A nurse is examining a client for tactile fremitus. The nurse should understand that what action is of primary importance when examining for tactile fremitus?

Palpate the chest symmetrically

Ask the client to cough

Use the bell of the stethoscope

instruct the client to breathe deeply

Answer and Explanation

The Correct Answer is A

A) Palpate the chest symmetrically:
Palpating the chest symmetrically is crucial when assessing tactile fremitus, as it allows the nurse to compare the intensity of vibrations felt on both sides of the chest. Tactile fremitus refers to the palpable vibrations transmitted through the bronchopulmonary system when a person speaks or breathes. Symmetrical palpation ensures that the nurse can detect any differences in fremitus, which may indicate abnormalities such as lung consolidation (e.g., pneumonia), pleural effusion, or pneumothorax. Uneven fremitus can suggest a pathological condition, and symmetrical palpation helps identify these variations.

B) Ask the client to cough:
Asking the client to cough is not directly related to the assessment of tactile fremitus. Coughing may be used in other aspects of the respiratory assessment (e.g., to clear secretions or to assess for a productive cough), but it is not necessary for palpating fremitus. Tactile fremitus is assessed while the client is speaking (e.g., repeating the phrase "ninety-nine") or breathing, not coughing.

C) Use the bell of the stethoscope:
The bell of the stethoscope is used for auscultating low-pitched sounds, such as heart murmurs or some lung sounds (e.g., certain adventitious sounds like crackles or wheezes). However, it is not used for palpating tactile fremitus, which is a physical exam technique that involves using the hands to feel for vibrations. Fremitus is a tactile (not auscultatory) finding, so the stethoscope, whether bell or diaphragm, is not relevant in this assessment.

D) Instruct the client to breathe deeply:
While it is important for the client to breathe deeply during a lung exam, deep breathing is not directly required for assessing tactile fremitus. Tactile fremitus is typically assessed while the client is speaking. When the client repeats a phrase like "ninety-nine," vibrations are transmitted through the chest wall, and the nurse can assess the intensity of the vibrations. Deep breathing would be more relevant for assessing breath sounds or the general respiratory effort.

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Correct Answer is A

Explanation

A) The atria contract toward the end of diastole and push the remaining blood into the ventricles:
This is the correct definition of the atrial kick. The atrial kick refers to the contraction of the atria just before the ventricles contract, which occurs late in diastole. During this phase, the atria contract to push the remaining blood into the ventricles, ensuring that the ventricles are as filled as possible before the next ventricular contraction. This action contributes to about 20–30% of the ventricular filling, especially important in situations where the heart rate is fast, as there may be less time for passive filling during diastole.

B) Contraction of the atria at the beginning of diastole can be felt as a click:
This statement is incorrect. Atria contract at the end of diastole, not the beginning. The atrial contraction is not typically felt as a "click." If there is a "click" sound, it could indicate an abnormal heart valve sound, such as from a mitral valve prolapse, rather than the normal atrial contraction. The atrial kick itself is not associated with any audible click but may be heard as part of the S4 heart sound, especially in conditions with stiff ventricles (such as hypertension or heart failure).

C) The ventricles contract during systole and attempt to push against closed atria:
This is not an accurate description of the atrial kick. During systole, the ventricles contract and push blood into the aorta and pulmonary artery through the open semilunar valves, not against the atria. The atrial kick is a part of diastole, not systole, and involves the atria pushing blood into the ventricles, not the ventricles pushing against the atria.

D) Atrial kick is the pressure exerted against the atria as the ventricles contract during systole:
This description is incorrect. The atrial kick occurs when the atria contract near the end of diastole, not during systole. During systole, the ventricles contract and pump blood out of the heart, but this is not related to the atrial kick. Instead, the atrial kick is the contribution of atrial contraction to the final phase of ventricular filling, just before the ventricles contract.

A. Fifth intercostal space, midaxillary line B. Between the scapulae C. Third intercostal space, midaxillary line D. Over the lobes, posterior side

Correct Answer is B

Explanation

A) Fifth intercostal space, midaxillary line:
This is incorrect. The fifth intercostal space at the midaxillary line is a location that can be assessed for tactile fremitus, but it is not typically where fremitus is felt most intensely. Fremitus tends to be stronger near the midline structures, such as over the trachea, rather than at this lateral position, which is more peripheral.

B) Between the scapulae:
This is the correct answer. Tactile fremitus is usually most intense over the area between the scapulae and near the sternum. This is because the bronchi and trachea are located close to the chest wall in these regions, creating more intense vibrations that can be palpated during assessment. The fremitus is transmitted through the airways and is easiest to feel when the lung tissue is close to the chest wall, as in the area between the scapulae.

C) Third intercostal space, midaxillary line:
This is incorrect. The third intercostal space at the midaxillary line is not typically the site where tactile fremitus is most prominent. This area is more peripheral, and fremitus tends to be weaker here compared to regions closer to the sternum or between the scapulae where the lungs are nearer to the chest wall.

D) Over the lobes, posterior side:
This is incorrect. While tactile fremitus can be assessed over the posterior lobes of the lungs, it is not generally felt most intensely here. Fremitus is usually stronger near the midline of the chest (sternum) or between the scapulae, and tends to be weaker as you move laterally or toward the lower lobes of the lungs.

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A nurse is examining a client for tactile fremitus. The nurse should understand that what action is of primary importance when examining for tactile fremitus?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse reviewing the anatomy and physiologic functioning of the heart. The nurse should recognize that which statement best describes the atrial kick?

Correct Answer is A

Explanation

A nurse is assessing a client for tactile fremitus. The nurse should recognize that it is normal to feel tactile fremitus most intensely over which location?

Correct Answer is B

Explanation

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