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Flashcards in Seidel's Chp 14 Deck (61)
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1
Q
Which chest structure contains all the thoracic viscera except the lungs?
A. Manubrium
B. Mediastinum
C. Sternum
D. Xiphoid 
E. Pleural cavities
A

B. Mediastinum
The mediastinum, situated between the lungs, contains all the thoracic viscera except the lungs. The manubrium and xiphoid are parts of the sternum. The pleural cavities enclose the lungs.

2
Q
Which bronchial structure(s) is (are) most susceptible to aspiration of foreign bodies?
A. Left mainstem bronchus
B. Terminal bronchioles
C. Right mainstem bronchus
D. Right respiratory bronchioles
E. Left respiratory bronchioles
A

C. Right mainstem bronchus
The right mainstem bronchus has a more downward slope and is less angled than the left bronchus. Therefore, it is more likely to be a site of aspiration and is a more likely site for endotracheal tubes that are advanced too far.

3
Q
When auscultations the apex of the lung, you should listen
A. Even with the second rib
B. 4cm above the first rib
C. Higher on the right side
D. On the convex diaphragm surface
E. Directly over the clavicles
A

B. 4cm above the first rib

The apices of the lungs are 4 cm above the first rib.

4
Q

You are documenting a rash between the 8th and 9th ribs on the lateral border. This intercostal space will be documented in terms of the
A. Rib immediately above it
B. Rib immediately below it
C. Number of centimeters it is positioned below the clavicle
D. Number of inches it is positioned below the clavicle
E. Relationship to the sternum

A

A. Rib immediately above it

5
Q
To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the
A. Distal point of the xiphoid
B. Manubriosternal junction
C. Suprasternal notch
D. Acromion process
E. Clavicle
A

B. Manubriosternal junction
The angle of Louis, the junction of the manubrium and the sternum, corresponds to the second rib, the reference point for counting ribs and intercostal spaces.

6
Q
Fetal gas exchange is mediated by the
A. Pleura
B. Heart
C. Amniotic fluid
D. Placenta
E. Lungs
A

D. Placenta

the lungs contain no air, and the alveoli are collapsed.

7
Q
The foramen ovale (atria) should close by
A. 24 weeks of gestation 
B. The initiation of labor
C. Within minutes of birth
D. 4 weeks of age
E. 12 months of age
A

C. Within minutes of birth

The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale.

8
Q
Increased oxygen tension in the arterial blood of a newborn infant causes
A. Closure of the ductus arteriosus
B. Hyperinflation of the lungs
C. Passive respiratory movements
D. Reopening of the foramen ovale
E. The pulmonary arteries to contract
A

A. Closure of the ductus arteriosus

9
Q
The anteroposterior diameter of the chest is normally approximately the same as the transverse diameter in which age group?
A. Infants
B. School-age children
C. Adolescents
D. Young adults
E. Older adults
A

A. Infants

10
Q
To accommodate the enlarging uterus of pregnancy, the chest changes result in
A. Intercostal muscle atrophy
B. Lower of the resting diaphragm
C. Decreased alveoli expansion
D. Decreased diaphragmatic movment
E. Increased costal angle
A

E. Increased costal angle
The costal angle progressively increases from approximately 68.5 degrees to 103.5 degrees in later pregnancy. The resting diaphragm rises, yet diaphragmatic movement increases, the alveolar ventilation and tidal volume increase, and the muscles do not atrophy.

11
Q

The characteristic barrel chest of an older adult is caused by a combination of factors, including
A. Skeletal changes of aging
B. Increased muscular expansion of the chest wall
C. Less fibrous alveoli
D. Increased vital capacity
E. Increased lung resiliency

A

A. Skeletal changes of aging
Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest.

12
Q
Nancy is a 16 year old young woman who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Nancy, apart from occasional colds, is not prone to respiratory problems. What potential risk factor is most important to assess concerning Nancy’s present problem?
A. Anorexia symptoms
B. Illegal drug use
C. Last menses
D. Signs of rheumatic fever
E. Sexual activity
A

B. Illegal drug use
Illegal drug use, particularly of cocaine, is especially important to prioritize as a social history question for all adolescents and adults who complain of severe chest pain. Cocaine use can lead to tachycardia, hypertension, coronary arterial spasm with infarction, and pneumothorax.

