Chapter 19: Thorax and Lungs

Question 1

1. 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.

Answer 1

a

Question 2

2. 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.

Answer 2

C

Question 3

3. 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.

Answer 3

A

Question 4

4. 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).

Answer 4

B

Question 5

5. 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.

Answer 5

B

Question 6

6. 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.

Answer 6

C

Question 7

7. 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.

Answer 7

A

Question 8

8. 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 8

B

Question 9

9. 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

Answer 9

C

Question 10

10. 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.

Answer 10

A

Question 11

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 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.”

Answer 11

C

Question 12

12. 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.

Answer 12

D

Question 13

13. 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

Answer 13

A

Question 14

14. 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 14

c

Question 15

15. 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

Answer 15

C

Question 16

16. 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 16

A

Question 17

17. 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

Answer 17

A

Question 18

18. 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.

Answer 18

B

Question 19

21. 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

Answer 19

D

Question 20

22. 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

Answer 20

C

Question 21

23. 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

Answer 21

B

Question 22

24. 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

Answer 22

C

Question 23

25. 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.

Answer 23

C

Question 24

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

Answer 24

A

Question 25

27. 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

Answer 25

D

Question 26

28. 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.

Answer 26

B

Question 27

29. 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.

Answer 27

A

Question 28

30. 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.

Answer 28

D

Question 29

32. 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.

Answer 29

C

Question 30

33. 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

Answer 30

A

Question 31

34. 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.

Answer 31

B

Question 32

36. 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.

Answer 32

A

Question 33

38. 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.

Answer 33

B

Question 34

39. 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

Answer 34

A

Question 35

41. 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.

Answer 35

B