A nurse observes that a client's anteroposterior (AP) chest ...

[audragclark]

A nurse observes that a client's anteroposterior (AP) chest diameter is the same as the lateral chest diameter. Which question should the nurse ask the client in response to this finding?
 
  a. Are you taking any medications or herbal supplements?
  b. Do you have any chronic breathing problems?
  c. How often do you perform aerobic exercise?
  d. What is your occupation and what are your hobbies?

Question 2

A nurse is providing care after auscultating clients' breath sounds. Which assessment finding is correctly matched to the nurse's primary intervention?
 
  a. Hollow sounds are heard over the trachea. - The nurse increases the oxygen flow rate.
  b. Crackles are heard in bases. - The nurse encourages the client to cough forcefully.
  c. Wheezes are heard in central areas. - The nurse administers an inhaled bronchodilator.
  d. Vesicular sounds are heard over the periphery. - The nurse has the client breathe deeply.

[meganlapinski]

Answer to Question 1

ANS: B
The normal chest has a lateral diameter that is twice as large as the AP diameter. When the AP diameter approaches or exceeds the lateral diameter, the client is said to have a barrel chest. Most commonly, barrel chest occurs as a result of a long-term chronic airflow limitation problem, such as chronic obstructive pulmonary disease or severe chronic asthma. It can also be seen in people who have lived at a high altitude for many years. Therefore, an AP chest diameter that is the same as the lateral chest diameter should be rechecked but is not as indicative of underlying disease processes as an AP diameter that exceeds the lateral diameter. Medications, herbal supplements, and aerobic exercise are not associated with a barrel chest. Although occupation and hobbies may expose a client to irritants that can cause chronic lung disorders and barrel chest, asking about chronic breathing problems is more direct and should be asked first.

Answer to Question 2

ANS: C
Wheezes are indicative of narrowed airways, and bronchodilators help to open the air passages. Hollow sounds are typically heard over the trachea, and no intervention is necessary. If crackles are heard, the client may need a diuretic. Crackles represent a deep interstitial process, and coughing forcefully will not help the client expectorate secretions. Vesicular sounds heard in the periphery are normal and require no intervention.