Splitting of the second heart sound (S2) is normally most pronounced during which of the following?Inhalation
In what space is the patient interview conducted by the clinician?Personal space
To minimize bony interference with percussion on the posterior chest wall, the practitioner should have the patient do which of the following?Raise his arms above his shoulders.
What change in the patient's respiratory breathing pattern is commonly seen with significant fever?More rapid rate
What two factors determine cardiac output?Stroke volume and heart rate
Your patient has an abnormal sensorium. Which of the following is most likely true?He is confused about where he is.
What term is used to describe difficult breathing in the reclining position?Orthopnea
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?Stridor
Which of the following changes in the characteristics of wheezing indicate improvement in airway obstruction following bronchodilator therapy?Lower pitch, shorter duration
Which of the following conditions would tend to shift the point of maximal impulse (PMI) farther to the left?II. Collapse of the left lower lobe IV. Right-sided tension pneumothorax
What is the technical term for secretions from the tracheobronchial tree that have not been contaminated by the mouth?Phlegm
What term is used to describe an abnormal anteroposterior curvature of the spine?Kyphosis
In patients with chronic respiratory disease, what does pedal edema indicate?Right ventricular failure
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?I. Central nervous system disorder II. Congestive heart failure
Which of the following is NOT a purpose of the interview?To identify plans for payment.
What is indicated by retractions?An increase in the work of breathing
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?Movement of excessive secretions in the airways.
Why should the respiratory therapist perform a blood pressure assessment fairly quickly?The procedure cuts off blood flow to the forearm temporarily.
What is indicated by the presence of central cyanosis?Respiratory failure
What artery is most often used to assess arterial blood pressure?Brachial
Which of the following is/are advantages of the digital blood pressure measurement devices?They reduce the risk of human error.
In auscultating the precordium of a patient, you hear a high-pitched “whooshing” noise occurring simultaneously with S1. This finding is most consistent with which of the following?Incompetent mitral valve
What breathing pattern is associated with severe atelectasis?Rapid and shallow
In which of the following disorders is digital clubbing a common physical sign?I. Congenital heart disease II. Lung cancer IV. Bronchiectasis
What breathing pattern is associated with diabetic ketoacidosis?Kussmaul breathing
Which of the following conditions is most likely to cause a dry, nonproductive cough?Pulmonary fibrosis
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?II. Right-sided lower pneumothorax. III. Right-sided lower pleural effusion. IV. Obstruction of a bronchus in the right lung.
A patient with asthma would tend to exhibit which of the following?Prolonged exhalation
During examination of a patient's extremities, you press firmly for a brief period on a fingernail. You observe that it takes about 5 seconds for the color to return to the nail bed. This finding is most consistent with which of the following?Reduction in cardiac output or poor peripheral perfusion.
All of the following are critical elements of a patient's past medical history except.Marital status
An increase in intensity and clarity of vocal resonance because of enhanced transmission of sound is referred to as which of the following?Bronchophony
Which of the following is TRUE of peripheral cyanosis?Sign of inadequate tissue perfusion.
What is the normal range for pulse pressure?30 to 40 mm Hg
Inspiratory crackles in patients without excess secretions are most commonly associated with which of the following?Airways popping open during inspiration
What does the presence of stridor indicate?Upper airway obstruction
The vibration created by percussion penetrates the lung to about what depth?5 to 7 cm
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?III. Pneumonia
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?Subcutaneous emphysema
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?II. Pleural effusion III. Pneumonia IV. Atelectasis
Diastolic murmurs are generally associated with which of the following?III. Incompetent semilunar valve IV. Stenotic atrioventricular valve
What is the normal range for systolic blood pressure in the adult patient?90 to 140 mm Hg
Which of the following terms is used to describe coughing up blood-streaked sputum?Hemoptysis
What is the most common cause of jugular venous distention (JVD)?Right-sided heart failure
In which of the following conditions might the intensity of the heart sounds be reduced?I. Heart failure II. Severe obesity III. Pneumothorax IV. Pleural effusion V. Pulmonary hyperinflation
What term is used to describe sputum that has pus in it?Purulent
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?II. Right-sided pleural effusion III. Atelectasis of the right lower lobe IV. Right lobar consolidation
Which of the following characteristics is least typical for pleuritic chest pain?Radiates to the arm
Which of the following is a common cause of pulsus paradoxus?Acute asthma attack
