Question 1

Which patient should the nurse assess first?

Accepted Answer

A)   The patient whose respiratory rate is 26 breaths/min and whose trachea deviates to the right.
B)   The patient who has pleuritic chest pain, bilateral crackles, a productive cough of yellow sputum, and fever.
C)   The patient who is short of breath, using pursed-lip breathing, and in a tripod position.
D)   The patient whose respiratory rate is 20 breaths/min, and has eight-word dyspnea and expiratory wheezes. A

Question 2

A patient reports a productive cough with yellow sputum, fever, and a sharp pain when taking a deep breath to cough. Based on these data, what abnormal finding will the nurse anticipate on examination?

Accepted Answer

A)   Decreased breath sounds on auscultation
B)   Increased tactile fremitus and dull percussion tones
C)   Inspiratory wheezing found on auscultation
D)   Muffled sounds heard when the patient says "e-e-e" B

Question 3

A patient has right lower lobe pneumonia, creating a consolidation in that lung. In assessing for vocal fremitus, the nurse found increased fremitus over the right lower lung. What finding does the nurse anticipate when assessing vocal resonance to confirm the consolidation?

Accepted Answer

A)   Bronchophony reveals the patient's spoken "99" as clear and loud.
B)   No sounds are expected since sounds cannot be transmitted through consolidation.
C)   Egophony reveals indistinguishable sounds when the patient says "e-e-e."
D)   Whispered pectoriloquy reveals a muffled sound when the patient says "1-2-3." A

Question 4

What are the functions of the upper airways? (Select all that apply.)

Accepted Answer

A)   Conduct air to lower airway.
B)   Provide area for gas exchange.
C)   Prevent foreign matter from entering respiratory system.
D)   Warm, humidify, and filter air entering lungs.
E)   Provide transportation of oxygen and carbon dioxide between alveoli and cells.

Question 5

On inspection, the nurse finds the patient's anteroposterior diameter of the chest to be the same as the lateral diameter. What other findings does this nurse expect during the examination? (Select all that apply.)

Accepted Answer

A)   Inspiratory wheezing found on auscultation
B)   Hyperresonance heard on percussion
C)   Decreased breath sounds heard on auscultation
D)   Deceased diaphragmatic excursion on percussion
E)   A sharp, abrupt pain reported when the patient breathes deeplyF)  Decreased to absent vibration on vocal fremitus

Question 6

A patient complains of shortness of breath and having to sleep on three pillows to breathe comfortably at night. During the nurse's examination, what findings will suggest that the cause of this patient's dyspnea is due to heart disease rather than respiratory disease?

Accepted Answer

A)   Increased anteroposterior diameter
B)   Clubbing of the fingers
C)   Bilateral peripheral edema
D)   Increased tactile fremitus

Question 7

A nurse had previously heard crackles over both lungs of a patient. As the patient improves, what lung sounds does the nurse expect to hear in the patient's lungs?

Accepted Answer

A)   Vesicular breath sounds heard in peripheral lung fields
B)   Bronchial breath sounds heard over the bronchi
C)   Bronchovesicular breath sounds heard over the apices
D)   Rhonchi heard over the main bronchi

Question 8

During a symptom analysis, a patient describes his productive cough and states his sputum is thick and yellow. Based on these data, the nurse suspects which factor as the cause of these symptoms?

Accepted Answer

A)   Virus
B)   Allergy
C)   Fungus
D)   Bacteria

Question 9

On inspection, a nurse finds the patient's anteroposterior diameter of the chest to be the same as the lateral diameter. Based on this finding, what additional data does the nurse anticipate?

Accepted Answer

A)   Increased vocal fremitus on palpation
B)   Dull tones heard on percussion
C)   Decreased breath sounds on auscultation
D)   Complaint of sharp chest pain on inspiration

Question 10

A nurse is auscultating the lungs of a healthy male patient and hears crackles on inspiration. What action can the nurse take to ensure this is an accurate finding?

Accepted Answer

A)   Make sure the bell of the stethoscope is used, rather than the diaphragm.
B)   Hold stethoscope firmly to prevent movement when placed over chest hair.
C)   Ask the patient not to talk while the nurse is listening to the lungs.
D)   Change the patient's position to ensure accurate sounds.

Question 11

On examination, a nurse finds the patient has a productive cough with green sputum and inspiratory crackles. What other findings does this nurse expect during the examination? (Select all that apply.)

