Chapter 14: Chest and Lungs Flashcards
A 44-year-old male patient who complains of a cough has presented to the emergency
department. He admits to smoking one pack per day. During your inspection of his chest, the
most appropriate lighting source to highlight chest movement is
a. bright tangential lighting.
b. daylight from a window.
c. flashlight in a dark room.
d. fluorescent ceiling lights.
ANS: A
Bright tangential light is best for visualizing chest movements.
When auscultating the apex of the lung, you should listen at a point
a. even with the second rib.
b. 4 cm above the first rib.
c. higher on the right side.
d. on the convex diaphragm surface.
ANS: B
The apex of the lung is 4 cm above the first rib.
To count the ribs and the intercostal spaces, you begin by palpating the reference point of the
a. distal point of the xiphoid.
b. manubriosternal junction.
c. suprasternal notch.
d. acromion process.
ANS: B
The angle of Louis, the junction of the manubrium and the sternum, corresponds to the second
rib, the reference point for counting ribs and intercostal spaces.
Mr. Curtis is a 44-year-old patient who has presented to the emergency department with
shortness of breath. During the history, the patient describes shortness of breath that gets
worse when he sits up. To document this, you will use the term
a. platypnea.
b. orthopnea.
c. tachypnea.
d. bradypnea.
ANS: A
Dyspnea that increases in the upright posture is called platypnea. Orthopnea is dyspnea that worsens when the person lies down. Tachypnea is an increased respiratory rate. Bradypnea is
a decreased respiratory rate.
Which finding suggests a minor structural variation?
a. Barrel chest
b. Clubbed fingers
c. Pectus carinatum
d. Chest wall retractions
ANS: C
Pectus carinatum (pigeon chest) is a minor structural variation. Barrel chest, clubbing of the
fingers, and chest wall retractions result from compromised respirations.
Ms. Rudman, age 74 years, has no known health problems or diseases. You are doing a
preventive healthcare history and examination. Which symptom is associated with
intrathoracic infection?
a. Barrel chest
b. Cor pulmonale
c. Funnel chest
d. Malodorous breath
ANS: D
Intrathoracic infections may make the breath malodorous.
The best time to observe and count respirations is while
a. the patient is answering questions.
b. weighing the patient.
c. palpating the pulse.
d. the patient is sleeping.
ANS: C
Counting respirations while you palpate the pulse does not make the patient self-conscious
because the patient expects you to be counting the pulse. Respiratory patterns change as the
patient speaks. Attempting to count during weighing would make the patient self-conscious
and affect the respiratory rate. Respiratory patterns change as the patient sleeps.
As you take vital signs on Mr. Barrow, age 78 years, you note that his respirations are 40
breaths/min. He has been resting, and his mucosa is pink. In regard to Mr. Barrow’s
respirations, you would
a. document his rate as normal.
b. do nothing because his color is pink.
c. note that his rate is below normal.
d. report that he has an above-average rate.
ANS: D
The normal adult respiratory rate is 12 to 20 breaths/min, and the ratio of breaths to heartbeats
is 1:4. A respiratory rate of 40 breaths/min is not within the normal range and should be
documented as above average
In which patient situation would you expect to assess tachypnea?
a. Patient who is depressed
b. Patient who abuses narcotics
c. Patient with metabolic acidosis
d. Patient with myasthenia gravis
ANS: C
In metabolic acidosis, the body compensates by increasing the respiratory rate to blow off the
excess carbon dioxide. A patient who is depressed, abuses narcotics, or has myasthenia gravis
would have respiratory depression.
Which site of chest wall retractions indicates a more severe obstruction in the asthmatic
patient?
a. Lower chest
b. Along the anterior axillary line
c. Above the clavicles
d. At the nipple line
ANS: C
Asthma usually causes retractions of the lower chest. The more severe the obstruction, the
greater the negative pressure produced in the chest during inspiration, and retractions are
manifested in the upper thorax.
You would expect to document the presence of a pleural friction rub for a patient being treated
for
a. pneumonia.
b. atelectasis.
c. pleurisy.
d. emphysema.
ANS: C
A pleural friction rub is caused by inflammation of the pleural surfaces and would be expected
to be auscultated with pleurisy.
Which type of apnea requires immediate action?
a. Primary apnea
b. Secondary apnea
c. Sleep apnea
d. Periodic apnea of the newborn
ANS: B
Secondary apnea is a grave condition, and unless resuscitative measures are instituted
immediately, breathing will not resume spontaneously. Primary apnea is self-limiting. Sleep
apnea should be evaluated but does not require immediate action. Periodic apnea of the
newborn is a normal condition.
With consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas
healthy lung tissue produces softer sounds. This is because
a. consolidation echoes in the chest.
b. consolidation is a poor conductor of sound.
c. air-filled lung sounds are from smaller spaces.
d. air-filled lung tissue is an insulator of sound
ANS: D
Air is a poor conductor of sound. Denser consolidation promotes louder sounds and is a better
conductor of sound. Consolidation is a better conductor of sound than air. Breath sounds are
easier to hear when the lungs are consolidated; the mass surrounding the tube of the
respiratory tree promotes sound transmission better than air-filled alveoli.
Which lung sounds are associated with atelectasis? (Select all that apply.)
a. Wheezes
b. Ronchi
c. Crackles
d. Crepitus
e. Rale
ANS: A, B, C
Wheezes, rhonchi, and crackles in varying amounts are associated with atelectasis
