Deck 15: Bedside Assessment of the Patient

Question 1

What term is used to describe shortness of breath in the upright position?

A)orthopnea
B)platypnea
C)eupnea
D)apnea

Answer 1

B

Question 2

Which of the following is an example of a leading question?

A)Is your breathing better now?
B)How is your breathing now?
C)When did your breathing change?
D)Where is your pain located?

Answer 2

A

Question 3

What is the technical term for secretions from the tracheobronchial tree that have not been contaminated by the mouth?

A)sputum
B)phlegm
C)mucus
D)pus

Answer 3

B

Question 4

Which of the following is associated with tripodding?

A)severe pulmonary hyperinflation
B)congestive heart disease
C)pneumonia
D)pulmonary fibrosis

Question 5

Which of the following is NOT associated with diaphoresis?

A)fever
B)severe stress
C)acute anxiety
D)hemoptysis

Question 6

Which of the following is NOT a common cause of an increase in the drive to breathe which would increase the sensation of dyspnea?

A)hypoxemia
B)acidosis
C)high fever
D)hypocarbia

Question 7

Which of the following terms is used to describe coughing up blood-streaked sputum?

A)hematemesis
B)hemoptysis
C)hemolysis
D)hematoectasis

Question 8

In what space is the patient interview conducted by the clinician?

A)social space
B)personal space
C)intimate space
D)critical space

Question 9

What is the most common cause of pedal edema?

A)liver failure
B)kidney failure
C)heart failure
D)electrolyte imbalances

Question 10

All of the following are critical elements of a patient's social and environmental history except:

A)occupation and employment history
B)drugs and medications
C)recent travel
D)living arrangements

Question 11

What term is used to describe difficult breathing in the reclining position?

A)orthopnea
B)platypnea
C)eupnea
D)apnea

Question 12

All of the following are critical elements of a patient's past medical history except:

A)childhood diseases
B)prior major illnesses or surgery
C)marital status
D)drugs and immunizations

Question 13

Which of the following characteristics is least typical for pleuritic chest pain?

A)located laterally
B)sharp and stabbing in nature
C)increases with breathing
D)radiates to the arm

Question 14

Your patient has an abnormal sensorium. Which of the following is most likely true?

A)He knows his name.
B)He is confused about where he is.
C)He is aware of the correct day.
D)He knows the name of the hospital he has been taken to.

Question 15

Which of the following factors has minimal or no impact on the effectiveness of the patient's cough?

A)lung recoil
B)airways resistance
C)lung volume
D)pulmonary vascular resistance

Question 16

Which of the following is NOT a purpose of the interview?

A)to collect diagnostic information
B)to establish a rapport with the patient
C)to identify plans for payment
D)to identify the effect of therapy

Question 17

What term is used to describe the chest pain associated with blockage of the coronary arteries?

A)angina
B)myocarditis
C)myalgia
D)infarction

Question 18

What change in the patient's respiratory breathing pattern is commonly seen with significant fever?

A)slower rate
B)more rapid rate
C)more prolonged expiratory time
D)more prolonged inspiratory time

Question 19

What term is used to describe sputum that has pus in it?

A)fetid
B)mucoid
C)purulent
D)tenacious

Question 20

Which of the following conditions is most likely to cause a dry, nonproductive cough?

A)chronic bronchitis
B)cystic fibrosis
C)pulmonary fibrosis
D)chronic obstructive pulmonary disease

Question 21

What is the normal range for systolic blood pressure in the adult patient?

A)90 to 140 mm Hg
B)80 to 100 mm Hg
C)75 to 100 mm Hg
D)60 to 100 mm Hg

Question 22

What artery is most often used to assess arterial blood pressure?

A)femoral
B)radial
C)ulnar
D)brachial

Question 23

What two factors determine cardiac output?

A)ventricular filling and heart rate
B)stroke volume and heart rate
C)stroke volume and respiratory rate
D)heart rate and tidal volume

Question 24

Why should the respiratory therapist perform a blood pressure assessment fairly quickly?

A)The procedure is expensive.
B)The procedure cuts off blood flow to the forearm temporarily.
C)The respiratory therapist has other procedures to do.
D)The procedure is billed by the time involved.

