The nurse is discussing Breast Self Examination (BSE) with a postmenopausal client. What instructions should the nurse give to the client about the correct time to perform BSE?

A) Both lungs are equal in size with varying numbers of lobes:
This is incorrect. The right lung is slightly larger than the left lung, as the left lung is somewhat smaller to accommodate the heart. The right lung has three lobes, while the left lung has only two lobes.

B) The diaphragm rises in the chest during inspiration:
This is incorrect. During inspiration (inhalation), the diaphragm contracts and moves downward to allow the lungs to expand and fill with air. It rises during exhalation as it relaxes and pushes air out of the lungs.

C) The left lung has two lobes to make room for the heart:
This is correct. The left lung has two lobes (upper and lower) compared to the three lobes of the right lung. The left lung is slightly smaller due to the space the heart occupies on the left side of the chest, allowing for asymmetry between the two lungs.

D) The right lung has two lobes to make room for the liver:
This is incorrect. The right lung has three lobes, not two. The liver is located lower in the abdomen and does not influence the number of lobes in the right lung. The asymmetry of the lungs is due to the position of the heart on the left side of the chest.

A) Inspection of the shape and configuration of the chest during normal breathing:
While inspecting the shape and configuration of the chest can provide important information about potential deformities or abnormalities (such as a barrel chest or scoliosis), it does not directly assess the symmetry of chest expansion. Inspection primarily focuses on the external appearance rather than the physiological movement of the chest wall during respiration. Symmetry of chest expansion requires more than visual observation; it involves assessing the movement of the chest during inhalation and exhalation.

B) Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10:
This technique is the most effective for confirming symmetric expansion of the chest. The nurse places their hands on the patient's back, with the thumbs positioned at the level of T9 or T10, and asks the patient to take a deep breath. As the patient inhales, the nurse assesses the expansion of both sides of the chest by observing whether the thumbs move apart symmetrically. This test directly evaluates the expansion of the lungs and chest wall during respiration and is the most accurate way to assess symmetry.

C) Percussion of the posterior chest to initiate vibration of the lung structures:
Percussion is a technique used to assess the underlying lung tissue and the presence of conditions like pneumonia, fluid accumulation, or air trapping. It does not directly assess the symmetry of chest expansion. While percussion may provide valuable diagnostic information about the lungs, it does not help in determining how evenly the chest is expanding during normal breathing.

D) Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety-nine":
This technique refers to vocal fremitus, where the nurse places their hands on the client's chest while the client repeats "ninety-nine." It helps assess the transmission of sound vibrations through the chest wall, which can be used to detect areas of consolidation or fluid in the lungs. However, it does not directly evaluate the symmetry of chest expansion. The vibration felt on both sides of the chest may be different in cases of lung disease, but this test does not assess the movement of the chest during breathing.