A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this?
A. Acute asthma
B. Chronic bronchitis
C. Pneumonia
D. Spontaneous pneumothorax
Correct Answer: D. Spontaneous pneumothorax
A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. For patients with larger spontaneous pneumothorax (more than 15%), there may be reduced movement of the chest wall, ipsilateral decreased or absent breath sounds, jugular venous distension, pulsus paradoxus, hyperresonance on percussion, and decreased tactile fremitus.
Option A: An asthma attack would show wheezing breath sounds. Patients will show some respiratory distress, often sitting forward to splint open their airways. On auscultation, a bilateral, expiratory wheeze will be heard.
Option B: Bronchitis would have rhonchi. Uncomplicated chronic bronchitis presents with a cough, and there is no evidence of airway obstruction physiologically. When patients have chronic asthmatic bronchitis, there is usually a wheeze present due to a hyperactive airway leading to intermittent bronchospasm.
Option C: Pneumonia would have bronchial breath sounds over the area of consolidation. When bronchial sounds are heard in areas distant from where they normally occur, the patient may have consolidation (as occurs with pneumonia) or compression of the lung. These conditions cause the lung tissue to be dense.
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