TEST 3 Elimination, Gas Exchange

A nurse is teaching an elderly client about developing good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? A. "I will eat raw, green-leafy vegetables, unpeeled fruit, and whole grain bread." B. "I need to use laxatives regularly to prevent constipation." C. "I should try to drink twice as much water as I am now." D. "I will take my dog for a walk every day."

B. "I need to use laxatives regularly to prevent constipation." Explanation: The client requires more teaching if they state that they will use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.

A 50-year old patient asks how he can reduce his risk of colon cancer. What is the most appropriate response by the nurse? A. "A diet high in animal protein reduces the risk." B. "Regular exercise to reduce body fat helps prevent colon cancer." C. "Taking antacids for heartburn can help prevent colon cancer" D. "Taking vitamin c daily helps prevent colon cancer."

B. "Regular exercise to reduce body fat helps prevent colon cancer"

A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which teaching point by her nurse is most appropriate? A. "Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often." B. "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." C. "Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube." D. "I'll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in."

B. "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." Explanation: Atelectasis is characterized by incomplete lung expansion, and can often be prevented by deep breathing and coughing. Pleural effusion, not atelectasis, is associated with fluid accumulation between the lungs and their lining. Neither chest tube insertion nor bronchodilators are common treatments for atelectasis.

A nurse is auscultating the lungs of a healthy female patient and hears crackles on inspiration. What action can the nurse take to ensure this is an accurate finding? A. Make sure the bell of the stethoscope is used rather than the diaphragm B. Ask the patient to cough then repeat auscultation C. Ask the patient not to talk while the nurse is listening to the lungs D. Change the patient's position to ensure accurate sounds

B. Ask the patient to cough then repeat auscultation Explanation: If an adventitious sound is heard, have the patient cough; repeat auscultation to determine if sound changed or disappeared

A nurse suspects a viral infection or upper respiratory allergies when the patient describes the sputum being which color? A. White B. Clear C. Yellow D. Pink tinged

B. Clear

A 68-year-old male patient has been admitted to the surgical unit from the PACU after surgical repair of an inguinal hernia. When performing the patient's admission assessment, the nurse notes that the patient has a barrel chest. This assessment finding should suggest to the nurse that the patient may have a history of what health problem? A.Asthma B.Emphysema C. Tuberculosis D.Chronic bronchitis

B. Emphysema Explanation: Barrel chest occurs as a result of lung hyperinflation, as in emphysema. There is an increase in the anteroposterior diameter of the thorax so that it approximates a 1:1 ratio. This assessment finding is not associated with asthma, bronchitis, or tuberculosis.

When assessing the abdomen the nurse uses assessment technique in which order? A. Inspection, palpation, and auscultation B. Inspection, auscultation, and palpation C. Auscultation, inspection, and palpation D. Palpation, auscultation, and inspection

B. Inspection, auscultation, and palpation

A nurse hears inspiratory and expiratory wheezes bilaterally. What is the meaning of this finding? A. Consolidation in alveoli B. Narrowed airways C. Sputum in the bronchi D. Fluid in the alveoli

B. Narrowed Airways Explanation: Air moving within narrowed bronchi creates the wheezing sound. Consolidation would cause decreased or absent breath sounds. Sputum causes rhonchi. Fluid in the alveoli causes crackles.

The nurse percusses a patient's chest and feels dullness. The nurse suspects which diagnosis? A. Emphysema B. Pneumonia C. Bronchiectasis D. Chronic obstructive pulmonary disease (COPD)

B. Pneumonia Explanation: Dullness can be caused by consolidation by pneumonia. Hyperresonance usually is percussed with emphysema. Bronchiectasis is associated with a rounded chest wall and may be characterized by resonance or hyperresonance. COPD typically is characterized by hyperresonance.

A nurse observes that a client's urine is cola colored and considers which factor as a possible reason? A. The client has ingested a dark-colored drink. B. The client's urine contains material from the degradation of red blood cells. C. The client has an elevation of urine potassium. D. The client's urine has a decrease in the specific gravity.

