Week 9: Respiratory

B

Which statement about the apices of the lungs is true? The apices of the lungs: a. Are at the level of the second rib anteriorly. b. Extend 3 to 4 cm above the inner third of the clavicles. c. Are located at the sixth rib anteriorly and the eighth rib laterally. d. Rest on the diaphragm at the fifth intercostal space in the midclavicular line (MCL).

B

You are prescribing antibiotics for a pregnant patient who has CAP. Which of the following treatment options would be contraindicated for this patient? a. Azithromycin b. Doxycycline c. Amoxicillin d. Augmentin

E

You suspect your patient has pneumonia which signs and symptoms would indicate need for chest x-ray? Pick all that apply a. Heart rate greater than 100 b. Dyspnea c. Respiratory rate greater than 20 d. Chest pain e. A & C

E

You're providing teaching to your patient who is being seen for asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Which of the following is not an early sign of an asthma attack? A. Reduced peak flow meter reading B. Slight chest retractions C. Wheezing with activity D. No relief with short-acting bronchodilator inhaler E. B & D

A

A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses, and has an unremarkable history. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe. What disorder of the thorax or lung best describes his symptoms? a. Spontaneous pneumothorax b. Chronic obstructive pulmonary disease (COPD) c. Asthma d. Pneumonia

C Rationale: Macrolides (-mycin) 1st line for adults; Doxy 2nd line Amoxicillin 1st line for children

A 30 year old patient has been diagnosed with community acquired pneumonia and requires treatment. This patient was previously healthy and the last time they used antibiotics was 8 months ago. Which of the following is considered first line therapy for this patient? a. Doxycycline b. Fluoroquinolone c. Azithromycin d. Amoxicillin

C Rationale: Although sputum is not diagnostic alone, TB usually produces rust colored sputum in addition to night sweats and low grade afternoon fevers

A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated with rust-colored sputum, low-grade afternoon fevers, and night sweats for the past 2 months. The nurse's preliminary analysis, based on this history, is that this patient may be suffering from: a. Bronchitis. b. Pneumonia. c. Tuberculosis. d. Pulmonary edema.

C Rationale: Patient is experiencing nocturnal dyspnea and need to be upright to achieve comfort

A 65-year-old patient with a history of heart failure comes to the clinic with complaints of "being awakened from sleep with shortness of breath." Which action by the nurse is most appropriate? a. Obtaining a detailed health history of the patient's allergies and a history of asthma b. Telling the patient to sleep on his or her right side to facilitate ease of respirations c. Assessing for other signs and symptoms of paroxysmal nocturnal dyspnea d. Assuring the patient that paroxysmal nocturnal dyspnea is normal and will probably resolve within the next week

A

A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe in this patient? a. Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema b. Rasping cough, thick mucoid sputum, wheezing, and bronchitis c. Productive cough, dyspnea, weight loss, anorexia, and tuberculosis d. Fever, dry nonproductive cough, and diminished breath sounds

B

A college student is seen as a walk-in at the health clinic. She complains of abrupt onset of sore throat, nasal congestion, runny nose, and malaise. Vital signs are Temp 99.8, HR 84 bpm, Resp 14 breaths/min. The physical exam reveals an erythematous throat, swollen nasal turbinates, and rhinitis. The NP suspects URI. All of the following treatments are appropriate except: a. Dextromethorphan b. Antihistamines c. Pseudoephedrine d. Ibuprofen e. Increasing PO fluids and rest

B Rationale: Infant is an obligatory nose breather until 3 months old. Retractions and nasal flaring indicate increased inspiratory effort as in pneumonia, acute airway obstruction, asthma, atelectasis; therefore immediate referral to physician is requires.

A mother brings her 3-month-old infant to the clinic for evaluation of a cold. She tells the nurse that he has had "a runny nose for a week." When performing the physical assessment, the nurse notes that the child has nasal flaring and sternal and intercostal retractions. The nurse's next action should be to: a. Assure the mother that these signs are normal symptoms of a cold. b. Recognize that these are serious signs, and contact the physician. c. Ask the mother if the infant has had trouble with feedings. d. Perform a complete cardiac assessment because these signs are probably indicative of early heart failure.

