EAQ Respiratory
Arrange the following steps to show the order in which lung development takes place from the embryonic stage to the birth of the infant. The primitive lung bud emerges during the first 5 weeks of fetal life. The conducting airways reach the same number as in an adult by 16 weeks. Surfactant is a complex lipid substance needed for sustained inflation of the air sacs. At 32 weeks, the surfactant is present in adequate amounts. At the time of birth, the lungs have 70 million primitive alveoli ready to begin respiration. Although the respiratory system develops in utero, it does not function until birth because the baby is suspended in fluid. At birth, the cord is cut and the blood supply to the placenta is taken away. The blood gushes into the pulmonary circulation. Respiratory development continues throughout childhood, because the airways increase in diameter and length and in size and number of alveoli.
1. Primitive lung bud emerges during fetal life. 2. Conducting airways develop as in the adult. 3. Surfactant is present in adequate amounts. 4. Lungs form about 70 million primitive alveoli. 5. Blood supply is detached from the placenta. Incorrect 6. Blood gushes into the pulmonary circulation.
How many thoracic vertebrae are present in the human body? A. 5 B. 6 C. 7 D. 12
12 In vertebrates, thoracic vertebrae are present in the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. There are 12 thoracic vertebrae present in the human body. The sizes of thoracic vertebrae are between those of the cervical and the lumbar vertebrae. There are 7 cervical, 5 lumbar, and 6 sacrococcygeal vertebrae.
In which location would the nurse auscultate the highest point of the lung on the anterior side of the chest? A. Seventh cervical vertebra B. 3 to 4 cm above the clavicle C. Twelfth thoracic vertebra D. Sixth rib in the midclavicular line
3 to 4 cm above the clavicle In the anterior chest, the apex or highest point of the lung tissue is 3 to 4 cm above the clavicles. The clavicle, commonly known as the collarbone, is located between the sternum and the scapula. Posteriorly, the location of the seventh cervical vertebra marks the apex of the lung tissue. The base, or the lower border of the lung, rests on the diaphragm at about the sixth rib in the midclavicular line. Deep inspiration expands the lungs, and the lower border of the lungs drops to the twelfth thoracic vertebra.
Which amount of diaphragmatic excursion is considered normal? A. 1 to 2 cm B. 3 to 5 cm C. 7 to 8 cm D. Less than 1 cm
3 to 5 cm The diaphragmatic excursion of a normal adult should be equal bilaterally and measure about 3 to 5 cm. This movement may be up to 7 to 8 cm in well-conditioned people. In patients who have chronic obstructive pulmonary disease, this movement is 1 to 2 cm. The breathing function will not work if the movement is less than 1 cm.
The nurse is aware that structures at which depth are able to be assessed with percussion? A. 5 to 7 cm B. 7 to 9 cm C. 9 to 11 cm D. 11 to 13 cm
5 to 7 cm The nurse percusses the lung fields to determine the predominant notes. The depth of the penetration of percussion has limits. Percussion sets into motion only the outer 5 to 7 cm of tissue. It does not penetrate to reveal any change in the density deeper than that. Depths of 7 to 9 cm, 9 to 11 cm, and 11 to 13 cm are not correct.
Which assessment finding is expected in a patient with pneumonia? A. A smooth chest expansion B. A lag in the chest expansion C. A palpable grating sensation D. A slight inspiratory variation
A lag in the chest expansion The nurse would note a lag in the chest expansion in a patient with pneumonia. Normally, the chest expansion should be smooth, with the thumbs moving apart symmetrically. The nurse is likely to find a palpable grating sensation with breathing in a patient who has pleural friction fremitus. The patient with emphysema is likely to have an abnormally wide costal angle with slight inspiratory variation.
Which is the end result of occasional sighing that punctuates normal breathing? Tachypnea Bradypnea Hypoventilation Alveolar expansion
Alveolar expansion Occasional sighing punctuates the normal breathing pattern and helps expand the alveoli. Frequent sighing may indicate emotional dysfunction, leading to hyperventilation and dizziness. It does not cause tachypnea, or rapid, shallow breathing; instead, it may increase the rate and the depth of breathing. Occasional sighing causes hyperventilation, not hypoventilation, and does not lead to bradypnea, or slow breathing.
