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.

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Correct Answer is B

Explanation

A. Palm: The palm of the hand is not ideal for palpating lymph nodes because it does not provide the fine sensitivity needed to detect subtle differences in size, texture, and tenderness.

B. Pads of fingers: The pads of the fingers are the best part of the hand to use when examining lymph nodes. This part allows for precise and gentle palpation, helping the nurse assess the size, consistency, and mobility of the lymph nodes effectively.

C. Base of hand: The base of the hand is less sensitive and not suitable for palpating lymph nodes as it provides less sensitivity compared to the pads of the fingers. The base of the hand is better suited for applying pressure during broader palpation techniques It does not provide the necessary tactile feedback for a thorough examination.

D. Ulnar surface: The ulnar surface of the hand is not typically used for palpation of lymph nodes. It is less sensitive compared to the pads of the fingers and is not appropriate for this examination.

A. Changes in peripheral vision in response to bright light B. Pupillary dilation when looking at a near object C. Pupillary constriction when looking at a near object D. involuntary blinking in the presence of bright light

Correct Answer is C

Explanation

A. Changes in peripheral vision in response to bright light: This assessment relates more to visual field testing and does not evaluate accommodation. Accommodation specifically involves the ability of the eye to focus on near objects.

B. Pupillary dilation when looking at a near object: Pupillary dilation occurs when focusing on distant objects due to decreased light and increased depth of focus, not during accommodation.

C. Pupillary constriction when looking at a near object: This is the correct assessment for visual accommodation. When a person looks at a near object, the pupils constrict to enhance focus and reduce light entry, aiding in clearer vision of nearby objects. This reaction is part of the accommodation reflex, which also involves changes in lens shape.

D. Involuntary blinking in the presence of bright light: This response is known as the photo pupillary reflex, which involves blinking in reaction to bright light but does not assess accommodation. Accommodation specifically evaluates the eye's ability to focus on objects at different distances.

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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

A 33 year old patient presents with complaints of enlarged lymph nodes in their neck. The nurse will use which part of the hand to examine the lymph node size?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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