Wilkins Clinical Assessment in Respiratory Care 7th Edition By Heuer - Test Bank

Wilkins Clinical Assessment in Respiratory Care 7th Edition By Heuer – Test Bank

 

Instant Download – Complete Test Bank With Answers

 

 

Sample Questions Are Posted Below

 

Chapter 5: Fundamentals of Physical Examination

Test Bank

 

MULTIPLE CHOICE

 

1. All of the following are components of the physical examination except:

a.	inspection.
b.	auscultation.
c.	manipulation.
d.	percussion.

 

 

ANS:  C

The four components of the physical examination are inspection, palpation, percussion, and auscultation.

 

REF:   pg. 75             OBJ:   1

 

2. A review of the patient’s history of present illness and past clinical history prior to a physical examination is helpful in that it:

a.	gives insight into the expected findings during the examination.
b.	suggests examination techniques to emphasize.
c.	helps establish a rapport with the patient.
d.	all of the above.

 

 

ANS:  D

A review of the history helps direct the course of the physical examination, allows the medical care team to begin to establish rapport with the patient, and may suggest the success or failure of past treatments.

 

REF:   pg. 76             OBJ:   2

 

3. What problem is associated with cyanosis of the oral mucosa?

a.	Low cardiac output
b.	Reduced arterial oxygenation
c.	Hyperventilation
d.	Hypoventilation

 

 

ANS:  B

Cyanosis of the oral mucosa is a sign of central cyanosis that occurs only with severe hypoxemia.

 

REF:   pg. 76             OBJ:   3

 

4. What problem is associated with nasal flaring?

a.	Hypoxemia
b.	Increased lung compliance
c.	Increased work of breathing
d.	Increased dead space ventilation

 

 

ANS:  C

Nasal flaring most often occurs in infants and children who are working very hard to breathe. Nasal flaring usually occurs when the lungs stiffen (e.g., with pneumonia) or when the airways narrow (e.g., with asthma).

 

REF:   pg. 76             OBJ:   3

 

5. Which of the following is not associated with dilated and unresponsive pupils?

a.	Opiates
b.	Atropine
c.	Brain death
d.	Catecholamines

 

 

ANS:  A

Atropine, brain hypoxia, and catecholamines can cause the pupils to become fixed and unresponsive to light. Opiates have no such effect.

 

REF:   pg. 76             OBJ:   3

 

6. Which of the following terms is used to describe constriction of the pupil of the eye?

a.	Lytosis
b.	Miosis
c.	Mydriasis
d.	Nystagmus

 

 

ANS:  B

Miosis refers to constriction of the pupils.

 

REF:   pg. 76             OBJ:   3

 

7. Which of the following terms is used to describe drooping of the eyelids?

a.	Ptosis
b.	Miosis
c.	Diplopia
d.	Chondrosis

 

 

ANS:  A

Ptosis is defined as drooping of the eyelids.

 

REF:   pg. 77             OBJ:   3

 

8. Which of the following physical examination findings is associated with myasthenia gravis?

a.	Ptosis
b.	Miosis
c.	Mydriasis
d.	Hepatomegaly

 

 

ANS:  A

Patients with myasthenia gravis often develop ptosis as part of the clinical picture.

 

REF:   pg. 77             OBJ:   3

 

9. Which of the following terms is used to describe double vision?

a.	Miosis
b.	Diplopia
c.	Nystagmus
d.	None of the above

 

 

ANS:  B

Diplopia refers to double vision.

 

REF:   pg. 77             OBJ:   3

 

10. Which of the following is most likely to cause tracheal deviation?

a.	Left upper lobe pneumonia
b.	Right upper lobe pneumothorax
c.	Left lower lobe pleural effusion
d.	Right lower lobe pleural effusion

 

 

ANS:  B

Upper lobe changes are more likely to influence tracheal position than are lower lobe problems. Pneumothorax usually causes a volume change in the upper lobe and alters the position of the trachea.

 

REF:   pg. 77             OBJ:   3

 

11. Which of the following is the most common cause of jugular venous distention?

a.	Auto-positive end-expiratory pressure (auto-PEEP)
b.	Pneumonia
c.	Pneumothorax
d.	Right heart failure

 

 

ANS:  D

Right heart failure causes a backup of venous blood into the venous system. This causes the neck veins to distend.

