1. Which bronchial structure(s) is (are) most susceptible to aspiration of foreign bodies? a. Left mainstem bronchus b. Terminal bronchioles c. Right
... [Show More] mainstem bronchus d. Right respiratory bronchioles e. Left respiratory bronchioles 2. When auscultating the apex of the lung, you should listen: a. even with the second rib. b. 4 cm above the first rib. c. higher on the right side. d. on the convex diaphragm sur- face. e. directly over the clavicles. 3. You are documenting a rash be- tween the eighth and ninth ribs on the lateral border. This intercostal space will be documented in terms of the: a. rib immediately above it. b. rib immediately below it. c. number of centimeters it is posi- tioned below the clavicle. d. number of inches it is positioned below the clavicle. e. relationship to the sternum. 4. To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the: a. distal point of the xiphoid. b. manubriosternal junction. c. suprasternal notch. d. acromion process. e. clavicle. ANS: C The right mainstem bronchus has a more downward slope and is less an- gled than the left bronchus. Therefore, it is more likely to be a site of aspiration and is a more likely site for endotra- cheal tubes that are advanced too far. ANS: B The apices of the lungs are 4 cm above the first rib. ANS: A The number of each intercostal space corresponds to that of the rib immedi- ately above it. ANS: B The angle of Louis, the junction of the manubrium and the sternum, corre- sponds to the second rib, the refer- ence point for counting ribs and inter- costal spaces. 5. The foramen ovale should close by: a. 24 weeks of gestation. b. the initiation of labor. c. within minutes of birth. d. 4 weeks of age. e. 12 months of age. 6. Increased oxygen tension in the ar- terial blood of a newborn infant causes: a. closure of the ductus arteriosus. b. hyperinflation of the lungs. c. passive respiratory movements. d. reopening of the foramen ovale. e. the pulmonary arteries to con- tract. 7. To accommodate the enlarging uterus of pregnancy, the chest changes result in: a. intercostal muscle atrophy. b. lowering of the resting di- aphragm. c. decreased alveoli expansion. d. decreased diaphragmatic move- ment. e. increased costal angle. ANS: C The decrease in pulmonary pressures within the first minutes of life leads to closure of the foramen ovale. ANS: A Increased oxygen tension in the arteri- al blood usually stimulates contraction and closure of the ductus arteriosus. ANS: E The costal angle progressively in- creases from around 68.5 to 103.5 degrees in later pregnancy. The rest- ing diaphragm rises, yet diaphragmat- ic movement increases, the alveolar ventilation and tidal volume increase, and the muscles do not atrophy. 8. The characteristic barrel chest of an ANS: A older adult is caused by a combina- tion of factors, including: a. skeletal changes of aging. b. increased muscular expansion of the chest wall. c. less fibrous alveoli. d. increased vital capacity. e. increased lung resiliency. Skeletal changes associated with ag- ing include an emphasis of the dorsal curve of the thoracic spine that con- tributes to a barrel chest. 9. A patient describes shortness of breath that gets worse when he sits up. Which term documents this? a. Platypnea b. Orthopnea c. Tachypnea d. Bradypnea e. Hypopnea 10. Bradypnea may accompany: a. pneumothorax. b. an excellent level of cardiovascu- lar fitness. c. ascites. d. a pulmonary embolus. e. anxiety. 11. A 34-year-old man is being seen for complaints of dull pain between the shoulder blades that is more intense with deep breathing and coughing. Upon auscultation of the chest, you suspect that you will hear: a. rhonchi. b. expiratory wheeze. c. crackles. d. pleural friction rub. e. crepitus. 12. Both pleural effusion and lobar pneumonia are characterized by percussion. a. tympany heard with b. dullness heard on c. resonance heard on d. hyperresonance heard on ANS: A Dyspnea that increases in the upright posture is called platypnea. Orthop- nea is dyspnea that worsens with lying down, tachypnea is increased respira- tory rate, and bradypnea is decreased respiratory rate. Hypopnea refers to abnormally shallow respirations. ANS: B Bradypnea, a rate slower than 12 breaths/min, may result from car- diorespiratory fitness. The other choic- es accompany tachypnea. ANS: A This patient is describing the bronchi as the source of the pain; the trachea divides at T4-5, between the shoul- der blades. The adventitious bronchial sound expected is rhonchi. Wheez- ing might be expected if the patient had productive coughing or dyspnea; a pleural friction rub usually causes sudden stabbing pain over the pleurit- ic site. Crepitus can be both palpated and heard; it indicates air in the sub- cutaneous tissue and is usually found anteriorly and toward the axilla. ANS: B Pleural effusion and lobar pneumonia are more dense than air, with an ex- pected finding of dullness to percus- sion. Tympany is expected over hol- low organs such as the stomach; reso- e. occasional hyperresonance heard on 13. In which patient situation would you expect to assess tachypnea? a. Patient with depression b. Patient who abuses narcotics c. Patient with metabolic acidosis d. Patient with myasthenia gravis e. Patient with metabolic alkalosis 14. Respiratory effort usually exhibited by the patient with cerebral brain damage is called: a. Cheyne-Stokes respiration. b. paroxysmal nocturnal dyspnea. c. Kussmaul breathing. d. Biot respiration. e. ataxic respiration. 