The nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from her findings?

Friction rub

Tactile fremitus

Crepitus

Adventitious sounds

Answer and Explanation

The Correct Answer is C

A. Friction rub:

A friction rub is a grating or rubbing sound or sensation heard or felt during auscultation or palpation. It occurs when inflamed pleural or pericardial surfaces rub against each other during breathing or heartbeats, respectively.

B. Tactile fremitus:

Tactile fremitus refers to the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks. It is assessed by placing hands on the patient's back while the patient speaks certain words. Increased tactile fremitus can occur in conditions with lung consolidation, such as pneumonia.

C. Crepitus:

Crepitus is a crackling or grating sensation felt under the skin or heard when the ends of a broken bone rub against each other. It can also occur when air leaks into subcutaneous tissue, leading to a crackling sensation upon palpation.

D. Adventitious sounds:

Adventitious sounds refer to abnormal lung sounds heard during auscultation. These sounds include crackles (rales), wheezes, rhonchi, and pleural friction rubs. Adventitious sounds can indicate various respiratory conditions, such as pneumonia, bronchitis, or asthma.

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Correct Answer is A

Explanation

A. Frenulum:

The frenulum is a thin band of tissue in the mouth that connects the tongue to the floor of the mouth. It aids in the tongue's movement and flexibility during speaking and swallowing.

B. Palate:

The palate refers to the roof of the mouth. It has two parts: the hard palate (at the front, made of bone) and the soft palate (at the back, made of muscle). The palate plays a crucial role in speech and swallowing.

C. Uvula:

The uvula is a small, fleshy extension at the back of the soft palate in the mouth. It participates in various functions, including speech articulation, preventing food from entering the nasal cavity during swallowing, and producing certain sounds.

D. Papillae:

Papillae are small, raised structures on the tongue that contain taste buds. They are responsible for detecting different tastes: sweet, salty, sour, bitter, and umami (savory). Papillae give the tongue its rough texture.

A. Have the client breathe quickly B. Palpate the chest symmetrically C. Ask the client to cough D. Use the bell of the stethoscope

Correct Answer is B

Explanation

A. Have the client breathe quickly:

This choice is incorrect because having the client breathe quickly is not a technique for assessing tactile fremitus. Tactile fremitus is assessed by feeling vibrations on the chest wall while the patient speaks, not during normal breathing.

B. Palpate the chest symmetrically:

This choice is correct. To assess tactile fremitus, the nurse places the palms or ulnar aspects of both hands firmly against the patient's chest while the patient speaks a phrase. The nurse should palpate the chest symmetrically to detect vibrations equally on both sides, which can help identify abnormalities in the lungs.

C. Ask the client to cough:

This choice is incorrect. Asking the client to cough is not a technique for assessing tactile fremitus. Tactile fremitus is evaluated by feeling vibrations while the patient speaks, not while coughing.

D. Use the bell of the stethoscope:

This choice is incorrect. Tactile fremitus is assessed by palpation, not auscultation with a stethoscope. Using the bell of the stethoscope is a technique for listening to low-pitched sounds, not for assessing tactile fremitus.

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The nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from her findings?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is performing an assessment of the client's mouth. The nurse recognizes that the tissue that connects the tongue to the floor of the mouth is the:

Correct Answer is A

Explanation

The nurse is examining a client for tactile fremitus. The nurse recognizes that when examining for tactile fremitus it is important to:

Correct Answer is B

Explanation

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