 

REF:   pg. 78             OBJ:   3

 

12. At what angle should the head of the bed be elevated to assess jugular vein pressure (JVP)?

a.	15 degrees
b.	30 degrees
c.	45 degrees
d.	90 degrees

 

 

ANS:  C

The current standardized procedure for checking the JVP at the bedside is to elevate the head of the bed to 45 degrees. If the head of the bed were placed at 90 degrees, gravity would make it difficult to see the JVP. If the head of the bed were placed at less than 45 degrees, venous blood would tend to pool in the neck, which would cause most patients to appear to have JVP.

 

REF:   pg. 77             OBJ:   4

 

13. In a patient’s chart, the physician has documented finding tender lymph nodes in the neck region during the physical examination. This problem is consistent with:

a.	respiratory infection.
b.	human immunodeficiency virus (HIV) infection.
c.	lymphoma.
d.	lung cancer.

 

 

ANS:  A

Tender lymph nodes often are associated with infection.

 

REF:   pg. 78             OBJ:   None

 

14. The horizontal fissure that separates the right upper lobe from the right middle lobe begins at what rib in the midsternal line?

a.	Rib 2
b.	Rib 4
c.	Rib 6
d.	Rib 8

 

 

ANS:  B

The horizontal fissure is located at the fourth rib at the midsternal line.

 

REF:   pg. 79             OBJ:   5

 

15. At what point on the posterior chest wall can the inferior border of the lung normally be found?

a.	Between T4 and T6
b.	Between T6 and T8
c.	Between T9 and T12
d.	None of the above

 

 

ANS:  C

Normally, the inferior border of the lung is located between T9 and T12 on the posterior chest.

 

REF:   pg. 80             OBJ:   5

 

16. Which of the following terms describes an abnormal lateral curvature of the spine?

a.	Kyphosis
b.	Scoliosis
c.	Anhidrosis
d.	Myelosis

 

 

ANS:  B

The term for lateral curvature of the spine is scoliosis. Kyphosis refers to an abnormal anteroposterior curvature of the spine.

 

REF:   pg. 80             OBJ:   6

 

17. Which of the following disorders is associated with a barrel chest?

a.	Chronic bronchitis
b.	Pneumonia
c.	Emphysema
d.	Chest trauma

 

 

ANS:  C

Patients with emphysema lose their lung recoil. This allows the ribs to straighten somewhat, causing the patient’s anteroposterior diameter to increase significantly.

 

REF:   pg. 80             OBJ:   6

 

18. Which of the following patterns of breathing is associated with a loss in lung volume?

a.	Slow and deep
b.	Rapid and deep
c.	Slow and shallow
d.	Rapid and shallow

 

 

ANS:  D

A loss of lung volume causes lung compliance to decrease. This makes it more difficult for the patient to breathe at normal tidal volumes. As a result, patients breathe with smaller volumes but at a faster rate.

 

REF:   pg. 80             OBJ:   8

 

19. What disease is most likely to cause a prolonged expiratory time?

a.	Asthma
b.	Pneumonia
c.	Pneumothorax
d.	Pulmonary fibrosis

 

 

ANS:  A

Asthma causes the intrathoracic airways to become narrow, which makes exhalation slow and prolonged.

 

REF:   pg. 80             OBJ:   8

 

20. Which of the following diseases is most likely to cause a prolonged inspiratory time?

a.	Chronic obstructive pulmonary disease (COPD)
b.	Asthma
c.	Epiglottitis
d.	Acute bronchitis

 

 

ANS:  C

Epiglottitis causes narrowing of the upper airway. This causes a prolonged inspiratory time because the narrowed upper airway slows inspiratory flow more than expiratory flow.

 

REF:   pg. 82             OBJ:   8

 

21. Which of the following terms describes the sinking inward of the skin overlying the rib cage with each inspiratory effort?

a.	Ataxia
b.	Bulging
c.	Retractions
d.	Mydriasis

 

 

ANS:  C

When intrathoracic pressures become extremely negative with inspiration, the skin overlying the chest wall may sink inward between the ribs. This is known as retractions, and it indicates a severe increase in the work of breathing.

