TNCC 9TH EDITION FINAL
You are caring for a patient admitted with asthma. During your assessment, you would expect
to find which abnormality?
a) "Funnel chest"
b) Right tracheal shift
c) Dull percussive sounds
d) Decreased fremitus -
d
A patient has just had a chest tube removed. While securing the dressing, you notice that the
patient is having difficulty breathing. Upon examination, you note that the trachea has shifted
to the left side. These findings are suggestive of which complication?
a) Acute lung failure
b) Aspiration of secretions
c) A pneumothorax
d) Atelectasis -
c
Which statement is true regarding assessment of breath sounds?
a) Place the patient in the left lateral position to better hear abnormal breath sounds.
b) Use a systematic approach to assess and contrast all areas of the lungs.
c) The bell of the stethoscope should be used to assess for normal breath sounds.
d) Breath sounds should be assessed on expiration. -
b
During your admission assessment, you note that a patient's chest diameter is greater than
expected. This suggests what condition?
a) Pneumothorax
b) Chronic obstructive pulmonary disease
c) Pneumonia
d) Pulmonary hypertension -
b
The nurse is assessing a patient admitted with shortness of breath. Upon percussion of the
anterior chest wall, the nurse notes a very loud and long booming sound. Which disorder is
this finding suggestive of?
a) Bronchitis
b) Emphysema
c) Pulmonary edema
d) Pleural effusion -
b
A patient has a history of respiratory problems. The nurse is assessing the patient's chest and
notes that the sternum and lower ribs are displaced posteriorly, creating a pit-shaped
depression in the chest. What is this finding called?
a) Barrel chest
b) Kyphosis
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,c) Pectus excavatum
d) Pectus carinatum -
c
A nurse is performing an assessment on a patient's lungs. While performing percussion on the
left lung, the nurse notes a low-pitched resonant sound. This is compatible with what disease
process?
a) Asthma
b) Bronchitis
c) Emphysema
d) Pneumothorax -
b
A nurse notes that a patient's trachea is deviated to the left side. What condition could cause
this to occur? (Select all that apply.)
a) Atelectasis in the left lung
b) Pneumothorax in the right lung
c) Bilateral pneumonia
d) Pleural effusion on the left side
e) Bronchiectasis in the left lung -
a,b,e
A patient has bronchial breath sounds over the peripheral lung fields. What condition could
cause this? (Select all that apply.)
a) Asthma
b) Lung mass with exudate
c) Bronchitis
d) Pulmonary edema
e) Bronchospasms -
b,d
In normal respiration, inspiration is longer than expiration. In which disorders will inspiration
be equal to expiration? (Select all that apply.)
a) Pneumothorax
b) Pneumonia with consolidation
c) Pulmonary fibrosis
d) Atelectasis
e) Effusion -
b,c
A patient is admitted for exacerbation of asthma. When auscultating for breath sounds, which
finding would confirm this diagnosis?
a) Vesicular breath sounds throughout all lung fields
b) Muffled breath sounds with localized crackles
c) Absent breath sounds in the bases; crackles on expiration
d) Distant breath sounds with audible wheezing -
d
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,A patient has just had a chest tube removed. While securing the dressing, you notice that the
patient is having difficulty breathing. Upon examination, you note that the trachea has shifted
to the left side. These findings are suggestive of which complication?
a) Acute lung failure
b) Aspiration of secretions
c) A pneumothorax
d) Atelectasis -
c
When auscultating for breath sounds, which statement is true?
a) Place the patient in the left lateral position to better hear abnormal breath sounds.
b) Use a systematic approach to assess and contrast all areas of the lungs.
c) The bell of the stethoscope should be used to assess for normal breath sounds.
d) Breath sounds should be assessed on expiration. -
b
During an admission assessment of a patient, it is noted that the patient's chest diameter is
greater than expected. This finding suggests what condition?
