Lungs And Thorax

Question 1

When assessing a 75-year-old patient who has asthma, the nurse notes that he assumes a tripod position, leaning forward with arms braced on the chair. On the basis of this observation, the nurse should:
A. recognize that a tripod position is often used when a patient is having respiratory difficulties.
B. assume that the patient is eager and interested in participating in the interview.
C. assume that the patient is having difficulty breathing and assist him to a supine position.
D. evaluate the patient for abdominal pain, which may be exacerbated in the sitting position.

Answer 1

Recognize that the tripod position is often used for a patient that is in respiratory distress

Question 2

__ are the point where the ribs join their cartilage. What is significant about these?

Answer 2

costochondral junction

they are not palpable

Question 3

the first seven ribs attach ____ ; ribs 8, 9, and 10 attach to ___, and ribs 11 and 12 are _____.

Answer 3

directly to the sternum via their coastal cartilages above
the coastal cartilage above
“floating” with free palpable tip

Question 4

feel this hollow U shaped depression just above the sternum, in between the clavicle

Answer 4

suprasternal notch

Question 5

the “breastbone” has three parts which are __,___,and___.

Answer 5

manubrium
the body
xiphoid process
this is the sternum

Question 6

The sternal angle is often called the ____, this is the articulation of the manubrium and the body of the sternum, and it is continuous with the second rib.

Answer 6

angle of louis

Question 7

the right and left coastal margins form an angle where they meet at the xiphoid process . usually 90 degrees or less, this angle increases when the rib cage is chronically overinflated, as in ____.

Answer 7

coastal angle

emphysema

Question 8

vertebra prominens- flex your head and feel for the most prominent bony spur protuding at the base of the neck . The is the ______. If two bumps seem equally prominent , this is _____.

Answer 8

spinous process of c7

the upper one is c7 and the lower one is t1

Question 9

What are the reference points on the anterior chest?

Answer 9

midsternal line

midclavicular line p.412

Question 10

what are the reference points on the posterior chest?

Answer 10

vertebral (or midspinal) line

scapular line

Question 11

The mediastinum is them middle section of the thoracic cavity containing ______.

Answer 11

esophagus, trachea, heart, and great vessels.

Question 12

The right and left pleural cavities contain the ___.

Answer 12

lungs

Question 13

In the anterior chest, the __, or the highest point,of the lung tissue is about 3 to 4 cm above the inner third of the clavicles. The __, or the lower border, rests on the diaphragm at about the sixth rib in the midclavicular line.

Answer 13

apex

base

Question 14

the right lung is ____ than the left lung because of ___.

Answer 14

shorter

of the underlying liver

Question 15

the left lung is ____ than the right lung because ____.

Answer 15

narrower

the heart bulges to the left

Question 16

the right lung has __ lobes and the left lung has __ lobes.

Answer 16

3,2

Question 17

the left lung has no ___ lobe.
the anterior chest contains mostly _____ lobe with very little ___ lobe.
the posterior chest contains almost all of the ___ lobe.

Answer 17

middle
upper and middle with very little lower
lower

Question 18

the thin, slippery ____ are serous membranes that form an envelope between the lungs and the chest wall.

Answer 18

pleurae

Question 19

The ___ pleura lines the outside of the lungs, dipping down into the fissures. it is continuous with the ___ pleura lining the inside of the chest wall and diaphragm.

Answer 19

visceral

parietal

Question 20

the pleurae extends about 3 cm below the level of the lungs, forming the ____. this is a potential space; when it abnormally fills with air or fluid, it compromises lung expansion

Answer 20

costodiaphragmatic recess

Question 21

the right main bronchus is __,___, and ____ than the left main bronchus.

Answer 21

shorter
wider
more vertical

Question 22

the __ and ____ transport gases between the environment and the lung parenchyma,

Answer 22

trachea

bronchi

Question 23

slow, shallow breathing

Answer 23

hypoventilation

Question 24

rapid, deep breathing

Answer 24

hyperventilation

Question 25

increase in carbon dioxide

Answer 25

hypercapnia

Question 26

decrease in oxygen in the blood

Answer 26

hypoxemia

Question 27

the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum

Answer 27

vital capacity

Question 28

the amount of air remaining in the lungs even after the most forceful expiration

Answer 28

residual volume

Question 29

acute cough last ____, chronic cough last____.

Answer 29

less than 2 or 3 weeks

last over 2 months

Question 30

cough continuous throughout the day

Answer 30

acute illness- respiratory infection

Question 31

cough in the afternoon/ evening

Answer 31

may reflect to irritants at work

Question 32

cough at night

Answer 32

post nasal drip, sinusitis

Question 33

cough in early morning

Answer 33

chronic bronchial inflammation of smokers

Question 34

white or clear mucoid sputum is from what condition:

Answer 34

colds, bronchitis, viral infections

Question 35

yellow or green sputum

Answer 35

bacterial infections

Question 36

rust colored sputum

Answer 36

tuberculosis, pneumococcal pnueumonia

Question 37

pink, frothy sputum

Answer 37

pulmonary edema

Question 38

hacking cough is associated with?