B Rationale: Postnasal drip or sinusitis causes cough primarily at night. Exposure to irritants at work would cause an afternoon or evening cough. Smokers experience an early morning cough. Coughing associated with acute illness like pneumonia is continuous throughout the day

A patient comes to the clinic complaining of a cough that is worse at night but not as bad during the day. The nurse recognizes that this cough may indicate: a. Pneumonia. b. Postnasal drip or sinusitis. c. Exposure to irritants at work. d. Chronic bronchial irritation from smoking.

B

A patient comes to the office with acute febrile illness, malaise, headache, and dyspnea, you suspect: a. Chronic Bronchitis b. Viral Pneumonia c. Bacterial Pneumonia d. Acute Bronchitis

D Rationale: Barrel chest is a characteristic sign of COPD bc of hyperinflation of lungs. Neck muscles would be hypertrophied from aiding in respirations. Chest expansion might be decreased but should still be symmetrical. Decreased tactile fremitus would be present bc of decreased transmission of vibration.

A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these? a. Unequal chest expansion b. Increased tactile fremitus c. Atrophied neck and trapezius muscles d. Anteroposterior-to-transverse diameter ratio of 1:1

C Rationale: Hypoventilation is characterized by irregular, shallow pattern and is caused usually be narcotic overdose. Bradypnea is slow breathing with a rate of <10 bpm, but isn't usually irregular.

A patient has been admitted to the emergency department for a suspected drug overdose. His respirations are shallow, with an irregular pattern, with a rate of 12 respirations per minute. The nurse interprets this respiration pattern as which of the following? a. Bradypnea b. Cheyne-Stokes respirations c. Hypoventilation d. Chronic obstructive breathing

C Rationale: PE s/s includes chest pain that is worse on deep inspiration, dyspnea, apprehension, anxiety, PaO2 < 80mmHG, diaphoresis, hypotension, crackles, wheezing

A patient has been admitted to the emergency department with a possible medical diagnosis of pulmonary embolism. The nurse expects to see which assessment findings related to this condition? a. Absent or decreased breath sounds b. Productive cough with thin, frothy sputum c. Chest pain that is worse on deep inspiration and dyspnea d. Diffuse infiltrates with areas of dullness upon percussion

E

A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise? a) Avoid warming up before exercise. b) Administer a short-acting beta agonist before exercise. c) Administer a short-acting beta agonist after exercise. d) Avoid exercising when experiencing a respiratory illness. e) B & D

D

A patient presents appearing ill, upon PE you palpate for fremitus and note an asymmetric increase in fremitus, this increase in fremitus leads you to suspect: a. Neoplasm b. Pleural effusion c. Pneumothorax d. Pneumonia

D

A patient presents to your office with acute heart failure and upon auscultation of his lungs you hear crackles. Which of the following are consistent findings with crackles? A). They are discontinuous nonmusical sounds that can be heard in early inspiration, late inspiration or biphasic. B) The are not cleared with coughing C) They are continuous, musical in nature and can be heard on inspiration, expiration or biphasic. D) A and B E) B and C

B Rationale: Pleuritis (inflammation of pleural space), would cause pain and friction rub upon auscultation. The sound is made when the inflamed plurae rub together upon inspiration. It is coarse and low pitched, as if two pieces of leather are being rubbed together. Stridor is associated with croup, epiglottitis and foreign body inhalation. Crackles are associated with pneumonia, HF, and chronic bronchitis. Wheezes are associated with asthma and emphysema.

A patient with pleuritis has been admitted to the hospital and complains of pain with breathing. What other key assessment finding would the nurse expect to find upon auscultation? a. Stridor b. Friction rub c. Crackles d. Wheezing

B Rationale: Pneumothorax would cause tachypnea, cyanosis, unequal chest expansion, decreased or absent tactile fremitus, tracheal deviation to opposite side, decreased chest expansion, hyperresonance to percussion and decreased or absent breath sounds on affected side

A teenage patient comes to the emergency department with complaints of an inability to breathe and a sharp pain in the left side of his chest. The assessment findings include cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. The nurse interprets that these assessment findings are consistent with: a. Bronchitis. b. Pneumothorax. c. Acute pneumonia. d. Asthmatic attack.

