The nurse suspects a client has a pneumothorax. Which combined physical examination finding supports this suspicion?
Dullness and bronchial breath sounds
Hyperresonance and decreased breath sounds
Resonance and wheezing
Tympany and fine crackles
The Correct Answer is B
Choice A reason: Dullness on percussion is indicative of increased tissue density or fluid, such as in lobar pneumonia, a pleural effusion, or a solid tumor. Bronchial breath sounds heard in the periphery also suggest consolidation. In a pneumothorax, the pleural space is filled with air rather than fluid or solid mass, making these findings inconsistent with the pathology.
Choice B reason: A pneumothorax involves the accumulation of air in the pleural space, which causes the underlying lung to collapse. On percussion, this excess air produces hyperresonance, a lower-pitched, booming sound. Because the lung is collapsed and separated from the chest wall by an air pocket, breath sounds are significantly diminished or entirely absent upon auscultation.
Choice C reason: Resonance is the characteristic sound of healthy, air-filled lung tissue during percussion. Wheezing is an adventitious sound caused by airway narrowing, typically associated with reactive airway diseases like asthma or COPD. Since a pneumothorax represents a structural collapse rather than simple airway constriction, normal resonance would not be present over the affected area.
Choice D reason: Tympany is a high-pitched, drum-like sound normally heard over air-filled viscera like the stomach, but it is not a standard finding over the thorax. Fine crackles are typically associated with the opening of collapsed alveoli due to fluid, as seen in heart failure or interstitial lung disease, rather than a gross pleural air collection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Increasing Low-Density Lipoprotein (LDL) levels is detrimental to cardiovascular health, as LDL is the primary carrier of cholesterol that contributes to plaque formation. Effective weight management aims to decrease LDL and increase High-Density Lipoprotein (HDL) to minimize the risk of atherosclerosis and subsequent coronary artery disease.
Choice B reason: Weight management does not reduce the need for physical activity; rather, regular exercise is a fundamental component of maintaining a healthy weight. Suggesting that weight loss negates the need for activity is medically inaccurate and counterproductive to improving overall cardiovascular endurance and metabolic efficiency.
Choice C reason: Promoting the buildup of fatty deposits, or atherogenesis, is the primary mechanism of heart disease. Weight management is intended to prevent this process by reducing circulating triglycerides and cholesterol, thereby maintaining the patency of the coronary arteries and ensuring adequate myocardial perfusion and oxygenation.
Choice D reason: Reduction in adipose tissue leads to decreased systemic vascular resistance and lower circulating blood volume, which directly reduces blood pressure. This alleviation of afterload decreases the workload and oxygen demand of the myocardium, effectively reducing heart strain and the risk of developing hypertensive heart disease.
Correct Answer is B
Explanation
Choice A reason: Asymmetrical chest expansion is typically associated with structural or pleural pathologies, such as a pneumothorax, large pleural effusion, or fractured ribs. Kussmaul's respiration is a systemic metabolic response rather than a localized mechanical issue, and it generally involves profound, symmetrical thoracic excursions as the body attempts to compensate for severe acidosis.
Choice B reason: Kussmaul's breathing is characterized by a markedly increased respiratory rate, often reaching 30 breaths per minute or higher, combined with extreme depth. This hyperpnea is a compensatory mechanism for metabolic acidosis, specifically diabetic ketoacidosis, where the lungs attempt to "blow off" excess carbon dioxide to increase the systemic pH levels.
Choice C reason: A respiratory rate of 10 breaths per minute indicates bradypnea, which is the opposite of the hyperventilation seen in Kussmaul's breathing. Bradypnea may be caused by central nervous system depression, opioid overdose, or end-stage respiratory failure, whereas Kussmaul's represents an active, vigorous effort by the respiratory center to expel acid.
Choice D reason: Shallow chest expansion is characteristic of hypoventilation or restrictive lung disease, not Kussmaul's. Kussmaul's respirations are famously "air hungry" and deep, involving maximal recruitment of respiratory muscles. Shallow breathing would lead to carbon dioxide retention, which would exacerbate the very metabolic acidosis that Kussmaul's breathing is designed to rectify.
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