The nurse is preparing to auscultate the lung sounds of a young adult. Which sound will the nurse expect to hear over most of the client's lungs?

Tracheal

Vesicular

Bronchovesicular

Bronchial

Answer and Explanation

The Correct Answer is B

Choice A Reason:
Tracheal sounds are harsh, high-pitched breath sounds typically heard over the trachea in the neck. They are not expected to be heard over the peripheral lung fields of a young adult during a routine lung auscultation.

Choice B Reason:
Vesicular breath sounds are the normal sounds heard over most of the lung fields. They are characterized by a soft, low-pitched, rustling sound during inhalation and are softer during exhalation. These sounds are created by air moving through the smaller airways such as the bronchioles and alveoli.

Choice C Reason:
Bronchovesicular sounds are heard over the major bronchi and are characterized by a moderate pitch and intensity. They are typically heard between the first and second intercostal spaces at the sternal border anteriorly and between the scapulae posteriorly, not over most of the lung fields.

Choice D Reason:
Bronchial breath sounds are high-pitched and louder than vesicular sounds, with a hollow quality, and are normally heard over the manubrium. If heard over the peripheral lung fields, they may indicate lung consolidation or other abnormalities.

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Correct Answer is D

Explanation

Choice a reason:
Pigeon Chest, or pectus carinatum, is a condition where the breastbone is pushed outward, and the chest appears to protrude. It is not typically associated with a barrel-shaped chest, which is characterized by a rounded and bulging appearance.

Choice b reason:
Pneumonia is an infection that inflames the air sacs in one or both lungs, which may fill with fluid or pus. While it can cause chest expansion, it does not lead to a barrel-shaped chest. The barrel-shaped chest is more indicative of a chronic condition rather than an acute infection like pneumonia.

Choice c reason:
Funnel Chest, or pectus excavatum, is a condition where the breastbone is sunken into the chest. Unlike a barrel-shaped chest, funnel chest gives the chest a depressed appearance.

Choice d reason:
COPD, or Chronic Obstructive Pulmonary Disease, is commonly associated with a barrel-shaped chest. This shape results from the chronic hyperinflation of the lungs due to obstructive lung disease, which causes the rib cage to remain expanded.

A. Refer the client for medical follow-up. B. Ask the client about a family history of cancer. C. Document the benign findings. D. Perform a random blood sugar test.

Correct Answer is A

Explanation

Choice a reason :
Referring the client for medical follow-up is the most appropriate action. Acanthosis Nigricans is often associated with insulin resistance and is a risk factor for diabetes mellitus. The client's symptoms of fatigue, thirst, and frequent urination are classic signs of diabetes. Therefore, a comprehensive medical evaluation is necessary to rule out diabetes or other underlying conditions that could be causing these symptoms.
Choice b reason
While Acanthosis Nigricans can sometimes be associated with malignancy, it is more commonly linked to insulin resistance and diabetes. The client's presenting symptoms are not typical of cancer but are indicative of diabetes. Therefore, while a family history of cancer is relevant to the client's overall health, it is not the immediate concern based on the current presentation.
Choice c reason
Documenting findings is an essential part of the nursing process; however, the presence of Acanthosis Nigricans, especially when coupled with symptoms of fatigue, thirst, and frequent urination, should not be considered benign without further investigation. These findings warrant further assessment to determine the underlying cause.
Choice d reason
Performing a random blood sugar test could be a part of the initial assessment; however, it should not replace a referral for a comprehensive medical evaluation. A random blood sugar test alone may not be sufficient to diagnose diabetes or determine the cause of the client's symptoms. A full medical follow-up will likely include blood sugar testing along with other diagnostic tests.

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The nurse is preparing to auscultate the lung sounds of a young adult. Which sound will the nurse expect to hear over most of the client's lungs?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While examining a client, the nurse observes the client's chest to be barrel-shaped. The nurse would interpret this as indicating which of the following?

Correct Answer is D

Explanation

A 45-year-old African-American client comes to the clinic complaining of fatigue, thirst, and frequent urination. During the physical exam, the nurse notices areas of linear hyperpigmentation around the neck and in the axillae (Acanthosis Nigricans). What would the nurse do next?

Correct Answer is A

Explanation

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