Health Assessment Exam 1

General Assessment, Interview, mental and pain assessment, Respiratory, breast, cardiac

How many lobes are present in the right lung compared to the left lung?

The right lung has 3 lobes (upper, middle, lower), while the left lung has 2 lobes (upper, lower).

What is the primary chemical stimulus that triggers the body to initiate a breath under normal physiological conditions?

Hypercapnia (elevated carbon dioxide levels in the blood).

What is the normal ratio of Anterior-Posterior (AP) to Transverse diameter of the thoracic cage?

1:2

An AP-to-Transverse thoracic ratio approaching 1:1 is known as a _____ chest, commonly seen in chronic hyperinflation conditions like emphysema.

barrel

When inspecting a patient sitting in a tripod position (leaning forward with arms braced), what is this finding indicative of?

Respiratory distress or severe SOB (utilizing accessory muscles to aid breathing).

How is tactile fremitus assessed during physical examination of the chest?

Palpating symmetric areas of the chest wall with the palmar or ulnar surface of the hands while the patient repeats the phrase "99" to feel for vocal vibrations.

What lung tissue alteration causes increased tactile fremitus?

Consolidation of lung tissue (such as lobar pneumonia), which conducts sound vibrations better than air-filled tissue

Which conditions lead to decreased or absent tactile fremitus?

Obstruction or trapped fluid/air outside the lung, such as pleural effusion, pneumothorax, emphysema, or bronchial obstruction.

What percussion note is expected over normal, healthy adult lung fields?

Resonance (low-pitched, clear, hollow sound).

What does a hyper-resonant percussion sound over the lungs signify?

Air trapping or excessive air in the pleural space/alveoli (e.g., pneumothorax, emphysema).

A dull percussion sound over lung fields indicates the presence of _____ or dense tissue.

Fluid, consolidation, or collapsed air sacs (e.g., lobar pneumonia, pleural effusion, atelectasis).

What are the pitch, location, and relative duration (inspiration vs. expiration) of normal bronchial breath sounds?

High-pitched, loud sound heard over the trachea; expiration is longer than inspiration (E>I).

Where are vesicular breath sounds normally heard, and what is their relative timing?

Heard over peripheral lung fields; low, soft-pitched sound where inspiration is longer than expiration (I>E).

What mechanism produces crackles (rales) during auscultation?

Fluid accumulation in the alveoli or air opening previously deflated airways (popping sound).

High-pitched, continuous musical sounds caused by air squeezing through narrowed airways (e.g., in asthma) are called _____.

Wheezes

What adventitious sound is described as a low-pitched, snoring or rumbling sound secondary to secretions in larger airways?

Rhonchi

What is stridor, and what urgent clinical scenario does it signal?

A high-pitched, crowing/screeching sound heard on inspiration without a stethoscope; signals upper airway obstruction.

A superficial, coarse, low-pitched rubbing sound heard on inspiration and expiration due to inflamed pleura rubbing together is a _____.

Pleural friction rub

What respiratory rate and pattern define tachypnea in an adult?

Rapid, shallow breathing with a rate >24 or 25 breaths per minute.

How does hyperventilation affect blood gas levels and systemic pH?

It blows off excess CO2​, leading to respiratory alkalosis.

What respiratory pattern is characterized by a regular cycle of waxing and waning depth of breathing followed by periods of apnea?

Cheyne-Stokes respirations

How do Biot respirations differ from Cheyne-Stokes respirations?

Biot respirations feature an irregular pattern consisting of 3 to 4 normal respirations interspersed with abrupt periods of apnea.

What physical exam findings define atelectasis (collapsed alveoli) on percussion and auscultation?

Dull percussion over the affected region and decreased or absent breath sounds.

What cluster of assessment cues distinguishes lobar pneumonia (solid consolidation) from pleural effusion?

Lobar pneumonia features increased tactile fremitus, dullness on percussion, bronchial breath sounds, and crackles due to fluid/tissue consolidation inside the lung.

