Question 1
A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings on exam reveal:
temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute
...
Question 1
A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings on exam reveal:
temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute.
Tachypnea in this child is most likely related to
Paradoxical respirations.
the child's febrile state. Correct
the child's age.
an airway obstruction.
Explanation:
In children, heart and respiratory rates will increase with fever. For every degree of fever the respiratory
rate will increase 3-4 breaths/minutes and the heart rate will increase 8-10 beats/minute.
Question 2
When percussing the lower posterior chest, begin by:
standing on the side rather than directly behind the patient.
Correct: having the patient lie supine on the examining table.
carefully palpating any area the patient has reported pain.
using the ball or the ulnar surface of the hand.
Explanation:
When percussing the lower posterior chest, stand on the side rather than directly behind the patient.
This position allows the ability to place the pleximeter finger more firmly on the chest and the plexor is
more effective in making a better percussion note. If the patient is lying supine, the posterior chest will
not be able to be percussed. Palpating painful areas is not percussion, so is not correct. Using the bony
part of the palm at the base of the fingers or the ulnar surface is a technique used to detect tactile
fremitus.
Question 3
The palpation technique used to assess respiratory expansion of the chest is placing the hands on the
eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand medially and
grasping a small fold of skin between the thumbs. Then:
ask the patient to cough and note chest expansion.
ask the patient to take a deep breathe and note any delay in expansion during inhalation.
Correct have the patient hold his breath for 15 seconds then note chest expansion.
have the patient exhale forcefully noting expansion on expiration.
Explanation:
To assess the respiratory expansion of the chest, the examiner places his hands on the eight or tenth
ribs posteriorly with the thumbs close to the vertebrae, slides the hand medially and grasps a small fold
of skin between the thumbs then asks the patient to take a deep breath. The thumbs should move
evenly away from the vertebrae during inspiration and there should be no delay in expansion.
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