Deck 15: Thorax And Lungs

Question 1

Retractions of the intercostal spaces generally occur

A) upon inspiration.
B) upon expiration.
C) while coughing.
D) throughout the respiratory cycle.

Answer 1

upon inspiration.

Question 2

Using the recommended approach,you should conduct your examination from the right anterior thorax at the apex of the lung for comparison with the

A) right anterior thorax at the base.
B) left anterior thorax at the apex.
C) right posterior thorax at the apex.
D) left lateral thorax at the apex.

Answer 2

left anterior thorax at the apex.

Question 3

Regular respirations characterized by increased rate and depth are an abnormal pattern known as

A) air trapping.
B) Kussmaul's respirations.
C) sighing.
D) hyperpnea.

Answer 3

Kussmaul's respirations.

Question 4

On expiration,the lung is approximately at the level of

A) the fifth rib at the midaxillary line.
B) T3.
C) T10.
D) the oblique fissure.

Question 5

A patient complains of dyspnea,which has gradually worsened over the past few years.To examine the quantity of the patient's dyspnea,you should determine

A) how far she can walk before she experiences shortness of breath.
B) how many packs of cigarettes she smokes a day.
C) whether she experiences shortness of breath during the night.
D) whether sitting up alleviates the dyspnea.

Question 6

Which patient is least likely to experience hypoventilation?

A) patient who weighs 350 pounds
B) patient who is recovering from gallbladder surgery and is requesting pain medication
C) patient who has emphysema and is walking in the hall
D) patient who has just had chest tubes inserted for a pneumothorax

Question 7

To perform anterior thoracic auscultation,you would

A) use the bell of the stethoscope.
B) instruct the patient to breathe deeply and slowly through the nose.
C) shave areas of coarse chest hair to avoid sound distortion.
D) ask the patient to displace the breast tissue when necessary to auscultate the lungs.

Question 8

In a normal adult,the shape of the thorax is

A) wider from front to back than from side to side.
B) wider from side to side than from front to back.
C) the same width side to side as front to back.
D) the same in infancy and throughout adulthood.

Question 9

To properly examine the respiratory rate,you should

A) first explain to the patient what you are doing.
B) count the number of respiratory cycles for one full minute.
C) first ask the patient to take several deep breaths through the mouth.
D) place your stethoscope over the patient's right lung and count the number of respiratory cycles for one full minute.

Question 10

Your patient is breathing in a crescendo-decrescendo pattern with periods of apnea lasting 20 seconds.Suspecting that he is displaying Cheyne-Stokes respirations,you obtain additional information listed below.Which of the following indicates that her breathing pattern may be a normal finding?

A) The patient is 35 years old.
B) The patient is sleeping.
C) The patient experienced a blow to the head during a fight.
D) The patient has a broken rib.

Question 11

To determine a patient's costal angle,you should visually estimate the angle formed by the

A) articulation of the manubrium and body of the sternum; it is continuous with the second rib.
B) costal ribs and the vertebrae.
C) right and left costal margins where they meet at the xiphoid process.
D) vertebrosternal ribs during inhalation.

Question 12

Which finding from your inspection of a patient's thorax is normal?

A) a costal angle of 95°
B) ribs at a 45° angle with the sternum
C) bulging of intercostal spaces
D) dilated superficial veins on the anterior chest wall

Question 13

A 62-year-old patient with emphysema states that he typically has two alcoholic drinks each evening to "help him relax." Your best response would be to

A) reassure him that by limiting his alcoholic intake to two drinks, he should not experience any serious effects on his respiratory functioning.
B) caution him that he is at risk for pneumoconiosis.
C) inform him that alcohol may decrease his carbon dioxide levels.
D) inform him that alcohol decreases the efficiency of his lung's defense mechanisms.

Question 14

Which respiratory condition reported by a patient when you obtain the family health history is not considered to be a familial disease?

A) lung cancer
B) tuberculosis
C) pneumonia
D) alpha1-antitrypsin deficiency

Question 15

Pectus carinatum is characterized by

A) a depression in the lower body of the sternum.
B) excessive concavity of the thoracic vertebrae.
C) a marked protrusion of the sternum.
D) ribs forced upward and inward.

Question 16

Paradoxical chest wall movement in a patient with multiple fractured ribs of the right thorax is characterized by

A) expansion of the thorax upon inspiration while the injured area of the chest wall is depressed.
B) bulging of the intercostal spaces during inspiration on the side of the injury.
C) unilateral expansion with no expansion on the side of the injury.
D) shallow respirations on the side of the injury.

Question 17

A patient reports that he has worked with ceramics for over 35 years.You recognize that this length of exposure to potentially hazardous substances increases her risk for

A) asbestosis.
B) byssinosis.
C) silicosis.
D) pulmonary neoplasms.

Question 18

A respiratory rate of more than 20 breaths per minute in an adult is called

A) apneustic respirations.
B) hyperpnea.
C) tachypnea.
D) eupnea.

