Test Bank For Advanced Health Assessment & Clinical Diagnosis in Primary Care 5th Edition by Joyce E. Dains

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Advanced Health Assessment & Clinical Diagnosis in Primary Care 5th Edition by Joyce E. Dains – Test Bank

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Sample Questions 

 

Chapter 4: Affective Changes

MULTIPLE CHOICE

  1. When performing a physical assessment, the first technique the nurse will

always use is:                                                                                                                         

a

.          Palpation.

b

.          Inspection.

d

.          Auscultation.

ANS: B

The skills requisite for the physical examination are inspection, palpation, percussion, and auscultation. The skills are performed one at a time and in this order (with the exception of the abdominal assessment, during which auscultation takes place before palpation and percussion). The assessment of each body system begins with inspection. A focused inspection takes time  and yields a surprising amount of information.

  1. The nurse is preparing to perform a physical Which statement

is true about the physical assessment? The inspection phase:                                              

a

.          Usually yields little information.

b

.          Takes time and reveals a surprising amount of information.

  1. Maybe somewhat uncomfortable for the expert practitioner.

 

d

.

ANS: B

Requires a quick glance at the patients body systems before proceeding with palpation.

 

A focused inspection takes time and yields a surprising amount of information. Initially, the examiner may feel uncomfortable, staring at the person without also doing something. A focused assessment is significantly more than a  quick glance.

  1. The nurse is assessing a patients skin during an office What part of the hand and technique should be used to best assess the patients skin

temperature?                                                                                                                          

a

.          Fingertips; they are more sensitive to small changes in temperature.

b

.          Dorsal surface of the hand; the skin is thinner on this surface than on the palms.

 

Ulnar portion of the hand; increased blood supply in this area enhances temperatur

 

c.

d

.

ANS: B

sensitivity.

Palmar surface of the hand; this surface is the most sensitive to temperature variations because of its increased nerve supply in this area.

 

The dorsa (backs) of the hands and fingers are best for determining temperature because the skin is thinner on the dorsal surfaces than on the palms. Fingertips are best for fine, tactile discrimination. The other responses are not useful for palpation.

  1. Which of these techniques uses the sense of touch to assess texture,

temperature, moisture, and swelling when the nurse is assessing a patient?                        

a

.          Palpation

b

.          Inspection

  1. Percussion

d

.          Auscultation

ANS: A

Palpation uses the sense of touch to assess the patient for these factors. Inspection involves vision; percussion assesses through the use of palpable vibrations and audible sounds; and auscultation uses the sense of hearing.

  1. The nurse is preparing to assess a patients abdomen by palpation. How

should the nurse proceed?                                                                                                     

  • Palpation of reportedly tender areas are avoided because palpation in these areas

.          may cause pain.

  • Palpating a tender area is quickly performed to avoid any discomfort that the patien

 

.

 

  1. d

.

ANS: D

may experience.

The assessment begins with deep palpation, while encouraging the patient to relax and to take deep breaths.

The assessment begins with light palpation to detect surface characteristics and to accustom the patient to being touched.

 

Light palpation is initially performed to detect any surface characteristics and to accustom the person to being touched. Tender areas should be palpated last, not first.

  1. The nurse would use bimanual palpation technique in which situation? a           Palpating the thorax of an infant

 

.

b

.          Palpating the kidneys and uterus

  1. Assessingpulsations and vibrations

d

.          Assessing the presence of tenderness and pain

ANS: B

Bimanual palpation requires the use of both hands to envelop or capture certain body parts or organs such as the kidneys, uterus, or adnexa. The other situations are not appropriate for bimanual palpation.

  1. The nurse is preparing to percuss the abdomen of a The purpose of

 

the percussion is to assess the

a

.          Turgor

b

.          Texture

  1. Density

d

.          Consistency

ANS: C

of the underlying tissue.

 

Percussion yields a sound that depicts the location, size, and density of the underlying organ. Turgor and texture are assessed with palpation.

  1. The nurse is reviewing percussion techniques with a newly graduated Which technique, if used by the new nurse, indicates that more review

is needed?                                                                                                                              

a

.          Percussing once over each area

b

.          Quickly lifting the striking finger after each stroke

  1. Strikingwith the fingertip, not the finger pad

d

.          Using the wrist to make the strikes, not the arm

ANS: A

For percussion, the nurse should percuss two times over each location. The striking finger should be quickly lifted because a resting finger damps off vibrations. The tip of the striking finger should make contact, not the pad of the finger. The wrist must be relaxed and is used to make the strikes, not the arm.