 

REF:   pg. 82             OBJ:   10

 

22. A respiratory therapist is examining a patient in respiratory distress. She observes that the patient has a barrel chest, is using his accessory muscles of inspiration even when sitting at rest, and has a prolonged expiratory phase with pursed-lip breathing. This finding is most consistent with:

a.	an upper respiratory infection.
b.	an acute exacerbation of asthma.
c.	severe COPD.
d.	none of the above.

 

 

ANS:  C

Patients with COPD tend to use their accessory muscles to breathe when the work of breathing increases and the diaphragm becomes less effective.

 

REF:   pg. 82             OBJ:   8

 

23. Which of the following breathing patterns is associated with fatigue of the diaphragm?

a.	Bradypnea
b.	Deep and fast breathing
c.	Biot breathing
d.	Abdominal paradox

 

 

ANS:  D

When the diaphragm is fatigued and can no longer assist with breathing, it needs a rest. As a result, the accessory muscles take over, and when they cause negative intrathoracic pressure to occur with inspiration, the abdominal contents tend to be pulled inward and upward. This is known as abdominal paradox because the abdomen is moving in the opposite direction from normal with breathing.

 

REF:   pg. 82             OBJ:   11

 

24. The muscles of inspiration include all of the following except:

a.	the diaphragm,
b.	the sternocleidomastoids,
c.	the scalene muscles.
d.	the rectus abdominus muscle.

 

 

ANS:  D

The rectus abdominus muscle is an accessory muscle of expiration.

 

REF:   pg. 81             OBJ:   9

 

25. Retractions and bulging are observed:

a.	when the work of breathing is very high.
b.	during heavy exercise.
c.	only in newborns and children.
d.	primarily in patients with pulmonary fibrosis.

 

 

ANS:  A

Retractions and bulging are signs of dramatically increased work of breathing.

 

REF:   pg. 82             OBJ:   10

 

26. In patients with severe COPD and hyperinflation, the low, flat diaphragm causes inward movement of the lateral chest walls with inspiration. What is this called?

a.	Abdominal paradox
b.	Biot breathing
c.	Hoover sign
d.	Respiratory alternans

 

 

ANS:  C

Inward movement of the lateral chest wall with inspiration in patients with COPD is known as the Hoover sign.

 

REF:   pg. 83             OBJ:   11

 

27. Which of the following clinical conditions is associated with central cyanosis?

a.	Hypercarbia
b.	Renal failure
c.	Poor circulation
d.	Respiratory failure

 

 

ANS:  D

Central cyanosis is a sign of severe hypoxemia and respiratory failure.

 

REF:   pg. 83             OBJ:   12

 

28. Which of the following will cause an increase in vocal fremitus upon palpation?

a.	COPD
b.	Obesity
c.	Pneumonia
d.	Pneumothorax

 

 

ANS:  C

Pneumonia causes an increase in lung tissue density. This causes vocal fremitus to increase.

 

REF:   pg. 83             OBJ:   13

 

29. Which of the following will cause a decrease in vocal fremitus upon palpation?

a.	Atelectasis
b.	Pneumonia
c.	Lung tumor
d.	Pneumothorax

 

 

ANS:  D

Pneumothorax puts more air between the outer chest wall and the source of the vocal fremitus and reduces the ability of vibrations to be felt at the surface.

 

REF:   pg. 83             OBJ:   13

 

30. What clinical disorder will cause a unilateral decrease in thoracic expansion?

a.	COPD
b.	Lobar pneumonia
c.	Acute asthma attack
d.	Neuromuscular disease

 

 

ANS:  B

Unilateral refers to only one side. Lobar pneumonia reduces expansion of the lung on the affected side.

 

REF:   pg. 84             OBJ:   14

 

31. A respiratory therapist (RT) examining a patient notes that on assessment of chest expansion with palpation, the right lower chest is found to lag behind the left lower chest. With which of the following problems is this finding consistent?

a.	COPD
b.	Right lower lobe pneumonia
c.	Left lower lobe pneumonia
d.	Severe asthma

 

 

ANS:  B

Pneumonia reduces the ability of the lung to expand normally.

 

REF:   pg. 84             OBJ:   14

 

32. A therapist examining a patient encounters an area of skin along the right midaxillary line, which, when palpated, produces a crackling sound and sensation. This is an indication of ______________ in this patient.

a.	previous scarring due to a burn injury
b.	a collection of fluid under the skin
c.	lymphadenopathy
d.	subcutaneous emphysema

 

 

ANS:  D

The sensation and sound of crackling just under the skin is an indication of air trapped in pockets in the subcutaneous tissue, which is known as subcutaneous emphysema.

