During auscultation of the breath sounds of an adult male client, ...

[armygirl]

During auscultation of the breath sounds of an adult male client, the nurse hears crackling sounds over most of the chest. Which action by the nurse is the most appropriate?
 
  1. Document this as abnormal.
  2. Wet the chest hair before auscultating the chest.
  3. Place the diaphragm on top of the client's shirt.
  4. Switch from the diaphragm to the bell.

Question 2

The nurse is preparing to assess the sinuses of an adult client using direct percussion. Which technique is the most appropriate for this assessment?
 
  1. Using the hyperextended middle finger of the nondominant hand.
  2. Using the closed fist of dominant hand.
  3. Using the palm of the nondominant hand.
  4. Using the fingertips of the dominant hand.

[cupcake16]

Answer to Question 1

Correct Answer: 2

Friction on either the bell or the diaphragm from coarse body hair may cause a crackling sound easily confused with abnormal breath sounds. To avoid artifact caused from friction, the nurse should wet the hair on the client's chest before auscultation. The crackling sounds may or may not be an abnormal finding; the cause of the sounds should be fully investigated before the nurse documents the finding as abnormal. Auscultation of lung sounds over the client's clothing will increase rather than decrease friction sounds. Lung sounds are high-pitched sounds, best heard with the diaphragm of the stethoscope. Friction from hair will cause abnormal crackling sounds using either the diaphragm or the bell, so switching them won't make a difference.

Answer to Question 2

Correct Answer: 4
Direct percussion is the technique of tapping the body with the fingertips of the dominant hand. It is used to assess the thorax of an infant and also to assess the sinuses of an adult client. Indirect percussion is the technique most commonly used and performed by placing the hyperextended middle finger of the nondominant hand firmly over the area to be examined and striking it with a plexor. Blunt percussion is used for assessing pain and tenderness in the gallbladder, liver, and kidneys and involves placing the palm of the nondominant hand flat against the body surface and striking the nondominant hand with the closed fist of the dominant hand. The palm of the nondominant hand is used to assess pain and tenderness of the gallbladder, liver, and kidneys in blunt percussion.

[armygirl]

Excellent

[jackie]

TYSM