Health Assessment Exam 3 Student Review

By Nicholas Boyce

● Chapter 2: Cultural Competence

● Chapter 10: Pain Assessment
● Chapter 17: Breasts and Regional Lymphatics
● Chapter 18: Thorax and Lungs
● Chapter 19: Heart and Neck Vessels
● Chapter 20: Peripheral Vascular System and Lymphatic System
● Chapter 21: Abdomen
Chapter 10: Pain Assessment
Q1: Specialized nerve endings called ______ are designed to detect pain from the
periphery and transmit them to the central nervous system.

A: Nociceptors

B: Opioid Receptors

C: Interneurons
Q2: Nociceptive pain develops when nerve fibers in the periphery and CNS are
stimulated, and is triggered by tissue damage from events that occur outside the
nervous system. What is the correct order of the four phases of nociceptive pain?

A: Transmission, Transduction, Modulation, Perception

B: Perception, Transmission, Transduction, Modulation

C: Transduction, Transmission, Perception, Modulation

Q3: Which of the following phases of nociceptive pain is NOT accurately described?

A: Transduction: A noxious stimulus takes place in the periphery

B: Transmission: A pain impulse travels from the spinal cord to the brain

C: Perception: Conscious awareness of the painful stimulation

D: Modulation: The pain message is increased by neurotransmitters until the original

stimulus is removed
Q4: Neuropathic pain is different from nociceptive pain in that it….

A: is more difficult to assess and treat.

B: is an abnormal processing of the pain message.

C: is often perceived long after the injury has healed.

D: is all of the above.

Q5: True or False. Pain is a common experience for the aging adult, and is
considered a normal process of aging.

A: True

B: False
Although we may assess pain and organize it into objective data pain is always
subjective. The most reliable indicator of pain is the subjective report. We can use
various pain assessment tools based on which tool is best for the situation. These
tools include: initial pain assessment, brief pain inventory, The short-form McGill
Pain Questionnaire, and pain rating scales.We can also use the PQRST method to
help with the subjective report.

P=Provocation/Palliation

Q=Quality/Quantity

R=Region/Radiation

S=Severity Scale

T=Timing
When collecting objective data inspect your patient for nonverbal cues and pain
behaviors. Acute pain behaviors and chronic pain behaviors may differ.

Acute pain behaviors include: guarding, grimacing, vocalizations, agitation,

restlessness, stillness, diaphoresis, and changes in vital signs.

Chronic pain behaviors include: bracing, diminished activity, changes in appetite,

prayer, rubbing, sighing, movement, exercise, and sleeping.

Poorly controlled pain may have negative impacts on the following systems: cardiac,
pulmonary, gastrointestinal, renal, musculoskeletal, endocrine, CNS, and immune.
Chapter 17: Breasts and Regional Lymphatics
Q1: The breasts lie on the anterior of the pectoralis major and serratus anterior muscles. They
are located between the 2nd and 6th ribs, and between the side of the sternum and the
midaxillary line. The breasts can be divided into four quadrants by an imaginary vertical and
horizontal line intersecting at the nipple. Which quadrant is the most common site of breast
cancer and contains the axillary tail of spence?

A. Upper outer quadrant

B. Upper inner quadrant
C. Lower outer quadrant
D. Lower inner quadrant
Q2: Four groups of axillary lymph nodes are present in the breasts. More than 75%
of the lymph drains into the same side axillary nodes. Only a small amount of lymph
drains to the infraclavicular group, opposite breast, abdomen, or deep into the chest.
Which of the following is NOT one of the four axillary nodes?

A. Central
B. Subscapular
C. Lateral
D. Infraclavicular
Q3: Which of the following is true regarding breast development in the adolescent?

A: Onset of breast development usually occurs by age 10 for White girls, and
between 8 or 9 for African-American girls

B: Menarche (beginning of menstruation) occurs about 2 years after the onset of

breast development

C: Occasionally one breast may grow faster than the other causing temporary
asymmetry, and tenderness is also common

D: All of the above

Q4: After menopause breast glandular tissue atrophies and is replaced with fibrous
connective tissue. The fat envelope also atrophies beginning in the middle years and
becomes marked in the 70s and 80s. Which of the following is true regarding
changes in the aging women? Select all that apply.

