After examining a patient who is in the hospital for shortness of breath, the advanced practice registered nurse (APRN) records the following respiratory examination: "There is dullness to percussion over the right lung base. Breath sounds are decreased at the right lung base with rhonchi egophony, +bronchophony, +cough." Which of the following is the most likely diagnosis?
Left-sided heart failure
Atelectasis
Pneumothorax
Pneumonia
The Correct Answer is D
A. Left-sided heart failure is incorrect because it typically presents with bilateral crackles (rales) due to pulmonary edema, not localized findings such as egophony and bronchophony. While dullness may occur, the presence of increased voice transmission findings is more specific to lung consolidation rather than fluid overload.
B. Atelectasis is incorrect because it can cause dullness to percussion and decreased breath sounds, but it usually results in decreased or absent voice sounds (not increased). Egophony and bronchophony are typically absent in atelectasis because the collapsed lung does not transmit sound effectively.
C. Pneumothorax is incorrect because it produces hyperresonance, not dullness, along with absent breath sounds and decreased fremitus. The findings described (dullness and increased voice transmission) are inconsistent with air in the pleural space.
D. Pneumonia is correct because it causes lung consolidation, which leads to dullness to percussion, decreased or bronchial breath sounds, and increased transmission of voice sounds, including egophony (“E” to “A” change) and bronchophony. The presence of rhonchi and cough further supports infection and mucus in the airways.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Headache coming and going over several days is incorrect because intermittent headaches alone are not an immediate red flag unless associated with other concerning symptoms. Many benign headaches, such as tension-type headaches, can be intermittent.
B. Fever, night sweats, and recent weight loss is correct because these systemic “red flag” symptoms may indicate a serious underlying condition, such as infection (e.g., meningitis), malignancy, or temporal arteritis. In a patient over 50 with new or unusual headache symptoms, these findings warrant urgent evaluation to rule out secondary causes.
C. Losing eyeglasses and using a borrowed pair is incorrect because vision changes due to incorrect glasses prescription are unlikely to indicate an emergent cause of headache. While it can contribute to eye strain, it is not a medical emergency.
D. Headache pain similar in nature to prior ones but less severe is incorrect because mild, familiar headaches typically do not require urgent workup, unless associated with new or alarming features (e.g., sudden onset, neurological deficits, or systemic symptoms).
Correct Answer is A
Explanation
A. Retinal detachment is correct because it often presents as sudden, painless, unilateral vision loss. Patients may describe a curtain or shadow descending over the visual field, flashes of light, or floaters. Retinal detachment is an ophthalmic emergency, as prompt surgical intervention is required to prevent permanent vision loss.
B. Corneal ulcer is incorrect because it typically causes pain, redness, tearing, photophobia, and decreased vision, not painless vision loss. Corneal ulcers are often associated with infection or trauma and are usually painful, unlike retinal detachment.
C. Acute glaucoma is incorrect because acute angle-closure glaucoma presents with sudden, severe eye pain, headache, nausea, halos around lights, and blurred vision, often with a steamy cornea and mid-dilated pupil. Vision loss is usually accompanied by significant discomfort, making it a painful condition rather than painless.
D. Uveitis is incorrect because it usually causes eye pain, photophobia, redness, and blurred vision, which are painful and inflammatory symptoms. Vision loss is not typically sudden and painless, and it may be bilateral depending on the underlying cause.
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