13
Q
A patient describes shortness of breath that gets worse when he sits up. Which term documents this?
A. Platypnea 
B. Orthopnea
C. Tachypnea 
D. Bradypnea 
E. Hyopnea
A

A. Platypnea
Dyspnea that increases in the upright posture is called platypnea. Orthopnea is dyspnea that worsens with lying down, tachypnea is increased respiratory rate, and bradypnea is decreased respiratory rate. Hypopnea refers to abnormally shallow respirations.

14
Q
Bradypnea may accompany
A. Pneumothorax
B. An excellent level of cardiovascular fitness
C. Ascites 
D. A pulmonary embolus
E. Anxiety
A

B. An excellent level of cardiovascular fitness
Bradypnea, a rate slower than 12 breaths/min, may result from cardiorespiratory fitness. The other choices accompany tachypnea.

15
Q
A 34 year old man is being seen for complaints of dull pain between the shoulder blades that is more intense with deep breathing and coughing. Upon auscultation of the chest, you suspect that you will hear
A. Rhonchi 
B. Expiratory wheeze
C. Crackles
D. Pleural friction rub
E. Crepitus
A

A. Rhonchi
This patient is describing the bronchi as the source of the pain; the trachea divides at T4–5, between the shoulder blades. The adventitious bronchial sound expected is rhonchi. Wheezing might be expected if the patient had productive coughing or dyspnea; a pleural friction rub usually causes sudden stabbing pain over the pleuritic site. Crepitus can be both palpated and heard; it indicates air in the subcutaneous tissue and is usually found anteriorly and toward the axilla.

16
Q
The most appropriate lighting source to highlight chest movement is (are)
A. Bright tangential lighting
B. Daylight from a window
C. Flashlight in a dark room
D. Fluorescent ceiling lights
E. A wood’s lamp
A

A. Bright tangential lighting

17
Q
Both pleural effusion and lobar pneumonia are characterized by \_\_\_\_\_ percussion.
A. Tympany heard with
B. Dullness heard on
C. Resonance heard on
D. Hyperresonance heard on
E. Occasional hyperresonance heard on
A

B. Dullness heard on percussion
Pleural effusion and lobar pneumonia are more dense than air, with an expected finding of dullness to percussion. Tympany is expected over hollow organs such as the stomach; resonance and hyperresonance are heard over air-filled areas.

18
Q
Which finding suggests a minor structural variation?
A. Barrel chest
B. Clubbed fingers
C. Pectus carinatum
D. Retractions
E. Tachypnea
A

C. Precuts carinatum

19
Q
Ms. R, age 74, has no known health problems or diseases. You are doing a preventative health care history and examination. Which symptom is associated with an intrathoracic infection?
A. Barrel chest
B. Cor pulmonale
C. Pectus excavated
D. Pectus carinatum
E. Malodorous breath
A

E. Malodorous breath

20
Q
In barrel chest, the ratio of the anteroposterior diameter to the transverse (lateral) diameter is
A. .7 to .75
B. 1.0
C. 1.3 to 1.5
D. 1.5 to 2
E. Greater than 2
A

B. 1.0

21
Q
The patient that you are examining is complaining of pain near the spine. While palpating the spinous process at T7 and medially to the inferior border of the right scapula, the patient feels more pain. When viewing the chest radiograph, you will carefully look at which rib?
A. Right sixth rib
B. Right seventh rib
C. Right eighth rib
D. Left seventh rib
E. Left eighth rib
A

C. Right eighth rib
Although each rib articulates with the corresponding vertebra, the palpated spinous process dips down so that the rib you feel in apparent association with the spinous process is actually the number of that process plus 1.