Accepted Answer

A)   Dull tones to percussion
B)   Increased vibration on vocal fremitus
C)   Fever
D)   Decreased diaphragmatic excursion
E)   A sharp, abrupt pain reported when patient breathes deeplyF)  Muffled sounds heard when the patient says e-e-e

Question 12

A nurse is assessing for vocal (tactile) fremitus on a patient with pulmonary edema. Which is the appropriate technique to use?

Accepted Answer

A)   Systematically percuss the posterior chest wall following the same pattern that is used for auscultation and listen for a change in tone from resonant to dull.
B)   Place the pads of the fingers on the right and left thoraces and palpate the texture and consistency of the skin feeling for a crackly sensation under the fingers.
C)   Place the palms of the hands on the right and left thoraces, ask the patient to say "99," and feel for vibrations.
D)   Place both thumbs on either side of the patient's spinal processes, extend fingers laterally, ask the patient to take a deep breath, and feel for vibrations.

Question 13

A nurse suspects a patient has a chest wall injury and wants to collect more data about thoracic expansion. Which is the appropriate technique to use?

Accepted Answer

A)   Place the palmar side of each hand against the lateral thorax at the level of the waist, ask the patient to take a deep breath, and observe lateral movement of the hands.
B)   Place both thumbs on either side of the patient's T9 to T10 spinal processes, extend fingers laterally, ask the patient to take a deep breath, and observe lateral movement of the thumbs.
C)   Place both thumbs on either side of the patient's T7 to T8 spinal processes, extend fingers laterally, ask the patient to exhale deeply, and observe lateral inward movement of the thumbs.
D)   Place the palmar side of each hand on the shoulders of the patient, ask the patient to sit up straight and take a deep breath, and observe symmetric movement of the shoulders.

Question 14

Which question will give the nurse additional information about the nature of a patient's dyspnea?

Accepted Answer

A)   "How often do you see the physician?"
B)   "How has this condition affected your day-to-day activities?"
C)   "Do you have a cough that occurs with the dyspnea?"
D)   "Does your heart rate increase when you are short of breath?"

Question 15

A patient is admitted to the emergency department with a tracheal obstruction. What sound does the nurse expect to hear as this patient breathes?

Accepted Answer

A)   Dull sounds on percussion
B)   Soft, muffled rhonchi heard over the trachea
C)   Bubbling or rasping sounds heard over the trachea
D)   High-pitched sounds on inspiration and exhalation

Question 16

The nurse is comparing pitch and duration of the various types of a patient's breath sounds and recognizes which one of these as an expected finding?

Accepted Answer

A)   Bronchial sounds are low-pitched and have a 2:1 inspiratory-versus-expiratory ratio.
B)   Bronchovesicular sounds have a moderate pitch and 1:1 expiratory-versus-inspiratory ratio.
C)   Vesicular breath sounds are high-pitched and have a 1:2 inspiratory-versus-expiratory ratio.
D)   Wheezes are low-pitched and have a 2.5:1 inspiratory-versus-expiratory ratio.

Question 17

A patient tells the nurse that he has smoked 1 $\frac{1}{2}$ packs of cigarettes a day for 14 years. The number of packs the nurse should record in the medical record is ___ pack-years.

Accepted Answer

The answer of A patient tells the nurse that he...

Question 18

A nurse is assessing a patient who was diagnosed with emphysema and chronic bronchitis 5 years ago. During the assessment of this patient's integumentary system, what finding should the nurse correlate to this respiratory disease?

Accepted Answer

A)   Dry, flaky skin
B)   Clubbing of the fingers
C)   Hypertrophy of the nails
D)   Hair loss from the scalp

Question 19

A patient is suspected of having a lung consolidation. A nurse uses the three techniques for assessing vocal resonance in this patient. What is the expected finding among the three procedures that will help eliminate consolidation as a problem?

Accepted Answer

A)   The nurse documents clearly hearing the patient say "99."
B)   The nurse documents hearing muffled sounds when the patient says "1-2-3."
C)   The nurse documents hearing no sounds when the patient says "e-e-e."
D)   The nurse documents clearly hearing the patient say "a-a-a."

Question 20

After taking a brief health history, a nurse needs to complete a focused assessment on which patient?

Accepted Answer

A)   A male who works as a painter
B)   A male who plays basketball and hockey
C)   A female who recently moved into a college dormitory
D)   A female who has a history of gout

Exam 11: Lungs and Respiratory System