rapid large volume breathing leads to intense
stimulation of resp center
- R/T metabolic acidosis
Cheyne-Stokes resp CORRECT ANSWERS - Rhythmic
- Waxing/waning of rate and TV
- Regular periods of apnea
- Seen in end-stage LV failure, neurologic dx, sleeping at high altitude
Extrapulmonary signs of intrinsic pulmonary disease CORRECT ANSWERS - Digital
clubbing
- Cyanosis
- Increased CVP
- BLE edema
Digital clubbing CORRECT ANSWERS - Lung abscess
- Empyema
- Bronchiectasis
- CF
- Idiopathic pulmonary fibrosis
- AV malformations
- Late presentation of concomitant lung cx
Cyanosis CORRECT ANSWERS - Blue or bluish-gray discoloration of skin & mm due to
amounts of unsaturated HgB
in capillary blood
Anemia CORRECT ANSWERS May prevent cyanosis from appearing
Polycythemia CORRECT ANSWERS Cyanosis in mild hypoxemia
Cyanosis not reliable indicator of hypoxemia CORRECT ANSWERS Get arterial PO2 or
HgB saturation measured
Increased CVP CORRECT ANSWERS - Indirectly measures pulmonary HTN (major
complication of chronic lung dx)
