Deck 18: Thorax and Lungs

Question 1

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

A) sounds normally auscultated over the trachea.
B) bronchial breath sounds and are normal in that location.
C) vesicular breath sounds and are normal in that location.
D) bronchovesicular breath sounds and are normal in that location.

Answer 1

vesicular breath sounds and are normal in that location.

Question 2

During an assessment,the nurse knows that expected assessment findings in the normal adult lung include the presence of:

A) adventitious sounds and limited chest expansion.
B) increased tactile fremitus and dull percussion tones.
C) muffled voice sounds and symmetrical tactile fremitus.
D) absent voice sounds and hyperresonant percussion tones.

Answer 2

muffled voice sounds and symmetrical tactile fremitus.

Question 3

When performing a respiratory assessment on a patient,the nurse notices a costal angle of approximately 90 degrees.This characteristic is:

A) seen in patients with kyphosis.
B) indicative of pectus excavatum.
C) a normal finding in a healthy adult.
D) an expected finding in a patient with a barrel chest.

Answer 3

a normal finding in a healthy adult.

Question 4

During auscultation of the lungs,the nurse expects decreased breath sounds to be heard in which situation?

A) When the bronchial tree is obstructed
B) When adventitious sounds are present
C) In conjunction with whispered pectoriloquy
D) In conditions of consolidation, such as pneumonia

Question 5

The primary muscles of respiration include the:

A) diaphragm and intercostals.
B) sternomastoids and scaleni.
C) trapezius and rectus abdominis.
D) external obliques and pectoralis major.

Question 6

The nurse knows that a normal finding when assessing the respiratory system of an elderly adult is:

A) increased thoracic expansion.
B) decreased mobility of the thorax.
C) a decreased anteroposterior diameter.
D) bronchovesicular breath sounds throughout the lungs.

Question 7

The nurse is observing the auscultation technique of another nurse.The correct method to use when progressing from one auscultatory site on the thorax to another is ____ comparison.

A) side-to-side
B) top-to-bottom
C) posterior-to-anterior
D) interspace-by-interspace

Question 8

The nurse is percussing over the lungs of a patient with pneumonia.The nurse knows that percussion over an area of atelectasis in the lungs would reveal:

A) dullness.
B) tympany.
C) resonance.
D) hyperresonance.

Question 9

When assessing a patient's lungs,the nurse recalls that the left lung:

A) consists of two lobes.
B) is divided by the horizontal fissure.
C) consists primarily of an upper lobe on the posterior chest.
D) is shorter than the right lung because of the underlying stomach.

Question 10

Which of these statements is true regarding the vertebra prominens? The vertebra prominens is:

A) the spinous process of C7.
B) usually not palpable in most individuals.
C) opposite the interior border of the scapula.
D) located next to the manubrium of the sternum.

Question 11

The nurse is reviewing the technique of palpating for tactile fremitus with a new graduate.Which statement by the graduate nurse reflects a correct understanding of tactile fremitus? "Tactile fremitus:

A) is caused by moisture in the alveoli."
B) indicates that there is air in the subcutaneous tissues."
C) is caused by sounds generated from the larynx."
D) reflects the blood flow through the pulmonary arteries."

Question 12

When assessing tactile fremitus,the nurse recalls that it is normal to feel tactile fremitus most intensely over which location?

A) Between the scapulae
B) Third intercostal space, MCL
C) Fifth intercostal space, MAL
D) Over the lower lobes, posterior side

Question 13

During percussion,the nurse knows that a dull percussion note elicited over a lung lobe most likely results from:

A) shallow breathing.
B) normal lung tissue.
C) decreased adipose tissue.
D) increased density of lung tissue.

Question 14

A mother brings her 3-month-old infant to the clinic for evaluation of a cold.She tells the nurse that he had "a runny nose for a week." When performing the physical assessment,the nurse notes that the child has nasal flaring and sternal and intercostal retractions.The nurse's next action should be to:

A) assure the mother that these are normal symptoms of a cold.
B) recognize that these are serious signs and contact the physician.
C) ask the mother if the infant has had trouble with feedings.
D) perform a complete cardiac assessment because these are probably signs of early heart failure.

Question 15

During an examination of the anterior thorax,the nurse keeps in mind that the trachea bifurcates anteriorly at the:

A) costal angle.
B) sternal angle.
C) xiphoid process.
D) suprasternal notch.

Question 16

When assessing the respiratory system of a 4-year-old child,which of these findings would the nurse expect?

