Chapter 19: Thorax and Lungs Flashcards

Questions and Answers

Which of these statements is true regarding the vertebra prominens?

Opposite the interior border of the scapula.

Usually nonpalpable in most individuals

Located next to the manubrium of the sternum.

The spinous process of C7. (correct)

When performing respiratory assessment on a patient, the nurse notices a costal angle of approximately 90 degrees. This characteristic is:

Indicative of pectus excavatum.

Observed in patients with kyphosis.

A normal finding in a healthy adult. (correct)

An expected finding in a patient with a barrel chest.

When assessing a patient's lungs, the nurse recalls that the left lung:

Is divided by the horizontal fissure.

Primarily consists of an upper lobe on the posterior chest.

Is shorter than the right lung because of the underlying stomach.

Consists of two lobes. (correct)

Which statement about apices of the lungs is true?

Extend 3 to 4 cm above the inner third of the clavicles. Signup and view all the answers

During an examination of the anterior thorax, the nurse is aware that the trachea bifurcates anteriorly at the:

Sternal angle. Signup and view all the answers

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

Muffled voice sounds and symmetric tactile fremitus. Signup and view all the answers

The primary muscles of respiration include the:

Diaphragm and intercostals. Signup and view all the answers

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?

Assessing for other signs and symptoms of paroxysmal nocturnal dyspnea. Signup and view all the answers

When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus most intensely over which location?

Between the scapulae. Signup and view all the answers

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?

Is caused by sounds generated from the larynx. Signup and view all the answers

During percussion, the nurse knows that a dull percussion note elicited over a lung lobe most likely results from:

Increased density of lung tissue. Signup and view all the answers

The correct method to use when progressing from one auscultatory site on the thorax to another is __________ comparison.

side-to-side Signup and view all the answers

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:

Vesicular breath sounds and normal in that location. Signup and view all the answers

The nurse auscultating the chest in an adult. Which technique is correct?

Firmly holding the diaphragm of the stethoscope against the chest. Signup and view all the answers

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:

Dullness. Signup and view all the answers

During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in which situation?

When the bronchial tree is obstructed. Signup and view all the answers

The nurse knows that a normal finding when assessing the respiratory system of an older adult is:

Decreased mobility of the thorax. Signup and view all the answers

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:

Recognize that these are serious signs and contact the physician. Signup and view all the answers

When assessing the respiratory system of a 4-year-old child, which of these findings would the nurse expect?

Presence of bronchovesicular breath sounds in the peripheral lung fields. Signup and view all the answers

When inspecting the anterior chest of an adult, the nurse should include which assessment?

Shape and configuration of the chest wall. Signup and view all the answers

The nurse knows that auscultation of fine crackles would most likely be noticed in:

The immediate newborn period. Signup and view all the answers

During an assessment of an adult, the nurse has noted unequal chest expansion and recognizes that this occurs in which situation?

When part of the lung is obstructed or collapsed. Signup and view all the answers

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?

Pulmonary consolidation. Signup and view all the answers

The nurse is reviewing the characteristics of breath sounds. Which statement about bronchovesicular breath sounds is true?

Expected near the major airways. Signup and view all the answers

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?

Wheezes. Signup and view all the answers

A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?

Anteroposterior-to-transverse diameter ratio of 1:1. Signup and view all the answers

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:

Pneumothorax. Signup and view all the answers

An adult patient with a history of allergies comes to the clinic complaining of difficulty breathing when working in his yard. The assessment findings include tachypnea, 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:

Asthma. Signup and view all the answers

The nurse is assessing the lungs of an older adult. Which of these changes are normal in the respiratory system of the older adult?

Lungs are less elastic and distensible, which decreases their ability to collapse and recoil. Signup and view all the answers

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?

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. Signup and view all the answers

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:

Tuberculosis. Signup and view all the answers

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?

Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema. Signup and view all the answers

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:

Postnasal drip or sinusitis. Signup and view all the answers

During a morning assessment, the nurse notices that the patient's sputum is frothy and pink. Which condition could this finding indicate?

Pulmonary edema. Signup and view all the answers

During auscultation of breath sounds, the nurse should correctly use the stethoscope in which of the following ways?

Listening to at least one full respiration in each location. Signup and view all the answers

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?

Chest pain that is worse on deep inspiration and dyspnea. Signup and view all the answers

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:

Crepitus. Signup and view all the answers

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:

Atelectatic crackles that do not have a pathologic cause. Signup and view all the answers

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?

Hypoventilation. Signup and view all the answers

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?

Friction rub. Signup and view all the answers

The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? Select all that apply.

As the patient says a long ee-ee-ee sound, the examiner also hears a long ee-ee-ee sound. Signup and view all the answers

Study Notes

Vertebra Prominens

The vertebra prominens refers to the spinous process of C7, which is easily palpable in most individuals.

Respiratory Assessment Findings

A costal angle of approximately 90 degrees is a normal finding in a healthy adult.
The left lung contains two lobes, while the right lung has three lobes.
The trachea bifurcates at the sternal angle, distinguishing it as an important landmark.

Lung Characteristics

The apices of the lungs are located 3 to 4 cm above the inner third of the clavicles and are at the level of the second rib anteriorly.
Normal lung assessment findings include symmetric tactile fremitus and muffled voice sounds.

Muscles of Respiration

The primary muscles responsible for respiration are the diaphragm and intercostals.

Shortness of Breath Assessment

In older patients with heart failure, shortness of breath during sleep may indicate paroxysmal nocturnal dyspnea.

Tactile Fremitus

Tactile fremitus is normally felt most intensely between the scapulae, indicating healthy lung function.
It reflects vibrations produced by sounds from the larynx and should be assessed during a respiratory examination.

Percussion and Auscultation Techniques

A dull percussion note suggests increased density of lung tissue, commonly found in conditions like pneumonia.
When auscultating, it is essential to compare sounds side-to-side for accurate assessment.
Normal lung sounds in the lower lobes are vesicular, with inspiration being longer than expiration.

In older adults, the thorax tends to have decreased mobility, which can limit respiratory function.

Pediatric Assessment

In children, bronchovesicular breath sounds may be heard in peripheral lung fields, which is a normal finding.
Signs like nasal flaring and intercostal retractions in infants indicate respiratory distress and require prompt evaluation.

Pathological Conditions

Findings such as frothy, pink sputum can indicate pulmonary edema.
Symptoms of a pneumothorax may include tracheal deviation away from the affected side, hyporesonance, and diminished breath sounds.

Specific Conditions

Chronic obstructive pulmonary disease (COPD) is characterized by an anteroposterior-to-transverse diameter ratio of 1:1, indicating a barrel chest.
Asthma may present with wheezing, prolonged expiration, and use of accessory muscles.

Auscultation of Adventitious Sounds

Fine crackles may be present in newborns and indicate no pathologic cause if they stop after a few breaths.
A friction rub is expected in pleuritis, characterized by pain with breathing.

Respiratory Patterns

Shallow, irregular breathing with a respiratory rate of 12 may indicate hypoventilation.

Voice Sounds Assessment

Normal voice sounds are faint, muffled, or indistinct when whispering, indicating adequate lung function.
Clear bronchophony, where the examiner hears distinct words, suggests pulmonary consolidation.

Emergency Situations

In cases of pulmonary embolism, expect chest pain worsening with deep breaths, along with dyspnea.

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Description

Test your knowledge on thorax and lung anatomy with these flashcards based on Chapter 19 of Jarvis. This quiz covers essential concepts, including the vertebra prominens and techniques for respiratory assessment.