B. The client's urine contains material from the degradation of red blood cells. Explanation: When red blood cells degrade in the urine, urine may appear cola colored.

The student nurse is reviewing the pathophysiology of inspiration. The primary muscles of inspiration are the diaphragm and the __. A. pectoral muscles B. external intercostal muscles C. abdominal muscles D. scalene muscles

B. external intercostal muscles The intercostal muscles help push the chest wall outward. The pectoralis minor muscle is considered an accessory muscle. The abdominal muscles are considered accessory muscles. The scalene muscles are considered accessory muscles.

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond? A. CF is autosomal dominant, so you have a 50% risk in another child. B. You have a 25% chance that your next child will have CF. C.Since the male carries the CF gene, you might consider a sperm donor. D. Now that you have one child with CF, the rest will also have it.

B.You have a 25% chance that your next child will have CF. Explanation: Cystic fibrosis is autosomal recessive, meaning that two defective genes are needed for a child to be born with the disorder. Both parents must either be carriers (having one defective gene, but no symptoms) or have the disease (two defective genes). If both parents are carriers, each child has 1 in 4 chance of receiving two normal genes, a 50 percent chance of inheriting at least one gene, and a 1 in 4 chance of receiving two abnormal genes and having CF.

A patient reports a gnawing, burning pain in the midepigastric region aggravated by bending over or lying down. Which additional information should the nurse ask for symptom analysis? A. "Do you have a family history of this type of pain?" B. "How long ago did you eat?" C. "Do you have any symptoms such as nausea with this pain?" D. "Have you noticed any yellow coloring of your eye or skin?"

C. "Do you have any symptoms such as nausea with this pain?"

Which question gives the nurse further information about the client's complaint of chest pain? A. "Have you had your influenza shot this year?" B. "Are there environmental factors that may affect your breathing at home?" C. "How would you describe the chest pain?" D. "Has the chest pain been interrupting your sleep?"

C. "How would you describe the chest pain?" Explanation: this is the only response that focuses specifically on the pain. Flu shots and environmental factors do not further inform the nurse about the patient's pain. Interrupted sleep could be a symptom, but it does not focus on the pain.

Which statement made by a client who was recently admitted to the medical unit with a diagnosis of pneumonia indicates a physical inability to learn? A. "May I have something to eat?" B. "The pain in my chest has gone." C. "I am having difficulty breathing." D. "Finally, I am getting medical attention."

C. "I am having difficulty breathing." Explanation: The statement "I am having difficulty breathing" indicates that the client is not physically well and that the client is unable to learn effectively until comfort is restored. "The pain in my chest has gone" and "May I have something to eat?" is suggesting that the client is physically well and is ready to learn. "Finally, I am getting medical attention" is suggesting that the client is psychologically ready to learn.

A patient reports having abdominal distention and having vomited several times yesterday and today. What question is appropriate for the nurse to ask in response to this information? A. "Has there been a change in the amount of distention?" B. "Did you have heartburn before vomiting?" C. "What did the vomitus look like?" D. "Have you noticed a change in color of urine or stools?"

C. "What did the vomitus look like?"

The nurse is palpating a patient's chest wall. What can be accomplished with palpation of the chest? A. Approximation of lung size B. Determination of oxygenation C. Assessment of equal chest expansion D. Identification of lung sounds

C. Assessment of equal chest expansion Explanation: Thoracic expansion is assessed easily. Lung size is not approximated. Oxygenation is best determined by skin color, mental status, and lab tests. Lung sounds are assessed through auscultation.

A nurse performing an abdominal assessment on a 37-year old woman would document which finding as abnormal? A. No aortic pulsations to light or deep palpation B. Bowel sounds every 15 seconds in lower quadrants C. Bulges observed when coughing D. Silver-white striae and faint vascular network

C. Bulges observed when coughing

A nurse finds the patient's anteroposterior diameter of the chest to be the same as the lateral diameter. Based on this finding, what additional data would the nurse anticipate? A. Bronchial breath sounds in the posterior thorax B. Decreased respiratory rate C. Decreased breath sounds on auscultation 4. Complaint of sharp chest pain on inspiration

C. Decreased breath sounds on auscultation Explanation: An increased anteroposterior diameter and diminished breath sounds are common in emphysema.

