Question 1

A patient tells the nurse that she has smoked 2 packs of cigarettes a day for 20 years. The nurse records this as how many pack-years?

Accepted Answer

Two packs of cigarettes × 20 years = 40 pack-years. This incorrect calculation was made by dividing 20 years by 2 packs. Option B is correct if the patient smoked 1 pack per day for 20 years. Option D is correct if the patient smoked 3 packs per day for 20 years or 2 packs a day for 30 years.

Question 2

A nurse auscultates low-pitched, coarse snoring sounds in a patient's lungs during inhalation. What is the most appropriate action for the nurse to take at this time?

Accepted Answer

The sounds indicate rhonchi, or secretions in the bronchi. The first action to take is to determine if the rhonchi clear with coughing. If the rhonchi clear, there is no need to further investigate this finding. An abnormal vocal fremitus (decreased or increased vibrations) is not expected for this patient. Abnormal vocal sounds (clear and loud sounds) are not expected for this patient. An abnormal percussion tone (hyperresonance or dull) is not expected for this patient.

Question 3

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

Accepted Answer

Option A is an abnormal finding and occurs in consolidation. The abnormal finding is hearing a clear sound. Options C and D are normal findings.

Question 4

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

Accepted Answer

The stethoscope moving even slightly on chest hair can mimic the sound of crackles. Using the bell will provide inaccurate sounds, but not mimic crackles. When the patient talks during auscultation, it does interfere with data collection, but the sound is a muffled voice. Changing the position will not affect the outcome of the assessment if the initial problem remains.

Question 5

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

Accepted Answer

Bacteria usually produce sputum that is yellow or green in color. A virus usually produces a nonproductive cough. An allergy usually produces clear sputum. A fungus usually produces few symptoms. The sputum used to diagnose the fungus is obtained from tracheal aspiration rather than the patient coughing up the sputum.

Question 6

Where does a nurse expect to hear bronchovesicular lung sounds in a healthy adult?

Accepted Answer

Bronchovesicular breath sounds are normally heard over the central area of the anterior thorax around the sternal border. Vesicular breath sounds are normally heard in the lower lobes. Bronchial sounds are normally heard over the trachea. Vesicular breath sounds are normally heard in the apices of the lungs.

Question 7

A nurse notices a patient's chest wall moving in during inspiration and out during expiration. What additional assessment must the nurse perform immediately?

Accepted Answer

Chest wall moving in during inspiration and out during expiration is paradoxical chest wall movement. It can be caused by a tension pneumothorax, which increases intrathoracic pressure in the thorax, causing tracheal deviation and indicating mediastinal shift. Tension pneumothorax does not create bronchovesicular breath sounds in the lung periphery. Option C is performed when the patient has air in the subcutaneous tissue or pleural friction rub. Absent breath sounds may be found in pneumothorax, but if the patient has a tension pneumothorax, tracheal deviation is a more important sign.

Question 8

A nurse in the emergency department is assessing a patient with a moderate left pneumothorax. What does this nurse expect to find during the respiratory examination?

Accepted Answer

The air separating the lung from the chest where the nurse is auscultating creates distant to absent breath sounds. Increased fremitus occurs over lung consolidation as in lobar pneumonia or tumor. If this patient had a tension pneumothorax, the trachea would deviate to the right. Hyperresonant percussion tones are heard when the lung is overinflated as in emphysema.

Question 9

During the problem-based history, a patient reports coughing up sputum when lying on the right side, but not when lying on the back or left side. The nurse suspects this patient may have a lung abscess. What additional question does the nurse ask to gather more data?

Accepted Answer

Sputum with odor and sputum production with change of position is associated with lung abscess or bronchiectasis. Chest pain on deep breathing is associated with pleural lining irritation. Tightness in the chest is associated with asthma. Coughing up rust-colored sputum is associated with pneumonia, but coughing up blood may be associated with lung cancer.

Question 10

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

Accepted Answer

Option B is the correct technique to assess thoracic expansion. The palms of the hands are not used and hands are not placed on the lateral thorax. The thoracic level is too high and the patient does not exhale. The hands are not placed on the shoulders.

