When examining a female client’s genitourinary system, Nurse Sandy assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. Normally, this percussion technique produces which sound?
A. A flat sound
B. A dull sound
C. Hyperresonance
D. Tympany
Correct Answer: B. A dull sound
Percussion over the costovertebral angle normally produces a dull, thudding sound, which is soft to moderately loud with a moderate pitch and duration. This sound occurs over less dense, mostly fluid-filled matter, such as the kidneys, liver, and spleen. Dull or thud-like sounds are normally heard over dense areas such as the heart or liver. Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors.
Option A: In contrast, a flat sound occurs over highly dense matter such as muscle. Flat or extremely dull sounds are normally heard over solid areas such as bones. Percussion is performed by placing the pad of the nondominant long finger on the chest wall and striking the distal interphalangeal joint of that finger with the top of the dominant long finger.
Option C: Hyperresonance occurs over the air-filled, overinflated lungs of a client with pulmonary emphysema or the lungs of a child (because of a thin chest wall). Hyperresonant sounds that are louder and lower-pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults. Hyperresonant sounds may also be heard when percussing lungs hyperinflated with air.
Option D: Tympany occurs over enclosed structures containing air, such as the stomach and bowel. Tympanic sounds are hollow, high, drumlike sounds. Tympany is normally heard over the stomach but is not a normal chest sound. Tympanic sounds heard over the chest indicate excessive air in the chest, such as may occur with pneumothorax.
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