TEST BANK Exam
NUR-631 Advanced Health Assessment TEST
BANK 2 Exam LATEST 2024/2025
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ANSWERS WITH RATIONALES) ACE
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Questions Carefully
Which of the following examination techniques is not often done when examining the chest and
lungs of a newborn?
A. General survey
B. Inspection
C. Percussion
D. Auscultation –
Correct Answer :C. Percussion
The examination of the chest and lungs of the newborn follows a sequence similar to that for
adults. Inspecting without disturbing the baby is key, and for this reason auscultation often
occurs at the same time as inspection. Percussion may be unreliable and is typically not
performed on infants. The examiner's fingers may be too large for a baby's chest, and
particularly so for the premature infant.
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The patient tells the examiner, "I have been coughing up a lot of yellowish-green phlegm." The
examiner should suspect:
A. viral infection.
B. tuberculosis.
C. pulmonary edema.
D. bacterial pneumonia. –
Correct Answer :D. bacterial pneumonia.
Yellow-green sputum is an example of a characteristic that can aide the examiner in making a
differential diagnosis of bacterial infection like pneumonia.
Which finding could indicate an intrathoracic infection?
A. Malodorous breath
B. Protrusion of the clavicle
C. Clubbing of the nail beds
D. Kussmaul respirations –
Correct Answer :A. Malodorous breath
Smell the breath; pulmonary infection may make it malodorous.
Which finding is considered unusual in a newborn?
A. Sneezing
B. Coughing
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C. Prominence of the xiphoid process
D. Nose breathing –
Correct Answer :B. Coughing
Coughing is rare in the newborn and should be considered a problem. Sneezing, on the other
hand, is frequent and expected—it clears the nose. Coughing in a newborn is considered unusual
as it or difficulty breathing of sudden onset may indicate possible aspiration of small object, toy,
or food.
When auscultating the lungs, which of the following sequences should be used?
A. Side to side comparison, from apex to base
B. Front to back comparison, from apex to base
C. Listen to the right lung first, apex to base, then the left lung apex to base
D. Listen to the right lung during inspiration, the left lung during expiration, from apex to base –
Correct Answer :A. Side to side comparison, from apex to base
When auscultating the lungs, listen systematically at each position throughout inspiration and
expiration, taking advantage of a side-to-side comparison as you move downward from apex to
base at intervals of several centimeters. The sounds of the middle lobe of the right lung and the
lingula on the left are best heard in the respective axillae.
In a newborn infant, a small chest-to-head size ratio is usually associated with:
A. maternal diabetes.
B. cocaine use during pregnancy.
C. intrauterine growth retardation.
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D. a normal finding. –
Correct Answer :C. intrauterine growth retardation.
When examining the newborn, inspect the thoracic cage, noting size and shape; measure the
chest circumference, which in the healthy full-term infant is usually about 30 to 36 cm, usually 2
to 3 cm smaller than the head circumference. This difference between the two increases with
prematurity. An infant with intrauterine growth retardation will have a relatively smaller chest
circumference compared with the head, whereas the infant of a mother with poorly controlled
diabetes will have a relatively larger chest circumference.
The Hamman sign can best be heard when the patient is:
A. in a supine position.
B. lying on the left side.
C. sitting completely upright.
D. positioned with the head elevated 30 degrees. –
Correct Answer :B. lying on the left side.
Mediastinal crunch (Hamman sign) is found with mediastinal emphysema. A great variety of
sounds—loud crackles, clicking, and gurgling—are heard over the precordium. They are
synchronous with the heartbeat and not particularly so with respiration. These sounds can be
more pronounced toward the end of expiration and are easiest to hear when the patient leans to
the left or lies down on the left side.
In addition to severe respiratory distress, which finding is indicative of a pneumothorax with
mediastinal shift?
A. Hemoptysis
B. Pleural friction fremitus
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