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NR 509 APEA 3P Exam/ NR509 APEA 3P Exam (NEW, 2023/2024): Chamberlain College of Nursing
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NR 509 APEA 3P Exam/ NR509 APEA 3P Exam (NEW, 2023/2024): Chamberlain College of Nursing
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NR 509 APEA Test -3 PQuestion 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.
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.
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.
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.
Question 4
When trying to differentiate between hemoptysis or blood streaked material, which one of the
following observations is correct?
Hemoptysis is seen frequently in infants, children, and adolescents with allergic rhinitis.
Blood originating in the stomach is usually brighter than blood originating from the respiratory
tract.
Hemoptysis is common in children with cystic fibrosis.
Blood streaked material often originates from the gastrointestinal tract.
Explanation:
Hemoptysis is rare in infants, children, and adolescents, although common in those with cystic
fibrosis. Blood originating in the stomach is usually darker than blood from the respiratory tract
and may be mixed with food particles. Blood or blood-streaked material may originate in the
mouth, pharynx, or less commonly from the gastrointestinal tract.
Question 5
, When percussing the chest in a patient who has left sided heart failure, the sound emanated
would be:
resonant.
dulltympany.
Diffusely
hyperresonant.
Explanation:
A patient with left sided heart failure experiences increased pressure in the pulmonary veins
causing congestion and interstitial edema. Percussion sounds emitted would most likely be
resonant. Consolidation in the lungs produces a dull sound on percussion. Tympany (low-high
pitched musical sound) is usually audible when percussing a distended abdomen or when a
pneumothorax is present. Chronic obstructive lung disease produces diffusely hyperresonant
sound on percussion.
Question 6
The line that extends through the inferior angle of the scapula when the arms are at the sides of
the body is the:
mid vertebral line.
scapular line.
midclavicular line.
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