Which patient population is most likely to be affected by scoliosis? A. Adolescents B. Menopausal women C. Postmenopausal women D. Women who exercise regularly
Adolescents
Which part of the lungs is assessed on the posterior chest? A. Most of the upper lobes B. Right middle lobe C. Left middle lobe D. All parts of the lower lobes
All parts of the lower lobes The entire lower lobe can be assessed on the posterior chest. The upper lobes occupy a small band of tissue from their apices at T1 down to T3 or T4. The right middle lobe does not project onto the posterior chest at all, and the left lung does not have a middle lobe. The lower lobes begin at T3 or T4 and their inferior border reaches down to the level of T10 on expiration and T12 on inspiration.
Which characteristics are included in the assessment of breath sounds? Select all that apply. A. Amplitude B. Depth C. Pitch D. Quality E. Pressure
Amplitude Pitch Quality Breath sounds originate in the large airways where the air velocity and turbulence induce vibrations in the airway walls. These vibrations are then transmitted through the lung tissue and the thoracic wall to the surface, where they may be heard readily with the aid of a stethoscope. The characteristics of normal breath sounds are amplitude, pitch, and quality. Amplitude is the size of the vibration, and this determines how loud the sound is. Pitch is the distinctive quality of the sound, which is dependent primarily on the frequency of the sound waves produced by its source. Sound quality is typically an assessment of the accuracy of the audio output. Quality can be measured objectively or subjectively. Depth and pressure are not considered to be characteristics of the normal breath sound.
Which abnormality would the nurse expect in a patient with kyphosis? A. A condition that involves the rotation of the vertebrae B. An exaggerated posterior curvature of the thoracic spine C. A lateral S-shaped curvature of the thoracic and lumbar spine D. An unequal shoulder and scapular height and unequal hip levels
An exaggerated posterior curvature of the thoracic spine The patient with kyphosis has a humpback or an exaggerated posterior curvature of the thoracic spine. The patient may hyperextend the neck to maintain a level of vision. Scoliosis is a condition that involves the rotation of the vertebrae. The patient with scoliosis has a lateral S-shaped curvature of the thoracic and lumbar spine. Scoliosis causes unequal shoulder and scapular height and unequal hip levels.
Which finding would the nurse identify as normal when assessing the chest of an older adult patient? A. An outward curvature noted in the thoracic spine B. Deeper respirations with a 40% increase in the tidal volume C. Costal angle is about 50% wider than seen in the younger adult D. Anteroposterior diameter is less than the transverse diameter
An outward curvature noted in the thoracic spine Kyphosis, or an outward curvature of the thoracic spine, is a normal finding in older adult patients. The person compensates by holding their head extended and tilted back. It is normal to find that the respirations are deeper with a 40% increase in the tidal volume in the pregnant patient, but not in the older adult patient. The thoracic cage appears wider and the costal angle widens by about 50% in the pregnant patient, but not in the older adult patient. The aging adult has a barrel-shaped chest, with the anteroposterior diameter equal to the transverse diameter.
A young adult patient reports difficulty in breathing. Upon inspection, the patient is cyanotic, using accessory neck muscles to breathe, and audibly wheezing. Palpation reveals decreased tactile fremitus with hyperresonant sounds on percussion. Normal breath sounds are distant and hard to hear because of wheezing. The nurse suspects further testing will lead to which diagnosis? A. Asthma B. Bronchitis C. Pneumonia D. Atelectasis
Asthma Asthma is an allergic hypersensitivity characterized by bronchospasm and inflammation, edema in the walls of the bronchioles, and secretion of highly viscous mucus into the airways. These greatly increase the airway resistance, especially during expiration, and produce the symptoms of wheezing, dyspnea, and chest tightness. During a severe attack, there is an increased respiratory rate, shortness of breath with audible wheezes, use of accessory neck muscles, and cyanosis. Bronchitis is an illness that affects the lungs. It is caused by the inflammation or infection of the lining of the bronchial tubes. Pneumonia is an infection in one or both lungs caused by microbes. Pneumonia causes inflammation in the lung's air sacs. Atelectasis is defined as the collapse or closure of the lung, resulting in reduced or absent gas exchange.
