NURS 550 Midterm Exam Review
with Exam Questions and Correct
Solutions Updated 2025/2026||100%
Guaranteed Pass A+
GRADED<<BRAND NEW VERSION>>
Techniques of Examination - Legs - ANSWER ✓ Compare one foot and leg with
the other • Check for pitting edema • Severity of edema graded on four-point scale
(slight to very marked)
• If edema is present, look for causes - Recent deep venous thrombosis - Chronic
venous insufficiency - Lymphedema • Note color of skin - Local area of redness -
Brownish areas near ankles - Ulcers and where - Thickness of skin (Venous ulcers
are wet in appearance, Arterial ulcers are dry)
• Femoral pulse - Press deeply below inguinal ligament, midway between anterior
superior iliac spine and symphysis pubis
• Popliteal pulse - Flex knee some, leg relaxed - Place fingertips of both hands to
meet midline behind knee and press deeply into popliteal fossa
• Dorsalis pedis pulse - Feel dorsum of foot, lateral to extensor tendon of great toe
• Posterior tibial pulse - Curve fingers behind and slightly below medial malleolus
of ankle
Objective Data—The Physical Exam - ANSWER ✓ Additional techniques - Color
changes - Doppler ultrasonic stethoscope - Ankle-brachial index (ABI)
Capillary refill
Notes: Assessment for Peripheral Arterial Disease - ANSWER ✓ Four P's of
occlusion -Pain -Pallor -Pulselessness -Poikilthermia (cold)
Differential Diagnoses - ANSWER ✓ Peripheral arterial disease - Stenosis of the
blood supply to the extremities by atherosclerotic plaques
• Raynaud phenomenon - Exaggerated spasm of the digital arterioles (occasionally
in the nose and ears) usually in response to cold exposure
• Arterial embolic disease - Atrial fibrillation can lead to clot formation within the
atrium, which may be dispersed throughout the arterial system.
, *Venous thrombosis - Sudden or gradual with varying severity of symptoms - Can
be the result of trauma or prolonged immobilization
• Venous ulcers - Results from chronic venous insufficiency in which lack of
venous flow leads to lower extremity venous hypertension
Thorax and Lungs HPI - ANSWER ✓ • Chest pain
- Initial questions should be as broad as possible, such as, "Do you have any
discomfort or unpleasant feelings in your chest?"
- Ask the patient to point to the location of the pain
- Use OLDCART • Onset and duration • Associated symptoms • Efforts to treat •
Other medications • Recreational drugs (e.g., cocaine)
Chest pain - Aside from lung conditions, chest pain may arise from cardiac,
vascular, gastrointestinal, musculoskeletal, or skin pathology; it is also commonly
associated with anxiety
- Lung tissue itself has no pain fibers; pain in lung conditions usually arises from
inflammation of the adjacent parietal pleura
- Other surrounding structures may also irritate the parietal pleura, causing pain
• Shortness of breath (Dyspnea)
- Non-painful but uncomfortable awareness of breathing that is inappropriate to the
level of exertion
- Begin assessment with a broad question, such as, "Have you had any difficulty
breathing?"
