Chapter 19. Lungs, thorax

Pneumonia

A 47-year-old receptionist comes to the office with fever, shortness of breath, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only worsened despite using over-the-counter cold remedies. She denies any weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type 2 diabetes for 5 years and high cholesterol level. She takes an oral medication for both diseases. She has had no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood pressure. Her father passed away from colon cancer. Examination reveals a middle-aged woman appearing her stated age. She looks ill and her temperature is elevated at 101 degrees Farenheit. Her blood pressure and pulse are unremarkable. Her head, eyes, ears, nose, and throat examination are unremarkable except for edema of the nasal turbinates. On auscultation she has decreased air movement and coarse crackles are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation, and egophony and whispered pectoriloquy on auscultation. What disorder of the thorax or lung best describes her symptoms? Chronic obstructive pulmonary disease (COPD) Spontaneous pneumothorax Asthma Pneumonia

fluid in the alveoli

A client comes to the clinic and states, "I have a bad cold and am having trouble breathing." The nurse checks the client's breath sounds and hears bilateral fine crackles at the base. Of what is this finding indicative? No fluid present Fluid in the bronchioles Fluid in the bronchus Fluid in the alveoli

severe brain damage

A client from a severe motor vehicle accident arrives in the emergency department. The nurse observes irregular respirations of varying depth and rate followed by periods of apnea. Which of the following would the nurse suspect? Severe brain damage Diabetic ketoacidosis Narcotic overdose Renal failure

hyperresonance

A client has a history of emphysema. The nurse percusses the chest, expecting to find which of the following? Hyperresonance Tympany Resonance Dullness

pneumothorax

A client is brought to the emergency department by ambulance after being involved in a motor vehicle accident. The nurse finds that he has decreased breath sounds over the left lung fields. What might the nurse suspect is the cause? Asthma Muscular weakness Atelectasis Pneumothorax

having his home checked for radon

A client is concerned about developing lung cancer, as he smoked for years. He tells the nurse that he quit smoking last year but wonders if there is anything else he can do to reduce his risk for developing this disease. Which of the following should the nurse recommend? Eating a low-fat diet Having his home checked for radon Researching his family's history of lung cancer Wearing SPF 30 sunscreen while outdoors

lung abscess

A client is coughing copious amounts of purulent mucous. What disease condition is related to this finding? lung abscess pneumococcal pneumonia lung cancer cystic fibrosis

Are you taking any medication on a regular basis?

A client presents to the health care clinic and reports a recent onset of a persistent cough. The client denies any shortness of breath, change in activity level, or other findings of an acute upper respiratory tract illness. What question by the nurse is most appropriate to further assess the cause for the cough? "Do you feel that you are under a great deal of stress?' "Have you changed your diet within the past few weeks?" "How much do you exercise during the week?" "Are you taking any medications on a regular basis?"

Impaired Gas Exchange

A client presents to the health care facility with a 2-week history of persistent dry, hacky cough, chest tightness, and shortness of breath with activity. The client admits to a 1-pack-per-day history of cigarette smoking for 20 years. The nurse observes a respiratory rate of 16 breaths per minute, easy and regular. Which nursing diagnosis should the nurse confirm based on this assessment data? Disturbed Sleep Pattern Risk for Imbalanced Nutrition Impaired Gas Exchange Ineffective Airway Clearance

area slightly above the clavicle

The apex of each lung is located at the level of the sixth rib. left oblique fissure. level of the diaphragm. area slightly above the clavicle.

manubrium

The clavicles extend from the acromion of the scapula to the part of the sternum termed the angle. manubrium. body. xiphoid process.

pulmonary edema

The client tells the nurse that he has been coughing up pink, frothy sputum. The nurse notifies the health care provider because the client may have what condition? Tuberculosis Atelectasis Pulmonary edema Infection

bronchi

The trachea splits into what?

COPD

Upon inspection of a client's chest, a nurse observes an increase in the anterior posterior diameter. The nurse recognizes this as a finding in which disease process? Carcinoma of the lungs Pneumothorax Chronic obstructive pulmonary disease Tuberculosis

The mediastinum refers to a central area in the thoracic cavity that contains the trachea, bronchi, esophagus, heart, and great vessels.

Where is the mediastinum?

