An advanced practice registered nurse (APRN) assesses chest expansion (also known as lung excursion). Which technique by the APRN is correct?
Palpate vibrations transmitted through the chest wall with the patient saying "ninety-nine
Assess the distance between the examiner's thumbs on the thorax during inspiration
Determine the distance between the diaphragm on expiration and inspiration
Percuss the anterior and posterior thorax using a ladder pattern
The Correct Answer is B
A. Palpate vibrations transmitted through the chest wall with the patient saying "ninety-nine" is incorrect because this describes tactile fremitus, not chest expansion. Fremitus assesses the transmission of vocal vibrations through lung tissue and can indicate consolidation, effusion, or pneumothorax, but it does not measure lung excursion.
B. Assess the distance between the examiner's thumbs on the thorax during inspiration is correct because chest expansion (lung excursion) is assessed by placing the examiner’s hands with thumbs along the posterior thorax at the level of the 10th ribs, palms on the lower ribs, and fingers grasping the lateral rib cage. The APRN asks the patient to take a deep breath, and observes the distance the thumbs move apart during inspiration, which indicates lung expansion and diaphragmatic movement. This technique helps identify asymmetry or restriction in chest expansion, which may occur in conditions such as pleural effusion, pneumothorax, or atelectasis.
C. Determine the distance between the diaphragm on expiration and inspiration is incorrect because diaphragmatic excursion is assessed using percussion to measure the diaphragm’s movement, not by manual palpation of the thumbs. While related, diaphragmatic excursion is a separate assessment from chest expansion.
D. Percuss the anterior and posterior thorax using a ladder pattern is incorrect because percussion evaluates lung resonance, presence of consolidation, fluid, or air, but does not directly measure chest expansion. Percussion is an inspection of sound quality, not the mechanical movement of the chest wall.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Sound will lateralize to the patient's ears equally is incorrect because in unilateral conductive hearing loss, the Weber test does not produce equal perception. Equal hearing occurs in patients with normal hearing or symmetric sensorineural hearing loss.
B. Sound will lateralize to the patient's unaffected ear is incorrect because in conductive hearing loss, such as otitis media with a perforated eardrum, sound is perceived louder in the affected ear, not the unaffected ear. Lateralization to the unaffected ear occurs in sensorineural hearing loss.
C. Sound will lateralize to the patient's affected ear is correct because conductive hearing loss (caused by fluid, infection, or perforation) increases the perception of bone-conducted sound in the affected ear. The impaired external or middle ear reduces ambient noise interference, making the sound from the tuning fork appear louder in the affected ear during the Weber test.
D. The patient will not hear the tuning fork at all is incorrect because even with a perforated eardrum, bone conduction is still possible, and the patient will perceive the tuning fork sound during the Weber test.
Correct Answer is B
Explanation
A. Lower mandible is incorrect because the mandible (jawbone) is superior to the thyroid gland. While it serves as a general landmark for the neck, the thyroid is located lower and is not directly palpated beneath the mandible.
B. Cricoid cartilage is correct because the thyroid gland lies immediately below the cricoid cartilage, spanning the 2nd to 4th tracheal rings. When palpating the thyroid, the APRN places their fingers just below the cricoid cartilage on either side of the trachea to assess for size, nodules, and symmetry. This landmark ensures accurate palpation of the thyroid without interference from other neck structures.
C. Vocal cords are incorrect because the vocal cords are internal structures within the larynx and cannot be palpated externally. Their location is superior to the thyroid gland, and they are assessed indirectly via laryngoscopy, not manual examination.
D. Suprasternal notch is incorrect because this is inferior and medial to the thyroid gland. While it is a useful landmark for identifying the trachea and jugular notch, thyroid palpation is performed above this notch, not directly on it.
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