Thorax and Lungs Chapt 30 (618-626)

Question 1

Assessing the pt’s thorax and lungs is critical to assessing the status of what about the pt?

Answer 1

Assessing the thorax and the lungs is critical for assessing the pt’s O2 status.

Question 2

In adults, the normal shape of the chest/thorax should be:

Answer 2

the thorax should be oval where its anteroposterior diameter is half its transverse diameter (1:2)

Question 3

In older adults, how would kyphosis and osteoporosis alter the size of the chest cavity?

Answer 3

Kyphosis and osteoporosis would cause the ribs to move downward and forward in older adults. Also a convex curvature of the spine which can appear as shrinking

Question 4

The method and order of chest and thorax examination is?

Answer 4

Inspection, palpation, percussion (will not do), and auscultation

Question 5

When observing the pt’s chest and thorax, I’m assessing for the:

Answer 5

rate, rhythm, depth, and effort of breathing.

Question 6

How do you assess for respiratory excursion (respiratory expansion) and what is the normal finding?

Answer 6

Place palms of both hands over the posterior lower thoracic w/thumbs adjacent to the spine and fingers stretched laterally. Normal finding will show thumbs to separate 1.5”-2” upon inspiration.

Question 7

What is the normal finding upon palpation the thorax for tactile fremitus?

Answer 7

Bilateral symmetry of vocal fremitus (pt says blue moon or 99) felt most clearly at apex of lungs

Question 8

Why is percussion of the thorax perfomed?

Answer 8

Percussion of the thorax is performed to determine whether underlying lung tissue is filled with air, liquid, or solid material; also notes resonates

Question 9

A chest deformity that displays a narrow transverse diameter, increased anteroposterior diameter, and a protruding sternum possibly caused by rickets (bone deformity due to Ca deficiency) is called?

Answer 9

pectus carinatum (pigeon chest)

Question 10

A chest deformity that displays a depressed sternum with a narrowing of the anteroposterior diameter due to a congenital defect and can cause abnormal pressure on the heart is called?

Answer 10

pectus excavatum (funnel chest)

Question 11

A chest deformity that displays a ratio of 1:1, is seen in pts w/Kyphosis and emphysema is called?

Answer 11

barrel chest

Question 12

A chest deformity that displays a lateral deviation of the spine is called?

Answer 12

scoliosis

Question 13

An excessive convex curvature of the thoracic spine and seen in pts w/a barrel chest is called?

Answer 13

kyphosis

Question 14

A chronic pulmonary condition in which the air sacs, or alveoli, are dilated and distended is called (often seen in pts w/a barrel chest)?

Answer 14

emphysema

Question 15

Breath sounds that are abnormal due to air passing through narrowed airways or airways filled w/fluid/mucus, or inflammed pleura linings are called?

Answer 15

adventitious breath sounds

Question 16

Soft-intensity, low-pitched gentle sighing sound best heard on inspiration and at the base of the lung is what type of sound?

Answer 16

vesicular (normal sound)

Question 17

A moderate-intensity and moderately pitched “blowing” sound caused by air moving through the bronchi between the scapula and lateral to the sternum is what type of sound?

Answer 17

Broncho-vesicular (normal sound)

Question 18

A high-pitched, loud, “harsh” sounds created by air moving through the trachea heard over the trachea is what type of breath sound?

Answer 18

bronchial (tubular)

Question 19

A fine, short, interrupted crackling sound (crinkling hair) caused by air passing through fluid or mucus in airway, commonly heard at the bases of the lower lungs on inspiration is what type of breath sound?

Answer 19

crackles/rales

Question 20

A continuos, low-pitched, course, gurgling, harsh, louder sounds w/moaning or snoring quality due to air passing through narrowed passages as a result of secretions, swelling, tumors, can be heard predominately over the trachea/bronchi on expiration is what type of breath sound?

Answer 20

rhonchi (gurgles)

Question 21

A crackling or superficial grating sound due to the rubbing together of inflamed pleural surfaces, and that can be heard during ventilation is what type of breath sound?

Answer 21

friction rub (most often heard in areas of greatest thoracic expansion)

Question 22

A continuous, high-pitched, squeaky, musical sound due to air passing through a constricted bronchus as a result of secretions, swelling, tumors, heard all over lung fields on expiration is what type of breath sound?

Answer 22

wheeze

Question 23

Why is the sitting position preferred to the lying position when assessing the thorax/chest?

Answer 23

The sitting position is preferred because it maximizes thorax expansion

Question 24

Upon percussion of the thorax, you find that all lung fields resonant (drum). This finding is:

Answer 24

normal

Question 25

Dullness upon percussion of the thorax means what? Hyper-resonance on percussion of the thorax means what?

Answer 25

Dullness=consolidation due to pneumonia/fluid-filled. Hyper-resonance=excess air (pneumothorax)

Question 26

When assessing the thorax and lungs, which side (anterior or posterior) is ideally assessed first?

Answer 26

Posterior is ideally assessed first

Question 27

Which lung has three lobes:

Answer 27

The R lung has three lobes

Question 28

What are the imaginary landmarks of the anterior thorax:

Answer 28

midsternal line, midclavicular line, and anterior axillary line

Question 29

What are the imaginary landmarks of the axillary side:

Answer 29

anterior axillary line, midaxillary line, and posterior axillary line

Question 30

A normal chest size and shape is:

Answer 30

oval with a ratio to 1:2

Question 31

Where are you more likely to hear crackles/rales:

Answer 31

bases of the lower lungs

Question 32

Where are you most likely to hear rhonchi (gurgles):

Answer 32

predominately over the trachea and bronchi

Question 33

Where are you most likely to hear wheezing:

Answer 33

all over lung fields

Question 34

Where are you most likely to hear friction rub:

Answer 34

all over greatest thoracic expansion (lower anterior and lateral chest)

Question 35

What are the most common adventitious breath sounds:

Answer 35

crackles/rales, rhonchi/gurgles, wheezing, and friction rubs

Question 36

What are the type of normal breath sounds:

Answer 36

vesicular, broncho-vesicular, bronchial/tubular

Question 37

You’re palpating the thorax for tactile fermitus (vibration). You notice almost absent fermitus of your pt. This finding is:

Answer 37

abnormal and indicative of pneumothorax

Question 38

You’re palpating the thorax for tactile fermitus and you notice increased fremitus of your pt. This finding is:

Answer 38

abnormal and indicative of PNA

Question 39

You’re assessing the chest of your pt and you notice that her costal angle appears to be more than a 90 degree angle. This finding is:

Answer 39

abnormal and indicative of COPD (angle should be less than 90 degrees)

Question 40

You’re assessing the thorax of an older pt and you notice that the diameter of the thorax is widened giving him a barrel chest appearance. This finding is:

Answer 40

maybe normal in older adults due to loss of skeletal muscle strength and excessive expiratory pressure of the alveoli

Question 41

Why would the elderly might be at a greater risk for a pulmonary infection:

Answer 41

decrease in number and effectiveness of cilia which decreases how the mucous removal could be decreased as well