TERM 2-MY NOTES HEALTH ASSESSMENT CH.18 " Thorax and Lungs " Flashcards Preview

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Flashcards in TERM 2-MY NOTES HEALTH ASSESSMENT CH.18 " Thorax and Lungs " Deck (700):
1

Thorax and Lungs

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2

STRUCTURE AND FUNCTION

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3

POSITION AND SURFACE LANDMARKS

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4

The ________ is a bony structure with a conical shape, which is narrower at the top. It is defined by the sternum, 12 pairs of ribs, and 12 thoracic vertebrae.

thoracic cage

5

The floor of the thoracic cage is called the ?

Its "floor" is the diaphragm, a musculotendinous septum that separates the thoracic cavity from the abdomen.

6

a musculotendinous septum that separates the thoracic cavity from the abdomen.

diaphragm,

a musculotendinous septum that separates the thoracic cavity from the abdomen.

7

The first seven ribs attach directly to the sternum via their costal cartilages;
A)true
B)false

A

8

ribs 8, 9, and I 0 attach to the costal cartilage above, (8,9,10 come together form one insertion site at the sternum.
A)true
B)false

A

9

ribs 11 and 12 are "floating," with free palpable tips.
A)true
B)false

A

10

The costochondral junctions are the points at which the ribs join their cartilages. They are not palpable.
A)true
B)false

A

11

Anterior Thoracic landmarks

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12

__________. Feel this hollow U-shaped depression just above the sternum, in between the clavicles.

Suprasternal Notch

13

. The "breastbone" has three parts-the manubrium, the body, and the xiphoid process. Walk your fingers down the manubrium a few centimeters until you feel a distinct bony ridge, the sternal angle.

Sternum

14

Often called the "angle of Louis," this is the articulation of the manubrium and body of the sternum, and it is continuous with the second rib. The angle of Louis is a useful place to start counting ribs, which helps localize a respiratory finding horizontally. Identify the angle of Louis, palpate lightly to the second rib, and slide down to the second intercostal space

Sternal Angle

15

Often called the "angle of Louis," this is the articulation of the manubrium and body of the sternum, and it is continuous with the second rib.

Sternal angle

16

The angle of Louis is a useful place to start counting ribs, which helps localize a respiratory finding horizontally. Identify the angle of Louis, palpate lightly to the second rib, and slide down to the second intercostal space
A)true
B)false

A

17

The angle of Louis is a useful place to start counting ribs, when localizing an respiratory finding horizontally.
A)true
B)false

A

18

The angle of Louis also marks the site of tracheal bifurcation into the right and left main bronchi; it corresponds with the upper border of the atria of the heart, and it lies above the fourth thoracic vertebra on the back.
A)true
B)false

A

19

_________ marks the site of tracheal bifurcation into the right and left main bronchi; it corresponds with the upper border of the atria of the heart, and it lies above the fourth thoracic vertebra on the back.

The angle of Louis

20

Division into two branches
A)bifurcation
B)spinal

A

21

The right and left costal margins form an angle where they meet at the xiphoid process. Usually 90 degrees or less, this angle increases when the rib cage is chronically overinflated, as in emphysema.

Costal Angle.

22

If costal angle increase beyond 90degrees than patient might have

Emphysema

23

It's okay if sternal angle a little less than 90.
A)true
B)false

A

24

Posterior Thoracic landmarks

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25

________. Start here. Flex your head and feel
for the most prominent bony spur protruding at the base of
the neck. This is the spinous process of C7. If two bumps
seem equally prominent, the upper one is C7 and the lower
one is T1.

Vertebra Prominens

26

Count down these knobs on the vertebrae, which stack together to form the spinal column. Note that the spinous processes align with their same numbered ribs only down to T4. After T4, the spinous processes angle downward from their vertebral body and overlie the vertebral body and rib below.

Spinous Processes.

27

Spinous process align with the ribs only down to T4
A)true
B)false

True

28

_________The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the seventh or eighth rib.

Inferior Border of the Scapula.

29

________Palpate midway between the spine and the person's side to identify its free tip.

Twelfth Rib.

30

To identify the 12th rib in a patient, lay patient on the side and palpate mid way between the spine.
A)true
B)false

True

31

Reference lines

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32

Use the reference lines to pinpoint a finding vertically on the
chest.
A)true
B)false

A

33

Use reference lines to pinpoint vertical findings
A)true
B)false

A

34

On the anterior chest, note the midsternal line and the midclavicular line.
A)true
B)false

True

35

The__________ line bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular joints

midclavicular

36

The posterior chest wall has the vertebral (or midspinal) line and the scapular line, which extends through the inferior angle of the scapula when the arms are at the sides of the body
A)true
B)false

True

37

Lift up the person's arm 90 degrees, and divide the lateral chest by three lines: the anterior axillary line extends down from the anterior axillary fold where the pectoralis major muscle inserts; the posterior axillary line continues down from the posterior axillary fold where the latissimus dorsi muscle inserts; and the midaxiUary line runs down from the apex of the axilla and lies between and parallel to the other two.
A)true
B)false

True

38

THE THORACIC CAVITY

,

39

The mediastinum is the middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels.
A)true
B)false

A

40

The___________ is the middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels.

mediastinum

41

The right and left pleural cavities, on either side of the mediastinum, contain the lungs.
A)true
B)false

True

42

In the anterior chest, the apex, or highest point, of lung tissue is 3 to 4 cm above the inner third of the clavicles. The base, or lower border, rests on the diaphragm at about the sixth rib in the midclavicular line.
A)true
B)false

A

43

In the anterior chest, the apex, or highest point, of lung tissue is 3 to 4 cm above the inner third of the clavicles.
A)true
B)false

True

44

The base, or lower border, rests on the diaphragm at about the sixth rib in the midclavicular line.
A)true
B)false

True

45

Laterally, lung tissue extends from the apex of the axilla down to the seventh or eighth rib.
A)true
B)false

True

46

Posteriorly, the location of C7 marks the apex of lung tissue, and T 10 usually corresponds to the base. Deep inspiration expands the lungs, and their lower border drops to the level of Tl2.
A)true
B)false

True

47

Lobes of the Lungs

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48

The right lung is shorter than the left lung because of the liver
A)true
B)false

True

49

The left lung is narrower than the right lung because the heart bulges to the left.
A)true
B)false

True

50

The right lung has three lobes, and the left lung has two lobes.
A)true
B)false

True

51

The lung lobes are not arranged in horizontal bands like dessert layers in a parfait glass. Rather, they stack in diagonal sloping segments and are separated by fissures that run obliquely through the chest.
A)true
B)false

True

52

On the anterior chest, the oblique (the major or diagonal) fissure crosses the fifth rib in the midaxillary line and terminates at the sixth rib in the midclavicular line. The right lung also contains the horizontal (minor) fissure, which divides the right upper and middle lobes. This fissure extends from the fifth rib in the right midaxiilary line to the third intercostal space or fourth rib at the right sternal border.
A)true
B)false

True

53

. The right lung also contains the horizontal (minor) fissure, which divides the right upper and middle lobes. This fissure extends from the fifth rib in the right midaxiilary line to the third intercostal space or fourth rib at the right sternal border.
A)true
B)false

True

54

The most remarkable point about the posterior chest is that it is almost all lower lobe. The upper lobes occupy a smaller band of tissue from their apices at Tl down to T3 or T4. At this level, the lower lobes begin, and their inferior border reaches down to the level of T10 on expiration and to T 12 on inspiration. Note that the right middle lobe does not project onto the posterior chest at all. If the person abducts the arms and places the hands on the back of the head, the division between the upper and lower lobes corresponds to the medial border of the scapulae.
A)true
B)false

True

55

At this level, the lower lobes begin, and their inferior border reaches down to the level of T10 on expiration and to T 12 on inspiration.
A)true
B)false

True

56

Laterally, lung tissue extends from the apex of the axilla down to the seventh or eighth rib.
A)true
B)false

A

57

The left lung contains only two lobes, upper and lower. These are seen laterally as two triangular areas separated by the oblique fissure. The left upper lobe extends from the apex of the axilla down to the fifth rib at the midaxillary line. The left lower lobe continues down to the eighth rib in the midaxillary line.
A) TURE
B)false

A

58

Take special note of the three points that commonly confuse beginning examiners:
I. The left lung has no middle lobe.
2. The anterior chest contains mostly upper and middle lobe with very little lower lobe.
3. The posterior chest contains almost all lower lobe

True

59

Pleurae

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60

The thin, slippery_________ are serous membranes that form an envelope between the lungs and the chest wall

pleurae

61

Pleurae form an envelope between the lungs and the chest wall
A)true
B)false

A

62

The visceral pleura lines the outside of the lungs, dipping down into the fissures. It is continuous with the parietal pleura lining the inside of the chest wall and diaphragm.
A)true
B)false

A

63

The visceral pleura lines the outside of the lungs, dipping down into the fissures.
A)true
B)false

A

64

parietal pleura lining the inside of the chest wall and diaphragm.
A)true
B)false

A

65

The inside of the envelope, the pleural cavity, is a potential space filled only with a few milliliters of lubricating fluid. It normally has a vacuum, or negative pressure, which holds the lungs tightly against the chest wall.
A)true
B)false

A

66

The pleurae extend about 3 cm below the level of the lungs, forming the costodiaphragrnatic recess. This is a potential space; when it abnormally fills with air or fluid, it compromises lung expansion.
A)true
B) false

A

67

The pleurae extend about 3 em below the level of the lungs, forming the ___________. This is a potential space; when it abnormally fills with air or fluid, it compromises lung expansion.

costodiaphragrnatic recess

68

Trachea and Bronchial Tree

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69

The trachea lies anterior to the esophagus and is 10 to 11 cm long in the adult. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and left main bronchi. Posteriorly, tracheal bifurcation is at the level of T4 or T5. The right main bronchus is shorter, wider, and more vertical than the left main bronchus.
A)true
B)false

A

70

The_________ lies anterior to the esophagus and is 10 to 11 cm long in the adult. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and left main bronchi.

trachea

71

Posteriorly, tracheal bifurcation is at the level of T4 or T5. The right main bronchus is shorter, wider, and more vertical than the left main bronchus.
A)true
B)false

A

72

The trachea and bronchi transport gases between the environment and the lung parenchyma. They constitute the dead space, or space that is filled with air but is not available for gaseous exchange. This is about 150 mL in the adult.
A)true
B)false

A

73

The bronchial tree also protects alveoli from small particulate matter in the inhaled air. The bronchi are lined with goblet cells, which secrete mucus that entraps the particles. The bronchi are lined with cilia, which sweep particles upward where they can be swallowed or expelled.
A)true
B)false

A

74

The bronchial tree also protects alveoli from small particulate matter in the inhaled air. The bronchi are lined with_______ cells, which secrete mucus that entraps the particles.

goblet

75

The bronchial tree also protects alveoli from small particulate matter in the inhaled air.The bronchi are lined with______, which sweep particles upward where they can be swallowed or expelled

cilia

76

An acinus is a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli. Gaseous exchange occurs across the respiratory membrane in the alveolar duct and in the millions of alveoli. Note how the alveoli are clustered like grapes around each alveolar duct. This creates millions of interalveolar septa (walls) that increase tremendously the working space available for gas exchange. This bunched arrangement creates a surface area for gas exchange that is as large as a tennis court.
A)true
B)false

A

77

Note how the alveoli are clustered like grapes around each alveolar duct. This creates millions of interalveolar septa (walls) that increase tremendously the working space available for gas exchange. This bunched arrangement creates a surface area for gas exchange that is as large as a tennis court.
A)true
B)false

A

78

MECHANICS OF RESPIRATION

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79

There are four major functions of the respiratory system:
(1) supplying oxygen to the body for energy production;
(2) removing carbon dioxide as a waste product of energy reactions;
(3) maintaining homeostasis (acid-base balance) of arterial blood; and
(4) maintaining heat exchange (less important in humans).

True

80

(1) supplying oxygen to the body for energy production;
(2) removing carbon dioxide as a waste product of energy reactions;
(3) maintaining homeostasis (acid-base balance) of arterial blood; and
(4) maintaining heat exchange (less important in humans).

Respiratory functions

81

By supplying oxygen to the blood and eliminating excess carbon dioxide, respiration maintains the pH or the acid-base balance of the blood.
A)true
B)fase

A

82

Supplying oxygen to the blood and eliminating carbon dioxide, respirations maintain ph balance
A)true
B)false

A

83

hypoventilation (slow, shallow breathing) causes carbon dioxide to build up in the blood.
A)true
B)false

A

84

_____causes carbon dioxide to build up in the the blood

Hypoventilation

85

hyperventilation (rapid, deep breathing) causes carbon dioxide to be blown off.
A)true
B)false

A

86

________ (rapid, deep breathing) causes carbon dioxide to be blown off.

hyperventilation

87

Control of Respirations

,

88

Normally, our breathing pattern changes without our awareness in response to cellular demands. This involuntary control of respirations is mediated by the respiratory center in the brainstem (pons and medulla).
A)true
B)false

A

89

Normally, our breathing pattern changes without our awareness in response to cellular demands. This involuntary control of respirations is mediated by the respiratory center in the__________ (pons and medulla).

brainstem

90

The major feedback loop is humoral regulation, or the change in carbon dioxide and oxygen levels in the blood and, less important, the hydrogen ion level.
A)true
B)false

A

91

The normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood, or hypercapnia.
A)true
B)false

A

92

The normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood, or __________

hypercapnia

93

hypercapnia is the normal stimulus for us to breath do to increase of carbon dioxide.
A)true
B)false

A

94

A decrease of oxygen in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia.
A)true
B)false

A

95

A decrease of oxygen in the blood (__________) also increases respirations but is less effective than hypercapnia.

hypoxemia

96

Changing Chest Size

,

97

Respiration is the physical act of breathing; air rushes into the lungs as the chest size increases (inspiration) and is expelled from the lungs as the chest recoils (expiration).
A)true
B)false

A

98

Respiration is the physical act of breathing;
A)true
B)false

A

99

The mechanical expansion and contraction of the chest cavity alters the size of the thoracic container in two dimensions:
(1) the vertical diameter lengthens or shortens, which is accomplished by downward or upward movement of the diaphragm; and
(2) the anteroposterior (A-P) diameter increases or decreases, which is accomplished by elevation or depression of the ribs

True

100

In inspiration, increasing the size of the thoracic container creates a slightly negative pressure in relation to the atmosphere, so air rushes in to fill the partial vacuum. The major muscle responsible for this increase is the diaphragm. During inspiration, contraction of the bell-shaped diaphragm causes it to descend and flatten. This lengthens the vertical diameter. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal. This increases the anteroposterior diameter.
A)true
B)false

A

101

In _________, increasing the size of the thoracic container creates a slightly negative pressure in relation to the atmosphere, so air rushes in to fill the partial vacuum. The major muscle responsible for this increase is the diaphragm.

inspiration

102

During _________, contraction of the bell-shaped diaphragm causes it to descend and flatten. This lengthens the vertical diameter. Intercostal muscles lift the sternum and elevate the ribs, making them more horizontal. This increases the anteroposterior diameter.

inspiration

103

Expiration is primarily passive. As the diaphragm relaxes, elastic forces within the lung, chest cage, and abdomen cause it to dome up. All this squeezing creates a relatively positive pressure within the alveoli, and the air flows out.
A) true
B) false

A

104

___________is primarily passive. As the diaphragm relaxes, elastic forces within the lung, chest cage, and abdomen cause it to dome up. All this squeezing creates a relatively positive pressure within the alveoli, and the air flows out.