What disease is associated with a barrel chest?Emphysema
In auscultating the heart sounds of a patient with chronic hypoxemia, you notice a marked increase in the intensity of the second heart sound (S2) and no splitting during inhalation. This finding is most consistent with which of the following?Pulmonary hypertension
Adventitious Breath Sounds(abnormal Breath Sounds) Crackles/rales, Rhonchi, Wheeze, Pleural Friction Rub, Stridor, Diminished
Auscultation of the lungsListening for normal-abnormal breath sounds-listen over thorax-listen in sequence, deep inhale, passive exhale- all lobes, top to bottom, side to side-include lateral and anterior, assesses condition and response to therapy
bilateral chest expansioneven movement, but not 3-5 cm, caused by neuromuscular or COPD
Bronchial Breath Sounds(normal breath sounds) E = I Heard over sternum, trach and main stem bronchi, loud – high pitched
bronchophony(99 or 123 will be louder) increased intensity and clarity of vocal resonance, more tissue density than air (consolidation), easier to detect unilaterally, dull percussion, increased vocal fremitus
bronchovesicular breath sounds(normal breath sounds) moderate pitch, moderate intensity, around upper part of sternum between scapula and right apex, I=E
thorasic expansionnormal chest expands symmetrically in I, anterior=thumbs toward xiphoid process, posterior= thumbs toward T-8 on I, thumbs should move equally 3-5 cm on deep I
crackles/rales(adventitious BS) bubbling-crackling sounds, mainly on I, air flow through fluid, discontinuous-specific locations, does not clear with cough. caused by pulmonary edema, pneumonia, emphysema, atelectasis, pulmonary fibrosis
crepitussensation of crackling felt when palpated skin of subcutaneous emphysema
decrease tactile fermitisedecreased vibrations, caused by pleural effusion, fluid, pneumothorax
diminished breath sounds(adventitious BS) decreased breath sounds caused by end stage COPD or pneumothorax
Dullness(hyporesonance percussion sound) medium sound, more tissue than air, caused by atelectasis, consolidation, pleural effusion, pleural thickening, pulmonary edema
egophonyincreased consolidation, patient says “eee”= sounds like “aaa”
flatness(hyporesonance percussion sound) low volume more tissue than air, caused by massive pleural effusion, massive atelectasis, or pneumonectomy
Hyperresonance(percussion sound) loud, high pitched, produced over area with more air than tissue, caused by COPD, emphysema, pneumothorax, air filled stomach, asthma
Hyporesonance(percussion sound) decreased resonance caused by atelectasis, consolidation, pleural thickening, pleural effusion
Increased tactile fermitesincreased vibrations, caused by atelectasis, pneumonia, lung mass
Normal breath soundsvesicular, bronchial, bronchovesicular, tracheal
Palpationtouching the chest wall to evaluate underlying structure and function, evaluates vocal fremitus, estimate thoracic expansion and assesses skin ans subcutaneous tissue, hands on back, breath in, measures thoracic expansion, skin=temp, damp, cool, dry etc.
Percussiontapping on surface to evaluate underlying structure, vibrations and sound help to evaluate lung structure, produces 5 sounds, hyperresonance and tympani, resonance, hyporesonance-dullness &flatness.
Pleural Effusiondecreased vibrations (tactile fremitus) dullness-medium-more tissue than air, caused by abnormal collection of fluid in the plural space
Pleural Friction Rub(adventitious BS) clicking or grating sound caused by friction of the parietal and visceral rubbing, very painful heard on I & E, caused by pleural effusion and pleurisy
Pneumoniainflammation of the lung parincima, usually caused by infection
Pneumothoraxair in the plural space
resonance(percussion sound) low pitch, equal air and tissue, normal lung tissue
Rhonchi(adventitious BS) ruble sound, fluid filled large airways heard on E, clears with cough, caused by asthma, emphysema, mucus plug, stenosis
strider(adventitious BS) DO NOT NEED A STETHOSCOPE TO HEAR, barking sound on I, heard when upper airways are constricted, caused by croup, epiglottis, post extubation
subcutaneous emphysemaair leaks from lung into subcutaneous tissue, fine bubbles produce crackling sensation when palpated, sensation produced is called cepitus
Tactile FremitisFremitus (voice vibrations)that can be felt. increased by solids like consolidation and atelectasis, decreased by obesity, pneumothorax, emphysema, COPD
Tracheal Breath Sounds(normal breath sounds) High pitch, loud intensity, harsh, located over trachea, I & E equal or E may be slightly longer
Tracheal Positioningthumbs on ea side of trachea-look for shift, away from affected side=tension pneumothorax, large pleural effusion, massive atelectasis. toward affected side= atelectasis, spontaneous pneumothorax
Tympani(hyperresonance percussion sound) drum like sound (tinny) caused by tension pneumothorax
Unilateral reduction in chest expansionNot evenly reduced, caused by atelectasis, pneumothorax, pleural effusion
vesicular breath sounds(normal breath sounds) low pitch, soft intensity-gentle, peripheral lung areas, longer I, clear sounds
vocal fremitusvibrations created by the vocal cords during speech
tactile fremitusfremitus that can be felt
wheeze(adventitious BS) Rhonchi (rumble) with musical tone, constricted airways, mainly on E, does not clear with cough, caused by asthma and CHF
Whispering Pectoriloquy(99 or 123) normal lung sounds muffled, consolidation sounds clear