NURSING 6501N-quizlet(6)

NURSING 6501N-quizlet(6) A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the: A. sphenoid and frontal sinuses. B. maxillary and frontal sinuses. C. maxillary sinuses only. D. sphenoid sinuses only. ANS: C Only the maxillary and the frontal sinuses are accessible for physical examination; however, the young child does not develop frontal sinuses until 7 to 8 years of age. A 6-month-old who can hear well can be expected to: A. exhibit the Moro reflex. B. stop breathing in response to sudden noise. C. turn his or her head toward the source of sound. D. imitate simple words. ANS: C Six-month-old infants turn their head toward the source of sound; they start babbling, but they begin imitating speech sounds closer to 10 months of age. The Moro reflex and cessation of breathing in response to noise are lost by 3 months of age. A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. One patient response to history of present illness questions that further supports a tentative diagnosis of renal calculi is: A. "My urine has been a bright yellow." B. "I have had fever and chills for 2 days." C. "I also have a headache and neck ache." D. "My left testicle and shoulder hurt as well." ANS: D Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder). A 29-year-old patient presents with a new complaint of productive cough with purulent sputum. He also complains of right lower quadrant abdominal pain. You suspect pneumonia in which lobe? A. Right lower B. Right upper C. Left upper D. Left lower ANS: A Right lower lobe pneumonia can stimulate the tenth thoracic nerve, causing right lower quadrant pain and simulating an abdominal process. A 44-year-old male patient who complains of a cough has presented to the emergency department. He admits to smoking 1 pack per day. During your inspection of his chest, the most appropriate lighting source to highlight chest movement is: A. bright tangential lighting. B. daylight from a window. C. flashlight in a dark room. D. fluorescent ceiling lights. ANS: A Bright tangential light is best for visualizing chest movements. A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: A. use topical over-the-counter hemorrhoid treatment for 1 week. B. exercise and eat more fiber. C. come to the laboratory for a stool guaiac test. D. eat six small meals a day. ANS: C Blood in the stools is an abnormal finding that should never be ignored, even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years. After thorough inspection of the abdomen, the next assessment step is: A. percussion. B. palpation. C. auscultation. D. rectal examination. ANS: C Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence occurs because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first. The American Thoracic Society suggests replacing the term rales with: A. wheezes. B. crunches. C. rhonchi. D. crackles. ANS: D The American Thoracic Society has suggested that the term rales be replaced with crackles to more precisely describe the sound. The anteroposterior diameter of the chest is normally approximately the same as the transverse diameter in which age group? A. Infants B. School-age children C. Adolescents D. Young adults ANS: A The chest of infants is generally round with equal dimensions of anteroposterior and transverse diameters. The apex of a 2-month-old baby's heart typically lies closest to the: A. fourth left intercostal space. B. midsternal area. C. midthoracic spinal area. D. sixth left intercostal space. ANS: A In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space. An apical PMI palpated beyond the fifth intercostal space may indicate: A. decreased cardiac output. B. obesity. C. left ventricular hypertrophy. D. hyperventilation. ANS: C An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. The appendix is an extension of the: A. stomach. B. pancreas. C. small intestine. D. large intestine. ANS: D The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum. As you take vital signs on Mr. Barrow, age 78, you note that his respirations are 40 per minute. He has been resting, and his mucosa is pink. Concerning Mr. Barrow's respirations, you would: A. document his rate as normal. B. do nothing because his color is pink. C. note that his rate is below normal. D. report that he has an above-average rate. ANS: D The normal adult respiratory rate is 12 to 20 breaths per minute, and the ratio of breaths to heartbeats is 1:4. A respiratory rate of 40 breaths per minute is not within the normal range and should be documented as above average. The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect: A. congestive heart failure. B. pericarditis. C. endocarditis. D. cardiac tamponade. ANS: B Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which comprises ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy. The auscultation of a triphasic friction rub in a patient with acute chest pain should not lead you to suspect congestive heart failure, endocarditis, or cardiac tamponade. Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausageshaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's symptoms? A. Intussusception B. Kidney stones C. Meconium ileus D. Pyloric stenosis ANS: A Intussusception refers to the prolapse of one segment of the intestine into another, causing intestinal obstruction. A sausage-shaped mass may be palpated in the right or left upper quadrant, whereas the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age. Before performing an abdominal examination, the examiner should: A. ascertain the patient's HIV status. B. have the patient empty his or her bladder. C. don double gloves. D. completely disrobe the patient. ANS: B The patient should empty the bladder to ensure an accurate examination of organs as well as to provide comfort for the patient. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing: A. pericardial friction rub. B. high-pitched murmurs. C. presystolic gallops. D. systolic ejection sounds. ANS: C Using the bell of the stethoscope at the apex is more useful for hearing low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position. The best time to observe and count respirations is while: A. the patient is answering questions. B. weighing the patient. C. palpating the pulse. D. the patient is sleeping. ANS: C Counting respirations while you palpate the pulse does not make the patient self-conscious, because the patient expects you to be counting the pulse. Respiratory patterns change as the patient speaks. Attempting to count during weighing would make the patient self-conscious and affect the respiratory rate. Respiratory patterns change as the patient sleeps Both pleural effusion and lobar pneumonia are characterized by ___________ percussion. ANS: dullness heard on Pleural effusion and lobar pneumonia are more dense than air, with an expected finding of dullness on percussion. Tympany is expected over hollow organs, such as the stomach; resonance and hyperresonance are heard over air-filled areas. Bradypnea may accompany: A. a subconscious response to observation. B. an excellent level of cardiovascular fitness. C. ascites. D. severe pain from a rib fracture. ANS: B Bradypnea, a respiratory rate slower than 12 breaths per minute, may be seen with cardiorespiratory fitness. Tachypnea is seen with a subconscious response to observation, with ascites, and with severe pain from a rib fracture. Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify: A. uremia. B. tuberculosis. C. hepatic failure. D. diabetic ketoacidosis. ANS: A An ammonia-like breath odor suggests uremia, a renal condition. A cinnamon-like breath odor suggests tuberculosis. A breath odor resembling musty fish or clover suggests hepatic failure. A sweet, fruity breath odor suggests diabetic ketoacidosis. Breath sounds normally heard over the trachea are called: A. bronchovesicular. B. amphoric. C. bronchial. D. vesicular. ANS: C The sounds highest in intensity and pitch are the bronchial sounds, which are normally heard over the trachea. Bulging of an amber tympanic membrane without mobility is most often associated with: A. middle ear effusion. B. healed tympanic membrane perforation. C. impacted cerumen in the canal. D. repeated and prolonged crying cycles. ANS: A An amber color, with bulging of the tympanic membrane and without mobility or redness, most often indicates the presence of fluid in the middle ear. A cause for alarm during chest assessment of a newborn is: A. crackles. B. rhonchi. C. gurgles from the gastrointestinal tract. D. stridor. ANS: D Stridor is alarming at any age. Crackles and rhonchi at birth are due to the presence of remaining fetal fluid and are not a cause for alarm. Intermittent gurgles are bowel sounds transmitted through the thinwalled chest and are not a cause for alarm. Changes in the clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish: A. consolidation from airway constriction. B. foreign body from purulent exudate. C. pulmonary edema from pleurisy. D. right from left tracheal deviation. ANS: A When chest auscultation results in decreased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish adventitious breath sounds caused by consolidation from those caused by narrowing of a patent lumen. The characteristic barrel chest of the older adult is due to a combination of factors, including: A. skeletal changes of aging. B. increased muscular expansion of the chest wall. C. less fibrous alveoli. D. increased vital capacity. ANS: A Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest. Chest pain with an organic cause in a child is most likely the result of: A. cardiac disease. B. asthma. C. esophageal reflux. D. arthritis. ANS: B Unlike chest pain in adults, chest pain in children and adolescents is seldom caused by a cardiac problem. More likely, the case is related to trauma, exercise-induced asthma, or cocaine use. Closure of the ductus arteriosus usually occurs: A. 24 to 48 hours after birth. B. after 7 days of life. C. between the second and third month. D. during the toddler period. ANS: A Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth. The condition in which a patient's heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called: A. amyloidosis. B. coarctation. C. dextrocardia. D. situs inversus. ANS: C Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Coarctation is the compression of the walls of a vessel such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left. A condition that is likely to present with dizziness and syncope is: A. bacterial endocarditis. B. hypertension. C. sick sinus syndrome. D. pericarditis. ANS: C Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent syncope, transient dizzy spells, lightheadedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis along with a triphasic friction rub. Contraction of the gallbladder propels bile into the: A. stomach. B. duodenum. C. jejunum. D. large intestine. ANS: B With contraction of the gallbladder, bile is excreted into the duodenum. Contraction of the ventricles causes: A. closure of the atrioventricular valves. B. closure of the pulmonic and aortic valves. C. opening of the auricular septa. D. opening of the mitral and tricuspid valves. ANS: A When the ventricles contract the semilunar valves, the pulmonic and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: A. gallbladder. B. kidney. C. liver. D. pancreas. ANS: C The liver is responsible for converting fat-soluble waste to water-soluble materials so that the kidneys can excrete them as well as convert ammonia to urea. Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: A. cholecystitis. B. pancreatitis. C. pyelonephritis. D. ulcerative colitis. ANS: C Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it: A. amplifies all types of sounds. B. filters extraneous sounds. C. pinpoints focal sound areas. D. transmits high-pitched sounds. ANS: D The diaphragm is the better source because it transmits the normally highpitched sounds of the lung, and it has a broader area from which to listen. Unless specially modified, the stethoscope does not amplify sound, filter extraneous sounds, or pinpoint focal sound areas. Dullness to percussion in intercostal spaces suggests the presence of: A. cor pulmonale. B. empyema. C. pneumonia. D. sickle cell disease. ANS: C Resonance is the expected percussion tone over normal lung tissue, which is accessible in the intercostal spaces. Dullness indicates an area of consolidation, as is seen with pneumonia. During a chest assessment, you note the patient's voice quality while auscultating the lung fields. The voice sound is intensified, the voice has a nasal quality, and the e's sound like a's. This is indicative of: A. lung consolidation. B. emphysema. C. bronchial obstruction. D. asthma. ANS: A Vocal resonance, as described, indicates lung consolidation. Sounds are transmitted more clearly through consolidation rather than air. During the auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the _____ area. ANS: pulmonic Splitting of S