22
Q

The best Tim to observe and count respirations is
A. While the patient is answering questions
B. While weighing the patient
C. After palpating the pulse
D. When the patient is sleeping
E. After a short walk

A

C. After palpating the pulse
Respiratory patterns change as the patient speaks and sleeps. Attempting to count during weighing would make the patient self-conscious and affect the respiratory rate. Counting respirations after you palpate the pulse does not make the patient self-conscious because the patient expects you to be counting the pulse.

23
Q

As you take vital signs on Mr. B, age 78 years, you note that his respiration’s are 40 breaths/min. He has been resting, and his mucosa is pink. Concerning Mr. B’s respiration’s you would
A. Document his rate as normal
B. Do nothing because his color is pink
C. Note that his rate is below normal
D. Report that he has an above average rate
E. Ignore one abnormal result

A

D. Report that he has an above average rate
The normal adult respiratory rate is 12 to 20 breaths/min, with a ratio of respirations to heartbeats of 1:4. Always note any variations in respiratory rate.

24
Q
In which patient situation would you expect to assess tachypnea?
A. Patient with depression
B. Patient who abuses narcotics
C. Patient with metabolic acidosis
D. Patient with myasthenia gravis
E. Patient with metabolic alkalosis
A

C. Patient with metabolic acidosis
In metabolic acidosis, the body compensates by increasing the respiratory rate to blow off the excess carbon dioxide. The other choices cause respiratory depression.

25
Q
What term would you use to document a respiratory rate greater than 20 breaths/min in an adult?
A. Dyspnea
B. Orthopnea
C. Platypnea
D. Tachypnea
E. Cheyenne-stokes
A

D. Tachypnea
Tachypnea is the correct term for respirations greater than 20 breaths/min. Dyspnea, orthopnea, and platypnea are terms that describe respiratory effort, not rate. Cheyne-Stokes refers to a particular abnormal pattern of respiration.

26
Q
Respiratory effort usually exhibited by the patient with cerebral brain damage is called
A. Cheyne-stokes respirations 
B. Paroxysmal nocturnal dyspnea
C. Kussmaul breathing
D. Biot respiration
E. Ataxic respiration
A

A. Cheyne-stokes respirations
Cheyne-Stokes respirations occur in children and older adults during sleep but otherwise occur in seriously ill patients, particularly those with brain damage at the cerebral level. The other choices are not apnea associated with cerebral damage.

27
Q
Which site of chest wall retractions indicates a more severe obstruction in a patient with asthma?
A. Lower chest
B. Along the anterior axillary line
C. Above the clavicles
D. At the nipple line
E. Along the posterior axillary line
A

C. Above the clavicles
Asthma more commonly produces retractions of the lower chest. The more severe the obstruction, the greater is the negative pressure produced in the chest during inspiration and retractions are seen in the upper thorax.

28
Q
Which type of apnea requires immediate action?
A. Primary apnea
B. Secondary apnea
C. Sleep apnea
D. Periodic apnea of the newborn
E. Apnea of prematurity
A

B. Secondary apnea
Primary apnea is self-limiting, sleep apnea should be evaluated but does not require immediate action, and periodic apnea of the newborn is a normal condition. Apnea of prematurity is a more intense version of periodic apnea of the newborn. Secondary apnea is grave, and unless resuscitative measures are immediately instituted, breathing will not resume spontaneously.

29
Q
Laryngeal obstructions would elicit which breath sound?
A. Fremitus
B. Stridor
C. Rhonchi
D. Crepitus
E. Wheezing
A

B. Stridor

Obstructions high in the respiratory tree are characterized by stridor.

30
Q
Mr. L has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect that he has cardiac or pulmonary difficulty. What additional sign would correspond with your impression?
A. Callus formation on the heels
B. Clubbing of the fingers
C. Graying of the hair
D. Swollen toes and ankles
E. Positioning of the head
A

B. Clubbing of the fingers

31
Q
Breath odors may alert the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify
A. Uremia
B. Tuberculosis
C. Hepatic dysfunction
D. Diabetic keto acidosis
E. Intestinal obstruction
A

A. Uremia
The breath smell described as ammonia-like suggests uremia, a renal condition; cinnamon suggests tuberculosis, a musty fish or clover odor suggests hepatic failure, a sweet and fruity odor suggests diabetic ketoacidosis; and a foul or feculent odor suggests intestinal obstruction.