- Determine the severity of dyspnea based on the patient's daily activities
• Shortness of breath (Dyspnea) - Onset - Pattern - Position most comfortable,
number of pillows used - Related to extent of exercise, certain activities, time of
day, eating - Harder to inhale or exhale - Severity - Associated symptoms - Efforts
to treat
• Wheezing
- Wheezes are musical respiratory sounds that may be audible to the patient and to
others
- Airway obstruction form secretions, inflammation or foreign body
• Cough
- Reflex response to stimuli that irritate receptors in the larynx, trachea, or large
bronchi
- May be cardiovascular in origin; left sided failure
,• Cough Ask the patient to describe the volume of any sputum and its color, odor,
and consistency - Onset - Nature of cough; dry or produces sputum, or phlegm -
Sputum production: frequency and amount in 24 hours - Sput
Past Medical History - ANSWER ✓ • Thoracic trauma or surgery • Dates of
hospitalization for pulmonary disorders • Use of oxygen and ventilation-assisting
devices - CPAP or BiPAP • Chronic pulmonary diseases or other respiratory
disorders • Previous testing such as peak flow, PFT's, bronchoscopy, CXR •
Immunization against Streptococcus pneumoniae, Influenza
Family History & Personal and Social History - ANSWER ✓ • Tuberculosis (TB)
• Cystic fibrosis • Emphysema • Allergy, Asthma, Atopic dermatitis (triad) •
Malignancy • Bronchiectasis • Bronchitis • Clotting disorders (risk of pulmonary
embolism)
• Any of forementioned disorders in family history • Employment/Occupation •
Home environment • Tobacco use • Exposure to respiratory infections, influenza,
tuberculosis • Nutritional status • Medications including use of herbal or other
remedies • Travel exposures • Hobbies • Use of alcohol/drugs • Exercise tolerance
Special Considerations: History - ANSWER ✓ • Pregnant Women • Weeks of
gestation • Presence of multiple fetuses, polyhydramnios, other conditions in which
uterus displaces diaphragm • Exercise type and energy expenditure • Exposure to
and frequency of respiratory infections, annual influenza immunization
• Older Adults • Exposure to and frequency of respiratory infections - History of
pneumococcal and flu vaccine • Effects of weather on respiratory efforts and
infection occurrence • Immobilization and sedentary habits • Difficulty swallowing
• Altered activities from respiratory symptoms
• Older Adults - Smoking history - Cough - Dyspnea on exertion or breathlessness
- Fatigue - Weight changes - Fever and night sweats
Thorax and Lungs
Physical Examination - ANSWER ✓ • Examination of the anterior and posterior
chest in sitting and supine positon - Proceed in an orderly fashion: inspect, palpate,
percuss, and auscultate - Anteriorally with percussion, the heart normally produces
an area of dullness to the left of the sternum from the 3rd to 5th rib interspaces -
Supraclavicular retraction is often present
, • Inspect the chest; front and back, noting thoracic landmarks, for the following: -
Size and shape (anteroposterior diameter compared with the lateral diameter) -
Symmetry - Color - Superficial venous patterns - Prominence of ribs
• Evaluate respirations for the following: - Rate - Rhythm or pattern • Inspect chest
movement with breathing for the following: - Symmetry - Use of accessory
muscles • Note any audible sounds with respiration
• Palpate the chest for the following: - Symmetry - Thoracic expansion - Sensations
such as crepitus, grating vibrations - Tactile fremitus
• Percuss on the chest, comparing sides, for the following: - Diaphragmatic
excursion - Percussion tone intensity, pitch, duration, and quality
• Auscultate the chest with the stethoscope diaphragm, from apex to base;
comparing sides for the following: - Intensity, pitch, duration, and quality of breath
sounds - Adventitious breath sounds (crackles, rhonchi, wheezes, friction rubs) -
Vocal resonance
Techniques of Examination - ANSWER ✓ • General techniques - Examine the
posterior thorax and lungs while the patient is sitting - Examine the anterior thorax
and lungs with the patient supine - Compare one side of the thorax and lungs with
