APSE EXAM STUDY GUIDE
Has all necessary equipment and appropriate lighting
Uses aseptic Technique and universal precautions
Introduces Self
General Survey
• Apparent state of health
• Level of consciousness
• Signs of distress (pallor, diaphoresis)
• Dress, grooming and personal hygiene
• Ask at this time about Height, Weight, and vital signs. - Answers-Introduces Self
General Survey
• Apparent state of health
• Level of consciousness
• Signs of distress (pallor, diaphoresis)
• Dress, grooming and personal hygiene
• Ask at this time about Height, Weight, and vital signs.
Thorax and Lungs Examination
Inspect anterior and posterior chest
• Shape and configuration
• Symmetry
• A/P ratio
• Quality of respirations
• Tactile fremitus (Place ulnar surface (pinky) against chest, 8 locations to assess on
posterior back. Have patient say "99") - Answers-❀ Trachea midline
(Palpate in the sternal notch to check the position of the trachea. It should be in the
midline)
❀ No cyanosis
(Check the patient's color for circumoral and nailbed cyanosis, a bluish color arising
from deoxygenation. Lips and fingernails are normally pink)
❀ Anterior and posterior chest expansion: chest expands symmetrically with inhalation,
no local lag
❀ Tactile Fremitus: no increased or decreased fremitus in noted
Anterior chest expansion - Answers-
Posterior chest expansion - Answers-
Tactile Fremitus - Answers-
Percuss
, • General anterior and posterior percussion for areas of
consolidation/dullness/hyperresonance - Answers-Percussion: Lungs are resonant
throughout
Precussion - Answers-
Auscultate (at all auscultation points)
• Anterior
• Posterior
Perform Consolidation Techniques (should perform at least 1 of the following)
• Egophony
• Bronchophony
• Whispered Petroliquy - Answers-❀ Auscultation: vesicular sounds are heard
throughout the lungs both anteriorly and posteriorly
❀ Egophony: over the area of consolidation, the spoken "e" will sound like an "a"
❀ Bronchophony: over the area of a consolidation, spoken words increase with clarity (
have the patients say 99)
❀ Whispered Petroliquy: over the area of consolidation whispered words will increase in
clarity ( have the patient whisper 1,2,3)
Observe the rate, rhythm, depth, and effort of breathing...and listen for any audible
sounds of breathing that may indicate respiratory distress.
Now listen and count the number of breaths per minute.
Inspect the patient's neck for retraction of the accessory muscles, namely the
supraclavicular,
sternocleidomastoid, or scalene muscles, suggesting respiratory difficulty. Normally, this
is not present. - Answers-With the patient's health history in mind, and after good hand
hygiene, you are ready for the physical
examination.
- Begin your examination of the chest with a brief survey of the patient's thorax and
respiration
❀ Note the shape of the chest and how it moves.
❀ Symmetry: chest rises symmetrically with no use of accessory muscle, bulging or
retraction of intercostal spaces , no bony deformities.
AP/lateral diameter ratio is 2:1, no barrel chest or enlargements noted
❀ Quality of respirations: respiration is 18, regular and non-labored, Inspiratory to
Expiratory ration is 2:1
Palpate
• Entire chest
• Anterior and posterior chest expansion (To test chest expansion, place your thumbs
close to the patient's spine at the level of the 10th ribs and
spread your fingers lightly across the lateral thorax.
Ask the patient to inhale and exhale deeply and fully while you watch the divergence of
your thumbs
Has all necessary equipment and appropriate lighting
Uses aseptic Technique and universal precautions
Introduces Self
General Survey
• Apparent state of health
• Level of consciousness
• Signs of distress (pallor, diaphoresis)
• Dress, grooming and personal hygiene
• Ask at this time about Height, Weight, and vital signs. - Answers-Introduces Self
General Survey
• Apparent state of health
• Level of consciousness
• Signs of distress (pallor, diaphoresis)
• Dress, grooming and personal hygiene
• Ask at this time about Height, Weight, and vital signs.
Thorax and Lungs Examination
Inspect anterior and posterior chest
• Shape and configuration
• Symmetry
• A/P ratio
• Quality of respirations
• Tactile fremitus (Place ulnar surface (pinky) against chest, 8 locations to assess on
posterior back. Have patient say "99") - Answers-❀ Trachea midline
(Palpate in the sternal notch to check the position of the trachea. It should be in the
midline)
❀ No cyanosis
(Check the patient's color for circumoral and nailbed cyanosis, a bluish color arising
from deoxygenation. Lips and fingernails are normally pink)
❀ Anterior and posterior chest expansion: chest expands symmetrically with inhalation,
no local lag
❀ Tactile Fremitus: no increased or decreased fremitus in noted
Anterior chest expansion - Answers-
Posterior chest expansion - Answers-
Tactile Fremitus - Answers-
Percuss
, • General anterior and posterior percussion for areas of
consolidation/dullness/hyperresonance - Answers-Percussion: Lungs are resonant
throughout
Precussion - Answers-
Auscultate (at all auscultation points)
• Anterior
• Posterior
Perform Consolidation Techniques (should perform at least 1 of the following)
• Egophony
• Bronchophony
• Whispered Petroliquy - Answers-❀ Auscultation: vesicular sounds are heard
throughout the lungs both anteriorly and posteriorly
❀ Egophony: over the area of consolidation, the spoken "e" will sound like an "a"
❀ Bronchophony: over the area of a consolidation, spoken words increase with clarity (
have the patients say 99)
❀ Whispered Petroliquy: over the area of consolidation whispered words will increase in
clarity ( have the patient whisper 1,2,3)
Observe the rate, rhythm, depth, and effort of breathing...and listen for any audible
sounds of breathing that may indicate respiratory distress.
Now listen and count the number of breaths per minute.
Inspect the patient's neck for retraction of the accessory muscles, namely the
supraclavicular,
sternocleidomastoid, or scalene muscles, suggesting respiratory difficulty. Normally, this
is not present. - Answers-With the patient's health history in mind, and after good hand
hygiene, you are ready for the physical
examination.
- Begin your examination of the chest with a brief survey of the patient's thorax and
respiration
❀ Note the shape of the chest and how it moves.
❀ Symmetry: chest rises symmetrically with no use of accessory muscle, bulging or
retraction of intercostal spaces , no bony deformities.
AP/lateral diameter ratio is 2:1, no barrel chest or enlargements noted
❀ Quality of respirations: respiration is 18, regular and non-labored, Inspiratory to
Expiratory ration is 2:1
Palpate
• Entire chest
• Anterior and posterior chest expansion (To test chest expansion, place your thumbs
close to the patient's spine at the level of the 10th ribs and
spread your fingers lightly across the lateral thorax.
Ask the patient to inhale and exhale deeply and fully while you watch the divergence of
your thumbs