15. Which site of chest wall retractions indicates a more severe obstruc- tion in a patient with asthma? a. Lower chest b. Along the anterior axillary line c. Above the clavicles d. At the nipple line e. Along the posterior axillary line 16. Which type of apnea requires imme- diate action? a. Primary apnea b. Secondary apnea c. Sleep apnea d. Periodic apnea of the newborn e. Apnea of prematurity nance and hyperresonance are heard over air-filled areas. ANS: C In metabolic acidosis, the body com- pensates by increasing the respirato- ry rate to blow off the excess carbon dioxide. The other choices cause res- piratory depression. ANS: A Cheyne-Stokes respirations occur in children and older adults during sleep but otherwise occur in seriously ill patients, particularly those with brain damage at the cerebral level. The oth- er choices are not apnea associated with cerebral damage. ANS: C Asthma more commonly produces re- tractions of the lower chest. The more severe the obstruction, the greater is the negative pressure produced in the chest during inspiration and retrac- tions are seen in the upper thorax. ANS: B Primary apnea is self-limiting, sleep apnea should be evaluated but does not require immediate action, and peri- odic apnea of the newborn is a normal condition. Apnea of prematurity is a more intense version of periodic ap- nea of the newborn. Secondary ap- nea is grave, and unless resuscitative measures are immediately instituted, 17. Laryngeal obstructions would elicit which breath sound? a. Fremitus b. Stridor c. Rhonchi d. Crepitus e. Wheezing 18. Breath odors may alert the exam- iner to certain underlying metabol- ic conditions. The odor of ammonia on the breath may signify: a. uremia. b. tuberculosis. c. hepatic dysfunction. d. diabetic ketoacidosis. e. intestinal obstruction. 19. You would expect to document the presence of a pleural friction rub for a patient being treated for: a. bronchitis. b. atelectasis. c. pleurisy. d. emphysema. e. pneumonia. 20. Tactile fremitus is best felt: a. along the costal margin and xiphoid process. b. in the suprasternal notch along the clavicle. c. at the level of bifurcation of the bronchi. d. posterolaterally over the scapu- breathing will not resume spontaneously. ANS: B Obstructions high in the respiratory tree are characterized by stridor. ANS A The breath smell described as ammo- nia-like suggests uremia, a renal con- dition; cinnamon suggests tuberculo- sis, a musty fish or clover odour sug- gests hepatic failure, a sweet and fruity odour suggests diabetic ketoacidosis; a foul or feculent odour suggests in- testinal obstruction. ANS: C A pleural friction rub is caused by inflammation of the pleural surfaces and is expected to be auscultated with pleurisy. ANS: C Fremitus is best felt posteriorly and laterally at the level of the bifurcation of the bronchi. There is great variability depending on the intensity and pitch of the voice and the structure and thick- ness of the chest wall. In addition, the scapulae obscure fremitus. las. e. in the midaxillary lines. 21. In the most effective percussion technique of the posterior lung fields, the patient cooperates by: a. folding the arms in front. b. bending the head back. c. standing and bending forward. d. lying on the side and extending the top arm. e. lying prone. 22. The examiner percusses for di- aphragmatic excursion along the: a. vertebral column. b. midvertebral line. c. midaxillary line. d. scapular line. e. sternum. 23. The diaphragm of the stethoscope is better than the bell for ausculta- tion of the lungs because it: a. amplifies all types of sounds. b. filters extraneous sounds. c. pinpoints focal sound areas. d. transmits high-pitched sounds. e. transmits low-pitched sounds. 24. Breath sounds normally auscultat- ed over most of the lung fields are called: a. vesicular. b. hyperresonance. ANS: A Asking the patient to sit with the head forward and arms folded in front moves the scapula laterally, exposing more lung to percussion. ANS: D The technique for diaphragmatic ex- cursion is to percuss along the scapu- lar line, after the patient inhales deeply, and to mark the site when res- onance changes to dullness, repre- senting the diaphragm. The sequence is repeated with exhalation. ANS: D Unless specially modified, the stetho- scope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does trans- mit sound waves from the source to the ear. The diaphragm is the better source because it transmits the nor- mally high-pitched sounds of the lung and has a broader area from which to listen. ANS: A The low-intensity sounds heard over most healthy lung tissue are called vesicular breath sounds. c. bronchial. d. tubular. e. bronchovesicular. 25. Breath sounds normally heard over the trachea are called: a. bronchovesicular. b. amphoric. c. crepitus. d. vesicular. e. bronchial. 