Which breath sounds are considered normal? Select all that apply. A. Crackles B. Wheezes C. Bronchial D. Vesicular E. Bronchovesicular
Bronchial Vesicular Bronchovesicular There are three normal breath sounds. Bronchial breath sounds are high-pitched and loud. Vesicular sounds are low-pitched and soft, and sound more like rustling of the leaves in the wind. Bronchovesicular sounds are moderate in pitch and are equal in duration during inspiration and expiration. Crackles and wheezes are abnormal breath sounds. Crackles are discontinuous popping sounds heard during inspiration. Wheezes are continuous musical sounds heard mainly during expiration.
Which finding would the nurse document as normal after auscultation of a toddler's chest for breath sounds? Crackles that are auscultated only in the lower lung fields Persistent fine crackles that are scattered all over the chest Persistent peristaltic sounds with diminished breath sounds Bronchovesicular breath sounds in the peripheral lung fields
Bronchovesicular breath sounds in the peripheral lung fields In the normal toddler, auscultation reveals bronchovesicular breath sounds. The child has thin chest walls with underdeveloped musculature, which causes harsher and louder breath sounds. The toddler with heart failure is likely to have crackles only in lower lung fields. Persistent fine crackles that are scattered over the chest occur with pneumonia, bronchiolitis, or atelectasis. Persistent peristaltic sounds with diminished breath sounds on the same side may indicate diaphragmatic hernia.
Which technique would the nurse use to assess for tactile fremitus? 1 By placing the fingertips on the sides of the neck 2 By placing the thumb on the spinous process of the patient 3 By placing warmed hands sideways on the posterolateral chest wall 4 By placing the palmar base of one hand to touch the patient's chest
By placing the palmar base of one hand to touch the patient's chest The nurse uses either the palmar base of the fingers or the ulnar edge of one hand to touch the patient's chest. The patient is asked to repeat resonant phrases such as "ninety-nine" or "blue moon." These phrases generate strong vibrations. The nurse can confirm symmetric chest expansion by placing the warmed hands sideways on the posterolateral chest wall with the thumbs pointing together at the thoracic ninth or tenth vertebra. The nurse places the thumb on the spinous process of the patient to assess the posterior chest. To assess the lymph nodes, the nurse places the fingertips on the sides of the neck of the patient.
Which posterior vertebral landmark is the most prominent spinous process? A. Cervical 1 B. Lumbar 1 C. Cervical 7 D. Thoracic 12
Cervical 1 The seventh cervical vertebra is the most prominent bony spur protruding at the base of the neck. Sometimes, two bumps are found to be equally prominent. In such a case, the upper one is the seventh cervical vertebra, and the lower one is the first thoracic vertebra. The first cervical, the twelfth thoracic, and the first lumbar vertebra are not the most prominent vertebra in the spinal column.
Which assessment finding would the nurse expect for a patient with chronic respiratory disease? A. Cutaneous angiomas B. Clubbing of the distal phalanges C. Significant drowsiness D. Restlessness and anxiousness
Clubbing of the distal phalanges Clubbing of the distal phalanges occurs with chronic respiratory disease after the growth of vascular connective tissue. Cutaneous angiomas, or spider nevi, are noted in the patient with liver disease. Cerebral hypoxia may cause excessive drowsiness. It may also cause the patient to be restless, anxious, and irritable.
The nurse auscultates the patient's respirations and notes breath sounds similar to opening Velcro. Which term would the nurse use to document this finding? A. Fine crackles B. Coarse crackles C. Pleural friction rub D. High-pitched wheeze
Coarse crackles Coarse crackles are loud, low-pitched bubbling and gurgling sounds. These sounds start during early inspiration and may be present in expiration. These sound like opening a Velcro fastener. Fine crackles are discontinuous, high-pitched, short crackling and popping sounds heard during inspiration. These sounds are not cleared by coughing. This sound can be simulated by rolling strands of hair between the fingers. A pleural friction rub is a very superficial sound that is both coarse and low pitched. It has a grating quality, as if two pieces of leather are being rubbed together. High-pitched wheezing is a musical squeaking sound that sounds polyphonic.