A patient has an infection of the terminal bronchioles and alveoli that involves the right lower lobe of the lung. Which abnormal findings are expected? A. Dyspnea with diminished breath sounds B. Asymmetric chest expansion on the right side C. Fever and tachypnea with crackles over right lower lobe D. Prolong expiration with an occasional wheeze in right lower lobe

C. Fever and tachypnea with crackles over right lower lobe Explanation: Pneumonia is an infection of the terminal bronchioles and alveoli. Symptoms include crackle sounds, increased tactile fremitus, fever, tachycardia, and tachypnea.

Which is an expected finding of an abdominal examination of an adult? A. Abdomen has rounded contour B. Venus hum over epigastrium C. High-pitched gurgles every 5-15 seconds D. Swishing sound over abdominal aorta

C. High-pitched gurgles every 5-15 seconds

The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first? A. Arterial blood gases B. Pulmonary function test C. Pulse oximetry D. Chest x-ray

C. Pulse oximetry Explanation: Pulse oximetry is a noninvasive method to determine arterial oxygen saturation. Normal values are 95% and above. Using this diagnostic test first provides rapid information of the client's respiratory system. All other options vary in amount of time and patient participation in determining further information regarding the respiratory system.

The nurse is preparing to perform an abdominal assessment. In which position should the patient be placed for abdominal assessment? A. Sitting upright on the examination table B. In a high-Fowler's position C. Supine D. In a left lateral position

C. Supine The supine position optimizes the ability to inspect, auscultate, percuss, and palpate. Sitting upright on the examination table makes palpation and percussion difficult. A high-Fowler's position makes palpation and percussion difficult. A left lateral position makes assessment difficult.

The nurse includes questions about chest pain as part of an abdominal history because myocardial pain can be: A. associated with ulcer disease. B. caused by esophageal herniation or rupture. C. perceived as esophageal and stomach pain. D. related to congenital abdominal defects.

C. perceived as esophageal and stomach pain. Patients may incorrectly assume that myocardial ischemic pain is caused by heartburn. Ulcers are not associated with myocardial ischemia. Esophageal herniation or rupture may cause intense chest pain. There are no congenital defects of the abdomen that mimic cardiac pain.

The nurse should auscultate the abdomen for at least __ before documenting an absence of bowel sounds. A. 5 to 15 seconds B. 30 seconds C. several minutes D. 1 hour

C. several minutes If no bowel sounds are heard after several minutes, an absence of bowel sounds can be documented. Typically bowel sounds should be heard every 5 to 15 seconds, but this is not enough time to establish an absence of bowel sounds. 30 seconds is not enough time to establish an absence of bowel sounds. 1 hour is too much time to assess for bowel sounds.

The nurse auscultates the abdomen to gain information regarding: A. the metabolic activity of the liver. B. the production of erythrocytes by the spleen. C. the peristaltic activity of the intestinal tract. D. the perfusion of the mesentery.

C. the peristaltic activity of the intestinal tract. Peristaltic activity produces bowel sounds. The liver does not produce sound. The spleen does not produce sound. Unless there is an audible bruit, perfusion of blood vessels is silent.

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of what? (Select all that apply) A. Adventitious sounds and limited chest expansion B. Increased tactile fremitus and dull percussion tones C. Muffled voice sounds and symmetric tactile fremitus D. Absent voice sounds and hyperresonant percussion tones E. Symmetric chest F. Resonant percussion tones G. Expansion muffled voice sounds

C.Muffled voice sounds and symmetric tactile fremitus E.Symmetric chest F.Resonant percussion tones G.Expansion muffled voice sounds Explanation: Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious sounds. The chest should fully expand. Percussion tones would be resonant in the normal assessment of an adult; voice sounds would be muffled.

