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NUR314 - Health Assessment - Exam 2

Ch 13 - Head, Face and Neck, Including Regional Lymphatics Ch 16 - Nose, Mouth and Throat Ch 18 - Thorax and Lungs Ch 19 - Ch 20 -
STUDY
PLAY
Ch 13:
Bleeding into the periosteum during birth is known as:

A) caput succedaneum.
B) craniosynostosis.
C) molding.
D) cephalhematoma.
D) cephalhematoma.

A cephalhematoma is a subperiosteal hemorrhage resulting from birth trauma. A caput succedaneum is edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma. Craniosynostosis is marked asymmetry caused by a severe deformity caused by premature closure of the sutures resulted in a long, narrow head. Molding of the cranial bones during passage through the birth canal makes the head asymmetric and ridges more prominent.
Ch 13:
Craniosynostosis is a severe deformity caused by:

A) premature closure of the sutures.
B) increased intracranial pressure.
C) a localized bone disease that softens, thickens, and deforms bone.
D) excess growth hormone or a deficit in thyroid hormone.
A) premature closure of the sutures.

Craniosynostosis is marked asymmetry caused by a severe deformity caused by premature closure of the sutures resulting in a long, narrow head. Hydrocephalus (obstruction of drainage of cerebrospinal fluid) results in excessive accumulation of cerebrospinal fluid, increasing intracranial pressure, and enlargement of the head. Paget disease (osteitis deformans) is a localized bone disease of unknown etiology that softens, thickens, and deforms bone. Acromegaly results from excessive secretion of growth hormone from the pituitary after puberty. Congenital hypothyroidism and myxedema are caused by thyroid hormone deficiency.
Ch 13:
Narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are characteristic of:

A) Down syndrome.
B) fetal alcohol syndrome.
C) chronic childhood allergies.
D) congenital hypothyroidism.
B) fetal alcohol syndrome.

Facial characteristics of fetal alcohol syndrome include narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia. Facial characteristics of Down syndrome include upslanting eyes with inner epicanthal folds, flat nasal bridge, small broad flat nose, protruding thick tongue, and ear dysplasia. Facial characteristics of chronic allergies include exhausted face, blue shadows below the eyes, double or single crease on the lower eyelids, central facial pallor, open mouth breathing (malocclusion of the teeth and malformed jaw), and a transverse line on the nose. Facial characteristics of congenital hypothyroidism include low hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open mouth, and a dull expression.
Ch 13:
Kyphosis of the spine is common with aging. To compensate, older adults will:

A) increase their center of gravity.
B) extend their heads and jaws forward.
C) stiffen their gait.
D) shuffle.
B) extend their heads and jaws forward.

The older adult may show an increased anterior cervical (concave or inward) curve when the head and jaw are extended forward to compensate for kyphosis of the spine.
Ch 13:
Which statement is accurate related to aggravating symptoms or triggers of headaches?

A) Alcohol consumption may precipitate the onset of cluster or migraine headaches.
B) Certain foods such as chocolate or cheese may precipitate the onset of tension headaches.
C) Premenstrual hormonal fluctuations may precipitate the onset of cluster headaches.
D) Poor posture may trigger a migraine headache.
A) Alcohol consumption may precipitate the onset of cluster or migraine headaches.

Aggravating symptoms or triggers for cluster headaches include alcohol consumption, stress, or wind or heat exposure. Aggravating symptoms or triggers for migraines include hormonal fluctuations, certain foods, letdown after stress, changes in sleep pattern, sensory stimuli, and changes in weather or physical activity. Aggravating symptoms or triggers for tension headaches include stress anxiety, depression, poor posture.
Ch 13:
Most facial bones articulate at a suture. Which facial bone articulates at a joint?

A) Nasal bone
B) Mandible
C) Zygomatic bone
D) Maxilla
B) Mandible

The facial bones articulate at sutures (nasal bone, zygomatic bone, and maxilla), except for the mandible. The mandible articulates at the temporomandibular joint.
Ch 13:
A severe deficiency of thyroid hormone leading to nonpitting edema, coarse facial features, dry skin, and dry coarse hair is known as:

A) congenital hypothyroidism.
B) scleroderma.
C) myxedema.
D) Hashimoto thyroiditis.
C) myxedema.

Myxedema (hypothyroidism) is a deficiency of thyroid hormone. If severe, the symptoms include nonpitting edema or myxedema; a puffy edematous face, especially around eyes (periorbital edema); coarse facial features; dry skin; and dry, coarse hair and eyebrows. Congenital hypothyroidism is a thyroid deficiency that occurs at an early age; characteristics include low hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open mouth, and a dull expression. Scleroderma is a rare connective tissue disease characterized by chronic hardening and shrinking degenerative changes in the skin blood vessels, synovium, and skeletal muscles. Hashimoto thyroiditis is a condition with excess thyroid hormone production; symptoms include goiter, nervousness, fatigue, weight loss, muscle cramps, heat intolerance, tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair and skin, infrequent blinking, and a staring appearance.
Ch 13:
Which of the following statements describing a headache would warrant an immediate referral?

A) "This is the worst migraine of my life."
B) "This is the worst headache I've had since puberty."
C) "I have never had a headache like this before; it is so bad I can't function."
D) "I have had daily headaches for years."
C) "I have never had a headache like this before; it is so bad I can't function."

A sudden severe headache in an adult or child who has never had it before warrants an immediate referral. A sudden severe headache could indicate a subarachnoid hemorrhage.
Ch 13:
What disease is characterized by a flat, expressionless, or mask-like face, a staring gaze, oily skin, and elevated eyebrows?

A) Acromegaly
B) Scleroderma
C) Cushing syndrome
D) Parkinson disease
D) Parkinson disease

Facial characteristics of Parkinson disease include a flat and expressionless face that is "mask-like" with elevated eyebrows, a staring gaze, oily skin, and drooling. Facial characteristics of acromegaly include an elongated head, a massive face, a prominent nose and lower jaw, a heavy eyebrow ridge, and coarse facial features. Facial characteristics of scleroderma include hard, shiny skin on forehead and cheeks; thin, pursed lips with radial furrowing; absent skinfolds; muscle atrophy on face and neck; and absence of expression. Facial characteristics of Cushing syndrome include a plethoric, rounded, "moonlike" face, prominent jowls, red cheeks, and hirsutism on the upper lip, lower cheeks, and chin.
Ch13:
A patient is admitted to the emergency room after a motor vehicle accident. The trachea is deviated to the left side. This finding is characteristic of:

A) right pneumothorax.
B) aortic arch aneurysm.
C) right pleural adhesion.
D) right sided atelectasis.
A) right pneumothorax.