Expiration

105

Negative pressure is on inspirations
A)true
B)false

A

106

Positive pressure is on explorations
A)true
B)false

A

107

Inspiration diaphragm is descend and flatten
A)true
B)false

A

108

Forced____________, such as that after heavy exercise or occurring pathologically with respiratory distress, commands the use of the accessory neck muscles to heave up the sternum and rib cage. These neck muscles are the sternomastoids, the scaleni, and the trapezii.

inspiration

109

In forced _______, the abdominal muscles contract powerfully to push the abdominal viscera forcefully in and up against the diaphragm, making it dome upward and making it squeeze against the lungs.

expiration

110

DEVELOPMENTAL COMPETENCE
Infants and Children

,

111

During the first 5 weeks of fetal life, the primitive lung bud emerges; by 16 weeks, the conducting airways reach the same number as in the adult; at 32 weeks, surfactant, the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts; and by birth, the lungs have 70 million primitive alveoli ready to start the job of respiration.
A)true
B)false

A

112

During the first 5 weeks of fetal life, the primitive lung bud emerges
A)true
B)false

A

113

Fetal life by 16 weeks, the conducting airways reach the same number as in the adult;
A)true
B)false

A

114

Fetal life at 32 weeks, surfactant, the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts;
A)true
B)false

A

115

by birth, the lungs have 70 million primitive alveoli ready to start the job of respiration.
A)true
B)false

A

116

When the newborn inhales the first breath, the lusty cry that follows reassures straining parents that their baby is all right.
A)true
B) false

A

117

When the newborn inhales the first breath, the lusty cry that follows, reassures straining parents that their baby is all right
A)true
B)false

A

118

respiratory system alone does not function until birth.
A)true
B)false

A

119

When the cord is cut, blood is cut off from the placenta and it gushes into the pulmonary circulation.
A)true
B)false

A

120

Relatively less resistance exists in the pulmonary arteries than in the aorta, so the foramen ovale in the heart closes just after birth.
A) true
B)false

A

121

foramen ovale in the heart closes just after birth do to Relatively less resistance exists in the pulmonary arteries than in the aorta,
A)true
B)false

A

122

The ductus arteriosus (linking the pulmonary artery and the aorta) contracts and closes some hours later, and pulmonary and systemic circulation are functional.
A)true
B)false

A

123

The ductus arteriosus (linking the pulmonary artery and the aorta) contracts and closes hours later, and pulmonary and systemic circulation are functional.
A)true
B)false

A

124

Respiratory development continues throughout childhood, with increases in diameter and length of airways and increases in size and number of alveoli, reaching the adult range of 300 million by adolescence.
A)true
B)false

A

125

The relatively smaller size and immaturity of children's pulmonary systems and the presence of parents and caregivers who smoke result in enormous vulnerability and increased risks to child health.
A)true
B)false

A

126

Prenatal exposure causes chronic hypoxia and low birth weight.
A)true, for smoking
B)false

A

127

Deficiency in the amount of oxygen reaching the tissues

Hypoxia

128

Passive smoking affect the child it sensitizes the fetal brain to nicotine, which increases risk for addiction when the child is exposed to nicotine at a later age.
A)true
B)false

A

129

Postnatal exposure to secondhand tobacco smoke leads to sudden infant death, lower respiratory illnesses, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood.
A)true
B)false

A

130

Postnatal exposure to secondhand tobacco smoke leads to sudden infant death, lower respiratory illnesses, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood.
A)true
B)false

A

131

DEVELOPMENTAL COMPETENCE
The Pregnant Woman

,

132

The enlarging uterus elevates the diaphragm 4 cm during pregnancy. This decreases the vertical diameter of the thoracic cage, but this decrease is compensated for by an increase in the horizontal diameter.
A)true
B)false

A

133

The enlarging uterus elevates the diaphragm 4 em during pregnancy. This decreases the vertical diameter of the thoracic cage, but an increase in the horizontal diameter compensates
A)true
B)false

A

134

The increase in estrogen level relaxes the chest cage ligaments. This allows an increase in the transverse diameter of the chest cage by 2 cm, and the costal angle widens.
A)pregnancy
B)infant

A

135

The total circumference of the chest cage increases by 6 cm during pregnancy
A)true
B)false

A

136

Although the diaphragm is elevated, it is not fixed. It moves with breathing even more during pregnancy, which results in an increase in tidal volume.
A)true
B)false

A

137

The growing fetus increases the oxygen demand on the mother's body. This is met easily by the increasing tidal volume (deeper breathing)
A)true
B)fase

A

138

The growing fetus increases the oxygen demand on the mother's body. This is met easily by the increasing tidal volume which is deeper breathing.
A) true
B)false

A

139

An increased awareness of the need to breathe develops, even early in pregnancy, and some pregnant women may interpret this as dyspnea although, structurally, nothing is wrong.
A)true
B)false

A

140

Early pregnancy as the need to breath. pregnant women may interpret dyspnea although, structurally, nothing is wrong.
A)true
B)false

A

141

DEVELOPMENTAL COMPETENCE
The Aging Adult

,

142

The costal cartilages become calcified, which produces a less mobile thorax. Respiratory muscle strength declines after age 50 years and continues to decrease into the 70s.
A)aging adult
B)pregnancy

A

143

A more significant change is the decrease in elastic properties within the lungs, making them less distensible and lessening their tendency to collapse and recoil.
A)aging adult
B)infant

A

144

A significant change in aging adult is the decrease in elastic properties within the lungs, making them less distensible and lessening their tendency to collapse and recoil.
A)true
B)false

A

145

In all, the aging lung is a more rigid structure that is harder to inflate.
A)true
B)false

A

146

These changes result in an increase in small airway closure, and that yields a decreased vital capacity (the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum) and an increased residual volume (the amount of air remaining in the lungs even after the most forceful expiration).
A)aging adult
B)infant

A

147

the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum

Vital capacity

148

the amount of air remaining in the lungs even after the most forceful expiration

Residual volume

149

These changes result in an increase in small airway closure, and that yields a decreased vital capacity and an increased residual volume.
A)aging adult
B)infant

A

150

With aging, histologic changes (i.e., a gradual loss of intraalveolar septa and a decreased number of alveoli) also occur, so less surface area is available for gas exchange.
A)true
B)false

A

151

Also, the lung bases become less ventilated as a result of closing off of a number of airways. This increases the older person's risk for dyspnea with exertion beyond his or her usual workload.
A)true
B)false

A

152

the lung bases become less ventilated as a result of closing off of a number of airways. This increases the older person's risk for dyspnea with exertion beyond his or her usual workload.
A)true
B)false

A

153

The histologic changes also increase the older person's risk for postoperative pulmonary complications.
A)true
B)false

A

154

histologic changes increase the older person's risk for postoperative pulmonary complications.
A)true
B)false

A

155

the older person has a greater risk for postoperative atelectasis and infection from a decreased ability to cough, a loss of protective airway reflexes, and increased secretions.
A)true
B)false

A

156

CULTURE AND GENETICS

,

157

10 times higher in foreign-born than in U.S. born; 8 times higher among Hispanic and Blacks than among whites; and 23 times higher among Asians than among whites
A)TB
B)FALSE

A

158

Asthma occurs in about 5% to 12% of the U.S. population and is the most common chronic disease in childhood.
A)true
B)false

A

159

Groups at increased risk include African Americans who reside in inner cities and premature or low-birth-weight infants.
A)asthma
B)herpes

A

160

Asthma prevalence is highest among African American and American Indian adults; it is lowest among Asian and Hispanic adults.
A)true
B)false

A

161

African Americans, Hispanics, and especially American Indians experience more than do whites or Asians.
A)asthma
B)false

A

162

Extrinsic/allergic asthma (or pediatric onset) involves a complex interaction between
genetic susceptibility (bronchial hyperresponsiveness, atopy, elevated immunoglobulin E) and environmental factors (viral respiratory infections, air pollution).
A)true
B)false

A

163

Extrinsic/allergic asthma involves a complex interaction between genetic susceptibility and environmental factors.
A)true
B)false

A

164

Biocultural differences in the size of the thoracic cavity significantly influence pulmonary functioning as determined
by vital capacity and forced expiratory volume. In descending order, the largest chest volumes are found in whites, Blacks, Asians, and American Indians. Even when the shorter height of Asians is considered, their chest volume remains significantly lower than that of whites and Blacks.
A)true
B)false

A

165

SUBJECTIVE DATA

,

166

Cough
History of respiratory infections
Environmental exposure
Shortness of breath
Smoking history
Self-care behaviors
Chest pain with breathing
A)subjective data
B)objective data

A

167

COUGH

,

168

Cough. Do you have a cough? When did it start? Gradual or sudden? • How long have you had it?
A)Acute cough lasts less than 2 or 3 weeks; chronic cough lasts over 2 months.
B) false

A

169

Acute cough lasts less than 2 or 3 weeks;
A)true
B)false

A

170

chronic cough lasts over 2 months.
A)true
B)false

A

171

How often do you cough? At any special time of day or just on arising? Cough wake you up at night?
A)Conditions with characteristic timing of cough: (l) continuous throughout day- acute illness (e.g., respiratory infection); (2) afternoon/evening-may reflect exposure to irritants at work; (3) nightpostnasal drip, sinusitis; ( 4) early morning-chronic bronchial inflammation of smokers.
B)none

A

172

Conditions with characteristic timing of cough:

,

173

continuous throughout day- acute illness (e.g., respiratory infection);
A)true
B)false

A

174

coughing in afternoon/evening-may reflect exposure to irritants at work
A)true
B)false

A

175

night postnasal drip, indicates sinusitis;
A)true
B)false

A

176

early morning coughing indicates -chronic bronchial inflammation of smokers.
A)true
B)false

A

177

Do you cough up any phlegm or sputum? How much? What color is it?
A)Chronic bronchitis is presents with a history of productive cough for 3 months of the year for 2 years in a row.
B)false

A

178

Cough up any blood? Does this look like streaks or frank blood? Does the sputum have a foul odor?
A)assessing for Hemoptysis.
B)Some conditions have characteristic sputum production: (l) white or dear mucoid-colds, bronchitis, viral infections; (2) yellow or green-bacterial infections; (3) rust colored-tuberculosis, pneumococcal pneumonia; (4) pink, frothypulmonary edema, some sympathomimetic medications have a side effect of pinktinged mucus.
C)both a and b

C

179

Some conditions have characteristic sputum production:

,

180

white or dear mucoid indicates colds, bronchitis, viral infections;
A) true
B)false

A

181

yellow or green-bacterial infections;
A)true
B)false

A

182

rust colored-tuberculosis, pneumococcal pneumonia;
A)true
B)false

A

183

pink, frothypulmonary edema, some sympathomimetic medications have a side effect of pinktinged mucus.
A)true
B)false

A

184

How would you describe your cough: hacking, dry, barking, hoarse, congested, bubbling?
A)Some conditions have a characteristic cough: mycoplasma pneumonia-hacking; early heart failure-dry; croup-barking; colds, bronchitis, pneumonia-congested.
B)false

A

185

Some conditions have a characteristic cough: mycoplasma pneumonia-hacking;
A)true
B)false

A

186

Some conditions have a characteristic cough; early heart failure-dry;
A)true
B)false

A

187

Some conditions have a characteristic cough; croup-barking; colds, bronchitis, pneumonia-congested.
A)true
B)false

A

188

Does the cough seem to come with anything: activity, position (lying), fever, congestion, talking, anxiety?
A)assessing cough
B)none

A

189

Does activity make it better or worse?
A)assessing cough
B)none

A

190

What treatment have you tried? Prescription or over-the-counter medications, vaporizer, rest, position change?
A)Assess the effectiveness of coping strategies
B)none

A

191

Does the cough bring on anything: chest pain, ear pain? Is it tiring? Are you concerned about it?
A)Note severity of the cough
B)none

A

192

SHORTNESS OF BREATH

,

193

Shortness of breath. Ever had any shortness of breath or hard-breathing spells? What brings it on? How severe is it? How long does it last?
A)Determine how much activity precipitates the shortness of breath (SOB)- state specific number of blocks walked, number of stairs
B)none

A

194

Is it affected by position, such as lying down?
A)Orthopnea is difficulty breathing when supine. State number of pillows needed to achieve comfort (e.g., "two-pillow orthopnea")
B)none

A

195

SOB does it, Occur at any specific time of day or night?
A)Paroxysmal nocturnal dyspnea is awakening from sleep with SOB and needing to be upright to achieve comfort.
B)none

A

196

_______________ is awakening from sleep with SOB and needing to be upright to achieve comfort

Paroxysmal nocturnal dyspnea

197

Shortness of breath episodes associated with night sweats?
A)assessing for Diaphoresis
B)none

A

198

Or cough, chest pain, or bluish color around lips or nails? Wheezing sound?
A)I'm assessing for Cyanosis which signals hypoxia.
B)none

A

199

Episodes seem to be related to food, pollen, dust, animals, season, or emotion?
A)assessing for asthma
B)Asthma attacks may be associated with a specific allergen or extreme cold, anxiety.
C)both a and b