C Rationale: Although growing fetus increases O2 demand on mom's body, this increased demand is easily met by increasing tidal volume (deeper breathing) and little change occurs in respiratory rate. Increases in estrogen during pregnancy should relax the chest cage ligaments, causing increase in transverse diameter.

A woman in her 26th week of pregnancy states that she is "not really short of breath" but feels that she is aware of her breathing and the need to breathe. What is the nurse's best reply? a. "The diaphragm becomes fixed during pregnancy, making it difficult to take in a deep breath." b. "The increase in estrogen levels during pregnancy often causes a decrease in the diameter of the rib cage and makes it difficult to breathe." c. "What you are experiencing is normal. Some women may interpret this as shortness of breath, but it is a normal finding and nothing is wrong." d. "This increased awareness of the need to breathe is normal as the fetus grows because of the increased oxygen demand on the mother's body, which results in an increased respiratory rate."

A Rationale: Asthma is allergic hypersensitivity to inhaled particles that causes inflammation and bronchospasm. It increases airway resistance, ESPECIALLY EXPIRATION. May see tachypnea, use of accessory muscles, retractions, prolonged expiration, decreased BS, expiratory wheezing

An adult patient with a history of allergies comes to the clinic complaining of wheezing and difficulty in breathing when working in his yard. The assessment findings include tachypnea, the use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. The nurse interprets that these assessment findings are consistent with: a. Asthma. b. Atelectasis. c. Lobar pneumonia. d. Heart failure.

B

An infant who does not have a history of reactive airway disease and allergy has both inspiratory and expiratory wheezing accompanied by fever, and clear nasal discharge with use of accessory muscles. Which of the following is most likely? A) Tracheobronchitis B) Bronchiolitis C) Croup D) A small foreign body that is lodged in the left main bronchus

D

Assessing transmitted voice sounds such as egophony helps the practitioner evaluate and/or detect all of the following except: a. Pleural effusion b. Consolidation c. Fibrosis d. Wheezing

B

Bronchiolitis is typically managed by: a) Antibiotics b) Hydration and nasal suctioning c) Bronchodilators d) Corticosteroids

B

Bronchophony is the result of the following except: a. fluid and cellular debris consolidation b. pneumothorax c. pulmonary edema d. hemorrhage

C Rationale: Bronchovesicular sounds are heard over major bronchi: between scapulae, anteriorly in upper sternum in the 1st and 2nd ICS

Bronchovesicular breath sounds are: a. Musical in quality. b. Usually caused by a pathologic disease. c. Expected near the major airways. d. Similar to bronchial sounds except shorter in duration.

D

Contraction of the external intercostal muscles causes which of the following to occur? A. The diaphragm moves downward. B. The rib cage is compressed. C. The thoracic cavity volume decreases. D. The ribs and sternum move upward.

D Rationale: Sputum alone is not diagnostic, but pink, frothy sputum indicates pulmonary edema. Croup is associated with a barking cough, not sputum production. TB produces rust colored sputum. Viral infections usually produce white or clear sputum.

During a morning assessment, the nurse notices that the patient's sputum is frothy and pink. Which condition could this finding indicate? a. Croup b. Tuberculosis c. Viral infection d. Pulmonary edema

B

During an assessment of an adult, the nurse has noted unequal chest expansion and recognizes that this occurs in which situation? a. In an obese patient b. When part of the lung is obstructed or collapsed c. When bulging of the intercostal spaces is present d. When accessory muscles are used to augment respiratory effort

C Rationale: Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds, muffled voice sounds, no adventitious breath sounds

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of: 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.