Question 11

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

Accepted Answer

Bilateral peripheral edema indicates heart failure; dyspnea occurs because the heart cannot adequately perfuse the lungs. Increased anteroposterior diameter is seen with lung hyperinflation and may be associated with emphysema. Clubbing of the fingers is associated with chronic hypoxia and may be associated with cystic fibrosis or chronic obstructive pulmonary disease. Increased tactile fremitus occurs when vibrations are enhanced and is associated with consolidation that may occur in pneumonia or tumor.

Question 12

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

Accepted Answer

Question B provides data about the severity of the dyspnea and what actions the patient has taken to cope with the dyspnea on a daily basis. Question A does not relate specifically to the patient's dyspnea. This closed question (Question C) provides data, but does not give additional facts about the patient's dyspnea. A closed question limits the amount of information gathered about the patient's dyspnea. Question D is a closed-ended question that does not collect additional data about this episode of dyspnea.

Question 13

A nurse inspects a patient's hands and notices clubbing of the fingers. The nurse correlates this finding with what condition?

Accepted Answer

Clubbing develops due to chronic hypoxemia, which occurs in chronic obstructive pulmonary disease. Pulmonary infection is acute and not associated with chronic hypoxia. Trauma to the thorax is acute and not associated with chronic hypoxia. Allergic reaction is acute and not associated with chronic hypoxia.

Question 14

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

Accepted Answer

High-pitched sounds on inspiration and exhalation are consistent with stridor. Dull sounds on percussion occur with pneumonia, pleural effusion, or atelectasis. Soft, muffled rhonchi heard over the trachea is not a description of stridor. Bubbling or rasping sounds heard over the trachea is not a description of stridor.

Question 15

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

Accepted Answer

Bronchovesicular sounds having a moderate pitch and 1:1 expiratory-versus-inspiratory ratio is a normal finding. Bronchial sounds are high pitched with a duration of 1:2 inspiration-to-expiration is the correct statement. Vesicular sounds are low pitched with a duration of 2.5:1 inspiration-to-expiration is the correct statement. Wheezes are high-pitched and have no specific duration because they are adventitious sounds.

Question 16

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

Accepted Answer

Clubbing of the fingers develops due to chronic hypoxemia, which occurs in chronic obstructive pulmonary disease. Dry, flaky skin occurs with dehydration. Hypertrophy of the nails occurs with repeated trauma. Hair loss from the scalp is alopecia, which occurs with many systemic diseases, but not chronic pulmonary disease.

Question 17

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

Accepted Answer

The fumes and chemicals from the paint may expose the patient to respiratory irritants. A baseline pulmonary assessment needs to be documented. Other patients are not at risk for pulmonary disease.

Question 18

During a history, a nurse notices a patient is short of breath, is using pursed-lip breathing, and maintains a tripod position. Based on these data, what abnormal finding should the nurse expect to find during the examination?

Accepted Answer

An increased anteroposterior diameter is consistent with emphysema. Increased tactile fremitus occurs when vibrations are enhanced and is associated with consolidation that may occur in pneumonia or tumor. Inspiratory and expiratory wheezing is associated with asthma. Tracheal deviation is associated with tension pneumothorax.

Question 19

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

Accepted Answer

The equal anteroposterior and lateral diameters of the chest indicate air trapping from enlarged or destroyed alveoli. This air trapping causes decreased to absent breath sounds on auscultation. Increased fremitus occurs when the vibrations feel enhanced. This is found when lung tissues are congested or consolidated, which may occur in patients who have pneumonia or a tumor. Dull tones may be heard in patients with pneumonia, pleural effusion, or atelectasis. Complaint of sharp chest pain on inspiration is pleuritic chest pain associated with pleural lining irritation and may occur in a patient with pleurisy or pneumonia.

Question 20

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

Accepted Answer

Vesicular breath sounds heard in peripheral lung fields are an expected finding for healthy lungs. Bronchial breath sounds are heard over the trachea. Bronchovesicular breath sounds are heard anteriorly near the sternal border first and second intercostals space. Rhonchi are adventitious sounds indicating secretions in the bronchi.

Quiz 11: Lungs and Respiratory System