 

  1. When percussing over the liver of a patient, the nurse notices a dull

The nurse should:                                                                                                                   

a

.          Consider this a normal finding.

b

.          Palpate this area for an underlying mass.

  1. Repositionthe hands, and attempt to percuss in this area

d

.          Consider this finding as abnormal, and refer the patient for additional treatment.

ANS: A

Percussion over relatively dense organs, such as the liver or spleen, will produce a dull sound. The other responses are not correct.

  1. The nurse is unable to identify any changes in sound when percussing

over the abdomen of an obese patient. What should the nurse do next?                              

a

.          Ask the patient to take deep breaths to relax the abdominal musculature.

b

.          Consider this finding as normal, and proceed with the abdominal assessment.

  1. Increase theamount of strength used when attempting to percuss over the abdome

d

.          Decrease the amount of strength used when attempting to percuss over the abdom

ANS: C

The thickness of the persons body wall will be a factor. The nurse needs a stronger percussion stroke for persons with obese or very muscular body walls. The force of the blow determines the loudness of the note. The other actions are not correct.

  1. The nurse hears bilateral loud, long, and low tones when percussing over

the lungs of a 4-year-old child. The nurse should:                                                                  

a

.          Palpate over the area for increased pain and tenderness.

b

.          Ask the child to take shallow breaths, and percuss over the area again.

  1. Immediatelyrefer the child because of an increased amount of air in the lungs.

d

.          Consider this finding as normal for a child this age, and proceed with the examinati

ANS: D

Percussion notes that are loud in amplitude, low in pitch, of a booming quality, and long in duration are normal over a childs lung.

 

  1. A patient has suddenly developed shortness of breath and appears to be in significant respiratory After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take

when further assessing the patient?                                                                                       

a

.          Count the patients respirations.

b

.          Bilaterally percuss the thorax, noting any differences in percussion tones.

  1. Callfor a chest x-ray study, and wait for the results before beginning an assessme

d

.          Inspect the thorax for any new masses and bleeding associated with respirations.

ANS: B

Percussion is always available, portable, and offers instant feedback regarding changes in underlying tissue density, which may yield clues of the patients physical status.

  1. The nurse is teaching a class on basic assessment Which of these

statements is true regarding the stethoscope and its use?                                                    

a

.          Slope of the earpieces should point posteriorly (toward the occiput).

b         Although the stethoscope does not magnify sound, it does block out extraneous ro

.          noise.

  1. Fitand quality of the stethoscope are not as important as its ability to magnify soun

d

.          Ideal tubing length should be 22 inches to dampen the distortion of sound.

ANS: B

The stethoscope does not magnify sound, but it does block out extraneous room sounds. The slope of the earpieces should point forward toward the examiners nose. Long tubing will distort sound. The fit and quality of the stethoscope are both important.

  1. The nurse is preparing to use a stethoscope for Which statement is true regarding the diaphragm of the stethoscope? The

diaphragm:                                                                                                                              

a

.          Is used to listen for high-pitched sounds.

b

.          Is used to listen for low-pitched sounds.

  1. Should belightly held against the persons skin to block out low-pitched sounds.

d         Should be lightly held against the persons skin to listen for extra heart sounds and

.          murmurs.

 

ANS: A

The diaphragm of the stethoscope is best for listening to high-pitched sounds such as breath, bowel, and normal heart sounds. It should be firmly held against the persons skin, firmly enough to leave a ring. The bell of the stethoscope is best for soft, low-pitched sounds such as extra heart sounds or murmurs.

  1. Before auscultating the abdomen for the presence of bowel sounds on a

patient, the nurse should:                                                                                                       

a

.          Warm the endpiece of the stethoscope by placing it in warm water.

b         Leave the gown on the patient to ensure that he or she does not get chilled during

.          examination.

  1. Ensure thatthe bell side of the stethoscope is turned to the on position.

 

d

.

ANS: D

Check the temperature of the room, and offer blankets to the patient if he or she fe cold.

