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1. Question
The nurse is assessing a client for tactile fremitus. Which client would most likely exhibit a decrease in tactile fremitus? A client with:
Correct
Answer A is correct.
Rationale: Tactile fremitus is checked by asking the client to repeat terms such as one, two, three as the nurse’s hands move down the thorax. Air does not conduct sound as well as a solid substance, so fremitus is increased with a solid substance and decreased when air is present, as with emphysema. Answers B and D are solid-tissue illnesses that would result in increased, not decreased, tactile fremitus. Answer C is incorrect because bronchopneumonia usually develops with tuberculosis, causing increased fremitus.
Incorrect
Answer A is correct.
Rationale: Tactile fremitus is checked by asking the client to repeat terms such as one, two, three as the nurse’s hands move down the thorax. Air does not conduct sound as well as a solid substance, so fremitus is increased with a solid substance and decreased when air is present, as with emphysema. Answers B and D are solid-tissue illnesses that would result in increased, not decreased, tactile fremitus. Answer C is incorrect because bronchopneumonia usually develops with tuberculosis, causing increased fremitus.
Checking for tactile fremitus
When you check the back of the thorax for tactile fremitus, ask the patient to fold his arms across his chest. This movement shifts the scapulae out of the way.
What to do
Check for tactile fremitus by lightly placing your open palms on both sides of the patient’s back, as shown, without touching his back with your fingers. Ask the patient to repeat the phrase “ninety-nine” loudly enough to produce palpable vibrations. Then palpate the front of the chest using the same hand positions.
What the results mean
Vibrations that feel more intense on one side than the other indicate tissue consolidation on that side. Less intense vibrations may indicate emphysema, pneumothorax, or pleural effusion. Faint or no vibrations in the upper posterior thorax may indicate bronchial obstruction or a fluid-filled space.