B Rationale: Sternal angle marks site of tracheal bifurcation into the right and left main bronchi

During an examination of the anterior thorax, the nurse is aware that the trachea bifurcates anteriorly at the: a. Costal angle. b. Sternal angle. c. Xiphoid process. d. Suprasternal notch.

A

During auscultation of breath sounds, the nurse should correctly use the stethoscope in which of the following ways? a. Listening to at least one full respiration in each location b. Listening as the patient inhales and then going to the next site during exhalation c. Instructing the patient to breathe in and out rapidly while listening to the breath sounds d. If the patient is modest, listening to sounds over his or her clothing or hospital gown

C

During auscultation of the lungs of an adult patient, the nurse notices the presence of bronchophony. The nurse should assess for signs of which condition? a. Airway obstruction b. Emphysema c. Pulmonary consolidation d. Asthma

A Rationale: Decreased breath sounds occur when bronchial tree is obstructed as in emphysema, pleurisy, pneumothorax, pleural effusion

During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in which situation? a. When the bronchial tree is obstructed b. When adventitious sounds are present c. In conjunction with whispered pectoriloquy d. In conditions of consolidation, such as pneumonia

B Rationale: Crepitus is coarse crackling with palpation. It occurs with subcutaneous emphysema when air escapes from lungs and enters SubQ tissue, such as after open thoracic injury or surgery

During palpation of the anterior chest wall, the nurse notices a coarse, crackling sensation over the skin surface. On the basis of these findings, the nurse suspects: a. Tactile fremitus. b. Crepitus. c. Friction rub. d. Adventitious sounds.

D Rationale: dullness upon percussion indicates abnormal density in lungs as in pneumonia, pleural effusion, atelectasis, or tumor. Resonance is the normal finding.

During percussion, the nurse knows that a dull percussion note elicited over a lung lobe most likely results from: a. Shallow breathing. b. Normal lung tissue. c. Decreased adipose tissue. d. Increased density of lung tissue.

D

How many colds a year can we expect the average child to have? A. 1-5 B. 2-6 C. 4-8 D. 6-10

D

In hospitalized infants with the diagnosis of bronchiolitis humidified, high-flow oxygen is provided. The mechanism of action is to: a) Improve mucous ciliary clearance b) Avoids nasal dryness c) Keep the alveoli open and reduce ventilation perfusion mismatch d) All of the above

A

Per COPD guidelines, the goal of inhaled corticosteroid use in stage III or severe COPD is to: a. Minimize the risk of repeated exacerbations b. Improve cough function c. Reverse alveolar hypertrophy d. Help mobilize secretions

D

Pulsus paradoxus is defined as? a. An increase in systolic pressure of >10 mmHg during expiration b. An increase in systolic pressure of >10 mmHg during inspiration c. A decrease in systolic pressure of < 10 mmHg during inspiration d. A decrease in systolic pressure of > 10 mmHg during inspiration

C

Pulsus paradoxus is more likely to be associated with: a. Sarcoidosis b. Acute bronchitis c. Status asthmaticus d. Bacterial pneumonia

A

Which of these statements is true regarding the vertebra prominens? The vertebra prominens is: a. The spinous process of C7. b. Usually nonpalpable in most individuals. c. Opposite the interior border of the scapula. d. Located next to the manubrium of the sternum.

B Rationale: >Coarse crackles with popping sound heard more in COPD, asthma, bronchiectasis, PNA, and HF >Rhonchi do disappear with coughing BUT are heard more with asthma, emphysema, mucus plugs >Pleural rub more seen with PNA, pulmonary infarction

Steve A patient of yours that you have seen for years presents to your clinic. He has known interstitial lung disease diagnosed as interstitial fibrosis. What adventitious lung sounds do you expect to hear? A) Course crackles with "popping" sound that are heard on all lung regions on early inspiration B) Fine crackles that are softer, higher pitched and heard on mid to late inspiration C) Rhonchi that have a low pitch and disappear after coughing D) Pleural rub that characterized as a discontinuous, low frequent grading sound that arises from inflammation

A

The NP knows that the pathophysiology of COPD includes the fact that alveolar destruction results in which manifestations? a. Decreased surface area for gas exchange b. Increased dead space air c. Development of pulmonary emboli d. Chronic dilation of bronchioles

D Rationale: With aging lungs become less elastic with less ability to recoil. Vital capacity is decreased, and less area for gas exchange.