32
Q
An expected finding from chest palpation in the adult would be
A.  Costal angle of 120 degrees
B. Cracking over the sternal notch
C. Greater right chest expansion
D. Crepitus
E. Inflexibility of the xiphoid
A

E. Inflexibility of the xiphoid
The sternum and xiphoid in adults are relatively inflexible, without cracking; the expected normal costal angle is 90 degrees, and the chest moves symmetrically. Crepitus is always an abnormal finding.

33
Q
You would expect to document the presence of a pleural friction rub for a patient being treated for
A. Bronchitis
B. Atelectasis
C. Pleurisy
D. Emphysema
E. Pneumonia
A

C. Pleurisy

34
Q

Tactile fremitus is best felt
A. Along the costal margin and xiphoid process
B. In the suprasternal notch along the clavicle
C. At the level of bifurcation of the bronchi
D. Posterolaterally over the scapulas
E. In the midaxillary lines

A

C. At the level of bifurcation of the bronchi
Fremitus is best felt posteriorly and laterally at the level of the bifurcation of the bronchi. There is great variability depending on the intensity and pitch of the voice and the structure and thickness of the chest wall. In addition, the scapulae obscure fremitus.

35
Q

In the most effective percussion technique of the posterior lung fields, the patient cooperates by
A. Folding the arms in front
B. Bending the head back
C. Standing and bending forward
D. Lying on the side and extending the top arm
E. Lying prone

A

A. Folding the arms in front
Asking the patient to sit with the head forward and arms folded in front moves the scapula laterally, exposing more lung to percussion.

36
Q
The examiner percusses for diaphragmatic excursion along the
A. Vertebral column
B. Midvertebral line
C. Midaxillary line
D. Scapular line
E. Sternum
A

D. Scapular line
The technique for diaphragmatic excursion is to percuss along the scapular line, after the patient inhales deeply, and to mark the site when resonance changes to dullness, representing the diaphragm. The sequence is repeated with exhalation.

37
Q
The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it
A. Amplifies all types of sounds
B. Filters extraneous sounds
C. Pinpoints focal sound areas
D. Transmits high-pitched sounds
E. Transmits low-pitched sounds
A

D. Transmits high-pitched sounds
Unless specially modified, the stethoscope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does transmit sound waves from the source to the ear. The diaphragm is the better source because it transmits the normally high-pitched sounds of the lung and has a broader area from which to listen.

38
Q
Breath sounds normally auscultated over most of the lung fields are called
A. Vesicular
B. Hyperresonace 
C. Bronchial
D. Tubular
E. Bronchovesicular
A

A. Vesicular

39
Q
Breath sounds normally heard over the trachea are called
A. Bronchovesicular
B. Amphoric
C. Crepitus
D. Vesicular
E. Bronchial
A

E. Bronchial

40
Q

When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because
A. Consolidation will echo in the chest
B. Consolidation is a poor conductor of sound
C. Air-filled lung sounds are from smaller spaces
D. Air-filled lung tissue is an insulator of sound
E. Consolidation causes hyperinflation of the lungs

A

D. Air-filled lung tissue is an insulator of sound
Whereas air is a poor conductor of sound, more dense consolidation promotes louder sounds and is a better conductor of sound.

41
Q

The middle lobe of the right lung is best auscultated over the

a. anterior chest.
b. posterior chest.
c. axilla.
d. midclavicular line.
e. scapula.

A

C

The sounds of the middle lobe of the right lung are best heard in the right axilla.

42
Q

Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by

a. percussing all lung fields.
b. auscultating the lung bases.
c. determining tactile fremitus.
d. estimating diaphragmatic excursion.
e. auscultating the apices.

