A nurse is performing an examination of a client's anterior thorax. The nurse should recall that the trachea bifurcates anteriorly at which location?

Suprasternal notch

Xiphoid process

Costal angle

Sternal angle

Answer and Explanation

The Correct Answer is D

A) Suprasternal notch:
This is incorrect. The suprasternal notch is a depression located at the top of the sternum, just above the manubrium. While this is an important landmark for palpating the trachea and assessing other structures in the thoracic region, it is not the point where the trachea bifurcates.

B) Xiphoid process:
This is incorrect. The xiphoid process is the small, pointed lower portion of the sternum. It is located at the inferior end of the sternum and does not play a role in the bifurcation of the trachea. The trachea bifurcates much higher in the thoracic region.

C) Costal angle:
This is incorrect. The costal angle is formed by the meeting of the costal margins of the ribs at the lower end of the ribcage. While it is an important anatomical landmark, it is not related to the bifurcation of the trachea.

D) Sternal angle:
This is the correct answer. The sternal angle (also known as the angle of Louis) is located at the junction between the manubrium and the body of the sternum, approximately at the level of the second rib. This is the anatomical landmark where the trachea bifurcates into the right and left mainstem bronchi, usually around the level of the T4 to T5 vertebrae. It is an important reference point during respiratory assessments.

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Correct Answer is B

Explanation

A) Inspection of the shape and configuration of the chest wall during normal breathing:
While inspection is an important part of the initial assessment, it is not the most effective method to confirm symmetric expansion of the chest. Inspecting the shape and configuration of the chest can reveal abnormalities, such as a barrel chest or scoliosis, but it does not directly assess the movement of the chest wall during breathing. The most reliable technique to assess for symmetric chest expansion involves palpation, not just visual inspection.

B) Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10:
This is the best technique for assessing symmetric chest expansion. The nurse places their hands with the thumbs pointing toward each other at the level of the T9 or T10 vertebrae on the patient's posterior chest wall. As the client inhales deeply, the nurse observes whether both thumbs move symmetrically outward. This test directly evaluates the expansion of the lungs and chest wall during respiration, making it the most accurate method for assessing symmetric chest movement.

C) Percussion of the posterior chest to initiate vibration of the lung structures:
Percussion is used to assess the underlying lung tissue and detect abnormalities such as fluid or air in the lungs (e.g., pneumonia, pleural effusion, or pneumothorax), but it does not assess chest expansion. Percussion helps in evaluating lung resonance but is not a direct method to confirm whether both sides of the chest are expanding symmetrically during breathing. It is a diagnostic technique, not an assessment for expansion symmetry.

D) Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety-nine":
This technique assesses for tactile fremitus, which involves feeling for vibrations as the client speaks. While it is useful in evaluating lung consolidation (such as pneumonia), it does not directly assess the symmetry of chest expansion. Tactile fremitus helps detect areas of increased or decreased vibration due to fluid or tissue changes in the lungs but does not measure how equally the chest is expanding during inhalation.

A. Lid lag when moving the eyes from a superior to an inferior position B. Nystagmus when reading the Snellen chart C. Parallel movement of both eyes D. Convergence of the eyes

Correct Answer is C

Explanation

A) Lid lag when moving the eyes from a superior to an inferior position:
This is incorrect. Lid lag refers to a delay in the movement of the eyelid as the eyes move downward. It is considered an abnormal finding and is often associated with conditions like hyperthyroidism (Graves' disease), where the eyelid does not follow the downward gaze appropriately. In the diagnostic positions test, normal eye movement should not include lid lag.

B) Nystagmus when reading the Snellen chart:
This is incorrect. Nystagmus is an involuntary, rhythmic oscillation of the eyes, which can be indicative of a neurological or vestibular issue. It is not a normal finding during the diagnostic positions test. Nystagmus may be seen with certain disorders, such as vestibular dysfunction, neurologic damage, or alcohol intoxication, but it should not occur as a normal response to eye movement during the diagnostic positions test.

C) Parallel movement of both eyes:
This is the correct answer. In a normal result of the diagnostic positions test, both eyes should move in parallel and remain aligned during all directions of gaze. The purpose of this test is to assess for any eye muscle weakness or cranial nerve dysfunction that might cause misalignment, such as strabismus or a disorder affecting the extraocular muscles. If both eyes track smoothly and simultaneously without deviation or lag, this is a normal and expected finding.

D) Convergence of the eyes:
This is incorrect. While convergence (the inward movement of both eyes toward the nose) is a normal response when focusing on a near object, it is not the specific goal of the diagnostic positions test. The diagnostic positions test is primarily concerned with assessing the ability of the eyes to move together in all directions of gaze without misalignment or abnormal movement. While convergence is a sign of normal eye function, it is not the primary focus of this particular test.

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A nurse is performing an examination of a client's anterior thorax. The nurse should recall that the trachea bifurcates anteriorly at which location?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is B

Explanation

A nurse is performing the diagnostic positions test. The nurse recognizes that normal findings from the diagnostic positions test should be which of these results?

Correct Answer is C

Explanation

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