What question does the nurse ask a patient with a history of pancreatitis who is complaining of abdominal pain? A. "Which foods aggravate the pain?" B. "Have you recently traveled outside of the United States? C. "Have you noticed a change in your bowel habits?" D. "How severe is the pain in a scale of 1-10?"

D. "How severe is the pain in a scale of 1-10?

The nurse auscultates prolonged expiration with expiratory wheezing and diminished breath sounds while assessing a patient. What does the nurse suspect? A. Tuberculosis B. Pneumonia C. Croup D. Asthma

D. Asthma Explanation: Asthma impairs airway movement, which contributes to wheezes and decreased breath sounds. Tuberculosis typically is associated with a cough, fever, and night sweats. Pneumonia is associated with a productive cough and fever. Croup is associated with labored breathing, fever, and a bark-like cough.

Which technique does the nurse use to palpate the patient's abdomen? A. Asks patient to breath slowly through the mouth B. Uses heel of hand to perform deep palpation C. Uses left hand to lift rib cage away from abdominal organs D. Depresses the abdomen 1 cm for light palpation

D. Depresses the abdomen 1 cm for light palpation

During inspection if the respiratory system the nurse documents which finding as abnormal? A. Skin color consistent with patient skin color B. 1:2 ratio of anterior posterior to lateral diameter C. Respiratory rate is 20 breaths per minute D. Patient leaning forward with arms braced on knees

D. Patient leaning forward with arms braced on knees Explanation: Indications of respiratory distress include an appearance of apprehension, nasal flaring, supraclavicular or intercostal retractions, and use of accessory muscles. Patient leaning forward with arms on knees (Tripod position) enhances accessory muscle use. All other options are nor al findings.

The nurse is assessing a patient's abdomen and suspects ascites. Which technique is used to confirm the presence of abdominal ascites? A. Auscultation of fluid movement within the abdominal cavity B. Palpation of rebound tenderness C. Palpation of pitting edema of the abdomen D. Percussion of dullness over dependent areas of the abdomen

D. Percussion of dullness over dependent areas of the abdomen Option D is performed with the patient in several positions and is known as testing for shifting dullness. Testing for fluid wave is done by palpation and inspection. Option B is a finding consistent with an inflammation such as appendicitis. Ascites causes a very tight, distended abdomen.

The nurse notes a black umbilicus on a 5-day-old infant. What does this finding indicate? A. The infant may have a feeding problem. B. The umbilicus is infected. C. The infant has hepatitis. D. This is a normal finding.

D. This is a normal finding. The umbilical cord turns black before it falls off. A feeding problem would be noted by hydration status and weight loss. An infected umbilicus would appear red and purulent. Hepatitis would be manifested in several ways, usually as a metabolic problem.

How does the nurse palpate the chest for tenderness, bulges, and symmetry? A. Uses fist of dominant hand to gently tap the anterior, lateral, and posterior chest, comparing one side with another B. Uses ulnar surfaces of one hand to palpate the anterior, posterior, and lateral chest, comparing one side with another C. With the tips of the fingers, palpates the skin over the chest and the alignment of vertebrae D. With the palmar surface of fingers of both hands, feel consistency of skin over chest and the alignment of vertebrae.

D. With the palmar surface of fingers of both hands, feel consistency of skin over chest and the alignment of vertebrae. Explanation: Using the palmar surface of the fingers is the correct way to test for chest tenderness, bulges, snd symmetry. Ulnar surfaces are used to test fremitus

A patient complains to the nurse of coughing up green phlegm and is having difficulty breathing at rest. The nurse suspects: A. a viral infection B. tuberculosis C. pulmonary edema D. bacterial pneumonia

D. bacterial pneumonia Explanation: The sputum by bacterial pneumonia also will have a foul smell. Viral infections usually are associated with the production of white or clear mucus. Sputum production with tuberculosis tends to be a rust color. Pink frothy sputum is a classic finding in patients with pulmonary edema.

