Page | 1
NURS550: Advanced Health Assessment and
Diagnostic Reasoning Week #3 Guided
Reading Questions with Detailed Verified
Answers
1. Identify the questions you need to ask in a respiratory review of
systems (page 12-13 in Bates') Ans: Respiratory: Cough, sputum
(color, quantity; presence of blood or hemoptysis),
shortness of breath (dyspnea), wheezing, pain with a deep breath
(pleuritic pain), last chest x-ray. You may wish to include asthma,
bronchitis, emphy- sema, pneumonia, and tuberculosis.
2. Describe the questions you would ask a patient presenting with the
following
a. Shortness of breath Ans: ✢ "Have you had any difficulty breathing?"
✢ rest or with exertion, and how much exertion produces onset
✢ How many steps or flights of stairs can the patient climb before
pausing for breath?
✢ What about carrying bags of groceries, vacuuming, or making the bed?
✢ Has shortness of breath altered the patient's lifestyle and daily
activities? How?
✢ Carefully elicit the timing and setting, any associated symptoms, and
relieving or aggravating factors.
, Page | 2
b. Wheezing Ans: history of asthma, any chance of foreign body being
stuck?
c. Cough
Establish the duration. Is the cough acute, lasting less than 3 weeks;
subacute, lasting 3 to 8 weeks; or chronic, more than 8 weeks? Ans: ✢
Ask whether the cough is dry or produces sputum, or phlegm.
✢ Ask the patient to describe the volume of any sputum and its color,
odor, and consistency.
"How much do you think you cough up in 24 hours: a teaspoon,
tablespoon, quarter cup, half cup, cupful?" If possible, ask the patient to
cough into a tissue; inspect the phlegm, and note its characteristics.
3. Describe a physical examination of the thorax and lungs system (go
step-by-step)
A. General survey (sign of distress) Ans: Signs of Respiratory Distress
■ Assess the respiratory rate for tachypnea (>25 breaths/minute).
■ Inspect the patient's color for cyanosis or pallor. Recall earlier relevant
findings, such as the shape and color of the fingernails.
■ Listen for audible sounds of breathing. Is there audible whistling during
inspiration over the neck or lungs?
■ Inspect the neck. During inspiration, is there contraction of the
accessory muscles, namely the SCM and scalene muscles, or
supraclavicular retraction? During expiration, is there contraction of the
intercostal or abdominal oblique muscles? Is the trachea midline?
NURS550: Advanced Health Assessment and
Diagnostic Reasoning Week #3 Guided
Reading Questions with Detailed Verified
Answers
1. Identify the questions you need to ask in a respiratory review of
systems (page 12-13 in Bates') Ans: Respiratory: Cough, sputum
(color, quantity; presence of blood or hemoptysis),
shortness of breath (dyspnea), wheezing, pain with a deep breath
(pleuritic pain), last chest x-ray. You may wish to include asthma,
bronchitis, emphy- sema, pneumonia, and tuberculosis.
2. Describe the questions you would ask a patient presenting with the
following
a. Shortness of breath Ans: ✢ "Have you had any difficulty breathing?"
✢ rest or with exertion, and how much exertion produces onset
✢ How many steps or flights of stairs can the patient climb before
pausing for breath?
✢ What about carrying bags of groceries, vacuuming, or making the bed?
✢ Has shortness of breath altered the patient's lifestyle and daily
activities? How?
✢ Carefully elicit the timing and setting, any associated symptoms, and
relieving or aggravating factors.
, Page | 2
b. Wheezing Ans: history of asthma, any chance of foreign body being
stuck?
c. Cough
Establish the duration. Is the cough acute, lasting less than 3 weeks;
subacute, lasting 3 to 8 weeks; or chronic, more than 8 weeks? Ans: ✢
Ask whether the cough is dry or produces sputum, or phlegm.
✢ Ask the patient to describe the volume of any sputum and its color,
odor, and consistency.
"How much do you think you cough up in 24 hours: a teaspoon,
tablespoon, quarter cup, half cup, cupful?" If possible, ask the patient to
cough into a tissue; inspect the phlegm, and note its characteristics.
3. Describe a physical examination of the thorax and lungs system (go
step-by-step)
A. General survey (sign of distress) Ans: Signs of Respiratory Distress
■ Assess the respiratory rate for tachypnea (>25 breaths/minute).
■ Inspect the patient's color for cyanosis or pallor. Recall earlier relevant
findings, such as the shape and color of the fingernails.
■ Listen for audible sounds of breathing. Is there audible whistling during
inspiration over the neck or lungs?
■ Inspect the neck. During inspiration, is there contraction of the
accessory muscles, namely the SCM and scalene muscles, or
supraclavicular retraction? During expiration, is there contraction of the
intercostal or abdominal oblique muscles? Is the trachea midline?
