The nurse suspects a client has a pneumothorax. Which combined physical examination finding supports this suspicion?

Choice A reason: Dullness on percussion is indicative of increased tissue density or fluid, such as in lobar pneumonia, a pleural effusion, or a solid tumor. Bronchial breath sounds heard in the periphery also suggest consolidation. In a pneumothorax, the pleural space is filled with air rather than fluid or solid mass, making these findings inconsistent with the pathology. Choice B reason: A pneumothorax involves the accumulation of air in the pleural space, which causes the underlying lung to collapse. On percussion, this excess air produces hyperresonance, a lower-pitched, booming sound. Because the lung is collapsed and separated from the chest wall by an air pocket, breath sounds are significantly diminished or entirely absent upon auscultation. Choice C reason: Resonance is the characteristic sound of healthy, air-filled lung tissue during percussion. Wheezing is an adventitious sound caused by airway narrowing, typically associated with reactive airway diseases like asthma or COPD. Since a pneumothorax represents a structural collapse rather than simple airway constriction, normal resonance would not be present over the affected area. Choice D reason: Tympany is a high-pitched, drum-like sound normally heard over air-filled viscera like the stomach, but it is not a standard finding over the thorax. Fine crackles are typically associated with the opening of collapsed alveoli due to fluid, as seen in heart failure or interstitial lung disease, rather than a gross pleural air collection.