Pneumothorax
Chronic obstructive pulmonary disease
Pneumonia
Pulmonary hypertension -
b
What is the proper sequencing of an assessment of the pulmonary system?
a) Inspection, auscultation, palpation, and percussion
b) Inspection, palpation, auscultation, and percussion
c) Inspection, auscultation, percussion, and palpation
d) Inspection, palpation, percussion, and auscultation -
d
The nurse performs inspection of the oral cavity as part of a focused pulmonary assessment to
check for evidence of what condition?
a.
Hypoxia
b.
Dyspnea
c.
Dehydration
d.
Malnutrition -
a
Which lung sounds would be most likely heard in a patient experiencing an asthma attack?
a.
Coarse rales
b.
Pleural friction rub
c.
Fine crackles
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, d.
Expiratory wheezes -
d
Which statement describes the major difference between tachypnea and hyperventilation?
a.
Tachypnea has increased rate; hyperventilation has decreased rate.
b.
Tachypnea has decreased rate; hyperventilation has increased rate.
c.
Tachypnea has increased depth; hyperventilation has decreased depth.
d.
Tachypnea has decreased depth; hyperventilation has increased depth. -
d
A patient presents with chest trauma from a motor vehicle accident. Upon assessment, the
nurse documents that the patient is complaining of dyspnea, shortness of breath, tachypnea,
and tracheal deviation to the right. In addition, the patient's tongue is blue-gray. Based on this
assessment data, what additional assessment findings would the nurse expect to find?
a.
Kussmaul breathing pattern
b.
Absent breath sounds in the right lower lung fields
c.
Absent breath sounds in the left lung fields
d.
Diminished breath sounds in the right upper lung fields -
c
While palpating a patient's lungs the nurse notes fremitus over the patient's trachea but not the
lung periphery. What do these findings indicate?
a.
Bilateral pleural effusion
b.
Bronchial obstruction
c.
A normal finding
d.
Apical pneumothorax -
c
Which chest wall deformity is characterized by an increase in anteroposterior (AP) diameter
with displacement of the sternum forward and the ribs outward?
a.
Funnel chest
b.
Pigeon breast
c.
Barrel chest
d.
4|Page
You are caring for a patient admitted with asthma. During your assessment, you would expect
to find which abnormality?
a) "Funnel chest"
b) Right tracheal shift
c) Dull percussive sounds
d) Decreased fremitus -
d
A patient has just had a chest tube removed. While securing the dressing, you notice that the
patient is having difficulty breathing. Upon examination, you note that the trachea has shifted
to the left side. These findings are suggestive of which complication?
a) Acute lung failure
b) Aspiration of secretions
c) A pneumothorax
d) Atelectasis -
c
Which statement is true regarding assessment of breath sounds?
a) Place the patient in the left lateral position to better hear abnormal breath sounds.
b) Use a systematic approach to assess and contrast all areas of the lungs.
c) The bell of the stethoscope should be used to assess for normal breath sounds.
d) Breath sounds should be assessed on expiration. -
b
During your admission assessment, you note that a patient's chest diameter is greater than
expected. This suggests what condition?
a) Pneumothorax
b) Chronic obstructive pulmonary disease
c) Pneumonia
d) Pulmonary hypertension -
b
The nurse is assessing a patient admitted with shortness of breath. Upon percussion of the
anterior chest wall, the nurse notes a very loud and long booming sound. Which disorder is
this finding suggestive of?
a) Bronchitis
b) Emphysema
c) Pulmonary edema
d) Pleural effusion -
b
A patient has a history of respiratory problems. The nurse is assessing the patient's chest and
notes that the sternum and lower ribs are displaced posteriorly, creating a pit-shaped
depression in the chest. What is this finding called?
a) Barrel chest
b) Kyphosis
1|Page
,c) Pectus excavatum
d) Pectus carinatum -
c
A nurse is performing an assessment on a patient's lungs. While performing percussion on the
left lung, the nurse notes a low-pitched resonant sound. This is compatible with what disease
process?
a) Asthma
b) Bronchitis
c) Emphysema
d) Pneumothorax -
b
A nurse notes that a patient's trachea is deviated to the left side. What condition could cause
this to occur? (Select all that apply.)
