Author:
tswhite
ID:
46305
Filename:
Chapter 5 & 21 Wilkins
Updated:
2010-11-09 17:34:32
Tags:
documentation
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Description:
physical examination, patient documentation
Show Answers:


  1. The patient record is a(an):
    a. financial document
    b. legal document
    c. educational tool
    d. all of the above
    • d. all of the above

  2. What is the primary goal of The Joint Commission?
    a. Monitor financial reimbursement of hospitals.
    b. Review healthcare organizations to improve the quality of healthcare and patient safety.
    c. Provide healthcare workers with a safe work environment.
    d. Monitor the ethical practice of medicine at healthcare organizations.
    • b. Review healthcare organizations to improve the quality of healthcare and patient safety.

  3. Which of the following organizations influences what needs to be documented in a patient's medical record?
    a. The Joint Commission
    b. Center for Medicare and Medicaid Services (CMS)
    c. Financial intermediaries
    d. All of the above
    • a. The Joint Commission

  4. Which of the following definitions is consistent with negligence?
    a. Failure to document a procedure performed on a patient
    b. Failure to explain to a patient the purpose of a therapy
    c. Failure to obtain a license to practice despite good clinical performace
    d. Failure to use a reasonable amt of care that results in injury or damage to another
    • d. Failure to use a reasonable amt of care that results in injury or damage to another

  5. Which of the following conditions is NOT required for the legal definition of negligence?
    a. The defendant owed a duty of care to the plaintiff.
    b. The defendant breached that duty.
    c. The plaintiff suffered a legally recognizable injury.
    d. The defenant's breach of duty of care did not cause the plaintiff's injury.
    • d. The defenant's breach of duty of care did not cause the plaintiff's injury.

  6. Which of the following outlines the professional standards for respiratory therapists?
    I. AARC clinical practice guidelines
    II. Respiratory care practice act and regulations
    III. Place of employment
    IV. The Joint Commission
    a. I, II, and IV
    b. I, II, and III
    c. I, II, III, and IV
    d. II and IV
    • c. I, II, III, and IV

  7. The absence of information or the lack of documented recognition of specific problems could result in one of the following situations?
    a. Malpractice
    b. Reduction in salary for the respiratory therapist
    c. Reduction in workload
    d. Probation status for the clinician at fault
    • a. Malpractice

  8. Which of the following sections of the patient assessment or procedures should be charted immediately?
    a. Date and time of test or treatment
    b. Vital Signs
    c. Result, or response to treatment, including adverse reactions
    d. Drugs and their dosages
    • b. Vital Signs

  9. Which of the following words is not consistent with the definition of the SOAP charting method?
    a. Subjective
    b. Objective
    c. Assessment
    d. Physical exam
    • d. Physical exam

  10. All of the following are examples of "objective" data, except:
    a. laboratory results.
    b. observation of a patient's sleep apnea.
    c. the patient's report of the amount of sputum that he or she produces daily.
    d. the physician's interpretation of the patient's ECG.
    • c. the patient's report of the amount of sputum that he or she produces daily.

  11. According to experts, obtaining a good medical history from the patient can give you a ____% chance of correctly identifying a patient's problem before you do a single test.
    a. 30
    b. 50
    c. 70
    d. 90
    • c. 70

  12. Which of the following data does not constitute part of the objective part of the SOAP charting method?
    a. vital signs
    b. review of systems
    c. review of clinical laboratory data
    d. review of pulmonary function test results
    • b. review of systems

  13. What does the letter "I" stand for in the APIE method of documentation?
    a. Implementation
    b. Impact
    c. Inconsistencies
    d. Initiative
    • a. Implementation

  14. Which method of documentation is probably best for a clinician who is pressed for time?
    a. SOAP
    b. APIE
    c. PIP
    d. SBAR
    • a. PIP