The trachea is normally midline; the trachea will deviated to the unaffected side (left) with a right pneumothorax. The trachea will be pulled downward with systole of an aortic arch aneurysm occurs. The trachea will be deviated to the affected side (right) with a large right sided pleural adhesion. The trachea will be deviated to the affected side (right) with a large right sided atelectasis.
Ch13:
The Head
The head includes the skull, a rigid, bony box that protects the brain and special sense organs. In the skull, cranial bones unite at immovable joints called sutures. Fourteen facial bones articulate at sutures, except the mandible, which has the movable temporomandibular joint anterior to each ear.
Ch13:
Temporal Artery
The temporal artery lies superior to the temporalis muscle and has a palpable pulsation anterior to the ear.
Ch13:
Salivary Glands
The sublingual and submandibular salivary glands are accessible to examination, but the parotid glands are not normally palpable.
Ch13:
The Neck
The neck is delimited by the skull and mandible above, and the manubrium sterni, clavicle, first rib, and first thoracic vertebra below.
Ch13:
Major neck arteries and veins
The carotid artery and internal jugular vein lie beneath the sternomastoid muscle. The external jugular vein runs diagonally across this muscle.
Ch13:
Other systems that pass through the neck
Along with nerves and lymphatics, parts of the respiratory and digestive systems pass through the neck.
Ch13:
Major neck muscles
The major neck muscles are the sternomastoid and the trapezius, innervated by cranial nerve XI. The sternomastoid muscle divides each side of the neck into two triangles. The anterior triangle extends to the mandible above and the midline of the body medially. The posterior triangle lies behind the sternomastoid muscle and in front of the trapezius.
Ch13:
Thyroid Gland
The thyroid gland straddles the trachea in the middle of the neck. The thyroid cartilage, with a small palpable notch, lies above the thyroid isthmus.
Ch13:
Lymph Nodes
The head and neck have a rich supply of lymph nodes.
- The preauricular nodes are located in front of the ear.
- The posterior auricular nodes lie superficial to the mastoid process.
- The occipital nodes are felt at the base of the skull.
- The submental nodes are midline structures behind the tip of the mandible.
- The submandibular nodes are found halfway between the angle of the mandible and its tip.
- The jugulodigastric nodes exist under the angle of the mandible.
- The superficial cervical nodes overlay the sternomastoid muscle.
- The deep cervical nodes are deep under the sternomastoid muscle.
-The posterior cervical nodes appear in the posterior triangle along the edge of the trapezius muscle.
- The supraclavicular nodes are located just above and behind the clavicle, at the sternomastoid muscle.
Ch13:
The head at birth
At birth, the head is larger than the chest circumference, and the neonate's skull bones are separated by sutures and fontanels. Lymphoid tissue is well developed at birth and reaches adult size by age 6. At age 10 or 11, lymph tissue exceeds adult size and then slowly atrophies.
Ch13:
The thyroid gland during pregnancy
During pregnancy, the thyroid gland enlarges.
Ch13:
Facial bones and orbits in aging adults
In aging adults, the facial bones and orbits appear more prominent.
Ch13:
To obtain subjective data about the head and neck, ask questions that investigate these topics:
Headache, Head injury, Dizziness, Neck pain or limited range of motion, Lumps or swelling, And a history of head or neck surgery.
Ch13:
To obtain objective data about the head and neck
First inspect and palpate the skull. Observe its size and shape and note any deformities, lumps, or tenderness. Palpate the temporal artery and temporomandibular joint. Next, inspect the face. Note the facial expression and the symmetry of movement, which reflect the functioning of cranial nerve seven. Also observe for any involuntary movements, edema, or lesions. Then inspect and palpate the neck. Check for symmetry and active range of motion. Palpate for enlargement of the lymph nodes, salivary glands, and thyroid gland. Also palpate the position of the trachea. If palpation reveals lymph node abnormalities, explore the area proximal to the affected node. This requires familiarity with lymphatic drainage. If the thyroid is enlarged, auscultate it for bruits.
Ch13:
Additional head assessments for infants
In an infant, measure the head size and palpate the fontanels.
Ch13:
Additional neck assessments for pregnant women
In a pregnant woman, assess for chloasma and thyroid gland enlargement.
Ch13:
Additional head assesments for aging adults
In an aging adult, observe for prominent temporal arteries and senile tremors.
Quiz 3:
1. A physician tells the nurse that a patient's vertebra prominens is tender and asks the nurse to reevaluate the area in 1 hour. The area of the body the nurse will assess is the area:

A) just above the diaphragm.
B) just lateral to the knee cap.
C) at the level of the C7 vertebra.
D) at the level of the T11 vertebra.
C) at the level of the C7 vertebra.

The C7 vertebra has a long spinous process, called the vertebra prominens, that is palpable when the head is flexed.
Quiz 3:
2. The nurse notices that a patient's palpebral fissures are not symmetrical. On examination, the nurse may find that there has been damage to cranial nerve:

A) III
B) V
C) VII
D) VIII
C) VII

Facial muscles are mediated by cranial nerve (CN) VII; asymmetry of palpebral fissures may be due to CN VII damage (Bell's palsy).
Quiz 3:
3. A patient's laboratory data reveal an elevated thyroxine level. The nurse would proceed with an examination of the _____ gland.

A) thyroid
B) parotid
C) adrenal
D) parathyroid
A) thyroid

The thyroid gland is a highly vascular endocrine gland that secretes thyroxine (T4) and tri-iodothyronine (T3). The other glands do not secrete thyroxine. Page: 260
Quiz 3:
4. The nurse needs to palpate the temporomandibular joint for crepitation. This joint is located just below the temporal artery and anterior to the:

A) hyoid
B) vagus nerve
C) tragus
D) mandible
C) tragus

The temporomandibular joint is just below the temporal artery and anterior to the tragus.
Quiz 3:
5. When performing a respiratory assessment on a patient, the nurse notices a costal angle of approximately 90 degrees. This characteristic is:

A) seen in patients with kyphosis.
B) indicative of pectus excavatum.
C) a normal finding in a healthy adult.
D) an expected finding in a patient with a barrel chest.
C) a normal finding in a healthy adult.

The right and left costal margins form an angle where they meet at the xiphoid process. Usually, this angle is 90 degrees or less. The angle increases when the rib cage is chronically overinflated, as in emphysema.
Quiz 3:
6. When assessing a patient's lungs, the nurse recalls that the left lung:

A) consists of two lobes.
B) is divided by the horizontal fissure.
C) consists primarily of an upper lobe on the posterior chest.
D) is shorter than the right lung because of the underlying stomach.
A) consists of two lobes.

The left lung has two lobes, and the right lung has three lobes. The right lung is shorter than the left lung because of the underlying liver. The left lung is narrower than the right lung because the heart bulges to the left. The posterior chest is almost all lower lobe.
Quiz 3:
7. When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus most intensely over which location?