a) Atelectasis in the left lung
b) Pneumothorax in the right lung
c) Bilateral pneumonia
d) Pleural effusion on the left side
e) Bronchiectasis in the left lung -
a,b,e
A patient has bronchial breath sounds over the peripheral lung fields. What condition could
cause this? (Select all that apply.)
a) Asthma
b) Lung mass with exudate
c) Bronchitis
d) Pulmonary edema
e) Bronchospasms -
b,d
In normal respiration, inspiration is longer than expiration. In which disorders will inspiration
be equal to expiration? (Select all that apply.)
a) Pneumothorax
b) Pneumonia with consolidation
c) Pulmonary fibrosis
d) Atelectasis
e) Effusion -
b,c
A patient is admitted for exacerbation of asthma. When auscultating for breath sounds, which
finding would confirm this diagnosis?
a) Vesicular breath sounds throughout all lung fields
b) Muffled breath sounds with localized crackles
c) Absent breath sounds in the bases; crackles on expiration
d) Distant breath sounds with audible wheezing -
d
2|Page
,A patient has just had a chest tube removed. While securing the dressing, you notice that the
patient is having difficulty breathing. Upon examination, you note that the trachea has shifted
to the left side. These findings are suggestive of which complication?
a) Acute lung failure
b) Aspiration of secretions
c) A pneumothorax
d) Atelectasis -
c
When auscultating for breath sounds, which statement is true?
a) Place the patient in the left lateral position to better hear abnormal breath sounds.
b) Use a systematic approach to assess and contrast all areas of the lungs.
c) The bell of the stethoscope should be used to assess for normal breath sounds.
d) Breath sounds should be assessed on expiration. -
b
During an admission assessment of a patient, it is noted that the patient's chest diameter is
greater than expected. This finding suggests what condition?
Pneumothorax
Chronic obstructive pulmonary disease
Pneumonia
Pulmonary hypertension -
b
What is the proper sequencing of an assessment of the pulmonary system?
a) Inspection, auscultation, palpation, and percussion
b) Inspection, palpation, auscultation, and percussion
c) Inspection, auscultation, percussion, and palpation
d) Inspection, palpation, percussion, and auscultation -
d
The nurse performs inspection of the oral cavity as part of a focused pulmonary assessment to
check for evidence of what condition?
a.
Hypoxia
b.
Dyspnea
c.
Dehydration
d.
Malnutrition -
a
Which lung sounds would be most likely heard in a patient experiencing an asthma attack?
a.
Coarse rales
b.
Pleural friction rub
c.
Fine crackles
3|Page
, d.
Expiratory wheezes -
d
Which statement describes the major difference between tachypnea and hyperventilation?
a.
Tachypnea has increased rate; hyperventilation has decreased rate.
b.
Tachypnea has decreased rate; hyperventilation has increased rate.
c.
Tachypnea has increased depth; hyperventilation has decreased depth.
d.
Tachypnea has decreased depth; hyperventilation has increased depth. -
d
A patient presents with chest trauma from a motor vehicle accident. Upon assessment, the
nurse documents that the patient is complaining of dyspnea, shortness of breath, tachypnea,
and tracheal deviation to the right. In addition, the patient's tongue is blue-gray. Based on this
assessment data, what additional assessment findings would the nurse expect to find?
a.
Kussmaul breathing pattern
b.
Absent breath sounds in the right lower lung fields
c.
Absent breath sounds in the left lung fields
d.
Diminished breath sounds in the right upper lung fields -
c
While palpating a patient's lungs the nurse notes fremitus over the patient's trachea but not the
lung periphery. What do these findings indicate?
a.
Bilateral pleural effusion
b.
Bronchial obstruction
c.
A normal finding
d.
Apical pneumothorax -
c
Which chest wall deformity is characterized by an increase in anteroposterior (AP) diameter
with displacement of the sternum forward and the ribs outward?
a.
Funnel chest
b.
Pigeon breast
c.
Barrel chest
d.
4|Page