A few centimeters below the suprasternal notch, a bony ridge can be palpated at the point where the manubrium articulates with the body of the sternum. This landmark, often referred to as the sternal angle (or angle of Louis), is also the location of the second pair of ribs and becomes a reference point for counting ribs and intercostal spaces. (Weber 369)

Where is the sternal angle? or the angle of Louis? (aka manubriosternal angle)

A U-shaped indentation located on the superior border of the manubrium is an important landmark known as the suprasternal notch. (Weber 369)

Where is the suprasternal notch?

The term thorax identifies the portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly. The lungs, distal portion of the trachea, and the bronchi are located in the thorax and constitute the lower respiratory system. (Weber 369) .

Where is the thorax?

The spinous process process of the 7th vertebra (c7) when you bend your neck forward, it is the most prominent bone

Where is the vertebra prominens?

nighttime when laying down

Which characteristic of a cough should alert the nurse to assess the client for other findings of sinusitis?

ineffective airway clearance

A client presents to the health care facility with sudden onset of shortness of breath, inability to lie flat, and a deep, wet cough. A nurse observes a respiratory rate of 18 breaths per minute, use of accessory muscles to breathe, and inability to cough up secretions. Which nursing diagnosis can be confirmed with this data?

pleurisy

A client reports sharp and stabbing chest pain that worsens with deep breathing and coughing. A cardiac cause to this pain is ruled out. The description of the pain is consistent with what respiratory condition? Pleurisy Pneumonia Asthma Rales

stridor

A high-pitched crowing sound from the upper airway results from tracheal or laryngeal spasm and is called what? Crackles Rales Stridor Wheezes

airway patent, breathing quite, denies dyspnea.

A hospitalized client experiences respiratory distress. The nurse should include which most appropriate client outcome in the plan of care? Gas exchange with oxygen saturation greater than 85% Client maintains safety; no falls Airway patent, breathing quiet, denies dyspnea Pain level stabilized at client goal

hypoventilation

A nurse assesses the respiration pattern on a client who arrives in the emergency department due to an overdose of narcotics. The nurse notes the respirations are decreased in rate and depth, and have an irregular pattern. How should the nurse document this finding? Biot's respiration Bradypnea Cheyne-Stokes respiration Hypoventilation

make them cough

A nurse auscultates a client's lungs and hears fine crackles. What is an appropriate action by the nurse? Assess for the use of accessory muscles Listen again with the bell of the stethoscope Have the client breathe through the mouth Instruct the client to cough forcefully

Instruct the client to cough forcefully

A nurse auscultates a client's lungs and hears fine crackles. What is an appropriate action by the nurse? Have the client breathe through the mouth Listen again with the bell of the stethoscope Instruct the client to cough forcefully Assess for the use of accessory muscles

Sibilant wheezes heard primarily during expiration but may also be heard on inspiration

A nurse is assessing a client with acute asthma. Which adventitious breath sound should the nurse expect to hear in this client? Course crackles occurring from early inspiration to early expiration Sibilant wheezes heard primarily during expiration but may also be heard on inspiration Fine crackles occurring late in inspiration Sonorous wheezes heard primarily during expiration but may be heard throughout the respiratory cycle

Angina, edema, orthopnea (shortness of breath)

A nurse is interviewing a client who complains of dyspnea. Which of the following findings would tend to indicate an underlying cardiovascular problem in the client? Select all that apply. Snoring and gasping while sleeping Angina Edema Coughing occurring at night Orthopnea Coughing that produces white sputum

less than 90 degrees

A nurse is palpating the sternum of a client. If the client is healthy, which of the following would characterize his costal angle? 100 degrees less than 90 degrees 110 degrees 110 degrees

A 64-year-old man with COPD who is short of breath and has a respiratory rate of 32 breaths/min

A nurse is receiving report from the night shift about four clients. Which client would the nurse see first? A 64-year-old man with COPD who is short of breath and has a respiratory rate of 32 breaths/min A 23-year-old woman who had a mountain biking accident in which she suffered a neck fracture and now has numbness and tingling in her right arm A 57-year-old woman who had surgery yesterday for a small bowel obstruction with possible wound dehiscence A 29-year-old woman with a history of drug abuse and a heart rate of 124 beats/min

accessory muscles

A nurse observes a client sitting in the tripod position. What is an appropriate action by the nurse in response to this observation? Percuss to determine diaphragmatic excursion Observe for the use of accessory muscles Auscultate for the presence of crackles Palpate for tactile fremitus

