Nurs 307 Thorax/lung Assessment

Front 1

Identify and describe the pictured condition.

Back 1

Note equal anteroposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope; associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs

Front 2

Identify and describe the pictured condition.

Back 2

A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast)

Front 3

Identify and describe the pictured respiratory pattern.

Back 3

Normal adult respiratory pattern

Rate: 10-20 breaths
Depth: 500-800 mL
Pattern: Even

Front 4

Identify the 4 functions of respiratory system.

Back 4

• Supply O2 to the body for energy production
• Remove CO2 as a waste product of energy
• Maintain Homeostasis (acid base balance of arterial blood)
• Maintain Heat Exchange

Front 5

Identify the nationality that has a high incidence of TB.

Back 5

Asians

Front 6

Identify the 2 cultures that have larger chest volumes than Native Americans and Asians.

Back 6

Caucasians and African Americans

Front 7

Identify 5 possible chief complaints related to thorax/lungs.

Back 7

• Wheezing
• Difficulty breathing
• Mucous
• Chest pain (related to lungs)
• Cough

Front 8

Describe the test for tactile fremitus, including what it's for and how to do it.

Back 8

Palpable vibration, should be even on both sides.

Have pt say "99" as you move the ball of your hands over pt's front/bank in specified locations.

Front 9

Identify the purpose of percussion and how you would perform it.

Back 9

Note resonance or dullness over the lung fields

Put finger on lung fields and tap between two topmost knuckles

Front 10

Identify the 3 adventitious sounds.

Back 10

Crackles
Wheezing
Rhonchi/coarse

Front 11

Describe the following adventitious sound: crackles.

Back 11

short, crackling, popping sounds

Tip: Rice Crispies

Front 12

Describe the following adventitious sound: wheezing.

Back 12

high pitched squeak/whistle

Front 13

Describe the following adventitious sound: rhonchi.

Back 13

low-pitched hoarse sounds

Front 14

Identify the 3 special lung assessment tests.

Back 14

Bronchophony
Egophony
Whispered pectoriloquy

Front 15

Describe the test for bronchophony, including what it's for and how to do it.

Back 15

pt repeats “99" while you auscultate; should hear sound but should NOT be able to distinguish it; if you can hear 99, result is abnormal

Front 16

Describe the test for egophony, including what it's for and how to do it.

Back 16

pt repeats “ee-ee-ee-ee,” should hear “ee-ee-ee” through stethoscope; positive for egophony when E sounds like letter A

Front 17

Describe the test for whispered pectoriloquy, including what it's for and how to do it.

Back 17

pt whispers a phrase like “1-2-3", should be faint, muffled, and almost inaudible ; positive result when whisper sounds clear

Front 18

Identify the ratio of a normal chest.

Back 18

2 : 1

Front 19

tachypnea

Back 19

increased RR, rapid shallow breathing (>20 respirations per minute)

Front 20

bradypnea

Back 20

slow breathing pattern, (<10 respirations per minute)

Front 21

Cheyne-Stokes respirations

Back 21

respirations gradually wax and wane, with periods of apnea, in a regular pattern, usually a sign of a poor prognosis (Common and it’s a sign of death)

Front 22

pleural effusion

Back 22

collection of excess fluid in the intrapleural space

Front 23

pneumothorax

Back 23

free air in pleural space causes lung collapse

Front 24

tuberculosis (TB)

Back 24

positive PPD and positive CXR, very contagious, characterized by 
a productive cough in which the sputum is usually purulent and thick. Incidence is on the rise.

Front 25

bronchitis

Back 25

Inflammation of bronchi, may have partial obstruction of bronchi 
from secretions or inflammation causing constriction.

Characterized by hacking, “mucousy” wet and often productive cough.

Crackles with auscultation, usually CXR will be clear.

Front 26

pneumonia

Back 26

Infection of the lung parenchyma, alveoli become consolidated with bacteria and fluid.

Lung sounds will auscultate crackles or be diminished, especially in the bases, percussion will illicit a dull sound

Front 27

asthma

Back 27

Reactive airway disease, an allergic response or hypersensitivity to allergens, irritants, microorganisms, and exercise.

Characterized by bronchospasm, inflammation and very thick mucous production in the airways.

Most common presenting symptoms are wheezing (usually expiratory), dyspnea, chest tightness or decreased air exchange/movement, and anxiety

Front 28

Identify the locations to check for tactile fremitus posteriorly.

Back 28

Note: 5 locations bilaterally

Front 29

Identify the locations to check for percussion posteriorly.

Back 29

Note: 9 locations bilaterally

Front 30

Identify the locations to auscultate posteriorly.

Back 30

Note: 9 locations bilaterally

Front 31

Identify the locations to check for percussion and to auscultate anteriorly.

Back 31

Note: 5 locations bilaterally

Front 32

Identify the 3 components of the thoracic cage.

Back 32

Sternum (breastbone)
Ribs (12)
Thoracic vertebrae

Front 33

Identify the lobes in the right lung and left lung anteriorly.

