Ch 13 Chest and Lungs PDF

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Ch 13 Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1.

Which chest structure contains all the thoracic viscera except the

lungs? Manubrium Mediastinum Sternum Xiphoid Pleural cavities

a. b. c. d. e.

2. 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. b. c. d. e.

3.

When auscultating the apex of the lung, you should listen even with the second rib. 4 cm above the first rib. higher on the right side. on the convex diaphragm surface. directly over the clavicles.

____ 4. You are documenting a rash between the eighth and ninth 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.

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. ____

5.

____ a. b. c. d. e.

6.

Fetal gas exchange is mediated by the pleura. heart. amniotic fluid. placenta. lungs.

____ a. b. c. d. e.

7.

The foramen ovale should close by 24 weeks of gestation. the initiation of labor. within minutes of birth. 4 weeks of age. 12 months of age.

____

8.

Increased oxygen tension in the arterial blood of a newborn infant

causes a. b. c. d. e.

closure of the ductus arteriosus. hyperinflation of the lungs. passive respiratory movements. reopening of the foramen ovale. the pulmonary arteries to contract.

____ 9. 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 ____ 10. To accommodate the enlarging uterus of pregnancy, the chest changes result in a. intercostal muscle atrophy. b. lowering of the resting diaphragm. c. decreased alveoli expansion. d. decreased diaphragmatic movement. e. increased costal angle. 11. 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.

____

12. 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

____

13. 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. Hypopnea

____

____ a. b.

14.

Bradypnea may accompany pneumothorax. an excellent level of cardiovascular fitness. ascites. a pulmonary embolus. anxiety.

c. d. e.

____ 15. 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. ____

16.

The most appropriate lighting source to highlight chest movement is

(are) bright tangential lighting. daylight from a window. flashlight in a dark room. fluorescent ceiling lights. a Wood’s lamp.

a. b. c. d. e.

Both pleural effusion and lobar pneumonia are characterized by _____ percussion. a. tympany heard with b. dullness heard on ____

17.

resonance heard on hyperresonance heard on occasional hyperresonance heard on

c. d. e. ____ a. b. c. d. e.

18.

Which finding suggests a minor structural variation? Barrel chest Clubbed fingers Pectus carinatum Retractions Tachypnea

____ 19. Ms. R, age 74 years, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with an intrathoracic infection? a. Barrel chest b. Cor pulmonale c. Pectus excavatum d. Pectus carinatum e. Malodorous breath ____ 20. In barrel chest, the ratio of the anteroposterior diameter to the transverse (lateral) diameter is a. 0.7 to 0.75. b. 1.0. c. 1.3 to 1.5. d. 1.5 to 2. e. greater than 2. ____ 21. 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 intense 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.

22.

The best time to observe and count respirations is while the patient is answering questions. while weighing the patient. after palpating the pulse. when the patient is sleeping. after a short walk.

23.

As you take vital signs on Mr. B, age 78 years, you note that his

b. c. d. e. ____

respirations are 40 breaths/min. He has been resting, and his mucosa is pink. Concerning Mr. B’s respirations, 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. b. c. d. e.

24.

In which patient situation would you expect to assess tachypnea? Patient with depression Patient who abuses narcotics Patient with metabolic acidosis Patient with myasthenia gravis Patient with metabolic alkalosis

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. Cheyne-Stokes ____

25.

Respiratory effort usually exhibited by the patient with cerebral brain damage is called a. Cheyne-Stokes respiration. b. paroxysmal nocturnal dyspnea. c. Kussmaul breathing. d. Biot respiration. e. ataxic respiration. ____

26.

____ 27. 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. b. c. d. e.

28.

Which type of apnea requires immediate action? Primary apnea Secondary apnea Sleep apnea Periodic apnea of the newborn Apnea of prematurity

____ a. b. c. d. e.

29.

Laryngeal obstructions would elicit which breath sound? Fremitus Stridor Rhonchi Crepitus Wheezing

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 ____

30.

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 ketoacidosis. e. intestinal obstruction. ____

31.

____ a. b. c. d. e.

32.

An expected finding from chest palpation in the adult would be costal angle of 120 degrees. cracking over the sternal notch. greater right chest expansion. crepitus. inflexibility of the xiphoid.

____ 33. 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. b. c.

34.

Tactile fremitus is best felt along the costal margin and xiphoid process. in the suprasternal notch along the clavicle. at the level of bifurcation of the bronchi.

posterolaterally over the scapulas. in the midaxillary lines.

d. e.

____ 35. 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. b. c. d. e.

36.

The examiner percusses for diaphragmatic excursion along the vertebral column. midvertebral line. midaxillary line. scapular line. sternum.

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. ____

37.

____

38.

Breath sounds normally auscultated over most of the lung fields are

called vesicular. hyperresonance. bronchial. tubular. bronchovesicular.

a. b. c. d. e. ____ a. b. c. d. e.

39.

Breath sounds normally heard over the trachea are called bronchovesicular. amphoric. crepitus. vesicular. bronchial.

____ 40. 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.

consolidation is a poor conductor of sound. air-filled lung sounds are from smaller spaces. air-filled lung tissue is an insulator of sound. consolidation causes hyperinflation of the lungs.

b. c. d. e.

____ a. b. c. d. e.

41.

The middle lobe of the right lung is best auscultated over the anterior chest. posterior chest. axilla. midclavicular line. scapula.

____ 42. Your older clinic patient is being seen today as a follow-up for a 2day 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.

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. ____

43.

Adventitious breath sounds previously referred to as rales has been replaced with the term a. wheezes. b. crunches. c. vesicular. d. crackles. e. rhonchi. ____

44.

____

45.

To distinguish crackles from rhonchi, you should auscultate the

lungs a.

before and after the patient coughs.

first at the lung base and then at the apex. with the patient inhaling and then exhaling. with the patient prone and then supine. with the patient recumbent and then sitting.

b. c. d. e.

____

46.

A musical squeaking noise heard on auscultation of the lungs is

called stridor. rales. rhonchi. wheezing. friction rub.

a. b. c. d. e.

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. ____

47.

____

48.

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

heard best? a. b. c. d. e.

In a supine position Lying on the left side Sitting completely upright With the head elevated 30 degrees In a prone position

____ 49. 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. ____ 50. 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.

emphysema. bronchial obstruction. pneumothorax. asthma.

b. c. d. e.

____ 51. 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. ____ 52. 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 nonodorous 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.

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 ____

53.

____ a. b. c. d. e.

54.

A signal for alarm during newborn chest assessment is crackles. rhonchi. gurgles from the gastrointestinal tract. stridor. a mobile xiphoid.

____

55.

Bronchovesicular breath sounds in young children that are loud and

harsh are an indication of an accumulation of fluid. malignant tumors or solid masses. normal, thin chest wall structures. pus-filled abscesses and tumors. tension pneumothorax.

a. b. c. d. e. ____ a.

56.

The pregnant woman is expected to develop tachypnea and decreased tidal volume. deep breathing but not more frequent breathing. dyspnea and increased functional residual capacity. bradypnea and increased tidal volume. tachypnea and increased functional residual capacity.

57.

Expected respiratory changes of normal aging include increased chest expansion. more frequent use of respiratory muscles. accentuated lumbar curve. more prominent bony structures. flattening of the dorsal thoracic curve.

b. c. d. e.

____ a. b. c. d. e.

____ 58. 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. b. c. d. e.

59.

Which condition requires immediate emergency intervention? Patient with pleuritic pain without dyspnea Patient with fever and a productive cough Patient with tachypnea but no chest retractions Patient with pleuritic pain and rib tenderness Patient with absent breath sounds and dull percussion tones

____ 60. 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 ____

61.

Epiglottitis has frequently associated with infection by which

organism? Respiratory syncytial virus Haemophilus influenzae type B Adenovirus Parainfluenza virus Human metapneumovirus

a. b. c. d. e.

Ch 13 Answer Section MULTIPLE CHOICE 1.

ANS: B

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. PTS: 1 REF: p. 260 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 2. ANS: C

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. PTS: 1 REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 3. ANS: B

The apices of the lungs are 4 cm above the first rib. PTS: 1 REF: p. 262 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 4. ANS: A

The number of each intercostal space corresponds to that of the rib immediately above it. PTS: 1 REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 5. ANS: B

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. PTS: 1 REF: p. 263 TOP: Discipline: Gross Anatomy MSC: Organ System: Pulmonary/Respiratory 6. ANS: D

The placenta is the source for fetal gas exchange; the lungs contain no air, and the alveoli are collapsed. PTS: 1 REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 7. ANS: C

The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale. PTS: 1 REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 8. ANS: A

Increased oxygen tension in the arterial blood usually stimulates contraction and closure of the ductus arteriosus. PTS: 1 REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 9. ANS: A

The chests of infants are generally round, with equal dimensions of anteroposterior and transverse diameters. PTS: 1 REF: p. 264 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 10. ANS: E

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. PTS: 1 REF: p. 265 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 11. ANS: A

Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest. PTS: 1 REF: p. 265 TOP: Discipline: Physiology MSC: Organ System: Pulmonary/Respiratory 12. ANS: B

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.

PTS: 1 REF: p. 267 TOP: Discipline: Pathophysiology MSC: Organ System: Pulmonary/Respiratory 13. ANS: A

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 abnormal...