Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Chapter 19: Thorax and Lungs Jarvis: Physical Examination & Health Assessment, 3rd Canadian edition 16pages

1. The nurse is teaching the nursing students to palpate the vertebra prominens when beginning posterior thoracic assessment of a patient. The students will: a. Look for the spinous process of C7. b. Usually not be able to palpate this on most individuals. c. Find the interior border of the scapula. d. Locate this 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: Understanding (Comprehension) MSC: Client Needs: General 2. When performing a respiratory assessment on a patient, the nurse notes 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 patient’s lungs, the nurse recognizes 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)