 

REF:   pg. 85             OBJ:   15

 

33. Which of the following clinical disorders will cause increased resonance to percussion?

a.	Atelectasis
b.	Pneumonia
c.	Pneumothorax
d.	Pleural effusion

 

 

ANS:  C

Air in the pleural space will cause an increase in the resonance to percussion.

 

REF:   pg. 86             OBJ:   16

 

34. Which of the following clinical disorders will cause decreased resonance to percussion?

a.	COPD
b.	Asthma
c.	Pneumonia
d.	Pneumothorax

 

 

ANS:  C

Consolidation of the lung will cause a decrease in resonance to percussion.

 

REF:   pg. 86             OBJ:   16

 

35. The bell portion of the stethoscope is best designed to listen to _____-pitched _____ sounds.

a.	low; lung
b.	low; heart
c.	high; lung
d.	high; heart

 

 

ANS:  B

The bell portion of the stethoscope is designed to capture low-pitched heart sounds.

 

REF:   pg. 86             OBJ:   17

 

36. Which of the following techniques is most useful for application of the bell portion of the stethoscope?

a.	Press it lightly against the chest wall.
b.	Press it firmly against the chest wall.
c.	Hold it about 1 cm from the chest wall.
d.	Slide it gently in a circular motion on the chest wall.

 

 

ANS:  A

The bell is to be placed lightly against the chest wall. If it is placed firmly against the chest wall, it will cause the underlying skin to act as a diaphragm and filter out certain sounds.

 

REF:   pg. 86             OBJ:   18

 

37. The diaphragm portion of the stethoscope is used to listen for:

a.	heart murmurs.
b.	pleural friction rubs.
c.	low-pitched heart sounds.
d.	most lung sounds.

 

 

ANS:  D

The diaphragm is most useful for listening to high-pitched sounds. Most lung sounds are relatively high pitched compared with heart sounds.

 

REF:   pg. 87             OBJ:   18

 

38. Where is the best anatomic place to begin auscultation in most patients?

a.	Over the trachea
b.	Over the upper lobes
c.	In the axillary regions
d.	In the dependent regions

 

 

ANS:  D

Starting auscultation in the lower lobes can be useful for identifying late-inspiratory crackles that would clear with several deep breaths. If the clinician started at the top of the lung and worked downward, the late-inspiratory crackles would be gone by the time the lower lobes were reached.

 

REF:   pg. 87             OBJ:   18

 

39. All of the following are characteristics of breath sounds that should be evaluated whenever chest auscultation is performed except:

a.	the breath rate.
b.	the pitch (vibration frequency).
c.	the amplitude or intensity (loudness).
d.	the duration of inspiration versus expiration.

 

 

ANS:  A

Normally, the breath rate is counted while one observes the patient, often in conjunction with determining the heart rate. In addition to the pitch, amplitude, and duration of inspiration versus expiration, the characteristics of the breath sounds should be noted.

 

REF:   pg. 87             OBJ:   19

 

40. Which of the following characteristics does not apply to normal tracheal breath sounds?

a.	Loud
b.	Low pitched
c.	High pitched
d.	Fairly equal inspiratory and expiratory components

 

 

ANS:  B

Tracheal breath sounds are high pitched.

 

REF:   pg. 87             OBJ:   20

 

41. Which of the following terms is used to describe the normal breath sounds heard around the sternum on the anterior chest and between the scapulae on the posterior chest?

a.	Tubular
b.	Vesicular
c.	Bronchial
d.	Bronchovesicular

 

 

ANS:  D

Although rarely assessed, the normal breath sounds heard around the sternum are known as bronchovesicular breath sounds.

 

REF:   Table 5-2, pg. 87                             OBJ:   20

 

42. Which of the following descriptions does not apply to normal vesicular breath sounds?

a.	Soft with low intensity
b.	Minimal expiratory component
c.	Heard primarily over the lung parenchyma
d.	High pitched as compared with tracheal breath sounds

 

 

ANS:  D

Normal breath sounds are low pitched.

