Rated A
Which of these statements is true regarding the b. Sternal angle.
vertebra prominens? The vertebra prominens is: с. Xiphoid process.
a. The spinous process of C7. d. Suprasternal notch. - ANSWER -B
b. Usually nonpalpable in most individuals
с. Opposite the interior border of the scapula.
d. Located next to the manubrium of the sternum. During an assessment, the nurse knows that
- ANSWER -A expected assessment findings in the normal adult
lung include the presence of
a. Adventitious sounds and limited chest
When performing respiratory assessment on a expansion.
patient, the nurse notices a costal angle of b. Increased tactile fremitus and dull percussion
approximately 90 degrees. This characteristic is: tones.
a. Observed in patients with kyphosis. b. c. Muffled voice sounds and symmetric tactile
Indicative of pectus excavatum. fremitus.
c. A normal finding in a healthy adult. d. Absent voice sounds and hyperresonant
d. An expected finding in a patient with a barrel percussion tones. - ANSWER -C
chest. - ANSWER -C
The primary muscles of respiration include the:
When assessing a patients lungs, the nurse a. Diaphragm and intercostals.
recalls that the left lung: b. Sternomastoids and scaleni.
a. Consists of two lobes. с. Trapezii and rectus abdominis.
b. Is divided by the horizontal fissure. d. External obliques and pectoralis major. -
c. Primarily consists of an upper lobe on the ANSWER -A
posterior chest
d. Is shorter than the right lung because of
underlying stomach. - ANSWER -A 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
Which statement about apices of the lungs is breath. Which action by the nurse is most
true? The apices of the lungs: appropriate?
а. Are at the level of the second rib anteriorly
b. Extend 3 to 4 cm above the inner third of the a. Obtaining a detailed health history of the
clavicles. patients allergies and a history of asthma
с. Are located at the sixth rib anteriorly and the b. Telling the patient to sleep on his or her right
eighth rib laterally side to facilitate ease of respirations
d. Rest on the diaphragm at the fifth intercostal c. Assessing for other signs and symptoms of
space in the midclavicular line (MCL). - paroxysmal nocturnal dyspnea
ANSWER -B d. Assuring the patient that paroxysmal nocturnal
dyspnea is normal and will probably resolve
within the next week - ANSWER -C
During an examination of the anterior thorax, the
nurse is aware that the trachea bifurcates
anteriorly at the: When assessing tactile fremitus, the nurse recalls
а. Costal angle that it is normal to feel tactile fremitus most
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, Chapter 19: Thorax and Lungs (by Jarvis) Questions and Answers
Rated A
intensely over which location? the nurse notes that low-pitched, soft breath
а. Between the scapulae sounds are heard over the posterior lower lobes,
b. Third intercostal space, MCL with inspiration being longer than expiration. The
с. Fifth intercostal space, midaxillary line (MAL) nurse interprets that these sounds are:
d. Over the lower lobes, posterior side -
ANSWER -A a. Normally auscultated over the trachea.
b. Bronchial breath sounds and normal in that
location
The nurse is reviewing the technique of palpating c. Vesicular breath sounds and normal in that
for tactile fremitus with a new graduate. Which location
statement by the graduate nurse reflects a d. Bronchovesicular breath sounds and normal in
correct understanding of tactile fremitus? Tactile that location. - ANSWER -C
fremitus:
a. Is caused by moisture in the alveoli. b.
Indicates that air is present in the subcutaneous The nurse auscultating the chest in an adult.
tissues. Which technique is correct?
c. Is caused by sounds generated from the
larynx. a. Instructing the patient to take deep, rapid
d. Reflects the blood flow through the pulmonary breaths
arteries. - ANSWER -C b. Instructing the patient to breathe in and out
through his or her nose
c. Firmly holding the diaphragm of the
During percussion, the nurse knows that a dull stethoscope against the chest
percussion note elicited over a lung lobe most d. Lightly holding the bell of the stethoscope
likely results from: against the chest to avoid friction -
a. Shallow breathing. ANSWER -C
b. Normal lung tissue.
c. Decreased adipose tissue.
d. Increased density of lung tissue. - The nurse is percussing over the lungs of a
ANSWER -D patient with pneumonia. The nurse knows that
percussion over an area of atelectasis in the
lungs will reveal:
The nurse is observing the auscultation
technique of another nurse. The correct method a. Dullness
to use when progressing from one auscultatory b. Tympany.
site on the thorax to another is с. Resonance.
___________comparison. d. Hyperresonance. - ANSWER -A
a. Side-to-side
b. Top-to-bottom During auscultation of the lungs, the nurse
с. Posterior-to-anterior expects decreased breath sounds to be heard in
d. Interspace-by-interspace - ANSWER -A which situation?
a. When the bronchial tree is obstructed
When auscultating the lungs of an adult patient, b. When adventitious sounds are present
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