Question 19

Patients experiencing hypoxemia or hypermetabolism try to increase their oxygen intake by using their sternocleidomastoid,rectus abdominis,trapezius,and scalene muscles.What are these muscles called?

A) external intercostal muscles
B) internal intercostal muscles
C) muscles of the diaphragm
D) accessory muscles

Question 20

The right mainstem bronchus is

A) congenitally absent in a small portion of the population.
B) not prone to aspiration pneumonia.
C) displaced by the mediastinum.
D) wider, shorter, and more vertical than the left.

Question 21

The auscultation of bronchophony,egophony,and whispered pectoriloquy provides useful information to determine if the lungs are filled with air or fluid.Which guideline is recommended for examining these voice sounds?

A) Only one of the three techniques needs to be performed, because they all provide the same information.
B) All of the techniques need to be included in a comprehensive examination if tactile fremitus has been performed.
C) All three techniques should be performed if an abnormality is detected during the general auscultation, percussion, or palpation.
D) Two of the three techniques should be performed if an abnormality is detected during the general auscultation, percussion, or palpation.

Question 22

You determine that a patient's diaphragmatic excursion is 5 cm with the diaphragm at T12 on inspiration and T10 on expiration.This finding

A) is abnormally low, indicating hypoventilation.
B) is normal.
C) indicates a high diaphragm level with displacement possibly by ascites.
D) indicates the presence of atelectasis or pleural effusion in the lower lobes, producing a dull sound on percussion and leading to a false determination of high diaphragm level.

Question 23

Your patient's medical record indicates severe chest trauma and recent onset of subcutaneous emphysema.Upon palpation of the patient's chest,you are most likely to feel

A) beads of air under the skin that pop with the pressure of your fingers, making a crackling sound.
B) a hard swollen mass covering the area of trauma.
C) air escaping around his chest tube that is being trapped by his bandages.
D) air flowing into his subcutaneous tissue as his lungs attempt to reinflate.

Question 24

A normal finding when examining thoracic expansion is separation of the thumbs by

A) 2-3 cm on inspiration with return to the midline on expiration.
B) 3-5 cm on inspiration with return to the midline on expiration.
C) 3-5 cm on inspiration and 1-2 cm on expiration.
D) 5-7 cm on inspiration and 3-5 cm on expiration.

Question 25

Your patient states that he is sitting upright because he has difficulty breathing when lying down.You determine that the patient has

A) dyspnea.
B) agonal respirations.
C) bradypnea.
D) orthopnea.

Question 26

Coarse crackles are characterized by crackling or gurgling sounds that

A) occur during both inspiration and expiration.
B) mimic the sound caused by rolling hair with your fingers near your ear.
C) cannot be cleared by coughing.
D) result from air passing through moisture in large airways that reinflate.

Question 27

Areas of the thorax where breath sounds are decreased may indicate

A) a lung tumor that has displaced normal lung tissue.
B) large distance between the lungs and the chest wall.
C) a pneumothorax with collapse of the lung.
D) complete airway obstruction.

Question 28

Which of the following is an example of a high-pitched adventitious breath sound that is heard predominantly on expiration?

A) fine crackle
B) sibilant wheeze
C) sonorous wheeze
D) stridor

Question 29

When percussing the anterior thorax,place the patient in the recommended position,which is sitting upright with

A) a slight forward tilt, head bent down, and arms folded in front at the waist.
B) the shoulders back.
C) arms to the side.
D) hands and arms raised directly overhead.

Question 30

The recommended procedure for locating the site of a fractured rib is to have the patient point to the site of pain after

A) you have systematically palpated each rib on the side of injury.
B) the patient has taken a deep breath.
C) you have lightly depressed the middle of the patient's sternum.
D) you have applied pressure to the chest wall on the uninjured side.

Question 31

Tactile fremitus is more pronounced in which area of the thorax?

A) near the major bronchi and trachea
B) over the ribs
C) in the periphery of the lung
D) over the scapula

Question 32

A pleural friction rub is often described as

A) crowing.
B) crackling or popping.
C) creaking or grating.
D) musical.

Question 33

To examine the posterior thorax,percuss two or three strikes,starting at the right lung apex along the top of the shoulder,and

A) repeat at the left lung apex, comparing the sounds from both.
B) move down 5 cm, repeat the percussion, and compare the sounds.
C) repeat at the right base, comparing the sounds.
D) repeat at each rib, comparing the sounds.

Question 34

Bronchovesicular sounds are normally auscultated

A) over the trachea.
B) at the third and fourth intercostal spaces, lateral to the sternum.
C) at the first and second intercostal spaces, lateral to the sternum.
D) over the peripheral lung parenchyma.

Question 35

You observe a patient pursing his lips during expiration.This is most likely due to

A) blocked nasal passages.
B) chronic obstructive pulmonary disease.
C) pneumonia.
D) pneumothorax.

Question 36

A patient has a tracheal deviation toward the affected side that can be caused by

A) pleural effusion.
B) tension pneumothorax.
C) enlarged thyroid.
D) atelectasis.

Question 37

A patient with decreased or absent tactile fremitus is most likely to have

A) asthma.
B) pneumonia.
C) atelectasis.
D) lung cancer.

Question 38

Pulsations on a patient's anterior chest wall detected by palpation may indicate a(n)

A) large tumor.
B) thoracic aortic aneurysm.
C) obstructed thoracic artery.
D) normal finding.

Question 39

Foul-smelling sputum is an abnormal finding and most likely indicates

A) anaerobic infection.
B) poor oral hygiene.
C) lung cancer.
D) viral infection.

Question 40

To palpate the anterior thorax,you should use the finger pads of your dominant hand and

A) start at the apex of the right lung (above the clavicle), move down to each rib and intercostal space, and then repeat on the left.
B) palpate any areas of tenderness first.
C) start at the base of the right lung, move upward to each rib and intercostal space, and then repeat on the left.
D) have the patient lift the arms over the head to stretch the skin and enhance detection of any abnormal findings.

Question 41

Upon performing egophony over a patient's anterior chest as he repeats the sound "ee," you clearly hear the sound "ay," spoken with a nasal quality.This finding most likely indicates

A) healthy lungs.
B) a pneumothorax.
C) pneumonia.
D) asthma.

Question 42

The thoracic anatomic landmark at the junction of the manubrium and the sternum is called the ____________________.

Question 43

Mucoid sputum is often seen in which of the following conditions? Select all that apply.

A) Coryza
B) Asthma
C) Lung cancer
D) Tuberculosis
E) Viral infection
F) Tracheobronchitis

Question 44

Pink,frothy sputum is expectorated by patients diagnosed with ______________________.

Question 45

A patient reports that he was climbing Mount Hood and noted an increase in the depth of his respirations.This physical examination finding is called

A) apneustic respirations.
B) Biot's respirations.
C) air trapping.
D) hyperpnea.

Question 46

Which of the following is a priority to include in the instructions given to a patient who has bronchitis?

A) Avoid malnutrition.
B) Decrease overweight status.
C) Increase activity.
D) Avoid cigarette smoking.

Question 47

Rust or blood-tinged sputum may be indicative of which of the following? Select all that apply.

A) Pneumonia
B) Tuberculosis
C) Pulmonary edema
D) Lung cancer
E) Bacterial infection
F) Pulmonary infarction

Question 48

Ataxic breathing,or Biot's respirations,indicate damage to the ____________________.

Question 49

The nurse is performing an examination of the thorax and lungs on a 30-year-old patient.Which of the following examinations does the nurse evaluate to be a normal adult finding?

A) The thorax is barrel shaped.
B) The costal margin is greater than 90°.
C) The accessory muscles are used during inspiration and expiration.
D) The ribs articulate with the sternum at a 45° angle.

Question 50

To determine the symmetry of a patient's chest wall,the nurse would do which of the following? Select all that apply.

A) Stand behind the patient.
B) Inspect the right and the left anterior thoraxes.
C) Note the shoulder height, observing any differences between the two sides of the chest wall, such as the presence of masses.
D) Move in front of the patient.
E) Inspect the right and the left posterior thoraxes, comparing right and left sides.
F) Note the position of the scapula.

Question 51

To examine forced expiratory time,with your stethoscope over the patient's trachea,you measure the length of time that passes when the patient

A) takes a deep breath and exhales as much as possible through the mouth.
B) exhales forcefully through the mouth.
C) inflates a balloon with air.
D) takes a normal breath and exhales as much as possible through the nose.

Question 52

Which of the following are risk factors for tuberculosis? Select all that apply.

A) Malnutrition
B) Homelessness
C) Chronic alcoholism
D) Acute renal failure
E) Being a migrant farm worker
F) Working with high-risk patients

Question 53

Which of the following statements is true regarding respirations? Select all that apply.

A) Apnea is the lack of spontaneous respirations for 10 or more seconds.
B) A respiratory rate greater than 20 breaths per minute is termed tachypnea.
C) In the resting adult, the normal respiratory rate is 12 to 20 breaths per minute.
D) In stressful situations, the body releases catecholamines that elevate the respiratory rate to supply sufficient oxygen.
E) In central sleep apnea, the respiratory drive is altered, leading to periods of respiratory cessation.
F) In drug overdoses (barbiturates, alcohol, and opiates), bradypnea is a sign
Of the drug's depressant effect on the respiratory center.

Question 54

Hyperresonance on thoracic percussion is abnormal in the majority of adults and may indicate that the patient is experiencing a(n)_____________________.

Question 55

You are caring for a patient who is mildly underweight and is complaining of shortness of breath.Upon inspection,you observe that your patient's right shoulder and scapula are higher than the left shoulder and scapula.The most likely cause is

A) kyphosis.
B) scoliosis.
C) barrel chest.
D) mediastinal tumor.