The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? A. regular heart rate and hypertension B. increased urinary output, tachycardia, and dry cough C. shortness of breath, bradycardia, and hypertension D. dyspnea, crackles, and irregular weak pulse

D. dyspnea, crackles, and irregular weak pulse Explanation: The nurse should be alert for signs of cardiac decompensation due to congestive heart failure which include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would not be dry. The heart rate would increase rather than decrease.

Which characteristic is seen with a healthy stoma? A. Painful B. Pink color C. No bleeding when cleansing the stoma D. Dry in appearance

Pink color Explanation: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

A client is diagnosed with frequent urinary tract infections. What would be an appropriate question for the nurse to ask the client? A."How frequently do you urinate each day?" B. "Are you on any type of special diet at home?" C. "How often do you have a bowel movement?" D. "Are you on any blood pressure medications?"

A. "How frequently do you urinate each day?" Explanation: The client with frequent urinary tract infections may have infrequent urination, which can lead to stagnation of urine in the bladder; this potentially leads to growth of bacteria and a UTI. Taking blood pressure medication, being on a special diet, or having bowel movements do not increase the risk for urinary tract infections.

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis. A. A 26-year-old female with anxiety who has been hyperventilating B. An 18-year-old female who has overdosed on narcotics C. A 63-year-old male with a 40-year history of smoking and chronic lung disease D. A 45-year-old male with pneumothorax after a car accident

A. A 26-year-old female with anxiety who has been hyperventilating Explanation: Respiratory alkalosis can occur with hyperventilating and the loss of CO2.The other three clients are more at risk for respiratory acidosis as a result of retaining CO2.

In which patient would a pulsation within the epigastric area be considered a normal finding during inspection? A. A very thin patient B. An obese patient C. A patient with ascites D. An elderly patient

A. A very thin patient Inspection of a pulsation in the epigastric area on a large person would be a cause for concern. This finding would be a cause for concern for an obese patient. Significant ascites obscures inspection findings. This finding would be a cause for concern because abdominal aortic aneurysms are most common in elderly individuals.

Which assessment would lead the nurse to believe a postpartal woman is developing a urinary complication? A. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. B. She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. C. She says she is extremely thirsty. D. Her perineum is obviously edematous on inspection.

A. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. Explanation: Postpartal women who void in small amounts may be experiencing bladder overflow from retention.

The nurse assesses a patient who has a costal angle greater than 90 degrees. What is the most likely cause of this finding? A. Chronic obstructive pulmonary disease B. Pneumothorax C. Infant respiratory distress syndrome D. Atelectasis

A. Chronic obstructive pulmonary disease Explanation: Chronic Obstructive Pulmonary Disease (COPD) is a group of progressive lung diseases; with emphysema and chronic bronchitis being the most common. The costal angle increases because of an increased AP diameter. Pneumothorax is an acute condition that does not affect the shape of the chest. Infant respiratory distress syndrome is an acute condition that does not affect the shape of the chest. Atelectasis is an airless state of alveoli, but it will not affect the shape of the chest.

The nurse palpates the abdomen to gather data about which organs in the right upper quadrant? A. Liver and gallbladder B. Stomach and spleen C. Uterus, if enlarged are right ovary D. Right ureter and ascending colon

A. Liver and gallbladder

The nurse is interviewing a patient with a history of flank pain, fever, chills, and pain radiating to the groin. What examination technique is most appropriate for this patient? A. Percussion of the costovertebral angle B. Deep palpation of lower abdomen C. Inspection of urine specimen D. Auscultation of lower quadrants of abdomen

A. Percussion of the costovertebral angle Patient should perceive a thud but no pain. Pain on percussion of the costovertebral angle can indicate nephronliathiasis (kidney stones) which symptoms include fever, chills, pain radiating to groin, flank pain.

On auscultation of a patient's lungs, the nurse hears a low-pitched, coarse, loud, and low snoring sound. Which term does the nurse use to document this finding? A. Rhonchi B. Wheeze C. Crackles D. Pleural friction rub

A. Rhonchi Explanation: Rhonchi sounds are low-pitched, coarse, loud, low snoring or moaning tone. Wheeze sounds are high-pitched, musical sound similar to a squeak. Crackle sounds are fine, high-pitched crackling and popping noises. Pleural friction rub sounds are superficial, low-pitched, coarse rubbing or grating sounds.

