NURS 6512 Week 6 Midterm Exam Paper

Question 1

2 out of 2 points

Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:

nurs 6512 week 6 midterm exam

Response Feedback:

Because the patient has consolidation and has been recumbent and fatigued, the most appropriate first step is to listen to the lung bases before the patient gets exhausted. The lung bases would be the most likely sites for adventitious sounds.

Question 2

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2 out of 2 points

The difference in blood pressure readings between the right and the left arms is considered normal up to _____ mm Hg.

Response Feedback:

Blood pressure readings between the left and right arms may vary by as much as 10 mm Hg and tend to be higher in the right arm.

Question 3

2 out of 2 points

Fat deposits in the circulatory system of an older adult can lead to:

Response Feedback:

Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke. nurs 6512 week 6 midterm exam.

Question 4

2 out of 2 points

Which dysrhythmia is a physiologic event during childhood?

Response Feedback:

Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.

Question 5

2 out of 2 points

Normal cardiac changes that occur during pregnancy include: nurs 6512 week 6 midterm exam.

Response Feedback:

The maternal blood volume increases by 40% to 50% due to an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), therefore resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally and there is a slight axis rotation.

Question 6

2 out of 2 points

An idiopathic spasm of arterioles in the digits is called:

Response Feedback:

Raynaud disease is idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries.

Question 7

2 out of 2 points

nurs 6512 week 6 midterm exam

The level at which the jugular venous pulse is visible gives an indication of:

Response Feedback:

The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.

Question 8

2 out of 2 points

A bounding pulse in an infant may be associated with:

Response Feedback:

A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities, or between femoral and radial pulses, and absence of the femoral pulse suggests a coarctation of the aorta. Painful swollen extremities are usually a sign of venous occlusion. nurs 6512 week 6 midterm exam.

Question 9

2 out of 2 points

Chest pain in a child with an organic cause is more likely the result of:

Response Feedback:

Unlike chest pain in adults, children and adolescents seldom are caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use.

Question 10

2 out of 2 points

In the adult, the apical impulse should be most visible when the patient is in what position?

Response Feedback:

In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem. nurs 6512 week 6 midterm exam.

Question 11

2 out of 2 points

The best time to observe and count respirations is:

Response Feedback:

Respiratory patterns change as the patient speaks and sleeps. Attempting to count during weighing would make the patient self-conscious and affect respiratory rate. Counting respirations while you palpate the pulse does not make the patient self-conscious because the patient expects you to be counting the pulse.

Question 12

2 out of 2 points

As you take vital signs on Mr. B., age 78, you note that his respirations are 40 per minute. He has been resting and his mucosa is pink. Concerning Mr. B. s respirations, you would:

Response Feedback:

The normal adult respiratory rate is 12 to 20, with a ratio of respiratory to heartbeats of 1:4. Always note any variations in respiratory rate.

Question 13

2 out of 2 points

A musical squeaking noise heard on auscultation of the lungs is called:

Response Feedback:

Wheezes are continuous, high-pitched musical sounds that can be heard on inspiration and expiration.

Question 14

2 out of 2 points

The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it:

Response Feedback:

Unless specially modified, the stethoscope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does transmit sound waves from the source to the ear. The diaphragm is the better source because it transmits the normally high-pitched sounds of the lung and it has a broader area to listen from.

Question 15

2 out of 2 points

An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in:

Response Feedback:

Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child (4 year old) varies in a cyclic pattern, usually faster on inspiration and slow on expiration.

Question 16

2 out of 2 points

A split second heart sound is: nurs 6512 week 6 midterm exam,

Response Feedback:

Splitting of S2 is an expected event, because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.

Question 17

2 out of 2 points

Closure of the ductus arteriosus usually occurs:

Response Feedback:

Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth.

Question 18

2 out of 2 points

A sound similar to a murmur that is heard over arteries is a:

Response Feedback:

A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.

Question 19

2 out of 2 points

You are examining Mr. S., a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial occlusion?

Response Feedback:

An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area, and loss of hair over the extremity. There may be collapsed superficial veins with delayed filling. nurs 6512 week 6 midterm exam.