C

200

What do you do in a hard-breathing attack? Take a special position, or use pursed-lip breathing? Use any oxygen, inhalers, or medications?
A)Assess effect of coping strategies and the need for more teaching
B) none

A

201

How does the shortness of breath affect your work or home activities? Getting better or worse or staying about the same?
A)Assess effect on activities of daily living.
B)none

A

202

CHEST PAIN WITH BREATHING

,

203

Chest pain with breathing Any chest pain with breathing? Please point to the exact location
A)Chest pain of thoracic origin occurs with muscle soreness from coughing or from inflammation of pleura overlying pneumonia. Distinguish this from chest pain of cardiac origin or from heartburn of stomach acid.
B)none

A

204

Chest pain of thoracic origin occurs with muscle soreness from coughing
A)true
B)false

A

205

Chest pain of thoracic origin occurs from inflammation of pleura overlying pneumonia.
A)true
B)false

A

206

Distinguish this from chest pain of cardiac origin or from heartburn of stomach acid.
A)true
B)false

A

207

When did it start? Constant, or does it come and go? Describe the pain: burning, stabbing? Brought on by respiratory infection, coughing, or trauma? Is it associated with fever, deep breathing, unequal chest inflation? What have you done to treat it? Medication or heat application?
A)assessing for chest pain
B)none

A

208

History of respiratory infections

,

209

History of respiratory infections. Any past history of breathing trouble or lung diseases such as bronchitis, emphysema, asthma, pneumonia?
A)consider sequelae after these conditions when assessing
B)none

A

210

Any unusually frequent or unusually severe colds?
A)Because most people have had some colds, it is more meaningful to ask about excess number or severity.
B)none

A

211

Any family history of allergies, tuberculosis, or asthma?
A)Assess possible risk factors
B)false

A

212

SMOKING HISTORY

A

213

Smoking history. Do you smoke cigarettes or cigars? At what age did you start? How many packs per day do you smoke now? For how long?
A) have the patient State number of packs per day and the number of years smoked.
B)false

A

214

Have you ever tried to quit? What helped? Why do you think it did not work? What activities do you associate with smoking?
A)Most people already know they should quit smoking. Instead of admonishing, assess smoking behavior, ways to modify daily smoking activities, identify triggers, how to manage withdrawal.
B)false

A

215

Environmental exposure.

,

216

Environmental exposure. Are there any environmental conditions that may affect your breathing? Where do you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy trafnc area?
A)assessing Pollution exposure.
B)false

A

217

Farmers may be at risk for grain inhalation, pesticide inhalation.
A)assessing people who are affected by environmental factors
B)false

A

218

People in the rural Midwest have a risk for histoplasmosis exposure;
A)assessing people who are affected by environmental factors
B)false

A

219

those in the Southwest and Mexico have a risk for coccidioidomycosis.
A)assessing people who are affected by environmental factors
B)false

A

220

Coal miners have a risk for pneumoconiosis.
A)assessing people who are affected by environmental factors
B)false

A

221

Stone cutters, miners, and potters have a risk for silicosis. Other irritants: asbestos, radon
A)assessing people who are affected by environmental factors
B)false

A

222

Do you do anything to protect your lungs, such as wear a mask or have the ventilatory system checked at work? Do you do anything to monitor your exposure? Do you have periodic examinations, pulmonary function tests, x-ray examination?
A)Assess self-care measures.
B)false

A

223

Do you know what specific symptoms to note that may signal breathing problems?
A)General symptoms: cough, shortness of breath.
B)Some gases produce specific symptoms: carbon monoxide-dizziness, headache, fatigue; sulfur dioxide-cough, congestion.
C)both a and b

A

224

specific symptoms to note that may signal breathing problems would be coughing, and shortness of breath.
A) true
B)false.

A

225

Some gases produce specific symptoms of breathing problems : carbon monoxide-dizziness, headache, fatigue
A)true
B)false

A

226

Some gases produce specific symptoms of breathing problems; sulfur dioxide-cough, congestion.
A)true
B)false

A

227

Self-care behaviors

,

228

Self-care behaviors.ask the patient when the he/she had their Last tuberculosis skin test, chest x-ray study, pneumonia vaccine or influenza immunization?
A)"Flu" vaccine is modified yearly; recommended for adults with chronic medical conditions, residents of nursing homes and group care, health care workers, and those who are immunosuppressed.
B)false

A

229

Additional History for Infants and Children

,

230

Has the child had any frequent or very severe colds?
A)Limit of 4 to 6 uncomplicated upper respiratory infections per year is expected in early childhood.
B)false

A

231

Limit of 4 to 6 uncomplicated upper respiratory infections per year is expected in early childhood.
A)true
B)false

A

232

Is there any history of allergy in the family? • (For child younger than 2 years): At what age were new foods introduced? Was the child breastfed or bottle-fed?
A)Consider new foods or formula as possible allergens for the infant and child
B)false

A

233

Does the child have a cough? Seem congested? Have noisy breathing or wheezing?
A)Screen for onset and follow course of childhood chronic respiratory problems: asthma, bronchitis
B)false

A

234

What measures have you taken to child-proof your home? Yard? Is there any possibility of the child inhaling or swallowing toxic substances?
A)Young child is at risk for accidental aspiration, poisoning, and injury.
B)false

A

235

Has anyone taught you emergency care measures in case of accidental choking or a hard-breathing spell?
A)Assess knowledge level of parent and caregivers.
B)false

A

236

Any smokers in the home or in the car with child?
A)Environmental smoke increases the risk for acute and chronic ear and respiratory infections in children.
B)

A

237

Additional History for the Aging Adult

,

238

Have you noticed any shortness of breath or fatigue with your daily activities?
A)Older adults have a less efficient respiratory system (decreased vital capacity, less surface area for gas exchange), so they have less tolerance for activity.
B)false

A

239

Ask the aging adult, Tell me about your usual amount of physical activity?
A)May have reduced exercise capacity because of pulmonary function deficits. B)Sedentary or bedridden people are at risk for respiratory dysfunction.
C)both a and b

C

240

__________May have reduced exercise capacity because of pulmonary function deficits.

Aging adult

241

Aging adult may have decrease in exercise capacity ,which may be do to pulmonary function deficits
A)true
B)false

A

242

For those with a history of chronic obstructive pulmonary disease [ COPD j, lung cancer, or tuberculosis): How are you getting along each day? Any weight change in the past 3 months? How much?
A)Assess coping strategies.
B)false

A

243

How about energy level? Do you tire more easily? How does your illness affect you at home? At work?
A)in aging adults Activities may decrease because of increasing shortness of breath or pain.
B)false

A

244

In aging adults Activities may decrease do to increasing shortness of breath or pain.
A)true
B)false

A

245

Do you have any chest pain with breathing?
A)Some older adults feel pleuritic pain less intensely than younger adults.
B)false

A

246

Any chest pain after a bout(short period) of coughing? After a fall?
A)Precisely localized sharp pain (points to it with one finger)-consider fractured rib or muscle injury.
B)false

A

247

In aging adult a Precisely localized sharp pain (points to it with one finger)-consider fractured rib or muscle injury.
A)true
B)false

A

248

OBJECTIVE DATA

,

249

PREPARATION

,

250

Ask the person to sit upright. Ask a man to disrobe to the waist. Ask a woman to leave the gown on and open at the back; when examining the anterior chest, lift up the gown and drape it on her shoulders rather than removing it completely.
A)true
B)false

A

251

These provisions will ensure further comfort: a warm room, a warm diaphragm endpiece, and a private examination time with no interruptions.
A)true
B)false

A

252

For smooth choreography in a complete examination, begin the respiratory examination just after palpating the thyroid gland when you are standing behind the person.
A)true
B)false

A

253

Perform the inspection, palpation, percussion, and auscultation on the posterior and lateral thorax.
A)true
B)false

A

254

Finally, clean your stethoscope endpiece with an alcohol wipe. Because your stethoscope touches many people, it is a possible vector for both aerobic and anaerobic bacteria. Cleaning with an alcohol wipe is very effective.
A)true
B)false

A

255

EQUIPMENT NEEDED

,

256

Stethoscope
Small ruler,
marked in centimeters
Marking pen
Alcohol wipe
A)true
B)false

A

257

INSPECT THE POSTERIOR CHEST

,

258

Thoracic Cage

,

259

Note the shape and configuration of the chest wall. The spinous processes should appear in a straight line. The thorax is symmetric, in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine. The scapulae are placed symmetrically in each hemithorax.
A)true
B)false

A

260

Abnormal finding is Skeletal deformities which may limit thoracic cage excursion: scoliosis, kyphosis.
A)true
B)false

A

261

The anteroposterior diameter should be less than the transverse diameter. The ratio of anteroposterior to transverse diameter is from 1:2 to 5:7.
A)true
B)false

A

262

AP = transverse diameter, or "barrel chest." Ribs are horizontal, chest appears as if held in continuous inspiration. This occurs in chronic emphysema from hyperinflation of the lungs.
A)true
B)false

A

263

AP = transverse diameter, or "barrel chest." .occurs in chronic emphysema from hyperinflation of the lungs
A) true
B)false

A

264

The neck muscles and trapezius muscles should be developed normally for age and occupation.
A)true
B)false

A

265

Neck muscles are hypertrophied in COPD from aiding in forced respirations.
A)abnormal findings
B)normal findings

A

266

Note the position the person takes to breathe. This includes a relaxed posture and the ability to support one's own weight with arms comfortably at the sides or in the lap.
A)true
B)false

A

267

People with COPD often sit in a tripod position, leaning forward with arms braced against their knees, chair, or bed. This gives them leverage so that their rectus abdominis, intercostal, and accessory neck muscles all can aid in expiration.
A) true
B) false

A

268

Assess the skin color and condition. Color should be consistent with person's genetic background, with allowance for sun-exposed areas on the chest and the back. No cyanosis or pallor should be present. Note any lesions. Inquire as to any change in a nevus on the back, for example, where the person may have difficulty monitoring
A)true
B)false

A

269

Cyanosis occurs with tissue hypoxia.
A) true
B)false

A

270

PALPATE THE POSTERIOR CHEST

,

271

Symmetric Expansion

,

272

Confirm symmetric chest expansion by placing your warmed hands on the posterolateral chest wall with thumbs at the level of T9 or T10. Slide your hands medially to pinch up a small fold of skin between your thumbs.
A)true
B)false

A

273

Ask the person to take a deep breath. Your hands serve as mechanical amplifiers; as the person inhales deeply, your thumbs should move apart symmetrically. Note any lag in expansion.
A)assessing symmetry chest expansion
B)false

A

274

Unequal chest expansion occurs with marked atelectasis, lobar pneumonia, pleural effusion; with thoracic trauma, such as fractured ribs; or with pneumothorax.
A)abnormal finding
B)normal findings

A

275

Pain accompanies deep breathing when the pleurae are inflamed.
A)true
B)false

A

276

Tactile Fremitus

,

277

Assess tactile (or vocal) fremitus. Fremitus is a palpable vibration. Sounds generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall, where you feel them as vibrations.
A)true
B)false

A

278

._________ is a palpable vibration. Sounds generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall, where you feel them as vibrations.

Fremitus

279

Use either the palmar base (the ball) of the fingers or the ulnar edge of one hand, and touch the person's chest while he or she repeats the words "ninetynine" or "blue moon." These are resonant phrases that generate strong vibrations. Start over the lung apices and palpate from one side to another.

Assess tactile (or vocal) fremitus.

280

ninetynine" or "blue moon." are resonant phrases that generate strong vibrations. To assess fremitus
A)true
B)false

A

281

Fremitus varies among persons
A)true
B)false

A

282

However, just between the scapulae, fremitus may feel stronger on the right side than on the left side because the right side is closer to the bronchial bifurcation.
A)true
B)false

A

283

Avoid palpating over the scapulae because bone damps out sound transmission.of testing for fremitus.
A)true
B)false

A

284

The following factors affect the normal intensity of tactile fremitus:

,

285

Relative location of bronchi to the chest wall.
• Normally, fremitus is most prominent between the scapulae and around the sternum, sites where the major bronchi are closest to the chest wall. Fremitus normally decreases as you progress down because more and more tissue impedes sound transmission.
A)true
B)false

A

286

fremitus is most prominent between the scapulae and around the sternum, sites where the major bronchi are closest to the chest wall. Fremitus normally decreases as you progress down because more and more tissue impedes sound transmission.
A)true
B)fase

A

287

Thickness of the chest wall.
• Fremitus feels greater over a thin chest wall than over an obese or heavily muscular one where thick tissue damps the vibration.
A)true
B)false

A

288

Fremitus feels greater over a thin chest wall than over an obese or heavily muscular one where thick tissue damps the vibration.
A)true
B)false

A

289

Pitch and intensity.
• A loud, low-pitched voice generates more fremitus than a soft, high-pitched one.
A)true
B)false

A

290

A loud, low-pitched voice generates more fremitus than a soft, high pitched one
A)true
B)false

A

291

CONTD....