 

REF:   pg. 87             OBJ:   20

 

43. Which of the following terms best describes a louder version of a vesicular sound that can be heard over lung consolidation?

a.	Tubular
b.	Tracheal
c.	Crepitation
d.	Harsh or bronchial

 

 

ANS:  D

Lung consolidation reduces the ability of the lung to attenuate the turbulent flow sounds created in the larger airways. As a result, harsh or bronchial breath sounds are heard over the lung.

 

REF:   pg. 87             OBJ:   20

 

44. Which of the following terms has had a confusing history with regard to its use and has been replaced with the term crackles?

a.	Rales
b.	Wheezes
c.	Rhonchi
d.	Crepitations

 

 

ANS:  A

The term rales has had a long and confusing history. It was used originally by a French physician and is the French word for “rattle.”

 

REF:   pg. 88             OBJ:   21

 

45. Which of the following terms best describes continuous types of adventitious lung sounds?

a.	Rhonchi
b.	Stridor
c.	Wheezes
d.	Sibilant rales

 

 

ANS:  C

Continuous adventitious lung sounds are best described as wheezes.

 

REF:   pg. 89             OBJ:   21

 

46. Which of the following terms is used to describe a continuous type of adventitious lung sound heard loudest over the neck of a patient with upper airway obstruction?

a.	Wheezes
b.	Stridor
c.	Rhonchi
d.	Sonorous rales

 

 

ANS:  B

The term stridor is reserved for describing a low-pitched, monophonic wheeze that is heard loudest over the neck.

 

REF:   pg. 90             OBJ:   21

 

47. Which of the following mechanisms is believed to be responsible for the normal vesicular breath sound?

a.	Air entering the alveoli
b.	Contraction of the inspiratory muscles
c.	Rubbing together of the two layers of the pleurae
d.	Filtration of turbulent flow sounds in the larger airways

 

 

ANS:  D

Normal lung tissue is known to act as a filter for sound. This attenuation causes the turbulent flow sounds of the larger airways to be converted to softer, vesicular breath sounds.

 

REF:   pg. 90             OBJ:   22

 

48. Which of the following statements is not true about vesicular or normal breath sounds?

a.	They have a minimal expiratory sound.
b.	They are produced somewhat regionally.
c.	They are produced when air enters the alveoli.
d.	They are used to help confirm proper placement of an endotracheal tube.

 

 

ANS:  C

Air entering the alveoli does so by diffusion, which is silent.

 

REF:   pg. 90             OBJ:   20

 

49. Which of the following lung conditions is associated with diminished breath sounds because of airflow limitation and poor transmission of sound through the lung?

a.	Bronchitis
b.	Pneumonia
c.	Lung tumor
d.	Emphysema

 

 

ANS:  D

Emphysema causes extreme hyperinflation of the lung and obstruction of the bronchi. These two factors contribute to reduced sound production and transmission and, therefore, very diminished breath sounds.

 

REF:   pg. 90             OBJ:   22

 

50. Which of the following factors most closely relates to the pitch of a wheeze?

a.	The patient’s inspiratory-to-expiratory (I:E) ratio
b.	The patient’s respiratory rate
c.	The length of the involved airway
d.	The degree of airway compression

 

 

ANS:  D

The narrower the airway, the higher the pitch of the wheeze.

 

REF:   pg. 91             OBJ:   21

 

51. Which of the following characteristics of wheezing is least reliable for predicting the degree of airway obstruction?

a.	Pitch
b.	Duration
c.	Intensity
d.	Sound frequency

 

 

ANS:  C

The loudness of the wheeze is independent of the degree of airway obstruction.

 

REF:   pg. 91             OBJ:   21

 

52. Which of the following types of wheezing is likely to be heard over the chest of a patient with a tumor that is partially obstructing a single airway?

a.	Sibilant wheezing
b.	Sonorous wheezing
c.	Polyphonic wheezing
d.	Monophonic wheezing

 

 

ANS:  D

A tumor that obstructs a single airway will produce a wheeze with a single (monophonic) note.

 

REF:   pg. 92             OBJ:   23

 

53. Which of the following adventitious lung sounds is related most closely to a life-threatening problem?

a.	Stridor
b.	Rhonchi
c.	Crackles
d.	Wheezing

 

 

ANS:  A

Stridor represents narrowing of the upper airway. Because humans have only one upper airway, its obstruction can be deadly.

