A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:
A. Resonant sounds.
B. Hyperresonant sounds.
C. Dull sounds.
D. Flat sounds.
Correct Answer: A. Resonant sounds.
When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Percussion over normal, healthy lung tissue should produce a resonant note. With the patient in an upright seated position, with the scapula protracted; percuss on the posterior chest wall; either side of the midclavicular line in the interspaces at 5cm intervals.
Option B: Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults.
Option C: Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Dull percussive sounds are indicative of abnormal lung density. Likely indicating: atelectasis, tumour, pleural effusion, lobar pneumonia
Option D: Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure. Percussion produces sounds on a spectrum from flat to dull depending on the density of the underlying tissue.
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