,

292

Decreased fremitus occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema). Any barrier that comes between the sound and your palpating hand will decrease fremitus.
A)true
B)false

A

293

Decreased fremitus occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema).
A)true
B)false

A

294

Any barrier that comes between the sound and your palpating hand will decrease fremitus.
A)true
B)false

A

295

Increased fremitus occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia). This is present only when the bronchus is patent and when the consolidation extends to the lung surface. Note that only gross changes increase fremitus. Small areas of early pneumonia do not significantly affect fremitus.
A)true
B)false

A

296

Increased fremitus occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia). This is present only when the bronchus is patent and when the consolidation extends to the lung surface.
A)true
B)false

A

297

Note any areas of abnormal fremitus. Sound is conducted better through a uniformly dense structure than through a porous one, which changes in shape and solidity (as does the lung tissue during normal respiration). Thus conditions that increase the density of lung tissue make a better conducting medium for sound vibrations and increase tactile fremitus
A)true
B)fase

A

298

Rhonchal fremitus is palpable with thick bronchial secretions.
A)true
B)false

A

299

Pleural friction fremitus is palpable with inflammation of the pleura.
A) true
B)false

A

300

Using the fingers, gently palpate the entire chest wall. This enables you to note any areas of tenderness, to note skin temperature and moisture, to detect any superficial lumps or masses, and to explore any skin lesions noted on inspection.
A)true
B)false

A

301

Crepitus is a coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.
A)true
B)false

A

302

Crepitus is a coarse, crackling sensation palpable over the skin surface. occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.
A)true
B)false

A

303

__________is a coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.

Crepitus

304

PERCUSS THE POSTERIOR CHEST

,

305

lung Fields

,

306

Determine the predominant note over the lung fields. Start at the apices and percuss the band of normally resonant tissue across the tops of both shoulders. Then, percussing in the interspaces, make a side-to-side comparison all the way down the lung region. Percuss at 5-cm intervals. Avoid the damping effect of the scapulae and ribs.
A)assessing lung field
B)none

A

307

Resonance is the low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult. However, resonance is a relative term and has no constant standard. The resonant note may be modified somewhat in the athlete with a heavily muscular chest wall and in the heavily obese adult in whom subcutaneous fat produces scattered dullness.
A)true
B)false

A

308

Hyperresonance is a lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax
A)true
B)false

A

309

Hyperresonance occurs with emphysema or pneumothorax.
A)true
B)false

A

310

_________is a lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax

Hyperresonance

311

A dull note (soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor.
A)true
B)false

A

312

A dull note signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor.
A)true, abnormal finding
B)false,normal finding

A

313

A______ note (soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor.

dull

314

The depth of penetration of percussion has limits. Percussion sets into motion only the outer 5 to 7 cm of tissue. It will not penetrate to reveal any change in density deeper than that.
A)true
B)false

A

315

Also, an abnormal finding must be 2 to 3 cm wide to yield an abnormal percussion note. Lesions smaller than that are not detectable by percussion.
A)true
B)false

A

316

Diaphragmatic Excursion

,

317

Determine diaphragmatic excursion. Percuss to map out the lower lung border, both in expiration and in inspiration. First, ask the person to "exhale and hold it" briefly while you percuss down the scapular line until the sound changes from resonant to dull on each side. This estimates the level of the diaphragm separating the lungs from the abdominal viscera. It may be somewhat higher on the right side (about l to 2 cm) because of the presence of the liver. Mark the spot.
A)true
B)false

A

318

Determine __________. Percuss to map out the lower lung border, both in expiration and in inspiration. First, ask the person to "exhale and hold it" briefly while you percuss down the scapular line until the sound changes from resonant to dull on each side. This estimates the level of the diaphragm separating the lungs from the abdominal viscera. It may be somewhat higher on the right side (about l to 2 cm) because of the presence of the liver. Mark the spot.

diaphragmatic excursion

319

Now ask the person to "take a deep breath and hold it." Continue percussing down from your first mark and mark the level where the sound changes to dull on this deep inspiration. Measure the difference. This diaphragmatic excursion should be equal bilaterally and measure about 3 to 5 cm in adults, although it may be up to 7 to 8 cm in well-conditioned people.
A)true
B)false

A

320

Now ask the person to "take a deep breath and hold it." Continue percussing down from your first mark and mark the level where the sound changes to dull on this deep inspiration. Measure the difference. This ___________ should be equal bilaterally and measure about 3 to 5 cm in adults, although it may be up to 7 to 8 cm in well-conditioned people.

diaphragmatic excursion

321

Note an abnormally high level of dullness and absence of excursion. These occur with pleural effusion (fluid in the space between the visceral and parietal pleura) or atelectasis of the lower lobes.

Diaphragmatic Excursion

322

Always hold your own breath when you ask your patient to. When you run out of air, the other person surely has too, especially if that person has a respiratory problem
A)true
B)false

A

323

AUSCULTATE THE POSTERIOR CHEST

M

324

The passage of air through the tracheobronchial tree creates a characteristic set of noises that are audible through the chest wall. These noises also may be modified by obstruction within the respiratory passageways or by changes in the lung parenchyma, the pleura, or the chest wall.
A)true
B)false

A

325

Breath Sounds

,

326

The person is sitting, leaning forward slightly, with arms resting comfortably across the lap. Instruct the person to breathe through the mouth, a little bit deeper than usual, but to stop if he or she begins to feel dizzy. Be careful to monitor the breathing throughout the examination and offer times for the person to rest and breathe normally. The person is usually willing to comply with your instructions in an effort to please you and to be a "good patient." Watch that he or she does not hyperventilate to the point of fainting.
A)true
B) false

A

327

Make sure patient does not hyperventilate during examination.
A)true
B)false

A

328

Clean the flat diaphragm endpiece of the stethoscope and hold it firmly on the person's chest wall. Listen to at least one full respiration in each location. Side-to-side comparison is most important
A) true
B)false

A

329

Do not confuse background noise with lung sounds. Become familiar with these extraneous noises that may be confused with lung pathology if not recognized:

,

330

l. Examiner's breathing on stethoscope tubing 2. Stethoscope tubing bumping together
3. Patient shivering
4. Patient's hairy chest: movement of hairs under stethoscope sounds like crackles (rales)-minimize this by pressing harder or by wetting the hair with a damp cloth
5. Rustling of paper gown or paper drapes

True

331

Use a damp wash cloth if patient is hairy, to listen to lung sounds
A)true
B)false

A

332

CONTD.....

,

333

Crackles are abnormal lung sounds.
A)true
B)false

A

334

While standing behind the person, listen to the following lung areas posterior from the apices at C7 to the bases (around T 10), and laterally from the axilla down to the seventh or eighth rib.
A) true
B)false

A

335

As you listen, think (I) what Am I'm hearing over this spot? and (2) what should I EXPECT to be hearing? You should expect to hear three types of normal breath sounds in the adult and older child: bronchial (sometimes called tracheal or tubular), bronchovesicular, and vesicular.
A)true
B)false

A

336

You should expect to hear three types of normal breath sounds in the adult and older child: bronchial (sometimes called tracheal or tubular), bronchovesicular, and vesicular.
A)true
B)false

A

337

Decreased or absent breath sounds occur:

,

338

1. When the bronchial tree is obstructed at some point by secretions, mucus plug, or a foreign body
2. In emphysema as a result of loss of elasticity in the lung fibers and decreased force of inspired air; also, the lungs are already hyperinflated so the inhaled air does not make as much noise
3. When anything obstructs transmission of sound between the lung and your stethoscope, such as pleurisy or pleural thickening, or air (pneumothorax) or fluid (pleural effusion) in the pleural space

Decreased or absent breath sounds occur:

339

A silent chest means no air is moving in or out, which is an ominous sign.
A)true
B)false

A

340

A silent chest means no air is moving in or out, gives an ominous sign.
A)true
B)false

A

341

Increased breath sounds mean that sounds are louder than they should be (e.g., bronchial sounds are abnormal when they are heard over an abnormal location, the peripheral lung fields). They have a high-pitched, tubular quality, with a prolonged expiratory phase and a distinct pause between inspiration and expiration They sound very close to your stethoscope, as if they were right in the tubing close to your ear. They occur when consolidation (e.g., pneumonia) or compression (e.g., fluid in the intrapleural space) yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface.
A)true
B)false

A

342

Increased breath sounds mean that sounds are louder than they should be. They have a high-pitched, tubular quality, with a prolonged expiratory phase and a distinct pause between inspiration and expiration.They sound very close to your stethoscope, as if they were right in the tubing close to your ear. They occur when consolidation or compression yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface.
A)true
B)false

A

343

They occur when consolidation (e.g., pneumonia) or compression (e.g., fluid in the intrapleural space) yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface.

Increase breath sounds

344

Characteristics of Normal Breath Sounds

,

345

_______ High, Loud, Inspiration

BRONCHIAL (TRACHEAL)

346

________Moderate, Inspiration = expiration, mixed, located Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in first and second intercostal spaces
A)VESICULAR
B)BRONCHOVESICULAR

BRONCHOVESICULAR

347

_________Low, Soft, Inspiration > expiration, Rustling, like the sound of the wind in the trees,located Over peripheral lung fields where air flows through smaller bronchioles and alveoli
A)VESICULAR
B)BRONCHOVESICULAR

VESICULAR

348

Adventitious Sounds

,

349

_______These are added sounds that are not normally heard in the lungs. If present, they are heard as being superimposed on the breath sounds. They are caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways. Sources differ as to the classification and nomenclature of these sounds, but crackles (or rales) and wheeze (or rhonchi) arc terms commonly used by most examiners.

Note the presence of any adventitious sounds

350

Sources differ as to the classification and nomenclature of these sounds, but crackles (or rales) and wheeze (or rhonchi) arc terms commonly used by most examiners.
A)assessing any adventitious sounds
B)none

A

351

One type of adventitious sound, atelectatic crackles, is not pathologic. They are short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths. When sections of alveoli are not fully aerated (as in people who are asleep or in older adults), they deflate slightly and accumulate secretions. Crackles are heard when these sections are expanded by a few deep breaths.
A)true
B)false

A

352

One type of adventitious sound, ____________, is not pathologic. They are short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths. When sections of alveoli are not fully aerated (as in people who are asleep or in older adults), they deflate slightly and accumulate secretions. Crackles are heard when these sections are expanded by a few deep breaths

atelectatic crackles

353

When sections of alveoli are not fully aerated as in people who are asleep or in older adults, Crackles are heard when these sections are expanded by a few deep breaths.

atelectatic crackles

354

Atelectatic crackles are heard only in the periphery, usually in dependent portions of the lungs, and disappear after the first few breaths or after a cough.
A)true
B)false

A

355

Atelectatic crackles are heard only in the periphery, usually in dependent portions of the lungs, and disappear after the first few breaths or after a cough.
A)true
B)false

A

356

In the past, persons were asked to "take a deep breath and blow it out hard" to screen for the presence of wheezing. However, this maneuver is futile because evidence shows wheezing may occur on maximal forced exhalation in healthy people.
A)true
B)false

A

357

During normal tidal flow, high-pitched wheeze occurs with asthma
A)true
B)false

A

358

During normal tidal flow, high-pitched wheeze occurs with ___________

asthma

359

Voice Sounds

,

360

Determine the quality of voice sounds or vocal resonance. The spoken voice can be auscultated over the chest wall just as it can be felt in tactile fremitus described earlier.
A)true
B)false

A

361

Ask the person to repeat a phrase such as "ninety-nine" while you listen over the chest wall. Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said.
A)true
B)false

A

362

Pailiology that increases lung density enhances transmission of voice sounds, and you can hear what is being said through the stethoscope
A)true
B)false

A

363

Consolidation or compression of lung tissue will enhance the voice sounds, making the words more distinct.
A)true
B)false

A

364

Consolidation or compression of lung tissue enhances the voice sounds, making the words more distinct.
A)true
B)false

A

365

___________or _________ of lung tissue will enhance the voice sounds, making the words more distinct.

Consolidation or compression

366

Eliciting the voice sounds is not done routinely. Rather, these are supplemental maneuvers performed if you suspect lung pathology on the basis of earlier data. When they are performed, you are testing for the possible presence of bronchophony, egophony, and whispered pectoriloquy
A)true
B)false

A

367

INSPECT THE ANTERIOR CHEST

,

368

Note the shape and configuration of the chest wall. The ribs are sloping downward with symmetric interspaces. The costal angle is within 90 degrees. Development of abdominal muscles is as expected for the person's age, weight, and athletic condition.
A)true
B)false

A

369

Barrel chest has horizontal ribs and costal angle >90 degrees.
A)true
B)false

A

370

Hypertrophy of abdominal muscles occurs in chronic emphysema.
A)true
B)false

A

371

Hypertrophy of abdominal muscles occurs in chronic _________.

emphysema

372

Note the person's facial expression. The facial expression should be relaxed and benign, indicating an unconscious effort of breathing.
A)true
B)false

A

373

Tense, strained, tired facies accompany COPD
A)true
B)false

A

374

Tense, strained, tired facies accompany ________

COPD

375

The person with COPD may purse the lips in a whistling position. By exhaling slowly and against a narrow opening, the pressure in the bronchial tree remains positive and fewer airways collapse.
A)true
B)false

A

376

The person with ________ may purse the lips in a whistling position. By exhaling slowly and against a narrow opening, the pressure in the bronchial tree remains positive and fewer airways collapse.