 

The examination room should be warm. If the patient shivers, then the involuntary muscle contractions can make it difficult to hear the underlying sounds. The end of the stethoscope should be warmed between the examiners hands, not with water. The nurse should never listen through a gown. The diaphragm of the stethoscope should be used to auscultate for bowel sounds.

  1. The nurse will use which technique of assessment to determine the

presence of crepitus, swelling, and pulsations?                                                                     

a

.          Palpation

b

.          Inspection

  1. Percussion

d

.          Auscultation

ANS: A

Palpation applies the sense of touch to assess texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and the presence of tenderness or pain.

  1. The nurse is preparing to use an otoscope for an examination. Which

statement is true regarding the otoscope? The otoscope:                                                      

a         Is often used to direct light onto the sinuses.

 

.

b

.          Uses a short, broad speculum to help visualize the ear.

  1. Isused to examine the structures of the internal ear.

d

.          Directs light into the ear canal and onto the tympanic membrane.

ANS: D

The otoscope directs light into the ear canal and onto the tympanic membrane that divides the external and middle ear. A short, broad speculum is used to visualize the nares.

  1. An examiner is using an ophthalmoscope to examine a patients The patient has astigmatism and is nearsighted. The use of which of these

techniques would indicate that the examination is being correctly performed?                      

a

.          Using the large full circle of light when assessing pupils that are not dilated

b

.          Rotating the lens selector dial to the black numbers to compensate for astigmatism

  1. Usingthe grid on the lens aperture dial to visualize the external structures of the ey

d

.          Rotating the lens selector dial to bring the object into focus

ANS: D

The ophthalmoscope is used to examine the internal eye structures. It can compensate for nearsightedness or farsightedness, but it will not correct for astigmatism. The grid is used to assess size and location of lesions on the fundus. The large full spot of light is used to assess dilated pupils. Rotating the lens selector dial brings the object into focus.

  1. The nurse is unable to palpate the right radial pulse on a The best

action would be to:                                                                                                                  

a

.          Auscultate over the area with a fetoscope.

b

.          Use a goniometer to measure the pulsations.

  1. Usea Doppler device to check for pulsations over the area.

d

.          Check for the presence of pulsations with a stethoscope.

ANS: C

Doppler devices are used to augment pulse or blood pressure measurements. Goniometers measure joint range of motion. A fetoscope is used to auscultate

 

fetal heart tones. Stethoscopes are used to auscultate breath, bowel, and heart sounds.

  1. The nurse is preparing to perform a physical The correct

action by the nurse is reflected by which statement? The nurse:                                           

a

.          Performs the examination from the left side of the bed.

b

.          Examines tender or painful areas first to help relieve the patients anxiety.

  1. Followsthe same examination sequence, regardless of the patients age or conditio

d         Organizes the assessment to ensure that the patient does not change positions too

 

.

ANS: D

often.

 

The steps of the assessment should be organized to ensure that the patient does not change positions too often. The sequence of the steps of the assessment may differ, depending on the age of the person and the examiners preference. Tender or painful areas should be assessed last.

  1. A man is at the clinic for a physical He states that he is very anxious about the physical examination. What steps can the nurse take to

make him more comfortable?                                                                                                 

a

.          Appear unhurried and confident when examining him.

b

.          Stay in the room when he undresses in case he needs assistance.

  1. Askhim to change into an examining gown and to take off his undergarments.

 

d

.

ANS: A

Defer measuring vital signs until the end of the examination, which allows him time become comfortable.

 

Anxiety can be reduced by an examiner who is confident, self-assured, considerate, and unhurried. Familiar and relatively nonthreatening actions, such as measuring the persons vital signs, will gradually accustom the person to the examination.

  1. When performing a physical examination, safety must be considered to protect the examiner and the patient against the spread of infection. Which of these statements describes the most appropriate action the nurse should take

when performing a physical examination?                                                                              

a         Washing ones hands after removing gloves is not necessary, as long as the gloves

.          are still intact.

b

.          Hands are washed before and after every physical patient encounter.

 

Hands are washed before the examination of each body system to prevent the spre

 

c.

d

.

ANS: B

of bacteria from one part of the body to another.

Gloves are worn throughout the entire examination to demonstrate to the patient concern regarding the spread of infectious diseases.

