Physical Examination and Health Assessment 9th Edition Test Bank

Correct Answer: A

Rationale: Inspiratory splitting of S occurs due to the normal physiological delay in the closure of the aortic and pulmonic valves during inspiration. During inspiration, the negative intrathoracic pressure leads to increased venous return to the right side of the heart, causing a slight delay in the closure of the pulmonic valve. This results in the aortic valve closing first, followed by the closure of the pulmonic valve, leading to the splitting of S during inspiration.

Correct Answer: A

Rationale: Inspiratory splitting of S occurs due to the normal physiological delay in the closure of the aortic and pulmonic valves during inspiration. During inspiration, the negative intrathoracic pressure leads to increased venous return to the right side of the heart, causing a slight delay in the closure of the pulmonic valve. This results in the aortic valve closing first, followed by the closure of the pulmonic valve, leading to the splitting of S during inspiration.

Correct Answer: C

Rationale: Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and multiple tender points on palpation, especially in the neck, shoulders, back, and hips. The patient's symptoms of widespread pain and tenderness at specific points on the muscles without arthritis, joint swelling, or limitation in range of motion are consistent with fibromyalgia. Fibromyalgia is often associated with poor sleep quality, morning stiffness, and fatigue, which the patient in the case provided experiences. Other conditions like rheumatoid arthritis, osteoarthritis, or polymyalgia rheumatica would typically present differently with specific joint involvement, swelling, and additional systemic symptoms, which are not seen in this patient.

Correct Answer: B

Rationale: Atrial flutter is a cardiac arrhythmia characterized by rapid, regular atrial contractions at a rate of around 250-350 beats per minute. This can lead to a ventricular response rate that is usually around 150 beats per minute, resulting in a fast heart rate. The ECG pattern in atrial flutter typically shows a sawtooth pattern of flutter waves, which distinguishes it from other arrhythmias. In contrast, second-degree A-V block, sinus arrhythmia, and atrial fibrillation would not typically present with the rapid regular atrial contractions seen in atrial flutter.

Correct Answer: C

Rationale: The next step would be to discuss the physical therapy plan with Mr. Larson. It is important to communicate openly with him, explain the recommendation for physical therapy, and ensure that he understands and agrees with the plan before proceeding further. This allows for any questions or concerns to be addressed, and ensures that the treatment plan is tailored to his needs and preferences. By discussing the plan with Mr. Larson first, you can also provide him with the opportunity to ask any questions and actively involve him in his own care, which can lead to better compliance and outcomes.