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Which of these statements is true regarding the vertebra prominens? The vertebra prominens is: -
correct ans:The spinous process of C7.
,When performing a respiratory assessment on a patient, the nurse notices a costal angle of
approximately 90 degrees. This characteristic is: - correct ans:A normal finding in a healthy adult.
When assessing a patients lungs, the nurse recalls that the left lung: - correct ans:Consists of two lobes.
Which statement about the apices of the lungs is true? The apices of the lungs: - correct ans:Extend 3 to
4 cm above the inner third of the clavicles.
During an examination of the anterior thorax, the nurse is aware that the trachea bifurcates anteriorly at
the: - correct ans:Sternal angle
During an assessment, the nurse knows that expected assessment findings in the normal adult lung
include the presence of: - correct ans:Muffled voice sounds and symmetric tactile fremitus.
The primary muscles of respiration include the: - correct ans:Diaphragm and intercostals.
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? - correct
ans:Assessing for other signs and symptoms of paroxysmal nocturnal dyspnea
When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus most intensely
over which location? - correct ans:Between the scapulae
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: -
correct ans:Is caused by sounds generated from the larynx.
Tactile Fremitus is what? - correct ans:Palpable vibration
During percussion, the nurse knows that a dull percussion note elicited over a lung lobe most likely
results from: - correct ans:Increased density of lung tissue.
, The nurse is observing the auscultation technique of another nurse. The correct method to use when
progressing from one auscultatory site on the thorax to another is _______ comparison. - correct
ans:Side-to-side
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: - correct ans:Vesicular breath sounds and normal in that location.
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: - correct ans:Dullness
The nurse is auscultating the chest in an adult. Which technique is correct? - correct ans:Firmly holding
the diaphragm of the stethoscope against the chest
During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in which
situation? - correct ans:When the bronchial tree is obstructed
The nurse knows that a normal finding when assessing the respiratory system of an older adult is: -
correct ans:Decreased mobility of the thorax.
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 nurses next action should be to: -
correct ans:Recognize that these are serious signs, and contact the physician.
When assessing the respiratory system of a 4-year-old child, which of these findings would the nurse
expect? - correct ans:Presence of bronchovesicular breath sounds in the peripheral lung fields
When inspecting the anterior chest of an adult, the nurse should include which assessment? - correct
ans:Shape and configuration of the chest wall
The nurse knows that auscultation of fine crackles would most likely be noticed in: - correct ans:The
immediate newborn period.