Question 20

2 out of 2 points

On a CXR, which of the following is true of the diaphragm?

Monday, October 9, 2017 1:03:17 AM EDT

Question 1

2 out of 2 points

On a CXR, which of the following is true of the diaphragm?

Selected Answer:

The right diaphragm is usually higher.

Correct Answer:

The right diaphragm is usually higher.

Question 2

2 out of 2 points

Tactile fremitus is best felt:

Selected Answer:

posteriorly and laterally at the bifurcation of the bronchi

Correct Answer:

posteriorly and laterally at the bifurcation of the bronchi

Response Feedback:

Fremitus is best palpated at the second intercostal space, which also corresponds to the bifurcation of the bronchi. nurs 6512 week 6 midterm exam.

Question 3

2 out of 2 points

The middle lobe of the right lung is best auscultated over the:

Selected Answer:

axilla.

Correct Answer:

axilla.

Response Feedback:

The sounds of the middle lobe of the right lung are best heard in the right axilla.

Question 4

2 out of 2 points

Expected respiratory changes of normal aging include:

Selected Answer:

more prominent bony structures.

Correct Answer:

more prominent bony structures.

Response Feedback:

In older adults, chest expansion is decreased and there is less use of respiratory muscles due to muscle weakness. The dorsal curve of the thoracic spine is prominent with flattening of the lumbar curve with bony landmarks becoming more prominent due to loss of subcutaneous tissue. nurs 6512 week 6 midterm exam.

Question 5

2 out of 2 points

You are listening to a patient s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?

Selected Answer:

Correct Answer:

Response Feedback:

S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration.

Question 6

2 out of 2 points

A bounding pulse in an infant may be associated with:

Selected Answer:

patent ductus arteriosus.

Correct Answer:

patent ductus arteriosus.

Response Feedback:

Question 7

2 out of 2 points

An apical PMI palpated beyond the left fifth intercostal space may indicate:

Selected Answer:

left ventricular hypertrophy.

Correct Answer:

left ventricular hypertrophy.

Response Feedback:

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. In dextrocardia the PMI would be displaced to the right.

Question 8

2 out of 2 points

A palpable rushing vibration over the base of the heart at the second intercostal space is called a:

Selected Answer:

thrill.

Correct Answer:

thrill.

Response Feedback:

A thrill is a fine, palpable, rushing vibration; a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is to move forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow.

Question 9

2 out of 2 points

Bradypnea may accompany:

Selected Answer:

an excellent level of cardiovascular fitness.

Correct Answer:

an excellent level of cardiovascular fitness.

Response Feedback:

Bradypnea, a rate slower than 12 breaths per minute, may result from cardiorespiratory fitness. The other choices accompany tachypnea.

Question 10

0 out of 2 points

Ms. R., age 74, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with intrathoracic infection?

Selected Answer:

Pectus carinatum

Correct Answer:

Malodorous breath

Question 11

2 out of 2 points

The apex of a 2-month-old baby s heart typically lies closest to the:

Selected Answer:

fourth left intercostal space.

Correct Answer:

fourth left intercostal space.

Response Feedback:

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.

Question 12

0 out of 2 points

Closure of the ductus arteriosus usually occurs:

Selected Answer:

24 to 48 hours after birth.

Correct Answer:

just prior to the initiation of labor.

Question 13

2 out of 2 points

Nancy is a 16-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Nancy, apart from occasional colds, is not prone to respiratory problems. What potential risk factor is most important to assess concerning Nancy s present problem?

Selected Answer:

Illegal drug use

Correct Answer:

Illegal drug use

Response Feedback:

Illegal drug use, particularly cocaine, is especially important to prioritize as a social history question for all adolescents and adults who complain of severe chest pain. Cocaine can lead to tachycardia, hypertension, coronary arterial spasm with infarction, and pneumothorax.

Question 14

2 out of 2 points

Laryngeal obstructions would elicit which breath sound? nurs 6512 week 6 midterm exam.

Selected Answer:

Stridor

Correct Answer:

Stridor

Response Feedback:

Obstructions high in the respiratory tree are characterized by stridor.

Question 15

2 out of 2 points

A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father had died of heart trouble. The most important follow-up question you should pose is which of the following?