What key physical exam findings differentiate pleural effusion from lobar pneumonia?

Pleural effusion causes decreased or absent tactile fremitus and decreased/absent breath sounds because fluid accumulates outside the lung in the pleural space.

What physical exam findings are expected over the affected side in a patient with a pneumothorax?

Hyper-resonance on percussion, decreased/absent tactile fremitus, and absent breath sounds (with tracheal deviation to the unaffected side in severe cases).

What key auscultatory finding and timing are characteristic of an acute asthma exacerbation?

Bilateral expiratory wheezing with a prolonged expiration phase.

What classic triad of systemic signs and symptoms points toward tuberculosis (TB)?

Night sweats, unexplained weight loss/fatigue, and hemoptysis (blood-tinged sputum) with persistent crackles.

What assessment findings are characteristic of emphysema ("pink puffer")?

Barrel chest (1:1 AP ratio), tripoding, pursed-lip breathing, hyper-resonant percussion, and decreased breath sounds with prolonged expiration.

What exam findings are associated with chronic bronchitis ("blue bloater")?

Recurrent productive cough with thick mucoid sputum, dyspnea, cyanosis, and finger clubbing.

What visual inspection finding on the fingernails indicates chronic long-term hypoxia?

Finger clubbing (loss of nail bed angle, rounded nail beds).

A patient presenting with sudden acute dyspnea, pleuritic chest pain, anxiety, tachycardia, and hypotension most likely has a _____.

Pulmonary embolism (PE)

What hallmark feature differentiates Acute Respiratory Distress Syndrome (ARDS) from standard pulmonary edema?

Refractory hypoxemia (blood oxygen saturation fails to increase despite high-flow supplemental oxygen therapy).

What key clinical findings indicate respiratory congestion due to heart failure?

Bilateral crackles at lung bases, orthopnea, paroxysmal nocturnal dyspnea (PND), pink frothy sputum (in severe cases), and an S3​ gallop.

Which quadrant of the breast extends into the axilla and contains the Tail of Spence?

The Upper Outer Quadrant (the site with the highest incidence of breast tumors).

What characterizes Tanner Stage 2 in female breast development?

Breast bud stage: A small mound of breast and nipple develops, and the areola widens.

Describe the appearance of the breast and nipple in Tanner Stage 3.

The breast and areola enlarge, and the nipple is flush with the breast surface.

In Tanner Stage 4 breast development, the areola and nipple form a _____ mound over the main breast tissue.

Secondary

How do breast tissue and feel fluctuate during the normal menstrual cycle in reproductive-age females?

Nodularity and fullness increase from midcycle through menstruation, followed by a decrease in volume post-menstruation.

What age-related structural changes occur in the breasts of older women due to decreased estrogen and progesterone?

Atrophy of breast glandular tissue, replacement with fibrous connective tissue, and loss of size and elasticity (resulting in sagging).

What expected breast changes occur during early pregnancy?

Breasts enlarge and become more nodular; nipples become larger and darker; areolae darken with prominent Montgomery tubercles; colostrum produces after the 4th month.

What is the correct positioning for a patient during palpation of breast tissue?

Patient positioned supine with a small pillow/towel under the shoulder and the arm raised behind the head.

What three position changes during inspection help screen for underlying skin dimpling or nipple retraction?

1. Raising arms overhead.

2. Pressing hands firmly against hips (or pressing palms together).

3. Leaning forward from the waist.

When examining a patient status-post unilateral mastectomy, which area should be palpated first?

Palpate the intact breast first, then palpate the mastectomy scar site and surrounding chest wall.

What physical characteristics define a fibroadenoma on breast palpation?

A solitary, nontender mass that is round, firm/rubbery, 1−5 cm in size, and freely movable/slippery.

What clinical features characterize benign fibrocystic breast disease?