 

The nurse should wash his or her hands before and after every physical patient encounter; after contact with blood, body fluids, secretions, and excretions; after contact with any equipment contaminated with body fluids; and after removing gloves. Hands should be washed after gloves have been removed, even if the gloves appear to be intact. Gloves should be worn when potential contact with any body fluids is present.

  1. The nurse is examining a patients lower leg and notices a draining

ulceration. Which of these actions is most appropriate in this situation?                                

a

.          Washing hands, and contacting the physician

b

.          Continuing to examine the ulceration, and then washing hands

Washing hands, putting on gloves, and continuing with the examination of the

  1. ulceration

d         Washing hands, proceeding with rest of the physical examination, and then continu

 

.

ANS: C

with the examination of the leg ulceration

 

The examiner should wear gloves when the potential contact with any body fluids is present. In this situation, the nurse should wash his or her hands, put on gloves, and continue examining the ulceration.

  1. During the examination, offering some brief teaching about the patients body or the examiners findings is often Which one of these

statements by the nurse is most appropriate?                                                                        

a

.          Your atrial dysrhythmias are under control.

b

.          You have pitting edema and mild varicosities.

  1. Yourpulse is 80 beats per minute, which is within the normal range.

d

.          Im using my stethoscope to listen for any crackles, wheezes, or rubs.

ANS: C

The sharing of some information builds rapport, as long as the patient is able to understand the terminology.

 

  1. The nurse keeps in mind that the most important reason to share information and to offer brief teaching while performing the physical

examination is to help the:                                                                                                      

a

.          Examiner feel more comfortable and to gain control of the situation.

b

.          Examiner to build rapport and to increase the patients confidence in him or her.

  1. Patientunderstand his or her disease process and treatment modalities.

d         Patient identify questions about his or her disease and the potential areas of patien

 

.

ANS: B

education.

 

Sharing information builds rapport and increases the patients confidence in the examiner. It also gives the patient a little more control in a situation during which feeling completely helpless is often present.

 

Chapter 6. Breasts lumps and nipple discharge

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

 

  1. Your patient has a rubbery, firm, mobile breast mass. In order to completely exclude the possibility of cancer, the triple test is necessary, which includes:
A

.

CT scan
B. MRI
C. Biopsy
D

.

All of the above

 

 

                     2.

A 23-year-old woman is concerned about a mass she found on palpation. Upon examination of the patient, the mass

 

feels cystic, round, and mobile with discrete borders. The diagnostic study that is recommended is:

A

.

CT scan
B. Mammogram
C. Biopsy
D

.

Ultrasound

 

 

                     3.

Which of the following variables is not a component of the Gail Model?

 

A

.

Age at menarche
B. Number of breast biopsies
C. Age at first live birth
D

.

Number of live births

 

 

                     4.

A 62-year-old female presents with a singular, hard, 1 cm, non-tender, non-mobile mass in the right breast. There are

 

no nipple or skin changes, however, you palpate an enlarged right-sided supraclavicular lymph node. The clinician should recognize these are signs of:

A

.

Fibroadenoma
B. Breast cyst
C. Malignancy
D

.

Paget’s disease

 

 

                     5.

A 45-year-old female patient presents in the emergency department due to multiple chest injuries as a result of a motor

 

vehicle accident. There is a palpable, tender, irregular 3 cm soft mass located in the left breast, with erythema and swelling of the breast. Which of the following is indicated?

A. Compression wrap for chest and breast trauma
B. Mammogram
C. Re-evaluation following complete resolution of obvious injuries
D. Ultrasound

 

 

  1. Your patient is a 46-year-old woman suffering from psychosis complains of milky discharge from both her breasts. Upon examination, there are no significant findings and the patient is not pregnant, breastfeeding, or in the postpartum period. You should:
A. Order CT scan of head to rule out pituitary tumor
B. Obtain a complete list of the patient’s medications
C. Have the patient keep a menstrual cycle diary
D. Refer the patient for mammogram

 

                     7..            Your patient is a 36-year-old woman who complains of milky discharge from both her breasts, episodes of headache, and menstrual irregularity. The patient is on no medications. Upon examination, there are no significant findings, and the patient is not pregnant, breastfeeding, or in the postpartum period. It is important to:

A

.

Order prolactin level
B. Obtain an MRI of head
C. Have the patient keep a menstrual cycle diary
D

.