the other, so the patient serves as his or her own control - Proceed in an orderly
fashion: inspect, palpate, percuss, and auscultate
• Initial survey (Inspection) of respiration and the thorax - Observe the rate,
rhythm, depth, and effort of breathing - Inspect for any signs of respiratory
difficulty o Assess the patient's color o Listen to the patient's breathing o Inspect
the patient's neck - Observe the shape of the chest
• Observe for peripheral clues may suggest pulmonary or cardiac difficulties: -
Breath: odor - Skin, nails, and lips: cyanosis or pallor - Fingers: clubbing - Lips:
pursing - Nostrils: flaring
• Examination of the posterior chest - Inspection o From a midline position behind
the patient, note the shape of the chest and the way in which it moves
• Palpation of the thoracic muscles/skeleton - Pulsations - Tenderness -
Bulges/depressions - Masses - Unusual movement/positions - Elasticity of rib cage
- Immovability of sternum - Rigidity of thoracic spine • Position of the trachea
(head & neck exam)
• Percuss chest -Anterior -Lateral -Posterior • Compare tones bilaterally
with Exam Questions and Correct
Solutions Updated 2025/2026||100%
Guaranteed Pass A+
GRADED<<BRAND NEW VERSION>>
Techniques of Examination - Legs - ANSWER ✓ Compare one foot and leg with
the other • Check for pitting edema • Severity of edema graded on four-point scale
(slight to very marked)
• If edema is present, look for causes - Recent deep venous thrombosis - Chronic
venous insufficiency - Lymphedema • Note color of skin - Local area of redness -
Brownish areas near ankles - Ulcers and where - Thickness of skin (Venous ulcers
are wet in appearance, Arterial ulcers are dry)
• Femoral pulse - Press deeply below inguinal ligament, midway between anterior
superior iliac spine and symphysis pubis
• Popliteal pulse - Flex knee some, leg relaxed - Place fingertips of both hands to
meet midline behind knee and press deeply into popliteal fossa
• Dorsalis pedis pulse - Feel dorsum of foot, lateral to extensor tendon of great toe
• Posterior tibial pulse - Curve fingers behind and slightly below medial malleolus
of ankle
Objective Data—The Physical Exam - ANSWER ✓ Additional techniques - Color
changes - Doppler ultrasonic stethoscope - Ankle-brachial index (ABI)
Capillary refill
Notes: Assessment for Peripheral Arterial Disease - ANSWER ✓ Four P's of
occlusion -Pain -Pallor -Pulselessness -Poikilthermia (cold)
Differential Diagnoses - ANSWER ✓ Peripheral arterial disease - Stenosis of the
blood supply to the extremities by atherosclerotic plaques
• Raynaud phenomenon - Exaggerated spasm of the digital arterioles (occasionally
in the nose and ears) usually in response to cold exposure
• Arterial embolic disease - Atrial fibrillation can lead to clot formation within the
atrium, which may be dispersed throughout the arterial system.
, *Venous thrombosis - Sudden or gradual with varying severity of symptoms - Can
be the result of trauma or prolonged immobilization
• Venous ulcers - Results from chronic venous insufficiency in which lack of
venous flow leads to lower extremity venous hypertension
Thorax and Lungs HPI - ANSWER ✓ • Chest pain
- Initial questions should be as broad as possible, such as, "Do you have any
discomfort or unpleasant feelings in your chest?"
- Ask the patient to point to the location of the pain
- Use OLDCART • Onset and duration • Associated symptoms • Efforts to treat •
Other medications • Recreational drugs (e.g., cocaine)
Chest pain - Aside from lung conditions, chest pain may arise from cardiac,
vascular, gastrointestinal, musculoskeletal, or skin pathology; it is also commonly
associated with anxiety
- Lung tissue itself has no pain fibers; pain in lung conditions usually arises from
inflammation of the adjacent parietal pleura
- Other surrounding structures may also irritate the parietal pleura, causing pain
• Shortness of breath (Dyspnea)
- Non-painful but uncomfortable awareness of breathing that is inappropriate to the
level of exertion
- Begin assessment with a broad question, such as, "Have you had any difficulty
breathing?"
