1
Chapter 18: Thorax and Lungs
Jarvis: Physical Examination & Health Assessment, 7th Edition
MULTIPLE CHOICE
1. 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.
ANS: A
The spinous process of C7 is the vertebra prominens and is the most prominent bony spur
protruding at the base of the neck. Counting ribs and intercostal spaces on the posterior thorax
is difficult because of the muscles and soft tissue. The vertebra prominens is easier to identify
and is used as a starting point in counting thoracic processes and identifying landmarks on the
posterior chest.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 414
MSC: Client Needs: General
2. 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.
ANS: C
The right and left costal margins form an angle where they meet at the xiphoid process.
Usually, this angle is 90 degrees or less. The angle increases when the rib cage is chronically
overinflated, as in emphysema.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 414
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. 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.
ANS: A
, 2
The left lung has two lobes, and the right lung has three lobes. The right lung is shorter than
the left lung because of the underlying liver. The left lung is narrower than the right lung
because the heart bulges to the left. The posterior chest is almost all lower lobes.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 415
MSC: Client Needs: General
4. 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).
ANS: B
The apex of the lung on the anterior chest is 3 to 4 cm above the inner third of the clavicles.
On the posterior chest, the apices are at the level of C7.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 415
MSC: Client Needs: General
5. 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.
ANS: B
The sternal angle marks the site of tracheal bifurcation into the right and left main bronchi; it
corresponds with the upper borders of the atria of the heart, and it lies above the fourth
thoracic vertebra on the back.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 416
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. 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.
ANS: C
Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular
breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious
sounds.
Chapter 18: Thorax and Lungs
Jarvis: Physical Examination & Health Assessment, 7th Edition
MULTIPLE CHOICE
1. 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.
ANS: A
The spinous process of C7 is the vertebra prominens and is the most prominent bony spur
protruding at the base of the neck. Counting ribs and intercostal spaces on the posterior thorax
is difficult because of the muscles and soft tissue. The vertebra prominens is easier to identify
and is used as a starting point in counting thoracic processes and identifying landmarks on the
posterior chest.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 414
MSC: Client Needs: General
2. 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.
ANS: C
The right and left costal margins form an angle where they meet at the xiphoid process.
Usually, this angle is 90 degrees or less. The angle increases when the rib cage is chronically
overinflated, as in emphysema.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 414
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. 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.
ANS: A
, 2
The left lung has two lobes, and the right lung has three lobes. The right lung is shorter than
the left lung because of the underlying liver. The left lung is narrower than the right lung
because the heart bulges to the left. The posterior chest is almost all lower lobes.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 415
MSC: Client Needs: General
4. 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).
ANS: B
The apex of the lung on the anterior chest is 3 to 4 cm above the inner third of the clavicles.
On the posterior chest, the apices are at the level of C7.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 415
MSC: Client Needs: General
5. 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.
ANS: B
The sternal angle marks the site of tracheal bifurcation into the right and left main bronchi; it
corresponds with the upper borders of the atria of the heart, and it lies above the fourth
thoracic vertebra on the back.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 416
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. 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.
ANS: C
Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular
breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious
sounds.