Which finding would the nurse expect upon auscultating the lung sounds of a patient with heart failure? 1 Occasional wheezing 2 Crackles in the lung bases 3 Crackles over upper lobes 4 Bilateral expiratory wheezing
Crackles in the lung bases The nurse is likely to hear crackles at the lung bases. Occasional wheezing may be identified while auscultating the patient with emphysema. Crackles over the upper lobes are heard in the patient with tuberculosis. Bilateral wheezing may be heard in the patient with asthma.
Decreased tactile fremitus is consistent with which diagnosis? A. Bronchitis B. Pleural effusion C. Lobar pneumonia D. Pulmonary infarction
Pleural effusion Decreased fremitus occurs when the bronchus of the patient is obstructed. Any barrier that comes between the sound and the palpating hand of the nurse will decrease the fremitus. When there is air outside the lung in the chest cavity, it prevents lung expansion and decreases the tactile fremitus. Pleural effusion, thickening pneumothorax, or emphysema may be responsible for this. During bronchitis and lobar pneumonia, tactile fremitus is normal and is not decreased. In case of pulmonary infarction, fremitus is increased and is not decreased.
Which term is used to document excessive sweating associated with shortness of breath? A. Diaphoresis B. Chronic dyspnea C. Two-pillow orthopnea D. Paroxysmal nocturnal dyspnea
Diaphoresis Diaphoresis is excessive sweating, which can be related to shortness of breath. Chronic dyspnea is SOB lasting for more than 1 month. It may have neurogenic, respiratory, or cardiac origin. Orthopnea refers to difficulty in breathing when a person is lying in the supine position. If the patient requires two pillows to breathe comfortably while lying down, the nurse notes the condition as two-pillow orthopnea. A patient with paroxysmal nocturnal dyspnea may awaken from sleep with SOB. This patient may need to be upright to achieve comfort.
Which structure separates the thoracic cavity from the abdomen? A. Sternum B. Diaphragm C. Manubrium D. Xiphoid process
Diaphragm The thoracic cage is defined by the sternum, ribs, the 12 thoracic vertebrae, and the diaphragm. The diaphragm is a musculotendinous septum that separates the thoracic cavity from the abdomen, and it makes up the floor of the thoracic cage. The manubrium and the xiphoid process are both parts of the sternum, which runs down the center of the ribcage. None of these structures separate the thoracic cavity from the abdomen.
Which changes take place during the process of inspiration? Select all that apply. A. Diaphragm descends B. Elastic recoil property acts C. Intercostal muscles contract D. Intrathoracic pressure decreases E. Anteroposterior diameter decreases
Diaphragm descends Intercostal muscles contract Intrathoracic pressure decreases During inspiration, the contraction of the bell-shaped diaphragm causes the chest cavity to descend and flatten. Contractions of the intercostal muscles during inspiration lift the sternum and elevate the ribs, making them more horizontal. Inspiration increases the size of the thoracic cavity and decreases the intrathoracic pressure. Elastic recoil property acts during expiration, not inspiration. The anteroposterior diameter decreases during expiration, not inspiration.
The nurse attributes the patient's regular breathing rate of eight breaths per minute to which condition? A. Prolonged bed rest B. Splinting of the chest C. Overdose of stimulants D. Drug-induced depression
Drug-induced depression Bradypnea, or slow breathing, is the regular breathing rate of less than 10 breaths per minute. It may be caused by drug-induced depression of the respiratory center in the medulla. Hypoventilation is a slow, irregular breathing pattern that occurs because of prolonged bed rest or conscious splinting of the chest to avoid respiratory pain. An overdose of stimulants will increase the respiratory rate, not decrease it.
he nurse attributes the patient's regular breathing rate of eight breaths per minute to which condition? A. Prolonged bed rest B. Splinting of the chest C. Overdose of stimulants D. Drug-induced depression
Drug-induced depression Bradypnea, or slow breathing, is the regular breathing rate of less than 10 breaths per minute. It may be caused by drug-induced depression of the respiratory center in the medulla. Hypoventilation is a slow, irregular breathing pattern that occurs because of prolonged bed rest or conscious splinting of the chest to avoid respiratory pain. An overdose of stimulants will increase the respiratory rate, not decrease it.