A) Crepitus palpated at the costochondral junctions
B) No diaphragmatic excursion as a result of a child's decreased inspiratory volume
C) The presence of bronchovesicular breath sounds in the peripheral lung fields
D) An irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest

Question 17

The nurse is auscultating the chest in an adult.Which technique is correct?

A) Instruct the patient to take deep, rapid breaths.
B) Instruct the patient to breathe in and out through his or her nose.
C) Use the diaphragm of the stethoscope held firmly against the chest.
D) Use the bell of the stethoscope held lightly against the chest to avoid friction.

Question 18

A 65-year-old patient with a history of heart failure comes to the clinic with complaints of "being awakened from sleep with shortness of breath." Which action by the nurse is most appropriate?

A) Obtain a detailed history of the patient's allergies and history of asthma.
B) Tell the patient to sleep on his or her right side to facilitate ease of respirations.
C) Assess for other signs and symptoms of paroxysmal nocturnal dyspnea.
D) Assure the patient that this is normal and will probably resolve within the next week.

Question 19

The nurse notes hyperresonant percussion tones when percussing the thorax of an infant.The nurse's best action would be to:

A) notify the physician.
B) suspect a pneumothorax.
C) consider this a normal finding.
D) monitor the infant's respiratory rate and rhythm.

Question 20

Which statement about the apices of the lungs is true? The apices of the lungs:

A) are at the level of the second rib anteriorly.
B) extend 3 to 4 cm above the inner third of the clavicles.
C) are located at the sixth rib anteriorly and the eighth rib laterally.
D) rest on the diaphragm at the fifth intercostal space in the midclavicular line.

Question 21

The nurse knows that auscultation of fine crackles would most likely be noticed in:

A) a healthy 5-year-old child.
B) a pregnant woman.
C) the immediate newborn period.
D) association with a pneumothorax.

Question 22

During auscultation of breath sounds,the nurse should use the stethoscope correctly,in which of the following ways?

A) Listen to at least one full respiration in each location.
B) Listen as the patient inhales and then go to the next site during exhalation.
C) Have the patient breathe in and out rapidly while the nurse listens to the breath sounds.
D) If the patient is modest, listen to sounds over his or her clothing or hospital gown.

Question 23

A teenage patient comes to the emergency department with complaints of an inability to breathe and a sharp pain in the left side of his chest.The assessment findings include cyanosis,tachypnea,tracheal deviation to the right,decreased tactile fremitus on the left,hyperresonance on the left,and decreased breath sounds on the left.The nurse interprets that these assessment findings are consistent with:

A) bronchitis.
B) a pneumothorax.
C) acute pneumonia.
D) an asthmatic attack.

Question 24

When inspecting the anterior chest of an adult,the nurse should include which assessment?

A) Diaphragmatic excursion
B) Symmetric chest expansion
C) The presence of breath sounds
D) The shape and configuration of the chest wall

Question 25

The nurse is reviewing the characteristics of breath sounds.Which statement about bronchovesicular breath sounds is true? They are:

A) musical in quality.
B) usually pathological.
C) expected near the major airways.
D) similar to bronchial sounds except that they are shorter in duration.

Question 26

The nurse is listening to the breath sounds of a patient with severe asthma.Air passing through narrowed bronchioles would produce which of these adventitious sounds?

A) Wheezes
B) Bronchial sounds
C) Bronchophony
D) Whispered pectoriloquy

Question 27

During palpation of the anterior chest wall,the nurse notices a coarse,crackling sensation over the skin surface.On the basis of these findings,the nurse suspects:

A) tactile fremitus.
B) crepitus.
C) friction rub.
D) adventitious sounds.

Question 28

A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated with rust-colored sputum,low-grade afternoon fevers,and night sweats for the past 2 months.The nurse's preliminary analysis,based on this history,is that this patient may be suffering from:

A) bronchitis.
B) pneumonia.
C) tuberculosis.
D) pulmonary edema.

Question 29

A patient comes to the clinic complaining of a cough that is worse at night but not as bad during the day.The nurse recognizes that this may indicate:

A) pneumonia.
B) postnasal drip or sinusitis.
C) exposure to irritants at work.
D) chronic bronchial irritation from smoking.

Question 30

When considering the biocultural differences in the respiratory systems,the nurse knows that which statement is true?

A) The smallest chest volumes are found in Asians.
B) The largest chest volumes are found in whites.
C) Asians are most likely to develop asthma.
D) Racial differences are of no significance when assessing the respiratory system.

Question 31

A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure.Which of these findings is the nurse most likely to observe in this situation?

A) Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, ankle edema
B) Rasping cough, thick mucoid sputum, wheezing, bronchitis
C) Productive cough, dyspnea, weight loss, anorexia, tuberculosis
D) Fever, dry nonproductive cough, diminished breath sounds

Question 32

A woman in her 26th week of pregnancy states that she is "not really short of breath" but feels that she is aware of her breathing and the need to breathe.What is the nurse's best reply?

A) "The diaphragm becomes fixed during pregnancy, making it difficult to take in a deep breath."
B) "The increase in estrogen levels during pregnancy often causes a decrease in the diameter of the rib cage and makes it difficult to breathe."
C) "What you are experiencing is normal. Some women may interpret this as shortness of breath, but it is a normal finding and nothing is wrong."
D) "This is normal as the fetus grows because of the increased oxygen demand on the mother's body and results in an increased respiratory rate."

Question 33

The nurse is auscultating the lungs of a patient who had been sleeping and notices short,popping,crackling sounds that stop after a few breaths.The nurse recognizes that these breath sounds are:

A) atelectatic crackles, and that they are not pathologic.
B) fine crackles, and that they may be a sign of pneumonia.
C) vesicular breath sounds.
D) fine wheezes.

Question 34

An adult patient with a history of allergies comes to the clinic complaining of wheezing and difficulty in breathing when working in his yard.The assessment findings include tachypnea,use of accessory neck muscles,prolonged expiration,intercostal retractions,decreased breath sounds,and expiratory wheezes.The nurse interprets that these assessment findings are consistent with:

A) asthma.
B) atelectasis.
C) lobar pneumonia.
D) heart failure.

Question 35

A patient has been admitted to the emergency department with a possible medical diagnosis of pulmonary embolism.The nurse expects to see which assessment findings related to this condition?

A) Absent or decreased breath sounds
B) Productive cough with thin, frothy sputum
C) Chest pain that is worse on deep inspiration, dyspnea
D) Diffuse infiltrates with areas of dullness upon percussion

Question 36

During a morning assessment,the nurse notices that the patient's sputum is frothy and pink.Which condition could this finding indicate?

A) Croup
B) Tuberculosis
C) Viral infection
D) Pulmonary edema

Question 37

During auscultation of the lungs of an adult patient,the nurse notices the presence of bronchophony.The nurse should assess for signs of which condition?

A) Airway obstruction
B) Emphysema
C) Pulmonary consolidation
D) Asthma

Question 38

A patient has a long history of chronic obstructive pulmonary disease.During the assessment,the nurse is most likely to observe which of these?

A) Unequal chest expansion
B) Increased tactile fremitus
C) Atrophied neck and trapezius muscles
D) An anteroposterior-to-transverse diameter ratio of 1:1

Question 39

The nurse is assessing the lungs of an older adult.Which of these describes normal changes in the respiratory system of the older adult?

A) Severe dyspnea is experienced on exertion resulting from changes in the lungs.
B) Respiratory muscle strength increases to compensate for a decreased vital capacity.
C) There is a decrease in small airway closure, leading to problems with atelectasis.
D) The lungs are less elastic and distensible, which decreases their ability to collapse and recoil.

Question 40

During an assessment of an adult,the nurse has noted unequal chest expansion and recognizes that this occurs in which situation?

A) An obese patient
B) When part of the lung is obstructed or collapsed
C) When bulging of the intercostal spaces is present
D) When accessory muscles are used to augment respiratory effort

Question 41

A patient has been admitted to the emergency department for a suspected drug overdose.His respirations are shallow,with an irregular pattern,with a rate of 12 per minute.The nurse interprets this respiration pattern as which of the following?

A) Bradypnea
B) Cheyne-Stokes respirations
C) Hypoventilation
D) Chronic obstructive breathing

Question 42

The nurse is assessing voice sounds during a respiratory assessment.Which of these findings indicates a normal assessment? Select all that apply.

A) Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice.
B) As the patient says "ninety-nine" repeatedly, the examiner hears the words "ninety-nine" clearly.
C) When the patient speaks in a normal voice, the examiner can hear a sound but cannot distinguish exactly what is being said.
D) As the patient says a long "ee-ee-ee" sound, the examiner also hears a long "ee-ee-ee" sound.
E) As the patient says a long "ee-ee-ee" sound, the examiner hears a long "aaaaaa" sound.

Question 43

A patient with pleuritis has been admitted to the hospital and complains of pain with breathing.What other key assessment finding would the nurse expect to find upon auscultation?

A) Stridor
B) Friction rub
C) Crackles
D) Wheezing