A: Breast size and elasticity decrease

B: Inner structures become more prominent

C: Lactiferous ducts around the nipple become more palpable and feel firm and stringy

D: Axillary hair decreases

E: A breast lump that was previously hidden may become palpable

Q5: BRCA1 and BRCA2 are tumor suppressor genes we all have. Woman who
inherit a mutation on one or both of these genes have a much greater risk of
developing breast or ovarian cancer. Which of the following is true?

A: Women from Asian-American, Hispanic, and American Indian groups have higher incidence
and death rates from breast cancer than Whites and African Americans.

B: African American women have a higher incidence of breast cancer than White women after
age 45, but are less likely to die from their disease.

C: White women have a higher incidence of breast cancer than African American women after
age 45, but African American women have a higher incidence before age 45 and are more
likely to die from their disease at all ages.
Subjective Data:

You should ask questions about any pain, lumps, discharge, rash, swelling, trauma,
surgeries, radiation, medications, self care behaviors and history of breast disease.
Also ask about tenderness, lumps, swelling, and rashes in the axilla since breast
tissue extends into here, and there are many lymph nodes.

For a preadolescent also ask about changes in the breasts. For a pregnant women
also ask about any enlargement of the breasts and if she is planning to breastfeed.
For menopausal women also ask about changes in the breasts contour, size, or
firmness.
Objective data:

Inspect the skin for color, bulging, dimpling, and lesions. Also inspect the lymphatic
drainage areas and nipple. When palpating the breasts you should use the pads of
your first 3 fingers and make a gentle rotary motion on the breast in a vertical strip
pattern. If you feel an abnormal mass, note these characteristics: location, size,
shape, consistency, mobility, distinctness, nipple retraction, overlying skin,
tenderness, and lymphadenopathy. After your assessment teach breast
self-examination and awareness.
Chapter 18: Thorax and Lungs
Q1: The thoracic cage is a bony structure with a conical shape, and is defined by the
sternum, 12 pairs of ribs, and 12 thoracic vertebrae. Which of the following is true
regarding the thoracic cage and it’s landmarks? Select all that apply.

A: The first 7 ribs connect directly to the sternum from their costal cartilages.

B: Ribs 8, 9, and 10 attach to the costal cartilage above while ribs 11 and 12 are free floating.

C: The sternal angle (angle of Louis) is continuous with the 1st rib.

D: The inferior angle of the scapula lies at the 7th or 8th rib
Q2: Which of the following is true regarding the lungs?

A: The apex of the lungs is 3 to 4 centimeters above the inner third of the clavicles,
while the base of the lungs rests on the diaphragm

B: The right lung is shorter and wider than the left lung

C: The left lung has 2 lobes unlike the right lung which has 3 lobes

D: All of the above

Q3: Which of the following is true regarding the borders of the lungs? Select all
that apply.

A: The base of the lungs rests on the diaphragm at about the 6th rib on the
midclavicular line.

B: Laterally, lung tissue extends from the apex of the axilla to the 7th or 8th rib.

C: Posteriorly, the apex of the lungs is marked at C7 and the base is at T10 (T12
when expanded).
Q4: The lobes of the lungs are divided by fissures that run obliquely through the
chest. Which of the following is true regarding the fissures of the lungs?

A: On the anterior chest, the oblique/major/diagonal fissure crosses the 5th rib in the
midaxillary line and ends at the 6th rib on the midclavicular line.

B: On the anterior chest in the right lung, the horizontal/minor fissure extends from the 5th rib
on the right midaxillary line to the 3rd intercostal space or 4th rib at the right sternal border.
This fissure divides the right upper and right middle lobes.

C: On the posterior of the chest the upper lobes extend from T1 to T3 or T4.

D: On the posterior chest the lower lobes extend from T3 or T4 to T10 (T12 when the lungs
are expanded).