Which statement is true regarding the right lung? A. It is shorter than the left lung. B. It has an upper and lower lobe. C. It is narrower than the left lung. D. Its lobes sit as horizontal bands.
It is shorter than the left lung. The lungs are paired, but asymmetrical, structures. The right lung is shorter than the left lung because of the presence of the liver, which sits just under the right lung. The right lung has three, not two, lobes: an upper, middle, and lower lobe. The left lung only has two lobes: an upper lobe and a lower lobe. The left lung is narrower than the right lung because the heart bulges to the left. The lobes of neither lung are set as horizontal bands; instead, they are stacked in diagonal sloping segments and are separated by fissures that run obliquely through the chest.
While auscultating the chest, the nurse asks the patient to phonate a long "ee-ee-ee-ee" sound. Through the stethoscope, the nurse hears a long "aaaaa" sound. Which term would the nurse to document this assessment? A. Egophony B. Bronchophony C. Sonorous wheezing D. Whispered pectoriloquy
Egophony Egophony in Greek means "the voice of a goat" and occurs when there is any consolidation or compression of the chest. The nurse auscultates the chest while the patient makes a long "ee-ee-ee-ee" sound. Through the stethoscope, the nurse hears a bleating long "aaaaa" sound. This change of sound occurs over the area of consolidation or compression. In bronchophony, the patient is asked to repeat "ninety-nine." Through the stethoscope, the words are more distinct than normal, and the sounds are close to the ears of the nurse. This occurs when the pathology increases the lung density. In whispered pectoriloquy, the patient is asked to whisper a phrase such as "one-two-three." The nurse auscultates through the stethoscope to hear a clear, distinct, but faint whispering sound. A sonorous wheeze used to be known as rhonchi; the sounds produced have a snoring and gurgling quality.
The goblet cells of the lungs serve which purpose? A. Enable the exchange of gases B. Sweep away particulate matter C. Provide space for gas exchange D. Entrap small particulate matter
Entrap small particulate matter The bronchi are lined with goblet cells, whose primary function is to secrete mucus that entraps particulate matter. Cilia are also structures in the bronchi, but their primary function is to sweep particulate matter up and away so that it can be swallowed or expelled through coughing. Gaseous exchange occurs across the respiratory membrane in the alveolar duct and the alveoli, but does not involve the goblet cells. The alveoli are clustered like grapes around each alveolar duct. This creates millions of interalveolar septa (walls) that increase the space available for gas exchange.
Which description of hypercapnia is correct? A. Beginning of rapid, deep breathing B. Presence of slow, shallow breathing C. Decreased oxygen level in the blood D. Increased carbon dioxide in the blood
Increased carbon dioxide in the blood Hypercapnia is the term used to describe an increase in the carbon dioxide levels in the blood. Hyperventilation is the presence of rapid, deep breathing in an individual, which blows off the excess carbon dioxide. On the other hand, hypoventilation, or slow, shallow breathing, causes carbon dioxide to build up in the blood. A decrease in oxygen in the blood is referred to as hypoxemia.
Which statement precisely describes the "angle of Louis"? A. It is continuous with the first rib. B. It marks the top edge of the sternum. C. It is also known as the suprasternal notch. D. It is the articulation of the manubrium and the body of the sternum.
It is the articulation of the manubrium and the body of the sternum. The angle of Louis is the articulation of the manubrium and the body of the sternum. It is a useful place to start counting the ribs. The angle of Louis helps the nurse localize a respiratory finding horizontally. It is a palpable ridge between the manubrium and the body of the sternum, and it does not mark the top edge of the sternum. The angle of Louis is also called the sternal angle, not the suprasternal notch. It is continuous with the second rib.