A) Between the scapulae
B) Third intercostal space, MCL
C) Fifth intercostal space, MAL
D) Over the lower lobes, posterior side
A) Between the scapulae

Normally, fremitus is most prominent between the scapulae and around the sternum. These are sites where the major bronchi are closest to the chest wall. Fremitus normally decreases as one progress down the chest because more tissue impedes sound transmission.
Quiz 3:
8. The nurse is observing the auscultation technique of another nurse. The correct method to use when progressing from one auscultatory site on the thorax to another is ____ comparison.

A) side-to-side
B) top-to-bottom
C) posterior-to-anterior
D) interspace-by-interspace
A) side-to-side

Side-to-side comparison is most important when auscultating the chest. The nurse should listen to at least one full respiration in each location. The other techniques are incorrect.
Quiz 3:
9. The nurse notes hyperresonant percussion tones when percussing the thorax of an infant. The nurse's best action would be to:

A) notify the physician.
B) suspect a pneumothorax.
C) consider this a normal finding.
D) monitor the infant's respiratory rate and rhythm.
C) consider this a normal finding.

The percussion note of hyperresonance occurs normally in the infant and young child, owing to the relatively thin chest wall. Anything less than hyperresonance would have the same clinical significance as would dullness in the adult.
Quiz 3:
10. The nurse is reviewing the characteristics of breath sounds. Which statement about bronchovesicular breath sounds is true? They are:

A) musical in quality.
B) usually pathological.
C) expected near the major airways.
D) similar to bronchial sounds except that they are shorter in duration.
C) expected near the major airways.

Bronchovesicular sounds are heard over major bronchi where fewer alveoli are located: posteriorly, between the scapulae, especially on the right; anteriorly, around the upper sternum in the first and second intercostal spaces. The other responses are not correct.
Quiz 3:
11. The nurse is listening to the breath sounds of a patient with severe asthma. Air passing through narrowed bronchioles would produce which of these adventitious sounds?

A) Wheezes
B) Bronchial sounds
C) Bronchophony
D) Whispered pectoriloquy
A) Wheezes

Wheezes are caused by air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors, such as with acute asthma or chronic emphysema.
Quiz 3:
12. The nurse is assessing the lungs of an older adult. Which of these describes normal changes in the respiratory system of the older adult?

A) Severe dyspnea is experienced on exertion resulting from changes in the lungs.
B) Respiratory muscle strength increases to compensate for a decreased vital capacity.
C) There is a decrease in small airway closure, leading to problems with atelectasis.
D) The lungs are less elastic and distensible, which decreases their ability to collapse and recoil.
D) The lungs are less elastic and distensible, which decreases their ability to collapse and recoil.

In the aging adult the lungs are less elastic and distensible, which decreases their ability to collapse and recoil. There is a decreased vital capacity and a loss of intraalveolar septa, causing less surface area for gas exchange. The lung bases become less ventilated, and the older person is at risk for dyspnea with exertion beyond his or her usual workload.
Quiz 3:
13. 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 months. The nurse's preliminary analysis, based on this history, is that this patient may be suffering from:

A) bronchitis.
B) pneumonia.
C) tuberculosis.
D) pulmonary edema.
C) tuberculosis.

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.
Quiz 3:
14. During auscultation of breath sounds, the nurse should use the stethoscope correctly, in which of the following ways?

A) Listen to at least one full respiration in each location.
B) Listen as the patient inhales and then go to the next site during exhalation.
C) Have the patient breathe in and out rapidly while the nurse listens to the breath sounds.
D) If the patient is modest, listen to sounds over his or her clothing or hospital gown.
A) Listen to at least one full respiration in each location.

During auscultation of breath sounds with a stethoscope, it is important to listen to one full respiration in each location. During the examination, the nurse should monitor the breathing and offer times for the person to breathe normally to prevent possible dizziness.
Quiz 3:
15. The primary purpose of the ciliated mucous membrane in the nose is to:

A) warm the inhaled air.
B) filter out dust and bacteria.
C) filter coarse particles from inhaled air.
D) facilitate movement of air through the nares.
B) filter out dust and bacteria.

The nasal hairs filter the coarsest matter from inhaled air, whereas the mucous blanket filters out dust and bacteria. The rich blood supply of the nasal mucosa warms the inhaled air.
Quiz 3:
16. In assessing the tonsils of a 30 year old, the nurse notices that they are involuted, granular in appearance, and appear to have deep crypts. What is correct response to these findings?

A) Refer the patient to a throat specialist.
B) Nothing, because this is the appearance of normal tonsils.
C) Continue with assessment looking for any other abnormal findings.
D) Obtain a throat culture on the patient for possible strep infection.
B) Nothing, because this is the appearance of normal tonsils.

The tonsils are the same color as the surrounding mucous membrane, although they look more granular and their surface shows deep crypts. Tonsillar tissue enlarges during childhood until puberty and then involutes.
Quiz 3:
17. A 92-year-old patient has had a stroke. The right side of his face is drooping. The nurse might also suspect which of these assessment findings?

A) Epistaxis
B) Rhinorrhea
C) Dysphagia
D) Xerostomia
C) Dysphagia

Dysphagia is difficulty with swallowing and may occur with a variety of disorders, including stroke and other neurologic diseases. Rhinorrhea is a runny nose; epistaxis is a bloody nose. Xerostomia is a dry mouth.
Quiz 3:
18. While obtaining a history from the mother of a 1 year old, the nurse notices that the baby has had a bottle in his mouth the entire time. The mother states, "It makes a great pacifier." The best response by the nurse would be:

A) "You're right, bottles make very good pacifiers."
B) "Use of a bottle is better for the teeth than thumb sucking."
C) "It's okay to do this as long as the bottle contains milk and not juice."
D) "Prolonged use of a bottle can increase the risk for tooth decay and ear infections."
D) "Prolonged use of a bottle can increase the risk

Prolonged bottle use during the day or when going to sleep places the infant at risk for tooth decay and middle ear infections.
Quiz 3:
19. A 72-year-old patient has a history of hypertension and chronic lung disease. An important question for the nurse to include in the history would be:

A) "Do you use a fluoride supplement?"
B) "Have you had tonsillitis in the last year?"
C) "At what age did you get your first tooth?"
D) "Have you noticed any dryness in your mouth?"
D) "Have you noticed any dryness in your mouth?"

Xerostomia (dry mouth) is a side effect of many drugs used by older people, including antidepressants, anticholinergics, antispasmodics, antihypertensives, antipsychotics, bronchodilators.
Quiz 3:
20. During an assessment of a 20-year-old patient with a 3-day history of nausea and vomiting, the nurse notices dry mucosa and deep vertical fissures in the tongue. These findings are reflective of:

A) dehydration.
B) irritation by gastric juices.
C) a normal oral assessment.
D) side effects from nausea medication.
A) dehydration.