  15. Which of the following charting methods has been promoted with implementation of rapid response teams (RRTs)?

    a. PIP

    b. SOAP

    c. SBAR

    d. APEI




    c. SBAR

  16. What problem is associated with cyanosis of the oral mucosa?
    a. Low cardiac output
    b. Reduced arterial oxygenation
    c. Hyperventilation
    d. Hypoventilation
    • b. Reduced arterial oxygenation


  17. What is associated with nasal flaring?

    a. Hypoxemia

    b. Increased lung compliance

    c. Increased work of breathing

    d. Increased dead space ventilation
    • c. Increased work of breathing

  18. Which of the following is not associated with dilated and unresponsive pupils?
    a. Opiates
    b. Atropine
    c. Brain Death
    d. Catecholamines
    • b. Atropine

  19. What term is used to describe constriction of the puils of the eye?
    a. Lytosis
    b. Miosis
    c. Mydriasis
    d. Nystagmus
    • b. Miosis


  20. What term is used to descrive drooping of the eyelids?
    a. Ptosis
    b. Miosis
    c. Diplopia
    d. Chondrosis
    • a. Ptosis

  21. Which of the following physical examination findings is associated with myasthenia gravis?
    a. Ptosis
    b. Miosis
    c. Mydriasis
    d. Hepatomegaly
    • a. Ptosis

  22. What term is used to describe double vision?
    a. Miosis
    b. Diplopia
    c. Nystagmus
    d. None of the above
    • b. Diplopia

  23. 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
    • b. right upper lobe pneumothorax

  24. Which of the following is the most common cause of jugular venous distention?
    a. auto-positive end-expiratory pressure (PEEP)
    b. pneumonia
    c. pneumothorax
    d. right heart failure
    • d. right heart failure

  25. At what angle should the head of the bed be elevated to to assess jugular vein pressure (JVP)?
    a. 15 degrees
    b. 30 degrees
    c. 45 degrees
    d. 90 degrees
    • c. 45 degrees

  26. In the patien's chart the physician documented fining lymphadenopathy in the neck region that is tender to the touch. This problem is consistent with:
    a. respiratory infection
    b. HIV
    c. lymphoma
    d. lung cancer
    • a. respiratory infection

  27. The horizontal fissure that separates the right upper lobe from the right middle lobe begins at what rib in the midsternal line?
    a. between T4 and T6
    b. between T6 and T8
    c. Between T9 and T12
    d. None of the above
    • c. Between T9 and T12

  28. What term describes an abnormal lateral curvature of the spine?
    a. Kyphosis
    b. Scoliosis
    c. Anhidrosis
    d. Myelosis
    • b. Scoliosis

  29. What disorder is associated with a barrel chest?
    a. Chronic bronchitis
    b. Pneumonia
    c. Emphysema
    d. Chest trauma
    • c. Emphysema

  30. What pattern 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
    • d. rapid and shallow

  31. What disease is most likely to cause a prolonged expiratory time?
    a. Asthma
    b. Pneumonia
    c. Pneumothorax
    d. Pulmonary fibrosis
    • a. Asthma

  32. What disease is most likely to cause a prolonged inspiratory time?
    a. Chronic obstructive pulmonary disease (COPD)
    b. Asthma
    c. Epiglottitis
    d. Acute bronchitis
    • c. Epiglottitis

  33. What term describes the sinking inward of the skin overlying the rib cage with each inspiratory effort?
    a. Ataxia
    b. Bulging
    c. Retractions
    d. Mydriasis
    • c. Retractions

  34. Which of the following is a sign of more severe chronic obstructive pulmonary disease?
    a. Prolonged inspiratory time
    b. Decrease in AP diameter of the chest
    c. Significant use of accessory muscles at rest
    d. small retrosternal airspace on the lateral chest film
    • c. Significant use of accessory muscles at rest

  35. What breathing pattern is associated with fatigue of the diaphragm?
    a. bradypnea
    b. Deep and fast breathing
    c. Biot's breathing
    d. Abdominal paradox
    • d. Abdominal paradox

  36. 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's breathing
    c. Hoover's sign
    d. Respiratory alternans
    • c. Hoover's sign

