Deck 19: Thorax and Lungs

Question 1

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

A)reassure the mother that these are normal symptoms of a cold.
B)recognize that these are serious signs and contact the physician.
C)recognize that these are symptoms of rachitic rosary and refer the infant to be seen by a physician within the week.
D)perform a complete cardiac assessment because these are probably signs of early heart failure.

Answer 1

recognize that these are serious signs and contact the physician.

Question 2

A normal finding when assessing the respiratory system of an older adult is:

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

Answer 2

decreased mobility of the thorax.

Question 3

When auscultating the chest in an adult,the nurse would:

A)instruct the patient to take deep,rapid breaths.
B)instruct the patient to breathe in and out through the nose.
C)hold the diaphragm of the stethoscope firmly against the chest.
D)hold the bell of the stethoscope lightly against the chest to avoid friction.

Answer 3

hold the diaphragm of the stethoscope firmly against the chest.

Question 4

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

A)consists of two lobes.
B)is divided by a 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 5

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 6

During auscultation of the lungs,the nurse is aware that decreased breath sounds would most likely be heard:

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 7

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 of the following actions by the nurse is most appropriate?

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

Question 8

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 9

Which of the following about the vertebra prominens is true? 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 10

Percussion over an area of atelectasis in the lungs reveals:

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

Question 11

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 12

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

A)Crepitus palpated at the costochondral junctions
B)No diaphragmatic excursion as a result of 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 13

During examination of the anterior thorax,the nurse is aware that the trachea bifurcates anteriorly at the:

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

Question 14

When assessing for tactile fremitus,over which location is it normal to feel tactile fremitus most intensely?

A)Between the scapulae
B)Third intercostal space,midclavicular line
C)Fifth intercostal space,midaxillary line
D)Over the lower lobes,posterior side

Question 15

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 is aware 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.

Question 16

The nurse is aware that tactile fremitus is produced by:

A)moisture in the alveoli.
B)air in the subcutaneous tissues.
C)sounds generated from the larynx.
D)blood flow through the pulmonary arteries.

Question 17

When performing respiratory assessment on a patient,the nurse notes 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."

Question 18

The nurse knows that expected assessment findings in the normal adult lung include:

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.

Question 19

The most important technique when progressing from one auscultatory site on the thorax to another is:

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

Question 20

The nurse notes hyperresonant 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 21

When inspecting the anterior chest of an adult,the nurse should assess for:

A)diaphragmatic excursion.
B)symmetrical chest expansion.
C)the presence of breath sounds.
D)the shape and configuration of the chest wall.

Question 22

Bronchovesicular breath sounds 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 23

A patient has a long history of chronic emphysema.During assessment,the nurse is most likely to observe:

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 24

An adult patient with a history of allergies comes to the clinic complaining of wheezing and difficulty breathing while working in his yard.Assessment findings include tachypnea,use of accessory neck muscles,prolonged expiration,intercostal retractions,decreased breath sounds,and expiratory wheezes.This description is consistent with:

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

Question 25

A patient complains of a cough that is worse at night.The nurse recognizes that this may indicate:

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

Question 26

In which of the following would fine crackles most likely be noted during auscultation?

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

Question 27

While auscultating for breath sounds,the nurse will use the stethoscope correctly by:

A)listening to at least one full respiration in each location.
B)listening as the patient inhales and then going to the next site during exhalation.
C)having the patient breathe in and out rapidly while listening to the breath sounds.
D)listening to sounds through clothing or the hospital gown if the patient is shy.

Question 28

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

A)"The diaphragm becomes fixed during pregnancy,making it difficult to take in deep breaths."
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 nothing is wrong."
D)"This is normal as the fetus grows because of the increased oxygen demand on the mother's body,which results in an increased respiratory rate."

Question 29

A teenage patient comes to the emergency department complaining of an inability to "breathe and a sharp pain in my left chest." 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.This description is consistent with:

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

Question 30

During palpation of the anterior chest wall,the nurse notes a coarse,crackling sensation over the skin surface and suspects:

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

Question 31

A patient has been admitted to the emergency department with a medical diagnosis of possible pulmonary embolism.Which assessment findings would the nurse recognize as 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 32

MATCHING
The nurse is evaluating voice sounds during respiratory assessment.Match the assessment with the correct technique.

The normal response is faint,muffled,and almost inaudible when the patient says "one,two,three" in a very soft voice.

A)Bronchophony
B)Egophony
C)Whispered pectoriloquy

Question 33

The nurse has noted unequal chest expansion and is aware that this occurs when:

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

Question 34

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

A)atelectatic crackles,and not pathological.
B)fine crackles,which may be a sign of pneumonia.
C)vesicular breath sounds.
D)fine wheezes.

Question 35

A 35-year-old recent immigrant complains of having a cough,expectoration of rust-coloured 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 36

Bronchophony heard upon auscultation is associated with:

A)pneumothorax.
B)hyperresonance.
C)increased lung density.
D)decreased breath sounds.

Question 37

Which of the following adventitious sounds would be produced by air passing through narrowed bronchioles?

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

Question 38

Which of the following describes normal changes in the respiratory system of the older adult?

A)Severe dyspnea is experienced on exertion as a result of age-related changes in the lungs.
B)Respiratory muscle strength increases to compensate for 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,decreasing their ability to collapse and recoil.

Question 39

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

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

Question 40

During morning assessment,the nurse notes that the patient's sputum is frothy and pink.Which of the following conditions could this finding indicate?

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

Question 41

MATCHING
The nurse is evaluating voice sounds during respiratory assessment.Match the assessment with the correct technique.

While the patient makes a long "ee-ee-ee" sound,a long "aaaaaa" sound may be noted over areas of consolidation.

A)Bronchophony
B)Egophony
C)Whispered pectoriloquy

Question 42

MATCHING
The nurse is evaluating voice sounds during respiratory assessment.Match the assessment with the correct technique.

The person says "ninety-nine" repeatedly while the chest wall is being auscultated.Normally,a sound will be heard,but the examiner will not be able to distinguish exactly what is being said.

A)Bronchophony
B)Egophony
C)Whispered pectoriloquy