John Joseph was scheduled for a physical assessment. When percussing the client’s chest, the nurse would expect to find which assessment data as a normal sign over his lungs?
A. Dullness
B. Resonance
C. Hyperresonance
D. Tympany
Correct Answer: B. Resonance
Normally, when percussing a client’s chest, percussion over the lungs reveals resonance, a hollow or loud, low-pitched sound of long duration. Since lungs are mostly filled with air that we breathe in, percussion performed over most of the lung area produces a resonant sound, which is a low-pitched, hollow sound. Therefore, any dullness or hyper-resonance is indicative of lung pathology, such as pleural effusion or pneumothorax, respectively.
Option A: Dullness is typically heard on percussion of solid organs, such as the liver or areas of consolidation. Dullness to percussion indicates denser tissue, such as zones of effusion or consolidation. Once an abnormality is detected, percussion can be used around the area of interest to define the extent of the abnormality. Normal areas of dullness are those overlying the liver and spleen at the anterior bases of the lungs.
Option C: Hyperresonance would be evidenced by percussion over areas of overinflation such as an emphysematous lung. Hyperresonant sounds may also be heard when percussing lungs hyperinflated with air, such as may occur in patients with COPD, or patients having an acute asthmatic attack. An area of hyper resonance on one side of the chest may indicate a pneumothorax.
Option D: Tympany is typically heard on percussion over such areas as a gastric air bubble or the intestine. 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.