 

REF:   pg. 92             OBJ:   23

 

54. Which of the following adventitious lung sounds is associated most closely with restrictive types of lung diseases?

a.	Polyphonic wheezing
b.	Monophonic wheezing
c.	Late-inspiratory crackles
d.	Early-inspiratory crackles

 

 

ANS:  C

Late-inspiratory crackles are produced when distal airways pop open, as occurs in atelectasis and pulmonary fibrosis. These are restrictive lung diseases.

 

REF:   pg. 92             OBJ:   23

 

55. Which of the following adventitious lung sounds is most likely to be heard in a patient with croup?

a.	Stridor
b.	Rhonchi
c.	Polyphonic wheezes
d.	Late-inspiratory crackles

 

 

ANS:  A

Croup causes narrowing of the upper airway and, therefore, stridor.

 

REF:   pg. 92             OBJ:   23

 

56. Which of the following terms applies to an abnormal increase in vocal resonance?

a.	Fremitus
b.	Egophony
c.	Bronchophony
d.	None of the above

 

 

ANS:  C

Bronchophony refers to an abnormal increase in vocal resonance.

 

REF:   pg. 93             OBJ:   24

 

57. Which of the following abnormalities would be associated with an increase in vocal resonance?

a.	Pneumonia
b.	Emphysema
c.	Pneumothorax
d.	Large pleural effusion

 

 

ANS:  A

Pneumonia produces an increase in lung tissue density, which causes sound vibrations to travel more rapidly through the lung.

 

REF:   pg. 93             OBJ:   24

 

58. Which of the following terms describes the area of the chest wall that overlies the heart?

a.	Periosteum
b.	Precordium
c.	Pericardium
d.	None of the above

 

 

ANS:  B

The precordium is the area that overlies the heart on the chest wall where auscultation is performed.

 

REF:   pg. 94             OBJ:   25

 

59. In which area is the point of maximal impulse normally felt during palpation of the chest wall?

a.	Midaxillary line at the fifth intercostal space
b.	Midclavicular line at the fifth intercostal space
c.	Just left of the sternum at the third intercostal space
d.	Just right of the sternum at the fourth intercostal space

 

 

ANS:  B

The point of maximal impulse is created by left ventricular contraction. The left ventricle normally is located at the midclavicular line at the fifth intercostal space.

 

REF:   pg. 94             OBJ:   26

 

60. What may cause the point of maximal impulse to shift to the anterior axillary region on the left?

a.	A tension pneumothorax on the right
b.	Right ventricular hypertrophy
c.	Cor pulmonale
d.	Pericarditis

 

 

ANS:  A

A tension pneumothorax will cause a buildup of pressure in the right chest and will push the mediastinal contents to the left. This shifts the point of maximal impulse laterally.

 

REF:   pg. 94             OBJ:   26

 

61. Which of the following clinical disorders is characterized by the point of maximal impulse being felt in the epigastric area?

a.	Atelectasis
b.	Emphysema
c.	Pneumothorax
d.	Chronic bronchitis

 

 

ANS:  B

Emphysema causes the diaphragm to be low and flat in the chest. This pulls the heart into a low, centrally located position in the epigastric area.

 

REF:   pg. 94             OBJ:   26

 

62. At which of the following sites on the chest wall is the pulmonic valve best auscultated?

a.	Second left intercostal space near the sternal border
b.	Fifth intercostal space on the left near the sternal border
c.	Sixth intercostal space on the left at the midaxillary line
d.	First intercostal space on the right at the midclavicular line

 

 

ANS:  A

The pulmonic valve is best heard at the second left intercostal space near the sternal border.

 

REF:   pg. 94, Figure 5-25                          OBJ:   27

 

63. What is believed to be responsible for production of the first heart sound?

a.	Closure of the atrioventricular (AV) valves
b.	Opening of the AV valves
c.	Closure of the semilunar valves
d.	Opening of the semilunar valves

 

 

ANS:  A

Systole causes pressure to build in the ventricles and sudden closure of the AV valves. This is the first heart sound.

 

REF:   pg. 94             OBJ:   28

 

64. Which of the following mechanisms is responsible for production of an abnormal third heart sound?

a.	Forceful opening of the aortic valve
b.	Forceful closure of the pulmonic valve
c.	Rapid filling of the atrium during ventricular systole
d.	Rapid filling of the ventricles immediately after systole

 

 

ANS:  D

Rapid filling of the ventricle that is already distended causes an S3 sound.