Question 25

What is the most common cause of jugular venous distention (JVD)?

A)right-sided heart failure
B)arterial hypoxemia
C)tension pneumothorax
D)acute systemic hypertension

Question 26

What is the normal range for diastolic blood pressure in the adult patient?

A)40 to 80 mm Hg
B)60 to 90 mm Hg
C)80 to 110 mm Hg
D)60 to 110 mm Hg

Question 27

Which of the following sites is closest to core body temperature?

A)axillary
B)oral
C)rectal
D)forehead

Question 28

What is indicated by the presence of central cyanosis?

A)respiratory failure
B)circulatory failure
C)anemia
D)hypotension

Question 29

What is the normal range for pulse pressure?

A)20 to 35 mm Hg
B)30 to 60 mm Hg
C)30 to 40 mm Hg
D)30 to 60 mm Hg

Question 30

Which of the following is a common cause of pulsus paradoxus?

A)acute asthma attack
B)severe pneumonia
C)congestive heart failure
D)myocardial infarction

Question 31

Which of the following is/are advantages of the digital blood pressure measurement devices?

A)They reduce the risk of human error.
B)They reduce the cost.
C)They have an alarm.
D)They measure blood pressure and stroke volume.

Question 32

Which of the following is a TRUE statement about the cause of systemic hypertension in adult patients?

A)The cause is often unknown.
B)The cause is often related to poor diet.
C)The cause is often related to a lack of exercise.
D)The cause is often related to sleep apnea.

Question 33

What is the most common cause of hypothermia?

A)exposure to cold environment
B)head injury
C)stroke
D)thyroid gland dysfunction

Question 34

What is the advantage of COPD patients breathing through pursed-lips during exhalation?

A)helps the patient focus on their breathing
B)promotes more complete emptying of the lungs
C)reduces the patient's anxiety level
D)improves arterial pH levels

Question 35

Which of the following may cause the trachea to shift to the right?

A)right-sided tension pneumothorax
B)right-sided large pleural effusion
C)right upper lobe atelectasis
D)left lower lobe pneumonia

Question 36

What structure in the body is responsible for regulating the body temperature?

A)pituitary gland
B)thyroid gland
C)hypothalamus
D)thymus gland

Question 37

Which of the following is the least likely cause of lymphadenopathy in the neck?

A)lymphoma
B)pulmonary infection
C)congestive heart failure
D)lung cancer

Question 38

Which of the following is NOT a common cause of tachypnea?

A)hypoxemia
B)exercise
C)narcotic overdose
D)metabolic acidosis

Question 39

Which of the following is least likely to cause tachycardia?

A)fever
B)severe pain
C)hypotension
D)hypothermia

Question 40

Which of the following is NOT a cause of hypotension?

A)heart failure
B)hypovolemia
C)mild tachycardia
D)peripheral vasoconstriction

Question 41

While percussing a patient's chest wall, you encounter an area that produces a decreased resonance to percussion. Which of the following are potential causes of this finding?
I)pneumothorax
II)pleural effusion
III)pneumonia
IV)atelectasis

A)II and III
B)II and IV
C)II, III, and IV
D)I, II, III, and IV

Question 42

On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling sound and sensation. What is the most likely cause of this observation?

A)subcutaneous emphysema
B)upper bronchial obstruction
C)pneumonia of the upper lobes
D)atelectasis of the upper lobes

Question 43

What term is used to describe the breathing pattern seen in COPD patients in which the lower costal margins of the chest wall draw inward with each inspiration?

A)Hoover's sign
B)Homan's sign
C)abdominal paradox
D)respiratory alternans

Question 44

Which of the following would cause an increase in tactile fremitus?

A)pleural effusion
B)pneumonia
C)emphysema
D)pneumothorax

Question 45

While observing a patient's breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following are potential causes of this abnormality?
I)central nervous system disorder
II)congestive heart failure
III)metabolic acidosis

A)I and II
B)II and III
C)I and III
D)I, II, and III

Question 46

What breathing pattern is associated with diabetic ketoacidosis?

A)Kussmaul breathing
B)apneustic breathing
C)Biot's breathing
D)apnea

Question 47

What term is used to describe an abnormal anteroposterior curvature of the spine?