  37. What clinical condition is associated with central cyanosis?
    a. Hypercarbia
    b. Renal failure
    c. Poor circulation
    d. Respiratory failure
    • d. Respiratory failure

  38. Which of the following will cause an increase in vocal fremitus upon palpation?
    a. COPD
    b. Obesity
    c. Pneumonia
    d. Pneumothorax
    • c. Pneumonia

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

    a. Atelectasis

    b. Pneumonia

    c. Lung tumor

    d. Pneumothorax


    d. Pneumothorax

  40. What clinical disorder will cause a decrease in vocal fremitus upon palpation?
    a. COPD
    b. Lobar pneumonia
    c. Acute asthma attack
    d. Neuromuscular Disease
    • b. Lobar pneumonia

  41. On assessment of chest expanstion with palpation, the right lower chest is found to lag behind the left. With what problem is this finding consistent?
    a. COPD
    b. Right lower lobe pneumonia
    c. left lower lobe pneumonia
    d. Severe asthma
    • b. Right lower lobe pneumonia

  42. What clinical disorder will cause increased resonance to percussion?
    a. Atelctasis
    b. Pneumonia
    c. Pneumothorax
    d. Pleural effusion
    • c. Pneumothorax

  43. What clinical disorder will cause decreased resonance to percussion?
    a. COPD
    b. Asthma
    c. Pneumonia
    d. Pneumothorax
    • c. Pneumonia

  44. 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
    • b. low; heart

  45. What technique is most useful for application of the bell portion of the stethoscope?
    a. Press lightly against the chest wall.
    b. Press firmly against the chest wall.
    c. Hold it 1 cm from the chest wall.
    d. Slide it in a circle.
    • a. Press lightly against the chest wall.

  46. 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.
    • d. most lung sounds.

  47. Where is the best anatomical 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
    • d. In the dependent regions

  48. What term 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
    • d. Bronchovesicular

  49. Which of the following characteristics does not apply to normal tracheal breath sounds?
    a. Loud
    b. Low pitched
    c. High pitched
    d. Fairly equal insp and exp components
    • b. Low pitched

  50. Which of the following descriptions does not apply to ormal vesicular breath sounds?
    a. Soft with low intensity
    b. Minimal expiratory component
    c. Heart primarily over lung parechyma
    d. High pitched as compared with tracheal breath sounds
    • d. High pitched as compared with tracheal breath sounds

  51. What term best describes a louder version of a vesicular sound that can be heard over long consolidation?
    a. Tubular
    b. Tracheal
    c. Crepitation
    d. Harsh or bronchial
    • d. Harsh or bronchial

  52. What term 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
    • a. Rales

  53. What term best describes types of adventitious lung sounds?
    a. Rhonchi
    b. Stridor
    c. Wheeze
    d. Sibilant rales
    • c. Wheeze

  54. What term is used to describe a continuous type of adventitious lung sound heard loudest over the nek of the patient with an upper airway obstruction?
    a. Wheeze
    b. Stridor
    c. Rhonchi
    d. Sonorous rales
    • b. Stridor

  55. What mechanism 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 pleura

    d. Filtration of turbulent flow sounds in the larger airways
    • d. Filtration of turbulent flow sounds in the larger airways

  56. Which of the following statements is not true about vesicular or normal breath sounds?
    a. They have minimal expiratory sounds.
    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 the ET tube.
    • c. They are produced when air enters the alveoli.
    • (...by diffusion, which is silent.)

  57. Which of the following lung conditions is associated with diminished breath sounds becuase of airflow limitation and poor transmission of sound through the lung?
    a. Bronchitis
    b. Pneumonia
    c. Lung tumor
    d. Emphysema
    • d. Emphysema

  58. Which of the following factors most closely relates to the pitch of a wheeze?
    a. The patient's I:E ratio.
    b. The patiet's respiratory rate.
    c. The length of the involved airway.
    d. The degree of airway compression.
    • d. The degree of airway compression.

