NURS 612 Exam 2 | Questions & Answers (100 %Score) Latest Updated 2024/2025
Comprehensive Questions A+ Graded Answers | With Expert Solutions
Crackles - CHF, pulmonary fibrosis, atelectasis. AKA rales. Often heard on inspiration.
Fine crackles are brief, discontinuous, popping lung sounds that are high-pitched. Fine
crackles are also similar to the sound of wood burning in a fireplace, or hook and loop
fasteners being pulled apart or cellophane being crumpled.
Crackles, previously termed rales, can be heard in both phases of respiration. Early
inspiratory and expiratory crackles are the hallmark of chronic bronchitis. Late
inspiratory crackles may mean pneumonia, CHF, or atelectasis.
Wheezes - Whistling, high-pitched bronchus; musical noise sounding like a squeak;
most often heard continuously during inspiration and expiration; usually louder during
expiration; COPD, bronchitis, asthma, pneumonia.
Pleural Friction rub - Loud/grating lung sound. Inflamed pleura, pneumonia, pleuritis,
malignancy. Happens outside tree.
Rhochi - Loud, low, coarse sounds like a snore most often heard continuously during
inspiration or expiration; usually louder during expiration; Coarse, low-pitched; may
clear with cough.
Rales - Crackles; abnormal respiratory sound heard more often during inspiration and
characterized by discrete discontinuous sounds, each lasting just a few milliseconds.
May be fine, high-pitched, and relatively longer in duration.
Causes of barrel chest? - Results from compromised respiration as in chronic asthma,
cystic fibrosis, or emphysema.
Resonance percussion chest - loud, low pitch, long duration, hollow quality (expected
lung sound, can usually be heard over all areas of lungs).
Dullness percussion - medium intensity, medium to high pitch, medium duration, dull
thud quality (suggests pneumonia, pleural effusion)
Tympany percussion - loud intensity, high pitch, medium duration, drumlike quality
Hyperresonance percussion - very loud intensity, very low pitch, longer duration,
booming quality (associated with hyperinflation and may indicate emphysema,
pneumothorax, or asthma).
Differential diagnoses for cough? - bronchitis, pleural effusion, URI, influenza,
pneumonia, croup, bronchiectasis, emphysema, GERD
, Normal vs abnormal findings of chest and skin including inspection, auscultation,
palpation? - Chest--> Inspection: note shape and symmetry of chest anterior/posterior;
Normal: chest symmetrical; AP diameter less than half transverse diameter ratio 1:2;
Barrel chest and pidgeon chest abnormal findings; observe respiration-rate should be
12-20 respirations a minute (ratio of respirations to heartbeat 1:4);
look for retractions and audible adventitious sounds. Palpation--> palpate for crepitus,
thoracic expansion, and tactile fremitus-decreased or absent fremitus may be caused by
excess air in lungs seen in emphysema, pleural thickening, effusion, or bronchial
obstruction; Percussion- resonance should be heard over all areas of lungs;
hyperresonance is from hyperinflation and may indicate emphysema, pneumo, or
asthma. Dullness may indicate pneumonia or pleural effusion; Auscultation--> normal bs
vesicular (heard over most lung fields), bronchovesicular (heard over bronchus area
and right upper lung field), and bronchial (heard only over trachea); Adventitious are
wheezes, crackles, pleural friction rub, and rhochi.
Skin---> Inspection: note color (abnormal jaundice); look for skin thickness, rashes,
ecchymosis, moles; Palpation--> moisture, temperature, texture, and mobility. Minimal
perspiration should be present; skin should be cool to warm; texture should be
smooth/even. Assess turgor and for skin lesions;
Bronchial breath sounds - heard over trachea; high pitch; loud and long expirations;
sometimes a bit longer than inspiration
Vesicular breath sounds - low-pitched, low-intensity sounds heard over healthy tissue
Bronchovesicular breath sounds - typically moderate in intensity; heard over the major
bronchi
Where is the diaphragmatic excursion? - Percuss along scapular line until you locate
the lower border, the point marked by a change in note from resonance to dullness.
Mark the point at the scapular line with a pen. Allow pt. to breathe, and then repeat on
other side.Excursion distance usually 3-5 cm
Pectus carninatum - Pigeon chest
Clubbed fingers - enlargement of terminal phalanges of the fingers/toes associated with
emphysema, lung ca, the cyanosis of congenital heart disease, and cystic fibrosis.
Barrel chest - When the AP diameter approaches or equals the lateral diameter (a ratio
of 1.0 or even greater). Results from compromised respiration as in chronic asthma,
cystic fibrosis, or emphysema.