Back 33

Right lung - 3 lobes
Left lung - 2 lobes

Front 34

Identify the lobes in the right lung and left lung posteriorly.

Back 34

Right lung - 2 lobes
Left lung - 2 lobes

Front 35

Identify the 3 reference lines for the thoracic cage.

Back 35

• Midsternal
• Midclavicular
• Axillary Line - posterior, mid and anterior axillary line

Front 36

The _______ contain the lungs.

Back 36

pleural cavities

Front 37

pleurae

Back 37

thin, slippery envelope between the lungs and chest wall; two kinds: visceral and parietal

Front 38

Identify the function of the trachea.

Back 38

transport gases between the environment and lung parenchyma

Front 39

Identify this sound.

Back 39

Wheezing

Front 40

Identify the subjective data required for a respiratory assessment. (7)

Back 40

Cough
SOB
Chest pain w/ breathing
Hx of respiratory infx
Smoking
Enviromental exposure
Self-care behaviors

Front 41

If you percuss a dull sound in the lungs, what does this mean?

Back 41

abnormal density in the lungs (like consolidation) seen with pneumonia, pleural effusion, atelectasis, and tumor

Front 42

Identify the 3 normal breath sounds.

Back 42

Bronchial
Bronchovesicular
Vesicular

Front 43

Decreased breath sounds occur due to ______.

Back 43

obstruction

Front 44

Increased breath sounds occur due to _______ because _________.

Back 44

consolidation and compression b/c it makes lungs more dense resulting in more transmission of sound

Front 45

Identify the disease/condition the following patient may have.

Pt has wet, hacking, productive cough. When you auscultate, you hear crackles, but the CXR is clear.

Back 45

bronchitis

Front 46

eupnea

Back 46

normal adult respiration

Front 47

apnea

Back 47

cessation of breathing

Front 48

consolidation

Back 48

the solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia

Front 49

Decreased fremitus occurs when _______.

Back 49

anything obstructs transmission of vibrations.

Front 50

Increased fremitus occurs with __________.

Back 50

compression or consolidation of lung tissue.

Front 51

Identify the lung borders.

Back 51

Apex - highest point

Base - lower border

Front 52

Describe the mediastinum of the thoracic cavity.

Back 52

middle section containing the esophagus, trachea, heart and
great vessels

Front 53

vertebra prominens

Back 53

most prominent bony spur at base of neck

Front 54

angle of Louis/manubriosternal angle

Back 54

articulation of the manubrium and body of the sternum; continuous with second rib

Front 55

The nurse is assessing an older adult patient who reports a decreased tolerance for exercise and that she must work harder to breathe. Which question assists the nurse in determining if these are normal changes related to aging?
a. "How old are you?"
b. "When did you first notice these symptoms?"
c. "Do you or have you ever smoked cigarettes?"
d. "How often do you exercise?"

Back 55

b. "When did you first notice these symptoms?"

Front 56

The patient's pulse oximetry reading is 89%. What is the nurse's priority action?
a. Recheck the reading with a different oximeter
b. Apply supplemental oxygen and recheck the oximeter reading in 15 minutes
c. Assess the patient for respiratory distress and recheck the oximeter reading
d. Place the patient in the recovery position and monitor frequently

Back 56

c. Assess the patient for respiratory distress and recheck the oximeter reading

Front 57

The nurse is taking a history on a patient who reports sleeping in a recliner chair at night because lying on the bed causes shortness of breath. How is this documented?
a. Orthopnea
b. Paroxysmal nocturnal dyspnea
c. Orthostatic nocturnal dyspnea
d. Tachypnea

Back 57

a. Orthopnea

Front 58

Which assessment finding is an objective sign of chronic oxygen deprivation?
a. Continuous cough productive of clear sputum
b. Audible inspiratory and expiratory wheeze
c. Chest pain that increases with deep inspiration
d. Clubbing of fingernails and a barrel-shaped chest

Back 58

d. Clubbing of fingernails and a barrel-shaped chest

Front 59

Identify the disease/condition the following patient may have.

A pt has unequal chest expansion and tactile fremitus is decreased. Per auscultation, breath sounds are decreased and when percussed, lungs were hyperresonant. There were no adventitious lung sounds.

Back 59

Pneumothorax

Front 60

Identify the disease/condition the following patient may have.

Tactile fremitus decreased and chest expansion not symmetrical. Percussion reveals dull to flat sounds with no adventitious sounds.

Back 60

Pleural effusion

Front 61

Identify the disease/condition the following patient may have.

Chest expansion not symmetrical, with lungs percussed dull. Per auscultation, crackles were heard. Also, pt had an increased RR.

Back 61

Pneumonia

Front 62

Identify the disease/condition the following patient may have.

A patient comes in with wheezing (during expiratory), shortness or breath, and anxiety.

Back 62

Asthma

Front 63

hyperresonance

Back 63

lower pitched booming sound found when too much air is present