A

B
Because the patient has consolidation and has been recumbent and fatigued, the most appropriate first step is to listen to the lung bases before the patient gets exhausted. The lung bases would be the most likely sites for adventitious sounds.

43
Q

Your trauma patient has no auscultated breath sounds in the right lung field. You can hear adequate sounds in the left side. A likely cause of this abnormality could be that the patient

a. has a closed head injury.
b. has minimal fluid in the pleural space.
c. is moaning and in severe pain.
d. is receiving high oxygen flow.
e. has a pneumothorax.

A

E
Trauma to the chest can cause an exudative pleural effusion or pneumothorax. In the affected areas, the breath sounds are diminished to absent.

44
Q

Adventitious breath sounds previously referred to as rales has been replaced with the term

a. wheezes.
b. crunches.
c. vesicular.
d. crackles.
e. rhonchi.

A

D

The term rales has been replaced with the term crackles to describe the sound more precisely.

45
Q

To distinguish crackles from rhonchi, you should auscultate the lungs

a. before and after the patient coughs.
b. first at the lung base and then at the apex.
c. with the patient inhaling and then exhaling.
d. with the patient prone and then supine.
e. with the patient recumbent and then sitting.

A

A
To distinguish between crackles and rhonchi, ask the patient to cough and auscultate again over the same area. Rhonchi, because they represent secretions in larger airways, can clear with coughing.

46
Q

A musical squeaking noise heard on auscultation of the lungs is called

a. stridor.
b. rales.
c. rhonchi.
d. wheezing.
e. friction rub.

A

D

Wheezes are continuous, high-pitched musical sounds that can be heard on inspiration and expiration.

47
Q

To distinguish between a respiratory friction rub and a cardiac friction rub, ask the patient to

a. hold his or her breath.
b. lean forward.
c. say “99” while you palpate the anterior chest.
d. identify the location of his or her pain.
e. arch backward.

A

A
A respiratory friction rub results from inflamed pleura rubbing against each other during the respiratory cycle, so if the breath is held, the rub stops.

48
Q

In what position can the mediastinal crunch (Hamman sign) be heard best?

a. In a supine position
b. Lying on the left side
c. Sitting completely upright
d. With the head elevated 30 degrees
e. In a prone position

A

B
The Hamman sign is heard with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side—these maneuvers bring the heart muscle closer to the chest wall.

49
Q

Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you distinguish

a. crepitus from stridor.
b. a foreign body from a purulent exudate.
c. pulmonary edema from pleurisy.
d. a right from left tracheal deviation.
e. consolidation from airway constriction.

A

E
When chest auscultation results in decreased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish these adventitious breath sounds as a result of consolidation rather than narrowing of a patent lumen.

50
Q

During chest assessment, you note the patient’s voice quality while auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and the e’s sound like a’s. This is indicative of

a. lung consolidation.
b. emphysema.
c. bronchial obstruction.
d. pneumothorax.
e. asthma.

A

A
Vocal resonance, as described, indicates lung consolidation. Sounds are transmitted more clearly through consolidation rather than air. Conditions of air trapping such as emphysema and asthma would not produce vocal resonance sounds; bronchial obstruction would more likely result in a wheeze. Pneumothorax would result in diminished or no breath sounds.

51
Q

During chest assessment, you note the patient’s voice quality while you are auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and e’s sound like a’s. This sound described is called

a. sonorous.
b. bronchophony.
c. pectoriloquy.
d. egophony.
e. resonance.

A

D
When the intensity of the spoken voice is increased, there is a nasal quality in which the e’s become stuffy broad a’s. This technique is called egophony.

52
Q

How is the sputum of a viral infection different from the sputum of a bacterial infection?

a. There is more sputum production with viral conditions than bacterial infections.
b. The sputum is odorous with viral conditions and non-odorous with bacterial infections.
c. The sputum is yellow, green, or rust colored with bacterial infections and mucoid with viral.
d. The sputum is much thinner with bacterial infections and viscid with viral.
e. Viral pneumonia sputum is never blood streaked.