Refer the patient for mammogram

 

 

                     8.

Bloody breast discharge is associated with which of the following?

 

A

.

Bleeding disorder such as von Willebrand disease
B. Malignancy
C. Excessive non-steroidal anti-inflammatories
D

.

A and C

 

 

                     9.

Your patient is a 64-year-old female who presents with complaints of a red, scaly rash on her nipple and areola of one

 

breast. It has been present for a few months. There is no mass or nipple discharge. You should be suspicious of:

A

.

Contact dermatitis
B. Mastitis
C. Paget’s disease
D

.

Eczema

 

 

                     10.

A 12-year-old boy is brought into the clinic by his mother. The teen boy is embarrassed because he has developed

 

breast tissue and would like to know if there is any treatment. The physical examination reveals early stages of puberty, otherwise it is normal. This presentation is:

A. Associated with a high rate of malignancy
B. Most often due to altered hormonal levels in puberty
C. Commonly indicative of pituitary tumor triggered by puberty
D. Too dense for a mammogram and requires biopsy

 

 

                     11

A condition that increases risk of breast cancer in a male is:

 

A

.

Pseudogynecomastia
B. BRCA1 and 2
C. Klinefelter’s syndrome
D

.

B and C

 

        Chapter 6. Breasts lumps and nipple discharge Answer Section

 

MULTIPLE CHOICE

 

 

PTS: 1
1. ANS: C

Palpation and mammography, alone or together, are inadequate to definitively identify the cause of a breast mass and to rule out malignancy. The “triple test” recommended for evaluation of a breast mass involves clinical examination, either ultrasound or mammogram, and aspiration and/or biopsy. The determination of whether an ultrasound or mammography is recommended is based on age and other situations.

 

PTS: 1
2. ANS: D

The American College of Radiology (2012) recommends that women under 40 years of age should be assessed through ultrasound, and women who are older than 40 years should be assessed with a mammogram. Younger women have denser

 

breasts, and ultrasound is, therefore, often more useful than a mammogram. Ultrasounds are helpful in determining whether or   not a mass that feels potentially “cystic” is fluid filled or solid. It is crucial that the woman understand that the imaging procedure is a screening tool and is never diagnostic regarding the existence or absence of a malignancy.

 

PTS: 1
3. ANS: D

The Gail model is a clinical prediction rule used to estimate a patient’s risk for breast cancer. The model identifies the relative risk associated with three factors obtained through history: age at menarche, number of previous breast biopsies, and the age at first live birth.

 

PTS: 1
4. ANS: C

The typical malignant breast mass is solitary, non-tender, hard, immobile or fixed, and poorly defined. It may be accompanied by nipple erosion or other inflammatory skin changes, as seen in Paget’s disease; nipple discharge; skin thickening or dimpling; retraction; and palpable axillary nodes. Although most malignant masses are painless, associated discomfort does not exclude the potential for breast cancer.

 

PTS: 1
5. ANS: B

Trauma to the anterior chest area may result in a palpable breast mass. An automobile accident with injury from contact with the seat belt, air bag, steering wheel, or dashboard is a common source of breast trauma. When a palpable mass results from chest trauma, it typically represents either a hematoma or area of secondary fat necrosis. Even when a mass is identified subsequent to direct trauma, the provider must remain suspicious for the possibility of malignancy that preexisted but was undetected before the accident.

 

PTS: 1
6. ANS: B

Galactorrhea is characterized by bilateral and milky discharge from multiple ducts in a woman who is neither pregnant nor lactating. Causes of galactorrhea include a variety of drugs as well as an elevated prolactin level associated with pituitary tumor  or hyperthyroidism. The drugs associated with galactorrhea include antidepressants (amitriptyline, imipramine), psychoactives (haloperidol, thioridazine), hormones (estrogens, progestogens), antiepileptics (valproic acid), and antihypertensives (verapamil). This list is not exhaustive.

 

PTS: 1
7. ANS: A

Galactorrhea can be a symptom of endocrine disorder, particularly pituitary dysfunction. In prolactinoma of the pituitary, a patient complains of galactorrhea, headaches, vision change, relative infertility, and amenorrhea. Laboratory studies should include a pregnancy test, prolactin level, and thyroid functions.