Multiple tender nodular masses, cyclic dull heavy pain (worsening before menses), and occasional nipple discharge.

What palpation findings strongly suggest invasive breast cancer?

A solid, stony hard, dense mass with irregular borders that is fixed to underlying chest tissues.

What is the primary difference between a plugged duct and mastitis in a lactating mother?

A plugged duct causes a localized tender lump without systemic infection signs. Mastitis involves localized erythema/heat PLUS systemic infection signs (fever, chills, headache, malaise).

What is the recommended supportive management for mastitis during lactation?

Antibiotic therapy, rest, warm moist heat, and frequent continued nursing/breast emptying.

A hard, localized pocket of pus with erythema and tenderness in a lactating breast that requires antibiotics and potential drainage is a breast _____.

Abscess

Atelactasis

collapsed alveoli

pleural effusion

fluid in interpleural space

Heart Failure

pump failure leading to backup pulmonary circulation (fluid in lung bases)

pneumothorax

free air in pleural space with fully or partially collapsed lung (air outside lung)

asthma

bronchospasm and inflammation in airways causing resistance (narrowed airways)

Lobar pneumonia

infection causes alveoli to be edematous and porous (solid/consolidated tissue)

Acute bronchitis

infection of trachea and larger bronchi, usually viral

Chronic bronchitis

proliferation of mucus in airways

Emphysema

destruction of pulmonary connective tissue

pulmonary embolism

blood clot in pulmonary artery (sudden)

Acute respiratory distress syndrome

damage to alveolar capillaries causes permeability and pulmonary edema

Trace the path of deoxygenated blood through the right side of the heart, starting from the systemic veins.

Superior/Inferior Vena Cava → Right Atrium → Tricuspid Valve → Right Ventricle → Pulmonic Valve → Pulmonary Artery → Lungs.

Trace the path of oxygenated blood through the left side of the heart, starting from the pulmonary veins.

Pulmonary Veins → Left Atrium → Mitral (Bicuspid) Valve → Left Ventricle → Aortic Valve → Aorta → Systemic Circulation.

Which vessel is the only artery in the human body that carries deoxygenated blood?

The Pulmonary Artery

What anatomical area on the anterior chest wall directly overlies the heart and great vessels?

The Precordium

What heart action produces the S1​ heart sound ("lub"), and what phase of the cardiac cycle does it signal?

Closure of the Atrioventricular (AV) valves (Mitral and Tricuspid); it signals the beginning of systole.

What heart action produces the S2​ heart sound ("dub"), and where is it heard loudest?

Closure of the semilunar valves (Aortic and Pulmonic); it signals the end of systole and is loudest at the base of the heart.

What causes the S3​ heart sound (ventricular gallop), and when does it occur in the cardiac cycle?

It occurs when ventricles are resistant to filling during early rapid filling (protodiastole), immediately after S2​.

When does the S4​ heart sound (atrial gallop) occur relative to other heart sounds?

At the end of diastole (presystole), right before S1​, when the ventricle resists filling during atrial contraction.

What underlying physical phenomenon creates a cardiac murmur?

Turbulent blood flow and collision currents within the heart or great vessels.

List three physiological conditions that can cause a benign murmur by increasing blood flow velocity.

1. Fever

2. Pregnancy

3. Exercise

Where is the anatomical landmark for auscultating the Aortic Valve?

2nd right intercostal space at the sternal border.

Where is the anatomical landmark for auscultating the Pulmonic Valve?

2nd left intercostal space at the sternal border.

Where is Erb's point located, and what is notable about heart sounds heard there?

3rd left intercostal space at the sternal border; S1​ and S2​ are heard equally well (S1​=S2​).

Where is the anatomical landmark for auscultating the Tricuspid Valve?

4th left intercostal space at the sternal border.

Where is the anatomical landmark for auscultating the Mitral Valve?

5th left intercostal space at the midclavicular line (apex of the heart).

What is the primary pacemaker of the heart, and what is its normal intrinsic firing rate?