COPD

377

Cerebral hypoxia may be reflected by excessive drowsiness or by anxiety, restlessness, and irritability.
A)true
B)false

A

378

Cerebral hypoxia may be reflected by drowsiness, restlessness, anxiety, and irritability.
A)true
B)false

A

379

Note skin color and condition. The lips and nail beds are free of cyanosis or unusual pallor. The nails are of normal configuration. Explore any skin lesions.
A)true
B)false

A

380

Clubbing of distal phalanx occurs with chronic respiratory disease.
A)true
B)false

A

381

________of distal phalanx occurs with chronic respiratory disease.

Clubbing

382

Cutaneous angiomas (spider nevi) associated with liver disease or portal hypertension may be evident on the chest.
A)true
B)false

A

383

Cutaneous angiomas (spider nevi) associated with liver disease , portal hypertension may be evident on the chest.
A)true
B)false

A

384

Assess the quality of respirations. Normal relaxed breathing is automatic and effortless, regular and even, and produces no noise. The chest expands symmetrically with each inspiration. Note any localized lag on inspiration.
A)true
B)false

A

385

Noisy breathing occurs with severe asthma or chronic bronchitis
A)true
B)false

A

386

Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as with pneumonia, or when guarding to avoid postoperative incisional pain or pleurisy pain.
A)true
B)false

A

387

Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as with pneumonia, or when guarding to avoid postoperative incisional pain or pleurisy pain
A)true
B)false

A

388

No retraction or bulging of the interspaces should occur on inspiration.
A)true
B) false

A

389

Retraction suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis.
A)true
B)fase

A

390

__________ suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis

Retraction

391

Bulging indicates trapped air as in the forced expiration associated with emphysema or asthma.
A)true
B)false

A

392

______indicates trapped air as in the forced expiration associated with emphysema or asthma.

Bulging

393

Normally, accessory muscles are not used to augment respiratory effort. However, with very heavy exercise, the accessory neck muscles (scalene, sternomastoid, trapezius) are used momentarily to enhance inspiration.
A)true
B)false

A

394

Abnormal finding, would be the Accessory muscles are used in acute airway obstruction and massive atelectasis.
A)true
B)false

A

395

Abnormal finding would be. Rectus abdominis and internal intercostal muscles are used to force expiration in COPD.
A)true
B)false

A

396

The respiratory rate is within normal limits for the person's age, and the pattern of breathing is regular. Occasional sighs normally punctuate breathing
A)true
B)false

A

397

Tachypnea and hyperventilation, bradypnea and hypoventilation, periodic breathing these are all

Abnormal findings

398

PALPATE THE ANTERIOR CHEST

,

399

Palpate symmetric chest expansion. Place your hands on the anterolateral wall with the thumbs along the costal margins and pointing toward the xiphoid process
A)true
B)false

A

400

Abnormally wide costal angle with little inspiratory variation occurs with emphysema.
A)true
B)false

A

401

Ask the person to take a deep breath. Watch your thumbs move apart symmetrically, and note smooth chest expansion with your fingers. Any limitation in thoracic expansion is easier to detect on the anterior chest because greater range of motion exists with breathing here.
A)assessing symmetry of the chest expansion
B)false

A

402

Symmetric chest expansion is better for assessing anterior or posterior

Anterior

403

A lag in chest expansion occurs with atelectasis, pneumonia, and postoperative guarding.
A)true
B)false

A

404

A palpable grating sensation with breathing indicates pleural friction fremitus.
A)abnormal finding in chest expansion
B)false

A

405

Assess tactile (vocal) fremitus. Begin palpating over the lung apices in the supraclavicular areas. Compare vibrations from one side to the other as the person repeats "ninety-nine." Avoid palpating over female breast tissue because breast tissue normally damps the sound.
A)true
B)false

A

406

Palpate the anterior chest wall to note any tenderness (normally none is present) and to detect any superficial lumps or masses (again, normally none are present). Note skin mobility and turgor, and note skin temperature and moisture.
A)true
B)false

A

407

If any lumps are found in the breast tissue, refer the man to a specialist.
A)true
B)false

A

408

PERCUSS THE ANTERIOR CHEST

,

409

lnterspaces are easier to palpate on the anterior chest than on the back. Do not percuss directly over female breast tissue because this would produce a dull note. Shift the breast tissue over slightly using the edge of your stationary hand. In females with large breasts, percussion may yield little useful data. With all people, use the sequence.
A)true
B)false

A

410

Note the borders of cardiac dullness normally found on the anterior chest and do not confuse these with suspected lung pathology.
A)true
B)false

A

411

In the right hemithorax, the upper border of liver dullness is located in the fifth intercostal space in the right midclavicular line. On the left, tympany is evident over the gastric space.
A)true
B)false

A

412

Lungs are hyperinflated with chronic emphysema, which results in hyperresonance where you would expect cardiac dullness.
A)true
B)false

A

413

Dullness behind the right breast occurs with right middle lobe pneumonia.
A)true
B)false

A

414

AUSCULTATE THE ANTERIOR CHEST

,

415

Breath Sounds

,

416

Auscultate the lung fields over the anterior chest from the apices in the supraclavicular areas down to the sixth rib. Progress from side to side as you move downward, and listen to one full respiration in each location. Use the sequence indicated for percussion. Do not place your stethoscope directly over the female breast. Displace the breast and listen directly over the chest wall.
A)true
B)false

A

417

Evaluate normal breath sounds, noting any abnormal breath sounds and any adventitious sounds. If the situation warrants, assess the voice sounds on the anterior chest.
A)true
B)false

A

418

Measurement of Pulmonary Function Status

,

419

The forced expiratory time is the number of seconds it takes for the person to exhale from total lung capacity to residual volume. It is a screening measure of airflow obstruction. Although the test usually is not performed in the respiratory assessment, it is useful when you wish to screen for pulmonary function.
A)true
B)false

A

420

Ask the person to inhale the deepest breath possible and then to blow it all out hard, as quickly as possible, with the mouth open. Listen with your stethoscope over the sternum. The normal time for full expiration is 4 seconds or less.
A)true
B)false

A

421

A forced expiration of 6 seconds or more occurs with obstructive lung disease. Refer this person for more precise pulmonary function studies.
A)true
B)false

A

422

In an ambulatory care setting, a handheld spirometer measures lung health in chronic conditions such as asthma. Ask the patient to inhale deeply and then to exhale into the spirometer as fast as possible until the most air possible is exhaled.
A) true
B)false

A

423

The forced vital capacity (FVC) is the total volume of air exhaled. The forced expiratory volume in 1 second (FEV1) is the volume exhaled in the first measured second. A normal outcome is a FEV1/FVC ratio of 75% or greater, meaning no significant obstruction of airflow is present.
A)true
B) false

A

424

The forced vital capacity (FVC) is the total volume of air exhaled.
A)true
B)false

A

425

The forced expiratory volume in 1 second (FEV1) is the volume exhaled in the first measured second.
A)true
B)false

A

426

A normal outcome is a FEV1/FVC ratio of 75% or greater, meaning no significant obstruction of airflow is present.
A)true
B)false

A

427

Mild obstruction of airflow is a FEV1/ FCV ratio of 60% to 70%;
A)true
B)false

A

428

moderate obstruction is a measure of 50% to 60%;
A)true
B)fAlse

A

429

severe obstruction is a ratio of less than 50%.
A)true
B)false

A

430

The pulse oximeter is a noninvasive method to assess arterial oxygen saturation (Spo2). A healthy person with no lung disease and no anemia normally has an Spo2 of 97% to 98%. However, every Spo2 result must be evaluated in the context of the person's hemoglobin level, acid-base balance, and ventilatory status.
A)true
B) false

A

431

However, every Spo2 result must be evaluated in the context of the person's hemoglobin level, acid-base balance, and ventilatory status.
A)true
B) false

A

432

The 6-minute distance (6MD) walk is a safer, simple, inexpensive, clinical measure of functional status in aging adults.The 6MD is used as an outcome measure for people in pulmonary rehabilitation because it mirrors conditions that are used in everyday life.
A)true
B)false

A

433

The 6MD is used as an outcome measure for people in pulmonary rehabilitation and aging adult because it mirrors conditions that are used in everyday life.
A)true
B)false

A

434

Locate a flat-surfaced corridor that has little foot traffic, is wide enough to permit comfortable turns, and has a controlled environment. Ensure that the person is wearing comfortable shoes, and equip him or her with a pulse oximeter to monitor oxygen saturation. Ask the person to set his or her own pace to cover as much ground as possible in 6 minutes, and assure the person it is all right to slow down or to stop to rest at any time.

6MD TEST

435

Use a stopwatch to time the walk. A person who walks >300 meters in 6 minutes is more likely to engage in activities of daily living.
A)true
B)false

A

436

Ask the person to stop the walk if you measure an Spo2 below 85% to 88% or if extreme breathlessness occurs. During a 6MD.
A)true
B)false

A

437

DEVELOPMENTAL COMPETENCE
Infants and Children

,

438

To prepare, let the parent hold an infant supported against the chest or shoulder. Ignore the usual sequence of the physical examination; seize the opportunity with a sleeping infant to inspect and then to listen to lung sounds next. This way you can concentrate on the breath sounds before the baby wakes up and possibly cries.
A)true
B) false

A

439

Infant crying does not have to be a problem for you, however, because it actually enhances palpation of tactile fremitus and auscultation of breath sounds.
A)true
B)false

A

440

Offer the stethoscope and let the child handle it. This reduces any fear of the equipment.
A)true
B)false

A

441

Promote the child's participation; school-age children usually are delighted to hear their own breath sounds when you place the stethoscope properly.
A)true
B)false

A

442

While listening to breath sounds, ask the young child to take a deep breath and "blow out" your penlight while you hold the stethoscope with your other hand. Time your letting go of the penlight button so the light goes off after the child blows. Or, ask the child to "pant like a dog" while you auscultate.
A)true
B)false

A

443

The infant has a rounded thorax with an equal AP-to-transverse chest diameter.
A)true
B)false

A

444

By age 6 years, the thorax reaches the adult ratio of 1:2 (AP-to-transverse diameter).
A)true
B)false

A

445

The newborn's chest circumference is 30 to 36 cm and is 2 cm smaller than the head circumference until 2 years of age.
A)true
B) false

A

446

The chest wall is thin with little musculature. The ribs and the xiphoid are prominent; you can see as well as feel the sharp tip of the xiphoid process. The thoracic cage is soft and flexible.
A)infant and children
B)adult

A

447

Note a barrel shape persisting after age 6 years, which may develop with chronic asthma or cystic fibrosis.
A)true
B)false

A

448

barrel shape chest persisting after age 6 years, which may develop with chronic asthma or cystic fibrosis.
A)true
B)false

A

449

In newborn males and females, the breasts may look enlarged by the second or third day from maternal estrogen. Occasionally a white fluid, sometimes referred to by the slang expression "witch's milk," can be expressed. This resolves within a week.
A)true
B)false

A

450

Infant and children up to 6 normally have barrels chest
A)true
B)false

A

451

In some children, "Harrison groove" occurs normally. This is a horizontal groove in the rib cage at the level of the insertion of the diaphragm, extending from the sternum to the midaxillary line.
A)true
B)false

A

452

In some children, ____________" occurs normally. This is a horizontal groove in the rib cage at the level of the insertion of the diaphragm, extending from the sternum to the midaxillary line

"Harrison groove

453

Harrison groove also occurs with rickets from the pull of the diaphragm on weakened ribs.
A)true
B)false

A

454

The newborn's first respiratory assessment is part of the Apgar scoring system to measure the successful transition to extrauterine life.
A)true
B) false

A

455

The five standard parameters are scored at 1 minute and at 5 minutes after birth. A 1-minute Apgar with a total score of 7 to lO indicates a newborn in good condition, needing only suctioning of the nose and mouth and otherwise routine care.
A)true
B)false

A

456

In the immediate newborn period, depressed respirations are due to maternal drugs, interruption of the uterine blood supply, or obstruction of the tracheobronchial tree with mucus or fluid.
A)true, abnormal finding
B)false, abnormal finding

A

457

A 1-minute Apgar score with a total score of 3 to 6 indicates a moderately depressed newborn needing more resuscitation and subsequent close observation.
A)true
B)false

A

458

A score of 0 to 2 indicates a severely depressed newborn needing full resuscitation, ventilatory assistance, and subsequent intensive care.
A)true
B)false

A

459

The infant breathes through the nose rather than the mouth and is an obligate nose breather until 3 months. Slight flaring of the lower costal margins may occur with respirations, but normally no flaring of the nostrils and no sternal retractions or intercostal retractions occur.
A)true
B)false

A

460

The diaphragm is the newborn's major respiratory muscle. Intercostal muscles are not well developed. Thus you observe the abdomen bulge with each inspiration but see little thoracic expansion.
A)true
B)false

A

461

diaphragm is the newborn's major respiratory muscle. Intercostal muscles are not well developed. Thus you observe the abdomen bulge with each inspiration but see little thoracic expansion.
A)true
B)false

A

462

Marked retractions of sternum and intercostal muscles indicate increased inspiratory effort, as in atelectasis, pneumonia, asthma, and acute airway obstruction.
A)abnormal finding in an infant or child
B)false

A

463

Count the respiratory rate for 1 full minute. Normal rates for the newborn are 30 to 40 breaths per minute but may spike up to 60 per minute. Obtain the most accurate respiratory rate by counting when the infant is asleep, because infants reach rapid rates with very little excitation when awake.
A)ture
B)false

A

464

Normal rates for the newborn are 30-40 breaths per minute but may spike up to 60 per minute. most accurate respiratory rate by counting when the infant is asleep, because infants reach rapid rates with very little excitation when awake.
A)true
B)false

A

465

The infants respiratory pattern may be irregular when extremes in room temperature occur or with feeding or sleeping.
A)true
B)false

A

466

Brief periods of apnea less than 10-15 seconds are common. This periodic breathing is more common in premature infants.
A)true
B)false

A

467

Rapid respiratory rates accompany pneumonia, fever, pain, heart disease, and anemia.
A)true
B)false

A

468

In an infant, tachypnea of 50 to 100 per minute during sleep may be an early sign of heart failure.
A)true
B)false

A

469

Palpate symmetric chest expansion by encircling the infant's thorax with both hands. Further palpation should yield no lumps, masses, or crepitus, although you may feel the costochondral junctions in some normal infants.
A)true
B)false

A

470

costochondral junctions in some normal infants.are palatable
A)true
B)false

A

471

Asymmetric of infant chest expansion occurs with diaphragmatic hernia or pneumothorax.
A)true
B)false

A

472

Crepitus is palpable around a fractured clavicle, which may occur with difficult forceps delivery.
A)true
B)false

A

473

Percussion is of limited usefulness in the newborn and especially in the premature newborn because the adult's fingers are too large in relation to the tiny chest. The percussion note of hyperresonance occurs normally in the infant and young child because of the relatively thin chest wall. Anything less than hyperresonance would have the same clinical significance as dullness in the adult. If measured, diaphragmatic excursion measures about one to two rib interspaces in children.
A)true
B)false

A

474

Auscultation normally yields bronchovesicular breath sounds in the peripheral lung fields of the infant and young child up to age 5 to 6 years. Their relatively thin chest walls with underdeveloped musculature do not damp off the sound as do the thicker walls of adults, so breath sounds are louder and harsher.
A)true
B)false

A

475

Auscultation normally yields bronchovesicular breath sounds in the peripheral lung fields of the infant and young child up to age 5 to 6 years. thin chest walls with underdeveloped musculature do not damp off the sound, so breath sounds are louder and harsher.
A)true
B)false

A

476

Diminished breath sounds occur with pneumonia, atelectasis, pleural effusion, or pneumothorax.
A)abnormal finding in infant and children
B)normal finding

A

477

Fine crackles are the adventitious sounds commonly heard in the immediate newborn period from opening of the airways and clearing of fluid. Because the newborn's chest wall is so thin, transmission of sounds is enhanced and sound is heard easily all over the chest, making localization of breath sounds a problem.
A)true
B)false

A

478

Persistent fine crackles that are scattered over the chest occur with pneumonia, bronchiolitis, or atelectasis.
A)abnormal finding for infant and children
B)normal finding

A

479

Even bowel sounds are easily heard in the chest. Try using the smaller pediatric diaphragm endpiece, or place the bell over the infant's interspaces and not over the ribs. Use the pediatric diaphragm on an older infant or toddler.
A)true
B)false