 

PTS: 1
8. ANS: B

Bloody discharge is often associated with malignancy but can stem from other conditions. If blood is not evident, the discharge should be tested for blood, using guaiac process.

 

PTS: 1
9 ANS: C

In Paget’s disease of the breast, the patient may describe the persistence of skin changes for several months. The typical presentation involves skin changes of the nipple and/or areola, with the nipple being involved first. The condition does not always involve a palpable mass or nodule. The skin changes of the nipple and areola range from scaling redness to various degrees of ulceration.

 

PTS: 1
10. ANS: B

Gynecomastia most often occurs during infancy, puberty, and senescence. It is caused by an altered balance between estradiol and testosterone levels. Although it can be an indication of primary hypogonadism, hyperthyroidism, cirrhosis, or renal disease, the majority of the cases are specific to hormonal changes of puberty, are drug induced, or are idiopathic. With the presentation of breast enlargement in a male, malignancy must always be considered.

 

PTS: 1
11 ANS: D

 

It is anticipated that over 2,000 new cases of male breast cancer will be diagnosed in 2013, with over 400 related deaths (ACS 2013). Men develop the same types of breast cancer as women. Therefore, it is important to include malignancy in the differential diagnosis when a man complains of breast enlargement. Factors that increase the risk of breast cancer in men include a previous history of breast or testicular disease and Klinefelter’s syndrome. A history of gynecomastia is not associated with an increased risk for breast cancer.

Chapter 11: Cough

 

  1. A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for hypertension. On physical examination, vital signs are 98 degrees, 18 resps/ min, pulse 56, and BP 100/60. Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These signs and symptoms are characteristic of:
A

.

Chronic renal failure
B. Congestive heart failure
C. Metabolic syndrome
D

.

Liver failure

 

ANS:         B

CHF, commonly occurring in the elderly or in patients with past myocardial infarctions or cardiomyopathy, can often present with complaints of fatigue, decreased activity tolerance, and/or shortness of breath. A patient with a history of hypertension and hyperlipidemia indicates cardiovascular disease that predisposes to heart failure with age. The signs of heart failure include cough, shortness of breath with exertion, S3 and S4 heart sounds, pulmonary crackles, ascites, hepatomegaly and ankle edema.

 

 

  1. A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion, shortness of breath, chronic cough, and On physical examination, patient shows barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields. Heart has regular rate and rhythm of 80 beats/min. Abdomen is obese and non- tender. Extremities show no significant findings. No neurological deficits. Arterial blood gases reveal acidosis. These signs and symptoms are characteristic of:
A

.

Congestive heart failure
B. Chronic obstructive pulmonary disease
C. Asthma
D

.

Lung cancer

 

 

ANS:         B

Chronic obstructive pulmonary disease, such as chronic asthma/bronchitis, bronchiolitis, and emphysema, may be associated with fatigue, shortness of breath, cough, and wheezing. The patient in the above scenario shows signs of chronic bronchitis and emphysema. Cough and cyanosis are caused by chronic bronchitis. Barrel-shaped chest and acidosis are caused by emphysema.

 

  1. A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated with rust-colored sputum, low-grade afternoon fevers, and night sweats for the past 2 The nurses preliminary analysis, based on this history, is that this patient may be suffering from:

a

.          Bronchitis.

b

.          Pneumonia.

  1. d

.          Pulmonary edema.

ANS: C

. Sputum is not diagnostic alone, but some conditions have characteristic sputum production. Tuberculosis often produces rust-colored sputum in addition to other symptoms of night sweats and low-grade afternoon fevers

  1. A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart Which of these findings is the nurse most likely to observe in this patient?

a

.          Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema

b

.          Rasping cough, thick mucoid sputum, wheezing, and bronchitis

  1. Productive cough, dyspnea, weight loss, anorexia, and tuberculosis d

.          Fever, dry nonproductive cough, and diminished breath sounds

ANS: A

  1. A person with heart failure often exhibits increased respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema, and pallor in light-skinned A patient with rasping cough, thick mucoid sputum, and wheezing may have bronchitis. Productive cough, dyspnea, weight loss, and dyspnea indicate tuberculosis; fever, dry nonproductive cough, and diminished breath sounds may indicate Pneumocystis jiroveci (P. carinii) pneumonia
  2. A patient comes to the clinic complaining of a cough that is worse at night but not as bad during the The nurse recognizes that this cough may indicate:

a

.          Pneumonia.

b

.          Postnasal drip or sinusitis.