  59. Which of the following characteristics of wheezing is the least reliable for predicting the degree of airway obstruction?
    a. Pitch
    b. Duration
    c. Intensity
    d. Sound Frequency
    • c. Intensity

  60. What type 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
    • d. Monophonic wheezing

  61. Which of the following adventitous lung sounds is related most closely to a life-threatening problem?
    a. Stridor
    b. Rhonchi
    c. Crackles
    d. Wheezing
    • a. Stridor

  62. 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
    • c. late-inspiratory crackles

  63. What adventitous lung sound is most likely to be heard in the patient with croup?
    a. Stridor
    b. Rhonchi
    c. Polyphonic wheeze
    d. Late-inspiratory crackles
    • a. Stridor

  64. What term applies to an abnormal increase in vocal resonance?
    a. Fremitus
    b. Egophony
    c. Bronchophony
    d. None of the above
    • c. Bronchophony

  65. Which of the following abnormalities would be associated with an increase in vocal resonance?
    a. Pneumonia
    b. Emphysema
    c. Pneumothorax
    d. Large pleural effusion
    • a. Pneumonia

  66. What term describes the area of the chest wall that overlies the heart?
    a. Perosteum
    b. Precordium
    c. Pericardium
    d. None of the above
    • b. Precordium

  67. The point of miscimal impulse normally is felt where during palpation of the chest wall?
    a. Midaxillary line at the 5th intercostal space
    b. Midclavicular line at the 5th intercostal space
    c. Just left of the sternum at the 3rd intercostal space
    d. Just right of the sternum at the 4th intercostal space
    • b. Midclavicular line at the 5th intercostal space

  68. What may cause the PMI to shift to the antrior axillary region on the left?
    a. A tension pneumothorax on the right
    b. Right ventricular hypertrophy
    c. Cor pulmonale
    d. Pericarditis
    • a. A tension pneumothorax on the right

  69. What is the clinical disorder characterized by the point of maximal impulse being felt in the epigastric area?
    a. Atelectasis
    b. Emphysema
    c. Pneumothorax
    c. Chronic bronchitis
    • b. Emphysema

  70. At what site on the chest wall is the pulmonic valve best auscultated?
    a. 2nd left intercostal space near the sternal border
    b. 5th intercostal space on the left near the sternal border
    c. 6th intercostal space on the left at the midaxillary line
    d. 1st intercostal space on the right at the midclavicular line
    • a. 2nd left intercostal space near the sternal border

  71. What is believed to be responsible for production of the first heart sound?
    • Closure of the AV valves (mitral, tricuspid)

  72. What mechanism is responsible for production of an abnormal third heart sound?
    • Rapid filling of the ventricles immediately after systole

  73. What clinical problem is associated with a gallop rhythm?
    • Left-to-right shunt, post myocardial infarction, overdistention of the ventricles (all of the above)

  74. What clinical condition may cause diminished heart sounds?
    • Emphysema

  75. What change in the heart sounds is associated with cor pulmonale?
    • Loud P2

  76. What type of murmur is associated with mitral valve stenosis?
    • Diastolic

  77. Which of the following is responsible for the production of murmurs?
    • Stenotic AV valves, Incompetent AV valves, Incompetent semilunar valve (all of the above)

  78. What is a common cause of hepatomegaly?
    • Chronic right heart failure

  79. What is the normal distance that the liver spans in the right upper quadrant of the abdomen?
    • 10 cm

  80. What is the term used to describe an abnormal collection of fluid in the peritoneal cavity?
    • Ascites

  81. Digital clubbing is associated with:
    • COPD, CF, bronchogenic carcinoma, *all of the above

  82. Which of the following findings is consistant with reduced perfusion?

    a. Peripheral cyanosis

    b. Hepatomegaly

    c. Loud P2 sound

    d. Jugular vein distention (JVD)
    • a. Peripheral cyanosis

  83. What clinical condition is associated with the onset of pedal edema?



    a. liver failure



    b. right heart failure



    c. status asthmaticus



    d. tension pneumothorax
    • b. right heart failure

  84. Normal capillary refill is less than ____ seconds?
    • 3