HESI A2 Critical Thinking Exam
Questions with Complete
Solutions
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) consists primarily of an upper lobe on the posterior chest.
D) is shorter than the right lung because of the underlying stomach. - Answer- A)
consists of two lobes.
Pages: 413-414. 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 lobe.
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 symmetrical tactile fremitus.
D) absent voice sounds and hyperresonant percussion tones. - Answer- C) muffled
voice sounds and symmetrical tactile fremitus.
Pages: 429-430. 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.
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?
A) Obtain a detailed history of the patient's allergies and history of asthma.
B) Tell the patient to sleep on his or her right side to facilitate ease of respirations.
C) Assess for other signs and symptoms of paroxysmal nocturnal dyspnea.
D) Assure the patient that this is normal and will probably resolve within the next week. -
Answer- C) Assess for other signs and symptoms of paroxysmal nocturnal dyspnea.
,Pages: 419-420. The patient is experiencing paroxysmal nocturnal dyspnea: being
awakened from sleep with shortness of breath and the need to be upright to achieve
comfort.
When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus
most intensely over which location?
A) Between the scapulae
B) Third intercostal space, MCL
C) Fifth intercostal space, MAL
D) Over the lower lobes, posterior side - Answer- A) Between the scapulae
Page: 424. Normally, fremitus is most prominent between the scapulae and around the
sternum. These are sites where the major bronchi are closest to the chest wall.
Fremitus normally decreases as one progress down the chest because more tissue
impedes sound transmission.
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? "Tactile fremitus:
A) is caused by moisture in the alveoli."
B) indicates that there is air in the subcutaneous tissues."
C) is caused by sounds generated from the larynx."
D) reflects the blood flow through the pulmonary arteries." - Answer- C) is caused by
sounds generated from the larynx."
Pages: 422-423. Fremitus is a palpable vibration. Sounds generated from the larynx are
transmitted through patent bronchi and the lung parenchyma to the chest wall where
they are felt as vibrations. Crepitus is the term for air in the subcutaneous tissues.
When auscultating the lungs of an adult patient, the nurse notes that over the posterior
lower lobes low-pitched, soft breath sounds are heard, with inspiration being longer than
expiration. The nurse interprets that these are:
A) sounds normally auscultated over the trachea.
B) bronchial breath sounds and are normal in that location.
C) vesicular breath sounds and are normal in that location.
D) bronchovesicular breath sounds and are normal in that location. - Answer- C)
vesicular breath sounds and are normal in that location.
Pages: 428-429. Vesicular breath sounds are low-pitched, soft sounds with inspiration
being longer than expiration. These breath sounds are expected over peripheral lung
fields where air flows through smaller bronchioles and alveoli.
, 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 would reveal:
A) dullness.
B) tympany.
C) resonance.
D) hyperresonance. - Answer- A) dullness.
Pages: 424-425. A dull percussion note signals an abnormal density in the lungs, as
with pneumonia, pleural effusion, atelectasis, or tumor.
The nurse knows that auscultation of fine crackles would most likely be noticed in:
A) a healthy 5-year-old child.
B) a pregnant woman.
C) the immediate newborn period.
D) association with a pneumothorax. - Answer- C) the immediate newborn period.
Pages: 436-437. Fine crackles are commonly heard in the immediate newborn period
as a result of the opening of the airways and clearing of fluid. Persistent fine crackles
would be noticed with pneumonia, bronchiolitis, or atelectasis.
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?
A) Airway obstruction
B) Emphysema
C) Pulmonary consolidation
D) Asthma - Answer- C) Pulmonary consolidation
Page: 446. Pathologic conditions that increase lung density, such as pulmonary
consolidation, will enhance transmission of voice sounds, such as bronchophony. See
Table 18-7.
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?
A) Wheezes
B) Bronchial sounds
C) Bronchophony
D) Whispered pectoriloquy - Answer- A) Wheezes
Page: 445. Wheezes are caused by air squeezed or compressed through passageways
narrowed almost to closure by collapsing, swelling, secretions, or tumors, such as with
acute asthma or chronic emphysema.
, An adult patient with a history of allergies comes to the clinic complaining of wheezing
and difficulty in 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:
A) asthma.
B) atelectasis.
C) lobar pneumonia.
D) heart failure. - Answer- A) asthma.
Page: 451. Asthma is allergic hypersensitivity to certain inhaled particles that produces
inflammation and a reaction of bronchospasm, which increases airway resistance,
especially during expiration. Increased respiratory rate, use of accessory muscles,
retraction of intercostal muscles, prolonged expiration, decreased breath sounds, and
expiratory wheezing are all characteristic of asthma. See Table 18-8 for descriptions of
the other conditions.
During auscultation of breath sounds, the nurse should use the stethoscope correctly,
in which of the following ways?
A) Listen to at least one full respiration in each location.
B) Listen as the patient inhales and then go to the next site during exhalation.
C) Have the patient breathe in and out rapidly while the nurse listens to the breath
sounds.
D) If the patient is modest, listen to sounds over his or her clothing or hospital gown. -
Answer- A) Listen to at least one full respiration in each location.
Pages: 426-427. During auscultation of breath sounds with a stethoscope, it is important
to listen to one full respiration in each location. During the examination, the nurse
should monitor the breathing and offer times for the person to breathe normally to
prevent possible dizziness.
88. 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:
A) tactile fremitus.
B) crepitus.
C) friction rub.
D) adventitious sounds. - Answer- B) crepitus.
Page: 424. Crepitus is a coarse, crackling sensation palpable over the skin surface. It
occurs in subcutaneous emphysema when air escapes from the lung and enters the
subcutaneous tissue, as after open thoracic injury or surgery.