A

C
The more likely differentiating characteristic between viral and bacterial sputum is the color. Whereas viral infections typically produce mucoid sputum, bacterial infections produce yellow, green, or rust-colored sputum.

53
Q

The respiratory rate of a newborn infant is expected to range from _____ breaths/min.

a. 10 to 20
b. 20 to 30
c. 40 to 60
d. 30 to 80
e. greater than 80

A

C

The expected rate varies from 40 to 60 respirations per minute, although a rate of 80 is not uncommon

54
Q

A signal for alarm during newborn chest assessment is

a. crackles.
b. rhonchi.
c. gurgles from the gastrointestinal tract.
d. stridor.
e. a mobile xiphoid.

A

D
Crackles and rhonchi at birth are caused by the presence of remaining fetal fluid; intermittent gurgles are transmitted bowel sound through the thin-walled chest and are not alarming; stridor is alarming at any age. The newborn’s xiphoid process is more mobile and prominent than in older children.

55
Q

Bronchovesicular breath sounds in young children that are loud and harsh are an indication of

a. an accumulation of fluid.
b. malignant tumors or solid masses.
c. normal, thin chest wall structures.
d. pus-filled abscesses and tumors.
e. tension pneumothorax.

A

C
Young children’s chest walls are usually thin and therefore able to normally transmit loud, harsh, and more bronchial breath sounds than can adults.

56
Q

The pregnant woman is expected to develop

a. tachypnea and decreased tidal volume.
b. deep breathing but not more frequent breathing.
c. dyspnea and increased functional residual capacity.
d. bradypnea and increased tidal volume.
e. tachypnea and increased functional residual capacity.

A

B
In pregnant women, tidal volume and vital capacity increase, and functional residual capacity decreases. Also, pregnant women breathe more deeply but not more frequently.

57
Q

Expected respiratory changes of normal aging include

a. increased chest expansion.
b. more frequent use of respiratory muscles.
c. accentuated lumbar curve.
d. more prominent bony structures.
e. flattening of the dorsal thoracic curve.

A

D
In older adults, chest expansion is decreased, and there is less use of respiratory muscles because of muscle weakness. The dorsal curve of the thoracic spine is prominent with flattening of the lumbar curve with bony landmarks becoming more prominent because of loss of subcutaneous tissue.

58
Q

Dullness to percussion in intercostal spaces is most consistent with the presence of

a. asthma.
b. empyema.
c. pneumonia.
d. sickle cell disease.
e. pneumothorax.

A

C
The expected percussion tone over normal lung tissue, accessible in the intercostal spaces, is resonance. Dullness would indicate an area of consolidation, as is seen with pneumonia.

59
Q

Which condition requires immediate emergency intervention?

a. Patient with pleuritic pain without dyspnea
b. Patient with fever and a productive cough
c. Patient with tachypnea but no chest retractions
d. Patient with pleuritic pain and rib tenderness
e. Patient with absent breath sounds and dull percussion tones

A

A
A patient who experiences unexpected pleuritic pain without prior respiratory distress or dyspnea has most likely developed a pulmonary embolism, a condition with a high mortality rate.

60
Q

A 29-year-old patient presents with a new complaint of productive cough with purulent sputum. He also complains of right lower quadrant abdominal pain. You suspect pneumonia in the _____ lobe.

a. right lower
b. right middle
c. right upper
d. left upper
e. left lower

A

A
Right lower lobe pneumonia can stimulate the tenth and eleventh thoracic nerves, causing right lower quadrant pain, and simulate an abdominal process.

61
Q

Epiglottitis has frequently associated with infection by which organism?

a. Respiratory syncytial virus
b. Haemophilus influenzae type B
c. Adenovirus
d. Parainfluenza virus
e. Human metapneumovirus

A

B
Epiglottitis is an acute inflammation of the epiglottis caused by bacterial invasion. Immunization against the bacterium Haemophilus influenzae type B has greatly reduced the incidence in the United States. All of the other choices are viruses associated with bronchiolitis.