A nurse is performing a respiratory system physical examination. To assess the resonance of voice sounds heard during auscultation of the lungs, the nurse instructs the patient to say "ee," and if the sound is heard as "ay," this is known as:
Bronchovesicular sound
Bronchophony
Normal voice resonance
Egophony
The Correct Answer is D
Choice a reason:
Bronchovesicular sounds are normal breath sounds heard over the main bronchus area and over the upper right posterior lung field. They have a medium pitch and intensity and are heard on both inspiration and expiration. Bronchovesicular sounds do not involve the change of vowel sounds during auscultation.
Choice b reason:
Bronchophony is the term used when the voice sounds are more clear and louder over the chest wall, usually indicating lung consolidation. However, it does not specifically refer to the change of vowel sounds from "ee" to "ay."
Choice c reason:
Normal voice resonance is when voice sounds heard through auscultation are muffled and indistinct. It does not involve a clear change in vowel sounds, which is what occurs with egophony.
Choice d reason:
Egophony is characterized by the change of the "ee" vowel sound to a nasal "ay" or "a" sound when auscultating the lungs. This phenomenon typically suggests lung consolidation, as might be seen with pneumonia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Discussing reactions to allergens typically focuses on environmental or food triggers that may cause allergic reactions. While it's important to understand a client's allergies, this topic is not closely related to alcohol use, which has different implications for health and lifestyle choices.
Choice B reason:
Asking about alcohol use naturally follows the discussion about cigarette smoking because both involve substance use and have potential health risks. It allows the nurse to transition smoothly from one lifestyle factor to another, which can impact the client's overall health. This approach also helps in creating a comprehensive picture of the client's habits that may contribute to or affect their current health status.
Choice C reason:
Reviewing current medications is an essential part of the health history, as it can reveal potential interactions with alcohol. However, it might be more appropriate to ask about alcohol use after discussing other lifestyle habits such as smoking, as they are more directly related. Once the client's substance use habits are established, the nurse can then discuss how these might interact with prescribed medications.
Choice D reason:
Asking about previous surgeries is important for understanding a client's medical history, but it is not directly related to the client's current lifestyle habits like alcohol use. Therefore, it would be more natural to ask about alcohol use in the context of other substance use discussions rather than after surgical history.
Correct Answer is C
Explanation
Choice a reason:
The inability of the eye to look outward, known as lateral rectus palsy, is associated with cranial nerve VI, the abducens nerve, not the oculomotor nerve. The oculomotor nerve does not control the lateral rectus muscle which governs this movement.
Choice b reason:
Myopia, or nearsightedness, is a refractive error of the eye where distant objects appear blurry while close objects can be seen clearly. It is not related to oculomotor nerve paralysis, which affects eye movements and pupil response, not the shape of the eyeball or the refractive properties of the lens.
Choice c reason:
Ptosis, or drooping of the upper eyelid, and an absence of pupillary constriction are classic signs of oculomotor nerve paralysis. The oculomotor nerve controls most of the eye's movements, including lifting the eyelid via the levator palpebrae superioris muscle and constricting the pupil through the circular muscles of the iris.
Choice d reason:
Normal eye movement would not be expected in a patient with oculomotor nerve paralysis. This nerve controls the majority of the eye's movements, so paralysis would lead to abnormal eye movement, such as the inability to move the eye upward, downward, or inward.
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