The Sinoatrial (SA) Node, firing at 60–100 bpm.

Which wave on an EKG tracing represents atrial depolarization?

The P wave

Which wave complex on an EKG tracing represents ventricular depolarization?

The QRS complex

Which wave on an EKG tracing represents ventricular repolarization?

The T wave

How is peripheral pulse force graded on a standard clinical scale?

0 - absent

1+ - weak, thready

2+ - normal

3+ - full, bounding

Why is it critical to palpate only one carotid artery at a time during physical assessment?

Simultaneous bilateral pressure can compromise cerebral arterial blood flow or trigger carotid sinus reflex bradycardia and syncope.

How should a nurse assess a carotid artery for the presence of a bruit?

Auscultate with the bell of the stethoscope at 3 locations (jaw angle, midcervical, base of neck) while the patient holds their breath.

What patient positioning is required when inspecting for Jugular Venous Distention (JVD)?

Position the patient supine with the head of bed elevated at a 30 to 45 degree angle.

What three anatomical mechanisms facilitate low-pressure venous return to the heart?

1. Contracting skeletal muscles (muscle pump)

2. Pressure gradient changes caused by breathing

3. Intraluminal unifirectional one-way valves

Arterial insufficiency

• intermittent claudation, worse with walking/exercise

• relieved by rest

• “6 Ps” - acute arterial occlusion or severe PAD

• Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia, Paralysis

Venous insuffiiciency

• Aching, cramping, heaviness

• worse at end of day

• relieved by elevation

• “TED” → TED stockings

• Thick skin, Edema, Discoloration

Contrast lower extremity skin findings in peripheral arterial disease vs. venous disease.

Arterial: Cool, pale, thin, shiny skin with loss of hair and thick ridged nails. • Venous: Warm, thickened, coarse, firm skin with brownish discoloration.

How does lower extremity edema differ between arterial and venous insufficiency?

Arterial: Rare or absent. • Venous: Common and prominent (worse in evenings or after prolonged standing).

What is intermittent claudication, and what underlying pathology does it indicate?

Ischemic muscle pain or cramping in the legs brought on by exercise and relieved by rest; indicates peripheral arterial disease (PAD).

Describe the classic tricolor sequence seen in Raynaud phenomenon upon exposure to cold or stress.

1. White (extreme pallor from vasospasm)

2. Blue (cyanosis from reduced oxygenation)

3. Red (rubor from reperfusion hypercapnia)

What are the key clinical manifestations of Deep Vein Thrombosis (DVT) in a lower extremity?

Unilateral leg swelling, localized calf tenderness/pain, warmth, and erythema.

What is lymphedema, and why does it commonly occur following breast cancer surgery?

Chronic accumulation of protein-rich lymph fluid in interstitial spaces; caused by removal or damage of axillary lymph nodes during surgery/radiation.

What drop in blood pressure parameters defines Orthostatic Hypotension upon standing?

A drop in systolic BP of >20 mmHg OR a drop in diastolic BP of >10 mmHg.

Why do older adults exhibit a gradual rise in systolic blood pressure and a widened pulse pressure?

Age-related arteriosclerosis causing stiffening and loss of elasticity in the aorta and major arteries.

In cardiovascular palpation, what is a palpable vibration on the precordium called, and what does it signify?

A thrill; signifies turbulent blood flow accompanying a loud murmur.

Orthopnea

SOB when you lie flat —> relieved by sitting or standing

Paroxysmal nocturnal dyspnea (PND)

sudden SOB that wakes a person from sleep, usually 1-2 hrs after lying down —> relieved by standing upright

Raynaud phenomenon

progressive tricolor change secondary to cold, vibration, stress

• cold, numbness, pain

• usually lasts 15-20 minutes

• avoid cold, smoking

What is the clinical definition of mental status?

A person's emotional and cognitive functioning, reflecting a balance between work, relationships, and self.