Chapter 19: Thorax and Lungs
Physical Examination and Health Assessment, 8th Edition by
Carolyn Jarvis
MULTIPLE CHOICE
1. Which of these statements is true regarding the vertebra prominens? The vertebra
prominens is:
a. The spinous process of C7.
b. Usually nonpalpable in most individuals.
c. Opposite the interior border of the scapula.
d. Located next to the manubrium of the sternum.
ANS: A
The spinous process of C7 is the vertebra prominens and is the most prominent
bony spur protruding at the base of the neck. Counting ribs and intercostal spaces
on the posterior thorax is difficult because of the muscles and soft tissue. The
vertebra prominens is easier to identify and is used as a starting point in counting
thoracic processes and identifying landmarks on the posterior chest.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
2. When performing a respiratory assessment on a patient, the nurse notices a costal angle of
approximately 90 degrees. This characteristic is:
a. Observed in patients with kyphosis.
b. Indicative of pectus excavatum.
c. A normal finding in a healthy adult.
d. An expected finding in a patient with a barrel chest.
ANS: C
The right and left costal margins form an angle where they meet at the xiphoid
process. Usually, this angle is 90 degrees or less. The angle increases when the rib
cage is chronically overinflated, as in emphysema.
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. When assessing a patients lungs, the nurse recalls that the left lung:
a. Consists of two lobes.
b. Is divided by the horizontal fissure.
c. Primarily consists of an upper lobe on the posterior chest.
d. Is shorter than the right lung because of the underlying stomach.
, ANS: A
The left lung has two lobes, and the right lung has three lobes. The right lung is
shorter than the left lung because of the underlying liver. The left lung is narrower
than the right lung because the heart bulges to the left. The posterior chest is
almost all lower lobes.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
4. Which statement about the apices of the lungs is true? The apices of the lungs:
a. Are at the level of the second rib anteriorly.
b. Extend 3 to 4 cm above the inner third of the clavicles.
c. Are located at the sixth rib anteriorly and the eighth rib laterally.
d. Rest on the diaphragm at the fifth intercostal space in the midclavicular line
(MCL).
ANS: B
The apex of the lung on the anterior chest is 3 to 4 cm above the inner third of the
clavicles. On the posterior chest, the apices are at the level of C7.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
5. During an examination of the anterior thorax, the nurse is aware that the trachea
bifurcates anteriorly at the:
a. Costal angle.
b. Sternal angle.
c. Xiphoid process.
d. Suprasternal notch.
ANS: B
The sternal angle marks the site of tracheal bifurcation into the right and left main
bronchi; it corresponds with the upper borders of the atria of the heart, and it lies
above the fourth thoracic vertebra on the back.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. During an assessment, the nurse knows that expected assessment findings in the normal
adult lung include the presence of:
a. Adventitious sounds and limited chest expansion.
b. Increased tactile fremitus and dull percussion tones.
c. Muffled voice sounds and symmetric tactile fremitus.
d. Absent voice sounds and hyperresonant percussion tones.
ANS: C
Normal lung findings include symmetric chest expansion, resonant percussion
, tones, vesicular breath sounds over the peripheral lung fields, muffled voice
sounds, and no adventitious sounds.
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. The primary muscles of respiration include the:
a. Diaphragm andintercostals.
b. Sternomastoids andscaleni.
c. Trapezii and rectus abdominis.
d. External obliques and pectoralis major.
ANS: A
The major muscle of respiration is the diaphragm. The intercostal muscles lift the
sternum and elevate the ribs during inspiration, increasing the anteroposterior
diameter. Expiration is primarily passive. Forced inspiration involves the use of
other muscles, such as the accessory neck musclessternomastoid, scaleni, and
trapezii muscles. Forced expiration involves the abdominal muscles.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
8. A 65-year-old patient with a history of heart failure comes to the clinic with complaints
of being awakened from sleep with shortness of breath. Which action by the nurse is
most appropriate?
a. Obtaining a detailed health history of the patients allergies and a history of asthma
b. Telling the patient to sleep on his or her right side to facilitate ease of respirations
c. Assessing for other signs and symptoms of paroxysmal nocturnal dyspnea
d. Assuring the patient that paroxysmal nocturnal dyspnea is normal and will
probably resolve within the next week
ANS: C
The patient is experiencing paroxysmal nocturnal dyspneabeing awakened from
sleep with shortness of breath and the need to be upright to achieve comfort.
DIF: Cognitive Level: Applying (Application)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
9. When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus
most intensely over which location?
a. Between the scapulae
b. Third intercostal space, MCL
c. Fifth intercostal space, midaxillary line (MAL)
d. Over the lower lobes, posterior side
ANS: A
Normally, fremitus is most prominent between the scapulae and around the
Physical Examination and Health Assessment, 8th Edition by
Carolyn Jarvis
MULTIPLE CHOICE
1. Which of these statements is true regarding the vertebra prominens? The vertebra
prominens is:
a. The spinous process of C7.
b. Usually nonpalpable in most individuals.
c. Opposite the interior border of the scapula.
d. Located next to the manubrium of the sternum.