A)scoliosis
B)pectus excavatum
C)kyphosis
D)pectus carinatum

Question 48

To minimize bony interference with percussion on the posterior chest wall, the practitioner should have the patient do which of the following?

A)Lean forward at a 45-degree angle.
B)Keep his arms at his sides.
C)Raise his arms above his shoulders.
D)Place his hands on his hips.

Question 49

What breathing pattern is associated with severe atelectasis?

A)rapid and deep
B)rapid and shallow
C)slow and shallow
D)slow and deep

Question 50

What disease is associated with a barrel chest?

A)emphysema
B)heart failure
C)pneumonia
D)pleural effusions

Question 51

What is indicated by retractions?

A)an increase in PaCO₂
B)an increase in the work of breathing
C)a decrease in blood flow to the lungs
D)reduce lung volumes

Question 52

While palpating the thorax of a patient who repeats the words "ninety-nine," you note a localized area of decreased tactile fremitus on the lower right side. Which of the following could explain this finding?
I)atelectasis on the right
II)right-sided lower pneumothorax
III)right-sided lower pleural effusion
IV)obstruction of a bronchus in the right lung

A)II, III, and IV
B)I and III
C)III and IV
D)I, III, and IV

Question 53

While percussing a patient's chest wall, you detect an abnormal increase in resonance. Which of the following are possible causes of this finding?
I)asthma
II)pneumothorax
III)emphysema
IV)pneumonia

A)I, II, and III
B)II and IV
C)I, III, and IV
D)I, II, III, and IV

Question 54

You observe a patient's breathing pattern as very irregular and interspersed with long periods of apnea. Which of the following is the most likely cause of this problem?

A)central nervous system disorder
B)congestive heart failure
C)metabolic acidosis
D)increased intracranial pressure

Question 55

What is indicated by the breathing pattern known as abdominal paradox?

A)obstructive lung disease
B)restrictive lung disease
C)heart failure
D)diaphragm fatigue

Question 56

While observing a patient's breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?

A)apneustic breathing
B)Cheyne-Stokes breathing
C)Biot's breathing
D)paradoxical breathing

Question 57

The vibration created by percussion penetrates the lung to about what depth?

A)1 to 2 cm
B)3 to 5 cm
C)5 to 7 cm
D)8 to 10 cm

Question 58

While palpating the chest of a patient who repeats the words "ninety-nine," you note an area of increased tactile fremitus over the left lower lobe. Which of the following could explain this finding?
I)pneumothorax
II)emphysema
III)pneumonia

A)II and III
B)I and II
C)I, II, and III
D)III

Question 59

A patient with asthma would tend to exhibit which of the following?

A)prolonged inhalation
B)slow and shallow breathing
C)prolonged exhalation
D)deep and fast breathing

Question 60

During posterior thoracic palpation of an adult, you notice little or no movement on the right side during a full, deep breath. Which of the following conditions could explain this finding?
I)bilateral phrenic nerve paralysis
II)right-sided pleural effusion
III)atelectasis of the right lower lobe
IV)right lobar consolidation

A)I, II, and III
B)II and III
C)II, III, and IV
D)I, II, III, and IV

Question 61

In which of the following conditions would late inspiratory crackles be most likely to occur?
I)emphysema
II)pulmonary fibrosis
III)pneumonia
IV)pulmonary edema
V)atelectasis

A)II, III, IV, and V
B)I, III, and V
C)III, IV, and V
D)I, II, IV, and V

Question 62

Which of the following are true of early inspiratory crackles?
I.They most often occur in COPD patients.
II.They generally indicate severe airway obstruction
III.They are not affected by coughing or positional change.
IV.They are usually scant (few in number).

A)II and IV
B)I, II, and III
C)I, III, and IV
D)I, II, III, and IV

Question 63

What term best describes a loud, high-pitched continuous sound heard (often with the unaided ear) primarily over the larynx or trachea during inhalation in patients with upper airway obstruction?

A)stridor
B)rhonchi
C)crackles
D)wheeze

Question 64

Right ventricular hypertrophy often produces a systolic thrust that can be felt and seen near which of the following?