E: All of the above

Also note the borders of the lobes laterally.

Q5: Determine if the following statements are true or false.

1. The trachea starts at the cricoid cartilage, is anterior to the trachea, and is
10-11 cm long.
2. The left bronchi is shorter, wider, and more vertical than the right bronchi.
3. The right bronchi has 3 branches while the left bronchi only has 2.
4. The visceral pleura lines the outside of the lungs and is continuous with the
parietal pleura which lines the inside of the chest wall and diaphragm.
5. An acinus is a functional respiratory unit that is made up of the bronchioles,
alveolar ducts, alveolar sacs, and the alveoli.
Q6: Three different types of sounds can be heard when auscultating the lungs,
trachea, and bronchioles. Which of the following statements are inaccurate
regarding the three different types of breath sounds?

A: Bronchial sounds are heard over the trachea and larynx, are loud and high
pitched, and inspiration is shorter than expiration.

B: Bronchovesicular sounds are heard over the major bronchi, are moderately loud
and pitched, and inspiration is equal to expiration.

C: Vesicular sounds are heard over most of the lungs, are soft and low pitched, and
inspiration is longer than expiration.

D: All of the above statements are accurate.

Aging Adults:

Costal cartilages become calcified and so the thorax becomes less mobile.
Respiratory muscle strength decreases after age 50 and continues to decrease into
the 70s. There is also a decrease in the elastic properties of the lungs, and a
decrease in the number of alveoli.

Vital capacity decreases and residual volume increases.

Abnormalities in respiration patterns:

Sigh=expand alveoli

Tachypnea=rapid shallow breathing, greater than 24 breaths/minute

Bradypnea=abnormally slow, less than 10 breaths per minute

Hyperventilation=increase rate and depth

Hypoventilation=decreased rate and depth

Cheyne-Stokes respiration=progressively deeper breathing followed by a gradual

decrease that results in a temporary stop
Some other abnormalities:

Hemoptysis: Coughing up blood

Dyspnea: shortness of breath

Orthopnea: difficulty breathing when supine

Barrel chest, scoliosis, and kyphosis

Emphysema: highly inflated lungs (usually due to smoking)

Asthma: airway constriction, bilateral wheezes

Pleural effusion thickening

Congestive heart failure

Pneumothorax: collapsed lung

Adventitious lung sounds;

Discontinuous sounds:

Fine crackles (rales)= high pitched, popping sounds during inspiration

Coarse crackles= low pitched, loud, bubbling/gurgling sounds start early in inspiration
Atelectatic crackles= Sound like fine crackles but do not last as long and are not pathologic. These
disappear after a few breaths.
Pleural friction rub= low pitched, coarse, very superficial, grating sounds during inspiration and expiration.

Continuous sounds:
Wheeze (sibilant)= high pitched, musical squeaking

Wheeze (sonorous rhonchi)= low pitched, monophonic, single note, musical snore/moan

Stridor= very high pitched, inspiratory, in children with croup or obstructed airway
Chapter 19 Heart and Neck Vessels
The precordium is the area on the anterior of the chest that overlies the heart and
great vessels. The mediastinum is the area between the lungs in the middle third of
the thoracic cage and is where the heart and great vessels are located. Opposite to
the lungs the superior portion of the heart is the base while the inferior or bottom of
the heart is the apex.
Q1: Which of the following is true of heart sounds? Select all that apply.

A: The first heart sound (S1) occurs with closure of the AV valves

B: The mitral component (M1) of S1 slightly precedes the tricuspid component (T1)
but usually these two components are heard as one sound.

C: The second heart sound (S2) occurs with the closure of the semilunar valves and
signals the end of systole.

D: S2 is loudest at the apex of the heart

Note: extra heart sounds such as a 3rd or 4th heart sound or murmurs. Heart sounds can be characterized
by frequency (pitch), intensity (loudness), duration, and timing (systole or diastole).
Q2: True or false?

1. When auscultating the carotid artery, a blowing, swishing sound known as a

bruit indicates blood flow turbulence.