patient C

A triage nurse is working in the emergency department of a busy hospital. Four patients have recently been admitted. Patient A has an arrhythmia diagnosed as atrial fibrillation; Patient B is in chronic congestive heart failure; Patient C is assessed and found to have a probable pulmonary embolism; Patient D complains of chest pain relieved by nitroglycerin and rest. Which patient would be the nurse's highest priority? Patient B Patient A Patient C Patient D

have the client cough and then listen again

Adventitious sounds are heard when auscultating a client's lungs. Which of the following would the nurse do first? Auscultate for egophony Perform bronchophony Have the client cough and then listen again Refer the client for further medical evaluation

hyperresonance

After percussing a client's lung fields the nurse suspects a client has a chronic lung disease. What sound did the nurse hear to make this clinical determination? flat dull resonance hyperresonance

tuberculosis

An adult client visits the clinic and tells the nurse that he has been "spitting up rust-colored sputum." The nurse should refer the client to the physician for possible tuberculosis. asthma. pulmonary edema. bronchitis.

rate and pattern

An elderly client reports a feeling of dyspnea with normal activities of daily living. What is an appropriate action by the nurse? Ask the client how long they have to rest between activities Assess for symmetry of chest expansion Observe the client's respiratory rate and pattern Report this to the health care provider immediately

Narrowing or partial obstruction of an airway passage

Auscultation of a 23-year-old client's lungs reveals an audible wheeze. What pathological phenomenon underlies wheezing? Blockage of a respiratory passage Decreased compliance of the lungs Narrowing or partial obstruction of an airway passage Fluid in the alveoli

The right, because it is shorter bronchi

Choked on objects are more likely to enter which lung?

The thoracic cavity is lined by a thin, double-layered serous membrane referred to as the pleura (Fig. 19-6). The parietal pleura line the chest cavity, and the visceral pleura covers the external surfaces of the lungs. The pleural space lies between the two pleural layers. In the healthy adult, the lubricating serous fluid between the layers allows movement of the visceral layer over the parietal layer during ventilation without friction (Weber 372)

Describe the pleura, the parietal pleura, the visceral pleura and the lubricating serous fluid

trauma, atelectasis, pheumothorax, pneumonia

During a physical assessment, the nurse identifies unequal chest expansion. The nurse knows this could be due to what? Select all that apply. Trauma Atelectasis Pneumonia Emphysema Pneumothorax

decreased, because a pneumothorax is a collapsed lung.

During the assessment of a client with a pneumothorax, what change should the nurse anticipate when auscultating for fremitus?

coarse crackles

During the lung assessment for a client with pneumonia, the nurse auscultates low-pitched bubbling, moist sounds that persists from early inspiration to early expiration. How should the nurse document these sounds? Pleural friction rubs Coarse crackles Sonorous wheezes Sibilant wheezes

coarse crackles

During the lung assessment for a client with pneumonia, the nurse auscultates low-pitched, bubbling, moist sounds that persist from early inspiration to early expiration. How should the nurse document these sounds? Pleural friction rubs Sonorous wheezes Sibilant wheezes Coarse crackles

10-12 cm long

How long is the trachea?

7, connect with it but indirectly through the costal cartilage in between.

How many ribs connect with the sternum directly?

suprasternal notch

In palpating the chest of a client, a nurse feels a U-shaped indentation on the superior border of the manubrium. The nurse recognizes this landmark as which of the following? Suprasternal notch Sternal angle Xiphoid process Acromion of the scapula

THIS IS WHERE I STOPPED WITH COURSE POINT AND START WITH NOTES FROM THE BOOK!!

THIS IS WHERE I STOPPED WITH COURSE POINT AND START WITH NOTES FROM THE BOOK!!

at the level of the diaphram

Where is the base of each lung?

anteriorly the 6th, laterally the 8th and posteriorly the tenth

The lung extends down to which number rib?

chronic bronchitis

The nurse assesses an adult client and observes that the client's breathing pattern is very labored and noisy, with occasional coughing. The nurse should refer the client to a physician for possible

chronic bronchitis

The nurse assesses an adult client and observes that the client's breathing pattern is very labored and noisy, with occasional coughing. The nurse should refer the client to a physician for possible atelectasis. chronic bronchitis. congestive heart failure. renal failure.

diabetic ketoacidosis

The nurse has assessed the respiratory pattern of an adult client. The nurse determines that the client is exhibiting Kussmaul respirations with hyperventilation. The nurse should contact the client's physician because this type of respiratory pattern usually indicates congestive heart failure. drug overdose. diabetic ketoacidosis. central nervous system injury.

