What should the examiner do during auscultation of breath sounds?

Listen with the bell of the stethoscope.

Listen only to the posterior chest for adventitious sounds.

Instruct the patient to breathe in and hold their breath.

Compare the sounds on the left and right sides.

Answer and Explanation

The Correct Answer is D

Choice A rationale

The bell of the stethoscope is designed to auscultate low-frequency sounds, such as certain heart murmurs or bowel sounds, due to its larger surface area and lower diaphragm tension. Breath sounds, however, are generally higher frequency and require the diaphragm for optimal clarity and discrimination of adventitious sounds, which are often subtle and require careful attention to pitch and quality.

Choice B rationale

Limiting auscultation to only the posterior chest misses significant lung fields, especially the anterior and lateral segments of the upper and middle lobes. Comprehensive respiratory assessment necessitates evaluating all accessible lung surfaces to detect localized abnormalities, ensuring no consolidation, atelectasis, or pleural effusions are overlooked, providing a complete diagnostic picture.

Choice C rationale

Instructing the patient to breathe in and hold their breath would prevent the continuous airflow necessary to generate breath sounds. Auscultation relies on the movement of air through the tracheobronchial tree. Holding the breath eliminates this vital acoustic phenomenon, rendering the assessment ineffective for evaluating air entry, presence of adventitious sounds, or symmetry.

Choice D rationale

Comparing sounds on the left and right sides allows for the identification of unilateral abnormalities, which are crucial for diagnosing localized pathologies. This systematic approach helps detect differences in breath intensity, the presence of unilateral adventitious sounds like wheezes or crackles, or diminished air entry, guiding further diagnostic investigation and treatment.

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Correct Answer is C

Explanation

Choice A rationale

Pain sensation behind the eyes, particularly during palpation of the frontal or ethmoid sinuses, suggests inflammation or infection within these sinuses. Under normal conditions, healthy paranasal sinuses are air-filled cavities and should not elicit pain upon palpation.

Choice B rationale

Pain during palpation of any sinus area is indicative of sinusitis or inflammation. The presence of pain signifies pressure buildup, mucosal edema, or infection within the sinus cavities. Normal findings would not involve pain, but rather a sensation of mild pressure.

Choice C rationale

Normal findings during sinus palpation should elicit a sensation of pressure but no pain or tenderness. This indicates that the sinuses are air-filled, patent, and free from inflammation or congestion. The pressure is a result of the gentle digital compression over the bony structures.

Choice D rationale

Tingling along the nose and eyes is not a typical sensation associated with normal sinus palpation. This sensation might suggest neurological irritation, such as nerve compression or neuropathy, rather than a direct physiological response from the paranasal sinuses themselves.

A. The best time to examine your breasts is immediately before menstruation. B. Examine your breasts on the 4-7 day of your menstrual period each month. C. The best time to examine your breasts is during ovulation. D. Examine your breasts every month on the same day of the month.

Correct Answer is B

Explanation

Choice A rationale

Immediately before menstruation, hormonal fluctuations, particularly increased estrogen levels, can lead to breast swelling and tenderness. This physiological engorgement can obscure subtle lumps or changes, making accurate palpation difficult and potentially leading to false positives or missed abnormalities during self-examination, thereby reducing its efficacy.

Choice B rationale

Days 4-7 of the menstrual cycle, specifically post-menstruation, are optimal for breast self-examination because hormonal influences are at their lowest point. Estrogen and progesterone levels are minimal, resulting in the least breast tenderness and swelling. This makes breast tissue softer and less nodular, facilitating the detection of any new or subtle changes.

Choice C rationale

During ovulation, estrogen levels are elevated, which can cause some degree of breast fullness and tenderness due to glandular changes. This hormonal influence can make it more challenging to distinguish normal breast tissue from suspicious lumps, potentially leading to inaccurate findings and reducing the sensitivity of the self-examination process.

Choice D rationale

While consistency is important, simply choosing any same day of the month without regard to the menstrual cycle can lead to less effective examinations. Hormonal fluctuations throughout the cycle significantly impact breast tissue consistency. A fixed day may coincide with breast swelling or tenderness, hindering accurate assessment and potentially masking abnormalities, thereby reducing detection rates.

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What should the examiner do during auscultation of breath sounds?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?

Correct Answer is C

Explanation

During a discussion about breast self-examination with a 30-year-old woman, which of these statements by the nurse is most appropriate?

Correct Answer is B

Explanation

Order: 1.5 L of 0.9 % NS over 20 hours. Calculate milliliters per hour. (ROUND TO WHOLE NUMBER & LABEL CORRECTLY TO RECEIVE CREDIT)

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