 

REF:   pg. 95             OBJ:   28

 

65. What clinical problem is associated with a gallop rhythm?

a.	Left-to-right shunt
b.	Myocardial infarction sequelae
c.	Overdistention of the ventricles
d.	All of the above

 

 

ANS:  D

A gallop rhythm refers to the addition of S3 and/or S4 to the heart sound pattern. This is produced most often with overdistention of the ventricles, as occurs following MI and with shunting in the heart.

 

REF:   pg. 95             OBJ:   29

 

66. Which of the following clinical conditions may cause diminished heart sounds?

a.	Bronchitis
b.	Pneumonia
c.	Emphysema
d.	Pulmonary embolism

 

 

ANS:  C

Emphysema causes severe hyperinflation of the lungs and surrounds the heart with air, which is a poor transmitter of sounds and causes the heart sounds to sound distant.

 

REF:   pg. 94             OBJ:   30

 

67. What change in the heart sounds is associated with cor pulmonale?

a.	Loud A2
b.	Loud M1
c.	Loud T2
d.	Loud P2

 

 

ANS:  D

Cor pulmonale refers to chronic right heart failure due to pulmonary hypertension. Pulmonary hypertension causes a loud P2 sound.

 

REF:   pg. 95             OBJ:   31

 

68. Which of the following types of murmurs is associated with mitral valve stenosis?

a.	Systolic
b.	Diastolic
c.	Pansystolic
d.	None of the above

 

 

ANS:  B

A narrowed mitral valve will cause a murmur when blood tries to pass through during diastole.

 

REF:   pgs. 95-96      OBJ:   32

 

69. Which of the following is responsible for the production of murmurs?

a.	Stenotic AV valves
b.	Incompetent AV valves
c.	Incompetent semilunar valves
d.	All of the above

 

 

ANS:  D

Murmurs are produced by rapid blood flow through a narrowed opening from any cause.

 

REF:   pg. 95             OBJ:   32

 

70. What is a common cause of hepatomegaly?

a.	Chronic right heart failure
b.	Pneumothorax
c.	Pleural effusion
d.	Acute asthma attack

 

 

ANS:  A

An enlarged liver is commonly produced by chronic right heart failure that causes venous congestion and an elevated central venous pressure (CVP). This reduces the ability of the liver to function properly, and it becomes enlarged.

 

REF:   pg. 96             OBJ:   33

 

71. What is the normal distance that the liver spans in the right upper quadrant of the abdomen?

a.	6 cm
b.	8 cm
c.	10 cm
d.	14 cm

 

 

ANS:  C

The normal liver in the adult spans 10 cm or less.

 

REF:   pg. 96             OBJ:   33

 

72. Which of the following terms is used to describe an abnormal collection of fluid in the peritoneal cavity?

a.	Ascites
b.	Pericarditis
c.	Pancreatitis
d.	Hepatomegaly

 

 

ANS:  A

Fluid buildup in the abdomen is known as ascites.

 

REF:   pg. 96             OBJ:   33

 

73. Digital clubbing is associated with:

a.	COPD.
b.	Cystic fibrosis.
c.	Bronchogenic carcinoma.
d.	All of the above.

 

 

ANS:  D

Digital clubbing is associated with numerous chronic lung diseases.

 

REF:   pg. 96             OBJ:   34

 

74. Which of the following findings is consistent with reduced perfusion?

a.	Peripheral cyanosis
b.	Hepatomegaly
c.	Loud P2 sound
d.	Jugular vein distention (JVD)

 

 

ANS:  A

Extremities become cool to the touch and turn blue when circulation is poor.

 

REF:   pg. 97             OBJ:   34

 

75. Which of the following clinical conditions is associated with the onset of pedal edema?

a.	Liver failure
b.	Right heart failure
c.	Status asthmaticus
d.	Tension pneumothorax

 

 

ANS:  B

Right heart failure causes a backup of venous blood flow and increases the hydrostatic pressure of fluids in the dependent regions. This leads to pedal edema.

 

REF:   pg. 97             OBJ:   34

 

76. The length of normal capillary refill is less than _____ second(s).

a.	1
b.	3
c.	5
d.	10

 

 

ANS:  B

When circulation is good, capillary refill is rapid, taking less than 3 seconds.

 

REF:   pg. 96             OBJ:   34