Dry mouth occurs with dehydration or fever. The tongue has deep vertical fissures.
Ch 13:
Bruit
blowing, swooshing sound heard through the stethoscope over an area of abnormal blood flow
Ch 13:
Goiter
increase in side of thyroid gland that occurs with hyperthyroidism
Ch 13:
Lymphadenopathy
enlargement of the lymph nodes due to infection, allergy, or neoplasm
Ch 13:
Macrocephalic
abnormally large head
Ch 13:
Microcephalic
abnormally small head
Ch 13:
Normocephalic
round symmetric skull that is appropirately related to body size
Ch 13:
Torticollis
head tilt due to shortening or spasm of one sternocleidomastoid muscle
Ch 13:
List the facial structures that should appear symmetric when inspecting the head
...
Ch 13:
Describe the characteristics of lymph nodes associated with acute infection
...
Ch 13:
Describe the characteristics of lymph nodes associated with chronic inflammation
...
Ch 13:
Describe the characteristics of lymph nodes associated with cancer
...
Ch 13:
Caput Succedaneum
...
Ch 13:
Cephalhematoma
...
Ch 13:
Infant Tonic Neck Reflex
...
Ch 13:
Characteristics of normal cervical lymph nodes during childhood
...
Ch 13:
Condition(s) associated with parotid gland enlargement
...
Ch 13:
Facial characteristics of Down Syndrome
...
Ch 13:
Facial characteristics of Fetal Alcohol Syndrome
...
Ch 13:
Facial characteristics of hyperthyroidism
...
Ch 13:
Facial characteristics of hypothyroidism
...
Ch 13:
Identify the facial bone that articulates at a joint instead of a suture.

A) zygomatic
B) maxilla
C) nasal
D) mandible
D) mandible
Ch 13:
Identify the blood vessel that runs diagonally across the sternomastoid muscle.

A) temporal artery
B) carotid artery
C) external jugular vein
D) internal jugular vein
C) external jugular vein
Ch 13:
The isthmus of the thyroid gland lies just below the:

A) mandible
B) cricoid cartilage
C) hyoid cartilage
D) thyroid cartilage
B) cricoid cartilage
Ch 13:
Select the statement that is true regarding cluster headaches

A) May be precipitated by alcohol and daytime napping
B) Usual occurrence is two per month, each lasting 1 to 3 days
C) Characterized as throbbing
D) Tend to be supraorbital, retro-orbital or frontotemporal.
A) May be precipitated by alcohol and daytime napping
Ch 13:
Select the symptom that is least likely to indicate a possible malignancy

A) history of radiation therapy to head, neck, or upper chest
B) history of using chewing tobacco
C) history of large alcohol consumption
D) tenderness
D) tenderness
Ch 13:
Providing resistance while the patient shrugs the shoulders is a test of the status of cranial nerve:

A) II
B) V
C) IX
D) XI
D) XI
Ch 13:
Upon examination, the fontanels should feel:

A) tense or bulging
B) depressed or sunken
C) firm, slightly concave, and well defined
D) pulsating
C) firm, slightly concave, and well defined
Ch 13:
If the thyroid gland is enlarged bilaterally, which of the following maneuvers is appropriate?

A) Check for deviation of the trachea
B) Listen for bruit over the carotid arteries
C) Listen for a murmur over the aortic area
D) List for a bruit over the thyroid lobes
D) List for a bruit over the thyroid lobes
Ch 13:
It is normal to palpate a few lymph nodes in the neck of a healthy person. What are the characteristics of these nodes?

A) mobile, soft, nontender
B) large, clumped, tender
C) matted,fixed, tender, hard
D) matted, fixed, nontender
A) mobile, soft, nontender
Ch 13:
Cephalhematoma is associated with:

A) subperiosteal hemorrhage
B) cranitabes
C) bossing
D) congenital syphilis
A) subperiosteal hemorrhage
Ch 13:
Normal cervical lymph nodes are:

A) smaller than 1cm
B) warm to palpation
C) fixed
D) firm
A) smaller than 1cm
Ch 13:
A throbbing, unilateral pain associated with nausea, vomiting, and photophobia is characteristic of