  1. Exposure to irritants at d

.          Chronic bronchial irritation from smoking.

ANS: B

 

A cough that primarily occurs at night may indicate postnasal drip or sinusitis. Exposure to irritants at work causes an afternoon or evening cough. Smokers experience early morning coughing. Coughing associated with acute illnesses such as pneumonia is continuous throughout the day.

 

  1. During a morning assessment, the nurse notices that the patients sputum is frothy and Which condition could this finding indicate?

a

.          Croup

b

.          Tuberculosis

  1. Viral infection d

.          Pulmonary edema

ANS: D

Sputum, alone, is not diagnostic, but some conditions have characteristic sputum production. Pink, frothy sputum indicates pulmonary edema or it may be a side effect of sympathomimetic medications. Croup is associated with abarking cough, not sputum production. Tuberculosis may produce rust-colored sputum. Viral infections may produce white or clear mucoid sputum.

  1. A patient has been admitted to the emergency department with a possible medical diagnosis of pulmonary embolism. The nurse expects to see which assessment findings related to this condition?

a

.          Absent or decreased breath sounds

b

.          Productive cough with thin, frothy sputum

  1. Chest pain that is worse on deep inspiration and dyspnea d

.          Diffuse infiltrates with areas of dullness upon percussion

ANS: C

Findings for pulmonary embolism include chest pain that is worse on deep inspiration, dyspnea, apprehension, anxiety, restlessness, partial arterial pressure of oxygen (PaO2) less than 80 mm Hg, diaphoresis, hypotension, crackles, and wheezes.

  1. The nurse is auscultating the lungs of a patient who had been sleeping and notices short, popping, crackling sounds that stop after a few The nurse recognizes that these breath sounds are:

a

.          Atelectatic crackles that do not have a pathologic cause.

b

.          Fine crackles and may be a sign of pneumonia.

  1. Vesicular breath

 

d

.          Fine wheezes.

ANS: A

One type of adventitious sound, atelectatic crackles, does not have a pathologic cause. They are short, popping, crackling sounds that sound similar to fine crackles but do not last beyond a few breaths. When sections of alveoli are not fully aerated (as in people who are asleep or in older adults), they deflate slightly and accumulate secretions.

Crackles are heard when these sections are expanded by a few deep breaths. Atelectatic crackles are heard only in the periphery, usually in dependent portions of the lungs, and disappear after the first few breaths or after a cough.

 

Chapter 17. Fever

 

  1. Your healthcare provider will consider that you to have a fever if your temperature taken by mouth is:
  2. 98.7°F (37°C) B. 99°F (37.2°C) C. 99.5°F (37.5°C) D. 100.4°F (38°C)

The correct answer is D. 100.4°F (38°C).

If you have a temperature above your normal temperature but below 100.4, it’s called a low- grade fever. A low-grade fever is mild, and most healthcare providers don’t consider it to be of medical importance. Normal body temperature is 98.6, but that can vary by 1 to 2 degrees from person to person. Your normal temperature may also be lower in the early morning and higher in late afternoon. You can find your own normal temperature by taking it several times a day for several days—when you’re not sick.

2.  A child’s body temperature will show as the same number, no matter if it’s measured by mouth, in the armpit, or in the rectum.

True , False, Not sure

The correct answer is B. False.

A person’s temperature varies depending on how it’s taken. Check with your child’s healthcare provider to find out what temperature he or she considers a fever. Some providers say that a child is considered to have a fever if his or her temperature is 99.5°F (37.5°C) or higher by mouth, 99°F (37.2°C) or higher in the armpit, or 100.4°F (38°C) or higher in the rectum. If you use a thermometer that’s put in the ear (tympanic) or held near the forehead (temporal), ask your provider what temperature means a fever on that device.

3.  Infections from viruses or bacteria can cause fever. What else can cause fever?

  1. Cancer
  2. Surgery
  3. Some medicines
  4. All of the above

The correct answer is D. All of the above.