A

480

Crackles only in upper lung fields occur with cystic fibrosis; crackles only in lower lung fields occur with heart failure.
A)abnormal finding in infant and children
B)normal finding in infant and children

A

481

Crackles only in upper lung fields occur with cystic fibrosis;
A)abnormal finding in infant and children
B)normal finding in infant and children

A

482

crackles only in lower lung fields occur with heart failure.
A)abnormal finding in infant and children
B)normal finding in infant and children

A

483

Expiratory wheezing occurs with lower airway obstruction (e.g., asthma or bronchiolitis). When unilateral, it may be foreign body aspiration.
A)abnormal finding in infant or children
B)normal finding in infant or children

A

484

Persistent peristaltic sounds with diminished breath sounds on the same side may indicate diaphragmatic hernia.
A)abnormal finding in infant or children
B)normal finding in infant or children

A

485

Stridor is a high-pitched inspiratory crowing sound heard without the stethoscope, occurring with upper airway obstruction (e.g., croup, foreign body aspiration, or acute epiglottitis).
A)abnormal finding in infant or children
B)normal finding in infant or children

A

486

DEVELOPMENTAL COMPETENCE
The Pregnant Woman

,

487

The thoracic cage may appear wider and the costal angle may feel wider than in the nonpregnant state. Respirations may be deeper, although this can be quantified only with pulmonary function tests.
A)pregnant woman
B)aging adult

A

488

In a pregnant woman, The thoracic cage may appear wider and the costal angle may feel wider than in the nonpregnant state. Respirations may be deeper, although this can be quantified only with pulmonary function tests.
A)true
B)false

A

489

DEVELOPMENTAL COMPETENCE
The Aging Adult

,

490

The chest cage commonly shows an increased anteroposterior diameter, giving a round barrel shape, and kyphosis or an outward curvature of the thoracic spine
A)aging adult
B) infant

A

491

Aging adult, barrel chest, kyphosis and increase in thoracic curvature
A)true
B)false

A

492

The person compensates by holding the head extended and tilted back.in kyphosis
A)aging adult
B)infant

A

493

You may palpate marked bony prominences because of decreased subcutaneous fat.
A)aging adult
B)infant

A

494

Chest expansion may be somewhat decreased with the older person, although it still should be symmetric. The costal cartilages become calcified with aging, resulting in a less mobile thorax.
A)true
B)false

A

495

The older person may fatigue easily, especially during auscultation when deep mouth breathing is required. Take care that this person does not hyperventilate and become dizzy. Allow brief rest periods or quiet breathing. If the person does feel faint, holding the breath for a few seconds will restore equilibrium.
A)aging adult
B)infant

A

496

If the person does feel faint, holding the breath for a few seconds will restore equilibrium.
A) aging adult
B)infant

A

497

DEVELOPMENTAL COMPETENCE
The Acutely Ill Person

,

498

Ask a second examiner to hold the person's arms and to support him or her in the upright position. If no one else is available, you need to roll the person from side to side, examining the uppermost half of the thorax. This obviously prevents you from comparing findings from one side to another.
A)true
B)false

A

499

Also, side flexion of the trunk alters percussion findings because the ribs of the upward side may flex closer together.
A)true
B)false

A

500

side flexion of the trunk alters percussion findings
A)true
B)false

A

501

PROMOTING A HEALTHY LIFESTYLE: ENVIRONMENTAL TOBACCO SMOKE (ETS) Secondhand Smoke-
There Is No Risk-Free Level of Exposure!

,

502

Secondhand smoke, also referred to as environmental tobacco smoke (ETS), is a mixture of sidestream and mainstream smoke.
A)true
B)false

A

503

Sidestream smoke is the smoke given off at the burning end of a tobacco product, whereas mainstream smoke is the smoke exhaled from the individual smoking the tobacco product
A)true
B)false

A

504

increases an adult's risk for cancer and heart disease.
A)true
B)false

A

505

Cotinine levels are consistently higher in African Americans than in whites and Mexican Americans.
A)true
B)false

A

506

ABNORMAL FINDINGS ---·

,

507

Configurations of the Thorax

,

508

The thorax has an elliptical shape with an anteroposteriorto-transverse diameter of 1:2 or 5 :7. This is

Normal Adult (for Comparison)

509

Note equal anteroposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.
A)Barrel Chest
B)Pectus Excavatum

A

510

A markedly sunken sternum and adjacent cartilages (also called funnel breast). Depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticeable on inspiration. Congenital, usually not symptomatic. When severe, sternal depression may cause embarrassment and a negative self-concept. Surgery may be indicated.
A)Pectus Excavatum
B)Pectus Carinatum

A

511

A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast). Less common than pectus excavatum, this minor deformity requires no treatment. If severe, surgery may be indicated.
A) Pectus Carinatum
B)pectus exactum

A

512

A lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. Note unequal shoulder and scapular height and unequal hip levels, rib interspaces Aared on convex side. More prevalent in adolescent age-groups, especially girls. Mild deformities are asymptomatic. If severe (>45 degrees) deviation is present, __________ may reduce lung volume and then person is at risk for impaired cardiopulmonary function. Primary impairment is cosmetic deformity, negatively affecting self-image. Refer early for treatment, often surgery.
A)Scoliosis
B)kyphosis

A

513

An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. Severe deformities impair cardiopulmonary function. If the neck muscles are strong, compensation occurs by hyperextension of head to maintain level of vision.
A)Kyphosis
B)scoliosis

A

514

___________has been associated with aging, especially the familiar "dowager's hump" of postmenopausal osteoporotic women. However, it is common well before menopause. It is related to physical fitness; women with adequate exercise habits are less likely to have kyphosis.

Kyphosis

515

Respiratory Patterns*

,

516

Rate-10 to 20 breaths per minute
Depth-500 to 800 mL
Pattern-even
The ratio of pulse to respirations is fairly constant, about 4:1. Both values increase as a normal response to exercise, fear, or fever. Depth-air moving in and out with each respiration.
This what finding of respirations

Normal Adult (for Comparison)

517

Depth-500 to 800 mL
The ratio of pulse to respirations is fairly constant, about 4:1. Both values increase as a normal response to exercise, fear, or fever.
A)true for normal respiration
B)false

A

518

'Assess the
(1) rate,
(2) depth (tidal volume), and
(3) pattern.
All for respirations
A)true
B)false

A

519

Occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli. Frequent sighs may indicate emotional dysfunction. Frequent sighs also may lead to hyperventilation and dizziness.
A) Sigh
B)tachypena

A

520

Rapid, shallow breathing. Increased rate, >24 per minute. This is a normal response to fever, fear, or exercise. Rate also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons.

Tachypnea

521

Increase in both rate and depth. Normally occurs with extreme exertion, fear, or anxiety. Also occurs with diabetic ketoacidosis (Kussmaul respirations), hepatic coma, salicylate overdose (producing a respiratory alkalosis to compensate for the metabolic acidosis), lesions of the midbrain, and alteration in blood gas concentration (either an increase in C02 or a decrease in oxygen). _____________ blows off C02, causing a decreased level in the blood (alkalosis).
A)Hyperventilation
B)tachypena
C)hypoventilation

A

522

Slow breathing. A decreased but regular rate (

Bradypnea

523

An irregular shallow pattern caused by an overdose of narcotics or anesthetics. May also occur with prolonged bedrest or conscious splinting of the chest to avoid respiratory pain.
A) Hypoventilation
B)hyperventilation

A

524

A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. The breathing periods last 30 to 45 seconds, with periods of apnea (20 seconds) alternating the cycle. The most common cause is severe heart failure; other causes are renal failure, meningitis, drug overdose, and increased intracranial pressure. Occurs normally in infants and aging persons during sleep.
A) Cheyne-Stokes Respiration
B)Bradypena

A

525

Occurs normally in infants and aging persons during sleep.
A) Cheyne-Stokes Respiration
B)Bradypena

A

526

Similar to Cheyne-Stokes respiration, except that the pattern is irregular. A series of normal respirations (three to four) is followed by a period of apnea. The cycle length is variable, lasting anywhere from 10 seconds to 1 minute. Seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis
A)Biot's Respiration
B)tachypena
C)both a and b

A

527

Normal inspiration and prolonged expiration to overcome increased airway resistance. In a person with chronic obstructive lung disease, any situation calling for increased heart rate (exercise) may lead to dyspneic episode (air trapping), because then the person does not have enough time for full expiration.
A)Chronic Obstructive Breathing
B)tachypena

A

528

Abnormal Tactile Fremitus

,

529

_________Tactile Fremitus Occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium for vibrations (e.g., compression or consolidation [pneumonia]). There must be a patent bronchus and consolidation must extend to lung surface for increased fremitus to be apparent.

Increased

530

____________Tactile Fremitus Occurs when anything obstructs transmission of vibrations (e.g., an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema). Any barrier that gets in the way of the sound and your palpating hand decreases fremitus.

Decreased

531

Decrease Tactile Fremitus Occurs when an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema.
A)true
B)false

A

532

compression or consolidation [pneumonia]. also there must be a patent bronchus and consolidation must extend to lung surface for increased fremitus to be apparent.
A)true
B)false

A

533

________Fremitus Vibration felt when inhaled air passes through thick secretions in the larger bronchi. This may decrease somewhat by coughing.
A)Rhonchal
B)increase
C)decrease

A

534

_________ Produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid. Then the opposing surfaces make a coarse grating sound when rubbed together during breathing. Although this sound is best detected by auscultation, it may sometimes be palpable and feels like two pieces of leather grating together. It is synchronous with respiratory excursion. Also called a palpable friction rub.
A)Pleural Friction Fremitus
B)fremitusitis

A

535

Adventitious Lung Sounds

,

536

Discontinuous Sounds are discrete, crackling sounds.
A)true
B)false

A

537

Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing; you can simulate this sound by rolling a strand of hair between your fingers near your ear or by moistening your thumb and index finger and separating them near your ear
A)Crackles-fine (formerly called rales)
B)Crackles-coarse (Coarse rales)

A

538

Late inspiratory crackles occur with restrictive disease: pneumonia, heart failure, and interstitial fibrosis
A)Crackles-coarse (coarse rales)
B)Crackles-fine (formerly called rales)

B

539

Early inspiratory crackles occur with obstructive disease: chronic bronchitis, asthma, and emphysema
A)Crackles-coarse (coarse rales)
B)Crackles-fine (formerly called rales)

B

540

Posturally induced crackles (PICs) are fine crackles that appear with a change from sitting to the supine position or with a change from supine to supine with legs elevated
A)Crackles-coarse (coarse rales)
B)Crackles-fine (formerly called rales)

B

541

Loud, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but will reappear shortly- sounds like opening a Velcro fastener
Clinical ex;Pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill who have a depressed cough reflex
A)Crackles-coarse (coarse rales)
B)Atelectatic crackles (atelectatic rales)

A

542

Sounds like fine crackles but do not last and are not pathologic; disappear after the first few breaths; heard in axillae and bases (usually dependent) of lungs.
Clinical ex;In aging adults, in bedridden persons, or in persons just aroused from sleep
A)Atelectatic crackles (atelectatic rales)
B)Pleural friction rub

A

543

A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces o f leather are being rubbed together; sounds just like crackles, but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory
Clinical ex;Pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae)
A)Pleural friction rub
B)Wheeze-high-pitched (sibilant)

A

544

Adventitious Lung Sounds-cont'd

,

545

Continuous Sounds are connected, musical sounds.
A)true
B)false

A

546

High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord ); predominate in expiration but may occur in both expiration and inspiration.
Clinical ex;Diffuse airway obstruction from acute asthma or chronic emphysema
A)Wheeze-high-pitched (sibilant)
B)Wheeze-low-pitched (sonorous rho nchi )

A

547

Low-pitched; monophonic single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing
Clinical ex;Bronchitis, single bronchus obstruction from airway tumor
A)Wheeze-low-pitched (sonorous rhonchi )
B)Stridor

A

548

High-pitched, monophonic, inspiratory, crowing sound, louder in neck than over chest wall
Clinical ex;Croup and acute epiglottitis in children, and foreign inhalation, obstructed airway m pay be life-threatening
A)Stridor
B)Wheeze-low-pitched (sonorous rhonchi )

A

549

ABNORMAL FINDINGS FOR
ADVANCED PRACTICE

,

550

Voice Sounds

,

551

Ask the person to repeat " ninety- nine" while you listen with the stethoscope over the chest wall; listen especially if you suspect pathology
A)Bronchophony
B)Egophony

A

552

Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said.
A)Bronchophony
B)egochony

A

553

Pathology that increases lung density will enhance transmission of voice sounds; you auscultate a clear " ninety-nine" The words are more distinct than normal and sound close to your ear
A)abnormal Bronchophony
B)Egophony

A

554

(Greek: " the voice of a goat") Auscultate the chest whi le the person phonates a long "ee-ee-ee-ee" sound
A)Egophony
B)Whispered Pectoriloquy

A

555

Normally, you should hear "eeeeeeee" through your stethoscope
A)Egophony
B)Whispered Pectoriloquy

A

556

Over area of consolidation or compression, the spoken "eeee" sound changes to a bleating long "aaaaa" sound.
A)Egophony
B)Whispered Pectoriloquy

A

557

Ask the person to whisper a phrase like " one-two-three" as you auscultate
A)Whispered Pectoriloquy
B)pain

A

558

The no rmal response is faint, muffled, and almost inaudible
A)Whispered Pectoriloquy
B)false

A

559

With only small amounts of consolidation, the whispered voice is transmitted very clearly and distinctly, although still somewhat faint; it sounds as if the person is whispering right into your stethoscope, " one-two-three"
A)abnormal Whispered Pectoriloquy
B)abnormal Egophony

A

560

Assessment of Common
Respiratory Conditions

,

561

Inspection: Anteroposterior

Normal Lung (for comparison)

562

Condition Collapsed shrunken section of alveoli or an entire lung as a result of
(1) airway obstruction (e.g., the bronchus is completely blocked by thick exudate, aspirated foreign body, or tumor), the alveolar air beyond it is gradually absorbed by the pulmonary capillaries, and the alveolar walls cave in;
(2) compression o n the lung; and
(3) lack of surfactant (hyaline membrane disease).