During the chest assessment of a patient, which reference line would the nurse note on the posterior chest wall? A. Midspinal B. Midaxillary C. Midsternal D. Midclavicular
Midspinal The nurse notes the midspinal line, also known as the vertebral line, on the posterior chest wall. The nurse notes the midaxillary line when the patient's arm is lifted at an angle of 90 degrees. The midaxillary line runs down from the apex of the axilla and lies between and parallel to the anterior axillary line and the posterior axillary line. The midsternal and midclavicular lines are noted on the anterior chest.
The nurse learns in shift report that the patient has Biot's respirations. The nurse anticipates which assessment? A. Breathing rate of less than 10 per minute B. Gradual wax-and-wane pattern of respiration C. Normal breathing interrupted by apnea D. Normal inspiration followed by prolonged expiration
Normal breathing interrupted by apnea The breathing pattern in Biot's respiration is irregular. A series of three to four normal respirations is followed by a period of apnea. The length of the cycle is variable and lasts for 10 seconds to 1 minute. It is generally seen in patients with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis. In chronic obstructive lung disease, the patient undertakes normal inspiration and prolonged expiration to overcome the increased airway resistance. Gradual wax-and-wane pattern of respiration is seen in the Cheyne-Stokes respiration. A breathing rate of less than 10 per minute occurs in patients who have bradypnea.
Where would the nurse place the stethoscope to assess the patient's bronchial breath sounds? A. Over the trachea and the larynx B. Over the peripheral lung fields C. Posteriorly between the scapulae D. Anteriorly near the upper sternum
Over the trachea and the larynx The nurse places the stethoscope over the trachea and the larynx to listen to bronchial breath sounds. These sounds have a high pitch and loud amplitude, with a harsh or hollow tubular quality. The nurse auscultates over the peripheral lung fields to note vesicular breath sounds. The nurse listens for bronchovesicular breath sounds over major bronchi with fewer alveoli. These are found on the posterior side between the scapulae and on the anterior side around the upper sternum and in the first and second intercostal spaces.
A college student presents to the emergency room with complaints of a sudden, sharp pain on the right side and shortness of breath. The right side of the chest is not moving with inspiration. The patient's trachea is deviated toward the left; there is no tactile fremitus on the right. The nurse hears hyperresonant percussion sounds on the right and resonant sounds on the left. There are no breath sounds heard on the right. Which disorder would the nurse suspect? A. Asthma B. Atelectasis C. Pneumonia D. Pneumothorax
Pneumothorax Pneumothorax is a condition in which free air in the pleural space causes partial or complete lung collapse. In pneumothorax, unequal chest expansion is seen with decreased tactile fremitus. The trachea shifts to the unaffected side. Breath sounds are decreased or absent, and percussion reveals hyperresonance. Atelectasis is defined as the collapse or closure of the lung, resulting in reduced or absent gas exchange. Pneumonia is an infection in either one or both the lungs and is caused by microbes. Pneumonia causes inflammation in the air sacs of the lungs. Asthma is an allergic hypersensitivity characterized by bronchospasms and inflammation, edema in the walls of the bronchioles, and secretion of highly viscous mucus into the airways.
The patient reports coughing up pink, frothy sputum. The nurse reports suspicion of which condition to the provider? A. Tuberculosis B. Viral infection C. Bacterial infection D. Pulmonary edema
Pulmonary Edema Pulmonary edema is likely to cause pink, frothy sputum production. Some sympathomimetic medications also have a side effect of pink-tinged mucus. Rust-colored sputum is associated with tuberculosis and pneumococcal pneumonia. Viral infections, colds, and bronchitis are likely to cause white or clear mucoid sputum. Yellow or green-colored sputum is associated with bacterial infections.