ANS: A
The spinous process of C7 is the vertebra prominens and is the most prominent
bony spur protruding at the base of the neck. Counting ribs and intercostal spaces
on the posterior thorax is difficult because of the muscles and soft tissue. The
vertebra prominens is easier to identify and is used as a starting point in counting
thoracic processes and identifying landmarks on the posterior chest.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
2. When performing a respiratory assessment on a patient, the nurse notices a costal angle of
approximately 90 degrees. This characteristic is:
a. Observed in patients with kyphosis.
b. Indicative of pectus excavatum.
c. A normal finding in a healthy adult.
d. An expected finding in a patient with a barrel chest.
ANS: C
The right and left costal margins form an angle where they meet at the xiphoid
process. Usually, this angle is 90 degrees or less. The angle increases when the rib
cage is chronically overinflated, as in emphysema.
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. When assessing a patients lungs, the nurse recalls that the left lung:
a. Consists of two lobes.
b. Is divided by the horizontal fissure.
c. Primarily consists of an upper lobe on the posterior chest.
d. Is shorter than the right lung because of the underlying stomach.
, ANS: A
The left lung has two lobes, and the right lung has three lobes. The right lung is
shorter than the left lung because of the underlying liver. The left lung is narrower
than the right lung because the heart bulges to the left. The posterior chest is
almost all lower lobes.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
4. Which statement about the apices of the lungs is true? The apices of the lungs:
a. Are at the level of the second rib anteriorly.
b. Extend 3 to 4 cm above the inner third of the clavicles.
c. Are located at the sixth rib anteriorly and the eighth rib laterally.
d. Rest on the diaphragm at the fifth intercostal space in the midclavicular line
(MCL).
ANS: B
The apex of the lung on the anterior chest is 3 to 4 cm above the inner third of the
clavicles. On the posterior chest, the apices are at the level of C7.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
5. During an examination of the anterior thorax, the nurse is aware that the trachea
bifurcates anteriorly at the:
a. Costal angle.
b. Sternal angle.
c. Xiphoid process.
d. Suprasternal notch.
ANS: B
The sternal angle marks the site of tracheal bifurcation into the right and left main
bronchi; it corresponds with the upper borders of the atria of the heart, and it lies
above the fourth thoracic vertebra on the back.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. During an assessment, the nurse knows that expected assessment findings in the normal
adult lung include the presence of:
a. Adventitious sounds and limited chest expansion.
b. Increased tactile fremitus and dull percussion tones.
c. Muffled voice sounds and symmetric tactile fremitus.
d. Absent voice sounds and hyperresonant percussion tones.
ANS: C
Normal lung findings include symmetric chest expansion, resonant percussion
, tones, vesicular breath sounds over the peripheral lung fields, muffled voice
sounds, and no adventitious sounds.
DIF: Cognitive Level: Understanding (Comprehension)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. The primary muscles of respiration include the:
a. Diaphragm andintercostals.
b. Sternomastoids andscaleni.
c. Trapezii and rectus abdominis.
d. External obliques and pectoralis major.
ANS: A
The major muscle of respiration is the diaphragm. The intercostal muscles lift the
sternum and elevate the ribs during inspiration, increasing the anteroposterior
diameter. Expiration is primarily passive. Forced inspiration involves the use of
other muscles, such as the accessory neck musclessternomastoid, scaleni, and
trapezii muscles. Forced expiration involves the abdominal muscles.
DIF: Cognitive Level: Remembering (Knowledge)
MSC: Client Needs: General
8. A 65-year-old patient with a history of heart failure comes to the clinic with complaints
of being awakened from sleep with shortness of breath. Which action by the nurse is
most appropriate?
a. Obtaining a detailed health history of the patients allergies and a history of asthma
b. Telling the patient to sleep on his or her right side to facilitate ease of respirations
c. Assessing for other signs and symptoms of paroxysmal nocturnal dyspnea
d. Assuring the patient that paroxysmal nocturnal dyspnea is normal and will
probably resolve within the next week
ANS: C
The patient is experiencing paroxysmal nocturnal dyspneabeing awakened from
sleep with shortness of breath and the need to be upright to achieve comfort.
DIF: Cognitive Level: Applying (Application)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
9. When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus
most intensely over which location?
a. Between the scapulae
b. Third intercostal space, MCL
c. Fifth intercostal space, midaxillary line (MAL)
d. Over the lower lobes, posterior side
ANS: A
Normally, fremitus is most prominent between the scapulae and around the
