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NUR 2180 ANSWERED QUIZ 10 MODULES .
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NUR 2180 ANSWERED QUIZ10 MODULES
2023/2024
, Where can bronchial breath sounds be heard?
o This sound is heard over the trachea and larynx areas
What type of adventitious sound is created by narrowing of the bronchi?
o Wheezing
What does a rhonchi finding represent?
o low pitched snoring or moaning sounds heard in bronchitis
Understand what tactile fremitus assesses
o Also, the nurse can palpate for vocal (or tactile) fremitus which is
vibration that is felt when the client says something like “ninety-nine”.
The vibration should feel symmetric in intensity and decrease as you move
your hands downward over the posterior thorax. The ulnar surface of the
hand is most sensitive to the sensation of vibration but the palm can also
be used. If you feel increased fremitus over a particular area, it may
indicate consolidation such as pneumonia as sound conducts better
through a dense structure rather than a porous one. Decreased fremitus can
indicate a problem such as pneumothorax or emphysema.
Know why side-to-side pattern is used during a respiratory assessment
o Auscultation of the lungs should be performed in a systematic manner,
listening side to side, either right to left then right to left or right to left
then left to right.
o To make sure sounds are symmetrical
Know what course crackles, stridor, and wheezes are and what they sound like
o crackles (crackling and popping sounds heard in issues like pneumonia)
o stridor (high pitched, inspiratory crowing, heard with croup or upper
airway obstruction from foreign body).
, o stridor (high pitched, inspiratory crowing, heard with croup or upper
airway obstruction from foreign body).
Understand normal breath sounds and how to document that
o Auscultation of the lungs should be performed in a systematic manner,
listening side to side, either right to left then right to left or right to left
then left to right.
o Be sure to listen to the full inspiration and expiration before moving the
stethoscope to the next area so you do not miss anything. There are often
end expiratory wheezes, and you might miss them otherwise.
o Have the client breathe through their mouth as this will lead to increased
air flow. Watch for dizziness though.
o Remember where lung tissue is located, there is a small amount above the
clavicles, listen downward to about T10 posteriorly, down to the 6th rib
anteriorly, and laterally to the 8th rib.
o Consider the things that can interfere with sounds – do not listen over
clothing (even though you may see it done all the time, but it is poor
practice). If the chest is hairy, try wetting the hair to decrease the crackling
sound. Watch for the tubing bumping together, patient shivering, and your
own breathing on the tubing.
Know tracheal, bronchovesicular, vesicular lung sounds and where to find them
o The first is the bronchial (tracheal). This sound is heard over the trachea
and larynx areas. These sounds are loud, harsh, and hollow sounding and
you will note that expiration lasts longer than inspiration.
o Bronchovesicular sounds are located along both sternal borders over the
major bronchi. Here inspiration lasts as long as expiration and the sounds
are moderate in pitch and loudness.
o Vesicular breath sounds are heard over the rest of the lung’s fields.
Inspiration lasts longer than expiration here and the sounds are low
pitched and soft. This is where the smaller bronchioles and alveoli are
located. On the posterior thorax, only the bronchovesicular sounds along
, the spinal column and the vesicular sounds over the remainder of the
posterior fields should be heard.
Know what thoracic expansion assesses
o The technique of palpation is performed to determine if the lungs are
expanding symmetrically. Place your hands over the posterolateral chest
wall with your thumbs side by side on either side of the spinal column.
Push inward with the thumbs slightly to create a crease in the skin and ask
the client to take a deep breath. You should feel and see your thumbs move
apart symmetrically. This is called thoracic or chest expansion.
Know how to assess for pneumonia and emphysema
o The ulnar surface of the hand is most sensitive to the sensation of
vibration but the palm can also be used. If you feel increased fremitus over
a particular area, it may indicate consolidation such as pneumonia as
sound conducts better through a dense structure rather than a porous one.
o Decreased fremitus can indicate a problem such as pneumothorax or
emphysema.
Know how to perform the egophony test and how to determine normal and abnormal
findings with this test
o With egophony, the client repeats “e-e-e-e,” which normally will sound
like “e-e-e” through the stethoscope. However, if there is a consolidation it
removes the higher frequency sounds so you will hear more of an “a-a-a”
sound. Last, with whispered pectoriloquy, the client whispers “1-2-3”.
Normally you would hear a muffled, faint sound, more like puffs of air.
However, if there is a small consolidation, you will hear the “1-2-3” a little
more clearly or, if it large, it will be very clear, as if they are whispering
into your stethoscope directly.
Be able to recognize all the different types of sternal abnormalities
o Pectus excavatum or funnel chest (chest goes in) and pectus carninatum or
pigeon chest, when the sternum protrudes outward like a bird’s chest
(chestv pushed outward).
Understand normal and abnormalities regarding costal angle
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