The nurse is assessing the lungs of an older adult. Which of these changes are normal in the respiratory system of the older adult? a. Severe dyspnea is experienced on exertion, resulting from changes in the lungs. b. Respiratory muscle strength increases to compensate for a decreased vital capacity. c. Decrease in small airway closure occurs, leading to problems with atelectasis. d. Lungs are less elastic and distensible, which decreases their ability to collapse and recoil.

A, C, D Rationale: "ninety nine" should be heard as muffled and indistinct when testing bronchophony. If clear "ninety nine" is heard, could indicate pneumonia or consolidation. If examiner hears an "aaaa" instead of "eeeee" upon egophony testing, it could also mean pneumonia or other consolidation.

The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? Select all that apply. a. Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice. b. As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninety-nine." c. When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said. d. As the patient says a long "ee-ee-ee" sound, the examiner also hears a long "ee-ee-ee" sound. e. As the patient says a long "ee-ee-ee" sound, the examiner hears a long "aaaaaa" sound.

C Rationale: Patient should be instructed to breathe through his or her mouth a little deeper than usual

The nurse is auscultating the chest in an adult. Which technique is correct? a. Instructing the patient to take deep, rapid breaths b. Instructing the patient to breathe in and out through his or her nose c. Firmly holding the diaphragm of the stethoscope against the chest d. Lightly holding the bell of the stethoscope against the chest to avoid friction

A Rationale: Atelectatic crackles don't have a pathologic cause. They are short, popping, crackling sounds that sound similar to fine crackles, but only last a few breaths. When sections of alveoli are not fully aerated, as in pt's who are asleep, they deflate slightly and accumulate secretions. They are only heard in the periphery portions of lungs

The nurse is auscultating the lungs of a patient who had been sleeping and notices short, popping, crackling sounds that stop after a few breaths. The nurse recognizes that these breath sounds are: a. Atelectatic crackles that do not have a pathologic cause. b. Fine crackles and may be a sign of pneumonia. c. Vesicular breath sounds. d. Fine wheezes.

A Rationale: Wheezes are caused by air compressed through narrowed passageways as in ASTHMA and EMPHYSEMA

The nurse is listening to the breath sounds of a patient with severe asthma. Air passing through narrowed bronchioles would produce which of these adventitious sounds? a. Wheezes b. Bronchial sounds c. Bronchophony d. Whispered pectoriloquy

A

The nurse is observing the auscultation technique of another nurse. The correct method to use when progressing from one auscultatory site on the thorax to another is _______ comparison. a. Side-to-side b. Top-to-bottom c. Posterior-to-anterior d. Interspace-by-interspace

A

The nurse is percussing over the lungs of a patient with pneumonia. The nurse knows that percussion over an area of atelectasis in the lungs will reveal: a. Dullness. b. Tympany. c. Resonance. d. Hyperresonance.

C

The nurse is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate nurse reflects a correct understanding of tactile fremitus? "Tactile fremitus: a. "Is caused by moisture in the alveoli." b. "Indicates that air is present in the subcutaneous tissues." c. "Is caused by sounds generated from the larynx." d. "Reflects the blood flow through the pulmonary arteries."

B Rationale: costal cartilage becomes calcified with aging resulting in less mobile thorax

The nurse knows that a normal finding when assessing the respiratory system of an older adult is: a. Increased thoracic expansion. b. Decreased mobility of the thorax. c. Decreased anteroposterior diameter. d. Bronchovesicular breath sounds throughout the lungs.

C Rationale: Fine crackles common in immediate newborns as a result of opening of airways and clearing of fluid

The nurse knows that auscultation of fine crackles would most likely be noticed in: a. A healthy 5-year-old child. b. A pregnant woman. c. The immediate newborn period. d. Association with a pneumothorax.

