Deck 19: Thorax and Lungs

Question 1

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

A)Normally auscultated over the trachea.
B)Bronchial breath sounds, which are normal in that location.
C)Vesicular breath sounds, which are normal in that location.
D)Bronchovesicular breath sounds, which are normal in that location.

Answer 1

Vesicular breath sounds, which are normal in that location.

Question 2

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 will reveal:

A)Dullness.
B)Tympany.
C)Resonance.
D)Hyper-resonance.

Answer 2

Dullness.

Question 3

During assessment of the patient's posterior chest for lung sounds, the nurse will auscultate the right lung for the:

A)Apex of the lung.
B)Upper and lower lobes.
C)Lower lobe, because the upper lobe is too small.
D)Upper, middle, and lower lobes.

Answer 3

Upper and lower lobes.

Question 4

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 air is present in the subcutaneous tissues."
C)"Is caused by sounds generated from the larynx."
D)"Reflects the blood flow through the pulmonary arteries."

Question 5

The primary respiratory muscles engaged in normal inspiration include the:

A)Diaphragm and intercostals.
B)Sternomastoid and scalene.
C)Trapezius and rectus abdominis.
D)External obliques and pectoralis major.

Question 6

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 health history of the patient's allergies and a history of asthma
B)Recommend that the patient 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 paroxysmal nocturnal dyspnea is normal and will probably resolve within the next week

Question 7

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 8

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

A)Observed 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 9

The nurse landmarks the apices of the lungs to:

A)Be at the level of the second rib anteriorly.
B)Extend 3 to 4 cm above the inner third of the clavicles.
C)Be 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 (MCL).

Question 10

A mother brings her 3-month-old infant to the clinic for evaluation of a cold.She tells the nurse that he has 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 signs 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 signs are probably indicative of early heart failure.

Question 11

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

A)Instructing the patient to take deep, rapid breaths
B)Instructing the patient to breathe in and out through his or her nose
C)Firmly holding the diaphragm of the stethoscope against the patient's skin
D)Lightly holding the bell of the stethoscope over the gown to avoid friction

Question 12

During an 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 13

When assessing tactile fremitus, the nurse normally feel tactile fremitus most intensely:

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

Question 14

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

A)Increased thoracic expansion.
B)Decreased mobility of the thorax.
C)Decreased anteroposterior diameter.
D)Bronchovesicular breath sounds throughout the lungs.

Question 15

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 16

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 17

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

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

Question 18

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)Presence of bronchovesicular breath sounds in the peripheral lung fields
D)Irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest

Question 19

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 hyper-resonant percussion tones.

Question 20

The nurse is teaching the nursing students to palpate the vertebra prominens when beginning posterior thoracic assessment of a patient.The students will:

A)Look for the spinous process of C7.
B)Usually not be able to palpate this on most individuals.
C)Find the interior border of the scapula.
D)Locate this next to the manubrium of the sternum.

Question 21

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 22

A patient has a long history of chronic obstructive pulmonary disease (COPD).During the assessment, the nurse will most likely observe which of these?

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

Question 23

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 24

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

A)Musical in quality.
B)Usually caused by a pathological condition.
C)Expected near the major airways.
D)Similar to bronchial sounds except shorter in duration.

Question 25

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, the 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 26

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

A)In 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 27

A 20-year-old tall, slim male 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, hyper-resonance on the left, and decreased breath sounds on the left.The nurse interprets that these assessment findings are consistent with:

A)Bronchitis.
B)Pneumothorax.
C)Acute pneumonia.
D)Asthmatic attack.

Question 28

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 and dyspnea
D)Diffuse infiltrates with areas of dullness upon percussion

Question 29

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 respirations 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 30

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

A)Diaphragmatic excursion
B)Symmetrical chest expansion
C)Presence of breath sounds
D)Shape and configuration of the chest wall

Question 31

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 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 increased awareness of the need to breathe 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 33

A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated with 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 34

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 35

To correctly auscultate the patient's breath sounds, the nurse will:

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)Instruct the patient to breathe in and out rapidly while listening to the breath sounds.
D)If the patient is modest, listen to sounds over his or her clothing or hospital gown.

Question 36

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 patient?

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

Question 37

The nurse is assessing the lungs of an 85-year-old patient who states having a decreased tolerance for activity.The nurse informs the patient that this results from some of the normal changes that occur in the respiratory system of the older adult:

A)Chest expansion increases with asymmetry.
B)Respiratory muscle strength increases to compensate for a decreased vital capacity.
C)A decrease in small airway closure occurs, leading to problems with atelectasis.
D)Lungs are less elastic and distensible, and this decreases their ability to collapse and recoil.

Question 38

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, which do not have a pathological cause.
B)Fine crackles and may be a sign of pneumonia.
C)Vesicular breath sounds.
D)Fine wheezes.

Question 39

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 40

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 cough may indicate:

A)Pneumonia.
B)Postnasal drip or sinusitis.
C)Exposure to irritants at work.
D)Chronic bronchial irritation from smoking.

Question 41

The nurse is assessing a 52-year-old patient admitted with aspiration pneumonia and a history of excessive alcohol consumption.The patient has been deteriorating and has developed sepsis.The nurse identifies the following findings indicating he likely has acute respiratory distress syndrome (ARDS): (Select all that apply.)

A)Respirations regular and easy
B)Crackles upon auscultation of lungs
C)Muscles between ribs pull in during inspiration
D)Very short of breath
E)Blood pressure 70/50 mm Hg
F)Apical heart rate 60 beats per minute

Question 42

A patient with pleuritis has been admitted to the hospital and complains of pain with breathing.Upon auscultation, the nurse notes coarse, low-pitched sounds with a grating quality and documents them as:

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

Question 43

The nurse is assessing a 65-year-old patient who has smoked a pack of cigarettes a day for the past 40 years.The nurse identifies the following findings indicating that the patient likely has emphysema: (Select all that apply.)

A)Decreased breath sounds with extended expirations
B)Respirations 10 breaths/minute
C)Diaphragmatic excursion 5 cm equal bilaterally
D)Heart sounds are muffled
E)Crackles auscultated throughout lung fields
F)Costal angle greater than 90 degrees

Question 44

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 repeatedly says "ninety-nine," the examiner clearly hears the words "ninety-nine."
C)When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish 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.