Studies have indicated that there is a genetic component in the development of lung cancer.

The nurse is planning a presentation to a group of high school students on the topic of lung cancer. Which of the following should the nurse plan to include in the presentation? Lung cancer is the third leading cause of death in the United States. There is a higher incidence of lung cancer in women than men in the United States. Studies have indicated that there is a genetic component in the development of lung cancer. Compared with whites in the United States, African Americans have a lower incidence of lung cancer.

asking the client to exhale forcefully and hold his breath.

The nurse is planning to percuss the chest of an adult male client for diaphragmatic excursion. The nurse should begin the assessment by percussing downward until the tone changes to resonance. asking the client to take a deep breath and hold it. percussing upward from the base of the lungs. asking the client to exhale forcefully and hold his breath.

ask the client to breathe deeply through her mouth.

The nurse is preparing to auscultate the posterior thorax of an adult female client. The nurse should ask the client to breathe deeply through her mouth. auscultate from the base of the lungs to the apices. place the bell of the stethoscope firmly on the posterior chest wall. ask the client to breathe normally through her nose.

funnel chest

The nurse is reviewing the client's health history and notes he has pectus excavatum. The nurse would assess the client for what? Intercostal bulging Pigeon chest Pectoriloquy Funnel chest

Pleural effusion= excess fluid builds up AROUND the lungs not in the lungs

The nurse obtains a flat sound when percussing the right lower lobe of a patient. What does this assessment finding indicate to the nurse? Pleural effusion Chronic bronchitis Healthy lung tissue Gastric air bubble

seventh

The spinous process termed the vertebra prominens is in which cervical vertebra? Fifth. Eighth. Sixth. Seventh.

7th

The spinous process termed the vertebra prominens is in which cervical vertebra? Sixth. Seventh. Fifth. Eighth.

Teaching strategies to reduce complications of existing diagnoses

The staff educator from the hospital's respiratory unit is providing a public educational event. The educator is talking about health promotion activities for people with respiratory diseases or those who are at high risk for respiratory complications. What would the educator include in the presentation? Encouraging adequate rest Showing participants how to diagnose respiratory problems Teaching strategies to reduce complications of existing diagnoses Reinforcing the need for a high-calorie diet

COPD

Upon inspection of a client's chest, a nurse observes an increase in the ratio of anteroposterior to transverse diameter. The nurse recognizes this as a finding in which disease process? Tuberculosis Pneumothorax Chronic obstructive pulmonary disease Carcinoma of the lungs

The thoracic cage is constructed of the sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles, and cartilage (Weber 369)

What are the components of the thoracic cage?

manubrium, body and xiphoid process

What are the three parts to the sternum

collapsed lung

What is a pneumothorax?

Diaphragmatic excursion is the movement of the thoracic diaphragm during breathing

What is diaphragmatic excursion

a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed.

What is emphysema?

sternal angle (what is this???)

What is the best guide to make vertical locations on the chest? Sternal angle 5th intercostal space Angle of Henri Midclavicular line

This is where the two sides of the front rib cage create like a triangle with the xiphoid process.

What is the costal angle?

the broad upper part of the sternum of mammals, with which the clavicles and first ribs articulate.

What is the manubrium

trachea=bronchi=bronchiole= alveolar ducts, alveolar sacs= alveoli

What is the sequence of body parts after the trachea turns into the bronchi?

hyaline cartilage

What is the trachea made of?

dullness

What replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space? Chief complaint Hyperresonance Tympany Dullness

Cheyne-Stokes

What type of respiratory pattern would the nurse consider normal in a client with severe heart failure? Cheyne-Stokes Biot's Bradypnea Kussmaul's

friction rub

What would the nurse expect to hear when auscultating the lungs of a client with pleuritis? Sibilant wheeze Friction rub Decreased breath sounds Stridor

T4 spinous process

When assessing posteriorly, where would the trachea bifurcate into its mainstem bronchi? Suprasternal notch T4 spinous process Sternal angle Midaxillary line

the lung has become airless

When assessing the breath sounds of a newly admitted patient, the nurse notes increased transmission of voice sounds over the right lung. What would this indicate to the nurse? The lung has become airless The lung is overinflated The lung has an embolus The lung is full of fluid

123

When assessing whispered pectoriloquy, the nurse would instruct a client to do which of the following? Softly repeat the words "one-two-three" Cough each time the stethoscope is moved Say the letter "e" Say "ninety-nine"

coarse crackles

When auscultating a client's lungs, the nurse hears a loud popping sound that clears when the client coughs. What sound is this client most likely demonstrating? fine crackles rhonchi wheezes coarse crackles

one deep breath in and one out through the mouth

When auscultating the lungs, the nurse listens over symmetrical lung fields for which of the following?

resonance over all lung fields

When percussing the posterior lung fields, which of the following findings is expected?