B

The nurse practitioner is assessing for transmitted voice sounds by having the patient repeat "ee" while auscultating, which is testing for which of the following? a. Bronchophony b. Egophony c. Whispered Pectoriloquy d. Adventitious breath sounds

A

The primary muscles of respiration include the: a. Diaphragm and intercostals. b. Sternomastoids and scaleni. c. Trapezii and rectus abdominis. d. External obliques and pectoralis major.

B

The symptoms of COPD are caused by which of the following? A) An overproduction of the antiprotease a1-antitrypsin B) Hyperinflation of alveoli and destruction of alveolar walls C) Hypertrophy and hyperplasia of goblet cells in the bronchi D) Collapse and hypoventilation of the terminal respiratory unit

A Rationale: left lung has two lobes, right lung has three lobes. Right lung is shorter than left bc of underlying liver. Left lung is narrower than right bc heart bulges to left. The posterior chest is almost all lower lobes

When assessing a patient's lungs, the nurse recalls that the left lung: a. Consists of two lobes. b. Is divided by the horizontal fissure. c. Primarily consists of an upper lobe on the posterior chest. d. Is shorter than the right lung because of the underlying stomach.

A Rationale: If the sound was clear and loud it could indicate pneumonia In egophony, if the "e" sounds like "ae" it could indicate pneumonia

When assessing for bronchophony, normal sound transmission through the chest wall is: a. muffled and indistinct b. very localized c. louder and more distinct d. changes a spoken "E" sound to an "A" sound

A

When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus most intensely over which location? a. Between the scapulae b. Third intercostal space, MCL c. Fifth intercostal space, midaxillary line (MAL) d. Over the lower lobes, posterior side

C Rationale: Bronchovesicular breath sounds in peripheral lung fields of infant and young children up to age 6yrs are normal findings. Their thin chest walls with underdeveloped musculature do not dampen the sound, as the thicker adult chest walls do, therefore the breath sounds are loud and harsh

When assessing the respiratory system of a 4-year-old child, which of these findings would the nurse expect? a. Crepitus palpated at the costochondral junctions b. No diaphragmatic excursion as a result of a child's decreased inspiratory volume c. Presence of bronchovesicular breath sounds in the peripheral lung fields d. Irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest

C Rationale: Vesicular breath sounds are low-pitched, soft sounds with inspiration longer than expiration. These are expected over lung fields

When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration being longer than expiration. The nurse interprets that these sounds are: a. Normally auscultated over the trachea. b. Bronchial breath sounds and normal in that location. c. Vesicular breath sounds and normal in that location. d. Bronchovesicular breath sounds and normal in that location.

C

When experiencing a common cold what causes mucus to be the yellow/green color ? A. Yellow/green mucus always means there is a bacterial infection B. The only thing that can cause this color of mucus is rhinovirus C. Polymorphonuclear leukocytes (PMN) D. The reason for yellow/green mucus is unknown

D Rationale: Is the only one you would do by INSPECTION. Symmetrical chest expansion would be tested by palpation.

When inspecting the anterior chest of an adult, the nurse should include which assessment? a. Diaphragmatic excursion b. Symmetric chest expansion c. Presence of breath sounds d. Shape and configuration of the chest wall

C Rationale: Costal angle should be 90 degrees or less. Angle increases when rib cage is chronically overinflated, as in emphysema

When performing a respiratory assessment on a patient, the nurse notices a costal angle of approximately 90 degrees. This characteristic is: a. Observed in patients with kyphosis. b. Indicative of pectus excavatum. c. A normal finding in a healthy adult. d. An expected finding in a patient with a barrel chest.

C

When used in treating COPD, Atrovent (ipratropium bromide) is prescribed to achieve which of the following therapeutic effects? A. Increase mucociliary clearance B. Reduce alveolar volume C. Bronchodilation D. Mucolytic action

C

Which finding most points to a viral upper respiratory infection a. Conjunctivitis not present b. Moderate to severe erythematous pharynx c. Thicker and more purulent nasal secretions after 3 days d. Tactile fremitus and egophony increased