Atelectasis (Collapse)

563

Inspection: Cough Lag on expansion on affected side. Increased respiratory rate and pulse. Possible cyanosis.
Palpation: Chest expansion decreased on affected side. Tactile fremitus decreased or absent over area. With large collapse, tracheal shift toward affected side.
Percussion: Dull over area (remainder of thorax sometimes may have hyperresonant note)
Auscultation: Breath sounds decreased vesicular or absent over area. Voice sounds variable, usually decreased or absent over affected area.
Adventitious Sounds: None if bronchus is obstructed. Occasional fine crackles if bronchus is patent.
A)Atelectasis (Collapse)
B)none

A

564

Condition Infection in lung parenchyma leaves alveolar membrane edematous and porous, so red blood cells (RBCs) and white blood cells (WBCs) pass from blood to alveoli. Alveoli progressively fill up (become consolidated) with bacteria, solid cellular debris, fluid, and blood cells, which replace alveolar air. This decreases surface area of the respiratory membrane, causing hypoxemia.
A)lobar Pneumonia
B)pneonia

A

565

Inspection: Increased respiratory rate. Guarding and lag on expansion on affected side. Children-sternal retraction, nasal flaring. Palpation: Chest expansion decreased on affected side. Tactile fremitus increased if bronchus patent, decreased if bronchus obstructed.
Percussion: Dull over lobar pneumonia.
Auscultation: Breath sou nds louder with patent bronchus, as if co ming directly from larynx. Voice sounds have increased clarity; bronchophony, egophony, whispered pectoriloquy present. Children-diminished breath sounds may occur early in pneumonia. Adventitious Sounds: Crackles, fine to medium.
A)lobar Pneumonia
B)brochlitits

A

566

Condition Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion. Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions. Sections of lu ng di stal to obstruction may be deflated. Bronchitis may be acute or chronic with recurrent productive cough. Chronic bronchitis is usually caused by cigarette smoking.
A)Bronchitis
B)lobar Pneumonia

A

567

Inspection: Hacking, rasping cough productive of thick mucoid sputum. Chronic-dyspnea, fatigue, cyanosis, possible clubbing of fingers. Palpation: Tactile frem itus normal.
Percussion: Resonant.
Auscultation: Normal vesicular. Voice sounds normal. Chronic-prolonged expiration. Adventitious Sounds: Crackles over deflated areas. May have wheeze.
A)Bronchitis
B)Emphysema

A

568

Condition Caused by destruction of pulmonary connective tissue (elastin, collagen); characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. This increases airway resistance, especially on expiration-producing a hyperinflated lung and an increase in lung volume. Cigarette smoking accounts for 80% to 90% of cases of _______.
A)Emphysema
B)Asthma (Reactive Airway Disease)

A

569

Inspection: Increased anteroposterior diameter. Barrel chest. Use of accessory muscles to aid respiration. Tripod position. Shortness of breath, especially on exertion. Respiratory distress. Tachypnea.
Palpation: Decreased tactile fremitus and chest expansion.
Percussion: Hyperresonant. Decreased diaphragmatic excursion.
Auscultation: Decreased b rea th sounds. May have prolonged expiration. Muffled heart sounds resulting from overdistention of lungs. Adventitious Sounds: Usually none; occasionally, wheeze.
A)Emphysema
B)Asthma (Reactive Airway Disease)

A

570

Condition An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus into ai rways. These factors greatly increase airway resistance, especially duri ng expiratio n, and prod uce the symptoms of wheezing, dyspnea, and chest tightness.
A)emphysema
B)Asthma (Reactive Airway Disease)

B

571

Inspection: During severe attack: increased respiratory rate, shortness of breath with audible wheeze, use of accessory neck muscles, cyanosis, apprehension, retraction of intercostal spaces. Expiration labored, prolonged. When chronic, may have barrel chest.
Palpation: Tactile fremitus decreased, tachycardia.
Percussion: Resonant. May be hyperresonan t if chronic.
Auscultation: Diminished air movement. Breath sounds decreased, with prolonged expiration. Voice sounds decreased.
Adventitious Sounds: Bilateral wheezing on expiration, sometimes inspiratory and expiratory wheezing.
A)emphysema
B)asthma

B

572

Condition Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. Effusion may contain watery capillary fluid (transudative), protein (exudative), purulent matter (empyemic), blood (hemothorax), or milky lymphatic fluid (chylothorax). Gravity settles fluid in dependent areas of thorax. Presence of fluid subdues all lung sounds.
A)Pleural Effusion (Fluid) or Thickening
B)Heart Failure

A

573

Inspection: Increased respirations, dyspnea; may have dry cough, tachycardia, cyanosis, abdominal distention.
Palpation: Tactile fremitus decreased or absent. Tracheal shift away from affected side. Chest expansion decreased on affected side. Percussion: Dull to flat. No diaphragmatic excursion on affected side.
Auscultation: Breath sounds decreased or absent. Voice sounds decreased or absent. When remainder of lung is compressed near the effusion, may have bronchial breath sounds over the compression along with bronchophony, egophony, whispered pectoriloquy.
Adventitious Sounds: None.
A)Pleural Effusion (Fluid) or Thickening
B)heart failure

A

574

Condition Pump failure with increasing pressure of cardiac overload causes pulmo nary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sacs are deflated. Pulmonary capillaries engorged. Bronchial mucosa may be swollen.
A)Heart Failure
B)emphysema

A

575

Inspection: Increased respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema, pallor in light-skinned people. Palpation: Skin moist, clammy. Tactile fremitus normal.
Percussion: Resonant.
Auscultation: Normal vesicular. Heart sounds include s3 gallop.
Adventitious Sounds: Crackles at lung bases.
A)heart failure
B)emphysema

A

576

Condition Free air in pleural space causes partial or complete lung collapse. Air in pleural space neutralizes the usual negative pressure present; thus lung collapses. Usually unilateral. ___________ can be
(1) spontaneous (air enters pleural space through rupture in lung wall,
(2) traumatic (air enters through opening or injury in chest wall), or
(3) tension (trapped air in pleural space increases, compressing lung and shifting mediastinum to t he unaffected side).
A)Pneumothorax
B)Pneumocystis jiroveci (P. carinii) Pneumonia

A

577

Inspection: Unequal chest expansion. If large, tachypnea, cyanosis, apprehension, bulging in interspaces.
Palpation: Tactile fremitus decreased or absent. Tracheal shift to opposite side (unaffected side). Chest expansion decreased on affected side. Tachycardia, decreased BP. Percussion: Hyperresonant. Decreased diaphragmatic excursion.
Auscultation: Breath sounds decreased or absent. Voice sounds decreased or absent. Adventitious Sounds: None.
A)Pneumothorax
B)Pneumocystis jiroveci (P. carinii) Pneumonia

A

578

Condition This virulent form of pneumonia is a protozoal infection associated with AIDS. The parasite P. jiroveci (P. cnrillii) is common in the United States and harm less to most people, except to the immunocompromised , in whom a diffuse interstitial pneumonitis ensues. Cysts containing the organism and macrophages form in alveolar spaces, alveolar walls thicken, and the disease spreads to bilateral interstitial infiltrates of foamy, protein-rich fluid.
A)Pneumocystis jiroveci (P. carinii) Pneumonia
B)heart disease

A

579

Inspection: Anxiety, shortness of breath, dyspnea on exertion, malaise are common; also tachypnea; fever; a dry, nonproductive cough; intercostal retractions in children; cyanosis.
Palpation: Decreased chest expansion. Percussion: Dull over areas of diffuse infiltrate. Auscultation: Breath sounds may be diminished.
Adventitious Sounds: Crackles may be present but often are absent.
A)Pneumocystis jiroveci (P. carinii) Pneumonia
B)TB

A

580

Condition Inhalation of tubercle bacilli into the alveolar wall starts:
(1) Initial complex is acute inflammatory response-macrophages engulf bacilli but do not kill them. Tubercle forms around bacilli.
(2) Scar tissue forms, lesion calcifies and shows on x-ray.
(3) Reactivation of previously healed lesion. Dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue (cheeselike).
(4) Extensive destruction as lesion erodes into bronchus, forming air-filled cavity. Apex usually has the most damage.
A)Tuberculosis
B)emphysema

A

581

Subjective
Initially asymptomatic, showing as positive skin test or on x-ray film. Progressive tuberculosis involves weight loss, anorexia, easy fatigability, low-grade afternoon fevers, night sweats. May have pleural effusion , recurrent lower respiratory infections.
A)TB
B)emphysema

A

582

Inspection: Cough initially nonproductive, later productive of purulent, yellow-green sputum, may be blood tinged. Dyspnea, orthopnea, fatigue, weakness.
Palpation: Skin moist at night from night sweats.
Percussion: Resonant initially. Dull over any effusion.
Auscultation: Normal or decreased vesicular breath sounds.
Adventitious Sounds: Crackles over upper lobes common, persist following full expiration and cough.
A)TB
B)emphysema

A

583

Condition Undissolved materials (e.g., thrombus or air bubbles, fat globules) originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels. Over 95% arise from deep vein thrombi in lower legs as a result of stasis of blood, vessel injury, or hypercoagulability. Pulmonary occlusion results in ischemia of downstream lung tissue, increased pulmonary artery pressure, decreased cardiac output, and hypoxia. Rarely, a saddle embolus in bifurcation of pulmonary arteries leads to sudden death from hypoxia. More often, small to medium pulmonary branches occlude, leading to dyspnea. These may resolve by fibrolytic activity.
A)Pulmonary Embolism
B)TB

A

584

Subjective: Chest pain, worse on deep inspiration, dyspnea.
Inspection: Apprehensive, restless, anxiety, mental status changes, cyanosis, tachypnea, cough, hemoptysis, Pao 2

B

585

Condition An acute pulmonary insult (trauma, gastric acid aspiration, shock, sepsis) damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema. Gross examination (autopsy) would show dark red, firm, airless tissue, with some alveoli collapsed, and hyaline membranes lining the d iste nded alveoli.
A)Acute Respiratory Distress Syndrome (ARDS)
B)TB

A

586

Subjective: Acute onset of dyspnea, apprehension.
Inspection: Restlessness; disorientation; rapid, shallow breathing; productive cough, thin, frothy sputum; retractions of intercostal spaces and stern um. Decreased Pao 2, blood gases show respiratory alkalosis, x- ray films show diffuse pulmonary infiltrates; a late sign is cyanosis.
Palpation: Hypotension.
Auscultation: Tachycardia.
Adventitious Sounds: Crackles, rhonchi.
A)Acute Respiratory Distress Syndrome (ARDS)
B)TB

A

587

Summary Checklist: Thorax and Lung Examination

,

588

1. Inspection
Thoracic cage
Respirations
Skin color and condition
Person's position
Facial expression
Level of consciousness
2. Palpation
Confirm symmetric expansion
Tactile fremitus
Detect any lumps, masses, tenderness
3. Percussion
Percuss over lung fields
Estimate diaphragmatic excursion
4. Auscultation
Assess normal breath sounds
Note any abnormal breath sounds lf abnormal breath sounds present, perform bronchophony, whispered pectoriloquy, egophony
Note any adventitious sounds

,

589

Assess the level of consciousness. The level of consciousness should be alert and cooperative.
A)true
B)false

A

590

EXTRA INFORMATION

,

591

The thoracic cage is defined by all the following except the:
A)sternum
B)ribs
C)costochondral junction
D)diaphragm

C

592

A patient has a nursing diagnosis of gas exchange related to alveolar–capillary membrane changes. What interventions are appropriate in this situation? Select all that apply.

Select all that apply:
A
Reduce fever
B
Increase fluids
C
Administer oxygen
D
Use an incentive spirometer
E
Facilitate deep breathing

c d e

593

A patient has a nursing diagnosis of ineffective airway clearance related to fatigue and inability to cough effectively as evidenced by respiratory rate and dyspnea. What outcome would be appropriate for this patient?

Choose one of the following
A
Breath sounds return to baseline within 1 week
B
Teach the patient cough and deep breathing techniques to perform every 2 hours
C
The patient demonstrated accurate cough and deep breathing techniques
D
The patient increases force and depth of breath to clear secretions

A

594

There are significant differences in the chest volumes of Caucasians, African Americans, and Hispanics. There are no differences in the chest volume between Caucasians and Asians.

Choose one of the following
A
True
B
False

B

595

A 66-year-old woman is brought to the ED by her daughter. The patient is cyanotic; her pulse is 117 beats/min, respirations 36 breaths/min, blood pressure 110/64, and O2 saturation 82%. What is the first nursing action?

Choose one of the following
A
Start an 18-gauge IV
B
Leave the patient and daughter so as not to overexcite them
C
Call a Code
D
Administer O2

D

596

When caring for a patient with chronic shortness of breath, fatigue is an issue. How might the nurse limit fatigue and still gather assessment information needed for daily care?

Choose one of the following
A
Use more than one nurse to gather assessment data
B
Cluster care during times when the patient is more rested
C
Use shorter assessments
D
Spread care throughout the shift to allow rest periods

B

597

The thoracic cavity contains which of the following organs? Select all that apply.

Select all that apply:
A
Stomach
B
Pancreas
C
Lungs
D
Heart
E
Most of the esophagus

C d e

598

A 78-year-old man comes to the clinic. He is pale and diaphoretic. He has smoked for 40 years. His respiratory rate is 30 breaths/min, and he has coarse crackles in all fields. Why is this patient at increased risk for pneumonia? Select all that apply.

Select all that apply:
A
At great risk for "stiff lungs," which are harder to ventilate, because of his age
B
Pooling of secretions because of decreased function of the cilia
C
Increased risk for COPD because of years of smoking
D
Decreased ability to cough up secretions because of weakened chest muscles

A B C D

599

A 26-year-old woman comes to the clinic and states, "I have a bad cold and am having trouble breathing." The nurse checks her breath sounds and hears bilateral fine crackles at the base. Of what is this finding indicative?

Choose one of the following
A
Fluid in the bronchus
B
No fluid present
C
Fluid in the bronchioles
D
Fluid in the alveoli

D

600

Pneumonia does not always cause pain on respiration nor does asthma.
A)true
B)false

A

601

A patient who just underwent hip replacement surgery reports pain at a 10 on a scale of 0 to 10 and receives 4 mg of morphine. A nurse on the orthopedic unit enters the patient's room and finds that the patient has a respiratory rate of 7 breaths/min. The patient is groggy and hard to arouse. What could be contributing to the patient's findings?