Which additional muscles are involved in increasing the size of the thoracic cage during forced inspiration after heavy exercise? Select all that apply. A. Scaleni B. Trapezii C. Diaphragm D. Sternomastoids E. Intercostal muscles
Scaleni Trapezii Sternomastoids
The nurse is caring for a child with acute epiglottitis. The child has a high-pitched, monophonic, inspiratory crowing sound. Which term would the nurse use to document this finding? A. Crackles B. Stridor C. Coarse rales D. Sonorous rhonchi
Stridor Stridor is a continuous high-pitched, monophonic, inspiratory crowing sound. The sound originates in the larynx or trachea from an upper airway obstruction because of swollen and inflamed tissues. The sound is louder in the neck than over the chest wall. Crackles are discontinuous, high-pitched, short crackling or popping sounds heard during inspiration. They are not cleared by coughing and are caused by fluid in the lungs. Coarse rales are loud, low-pitched, bubbling, and gurgling sounds that start in early inspiration and are caused by pulmonary congestion. Sonorous rhonchi are low-pitched, monophonic, single-note, musical snoring and moaning sounds. They are heard throughout the cycle, but are more prominent on expiration. They may be cleared by coughing.
Which characteristics are consistent with pectus excavatum? Select all that apply. A. The patient has a markedly sunken sternum. B. The condition is congenital, not symptomatic. C. The ribs slope back on either side of the sternum. D. The depression is more noticeable on inspiration. E. The depressions are at the costochondral junction.
The patient has a markedly sunken sternum. The condition is congenital, not symptomatic. The depression is more noticeable on inspiration. The patient with pectus excavatum has a markedly sunken sternum and adjacent cartilages. This condition is also known as funnel breast. It is congenital, but not a symptomatic condition. Surgery may be indicated if the sternal depression is severe. Depression begins at the second intercostal space, becoming depressed mostly at the junction of the xiphoid with the body of the sternum. It is more noticeable on inspiration. Pectus carinatum, or pigeon breast, is a condition in which the sternum protrudes forward. The ribs slope back at either side and the vertical depressions are present along the costochondral junctions.
Which assessment of the thorax and lungs of an infant requires further investigation? A. The anteroposterior and transverse diameters are equal. B. The chest circumference is 2 cm smaller than the head. C. The chest wall is thin, with prominent ribs and xiphoid. D. The respiration causes marked retraction of the sternum.
The respiration causes marked retraction of the sternum. Marked retractions of the sternum and intercostal muscles indicate increased inspiratory efforts and the need for further investigation. The finding may indicate atelectasis, pneumonia, asthma, or an acute airway obstruction. Normal findings for an infant include equal anteroposterior and transverse diameters. The newborn's chest circumference is 30 to 36 cm, and is 2 cm smaller than the head circumference. The chest wall is thin with little musculature, while the ribs and the xiphoid are prominent.
Intercostal spaces are numbered based on which structures? A. The ribs present above the spaces B. The vertebrae attached to the spaces C. The tracheal rings present below the spaces D. The intercostal muscles attached to the spaces
The ribs present above the spaces The intercostal space is the anatomic space between the two ribs. Because there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib above it. Vertebrae are not attached to the intercostal spaces. Tracheal rings are parts of the trachea and are not related to the intercostal spaces. The intercostal spaces are not numbered by the intercostal muscles attached to the spaces.
Which statement describes the structure of the lungs? A. The lungs contain approximately 300 alveoli. B. The right lung is shorter and wider than the left lung. C. The trachea bifurcates at the level of T10 posteriorly. D. The right lung has two lobes, and the left lung has three lobes
The right lung is shorter and wider than the left lung. The lungs are paired, but are not symmetric structures. The right lung is shorter than the left lung because of the liver below it. The right lung is wider because the heart bulges to the left. The right lung has three lobes, whereas the left lung has two lobes. The trachea lies anterior to the esophagus. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and the left main bronchi. Each lung contains millions of alveoli.
Palpable rhonchal fremitus indicates which condition? A. Pneumothorax B. Thick bronchial secretions C. Inflammation of the pleura D. Consolidation of lung tissue
Thick bronchial secretions Fremitus is a palpable vibration. When the patient is asked to say something, the sounds generated from the larynx are transmitted through the patent bronchi and the lung parenchyma to the chest wall, and can be felt as vibrations. Rhonchal fremitus is found when bronchial secretions are thick. A pneumothorax may result in decreased fremitus. Inflammation of the pleura may cause pleural friction fremitus. Consolidation of lung tissues may cause increased fremitus.
