A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?

Anteroposterior-to-transverse diameter ratio of 1:1

Unequal chest expansion

Atrophied neck and trapezius muscles

Increased tactile fremitus

Answer and Explanation

The Correct Answer is A

A. Anteroposterior-to-transverse diameter ratio of 1:1: In COPD, chronic air trapping leads to hyperinflation of the lungs, causing a "barrel chest" appearance where the anteroposterior (AP) diameter approaches or equals the transverse diameter (1:1 ratio). This is a hallmark physical finding in advanced stages of the disease.

B. Unequal chest expansion: COPD causes diffuse rather than localized lung pathology, leading to generally reduced but symmetrical chest expansion. Unequal expansion is more characteristic of conditions like pneumothorax, pleural effusion, or unilateral lung consolidation.

C. Atrophied neck and trapezius muscles: Patients with COPD often develop hypertrophy of the neck and accessory muscles due to chronic respiratory effort, not atrophy. These muscles become more prominent as they assist with breathing, especially during exacerbations.

D. Increased tactile fremitus: Fremitus is the vibration felt on the chest wall when a patient speaks. In COPD, hyperinflation and air trapping decrease lung density, leading to reduced tactile fremitus. Increased fremitus is typically found in conditions with lung consolidation, such as pneumonia.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is A

Explanation

A. An otitis media: A bright red tympanic membrane with an abnormal light reflex suggests inflammation and infection of the middle ear, characteristic of otitis media. Young children are particularly susceptible due to their shorter and more horizontal eustachian tubes, which facilitate bacterial or viral entry. Symptoms such as ear pulling, irritability, and fever often accompany the condition.

B. Cholesteatoma: Cholesteatoma is an abnormal skin growth in the middle ear that may result from chronic infections. It typically presents with a foul-smelling discharge, conductive hearing loss, and a white or pearly mass on the tympanic membrane rather than generalized redness.

C. A fungal infection: Fungal infections (otomycosis) usually present as black or white spots on the tympanic membrane or ear canal rather than diffuse redness. The condition often causes itching and mild discomfort rather than acute pain and fever.

D. A perforation of the eardrum: A perforation would likely present with a visible tear or hole in the tympanic membrane, often accompanied by drainage. While infections like otitis media can lead to perforation, the findings described in the question suggest inflammation rather than rupture.

A. Perform the confrontation test. B. Determine the patient's ability to read newsprint at a distance of 12 to 14 inches. C. Ask the patient to read the print on a handheld Jaeger card. D. Use the Snellen chart positioned 20 feet away from the patient.

Correct Answer is D

Explanation

A. Perform the confrontation test: The confrontation test is used to assess peripheral vision rather than overall visual acuity. It is not the standard method for measuring visual acuity in routine physical examinations.

B. Determine the patient's ability to read newsprint at a distance of 12 to 14 inches: While this can be useful for assessing near vision, it does not provide a complete assessment of visual acuity, which includes both near and distance vision.

C. Ask the patient to read the print on a handheld Jaeger card: The Jaeger card is specifically used for assessing near vision. While it is useful for determining how well the patient can see up close, it does not assess distance visual acuity, which is typically required in routine examinations for teenagers.

D. Use the Snellen chart positioned 20 feet away from the patient: The Snellen chart is the standard tool for measuring distance visual acuity. It is positioned 20 feet away from the patient to evaluate how well they can see letters of various sizes. This method provides a clear assessment of the patient’s visual acuity for routine physical examinations.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex is abnormal. What do these findings indicate?

Correct Answer is A

Explanation

The nurse is preparing to assess the visual acuity of a 16-year-old patient for a routine physical. How should the nurse proceed?

Correct Answer is D

Explanation

The nurse is performing the diagnostic positions test (6 Cardinal Gazes). Which result is a normal finding?

During ocular examinations, what should the nurse keep in mind regarding the movement of the extraocular muscles?

The nurse is performing an eye assessment on an 80-year-old patient. Which of these findings is considered abnormal?

Which sequence does the electrical stimulus of the cardiac cycle follow?

The nurse is performing an eye-screening clinic at a daycare center. When examining a 2-year-old child, the nurse suspects that the child has a "lazy eye". What should the nurse do next?

When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration being longer than expiration. How should the nurse interpret these findings?

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. Which nerve does the nurse suspect is damaged and how should the nurse proceed with the examination?