A nursing student asked the respiratory floor nurse why the adventitious wheezing breath sounds are present in asthmatic patients. The nurse should respond:
this is an abnormal breath sound due to bronchial airways being narrowed, bronchoconstriction
this is a normal breath sound due to normal gas exchanged
this is an abnormal breath sound due to bronchial airways being dilated, bronchodilation
this is a normal breath sound due to the alveoli being fluid-filled
The Correct Answer is A
A) This is an abnormal breath sound due to bronchial airways being narrowed, bronchoconstriction: Wheezing is an abnormal breath sound characterized by a high-pitched whistling noise produced during breathing. It occurs when the bronchial airways are narrowed due to bronchoconstriction, inflammation, or mucus, common in conditions like asthma. This narrowing of the airways creates turbulent airflow, leading to the wheezing sound.
B) This is a normal breath sound due to normal gas exchange: Wheezing is not a normal breath sound and is indicative of an obstruction or narrowing in the airways. Normal breath sounds, such as vesicular breath sounds, are smooth and do not include wheezing.
C) This is an abnormal breath sound due to bronchial airways being dilated, bronchodilation: Wheezing results from airway narrowing, not dilation. Bronchodilation, which is the widening of the airways, would typically reduce or resolve wheezing rather than cause it.
D) This is a normal breath sound due to the alveoli being fluid-filled: Wheezing is related to airway narrowing rather than fluid in the alveoli. Fluid in the alveoli would more commonly cause crackles or rales, not wheezing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
A) Background: Orientation to "background" is not a standard component of the "AOX3" (alert and oriented times three) assessment. Typically, orientation assessments focus on more specific elements such as person, place, and time, rather than background information.
B) Person: Orientation to "person" means that the patient is aware of who they are. This is a key aspect of the AOX3 assessment, which checks whether the patient can identify themselves correctly.
C) Situation: While awareness of the situation or current circumstances is important, "situation" is not included in the standard AOX3 assessment. The usual components are person, place, and time.
D) Place: Orientation to "place" means the patient knows where they are. This is a critical component of the AOX3 assessment, indicating that the patient can identify their current location.
E) Time: Orientation to "time" means that the patient is aware of the current date, day of the week, and time of day. This is another essential part of the AOX3 assessment, reflecting the patient's awareness of the temporal context.
Correct Answer is D
Explanation
A. Flatness: This percussion note is typically associated with areas of high density, such as over muscle or a solid organ like the liver. In a pneumothorax, the lung tissue is not solidified, so flatness is not expected.
B. Dullness: Dullness is generally noted over fluid-filled areas or solid structures, such as a pleural effusion or a mass. In the case of a pneumothorax, where there is air in the pleural space, dullness would not be the expected finding.
C. Resonance: Resonance is the normal percussion note over healthy lung tissue. It indicates normal air-filled lung spaces. In a pneumothorax, the increased air in the pleural space causes an abnormal note.
D. Hyperresonance: This percussion note is associated with increased air in the pleural space, as seen in conditions like a pneumothorax. The extra air causes a more resonant, hollow sound when percussed, distinguishing it from normal lung resonance.
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