RN Nursing · Health Assessment · Practice question
A patient is undergoing testing to see if he has a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis?
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Increased tactile fremitus, egophorny, and a dull sound upon percussion of the chest wall
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✓
Absent breath sounds and decreased fremitus
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Decreased tactile fremitus, wheezing, and a hyper resonant sound upon percussion of the chest wall
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Normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion of the chest wall
Answer & explanation
Correct: Absent breath sounds and decreased fremitus
Pleural effusion is the accumulation of fluid in the pleural space. The fluid prevents sound transmission, producing decreased or absent breath sounds over the affected area. Tactile fremitus is decreased because the fluid dampens the transmission of vibrations from the lung to the chest wall. Percussion over a pleural effusion produces a dull sound, not hyper-resonance, because fluid replaces air. Therefore the classic triad is decreased tactile fremitus, absent or significantly decreased breath sounds, and dullness to percussion. The option stating 'absent breath sounds and decreased fremitus' best captures these findings, even though percussion is not mentioned. Increased tactile fremitus and egophony with a dull percussion note is more characteristic of lung consolidation (pneumonia). The option describing decreased fremitus, wheezing, and hyper-resonance is consistent with air trapping as seen in COPD or pneumothorax, not effusion. Normal fremitus and resonant percussion would not indicate any significant pathology. The keyed answer of absent breath sounds and decreased fremitus is correct for pleural effusion.
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