Choose one of the following
A
Opiates, which may cause hyperventilation
B
Nothing, this is normal following surgery
C
Opiates, which may cause hypoventilation
D
Anesthesia, from surgery that morning

C

602

A high-pitched crowing sound from the upper airway results from tracheal or laryngeal spasm and is called what?

Choose one of the following
A
Crackles
B
Rales
C
Wheezes
D
Stridor

D

603

A patient in the ED tells the nurse that she is having difficulty breathing at rest. What term would the nurse use in documenting this finding?

Choose one of the following
A
Anxiety
B
Tachypnea
C
Dyspnea
D
Shortness of breath

C

604

A patient reports sharp and stabbing chest pain that worsens with deep breathing and coughing. A cardiac cause to this pain is ruled out. The description of the pain is consistent with what respiratory condition?

Choose one of the following
A
Pleurisy
B
Pneumonia
C
Rales
D
Asthma

A

605

Pleurisy can follow inflammation of the parietal pleura. Patients usually describe such pain as sharp or stabbing, worsening with deep breathing or coughing.
A)true
B)false

A

606

Rales are a breath sound, not a respiratory condition.
A)true
B)false

A

607

A nurse in the operating room has a patient who just underwent gastric bypass surgery and weighs 243 kilograms. Upon extubation, the patient's oxygen saturation drops to 84% and the patient has difficulty catching her breath. What could be causing these problems?

Choose one of the following
A
Obesity, which can limit chest wall expansion and compromise breathing
B
A progressive loss of muscle function
C
Pain, which is inhibiting the patient's ability to breathe
D
Anesthesia, which is causing the patient to be more sleepy than usual

A

608

Rhonchi (also called coarse wheezes or gurgles) are lower pitched and louder sounds resulting from secretions moving around during inhalation or exhalation. They commonly accompany pneumonia.
A) true
B)false

A

609

The patient denies chest pain or discomfort, dyspnea, orthopnea, paroxysmal noctural dyspnea, cough, mucus, wheezing or tightness in chest, and decrease in functional ability. This documentation is a correct representation of normal respiratory subjective data.

Choose one of the following
A
True
B
False

A

610

A nurse is receiving report from the night shift about four patients. Which patient would the nurse see first?

Choose one of the following
A
A 23-year-old woman who had a mountain biking accident in which she suffered a neck fracture and now has numbness and tingling in her right arm
B
A 64-year-old man with COPD who is short of breath and has a respiratory rate of 32 breaths/min
C
A 29-year-old woman with a history of drug abuse and a heart rate of 124 beats/min
D
A 57-year-old woman who had surgery yesterday for a small bowel obstruction with possible wound dehiscence

B

611

What are the signs of hypoxia, which is a medical emergency? Select all that apply.

Select all that apply:
A
Retractions
B
Increased level of consciousness
C
O2 saturation of 90%
D
Cyanosis
E
Use of accessory muscles to breathe
F
Respiratory rate > 30

A. D E F

612

The upper division of the respiratory tract is where oxygenation and ventilation occur.

Choose one of the following
A
True
B
False

B

613

The _________ is formed by the right and left costal margins where they meet at the xiphoid process. It is usually 90 degrees or less.

costal angle

614

An acinus is a functional respiratory unit and consists of the bronchioles and alveoli.
A)true
B)false

A

615

An acinus is a functional respiratory unit that consists of bronchioles and alveoli.
A)true
B)false

A

616

Anterior to the chest The base of the lungs, or lower border, rests on the diaphragm.
A)true
B)false

A

617

Posteriorly, the location of the seventh cervical vertebra (C7) marks the apex of lung tissue and TI0 usually corresponds to the base of the lung.
A)true
B)false

A

618

The incidence of tuberculosis (TB) is higher in those who have recently immigrated to the United States from countries with a high endemic rate of TB including Mexico, the Philippines, Vietnam, India, and China.
A)true
B)false

A

619

With COPD, a tripod position is performed by the patient.
A)true
B)false

A

620

Symmetric Expansion,placing your warmed hands on the posterolateral chest wall with thumbs at the level of T9 or T I0.
A)true
B)false

A

621

Unequal chest expansion occurs with atelectasis, pneumonia, thoracic trauma,and pneumothorax.
A)true
B)false

A

622

Pain accompanies deep breathing when the pleurae are inflamed.
A)true
B)false

A

623

Decreased fremitus occurs when anything obstructs transmission of vibrations.
A)true
B)false

A

624

Decreased fremitus occurs with obstructed bronchus, pleural effusions, pneumothorax, emphysema.
A)true
B)false

A

625

fremitus is most prominent between the scapulae and around the sternum, sites where the major bronchi arc closest to the chest wall.
A)true
B)false

A

626

Increased fremitus occurs with compression or consolidation of lung tissue, ex:lobar pneumonia.
A)true
B)false

A

627

Resonance predominates in healthy lung tissue in the adult
A)true
B)false

A

628

Hyperresonance is found when too much air is present, as in emphysema or pneumothorax.
A)true
B)false

A

629

A dull note signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor.
A)true
B)false

A

630

A dull note signals abnormal density in the lungs ex:pneumonia, pleural effusion, atelectasis, and tumor.
A)true
B)false

A

631

Diaphragmatic Excursion. Percuss to map out the lower lung border, both in expiration and inspiration. Measure the difference.
A)true
B)false

A

632

An abnormally high level of dullness on the chest wall, as well as absence of excursion, occurs with pleural effusion and atelectasis of the lower lobes.
A)true
B)false

A

633

An abnormal high level of dullness on the chest wall in a Diaphragmatic Excursion. Test would be pleural effusion or atelectasis of the lower lobes.
A)true
B)false

A

634

Decreased or absent breath sounds occur:
A)bronchial tree is obstructed by secretions, mucous plug, or a foreign body.
B)In emphysema
C)When anything obstructs transmission of sound, such as pleurisy, pleural thickening, pneumothorax, pleural effusion.
D)all the above

D

635

_________ These are abnormal sounds caused by the collision of moving air with secretions in the tracheobronchial passageways or by the popping open of a previously deflated airway.

adventitious sounds.

636

Crackles (or rales) occur with pneumonia and pulmonary edema.
A)true
B)false

A

637

wheezes (or rhonchi) occur with asthma and emphysema.
A)true
B)false

A

638

Hypertrophy of abdominal muscles occurs with chronic emphysema.
A)true
B)false

A

639

Tense, strained, tired facies accompanies COPD.
A)true
B)false

A

640

Level of Consciousness. Abnormal finding would be,Cerebral hypoxia presents with excessive drowsiness or by anxiety, restlessness, and irritability.
A)true
B)false

A

641

Noisy breathing occurs with severe asthma or chronic bronchitis.
A)true
B)false

A

642

Unequal chest expansion occurs when part of the lung is obstructed or collapsed,pneumonia, or with guarding to avoid postoperative incisional pain, and the pain of pleurisy.
A)true
B)false

A

643

The rectus abdominis and internal intercostal muscles are used to force expiration in COPD.
A)true
B)false

A

644

Lungs are hyperinflated with chronic emphysema, resulting in hyperresonance where cardiac dullness would be expected.
A)true
B)false

A

645

Infants and Children

A

646

Rapid respiratory rates accompany pneumonia, fever, pain, heart disease, and anemia.
A)infant and children
B)aging adult

A

647

In an infant, tachypnea of 50 to 100 breaths per minute during sleep may be an early sign of congestive heart failure.
A)true
B)false

A

648

The respiration pattern may be irregular when there are extremes in room temperature or with feeding or sleeping.
A)true
B)false

A

649

Auscultation normally yields bronchovesicular breath sounds in the peripheral lung fields in the infant and young child up to age 5 or 6 years, because of the relatively thin chest wall with underdeveloped musculature.
A)true
B)false

A

650

Diminished breath sounds occur with pneumonia, atelectasis, pleural effusion, or pneumothorax.
A)infant and children
B)false

A

651

Fine crackles are the adventitious sounds commonly heard in the immediate newborn period and arc due to opening of the airways and clearing of fluid
A)true
B)false

A

652

Crackles only in upper lung fields occur with cystic fibrosis; crackles only in lower lung fields occur with heart failure.
A)true
B)false

A

653

Expiratory wheezing occurs with asthma or bronchiolitis.
A)true
B)false

A

654

Persistent peristaltic sounds with diminished breath sounds on the same side may indicate diaphragmatic hernia.
A) true
B) false

A

655

Stridor is a high-pitched inspiratory crowing sound heard without the stethoscope that occurs with croup, acute epiglottitis, or foreign body aspiration
A)true
B)false

A

656

_______is a high-pitched inspiratory crowing sound heard without the stethoscope that occurs with croup, acute epiglottitis, or foreign body aspiration

Stridor

657

The Pregnant Woman

,

658

The thoracic cage may appear wider and the costal angle may feel wider than in the nonpregnant state. Respirations may be deeper.
A)true
B)false

A

659

Surfactant: A fluid secreted by the cells of the alveoli (the tiny air sacs in the lungs) that serves to reduce the surface tension of pulmonary fluids; surfactant contributes to the elastic properties of pulmonary tissue.
A)true
B)false

A

660

Harrison's groove a horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm; seen in advanced rickets in children.
A)true
B)false

A

661

Harrison's groove, also known as Harrison's sulcus, is a horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm; It is usually caused by chronic asthma or obstructive respiratory disease. It may also appear in rickets.
A)true
B)false

A

662

the nurse assess a patient who has a costal angle greater than 90 degrees. what is the most likely cause of this finding?
A)COPD
B)pneumothroax

A

663

the nurse percusses a patient chest and feels dullness. the nurse suspect which diagnosis?
A)pneumonia
B)emphysema

A

664

a nurse hears inspiratory and expiratory wheezes bilaterally. what is the meaning of this finding.
A)narrowed airways
B)consolidation in alveoli

A

665

the examiner notes a diaphragmatic excursive of 4 cm on the right side and 8 cm on the left side. what do these finding mean?
A)the patient may have a pleural effusion
B)none

a

666

a pneumothorax will be evidenced by decreased lung sounds and changes in percussion tone on the affected side
A)true
B)False

a

667

muffled voice sounds and symmetric tactile fremitus, symmetric chest, resonant percussion tones, expansion muffled voice sounds.
A)normal assessment finding.
B)abnormal assessment finding.

A

668

functional units of the lungs:thin walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen
A)Alveoli
B)Apena

A

669

Cessation of breathing
A)apena
B)bronchophony

A

670

the spoken voice sound heard through the stethoscope, which sounds soft, muffled and indistinct over normal lung tissue.
A)bronchophony
B)bronchovesicular

A

671

the normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration.
A)bronchovesicular
B)COPD

A

672

a functional category of abnormal respiratory conditions, characterized by airflow obstruction(emphysema, chronic bronchitis)
A)COPD
B)consolidation

A

673

the soildication of portions of the lung tissue as it fills up with infectious exudate as in pneumonia
A)consolidation
B)crackles

A

674

(rales) abnormal, discontinuous, adventitious lung sounds heard on inspirations
A)Crackles
B)creptious

A

675

coarse, crackling sensations palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue
A)crepitus
B) dead space

A

676

passageway that transport air but are not available for gaseous exchange (trachea,bronchi)
A)dead space
B)fissure

A

677

the narrow crack dividing the lobes of the lungs
A)fissure
B)friction rub

A

678

a coarse, grating, adventitious lung sound heard when the pleurae are inflamed
A)friction rub
B)kussmual respirations

A

679

a type of hyperventilation that occurs with diabetic ketoacidosis
A)kussmal respiration
B)PND

a

680

sudden awakening from sleeping with SOB
A)paroxysmal noctural dyspena
B)rhonic

A

681

abnormal fluid between the layers of the pleura
A)pleural effusions
B)Rhonchi

A

682

low pitched,musical,snoring, adventitious lung sound caused by airflow obstruction from secretions
A)rhonchi
B)vescular

A

683

the soft, low pitched, normal breath sounds heard over peripheral lung fields.
A)Vesicular
B)wheeze

A

684

high-piitched, musical, squeaking, adventitious sound.
A)wheeze
B)back

A

685

the manubriosternal angle is also called ____________

angle of louis

686

the angle of louis, it is useful place to start when counting ribs because it is continuous with the 2nd ribs
A)true
B)false

A

687

absence of diaphragmatic excursion occurs with
A)plerural effusion or atelectasis of the lower lobes
B)asthma

A

688

auscultation of the breath sounds is an important component of respiratory assessment select the most accurate description of this part of the examination.
A)hold the diaphragm of the stethoscope against the chest wall;listen to one full respiration in each location, being sure to do side to side comparison.
B)flaase

A

689

select the best description of bronchovesicular breath sounds:
A)moderate pitched, inspiration equal to respirations
B)high-pitched

A

690

after examining a patient, you make the following notation:increased respiratory rate, chest exxpansion decreased on left side, dull percussion over left lower lobe, breath soouds louder with fine crackles over left lower lobe. these findings are consistent with a diagnosis of.
A)labor pneummoia
B)pleuraal effusion

A

691

upon examining a patient nails, you note that the angle of the nail base is >160 degrees and that the nail base feels spongy to palpation.these finding are consistent with.
A)chronic congenital heart disease and COPD
B)atelectasis

A

692

upon examination of a patient, you note a coarse, low-pitched sound during both inspiration and expiration.this patient complains of pain with breathing.these finding are consistent with?
A)pleural friction rub
B)palpate the chest symmetrically

A

693

when examine for tactile fremitus, it is important to.
A)palpate the chest symmetrically
B)arterial oxygen

A

694

the pulse oximeter measures
A)arterial oxygen saturation
B)observations

A

695

a pleural friction rub is best detected by
A)auscultation
B)palpation

A

696

apex of the lung is 3-4 cm above the inner third of the clavicles
A)true
B)false

A

697

base of the lung rest on the diaphragm
A)True
B)False

A

698

lateral left lung, sixth rib, midclavicular line
A)true
B)false

A

699

lateral right: fifth intercostal.
A)true
B)false

A

700

posterior apex of the lung C7?
A)true
B)false

A

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