Chapter 19: Thorax and Lungs
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. Which of these statements is true regarding the vertebra prominens?
a.
It is the spinous process of C7.
b.
It is nonpalpable in most individuals.
c.
It is opposite the interior border of the scapula.
d.
It is located next to the manubrium of the sternum.
2. When performing a respiratory assessment on a patient, the nurse notices a costal angle of
approximately 90 degrees. What should the nurse recognize about this finding?
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.
3. When assessing a patient’s lungs, what should the nurse recall about 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.
4. Which statement about the apices of the lungs is true?
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
(MCL).
5. Where does the trachea bifurcate on the anterior chest?
a.
Costal angle
b.
Sternal angle
c.
Xiphoid process
d.
Suprasternal notch
6. During an assessment, the nurse knows that expected assessment findings in the normal adult
lung include which findings?
a.
Adventitious sounds and limited chest expansion
b.
Muffled voice sounds and symmetric tactile fremitus
c.
Increased tactile fremitus and dull percussion tones
d.
Absent voice sounds and hyperresonant percussion tones
7. What are the primary muscles of respiration?
a.
Diaphragm and intercostals
b.
Sternomastoids and scaleni
c.
Trapezii and rectus abdominis
d.
External obliques and pectoralis major
8. A 65-year-old patient with a history of heart failure comes to the clinic stating “I keep waking
up 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.
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 paroxysmal nocturnal dyspnea is normal and will probably
resolve within the next week.
9. 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.
Over the lower lobes, posterior side
d.
Fifth intercostal space, midaxillary line (MAL)
10. 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?
a.
“Is caused by moisture in the alveoli.”
b.
“Is caused by sounds generated from the larynx.”
c.
“Reflects the blood flow through the pulmonary arteries.”
d.
“Indicates that air is present in the subcutaneous tissues.”
11. During percussion, the nurse hears a dull percussion note elicited over a lung lobe. What is the
most likely cause of this finding?
a.
Shallow breathing
b.
Normal lung tissue
c.
Decreased adipose tissue
d.
Increased density of lung tissue
12. The nurse is observing the auscultation technique of a student nurse. What is the correct
method to use when progressing from one auscultatory site on the thorax to another?
a.
Side-to-side comparison
b.
Top-to-bottom comparison
c.
Posterior-to-anterior comparison
d.
Interspace-by-interspace comparison
13. 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.
How should the nurse interpret these findings?
a.
Normal sounds auscultated over the trachea.
b.
Bronchial breath sounds that are normal in that location.
c.
Vesicular breath sounds that are normal in that location.
d.
Bronchovesicular breath sounds that are normal in that location.
14. The nurse is auscultating the chest in an adult. 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 skin of the chest
d.
Lightly holding the bell of the stethoscope against the skin on the chest to avoid
friction
15. The nurse is percussing over the lungs of a patient with pneumonia. If the patient has
atelectasis, what sound will the nurse hear?
a.
Tympany
b.
Dullness
c.
Resonance
d.
Hyperresonance
16. During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in
which situation?
a.
When adventitious sounds are present
b.
When the bronchial tree is obstructed
c.
In conjunction with whispered pectoriloquy
d.
In conditions of consolidation, such as pneumonia
17. Which is a normal finding when assessing the respiratory system of an older adult?
a.
Increased thoracic expansion
b.
Decreased mobility of the thorax
c.
Decreased anteroposterior diameter
d.
Bronchovesicular breath sounds throughout the lungs
18. 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. What
should the nurse do next?
a.
Ask the mother if the infant has had trouble with feedings.
b.
Assure the mother that these signs are normal symptoms of a cold.
c.
Recognize that these are serious signs, and contact the physician.
d.
Perform a complete cardiac assessment because these signs are probably indicative
of early heart failure.
19. 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.
Presence of bronchovesicular breath sounds in the peripheral lung fields
c.
No diaphragmatic excursion as a result of a child’s decreased inspiratory volume
d.
Irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest
20. When inspecting the anterior chest of an adult, the nurse should include which assessment?
a.
Diaphragmatic excursion
b.
Symmetric chest expansion
c.
Presence of breath sounds
d.
Shape and configuration of the chest wall
21. The nurse would most likely hear fine crackles in which patient or situation?
a.
A pregnant woman
b.