- Determine the severity of dyspnea based on the patient's daily activities
• Shortness of breath (Dyspnea) - Onset - Pattern - Position most comfortable,
number of pillows used - Related to extent of exercise, certain activities, time of
day, eating - Harder to inhale or exhale - Severity - Associated symptoms - Efforts
to treat
• Wheezing
- Wheezes are musical respiratory sounds that may be audible to the patient and to
others
- Airway obstruction form secretions, inflammation or foreign body
• Cough
- Reflex response to stimuli that irritate receptors in the larynx, trachea, or large
bronchi
- May be cardiovascular in origin; left sided failure
,• Cough Ask the patient to describe the volume of any sputum and its color, odor,
and consistency - Onset - Nature of cough; dry or produces sputum, or phlegm -
Sputum production: frequency and amount in 24 hours - Sput
Past Medical History - ANSWER ✓ • Thoracic trauma or surgery • Dates of
hospitalization for pulmonary disorders • Use of oxygen and ventilation-assisting
devices - CPAP or BiPAP • Chronic pulmonary diseases or other respiratory
disorders • Previous testing such as peak flow, PFT's, bronchoscopy, CXR •
Immunization against Streptococcus pneumoniae, Influenza
Family History & Personal and Social History - ANSWER ✓ • Tuberculosis (TB)
• Cystic fibrosis • Emphysema • Allergy, Asthma, Atopic dermatitis (triad) •
Malignancy • Bronchiectasis • Bronchitis • Clotting disorders (risk of pulmonary
embolism)
• Any of forementioned disorders in family history • Employment/Occupation •
Home environment • Tobacco use • Exposure to respiratory infections, influenza,
tuberculosis • Nutritional status • Medications including use of herbal or other
remedies • Travel exposures • Hobbies • Use of alcohol/drugs • Exercise tolerance
Special Considerations: History - ANSWER ✓ • Pregnant Women • Weeks of
gestation • Presence of multiple fetuses, polyhydramnios, other conditions in which
uterus displaces diaphragm • Exercise type and energy expenditure • Exposure to
and frequency of respiratory infections, annual influenza immunization
• Older Adults • Exposure to and frequency of respiratory infections - History of
pneumococcal and flu vaccine • Effects of weather on respiratory efforts and
infection occurrence • Immobilization and sedentary habits • Difficulty swallowing
• Altered activities from respiratory symptoms
• Older Adults - Smoking history - Cough - Dyspnea on exertion or breathlessness
- Fatigue - Weight changes - Fever and night sweats
Thorax and Lungs
Physical Examination - ANSWER ✓ • Examination of the anterior and posterior
chest in sitting and supine positon - Proceed in an orderly fashion: inspect, palpate,
percuss, and auscultate - Anteriorally with percussion, the heart normally produces
an area of dullness to the left of the sternum from the 3rd to 5th rib interspaces -
Supraclavicular retraction is often present
, • Inspect the chest; front and back, noting thoracic landmarks, for the following: -
Size and shape (anteroposterior diameter compared with the lateral diameter) -
Symmetry - Color - Superficial venous patterns - Prominence of ribs
• Evaluate respirations for the following: - Rate - Rhythm or pattern • Inspect chest
movement with breathing for the following: - Symmetry - Use of accessory
muscles • Note any audible sounds with respiration
• Palpate the chest for the following: - Symmetry - Thoracic expansion - Sensations
such as crepitus, grating vibrations - Tactile fremitus
• Percuss on the chest, comparing sides, for the following: - Diaphragmatic
excursion - Percussion tone intensity, pitch, duration, and quality
• Auscultate the chest with the stethoscope diaphragm, from apex to base;
comparing sides for the following: - Intensity, pitch, duration, and quality of breath
sounds - Adventitious breath sounds (crackles, rhonchi, wheezes, friction rubs) -
Vocal resonance
Techniques of Examination - ANSWER ✓ • General techniques - Examine the
posterior thorax and lungs while the patient is sitting - Examine the anterior thorax
and lungs with the patient supine - Compare one side of the thorax and lungs with
the other, so the patient serves as his or her own control - Proceed in an orderly
fashion: inspect, palpate, percuss, and auscultate
• Initial survey (Inspection) of respiration and the thorax - Observe the rate,
rhythm, depth, and effort of breathing - Inspect for any signs of respiratory
difficulty o Assess the patient's color o Listen to the patient's breathing o Inspect
the patient's neck - Observe the shape of the chest
• Observe for peripheral clues may suggest pulmonary or cardiac difficulties: -
Breath: odor - Skin, nails, and lips: cyanosis or pallor - Fingers: clubbing - Lips:
pursing - Nostrils: flaring
• Examination of the posterior chest - Inspection o From a midline position behind
the patient, note the shape of the chest and the way in which it moves
• Palpation of the thoracic muscles/skeleton - Pulsations - Tenderness -
Bulges/depressions - Masses - Unusual movement/positions - Elasticity of rib cage
- Immovability of sternum - Rigidity of thoracic spine • Position of the trachea
(head & neck exam)
• Percuss chest -Anterior -Lateral -Posterior • Compare tones bilaterally