They are found running up and down, if you are looking at the patient from the side

Where are the axillary lines?

Hilum

Where do the bronchi enter the lungs?

Anteriorly, the lower border of the lung crosses the 6th rib at the midclavicular line.

Which description of exterior landmarks indicates normal positioning of the lungs? Anteriorly, the lower border of the lung crosses the 6th rib at the midclavicular line. Posteriorly, the lower border of the lung lies at the level of T9. Posteriorly, the lower border of the lung ascends to the level of T8 during inspiration. The anterior baseline of the lungs cross the midaxillary line at the 7th rib.

Anteriorly, the lower border of the lung crosses the 6th rib at the midclavicular line.

Which description of exterior landmarks indicates normal positioning of the lungs? The anterior baseline of the lungs cross the midaxillary line at the 7th rib. Posteriorly, the lower border of the lung lies at the level of T9. Anteriorly, the lower border of the lung crosses the 6th rib at the midclavicular line. Posteriorly, the lower border of the lung ascends to the level of T8 during inspiration.

unequal expansion of the chest

Which finding during an assessment of a client should alert the nurse to the presence of a persistent atelectasis?(a complete or partial collapse of a lung or lobe of a lung ) Retraction of intercostal spaces A depressed sternum and cartilages The presence of crepitus on palpation Unequal expansion of the chest

The trachea is anterior to the esophagus.

Which goes infront of the other? the trachea or the esphagus?

The thoracic cavity enlarges

Which observation confirms to the nurse that the client is experiencing a normal inspiration? Air can be heard moving out of the tracheobronchial tree. The diaphragm is seen relaxing. The thoracic cavity enlarges. The abdominal wall is pushed inward.

large pneumothorax

Which of the following conditions would produce a hyperresonant percussion note? Empyema Lobar pneumonia Pleural effusion Large pneumothorax

diaphram

Which of the following muscles is primarily responsible for thoracic cavity enlargement? Parasternal Scalene Diaphragm Sternomastoid

Skin between the ribs moves inward with inspiration.

Which of the following occurs in respiratory distress? Skin between the ribs moves inward with inspiration. The client speaks in sentences of 10-20 words. Client torso leans posteriorly. Neck muscles are relaxed.

bronchitis is characterized by excess mucus production and chronic cough

Which of the following statements relating to assessment of the lungs and thorax is most accurate?

Bronchitis is characterized by excess mucus production and chronic cough.

Which of the following statements relating to assessment of the lungs and thorax is most accurate? Hemoptysis is more common in children and adolescents than in older clients. Moderate to severe chest pain is associated with a cardiac etiology, while mild to moderate chest pain is most often respiratory in origin. Bronchitis is characterized by excess mucus production and chronic cough. Loud and very loud percussion notes denote pathological findings.

palm

Which of the following would be best for a nurse to use when assessing for fremitus in a client? Pads of fingers Palmar base (ulnar surface) Dorsal hand surface Fist

11th and 12th

Which ribs are considered "floating ribs"? 9th and 10th 11th and 12th 10th and 11th 8th and 9th

7th or 8th

Which ribs are found at the lower tip of the scapula?

upper lobe middle lobe lower lobe

Which terms are used to identify the lobes of the right lung? Select all that apply. base lobe lower lobe middle lobe major lobe upper lobe

pneumonia

While assessing an adult client's lungs during the postoperative period, the nurse detects coarse crackles. The nurse should refer the client to a physician for possible asthma. bronchitis. pneumonia. pleuritis.

99

While assessing the thoracic area of an adult client, the nurse plans to auscultate for voice sounds. To assess bronchophony, the nurse should ask the client to repeat the phrase "ninety-nine." repeat the letter "A." repeat the letter "E." whisper the phrase "one-two-three."

anteroposterior to lateral diameter

While inspecting the thorax, the nurse views it from posterior and lateral positions to assess which of the following? Curvature of the cervical spine Inflammation of the costochondral junction Position of the trachea Anteroposterior to lateral diameter