A healthy 5-year-old child
c.
The immediate newborn period
d.
A patient with a pneumothorax
22. 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
23. 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.
Asthma
b.
Emphysema
c.
Airway obstruction
d.
Pulmonary consolidation
24. The nurse is reviewing the characteristics of breath sounds. Which statement about
bronchovesicular breath sounds is true?
a.
Musical in quality
b.
Expected near the major airways
c.
Usually caused by a pathologic disease
d.
Similar to bronchial sounds except shorter in duration
25. 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.
Bronchophony
c.
Bronchial sounds
d.
Whispered pectoriloquy
26. 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
27. 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. What do these findings
suggest?
a.
Bronchitis
b.
Pneumothorax
c.
Acute pneumonia
d.
Asthmatic attack
28. 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. What do these findings suggest?
a.
Asthma
b.
Atelectasis
c.
Lobar pneumonia
d.
Heart failure
29. The nurse is assessing the lungs of an older adult. Which of these changes are normal in the
respiratory system of the older adult?
a.
Decrease in small airway closure occurs, leading to problems with atelectasis.
b.
Severe dyspnea is experienced on exertion, resulting from changes in the lungs.
c.
Respiratory muscle strength increases to compensate for a decreased vital capacity.
d.
Lungs are less elastic and distensible, which decreases their ability to collapse and
recoil.
30. 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 best reply by the nurse?
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.”
31. A 35-year-old recent immigrant is being seen in the clinic for symptoms of a cough associated
with rust-colored sputum, low-grade afternoon fevers, and night sweats for the past 2 months.
Based on these findings, what is the most likely cause?
a.
Pneumonia
b.
Bronchitis
c.
Tuberculosis
d.
Pulmonary edema
32. 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.
Fever, dry nonproductive cough, and diminished breath sounds
b.
Rasping cough, thick mucoid sputum, wheezing, and bronchitis
c.
Productive cough, dyspnea, weight loss, anorexia, and tuberculosis
d.
Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema
33. A patient comes to the clinic reporting a cough that is worse at night but not as bad during the
day. What does the nurse suspect?
a.
Pneumonia
b.
Postnasal drip or sinusitis
c.
Exposure to irritants at work
d.
Chronic bronchial irritation from smoking
34. 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
35. During auscultation of breath sounds, the nurse should correctly use the stethoscope in which
of the following ways?
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.
If the patient is modest, listening to sounds over his or her clothing or hospital
gown
d.
Instructing the patient to breathe in and out rapidly while listening to the breath
sounds
36. 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
37. During palpation of the anterior chest wall, the nurse notices a coarse, crackling sensation
over the skin surface. What does this finding indicate?
a.
Crepitus
b.
Friction rub
c.
Tactile fremitus
d.
Adventitious sounds
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. What does this finding indicate?
a.
Fine wheezes
b.
Vesicular breath sounds
c.
Fine crackles and may be a sign of pneumonia
d.
Atelectatic crackles that do not have a pathologic cause
39. A patient has been admitted to the emergency department for a suspected drug overdose. His
respirations are shallow, with an irregular pattern, at a rate of 12 respirations per minute. The
nurse interprets this respiration pattern as which of the following?
a.
Bradypnea
b.
Hypoventilation
c.
Cheyne-Stokes respirations
d.
Chronic obstructive breathing
40. A patient with pleuritis has been admitted to the hospital and reports pain with breathing.
What other key assessment finding would the nurse expect to find upon auscultation?
a.
Stridor
b.
Crackles
c.
Wheezing
d.
Friction rub
MULTIPLE RESPONSE
1. The nurse is assessing voice sounds during a respiratory assessment. Which of these findings
indicates a normal assessment? (Select all that apply).
a.
As the patient says a long “ee–ee–ee” sound, the examiner hears a long “aaaaaa”
sound.
b.
As the patient says a long “ee–ee–ee” sound, the examiner also hears a long
“ee–ee–ee” sound.
c.
As the patient repeatedly says “ninety–nine,” the examiner clearly hears the words
“ninety–nine.”
d.
Voice sounds are faint, muffled, and almost inaudible when the patient whispers
“one, two, three” in a very soft voice.
e.
When the patient speaks in a normal voice, the examiner can hear a sound but
cannot exactly distinguish what is being said.