The examiner notes a diaphragmatic excursion of 4 cm on the right side and 8 cm on the left side. What do these findings mean? A. The patient may have a pleural effusion. B. The patient may have a pneumothorax. C. Asymmetric findings are common in well-conditioned adults. D. This is a normal finding because the right lung is larger than the left lung.

A. The patient may have a pleural effusion. Explanation: Fluid in the pleural space can be detected by noting a difference in diaphragmatic excursion. A pneumothorax will be evidenced by decreased lung sounds and changes in percussion tone on the affected side. Measurements should be bilaterally equal. Measurements should be bilaterally equal.

The nurse is percussing a patient's abdomen and hears tympany. Which anatomic features explain the finding of tympany with stomach percussion? A. The stomach is hollow. B. The stomach is flask-shaped. C. The stomach secretes digestive enzymes. D. The stomach is a muscular organ.

A. The stomach is hollow. Tympany may not be pronounced if the stomach is full. The shape of the stomach does not affect the percussion tone. Option C does not affect percussion tone. Although dense muscles may cause a dull tone, the stomach is not a solid, dense organ.

Which breath sounds are expected over the posterior chest of an adult? A. Vesicular B. Bronchovesicular C. Bronchial D. Bronchoalveolar

A. Vesicular Explanation: Vesicular sounds are expected over all of the posterior and lateral thorax. This would be an abnormality for bronchovesicular(first and second intercostal spaces at sternal border and T4 medial to scapula) & bronchial sounds (over trachea)

Narrowing if the bronchi create which adventitious sound? A. Wheeze B. Crackles C. Rhonchi D. Pleural friction rub

A. Wheeze

A nurse hears bronchovesicular sounds in the posterior chest on either side of the spine. This finding indicates: A. a normal finding B. pneumonia C. lung cancer D. pleural effusion

A. a normal finding Bronchovesicular sounds are expected in this area of the chest. Pneumonia would cause crackles or no breathing sounds if there were consolidation. Lung cancer usually is not detected by auscultation. No breath sounds would be heard over a pleural effusion.

Frequently, what is the earliest symptom of left-sided heart failure? A.dyspnea on exertion B. anxiety C. confusion D. chest pain

A. dyspnea on exertion Explanation: Dyspnea on exertion is often the earliest symptom of left-sided heart failure.

When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating A. orthopnea. B. dyspnea upon exertion. C. hyperpnea. D. paroxysmal nocturnal dyspnea.

A. orthopnea Explanation: Clients with orthopnea prefer not to lie flat and will need to maintain their beds in a semi- to high Fowler position. Dyspnea upon exertion refers to difficulty breathing with activity. Hyperpnea refers to increased rate and depth of respiration. Paroxysmal nocturnal dyspnea refers to orthopnea that occurs only at night.

The nurse auscultates lung sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as A. pleural friction rub. B. crackles. C.sonorous wheezes. (Rhonchi) D. sibilant wheezes. (Wheeze)

A. pleural friction rub Explanation: A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid. Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration. Sonorous wheezes are deep, low-pitched rumbling sounds heard primarily during expiration. Sibilant wheezes are continuous, musical, high-pitched, whistlelike sounds heard during inspiration and expiration.

People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which muscles to help air leave the lungs more effectively? A. Intercostal and abdominal muscles B. Shoulder and diaphragmatic muscles C. Abdominal and pelvic muscles D. Pulmonary and scalene muscles

A.Intercostal and abdominal muscles Explanation: Air trapping in clients with emphysema occurs due to the loss of elasticity of the alveoli and interferes with the intake of air and gas exchange. The goal of pulmonary rehabilitation in relation to air trapping is to increase a client's ability to exhale. The use of the internal intercostal muscles constrict the rib cage, causing a decrease in the thoracic volume, and the abdominal muscles force the abdomen to push up against the diaphragm moving it upward toward the thorax. Reference: