Chapter 12 Cough
A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the
ankles. Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for
hypertension. On physical examination, vital signs are 98 degrees, 18 resps/min, pulse 56, and BP 100/60.
Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with
shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These
signs and symptoms are characteristic of:
A. Chronic renal failure
B. Congestive heart failure
C. Metabolic syndrome
D. Liver failure
ANS: B
CHF, commonly occurring in the elderly or in patients with past myocardial infarctions or
cardiomyopathy, can often present with complaints of fatigue, decreased activity tolerance, and/or shortness
of breath. A patient with a history of hypertension and hyperlipidemia indicates cardiovascular disease that
predisposes to heart failure with age. The signs of heart failure include cough, shortness of breath with
exertion, S3 and S4 heart sounds, pulmonary crackles, ascites, hepatomegaly and ankle edema.
A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion, shortness
of breath, chronic cough, and wheezing. On physical examination, patient shows
barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields.
Heart has regular rate and rhythm of 80 beats/min. Abdomen is obese and non- tender. Extremities show no
significant findings. No neurological deficits. Arterial blood gases reveal acidosis. These signs and
symptoms are characteristic of:
A. Congestive heart failure
B. Chronic obstructive pulmonary disease
C. Asthma
D. Lung cancer
ANS: B
Chronic obstructive pulmonary disease, such as chronic asthma/bronchitis, bronchiolitis, and emphysema,
may be associated with fatigue, shortness of breath, cough, and wheezing. The patient in the above scenario
shows signs of chronic bronchitis and emphysema. Cough and cyanosis are caused by chronic bronchitis.
Barrel-shaped chest and acidosis are caused by emphysema.
, 3. A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated
with rust-colored sputum, low-grade afternoon fevers, and night sweats for the past 2 months. The nurses
preliminary analysis, based on this history, is that this patient may be suffering from:
A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the
ankles. Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for
hypertension. On physical examination, vital signs are 98 degrees, 18 resps/min, pulse 56, and BP 100/60.
Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with
shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These
signs and symptoms are characteristic of:
A. Chronic renal failure
B. Congestive heart failure
C. Metabolic syndrome
D. Liver failure
ANS: B
CHF, commonly occurring in the elderly or in patients with past myocardial infarctions or
cardiomyopathy, can often present with complaints of fatigue, decreased activity tolerance, and/or shortness
of breath. A patient with a history of hypertension and hyperlipidemia indicates cardiovascular disease that
predisposes to heart failure with age. The signs of heart failure include cough, shortness of breath with
exertion, S3 and S4 heart sounds, pulmonary crackles, ascites, hepatomegaly and ankle edema.
A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion, shortness
of breath, chronic cough, and wheezing. On physical examination, patient shows
barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields.
Heart has regular rate and rhythm of 80 beats/min. Abdomen is obese and non- tender. Extremities show no
significant findings. No neurological deficits. Arterial blood gases reveal acidosis. These signs and
symptoms are characteristic of:
A. Congestive heart failure
B. Chronic obstructive pulmonary disease
C. Asthma
D. Lung cancer
ANS: B
Chronic obstructive pulmonary disease, such as chronic asthma/bronchitis, bronchiolitis, and emphysema,
may be associated with fatigue, shortness of breath, cough, and wheezing. The patient in the above scenario
shows signs of chronic bronchitis and emphysema. Cough and cyanosis are caused by chronic bronchitis.
Barrel-shaped chest and acidosis are caused by emphysema.
, 3. A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated
with rust-colored sputum, low-grade afternoon fevers, and night sweats for the past 2 months. The nurses
preliminary analysis, based on this history, is that this patient may be suffering from:
