N 270 Thorax & lungs practice questions

Assessing a patient with subcutaneous emphysema, the nurse observes a coarse crackling sensation palpable over the skin surface. Which of the following terms refers to this? A. Crepitus B. Pleural friction rub C. Rhonchal fremitus D. Increased fremitus

A. Crepitus

A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client's chest wall, the nurse expects to elicit: A. Resonant sounds B. Hyperresonant sounds C. Dull sounds D. Flat sounds

A. Resonant sounds Rationale: When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they're louder and lower pitched than resonant sounds. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

The function of the trachea and bronchi is to: A. Transport gases between the environment and the lung parenchyma. B. Condense inspired air for better gas exchange. C. Moisturize air for optimum respiration. D. Increase air turbulence and velocity for maximum gas transport.

A. Transport gases between the environment and the lung parenchyma.

Stridor is a high-pitched, inspiratory crowing sound commonly associated with: A. Upper airway obstruction. B. Atelectasis. C. Congestive heart failure. D. Pneumothorax.

A. Upper airway obstruction;from swollen, inflamed tissues or a lodged foreign body.

A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? A.Dyspnea B. Bradypnea C. Bradycardia D. Decreased respirations

A.Dyspnea Rationale: The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.

The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A.It helps prevent early airway collapse B. It increases inspiratory muscle strength C. It decreases use of accessory breathing muscles D. It prolongs the inspiratory phase of respiration

A.It helps prevent early airway collapse

Which of the following fremitus occurs with compression or consolidation of lung tissue like lobar pneumonia. A. Decreased B.Increased C.Rhonchal D. Pleural rub

B Increased

Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? A. Hypocapnia B. A hyperinflated chest noted on the chest x-ray C. Increased oxygen saturation with exercise D. A widened diaphragm noted on the chest x-ray

B. A hyperinflated chest noted on the chest x-ray **Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

On auscultation, which finding suggests a right pneumothorax? A. Bilateral inspiratory and expiratory crackles B. Absence of breaths sound in the right thorax C. Inspiratory wheezes in the right thorax D. Bilateral pleural friction rub

B. Absence of breaths sound in the right thorax *In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. None of the other options are associated with pneumothorax

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? A. A low respiratory rate B. Diminished breath sounds C. The presence of a barrel chest D. A sucking sound at the site of injury

B. Diminished breath sounds Rationale: This client has sustained a blunt or a closed chest injury. -Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. -A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. -Hyperresonance also may occur on the affected side. -A sucking sound at the site of injury would be noted with an open chest injury.

Percussion of the chest is: A. A useful technique for identifying small lesions in lung tissue. B. Helpful only in identifying surface alterations of lung tissue. C. Is not influenced by the overlying chest muscle and fat tissue. D. Normal if a dull note is elicited.

B. Helpful only in identifying surface alterations of lung tissue.

An increase in the transverse diameter of the chest cage in a pregnant woman is due to a(n): A. Compensatory increase in respiratory parenchyma. B. Increase in estrogen. C. Increase in surfactant. D. Increase in tidal volume.

B. Increase in estrogen. The increase in estrogen level during pregnancy relaxes the chest cage ligaments. This allows an increase in the transverse diameter of the chest cage by 2 cm, and the costal angle widens.

An african-american client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the: A. Lips B. Mucous membranes C. Nail beds D. Earlobes

B. Mucous membranes Rationale:Skin color doesn't affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they're affected by skin color.

INCREASED tactile fremitus would be evident in an individual who has which of the following conditions? A. Emphysema B. Pneumonia C. Crepitus D. Pneumothorax

B. Pneumonia

A common clinical manifestation in a patient with chronic obstructive pulmonary disease (COPD) is: A.Periodic breathing patterns. B. Pursed-lip breathing. C. Unequal chest expansion. D. Hyperventilation.

B. Pursed-lip breathing; people with COPD may purse the lips in a whistling position in order to exhale slowly & against a narrow opening. So the pressure in the bronchial tree remains positive, & fewer airways collapse.

Which of the following fremitus is palpable with thick bronchial secretions? A. Increased B. Rhonchal C. Pleural friction D. Crepitus

B. Rhonchal

Which of the following voice sounds would be a NORMAL finding? A. The voice transmission is distinct and sounds close to the ear. B. The "eeeee" sound is clear and sounds like "eeeee." C. The whispered sound is transmitted clearly. D. Whispered "1-2-3" is audible and distinct.

B. The "eeeee" sound is clear and sounds like "eeeee."

The nurse assesses a male client's respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A. Diaphragmatic breathing B. Use of accessory muscles C. Pursed-lip breathing D. Controlled breathing

B. Use of accessory muscles Rationale: The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: A. Pleural effusion B. Pulmonary edema C. Atelectasis D. Oxygen toxicity

C. Atelectasis Rationale: In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). -Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. -Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

Which of the following is not included in the definition of the thoracic cage? A. Sternum B. Ribs C. Costochondral junction D. Diaphragm

C. Costochondral junction

The gradual loss of intra-alveolar septa and a decreased number of alveoli in the lungs of elderly adults cause: A. Hyperventilation. B. Spontaneous atelectasis. C. Decreased surface area for gas exchange. D. Decreased dead space.

C. Decreased surface area for gas exchange.

A male patient's X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from: A. Cardiogenic pulmonary edema B. Respiratory alkalosis C. Increased pulmonary capillary permeability D. Renal failure

C. Increased pulmonary capillary permeability

Which of the following pairs correctly expresses the relationship to the lobes of the lungs and their anatomic position? A. Upper lobes—lateral chest B. Upper lobes—posterior chest C. Lower lobes—posterior chest D. Lower lobes—anterior chest

C. Lower lobes—posterior chest The POSTERIOR chest is almost all LOWER lobe. The ANTERIOR chest contains mostly UPPER and MIDDLE lobe with very little lower lobe.

Which phrase is used to describe the volume of air inspired and expired with a normal breath? A. Total lung capacity B. Forced vital capacity C. Tidal volume D. Residual volume

C. Tidal volume

The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? A. Make inhalation longer than exhalation B. Exhale through an open mouth C. Use diaphragmatic breathing D. Use chest breathing

C. Use diaphragmatic breathing Rationale:In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

A female client is undergoing a complete physical examination as a requirement for college. When checking the client's respiratory status, the nurse observes respiratory excursion to help assess: A. Lung vibrations B. Vocal sounds C. Breath sounds D. Chest movements

D. Chest movements Rationale:The nurse observes respiratory excursion to help assess chest movements. Normally, thoracic expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolus, or a rib or sternum fracture. - The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after asking the client to say "99," the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to the nurse's palms. -The nurse assesses breath sounds during auscultation.

Inspiration is primarily facilitated by which of the following muscles? A.Diaphragm and rectus abdominis B. Trapezius and sternomastoids C. Internal intercostal and abdominis D. Diaphragm and intercostal

D. Diaphragm and intercostal Diaphragm is the major muscle responsible for inspiration. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal; which increases the anteroposterior diameter.

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: A. Promote oxygen intake B. Strengthen the diaphragm C. Strengthen the intercostal muscles D. Promote carbon dioxide elimination

D. Promote carbon dioxide elimination Rationale: Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options A, B, and C are not the purposes of this type of breathing.