18

CHAPTER
Thorax and Lungs

Chapter Overview
Respiration is a life-sustaining function, which makes precise assessment of the chest and breathing
structures an essential nursing skill. Use the following exercises and quizzes as a guide to effective
physical assessment of the thorax and lungs.

CHAPTER PRETEST
Activity A MULTIPLE CHOICE
Choose one best answer for each of the following multiple-choice questions.
1. The clavicles extend from the acromion of the scapula to the part of the sternum termed the
a. body.
b. xiphoid process.
c. angle.
d. manubrium.
2. A bony ridge located at the point where the manubrium articulates with the body of the
sternum is termed the sternal
a. angle.
b. notch.
c. space.
d. prominens.
3. The spinous process termed the vertebra prominens is in which cervical vertebra?
a. fifth.
b. sixth.
c. seventh.
d. eighth.
4. The apex of each lung is located at the
a. level of the diaphragm.
b. area slightly above the clavicle.
c. level of the sixth rib.
d. left oblique fissure.

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5. The thin double-layered serous membrane that lines the chest cavity is termed
a. parietal pleura.
b. pulmonary pleura.
c. visceral pleura.
d. thoracic pleura.
6. The lining of the trachea and bronchi, which serves to remove dust, foreign bodies, and bac-
teria, is termed the
a. bronchioles.
b. alveolar sacs.
c. alveolar ducts.
d. cilia.
7. Under normal circumstances, the strongest stimulus in a human being to breathe is
a. hypoxemia.
b. hypocapnia.
c. pH changes.
d. hypercapnia.

Activity B LABELING ACTIVITIES

Label the following structures of the anterior thoracic cage.

1
2
3

8
9
10

Anterior thoracic cage.

Label the structure indicated by the line; then match your answer with the label on the matching
figure in Chapter 18 of your textbook.

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 CHAPTER 18 THORAX AND LUNGS 127

CHAPTER POSTTEST
Activity F MULTIPLE CHOICE
Choose the one best answer for each of the following multiple-choice questions.
1. While assessing an adult client, the client tells the nurse that she “has had difficulty catching
her breath since yesterday.” The nurse should assess the client further for signs and
symptoms of
a. emphysema.
b. cardiac disease.
c. trauma to the chest.
d. infection.
2. An adult client visits the clinic and tells the nurse that he has been “spitting up rust-colored
sputum.” The nurse should refer the client to the physician for possible
a. pulmonary edema.
b. bronchitis.
c. asthma.
d. tuberculosis.
3. The nurse is planning a presentation to a group of high school students on the topic of lung
cancer. Which of the following should the nurse plan to include in the presentation?
a. Compared with whites in the United States, African-Americans have a lower incidence of
lung cancer.
b. Lung cancer is the third leading cause of death in the United States.
c. There is a higher incidence of lung cancer in women than men in the United States.
d. Studies have indicated that there is a genetic component in the development of lung
cancer.
4. While assessing an adult client, the nurse observes decreased chest expansion at the bases of
the client’s lungs. The nurse should refer the client to a physician for possible
a. atelectasis.
b. pneumonia.
c. chest trauma.
d. chronic obstructive pulmonary disease.
5. The nurse is planning to percuss the chest of an adult male client for diaphragmatic excur-
sion. The nurse should begin the assessment by
a. asking the client to take a deep breath and hold it.
b. percussing upward from the base of the lungs.
c. percussing downward until the tone changes to resonance.
d. asking the client to exhale forcefully and hold his breath.
6. The nurse is preparing to auscultate the posterior thorax of an adult female client. The nurse
should
a. place the bell of the stethoscope firmly on the posterior chest wall.
b. auscultate from the base of the lungs to the apices.
c. ask the client to breathe deeply through her mouth.
d. ask the client to breathe normally through her nose.

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128 CHAPTER 18 THORAX AND LUNGS

7. While assessing the thoracic area of an adult client, the nurse plans to auscultate for voice
sounds. To assess bronchophony, the nurse should ask the client to
a. repeat the phrase “ninety-nine.”
b. repeat the letter “E.”
c. whisper the phrase “one-two-three.”
d. repeat the letter “A.”
8. The nurse assesses an adult client’s thoracic area and observes a markedly sunken sternum
and adjacent cartilages. The nurse should document the client’s
a. pectus thorax.
b. pectus excavatum.
c. pectus carinatum.
d. pectus diaphragm.
9. The nurse assesses an adult client and observes that the client’s breathing pattern is very
labored and noisy, with occasional coughing. The nurse should refer the client to a physician
for possible
a. chronic bronchitis.
b. atelectasis.
c. renal failure.
d. congestive heart failure.
10. While assessing an adult client’s lungs during the postoperative period, the nurse detects
coarse crackles. The nurse should refer the client to a physician for possible
a. pneumonia.
b. pleuritis.
c. bronchitis.
d. asthma.
11. The nurse assesses an adult client’s breath sounds and hears sonorous wheezes, primarily
during the client’s expiration. The nurse should refer the client to a physician for possible
a. asthma.
b. chronic emphysema.
c. pleuritis.
d. bronchitis.
12. The nurse has assessed the respiratory pattern of an adult client. The nurse determines that
the client is exhibiting Kussmaul’s respirations with hyperventilation. The nurse should con-
tact the client’s physician because this type of respiratory pattern usually indicates
a. diabetic ketoacidosis.
b. central nervous system injury.
c. drug overdose.
d. congestive heart failure.

Copyright © 2010. Lippincott Williams and Wilkins.