The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? (Select All that Apply)
As the patient says a long "ee-ee ee" sound, the examiner hears a long "aaaaaa" sound.
When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said
As the patient says a long "ee-ee-ee sound, the examiner also hears a long "ee-ee-ee" sound.
As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninetynine."
Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice
Correct Answer : C,D
A. As the patient says a long "ee-ee-ee" sound, the examiner hears a long "aaaaaa" sound. - This indicates a possible consolidation in the lungs, which is abnormal.
B. When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said. - This suggests abnormal voice transmission and could indicate lung consolidation or other issues.
C. As the patient says a long "ee-ee-ee" sound, the examiner also hears a long "ee-ee-ee" sound. - This is normal, indicating clear and symmetrical transmission of voice sounds.
D. As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninety-nine." - This is also normal, as it indicates normal transmission of sound and no lung consolidation.
E. Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice. - This is normal for whispered voice sounds and is not a sign of abnormal lung findings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The ballottement test involves pressing on the knee joint to check for the presence of fluid, which can indicate joint effusion.
B. The McMurray test is used to assess for meniscal tears, not for fluid around the patella.
C. The Tinel sign is used to assess for nerve compression, not fluid accumulation.
D. The Phalen test is used to diagnose carpal tunnel syndrome, not to assess for joint effusion.
Correct Answer is A
Explanation
A. The whispered voice test is used to assess the function of Cranial Nerve VIII, which is responsible for hearing and balance. The nurse's whisper tests the auditory function of this nerve.
B. The vagus nerve is involved in swallowing, voice production, and parasympathetic functions but is not assessed by whispering.
C. This nerve controls lateral eye movement, and a whispered voice test does not assess eye movement.
D. This nerve also controls eye movement, specifically the superior oblique muscle, and is not evaluated by the whispered voice test.
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