A nurse is assessing the symmetry of a client's chest. The nurse should understand that which technique best confirms symmetric expansion of the chest?

Inspection of the shape and configuration of the chest during normal breathing

Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10

Percussion of the posterior chest to initiate vibration of the lung structures

Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety nine’’

Answer and Explanation

The Correct Answer is B

A) Inspection of the shape and configuration of the chest during normal breathing:
While inspecting the shape and configuration of the chest can provide important information about potential deformities or abnormalities (such as a barrel chest or scoliosis), it does not directly assess the symmetry of chest expansion. Inspection primarily focuses on the external appearance rather than the physiological movement of the chest wall during respiration. Symmetry of chest expansion requires more than visual observation; it involves assessing the movement of the chest during inhalation and exhalation.

B) Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10:
This technique is the most effective for confirming symmetric expansion of the chest. The nurse places their hands on the patient's back, with the thumbs positioned at the level of T9 or T10, and asks the patient to take a deep breath. As the patient inhales, the nurse assesses the expansion of both sides of the chest by observing whether the thumbs move apart symmetrically. This test directly evaluates the expansion of the lungs and chest wall during respiration and is the most accurate way to assess symmetry.

C) Percussion of the posterior chest to initiate vibration of the lung structures:
Percussion is a technique used to assess the underlying lung tissue and the presence of conditions like pneumonia, fluid accumulation, or air trapping. It does not directly assess the symmetry of chest expansion. While percussion may provide valuable diagnostic information about the lungs, it does not help in determining how evenly the chest is expanding during normal breathing.

D) Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety-nine":
This technique refers to vocal fremitus, where the nurse places their hands on the client's chest while the client repeats "ninety-nine." It helps assess the transmission of sound vibrations through the chest wall, which can be used to detect areas of consolidation or fluid in the lungs. However, it does not directly evaluate the symmetry of chest expansion. The vibration felt on both sides of the chest may be different in cases of lung disease, but this test does not assess the movement of the chest during breathing.

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Correct Answer is D

Explanation

A) AV node → SA node → bundle of His → Erb's Point:
This sequence is incorrect because the electrical impulse of the heart starts at the SA (sinoatrial) node, not the AV (atrioventricular) node. The SA node is the natural pacemaker of the heart, initiating the electrical signal. The correct order of conduction is SA node → AV node → bundle of His → bundle branches, and finally, the Purkinje fibers. Erb's Point is an anatomical reference point for auscultation, not part of the electrical conduction pathway.

B) Bundle of His → AV node → SA node → Erb's Point:
This sequence is also incorrect. The electrical impulse originates at the SA node, not the bundle of His. The SA node stimulates the AV node, which in turn sends the signal to the bundle of His and then to the bundle branches. This pathway is essential for coordinating the contraction of the heart muscle, starting from the atria and moving to the ventricles.

C) AV node → SA node → bundle of His → bundle branches:
This sequence is reversed and incorrect. The impulse starts at the SA node, not the AV node. The SA node fires first, sending the electrical signal to the AV node, and then the signal travels down the bundle of His, into the left and right bundle branches, and finally to the Purkinje fibers.

D) SA node → AV node → bundle of His → bundle branches:
This is the correct sequence of the electrical conduction pathway of the heart. The electrical impulse originates at the SA node (the heart's natural pacemaker), then travels to the AV node, where it is delayed to allow the atria to contract and fill the ventricles. From there, the impulse moves down the bundle of His, which splits into the left and right bundle branches, leading to the Purkinje fibers that transmit the impulse throughout the ventricles, causing them to contract. This sequence ensures proper coordination and timing of the heart's contractions.

A. Inform the client that his breast enlargement is benign, and normal for an adult male B. Recommend that he alter his diet to include fewer fats and more lean proteins C. Explain that this condition may be the result of hormonal changes, and recommend that he see his physician D. Explain that gynecomastia in men usually associated with prostate enlargement and recommend that he be screened

Correct Answer is C

Explanation

A) Inform the client that his breast enlargement is benign, and normal for an adult male:
Although gynecomastia is common and often benign, it is not always normal for adult males to experience breast enlargement. The condition can be related to various factors such as hormonal imbalances, medications, or underlying health issues. It is important not to reassure the client without further assessment, as gynecomastia may need to be evaluated by a healthcare provider to rule out any medical conditions.

B) Recommend that he alter his diet to include fewer fats and more lean proteins:
While diet can have an impact on overall health, the enlargement of the breasts in males (gynecomastia) is typically not related to fat intake. This recommendation is not appropriate for addressing the root cause of gynecomastia, which often involves hormonal changes rather than diet alone. A dietary change may not resolve the underlying condition, and medical evaluation is warranted.

C) Explain that this condition may be the result of hormonal changes, and recommend that he see his physician:
This is the most appropriate response. Gynecomastia is often caused by hormonal imbalances, particularly an imbalance between estrogen and testosterone. It can occur during puberty, in older age, or as a result of certain medications or medical conditions. The nurse should advise the client to consult a physician for further evaluation and diagnosis, as appropriate treatment depends on the underlying cause.

D) Explain that gynecomastia in men is usually associated with prostate enlargement and recommend that he be screened:
This is not accurate. While prostate issues can affect male hormones, gynecomastia is typically not directly associated with prostate enlargement. The condition is more often linked to hormonal changes involving estrogen or testosterone, not necessarily prostate problems. Recommending prostate screening would not address the underlying cause of gynecomastia and is not the most relevant next step in care.

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A nurse is assessing the symmetry of a client's chest. The nurse should understand that which technique best confirms symmetric expansion of the chest?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the sequence of the cardiac cycle. The nurse recognizes that the electrical stimulus of the cardiac cycle follows which sequence?

Correct Answer is D

Explanation

A nurse is examining a male client within normal weight range who is questioning about the cause of his enlarged breasts. Which course of action best describes how the nurse should address the client's bilateral gynecomastia?

Correct Answer is C

Explanation

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