Answer 38

mycoplasma pneumonia

Question 39

dry cough is associated with?

Answer 39

early heart failure

Question 40

barking cough is associated with?

Answer 40

croup; colds, bronchitis, pneumonia – congested

Question 41

awakening from sleep with SOB and needing to be upright to achieve comfort

Answer 41

paraxysmal nocturnal dyspnea

Question 42

difficulty breathing when supine

Answer 42

orthopnea

Question 43

what is significant about when asking a patient their smoking history?

Answer 43

state number of packs per day and the number of years smoked.

Question 44

what are these symptoms to note that may have signal breathing problems, for carbon monoxide?
for sulfur dioxide?

Answer 44

dizziness, headache, fatigue

cough, congestion

Question 45

older adults have a less efficient respiratory system (___,____), so they have less tolerance for activity.

Answer 45

decreased vital capacity

less surface area for gas exchange

Question 46

sedentary or bedridden people are at risk for ___.

Answer 46

respiratory dysfunction

Question 47

some older people feel ___ less intensely than younger adults.

Answer 47

pleuritic pain

Question 48

precisely localized sharp pain (points to it with one finger) - consider____.

Answer 48

fractured rib or muscle injury

Question 49

Inspecting the posterior chest; thoracic cage. What should you do and what is NORMAL?

Answer 49

• **note the shape and configuration of the chest wall.
• the spinous process should be in a straight line
• the thorax is symmetric, in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine
• **anteroposterior diameter should be less than transverse diameter
• the ratio is from 1:2 to 5:7
• **note the position the person take a breath
• relaxed posture and the ability to supports own’s weight
• **skin color and condition
• color should be consistent with person’s genetic background .

Question 50

ribs are horizontal, chest appears as if held in continuous inspiration.

Answer 50

barrel chest

this occurs in chronic emphysema from hyperinflation of the lungs.

Question 51

neck muscles are hypertrophied in ___ from aiding in forced inspirations.

Answer 51

COPD

Question 52

people with ____ often sit in a tripod position, leaning forward with arms braced against their knees, chair, or bed.

Answer 52

COPD

Question 53

to confirm symmetric chest expansion, you should?

Answer 53

place your hands on the posterolateral chest wall with thumbs at level of T9 or T10. slide your hands medically to pinch up a small fold of skin between your thumbs. when the person takes a deep breath, you thumbs should move apart symmetrically.

Question 54

unequal chest expansion occurs with which conditions?

Answer 54

mark atelectasis
lobar pneumonia
pleural effusion
thoracic trauma such as fractured rib
pneumothorax

Question 55

when accessing tactile fremitus, just between the scapula, fremitus may feel ____ on the right side than on the left because ___.

Answer 55

stronger

the right side is closer to the bronchial bifurcation

Question 56

coarse, crackling sensation palpable over the skin surface

Answer 56

crepitus; it occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue , as after open thoracic injury or surgery.

Question 57

the low-pitched, clear, hollow sound that prodominates in healthy lung tissue in adults.

Answer 57

resonance

Question 58

the resonant note may be modified somewhat in the athlete with a heavily muscular chest wall and in the heavily obese adult in whom subcutaneous fat produces ____.

Answer 58

scattered dullness

Question 59

lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax

Answer 59

hyperresonance

Question 60

what is the normal for diaphragmatic excursion?

Answer 60

about 3 to 5 in adults, although it may be up to 7 to 8 cm in well-conditioned people.

Question 61

added sounds not normally heard in the lungs.

Answer 61

adventitous sounds.

Question 62

short, popping, crackling sound that sound like fine crackles but do not last beyond a few breaths. not pathologic

Answer 62

atelectatic crackles.

Question 63

outward curvature of the thoracic spine

Answer 63

kyphosis

Question 64

markedly sunken sternum and adjacent cartilage. (funnel breast). congential usually not symptomatic. surgery may be indicated.

Answer 64

pectus excavatum

Question 65

a forward protrusion of the sternum, with ribs sloping back at either side and vertical depression along costochondral juntions (pigeon chest). if severe, surgery may be indicated.

Answer 65

pectus carinatum

Question 66

a cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and deth and then decreasing. the breathing periods last 30 to 45 seconds, with periods of apnea (20 sec) alternating the cycle.

Answer 66

cheyne-stokes respiration

Question 67

breathing pattern is irregular. a series of normal respirations (3 to 4) is followed by a period of apnea. the cycle lenght is variable, lasting anywhere from 10 sec to 1 min.

Answer 67

biot’s respiraton

Question 68

normal inspiration and prolonged expiration to overcome increased airway resistance.

Answer 68

chronic obstructive breathing

Question 69

vibrations felt when inhaled air passes through thick seccretion in the larger bronchi. this may decrease somewhat by coughing.

Answer 69

rhonchal fremitis