Selected Answer:

What age was your father at the time of his death?

Correct Answer:

What age was your father at the time of his death?

Response Feedback:

A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one s chance of a similar occurrence. nurs 6512 week 6 midterm exam.

Question 16

2 out of 2 points

In the fetus, the right ventricle pumps blood through the:

Selected Answer:

ductus arteriosus.

Correct Answer:

ductus arteriosus.

Response Feedback:

The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs.

Question 17

2 out of 2 points

A third heart sound is created by:

Selected Answer:

diastolic filling.

Correct Answer:

diastolic filling.

Response Feedback:

Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria and the filling sometimes produces a third heart sound S3.

Question 18

2 out of 2 points

The level at which the jugular venous pulse is visible gives an indication of:

Selected Answer:

right atrial pressure.

Correct Answer:

right atrial pressure.

Response Feedback:

Question 19

2 out of 2 points

What term would you use to document a respiratory rate greater than 20 per minute in an adult?

Selected Answer:

Tachypnea

Correct Answer:

Tachypnea

Response Feedback:

Tachypnea is the correct term for respirations greater than 20. Dyspnea, orthopnea, and platypnea are terms that describe respiratory effort, not rate. Cheyne-Stokes refers to a particular abnormal pattern of respiration. nurs 6512 week 6 midterm exam.

Question 20

2 out of 2 points

An expected finding from chest palpation in the adult would be:

Selected Answer:

inflexibility of the xiphoid.

Correct Answer:

inflexibility of the xiphoid.

Response Feedback:

The sternum and xiphoid in adults are relatively inflexible, without cracking; the expected normal costal angle is 90 degrees and the chest moves symmetrically. Crepitus is always an abnormal finding.

Response Feedback:

Question 2

2 out of 2 points

A split second heart sound is:

Response Feedback:

Question 3

2 out of 2 points

During 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. nurs 6512 week 6 midterm exam.

Response Feedback:

Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site.

Question 4

2 out of 2 points

Which finding suggests a minor structural variation?

Response Feedback:

Barrel chest, clubbed fingers, chest wall retractions, and tachypnea result from compromised respirations; pectus carinatum (pigeon chest) is a minor structural variation. nurs 6512 week 6 midterm exam.

Question 5

2 out of 2 points

Response Feedback:

A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one s chance of a similar occurrence.

Question 6

2 out of 2 points

Which two structures together form the primary muscle mass of the heart?

Response Feedback:

The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atrium pumps blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria.

Question 7

2 out of 2 points

In pregnancy, blood pressure is at its nadir at:

Response Feedback:

Nadir is the lowest measured value. In pregnancy, the lowest level of blood pressure occurs in the second trimester (16 to 20 weeks). nurs 6512 week 6 midterm exam.

Question 8

0 out of 2 points

Closure of the ductus arteriosus usually occurs:

Correct answer: 24 to 48 hours after birth

Question 9

2 out of 2 points

The pregnant woman is expected to develop:

Response Feedback:

In the pregnant woman, tidal volume and vital capacity increase, functional residual capacity decreases, and she breathes more deeply but not more frequently.

Question 10

2 out of 2 points

When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear while healthy lung tissue produces softer sounds. This is because:

Response Feedback:

Air is a poor conductor of sound whereas more dense consolidation promotes louder sounds and is a better conductor of sound.

Question 11

2 out of 2 points

Normal cardiac changes that occur during pregnancy include:

Response Feedback:

Question 12

2 out of 2 points

Which arterial pulse is most useful in evaluating heart activity?

Response Feedback:

Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.

Question 13

0 out of 2 points

Which of the following statements is true regarding the examination of peripheral arteries?

Correct answer: the pulses are most readily felt on arteries that lie over bones

Question 14

0 out of 2 points

Which dysrhythmia is a physiologic event during childhood?

Correct answer: Sinus Arrhythmia

Question 15

0 out of 2 points

The earliest sign of heart failure in an infant is frequently:

Correct answer: Liver enlargement

Question 16

2 out of 2 points

The major heart sounds are normally created by:

Response Feedback:

At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 lub. When the pressure in the ventricles falls, when the ventricles are almost empty, below that of the aorta and pulmonary artery, the aortic and pulmonic valves close, producing the second heart sound S2 dub. Valve opening is usually a silent event.