2. Although the internal jugular vein lies deep to the sternomastoid muscle and is
not usually visible, its diffuse pulsations may be seen in the sternal notch when
a person is supine.
Q3: Which of the following locations for auscultating heart sounds is incorrect?

A: Aortic valve=2nd intercostal space on the right sternal border

B: Pulmonic valve=2nd intercostal space on the left sternal border

C: Tricuspid valve=4th intercostal space on the right midclavicular line

D: Mitral valve=5th intercostal space at the left midclavicular line

The Aging Adult:

With ageing there is an increase in systolic BP, and after the 60s diastolic BP may
decrease leading to an increased pulse pressure. With age the left ventricular wall
thickness also increases. There is a decrease in maximum work performance.

Tachydysrhythmias may not be tolerated as well in older people. Supraventricular

and ventricular dysrhythmias increase with age. Ectopic beats (adding or skipping a
beat) are common in aging people, but are usually asymptomatic in healthy older
people.
Chapter 20: Peripheral Vascular System and Lymphatic System

Q1: Unlike arteries, veins are a low-pressure system. Veins do not have a pump to
push blood back to the heart so they need a mechanism to keep blood moving. Which
of the following is a mechanism to keep venous blood moving?

A: Contracting skeletal muscles

B: The pressure gradient created by breathing

C: Intraluminal valves for one way flow

D: All of the above are needed for adequate blood return to the heart
Q2: Which of the following is NOT a function of the lymphatic system?

A: Conserve fluid/plasma proteins that leak out of capillaries

B: Helps body defend against disease

C: Produce T-cells

D: Absorb lipids from small intestine

Q3: True of false:

1. The thoracic duct drains the right side of the head and neck, right arm, right
side of the thorax, right lung and pleura, right side of the heart, and right upper
section of the liver, while the right lymphatic duct drains the rest of the body.

2. The spleen, tonsils, and thymus gland aid the lymphatic system.
The Aging Adult:

Arteriosclerosis: With age peripheral blood vessels grow more rigid. This causes
increased systolic blood pressure.

Atherosclerosis: The deposition of fatty plaques in the arteries.

Abnormal Findings: Peripheral Vascular Disease
Arms;

Raynaud’s Syndrome

Lymphedema: protein rich lymph builds up in interstitial spaces causing swelling of the limb(s).
It is most commonly caused by breast cancer treatment.

Legs;

Arterial (Ischemic) Ulcer: atherosclerosis and arteriosclerosis cause ulcers with well defined
edges and no bleeding.

Venous (Stasis) Ulcer: Occur after acute DVT or chronic incompetent valves in deep veins.
Account for 80% of lower leg ulcers. Bleeding, uneven edges.

Also note: occlusions, aneurysms, and abnormal findings in arterial pulses.

Chapter 21: Abdomen
The abdomen is a large oval cavity which extends from the diaphragm down to the
pelvis. It is bordered in the back by the vertebral column and paravertebral muscles.
It is bordered at the sides and front by the lower rib cage and abdominal muscles.

All the internal organs of the abdomen can be classified as hollow or solid viscera.
The abdomen can be divided into four quadrants by a vertical and horizontal line
that intersect at the umbilicus.
Solid Viscera: Liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus.

Hollow Viscera: Stomach, gallbladder, small intestine, colon, bladder.

RUQ: Liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal,
hepatic flexure of colon, part of ascending and transverse colon.

LUQ: Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal,
splenic flexure of colon, part of transverse and descending colon.

RLQ: Cecum, appendix, right ovary and tube, right ureter, right spermatic cord.

LLQ: Part of descending colon, sigmoid colon, left ovary and tube, left ureter, left
spermatic cord
The Aging Adult:

Fat accumulates around the abdomen.

Salivation decreases causing dry mouth and decreased sense of taste. Esophageal
emptying is delayed. Gastric acid secretion decreases which may lead to pernicious
anemia, iron deficiency anemia, and malabsorption of calcium. Liver size decreases
by 25% between ages 20 and 70 which in part impairs drug metabolism.

Risk of constipation and Gall Stones increases.