Fever is a common symptom of cancer, especially with a cancer that affects the immune system, or a blood cancer such as leukemia or lymphoma. Many people have a fever for a day or two after major surgery, with no sign of infection. This is called “postoperative fever.” And many medicines can cause a fever, such as pain medicines, diuretics, antiseizure medicines, sedatives, and antihistamines. Heatstroke is a life-threatening condition that happens when a person is exposed to high heat. It can happen if an adult or child is in a hot car or outside on a hot day with no shade. Other symptoms include hot skin, lack of sweat, and confusion or loss of consciousness. If a person has heatstroke, call 911. Move the person into shade and spray or shower them with water until help arrives.

4.  Some children can have a seizure caused by fever (febrile seizure). These are often harmless, and are most common in children ages:

  1. Newborn to 6 months
  2. 6 months to 5 years old
  3. 6 to 8 years old

 

  1. 11 to 14 years old

The correct answer is B. 6 months to 5 years old.

A febrile seizure is when a child with a fever loses consciousness and his or her arms and legs shake. A febrile seizure can last a few seconds, a minute or two, or as long as 15 minutes. They happen most often in children ages 6 months to 5 years who have a fever between 100°F (37.8°C) and 102°F (38.9°C). But they can happen with a fever of any level. A febrile seizure is more likely to happen with a temperature that rises quickly. A febrile seizure is most often harmless, and is not a sign of epilepsy. They can run in families. It can be scary if your child has a febrile seizure, but the best thing to do is stay calm and watch your child to help prevent injury. Don’t restrain your child. Instead, make sure he or she is lying safely on the floor or ground, and gently roll your child on his or her side. Don’t put anything in your child’s mouth. Get medical attention right away for any child who has a seizure.

5.  A baby 6 to 8 weeks old or younger who has a rectal temperature of 100.4°F (38°C) or higher should see a doctor right away.

T or F

The correct answer is A. True.

A fever of this temperature is considered a medical emergency. Take your baby to his or her doctor or to the emergency room right away. Don’t give your child any fever-reducing medicine unless your doctor tells you to do so. These medicines can mask symptoms that your provider wants to see to help with a diagnosis.

 

If your child is 8 weeks to 3 months old and has a fever of more than 101°F (38.3°C), you should see your doctor within the next several hours. Follow your doctor’s instructions for treating fever or being seen at an emergency room.

 

If a child has any of these symptoms, seek care for your child right away:

 

Fever of 104°F (40°C) or higher. Lethargy. This means your child is limp or unresponsive, or won’t make eye contact or interact with you. Irritableness. This goes beyond fussiness. It means that your child can’t be comforted and cries for extended periods of time.

Stiff neck or pain in the back of the neck along with a high fever. This may mean meningitis. Other symptoms of meningitis include vomiting, headache, and sensitivity to bright lights and loud noises.

  1. A person with a fever and chills should dress in warm clothes or stay in bed under lots of warm

T or F

The correct answer is B. False.

These things can raise a person’s body temperature by trapping body heat. Lightweight clothing and lightweight bed coverings are best. These allow body heat to escape and help to not raise a person’s temperature. If a person’s body temperature gets too high, it can cause serious  problems. In a child, it may cause a febrile seizure. In children and adults, it can cause damage to the brain and other organs.

  1. There are no medicines that can reduce a You just have to wait for a fever to go away on its own.

T or F

The correct answer is B. False.

 

Acetaminophen and ibuprofen can lower a fever in both children and adults. These medicines won’t make an illness that causes fever to go away, but they can help lessen the discomfort of a fever. Talk with your child’s doctor before giving any medicine. You should never give aspirin to a child.

  1. Eating or drinking just before taking your temperature doesn’t affect the reading of an oral

T or F

The correct answer is B. False.

Hot or cold food and drinks can affect the temperature reading in a person’s mouth. You should take your oral temperature at least 20 minutes after you eat or drink anything.

  1. A person under age 19 with a fever should never be given T or F

The correct answer is A. True.

When someone under age 19 with a fever is given aspirin, it can lead to a rare but very serious disease called Reye syndrome. Reye syndrome is a condition that causes pressure in the brain and fat to build up quickly in the liver and other organs. It only follows a viral infection, such a cold, the flu, or chickenpox. Taking aspirin can trigger it. Symptoms include vomiting, lethargy, confusion, convulsions, and loss of consciousness. It can cause coma and even death. Make sure to read all medicine labels to see if they contain aspirin. Look for the words acetylsalicylic acid or salicylate.

 

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