A) cluster headache
B) subarachnoid hemorrhage
C) migraine headache
D) tension headache
C) migraine headache
Ch 13:
Preauricular
in front of the ear
Ch 13:
Posterior auricular
superficial to the mastoid process
Ch 13:
Occipital
at the base of the skull
Ch 13:
Submental
behind the tip of the mandible
Ch 13:
Submandibular
halfway between the angle and the tip of the mandible
Ch 13:
Jugulodigastric
under the angle of the mandible
Ch 13:
Superficial cervical
overlying the sternomastoid muscle
Ch 13:
Deep cervical
deep under the sternomastoid muscle
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Posterior cervical
in the posterior triangle along the edge of the trapezius muscle
Ch 13:
Supraclavicular
above and behind the clavicle
Ch 16:
Nose
The nose is the first segment of the respiratory system. It warms, moistens, and filters inhaled air and is the sensory organ of smell, innervated by cranial nerve one.
Ch 16:
External features of the nose
Externally, the nose is shaped like a triangle. It consists of a bridge, a tip, two nares, a columella that divides the nares, and two ala (or wings at each side of the nose).
Ch 16:
Internal features of the nose
Internally, the nasal cavity extends back over the roof of the mouth.
Ch 16:
Nasal hairs
Nasal hairs line the cavity's anterior edge to filter coarse matter from inhaled air.
Ch 16:
Ciliates mucous membranes
Ciliated mucous membranes line the rest of the cavity and filter dust and bacteria.
Ch 16:
Nasal Mucosa
The nasal mucosa has a rich blood supply, which warms inhaled air and is redder than the oral mucosa.
Ch 16:
Nasal Septum
The septum divides the nasal cavity into two air passages. The anterior septum holds Kiesselbach's plexus, the most common site of nosebleeds.
Ch 16:
Nasal Turbinates (concha)
The superior, middle, and inferior turbinates are bony projections that help warm, humidify, and filter inhaled air. Under each turbinate is a meatus, named for the turbinate above. The sinuses drain into the middle meatus, and the nasolacrimal ducts drain into the inferior meatus.
Ch 16:
Paranasal Sinuses
The paranasal sinuses are air-filled pockets in the cranium. They lighten the weight of the skull, serve as sound resonators, and provide mucus. The frontal and maxillary sinuses are accessible to examination. The ethmoid and sphenoid sinuses are not.
Ch 16:
Mouth
The mouth is the first segment of the digestive system and an airway for the respiratory system. It also contains taste buds and aids in speech production.
Ch 16:
Oral cavlty
The oral cavity is a short passage bordered by the lips, hard palate, soft palate, cheeks, and tongue. The oral cavity includes the tongue, 32 teeth, gums, the uvula, and openings for three pairs of salivary glands—the parotid, submandibular, and sublingual glands.
Ch 16:
Pharanyx (throat)
The throat (or pharynx) is the area behind the mouth and nose.
Ch 16:
Oropharaynx
The oropharynx is separated from the mouth by folds of tissue on each side, which are the anterior tonsillar pillars. Behind these folds are the tonsils. These masses of lymphoid tissue enlarge until puberty and then involute.
Ch 16:
Nasopharynx
The nasopharynx is continuous with the oropharynx, although it is above the oropharynx and behind the nasal cavity. It contains the pharyngeal tonsils (or adenoids) and the eustachian tube openings.
Ch 16:
Developmental changes to the nose, mouth and throat
By age 21⁄2, children normally have 20 deciduous (or temporary) teeth. These teeth are lost between ages 6 and 12 and replaced by permanent teeth. In pregnant women, nasal stuffiness and epistaxis may occur, and the gums may be hyperemic and softened. In aging adults, loss of subcutaneous fat may make the nose appear more prominent. Older adults also may experience a decreased sense of smell and taste as well as tooth loss, which can contribute to nutritional deficits.
Ch 16:
Subjective data questions to ask about the nose:
Nasal discharge, Frequent colds or upper respiratory tract infections, Sinus pain, Trauma, Nosebleeds, Allergies, And altered sense of smell.
Ch 16:
Subjective data questions to ask about the mouth and throat:
Sores or lesions in the mouth, tongue, or gums, Sore throat, Bleeding gums, Toothache, Hoarseness, Dysphagia, Altered sense of taste, Smoking and alcohol consumption, And self-care behaviors, including dental care.
Ch 16:
Objective data to collect about the nose:
Begin by inspecting the external nose. Observe for symmetry, deformity, inflammation, and lesions. Then use palpation to test the patency of each nostril. Next inspect the nasal cavity with a nasal speculum. Note the color and integrity of the nasal mucosa, and check the septum for deviation, perforation, or bleeding. Also observe the turbinates to check their color and detect exudate, swelling, or polyps. Complete the nose assessment by palpating the frontal and maxillary sinus areas, identifying any areas of tenderness.
Ch 16:
Objective data to collect about the mouth:
Using a tongue blade and penlight, inspect the lips, teeth and gums, tongue, and buccal mucosa. Assess the color and intactness of these structures and note any lesions. Inspect the palate and uvula. Also, check their integrity and mobility as the person says "ahhh." This action also tests one function of cranial nerve ten. If indicated, perform bimanual palpation of the mouth while wearing gloves.
Ch 16:
Subjective data questions to ask about the throat:
Begin by inspecting and grading the tonsils. Also inspect the pharyngeal wall, noting its color and checking for any exudates or lesions. Test cranial nerve twelve by having the patient stick out the tongue. If indicated, also assess the gag reflex, which tests cranial nerves nine and ten. Remember to perform developmentally appropriate assessments. For example, in a neonate, palpate to assess the integrity of the palate as well as the sucking reflex.
Ch 13: Difference between normal and malignant lymph nodes
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Ch 13: 4 areas where lymph nodes are accessible for palpation
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Ch 13: Head growth throughout the life span
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Ch 13: Difference between meningeal inflammation, tension, migraine and cluster headaches (pgs 256, 257, 258 and 270 in book)
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Ch 13: Difference between craniotabes, microcephaly, hydrocephaly and caput succedaneum and signs and symptoms of each
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Ch 13: Hypothyroidism vs. Hyperthyroidism signs and symptoms
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Ch 13: Thyroid Assessment: Inspection, Palpation and Auscultation and findings
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Ch 13: Acromegaly, CVA and Down's Syndrome Assessment findings Table 13-4 and Table 13-5
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Ch 16: Impact of aging on the senses and anatomy
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Ch 16: Evaluation of the sinuses and clinical findings throughout the lifespan
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Ch 16: Patient teaching and oral care throughout the lifespan
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Ch 16: Normal and abnormal nasal and oral mucosal findings throughout the lifespan and taking into account cultural differences
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Ch 16: Signs and symptoms of dehydration
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Ch 16: How to evaluate the throat for staging of tonsillitis
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Ch 16: Common abnormalities and diseases of nose and mouth pgs 373-381
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Ch 18: Normal anatomy of the lungs and landmarks
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Ch 18: Normal muscles for respiration along with accessory muscles in respiratory difficulty
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Ch 18: Tactile femitus - what is it - what does it mean clinically, and how to you evaluate it.
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Ch 18: Techniques for inspection, auscultation, palpation, and percussion of the lungs and significant findings.
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Ch 18: The different types of lung sounds - adventitious, vesicular, and bronchovesicular and where they should be heard.
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Ch 18: Impact of COPD on anatomy and assessment of patients.
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Ch 18: Signs and symptoms of pnuemothorax.
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Ch 18: Normal anatomical changes associated with aging.
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Ch 18: Clinical evaluation of heart failure with assessment findings.
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Ch 18: Review developmental competence pgs 434-437
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Ch 19: Trace the blood through the chambers of the hearts and valves in order.
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Ch 19: Trace electrical conduction of the heart
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Ch 19: Recognize the correct technique for evaluation of jugular vein distention and understand clinical significance of abnormal.
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Ch 19: Normal clinical indications of aging on the cardiovascular system
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Ch 19: Risk factors - modifiable and nonmodifiable for heart disease
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Ch 19: Techniques for auscultation for bruits and murmurs along with the anatomical locations for the appropriate sounds.
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Ch 19: Recognize "thrills"
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Ch 19: Recognize bruit and murmur as turbulent blood flow
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Ch 19: Technique for palpation of an apical pulse and significance if it is displace laterally. Table 19-8
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Ch 19: Understanding of S1 and S2 sounds as well as significance of Normal Split S2, S3 and S4 and when during the cardiac cycle the sounds are heard (pgs 460 and Table 19-7)
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Ch 19: Developmental and Cultural Competence ; normal and abnormal findings throughout the lifespan
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Ch 19: Review table 19-2
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Ch 20: Normal anatomy of the systems (structure and function) and impact of aging on functioning of systems
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Ch 20: Review major arteries and blood supply
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Ch 20: Know location of pulses and how to assess pulses (pgs 506-512 and your slides).
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Ch 20: Developmental competence normal and abnormal findings throughout the lifespan
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Ch 20: Clinical indications of peripheral artery disease and peripheral vascular disease pages 520-524
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Ch 20: Review lymphatic system drainage
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Ch 20: Understand the difference between lymph edema and pitting edema
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Ch 20: Understanding of the ABI - and how to assess (Ankle-Brachial Index)
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Ch 20: How to evaluate pulse and capillary refill
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Ch 20: Review Table 20-3
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Ch 16:
The most common site of nosebleeds is:

A) the turbinates
B) the columellae
C) Kiesselbach's plexus
D) the meatus
C) Kiesselbach's plexus
Ch 16:
The sinuses that are accessible to examination are the:

A) ethmoid and sphenoid
B) frontal and ethmoid
C) maxillary and sphenoid
D) frontal and maxillary
D) frontal and maxillary
Ch 16:
The frenulum is:

A) the midline fold of tissue that connects the tongue to the floor of the mouth
B) the anterior border of the oral cavity
C) the arching roof of the mouth
D) the free projection hanging down from the middle of the soft palate
A) the midline fold of tissue that connects the tongue to the floor of the mouth
Ch 16:
The largest salivary gland is located:

A) within the cheeks in front of the ear
B) beneath the mandible at the angle of the jaw
C) within the floor of the mouth under the tongue
D) at the base of the tongue
A) within the cheeks in front of the ear
Ch 16:
A 70-year-old woman complains of dry mouth. The most frequent cause of this problem is:

A) the aging process
B) related to medications she may be taking
C) the use of dentures
D) related to a dimished sense of smell
B) related to medications she may be taking
Ch 16:
Because of a history of headache, the examiner uses transillumination to assess for an inflamed sinus. The findings in a healthy individual would be:

A) a diffuse red glow
B) no transillumination
C) findings vary with ethnicity of the person
D) light visible in the nares through a speculum
A) a diffuse red glow
Ch 16:
During an inspection of the nares, a deviated septum is noted. The best action is to:

A) request a consultation with an ear, nose, and throat specialist
B) document the deviation in the medical record in case the person needs to be suctioned
C) teach the person what to do if a nosebleed should occur
D) explore further because polyps frequently accompany a deviated septum
B) document the deviation in the medical record in case the person needs to be suctioned
Ch 16:
Oral malignancies are more likely to develop:

A) on the soft palate
B) on the tongue
C) in the buccal cavity
D) under the tongue
D) under the tongue
Ch 16:
In a medical record, the tonsils are graded as 3+. The tonsils would be:

A) visible
B) halfway between the tonsillar pillars and uvula
C) touching the uvula
D) touching each other
C) touching the uvula
Ch 16:
The function of the nasal turbinates is to:

A) warm the inhaled air
B) detect odors
C) stimulate tear formation
D) lighten the weight of the skill bones
A) warm the inhaled air
Ch 16:
The opening of an adult's parotid gland (Stensen's duct) is opposite the:

A) lower 2nd molar
B) lower incisors
C) upper incisors
D) upper 2nd molar
D) upper 2nd molar
Ch 16:
A nasal polyp may be distingished from the nasal turbinates for 3 of the following reasons. Which reason is false?

A) The polyp is highly vascular
B) The polyp is movable
C) The polyp is pale gray in color
D) The polyp is nontender
A) The polyp is highly vascular
Ch 16:
Aphthous ulcers
"canker sores" - small, painful, round ulcers in the oral mucosa of unknown cause
Ch 16:
Buccal
pertaining to the cheek
Ch 16:
Candidiasis
(moniliasis) white, cheesy, curdlike patch on buccal mucosa due to superficial fungal infectio
Ch 16:
Caries
decay in the teeth
Ch 16:
Crypts
indentations on surface of tonsils
Ch 16:
Cheilitis
red, scaling, shallow, painful fissures at corners of mouth
Ch 16:
Choanal atresia
closure of nasal cavity due to congenital septum between nasal cavity and pharynx
Ch 16:
Epistaxis
nosebleed, usually from anterior septum
Ch 16:
Epulis
nontender, fibrous nodule of the gum
Ch 16:
Fordyce's granules
small, isolated, white or yellow papules on oral mucosa
Ch 16:
Gingivitis
red, swollen gum margins that bleed easily
Ch 16:
Herpes simplex
"cold sores" - clear vesicles with red base, which evolve into pustules, usually at lip-skin junction
Ch 16:
Koplik's spots
small, blue-white spots with red halo over oral mucosa; early sign of measles
Ch 16:
Leukoplakia
chalky white, thick raised patch on sides of tongue; precancerous
Ch 16:
Malocclusion
upper or lower dental archers out of alignment
Ch 16:
Papillae
rough bumpy elevation on dorsal surface of tongue
Ch 16:
Parotid glands
pair of salivary glands in the cheeks in from of the ears
Ch 16:
Pharyngitis
inflammation of the throat
Ch 16:
Plaque
soft whitish debris on teeth
Ch 16:
Polyp
smooth, pale gray nodules in the nasal cavity due to chronic allergic rhinitis
Ch 16:
Rhinitis
red swollen inflammation of nasal mucosa
Ch 16:
Thrush
oral candidiasis in the newborn
Ch 16:
Turbinate
one of three bony projections into nasal cavity
Ch 16:
Uvula
free projection hanging down from the middle of the soft palate
Ch 18:
Alveoli
functional units of the lung; the thin-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen
Ch 18:
Angle of Louis
manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib
Ch 18:
Apnea
cessation of breathing
Ch 18:
Asthma
an abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens, characterized by bronchospasm, wheezing and dyspnea
Ch 18:
Atelectasis
an abnormal respiratory condition characterized by collapsed, shrunken, deflated section of alveoli
Ch 18:
Bradypnea
slow breathing <10 breaths per minute, regular rate
Ch 18:
Bronchiole
one of the smaller respiratory passageways into which the segmental bronchi devide
Ch 18:
Bronchitis
inflammation of the bronchi with partial obstruction of bronchi due to exessive mucus secretion
Ch 18:
Bronchophony
the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue
Ch 18:
Bronchovesicular
the normal breath sound hear over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration
Ch 18:
Chronic obstructive pulmonary disease (COPD)
a functional category of abnormal respiratory conditions characterized by airflow obstruction, e.g.; ephysema, chronic bronchitis
Ch 18:
Cilia
millions of hairlike cells lining the tracheobronchial tree
Ch 18:
Consolidation
the solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia
Ch 18:
Crackles / Rales
abnormal, discontinuous, adventitous lung sounds heard on inspiration
Ch 18:
Crepitus
coarse crackling sensation palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue
Ch 18:
Dead space
passageways that transport air but are not available for gaseous exchange, e.g. trachea and bronchi
Ch 18:
Egophony
the voice sound of "eeeeee" heard through the stethoscope
Ch 18:
Emphysema
the chronic obstructive pulmonary disease characterized by enlargement of alveoli distal to terminal bronchioles
Ch 18:
Fissure
the narrow crack dividing the lobes of the lungs
Ch 18:
Fremitus
a palpable vibration from the spoken voice felt over the chest wall
Ch 18:
Friction rub
a coarse, grating, adventitious lung sound heard when the pleurae are inflamed
Ch 18:
Hypercapnia
(hypercarbia) increased levels of carbon dioxide in the blood
Ch 18:
Intercostal space
space between the ribs
Ch 18:
Kussmaul's respiration
a type of hyperventilation that occurs with diabetic ketoacidosis
Ch 18:
Orthopnea
ability to breathe easily only in an upright position
Ch 18:
Paroxysmal nocturnal dyspnea
sudden awakening from sleeping with shortness of breath
Ch 18:
Percussion
striking over the chest wall with short sharp blows of the fingers in order to determine the size and density of the underlying organ
Ch 18:
Pleural effusion
abnormal fluid between the layers of the pleura
Ch 18:
Rhonchi
low-pitched, musical, snoring, adventitious lung sound cause by air-flow obstruction from secretions
Ch 18:
Tachypnea
rapid shallow breathing, >24 breaths per minute
Ch 18:
Vesicular
the soft, low-pitched, normal breath sounds heard over peripheral lung fields
Ch 18:
Vital capacity
the amount of air, following maximal inspiration, that can be exhaled
Ch 18:
Wheeze
high-pitched, musical, squeaking adventitious lung sound
Ch 18:
Whispered pectoriloquy
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue
Ch 18:
Xiphoid process
sword-shaped lower tip of the sternum
Ch 18:
The manubriosternal angle is:

A) the articulation of the manubrium and the body of the sternum
B) a hollow, U-shaped depression just above the sternum
C) also known as the breastbone
D) a term synonymous with costochondral junction
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Ch 18:
Select the correct description of the left lung.

A) narrower than the right lung with three lobes
B) narrower than the right lung with two lobes
C) wider than the right lung with two lobes
D) shorter than the right with three lobes
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Ch 18:
Some conditions have a cough with characteristic timing. The cough associated with chronic bronchitis is best described as

A) continuous throughout the day
B) productive cough for at least 3 months of the year for 2 years in a row
C) occurring in the afternoon/evening because of exposure to irritants at work
D) occuring in the early morning
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Ch 18:
Symmetric chest expansion is best confirmed by:

A) placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10, then sliding the hands up to pin up a small fold of skin between the thumbs
B) inspection of the shape and configuration of the chest wall
C) placing the palmar surface of the fingers of one hand against the chest and having the person repeat the words "ninety-nine"
D) percussion of the posterior chest
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Ch 18:
Absence of diaphragmatic excursion occurs with

A) asthma
B) an unusually thick chest wall
C) pleural effusion or atelectasis of the lower lobes
D) age-related changes in the chest wall
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Ch 18:
Ascultation of breath sounds is an important components of respiratory assessment. Select the most accurate description of this part of the examination.

A) Hold the bell of the stethoscope against the chest wall, listen to the entire right field, then the entire left field.
B) Hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons.
C) Listen for the apices to the bases of each lung field using the bell of the stethoscope
D) Select the bell or diaphragm depending upon the quality of sounds heard; listen for one respiration in each location, moving from side to side.
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Ch 18:
Select the best description of bronchovesicular breath sounds:

A) high pitched, of longer duration on inspiration than expiration
B) moderate pitch, inspiration equal to expiration
C) low pitched, inspiration greater than expiration
D) rustling sound, like the wind in the trees
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Ch 18: Increased tactile fremitus would be evident in an individual who has which of the following conditions?

A) Emphysema
B) Pneumonia
C) Crepitus
D) Pneumothorax
B) Pneumonia

Fremitus is a palpable vibration. Increased fremitus occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia). Decreased fremitus occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema). Crepitus is a coarse crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue.
Ch 18: A clinical manifestation common in an individual with chronic obstructive pulmonary disease (COPD) is:

A) periodic breathing patterns.
B) pursed-lip breathing.
C) unequal chest expansion.
D) hyperventilation.
B) pursed-lip breathing.

An individual with COPD may purse the lips in a whistling position. By exhaling slowly and against a narrow opening, the pressure in the bronchial tree remains positive, and fewer airways collapse. Periodic breathing patterns are Cheyne-Stokes or Biot respirations. Cheyne-Stokes respirations occur in heart failure, renal failure, meningitis, drug overdose, and increased intracranial pressure; this type also normally occurs in infants and aging persons during sleep. Biot respirations occur with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis. Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as with pneumonia, or when guarding to avoid postoperative incisional pain or pleurisy pain. Hyperventilation is a normal response to fever, fear, or exercise; respiration rate also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons.
Ch 18: The thoracic cage is defined by all of the following except the:

A) sternum.
B) ribs.
C) costochondral junction.
D) diaphragm.
C) costochondral junction.

The thoracic cage is defined by the sternum, ribs, vertebrae, and diaphragm.
Ch 18: Inspiration is primarily facilitated by which of the following muscles?

A) Diaphragm and abdominus rectus
B) Trapezia and sternomastoids
C) Internal intercostals and abdominal
D) Diaphragm and intercostals
D) Diaphragm and intercostals

The major muscle responsible for inspiration is the diaphragm. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal; this increases the anteroposterior diameter.
Ch 18: Which of the following voice sounds would be a normal finding?

A) The voice transmission is distinct and sounds close to the ear.
B) The "eeeee" sound is clear and sounds like "eeeee".
C) The whispered sound is transmitted clearly.
D) Whispered "1-2-3" is audible and distinct.
B) The "eeeee" sound is clear and sounds like "eeeee".

A normal finding from voice sounds is egophony; "eeeee" heard through the stethoscope clearly. A normal finding from voice sounds is bronchophony; normal voice transmission is soft, muffled, and indistinct. A normal finding from voice sounds is whispered pectoriloquy: whispered sound is faint, muffled, and almost inaudible.
Ch 18: The gradual loss of intraalveolar septa and a decreased number of alveoli in the lungs of the elderly cause:

A) hyperventilation.
B) spontaneous atelectasis.
C) decreased surface area for gas exchange.
D) decreased dead space.
C) decreased surface area for gas exchange.

The histologic changes result in less surface area for gas exchange.
Ch 18: The function of the trachea and bronchi is to:

A) transport gases between the environment and the lung parenchyma.
B) condense inspired air for better gas exchange.
C) moisturize air for optimum respiration.
D) increase air turbulence and velocity for maximum gas transport.
A) transport gases between the environment and the lung parenchyma.

The trachea and bronchi transport gases between the environment and the lung parenchyma.
Ch 18: Stridor is a high-pitched, inspiratory crowing sound commonly associated with:

A) upper airway obstruction.
B) atelectasis.
C) congestive heart failure.
D) pneumothorax.
A) upper airway obstruction.

