A nurse is performing a lung assessment on a client. The nurse should understand which information about lung structures?

A) Obtain a throat culture for possible streptococcal (strep) infection:
A throat culture for streptococcal infection is generally warranted when there are signs and symptoms of a bacterial infection, such as a sore throat, fever, exudate on the tonsils, or swollen lymph nodes. The description provided—involuted, granular tonsils with deep crypts—is a normal, age-related finding and not indicative of an infection. Therefore, obtaining a throat culture is unnecessary unless additional clinical signs of infection are present.

B) Continue with the assessment, looking for any other abnormal findings:
While it is always important to complete a thorough assessment and look for other abnormal findings, the specific characteristics described (involuted, granular tonsils with deep crypts) are normal, particularly in adults. This is a common finding and does not require further investigation unless accompanied by other symptoms such as pain, swelling, or visible pus, which would warrant a closer look.

C) Refer the client to their primary provider:
Referral to a primary provider is generally recommended if there are significant concerns about the tonsils, such as persistent swelling, pain, or signs of infection. However, the description provided does not suggest a pathological issue; these characteristics are typically considered normal in adults. Referral would only be necessary if additional concerning symptoms were present, such as fever, difficulty swallowing, or changes in voice.

D) No response is needed; this appearance is normal for the tonsils:
This is the correct response. Involuted (shrunken), granular tonsils with deep crypts are a normal, age-related finding, especially in adults. Over time, the tonsils tend to shrink and develop more pronounced crypts (pockets). This is part of the natural aging process and is not usually a sign of pathology. These tonsil changes are often seen in individuals who have had repeated infections or as part of the natural aging process.

A) Listening for sounds from the apex to the heart to the base of the heart: This technique is not the most effective for auscultation of heart sounds. While it may seem logical to start at the apex and move toward the base, heart sounds are best heard at specific anatomical locations where the valves are closest to the chest wall. Moving from apex to base does not follow the traditional systematic approach used to assess all heart sounds.

B) Listening to the sounds at the site where the apical pulse is heard to be the loudest: The apical pulse is typically located at the mitral area (left 5th intercostal space, midclavicular line), and while this is an important location for assessing heart sounds, it is not the recommended approach for auscultation. The nurse should listen to all the key valve areas to fully assess the heart's function and detect abnormalities such as murmurs or extra heart sounds.

C) Listening from the base of the heart across and down, then over to the apex: This approach is not systematic and may cause the nurse to miss important sounds in the other areas of the heart. The base of the heart is located at the top (around the second intercostal space), while the apex is at the bottom (left 5th intercostal space). A more structured method of auscultation is required to ensure all key areas are evaluated.

D) Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas: This is the correct technique for auscultating heart sounds. The nurse should listen over the aortic, pulmonic, tricuspid, and mitral valve areas in sequence to assess heart sounds thoroughly. Each of these areas is associated with a specific valve, and auscultation at these locations helps the nurse identify any abnormal heart sounds, such as murmurs, S3, or S4, as well as the timing of S1 and S2 heart sounds. This systematic approach ensures a comprehensive assessment of heart function.