26. When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because: a. consolidation will echo in the chest. b. consolidation is a poor conduc- tor of sound. c. air-filled lung sounds are from smaller spaces. d. air-filled lung tissue is an insula- tor of sound. e. consolidation causes hyperinfla- tion of the lungs. 27. The middle lobe of the right lung is best auscultated over the: a. anterior chest. b. posterior chest. c. axilla. d. midclavicular line. e. scapula. 28. To distinguish crackles from rhonchi, you should auscultate the lungs: ANS: E The highest sounds in intensity and pitch are called the bronchial sounds, which are normally heard over the tra- chea. ANS: D Whereas air is a poor conductor of sound, more dense consolidation pro- motes louder sounds and is a better conductor of sound. ANS: C The sounds of the middle lobe of the right lung are best heard in the right axilla. ANS: A To distinguish between crackles and rhonchi, ask the patient to cough and a. before and after the patient coughs. b. first at the lung base and then at the apex. c. with the patient inhaling and then exhaling. d. with the patient prone and then supine. e. with the patient recumbent and then sitting. 29. In what position can the mediasti- nal crunch (Hamman sign) be heard best? a. In a supine position b. Lying on the left side c. Sitting completely upright d. With the head elevated 30 de- grees e. In a prone position 30. Changes in clarity and volume of spoken sounds during auscultation of the lungs can help you distin- guish: a. crepitus from stridor. b. a foreign body from a purulent exudate. c. pulmonary edema from pleurisy. d. a right from left tracheal devia- tion. e. consolidation from airway con- striction. 31. How is the sputum of a viral infec- tion different from the sputum of a bacterial infection? a. There is more sputum production with viral conditions than bacterial auscultate again over the same area. Rhonchi, because they represent se- cretions in larger airways, can clear with coughing. ANS: B The Hamman sign is heard with medi- astinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side—these maneu- vers bring the heart muscle closer to the chest wall. ANS: E When chest auscultation results in de- creased breath sounds or wheezes, the examiner can use techniques that involve the spoken word to distinguish these adventitious breath sounds as a result of consolidation rather than narrowing of a patent lumen. ANS: C The more likely differentiating char- acteristic between viral and bacterial sputum is the color. Whereas viral in- fections typically produce mucoid spu- infections. b. The sputum is odorous with vi- ral conditions and nonodorous with bacterial infections. c. The sputum is yellow, green, or rust colored with bacterial infec- tions and mucoid with viral. d. The sputum is much thinner with bacterial infections and viscid with viral. e. Viral pneumonia sputum is never blood streaked. 32. A signal for alarm during newborn chest assessment is: a. crackles. b. rhonchi. c. gurgles from the gastrointestinal tract. d. stridor. e. a mobile xiphoid. 33. Bronchovesicular breath sounds in young children that are loud and harsh are an indication of: a. an accumulation of fluid. b. malignant tumors or solid mass- es. c. normal, thin chest wall struc- tures. d. pus-filled abscesses and tumors. e. tension pneumothorax. 34. The pregnant woman is expected to develop: a. tachypnea and decreased tidal volume. tum, bacterial infections produce yel- low, green, or rust-colored sputum. ANS: D Crackles and rhonchi at birth are caused by the presence of remain- ing fetal fluid; intermittent gurgles are transmitted bowel sound through the thin-walled chest and are not alarm- ing; stridor is alarming at any age. The newborn's xiphoid process is more mobile and prominent than in older children. ANS: C Young children's chest walls are usu- ally thin and therefore able to nor- mally transmit loud, harsh, and more bronchial breath sounds than can adults. ANS: B In pregnant women, tidal volume and vital capacity increase, and function- al residual capacity decreases. Also, b. deep breathing but not more fre- quent breathing. c. dyspnea and increased function- al residual capacity. d. bradypnea and increased tidal volume. e. tachypnea and increased func- tional residual capacity. 35. Which condition requires immedi- ate emergency intervention? a. Patient with pleuritic pain without dyspnea b. Patient with fever and a produc- tive cough c. Patient with tachypnea but no chest retractions d. Patient with pleuritic pain and rib tenderness e. Patient with absent breath sounds and dull percussion tones 36. Epiglottitis has frequently associat- ed with infection by which organ- ism? a. Respiratory syncytial virus b. Haemophilus influenzae type B c. Adenovirus d. Parainfluenza virus e. Human metapneumovirus pregnant women breathe more deeply but not more frequently. ANS: A A patient who experiences unexpect- ed pleuritic pain without prior respira- tory distress or dyspnea has most like- ly developed a pulmonary embolism, a condition with a high mortality rate. ANS: B Epiglottitis is an acute inflammation of the epiglottis caused by bacterial in- vasion. Immunization against the bac- terium Haemophilus influenzae type B has greatly reduced the incidence in the United States. All of the other choices are viruses associated with bronchiolitis. [Show Less]