Questions with Complete
Solutions
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) consists primarily of an upper lobe on the posterior chest.
D) is shorter than the right lung because of the underlying stomach. - Answer- A)
consists of two lobes.
Pages: 413-414. 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 lobe.
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 symmetrical tactile fremitus.
D) absent voice sounds and hyperresonant percussion tones. - Answer- C) muffled
voice sounds and symmetrical tactile fremitus.
Pages: 429-430. 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.
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?
A) Obtain a detailed history of the patient's allergies and history of asthma.
B) Tell the patient to sleep on his or her right side to facilitate ease of respirations.
C) Assess for other signs and symptoms of paroxysmal nocturnal dyspnea.
D) Assure the patient that this is normal and will probably resolve within the next week. -
Answer- C) Assess for other signs and symptoms of paroxysmal nocturnal dyspnea.
,Pages: 419-420. The patient is experiencing paroxysmal nocturnal dyspnea: being
awakened from sleep with shortness of breath and the need to be upright to achieve
comfort.
When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus
most intensely over which location?
A) Between the scapulae
B) Third intercostal space, MCL
C) Fifth intercostal space, MAL
D) Over the lower lobes, posterior side - Answer- A) Between the scapulae
Page: 424. Normally, fremitus is most prominent between the scapulae and around the
sternum. These are sites where the major bronchi are closest to the chest wall.
Fremitus normally decreases as one progress down the chest because more tissue
impedes sound transmission.
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? "Tactile fremitus:
A) is caused by moisture in the alveoli."
B) indicates that there is air in the subcutaneous tissues."
C) is caused by sounds generated from the larynx."
D) reflects the blood flow through the pulmonary arteries." - Answer- C) is caused by
sounds generated from the larynx."
Pages: 422-423. Fremitus is a palpable vibration. Sounds generated from the larynx are
transmitted through patent bronchi and the lung parenchyma to the chest wall where
they are felt as vibrations. Crepitus is the term for air in the subcutaneous tissues.
When auscultating the lungs of an adult patient, the nurse notes that over the posterior
lower lobes low-pitched, soft breath sounds are heard, with inspiration being longer than
expiration. The nurse interprets that these are:
A) sounds normally auscultated over the trachea.
B) bronchial breath sounds and are normal in that location.
C) vesicular breath sounds and are normal in that location.
D) bronchovesicular breath sounds and are normal in that location. - Answer- C)
vesicular breath sounds and are normal in that location.
Pages: 428-429. Vesicular breath sounds are low-pitched, soft sounds with inspiration
being longer than expiration. These breath sounds are expected over peripheral lung
fields where air flows through smaller bronchioles and alveoli.
, 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 would reveal:
A) dullness.
B) tympany.
C) resonance.
D) hyperresonance. - Answer- A) dullness.
Pages: 424-425. A dull percussion note signals an abnormal density in the lungs, as
with pneumonia, pleural effusion, atelectasis, or tumor.
The nurse knows that auscultation of fine crackles would most likely be noticed in:
A) a healthy 5-year-old child.
B) a pregnant woman.
C) the immediate newborn period.
D) association with a pneumothorax. - Answer- C) the immediate newborn period.
Pages: 436-437. Fine crackles are commonly heard in the immediate newborn period
as a result of the opening of the airways and clearing of fluid. Persistent fine crackles
would be noticed with pneumonia, bronchiolitis, or atelectasis.
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?
A) Airway obstruction
B) Emphysema
C) Pulmonary consolidation
D) Asthma - Answer- C) Pulmonary consolidation
Page: 446. Pathologic conditions that increase lung density, such as pulmonary
consolidation, will enhance transmission of voice sounds, such as bronchophony. See
Table 18-7.
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?
A) Wheezes
B) Bronchial sounds
C) Bronchophony
D) Whispered pectoriloquy - Answer- A) Wheezes
Page: 445. Wheezes are caused by air squeezed or compressed through passageways
narrowed almost to closure by collapsing, swelling, secretions, or tumors, such as with
acute asthma or chronic emphysema.
, An adult patient with a history of allergies comes to the clinic complaining of wheezing
and difficulty in 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:
A) asthma.
B) atelectasis.
C) lobar pneumonia.
D) heart failure. - Answer- A) asthma.
Page: 451. Asthma is allergic hypersensitivity to certain inhaled particles that produces
inflammation and a reaction of bronchospasm, which increases airway resistance,
especially during expiration. Increased respiratory rate, use of accessory muscles,
retraction of intercostal muscles, prolonged expiration, decreased breath sounds, and
expiratory wheezing are all characteristic of asthma. See Table 18-8 for descriptions of
the other conditions.
During auscultation of breath sounds, the nurse should use the stethoscope correctly,
in which of the following ways?
A) Listen to at least one full respiration in each location.
B) Listen as the patient inhales and then go to the next site during exhalation.
C) Have the patient breathe in and out rapidly while the nurse listens to the breath
sounds.
D) If the patient is modest, listen to sounds over his or her clothing or hospital gown. -
Answer- A) Listen to at least one full respiration in each location.
Pages: 426-427. During auscultation of breath sounds with a stethoscope, it is important
to listen to one full respiration in each location. During the examination, the nurse
should monitor the breathing and offer times for the person to breathe normally to
prevent possible dizziness.
88. 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:
A) tactile fremitus.
B) crepitus.
C) friction rub.
D) adventitious sounds. - Answer- B) crepitus.
Page: 424. Crepitus is a coarse, crackling sensation palpable over the skin surface. It
occurs in subcutaneous emphysema when air escapes from the lung and enters the
subcutaneous tissue, as after open thoracic injury or surgery.
