Deck 13: Chest and Lungs

Question 1

Which chest structure contains all the thoracic viscera except the lungs?

A) Manubrium
B) Mediastinum
C) Sternum
D) Xiphoid

Answer 1

Mediastinum

Question 2

Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies?

A) Left mainstem bronchus
B) Terminal bronchioles
C) Right mainstem bronchus
D) Respiratory bronchioles

Answer 2

Right mainstem bronchus

Question 3

Nancy Walker is a 16-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that, apart from occasional colds, Nancy is not prone to respiratory problems. Which potential risk factor is most important to assess with regard to Nancy's current problem?

A) Anorexia symptoms
B) Cocaine use
C) Last menses
D) Signs of rheumatic fever

Answer 3

Cocaine use

Question 4

You are documenting a rash between the eighth and ninth ribs on the lateral border. This intercostal space will be documented in terms of the:

A) rib immediately above it.
B) rib immediately below it.
C) number of centimeters it is positioned below the clavicle.
D) number of inches it is positioned below the clavicle.

Question 5

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.

Question 6

Ms. Rudman, age 74 years, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with intrathoracic infection?

A) Barrel chest
B) Cor pulmonale
C) Funnel chest
D) Malodorous breath

Question 7

Which finding suggests a minor structural variation?

A) Barrel chest
B) Clubbed fingers
C) Pectus carinatum
D) Chest wall retractions

Question 8

The characteristic barrel chest of the older adult is the result of a combination of factors, including:

A) skeletal changes of aging.
B) increased muscular expansion of the chest wall.
C) less fibrous alveoli.
D) increased vital capacity.

Question 9

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.

Question 10

The anteroposterior diameter of the chest is normally approximately the same as the transverse diameter in which age group?

A) Infants
B) School-age children
C) Adolescents
D) Young adults

Question 11

To accommodate the enlarging uterus of pregnancy, chest changes result in:

A) intercostal muscle atrophy.
B) lowering of the resting diaphragm.
C) a decrease in alveoli expansion.
D) an increase in the subcostal angle.

Question 12

When the umbilical cord is cut:

A) blood flows through the infants lungs more vigorously.
B) lungs fill with air.
C) closure of the foramen ovale occurs
D) closure of the ductus arteriosus occurs.

Question 13

The patient tells you that she uses herbal and other alternative therapies to maintain her health. This information is recorded in the:

A) past medical history.
B) chief complaint.
C) social history.
D) family history.

Question 14

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.

Question 15

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.

Question 16

Increased oxygen tension in the arterial blood of a newborn infant causes:

A) closure of the ductus arteriosus.
B) hyperinflation of the lungs.
C) passive respiratory movements.
D) reopening of the foramen ovale.

Question 17

Fetal gas exchange is mediated by the:

A) lungs.
B) heart.
C) amniotic fluid.
D) placenta.

Question 18

The foramen ovale should close:

A) by 24 weeks of gestation.
B) within minutes of birth.
C) by 4 weeks of age.
D) By 12 months of age.

Question 19

Bradypnea may accompany:

A) a subconscious response to observation.
B) an excellent level of cardiovascular fitness.
C) ascites.
D) severe pain from a rib fracture.

Question 20

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.

Question 21

Breath sounds normally heard over the trachea are called:

A) bronchovesicular.
B) amphoric.
C) bronchial.
D) vesicular.

Question 22

An expected finding of chest palpation in the adult would be:

A) a costal angle of 100 degrees.
B) cracking over the sternal notch.
C) greater right chest expansion.
D) inflexibility of the xiphoid.

Question 23

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

Question 24

Which type of apnea requires immediate action?

A) Primary apnea
B) Secondary apnea
C) Sleep apnea
D) Periodic apnea of the newborn

Question 25

During the most effective percussion technique for the posterior lung fields, the patient cooperates by:

A) folding their arms in front.
B) bending their head back.
C) standing and bending forward.
D) lying on the side and extending their top arm.

Question 26

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

Question 27

Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:

A) percussing all lung fields.
B) auscultating the lung bases.
C) determining tactile fremitus.
D) estimating diaphragmatic excursion.

Question 28

Respiratory effort usually exhibited by a patient with cerebral brain damage is called:

A) Cheyne-Stokes respiration.
B) paroxysmal nocturnal dyspnea.
C) Kussmaul breathing.
D) Biot respiration.

Question 29

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.

Question 30

Laryngeal obstructions would elicit which breath sound?

A) Fremitus
B) Stridor
C) Rhonchi
D) Crepitus

Question 31

Breath odors may alert the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:

A) uremia.
B) tuberculosis.
C) hepatic failure.
D) diabetic ketoacidosis.

Question 32

The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it:

A) amplifies all types of sounds.
B) filters extraneous sounds.
C) pinpoints focal sound areas.
D) transmits high-pitched sounds.

Question 33

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.

Question 34

The middle lobe of the right lung is best auscultated in the:

A) anterior chest.
B) posterior chest.
C) axilla.
D) midclavicular line.

Question 35

Which term would you use to document a respiratory rate more than 20 breaths/min in an adult?

A) Dyspnea
B) Orthopnea
C) Platypnea
D) Tachypnea

Question 36

Breath sounds normally auscultated over most of the lung fields are called:

A) vesicular.
B) bronchovesicular.
C) bronchial.
D) tubular.

Question 37

Your trauma patient has no auscultated breath sounds in the right lung field. You can hear adequate sounds on the left side. A likely cause of this abnormality could be that the patient:

A) has a closed head injury.
B) has fluid in the pleural space.
C) is moaning and in severe pain.
D) is receiving high-flow oxygen.

Question 38

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.

Question 39

The examiner percusses for diaphragmatic excursion along the:

A) sternum.
B) midvertebral line.
C) midaxillary line.
D) scapular line.

Question 40

Mr. L has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect that he is having cardiac or pulmonary difficulty. Which additional sign would support this impression?

A) Callus formation on the heels
B) Clubbing of the fingers
C) Graying hair
D) Swollen toes and ankles

Question 41

Which symptom is the most significant indicator of asthma and should be identified in the health history?

A) Wheezing
B) Paroxysmal dyspnea
C) Coexistent skin conditions
D) Chest pain

Question 42

A cause for alarm during chest assessment of a newborn is:

A) crackles.
B) rhonchi.
C) gurgles from the gastrointestinal tract.
D) stridor.

Question 43

A musical squeaking noise heard on auscultation of the lungs is called:

A) a friction rub.
B) rales.
C) rhonchi.
D) wheezing.

Question 44

Changes in the clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish:

A) consolidation from airway constriction.
B) a foreign body from a purulent exudate.
C) pulmonary edema from pleurisy.
D) right from left tracheal deviation.

Question 45

A pregnant woman is expected to develop:

A) tachypnea and decreased tidal volume.
B) deep breathing but not more frequent breathing.
C) dyspnea and increased functional residual capacity.
D) bradypnea and increased tidal volume.

Question 46

Which of the following is an expected finding in newborns ?

A) Mottling of the thorax
B) Sternal retractions
C) Cough
D) Sneezing

Question 47

During a chest assessment, you note the patient's voice quality while auscultating the lung fields. The voice sound is intensified, the voice has a nasal quality, and the e's sound like a's. This is indicative of:

A) lung consolidation.
B) emphysema.
C) bronchial obstruction.
D) asthma.

Question 48

To distinguish between a respiratory friction rub and cardiac friction rub, ask the patient to:

A) hold the breath.
B) lean forward.
C) say "99" while you palpate the anterior chest.
D) identify the location of the pain.

Question 49

A 29-year-old patient presents with a new complaint of productive cough, with purulent sputum. He also complains of right lower quadrant abdominal pain. You suspect pneumonia in which lobe?

A) Right lower
B) Right upper
C) Left upper
D) Left lower

Question 50

Both pleural effusion and lobar pneumonia are characterized by ______________ percussion.

Question 51

Expected respiratory changes of normal aging include:

A) increased chest expansion.
B) more frequent use of respiratory muscles.
C) accentuated lumbar curve.
D) more prominent bony structures.

Question 52

The term rales has been replaced with:

A) wheezes.
B) crunches.
C) rhonchi.
D) crackles.

Question 53

To distinguish crackles from rhonchi, you should auscultate the lungs:

A) before and after the patient coughs.
B) first at the lung base and then at the apex.
C) with the patient inhaling and then exhaling.
D) with the patient recumbent and then sitting.

Question 54

Dullness to percussion in intercostal spaces suggests the presence of:

A) cor pulmonale.
B) empyema.
C) pneumonia.
D) sickle cell disease.

Question 55

How is the sputum of a viral infection different from the sputum of a bacterial infection?

A) Sputum production is greater with viral conditions than with bacterial infections.
B) The sputum is odorous in viral conditions and nonodorous in bacterial infections.
C) The sputum is yellow, green, or rust-colored in bacterial infections and mucoid in viral infections.
D) The sputum is much thinner in bacterial infections than in viral infections.

Question 56

While auscultating the lung fields, you note that the patient's voice sound is intensified, the voice has a nasal quality, and e's sound like a's. This describes:

A) resonance.
B) bronchophony.
C) pectoriloquy.
D) egophony.

Question 57

Tactile fremitus is best felt:

A) along the costal margin and xiphoid process.
B) in the suprasternal notch along the clavicle.
C) parasternally at the second intercostal space.
D) posterolaterally beneath the scapula.

Question 58

In which position can the mediastinal crunch (Hamman sign) best be heard?

A) A supine position
B) Lying on the left side
C) Sitting completely upright
D) With the head elevated 30 degrees

Question 59

Which condition requires immediate emergency intervention?

A) Patient with pleuritic pain without dyspnea
B) Patient with fever and a productive cough
C) Patient with tachypnea but no chest retractions
D) Patient with absent breath sounds and dull percussion tones

Question 60

Loud, harsh bronchovesicular breath sounds in young children are an indication of:

A) the accumulation of fluid.
B) malignant tumors or solid masses.
C) normal, thin chest wall structures.
D) pus-filled abscesses and tumors.

Question 61

The respiratory rate of a sleeping newborn is expected to be _____ breaths/min.

Question 62

In barrel chest, the ratio of the anteroposterior diameter to the transverse (lateral) diameter is _____.