A nurse examines a client's auditory canal and tympanic membrane with an otoscope. The nurse should recognize that which of the following is considered an abnormal finding?

A) Inspection of the shape and configuration of the chest during normal breathing:
While inspecting the shape and configuration of the chest can provide important information about potential deformities or abnormalities (such as a barrel chest or scoliosis), it does not directly assess the symmetry of chest expansion. Inspection primarily focuses on the external appearance rather than the physiological movement of the chest wall during respiration. Symmetry of chest expansion requires more than visual observation; it involves assessing the movement of the chest during inhalation and exhalation.

B) Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10:
This technique is the most effective for confirming symmetric expansion of the chest. The nurse places their hands on the patient's back, with the thumbs positioned at the level of T9 or T10, and asks the patient to take a deep breath. As the patient inhales, the nurse assesses the expansion of both sides of the chest by observing whether the thumbs move apart symmetrically. This test directly evaluates the expansion of the lungs and chest wall during respiration and is the most accurate way to assess symmetry.

C) Percussion of the posterior chest to initiate vibration of the lung structures:
Percussion is a technique used to assess the underlying lung tissue and the presence of conditions like pneumonia, fluid accumulation, or air trapping. It does not directly assess the symmetry of chest expansion. While percussion may provide valuable diagnostic information about the lungs, it does not help in determining how evenly the chest is expanding during normal breathing.

D) Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety-nine":
This technique refers to vocal fremitus, where the nurse places their hands on the client's chest while the client repeats "ninety-nine." It helps assess the transmission of sound vibrations through the chest wall, which can be used to detect areas of consolidation or fluid in the lungs. However, it does not directly evaluate the symmetry of chest expansion. The vibration felt on both sides of the chest may be different in cases of lung disease, but this test does not assess the movement of the chest during breathing.

A) Vena cava → right atrium → right ventricle → pulmonary artery → lungs → pulmonary vein → left atrium → left ventricle:
This is the correct answer. The accurate blood flow pattern through the heart starts with deoxygenated blood returning to the heart from the body via the vena cava into the right atrium. From there, it passes into the right ventricle, which pumps it into the pulmonary artery. The blood then travels to the lungs for oxygenation. Oxygenated blood returns to the heart via the pulmonary veins, enters the left atrium, flows into the left ventricle, and is then pumped out to the body through the aorta. This is the correct sequence of blood flow through the heart and lungs.

B) Aorta → right atrium → right ventricle → pulmonary vein → lungs → pulmonary artery → left atrium → left ventricle:
This is incorrect. The aorta is the main artery that carries oxygenated blood from the left ventricle to the body, not part of the pathway for deoxygenated blood returning to the heart. The flow pattern described here is mixed up, with oxygenated blood returning to the heart via the pulmonary veins, which is correct, but it places the pulmonary vein and pulmonary artery in an incorrect order, as the pulmonary artery carries deoxygenated blood from the heart to the lungs, not the other way around.

C) Aorta → right atrium → right ventricle → lungs → pulmonary vein → left atrium → left ventricle → vena cava:
This is incorrect. The right atrium does not receive blood from the aorta. The aorta carries oxygenated blood from the left ventricle to the body, not from the right side of the heart. Additionally, the vena cava is responsible for carrying deoxygenated blood back to the right atrium, not part of the blood flow from the heart to the lungs.

D) Vena cava → right atrium → right ventricle → pulmonary vein → lungs → pulmonary artery → left atrium → left ventricle:
This is incorrect. The pulmonary vein carries oxygenated blood back to the heart, not deoxygenated blood from the right ventricle to the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs for oxygenation. The correct sequence of flow is from the right ventricle to the pulmonary artery and then to the lungs, followed by pulmonary veins returning oxygenated blood to the left atrium.