The nurse is listening to the breath sounds of young adult client with severe asthma. The nurse recognizes that air passing through narrowed bronchioles would produce which of these adventitious sounds?
Wheezes
Whispered pectoriloquy
Bronchial sounds
Bronchophony
The Correct Answer is A
A. Wheezes:
Wheezes are continuous, high-pitched, whistling lung sounds that are heard especially during expiration and sometimes during inspiration. They are caused by the rapid movement of air through narrowed or constricted airways, which is common in conditions like asthma. Wheezing is a characteristic adventitious sound associated with asthma and other obstructive respiratory disorders.
B. Whispered Pectoriloquy:
Whispered Pectoriloquy is an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields. This phenomenon occurs when sound is transmitted clearly through consolidated or compressed lung tissue, making whispered sounds more distinct. It is a sign of lung consolidation, often seen in conditions like pneumonia.
C. Bronchial Sounds:
Bronchial sounds are harsh, high-pitched sounds heard over the trachea and the large bronchi. These sounds are normally heard during expiration. If they are heard over peripheral lung areas, it can indicate consolidation or compression of lung tissue, possibly due to pneumonia or tumor.
D. Bronchophony:
Bronchophony is a phenomenon in which spoken sounds are heard more clearly and distinctly through the stethoscope on auscultation of the lungs. Normally, sounds are muffled during auscultation. Increased clarity of spoken sounds can indicate lung consolidation, similar to whispered pectoriloquy, and is often associated with conditions like pneumonia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. When bronchial breath sounds are auscultated in the trachea.
Auscultating bronchial breath sounds in the trachea is a normal finding, as the trachea is close to the upper airway, and this is where bronchial sounds are normally heard. However, if these sounds are heard in the peripheral lung fields, it can indicate an abnormal condition.
B. When the client is experiencing excessive sneezing from a tree pollen allergy.
Excessive sneezing due to allergies would not typically result in increased breath sounds. Allergies may cause nasal congestion, but they don't directly lead to increased breath sounds.
C. When the client is resting in bed and not experiencing respiratory issues.
If a client is at rest and not experiencing any respiratory issues, breath sounds should typically be normal. There would be no reason to expect increased breath sounds in this scenario.
D. When the bronchial tree is obstructed by secretions.
Increased breath sounds, such as wheezing or rhonchi, can be auscultated when there is an obstruction in the bronchial tree due to secretions, narrowing of the airways, or other causes. These sounds are typically abnormal and indicate an issue with air movement through the airways.
Correct Answer is A
Explanation
A. The best time to perform a BSE is 4 to 7 days after the first day of the menstrual period:
This statement is correct. Performing BSE a few days after the menstrual period ensures that the breasts are less likely to be swollen or tender, which can make it easier to detect any unusual changes.
B. If she suspects that she is pregnant, then the woman should not perform a BSE until her baby is born:
This statement is incorrect. Pregnant women can still perform breast self-examinations. In fact, it's important for pregnant women to be aware of any changes in their breasts.
C. The best time to perform BSE is in the middle of the menstrual cycle:
This statement is not as accurate as the first choice. While it's true that performing BSE a few days after the menstrual period can be easier due to reduced breast tenderness, it doesn't necessarily mean the middle of the menstrual cycle for every woman. The timing can vary based on an individual's menstrual cycle.
D. The woman needs to perform BSE only bimonthly unless she has fibrocystic breast tissue:
This statement is incorrect. Regular monthly breast self-examinations are recommended for all women, regardless of whether they have fibrocystic breast tissue or not. Detecting changes early is crucial for breast health.
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