A)lower left border of the sternum
B)upper right border of the sternum
C)left fifth intercostal space, midclavicular line
D)lower right border of the sternum

Question 65

Soft, muffled sounds heard mainly during inspiration over the peripheral lung parenchyma best describe which of the following breath sounds?

A)vesicular
B)bronchovesicular
C)bronchial
D)tracheal

Question 66

Which of the following represent proper chest auscultation technique?
I.The practitioner should begin auscultation at the lung bases.
II.The bell or diaphragm should be placed directly on the chest wall.
III.The patient should be instructed to breathe through an open mouth.
IV.The patient should be placed in a comfortable upright position.
V.The patient should be told to breathe more deeply than normal.

A)II, III, IV, and V
B)I, II, III, and V
C)III, IV, and V
D)I, II, III, IV, and V

Question 67

Inspiratory crackles in patients without excess secretions are most commonly associated with which of the following?

A)reduced chest-wall sound transmission
B)airways popping open during inspiration
C)complete obstruction of the upper airway
D)mucosal edema or inflammation

Question 68

High-pitched, loud, tubular breath sounds with an expiratory component equal to the inspiratory component best describes which of the following breath sounds?

A)adventitious
B)bronchial
C)vesicular
D)bronchovesicular

Question 69

During auscultation of a patient's chest, you hear coarse crackles throughout both inspiration and expiration. These sound clear when the patient coughs. Which of the following is the most likely cause of these adventitious sounds?

A)opening of closed smaller airways or alveoli
B)opening of collapsed large, proximal airways
C)variable obstruction to flow in the upper airway
D)movement of excessive secretions in the airways

Question 70

What is the area of the anterior chest wall overlying the heart is called?

A)epigastrium
B)precordium
C)pericardium
D)axilla

Question 71

Which of the following causes decreased breath sounds?
I)air or fluid in the pleural space
II)hyperinflation of lung tissue
III)mucus plugging of the airways
IV)shallow or slow breathing

A)II and IV
B)I, II, and III
C)I, II, III, and IV
D)II, III, and IV

Question 72

Which of the following changes in the characteristics of wheezing indicate improvement in airway obstruction following bronchodilator therapy?

A)lower pitch, shorter duration
B)higher pitch, shorter duration
C)lower pitch, longer duration
D)higher pitch, longer duration

Question 73

What does the presence of stridor indicate?

A)lower airway obstruction
B)increased secretions in the large airways
C)upper airway obstruction
D)bronchial spasm

Question 74

An increase in intensity and clarity of vocal resonance because of enhanced transmission of sound is referred to as which of the following?

A)bronchophony
B)vesicularity
C)pectoriloquy
D)egophony

Question 75

During auscultation of a patient's chest, you hear abnormal discontinuous "bubbling" sounds at the lung bases. Which of the following chart entries best describes this finding?

A)"Bronchial sounds heard at lung bases."
B)"Wheezes heard at lung bases."
C)"Crackles heard at lung bases."
D)"Rhonchi heard at lung bases."

Question 76

Which of the following conditions would tend to shift the point of maximal impulse (PMI) farther to the left?
I)pulmonary emphysema
II)collapse of the left lower lobe
III)collapse of the right lower lobe
IV)right-sided tension pneumothorax

A)I, II, and III
B)II and IV
C)II, III, and IV
D)I, II, III, and IV

Question 77

Where is the normal apical impulse (point of maximal impulse [PMI]) usually identified?

A)third right intercostal space, left sternal border
B)fifth left intercostal space, midclavicular line
C)third left intercostal space, anterior axillary line
D)fifth right intercostal space, midclavicular line

Question 78

A creaking or grating sound that increases in intensity with deep breathing and is similar to coarse crackles, but is not affected by coughing, best describes which of the following?

A)rhonchi
B)friction rub
C)rales
D)wheezing

Question 79

Normal heart sounds are created primarily by which of the following?

A)opening of the heart valves
B)rush of blood during systole
C)closing of the heart valves
D)electrical conduction in the heart

Question 80

In which of the following patient categories would the intensity of the point of maximal impulse (PMI) be most difficult to palpate?

A)chronic pulmonary hyperinflation
B)mitral (bicuspid) stenosis
C)left ventricular hypertrophy
D)right ventricular hypertrophy