Stridor is associated with upper airway obstruction from swollen, inflamed tissues or a lodged foreign body.
Ch 18: Percussion of the chest is:

A) a useful technique for identifying small lesions in lung tissue.
B) helpful only in identifying surface alterations of lung tissue.
C) is not influenced by the overlying chest muscle and fat tissue.
D) normal if a dull note is elicited.
B) helpful only in identifying surface alterations of lung tissue.

Percussion detects only the outer 5 to 7 cm of tissue; it will not penetrate to reveal any change in density deeper than that. An abnormal finding must be 2 to 3 cm wide to yield an abnormal percussion note. Percussion findings (resonant notes) may be modified by a muscular chest wall of an athlete or subcutaneous tissue of the obese person. Resonance is a low-pitched, clear, hollow sound that predominates with percussion of healthy lung tissue.
Ch 18: Which of the following correctly expresses the relationship to the lobes of the lungs and their anatomic position?

A) Upper lobes—lateral chest
B) Upper lobes—posterior chest
C) Lower lobes—posterior chest
D) Lower lobes—anterior chest
C) Lower lobes—posterior chest

The posterior chest is almost all lower lobe. The anterior chest contains mostly upper and middle lobe with very little lower lobe.
Ch 18: An increase in the transverse diameter of the chest cage in a pregnant female is due to a(n):

A) compensatory increase in respiratory parenchyma.
B) increase in estrogen.
C) increase in surfactant.
D) increase in tidal volume.
B) increase in estrogen.

The increase in estrogen level during pregnancy relaxes the chest cage ligaments. This allows an increase in the transverse diameter of the chest cage by 2 cm, and the costal angle widens.
Ch 16: The nasal mucosa of an individual with rhinitis would be:
A) moist and pink.
B) swollen, boggy, and gray.
C) bright red and swollen.
D) pale with bright red bleeding.
C) bright red and swollen.

The nasal mucosa is bright red and swollen with rhinitis. Normally, the nasal mucosa is red with a smooth and moist surface. The nasal mucosa is swollen, boggy, pale, and gray with chronic allergies. Bright red bleeding occurs with epistaxis (bleeding from the nose).
Ch 16: The examiner notices a fine tremor when the patient sticks out his or her tongue. What disorder is consistent with this finding?
A) Hyperthyroidism
B) Diabetic ketoacidosis
C) Halitosis
D) Alcoholism
A) Hyperthyroidism

A fine tremor of the tongue occurs with hyperthyroidism. A patient in diabetic ketoacidosis will have a sweet, fruity breath odor. Halitosis is a term used to describe any breath odor. A coarse tremor occurs with alcoholism.
Ch 16: Which of the following questions would the examiner ask to determine whether an individual has epistaxis?
A) "Do you have any difficulty with swallowing?"
B) "Have you ever noticed any unusual lesions on the inside of your mouth?"
C) "Do you experience nose bleeds?"
D) "Do you experience a runny nose frequently?"
C) "Do you experience nose bleeds?"

Epistaxis is the medical term for a nose bleed. Dysphagia is the medical term for difficulty swallowing. Rhinorrhea is the medical term for a runny nose.
Ch 16: On examination of an American Indian's mouth, the examiner notices the presence of a bifid uvula. How should this finding be interpreted?
A) This is an expected variation associated with this individual.
B) This condition is frequently associated with cleft palate.
C) This may indicate the presence of oral cancer.
D) This is rare and indicates other congenital anomalies may be present.
A) This is an expected variation associated with this individual.

Bifid uvula is a condition in which the uvula is split either completely or partially. This condition occurs in 18% of some American Indian groups. Bifid uvula may indicate a submucous cleft palate. Bifid uvula is not associated with oral cancer. The incidence of bifid uvula is common in American Indians.
Ch 16: An enlarged tongue (macroglossia) may accompany:
A) cleft palate.
B) hairy tongue.
C) Down syndrome.
D) fissured tongue.
C) Down syndrome.

Macroglossia occurs with Down syndrome; it also occurs with cretinism, myxedema, and acromegaly. A transient swelling also occurs with local infections.
Ch 16: In addition to initiating digestion of food, saliva also:
A) augments taste sensation.
B) protects the mucosa from caustic substances.
C) inhibits overgrowth of bacteria in the mouth.
D) cleans and protects the mucosa.
D) cleans and protects the mucosa.

Saliva moistens and lubricates the food bolus, starts digestion, and cleans and protects the mucosa.
Ch 16: One of the purposes of the paranasal sinuses is to:
A) lighten the weight of the skull bones.
B) warm and moisten the inspired air.
C) amplify sound.
D) augment the sensory sensation of smell.
A) lighten the weight of the skull bones.

The paranasal sinuses lighten the weight of the skull bones. Nasal mucosa and nasal turbinates warm, humidify, and filter the inhaled air. The paranasal sinuses serve as resonators for sound production. Olfactory receptors (responsible for the sensation of smell) are located in the nasal cavity and septum and merge into the olfactory nerve.
Ch 16: The parotid gland's duct that opens into the mouth opposite the second molar is:
A) the Wharton duct.
B) the salivary duct.
C) Stensen duct.
D) the sublingual duct.
C) Stensen duct.

The parotid gland's duct is the Stensen duct; it runs forward to open on the buccal mucosa opposite the second molar. The Wharton duct (for the submandibular gland) runs up and forward to the floor of the mouth and opens at either side of the frenulum. The mouth contains three pairs of salivary glands, which are the parotid gland, the submandibular gland, and the sublingual gland. The sublingual gland lies within the floor of the mouth under the tongue.
Ch 16: Which of the following pairs of sinuses is absent at birth, is fairly well developed between 7 and 8 years of age, and is fully developed after puberty?
A) Maxillary
B) Frontal
C) Sphenoid
D) Ethmoid
B) Frontal

The frontal sinuses are absent at birth, are fairly well developed between 7 and 8 years of age, and reach full size after puberty. The maxillary sinuses are present at birth and reach full size after all permanent teeth have erupted. The sphenoid sinuses are minute at birth and develop after puberty. The ethmoid sinuses are present at birth and grow rapidly between 6 and 8 years of age and after puberty.
Ch 16: What is the major cause of decreased saliva production in the older adult?
A) Use of anticholinergic medications
B) Normal aging process
C) Decreased fluid intake
D) A diminished sense of taste and smell
A) Use of anticholinergic medications

The major cause of decreased saliva flow is the use of medications that have anticholinergic effects. Normal aging is a secondary cause of decreased saliva flow. Decreased fluid intake is not the major cause of decreased saliva production in the older adult. Diminished sense of taste and smell associated with aging may decrease the older adult's interest in food and may contribute to malnutrition.