RESP

Question 1

List 3 anterior reference lines of the thorax.

Answer 1

1- mistesternal line
2- midclavicular line
3- anterior axillary line

Question 2

List 2 posterior referance line of the thorax.

Answer 2

1- Midspinal line (vertebral line)
2- Scapular line (extends parallel to infer angle of scapula)

Question 3

How many spots do you auscultate laterally?

Answer 3

2 on the left

3 on the right

coincides with number of lobes

Question 4

T of F: both lungs have a horizontal fissure, the right lung has an added oblique fissure.

Answer 4

FALSE- both lungs have an oblique fissure, the right lung has an added horizontal fissure.

Question 5

Where is the oblique fissure anatomically located?

Answer 5

crosses the 5th rib at the midaxillary line and terminates at the 6th rib in the midclavicular line

Question 6

Where is the horizontal fissure anatomically located?

Answer 6

extends from the 5th rib in the right midaxillary line to the 3rd intercostal space or 4th rib and midsternal border

Question 7

T or F: the most remarkable point about the posterior chest is that it is almost all lower lobe.

Answer 7

True

Question 8

T or F: Laterally, lung tissue extends from the apex of the axilla down to the 7th or 8th rib.

Answer 8

True

Question 9

Which layer of pleura lines the chest wall and diaphragm?

Answer 9

Visceral pleura

Question 10

What vertebral level does tracheal bifurcation coincide with?

Answer 10

T4-T5

Question 11

What is an acinus?

Answer 11

a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs and the alveoli

Question 12

What vertebral levels to the lung fields run from?

Answer 12

C7-T10

Question 13

What are you predominantly assessing anteriorly?

Answer 13

upper lobes

Question 14

With deep inspiration, lungs can expand down to what vertebral level?

Answer 14

T12

Question 15

While palpating the chest you feel a course crackling sensation. What may this indicate?

Answer 15

Crepitus- It occurs with subcutaneous emphysema – when air escapes from the lung and is in the subcutaneous tissue. This can occur with thoracic surgery or with thoracic injury.

Question 16

How do we palpate chest expansion?

Answer 16

Posterior
- place thumbs at level T9 or T 10.
- pinch skin fold by pushing hands closer to midline
- ask pt to take deep breath
- you should see your thumbs move apart
symmetrically

Anterior
- place thumbs along costal margins pointing to
xiphoid process
- ask pt to take deep breath
- thumbs should move apart symmetrically
- watch for smooth chest expansion

Question 17

Is tactile fremitus sometimes greater on the left or right when palpating fremitus between scapula and vertebrae and why?

Answer 17

right because of the bronchial bifurcation

Question 18

How does percussion vary from anterior to posterior?

Answer 18

posterior- 9 spots bilaterally (technically 11)

anterior- 5 spots bilaterally

Question 19

How large do masses/lesions need to be to be detected during percussion?

Answer 19

2-3cm
*doesn’t reveal density changes deeper than 5-7cm

Question 20

How does hyperresonant sound different to resonance?

Answer 20

louder amplitude, lower pitch, booming quality

*heard when too much air is in lungs
ex. COPD

Question 21

Describe the 3 normal breath sounds

Answer 21

Bronchial:
High-pitched & loud; louder & longer during expiration; trachea

Bronchovesicular:
Loud & medium pitched; = inspiratory & expiratory phases; upper intercostal toward sternum

Vesicular:
Soft, low-pitched; mostly inspiration; over peripheral lung fields (smaller bronchioles & alveoli)

Question 22

Describe crackles/rales and wheezing.

Answer 22

Crackles/Rales:
fine – higher pitched & soft, mostly heard in small airways & alveoli
course – lower pitched & louder & longer sounding, bubbling or gurgling

Wheezing: high pitched, musical sound – air going through narrowed airways

Question 23

What is something to consider when auscultating a pt with a hairy chest? How should you adjust your technique?

Answer 23

movement of hairs under your stethoscope sounds like “crackles” – press harder with your stethoscope or wet the hair

Question 24

What is a pneumothorax? How might this present during a respiratory assessment?

Answer 24

Free air in pleural spaces – lung collapse

-Affected side – decreased or absent breath sounds
-Unequal chest expansion
-hyperresonant

Question 25

The home health client is diagnosed with chronic obstructive disease. The care aide (unlicensed assistive personnel (UAP)) tells the home health nurse that the client has trouble breathing when the client lies in a supine position. Which priority instruction should the nurse provide to the care aide? A. To ensure the client’s oxygen is in place correctly. B. To allow the client to sleep in a recliner. C. To allow a fan to blow on the client when lying in bed. D. To have the client take slow, deep breaths.

Answer 25

Answer: B – sitting will help the client breath better Oxygen should always be placed correctly but it is not the priority intervention for difficulty breathing. Having a fan at times will help with breathing but this is not the priority. Slow deep breaths will not help the client with difficulty breathing as much as sitting up. Nursing process – planning – physiological integrity, basic care & comfort, Synthesis

Question 26

The care aide (unlicensed assistive personnel (UAP)) tells the clinic nurse that the male client in Room #1 is “really breathing hard and can’t seem to catch his breath.” What priority action should the nurse do? A. Tell the care aide to place 4L/min of oxygen on the client. B. Tell the care aide to sit the client upright in a chair. C. Tell the care aide to accompany her/him (the nurse) to go to the client’s room. D. Tell the care aide to take vital signs.

Answer 26

Answer: C – nurse must assess the client – the nurse then can ask the care aide to obtain any needed equipment. The nurse can’t rely on the aide to care for a client who could be potentially experiencing life threatening condition, aide can’t apply 02 (considered medication). Management of care – integrated process – nursing process – implementation – client needs – physiological integrity – reduction of risk potential – cognitive level - analysis

Question 27

The clinic nurse is scheduling a chest x-ray for a 35 yr old female client who may have pneumonia. Which question is most important for the nurse to ask the client? A. “Have you ever had a chest x-ray before?” B. “Can you hold your breath for a minute?” C. “Do you smoke or have you ever smoked?” D. “Is there any chance you may be pregnant?”

Answer 27

Answer: D – xrays can harm the fetus Management of care – Integrated process – nursing process – assessment – Client needs – safe & effective care environment – cognitive level - analysis

Question 28

Which client should the medical unit nurse assess first after receiving the shift report? A. The 84 year old client diagnosed with pneumonia who is afebrile but getting restless. B. The 25 year old client diagnosed with influenza who is febrile & has a headache. C. The 38 year old client diagnosed with a sinus infection who has green drainage from the nose.

Answer 28

Answer: A – elderly client may not present with “normal” symptoms, such as fever – restlessness may indicate a decrease in 02 to brain – needs to be seen first. Other clients – S & S are expected with these types of diagnoses so these clients aren’t seen first Integrated process – nursing process – assessment – client needs – physiological integrity – reduction of risk potential – cognitive level – synthesis

Question 29

How many degrees is the expected angle of the costal margin?

Answer 29

90

Question 30

Are women or men more susceptible to COPD?

Answer 30

Women