Question 17

0 out of 2 points

The American Thoracic Society suggests replacing the term rales with:

Correct Answer: Crackles

Question 18

0 out of 2 points

During chest assessment, you note the patient s voice quality while you are auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and e s sound like a s. This sound described is called:

Correct answer: Egophony

Question 19
0 out of 2 points

The carotid pulse should coincide with which heart sound? nurs 6512 week 6 midterm exam.

Correct answer: S1

Question 20

0 out of 2 points

On a CXR, which of the following is true of the diaphragm?

Correct answer: The right diaphragm is usually higher

On a CXR, which of the following is true of the diaphragm?

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Question 2

2 out of 2 points

A condition that is likely to present with dizziness and fainting is:

Response Feedback:

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 fainting, 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. Hyperlipidemia is a risk factor for myocardial infarction that commonly presents with chest pain. nurs 6512 week 6 midterm exam.

Question 3

2 out of 2 points

To hear diastolic heart sounds, you should ask patients to:

Response Feedback:

Left lateral recumbent is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. Right lateral recumbent position is the best position for evaluating right rotated heart of dextrocardia.

Question 4

2 out of 2 points

The patient tells you that she uses herbal and other alternative therapies to maintain health. This information will be recorded in the:

Response Feedback:

Patient data concerning the use of herbal or other remedies and other complementary or alternative therapies are recorded within the social history component of the history and physical.

Question 5

0 out of 2 points

Normal heart sounds are best heard:

Question 6

2 out of 2 points

The carotid pulse should coincide with which heart sound?

Response Feedback:

S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound. nurs 6512 week 6 midterm exam.

Question 7

2 out of 2 points

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:

Response Feedback:

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. Cardiomyopathy is the deterioration of heart muscle function. 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.

Question 8

0 out of 2 points

Ms. R., age 74, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with intrathoracic infection?

Question 9

2 out of 2 points

In what position can the mediastinal crunch (Hamman sign) be heard best?

Response Feedback:

Hamman sign occurs with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side (these maneuvers bring the heart muscle closer to the chest wall).

Question 10

2 out of 2 points

Expected respiratory changes of normal aging include:

Response Feedback:

Question 11

2 out of 2 points

The major heart sounds are normally created by:

Response Feedback:

Question 12

2 out of 2 points

Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:

Response Feedback:

The breath smell described as ammonia-like suggests uremia, a renal condition; cinnamon suggests tuberculosis; musty fish or clover suggests hepatic failure; sweet and fruity suggests diabetic ketoacidosis; and foul or feculent suggests intestinal obstruction.

Question 13

2 out of 2 points

The respiratory rate of a sleeping newborn is expected to range from _____ breaths per minute.

Response Feedback:

The expected respiratory rate for infants is from 40 to 60 breaths per minute. nurs 6512 week 6 midterm exam.

Question 14

2 out of 2 points

Chest pain in a child with an organic cause is more likely the result of:

Response Feedback:

Unlike chest pain in adults, children and adolescents seldom are caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use.

Question 15

2 out of 2 points

Which of the following information belongs in the past medical history section related to heart and blood vessel assessment?

Response Feedback:

Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage.

Question 16

2 out of 2 points

In which patient situation would you expect to assess tachypnea?

Response Feedback:

In metabolic acidosis, the body compensates by increasing the respiratory rate in order to blow off the excess carbon dioxide. The other choices cause respiratory depression.

Question 17

2 out of 2 points

The American Thoracic Society suggests replacing the term rales with:

Response Feedback:

The term rales is suggested to be replaced with crackles in order for the term to more precisely describe the sound.

Question 18

2 out of 2 points

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the: nurs 6512 week 6 midterm exam.

Response Feedback:

The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to initiation of stimulation of the ventricles. The T wave is the return of stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave.

Question 19

2 out of 2 points

Contraction of the ventricles causes:

Response Feedback:

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. nurs 6512 week 6 midterm exam.

Question 20

0 out of 2 points

Closure of the ductus arteriosus usually occurs: