An advanced practice registered nurse (APRN) assesses chest expansion (also known as lung excursion). Which technique by the APRN is correct?

A. Palpate vibrations transmitted through the chest wall with the patient saying "ninety-nine" is incorrect because this describes tactile fremitus, not chest expansion. Fremitus assesses the transmission of vocal vibrations through lung tissue and can indicate consolidation, effusion, or pneumothorax, but it does not measure lung excursion. B. Assess the distance between the examiner's thumbs on the thorax during inspiration is correct because chest expansion (lung excursion) is assessed by placing the examiner’s hands with thumbs along the posterior thorax at the level of the 10th ribs, palms on the lower ribs, and fingers grasping the lateral rib cage. The APRN asks the patient to take a deep breath, and observes the distance the thumbs move apart during inspiration, which indicates lung expansion and diaphragmatic movement. This technique helps identify asymmetry or restriction in chest expansion, which may occur in conditions such as pleural effusion, pneumothorax, or atelectasis. C. Determine the distance between the diaphragm on expiration and inspiration is incorrect because diaphragmatic excursion is assessed using percussion to measure the diaphragm’s movement, not by manual palpation of the thumbs. While related, diaphragmatic excursion is a separate assessment from chest expansion. D. Percuss the anterior and posterior thorax using a ladder pattern is incorrect because percussion evaluates lung resonance, presence of consolidation, fluid, or air, but does not directly measure chest expansion. Percussion is an inspection of sound quality, not the mechanical movement of the chest wall.