Answer to Question 1
D
A, B, C, D. Standing behind client, place thumbs along the spinal processes at the tenth rib, with the palms lightly contacting the posterolateral surfaces (see illustration A). The nurse's thumbs should be about 2 inches (5 cm) apart, with the thumbs pointing toward the spine and the fingers pointing laterally. Press hands toward client's spine to form small skinfold between thumbs. After exhalation, client takes deep breath. Note movement of thumbs (see illustration B), and note symmetry of chest wall movement. Normally symmetrical separation of the thumbs occurs during chest excursion.
Answer to Question 2
C
C. Step 2. POSTERIOR THORAX: If possible, stand behind client to inspect thorax for shape, deformities, position of the spine, slope of the ribs, retraction of intercostal spaces during inspiration, and bulging of intercostal spaces during expiration.
A. Step 3. Determine the rate and rhythm of breathing (see Chapter 17). Have client relaxed.
B. Step 10. ANTERIOR THORAX: Inspect accessory muscles of breathing: sternocleidomastoid, trapezius, and abdominal muscles, noting effort to breathe.
D. Step 8. LATERAL THORAX: Instruct client to raise arms and inspect chest wall for same characteristics as reviewed for posterior chest. Step 9. Extend palpation, percussion, and auscultation of posterior thorax to lateral sides of chest, except for excursion measurement.
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