NURS 6023 Respiratory Exam Cram Study Guide Arkansas State University, Main Campus 2026 Update with complete solutions.

Fast exam pearls: what findings usually mean Finding What it suggests Remember cue Cyanosis Late sign of hypoxemia; patient is already in a dangerous range. Cyanosis = late. Do not wait for blue lips to call it respiratory distress. Pursed-lip breathing Increased respiratory effort, often seen with COPD or exacerbations. Pursed lips help keep airways open longer. Nasal flaring Air hunger or increased work of breathing. Nose flares = patient is working. Retractions Obstruction or increased work of breathing. Unilateral may suggest foreign body; bilateral is common with asthma. Unilateral = think one-sided problem. Bilateral = think diffuse airway narrowing. Decreased chest expansion on one side Problem is usually on the side with decreased movement: pneumothorax, rib fracture, severe pneumonia, or large effusion. The bad side moves less. Tracheal deviation Can occur with pneumothorax or large pleural effusion. Significant deviation needs urgent evaluation. Deviation away from a pneumothorax is a late and serious sign. Tactile fremitus decreased Less vibration transmission: pneumothorax, emphysema, bronchial obstruction, or pleural effusion. Air outside lung or trapped air = less vibration. Tactile fremitus increased More sound transmission through dense/fluid-filled lung tissue or secretions, such as consolidation. Solid/fluid conducts sound better than normal air-filled lung. Pleuritic chest pain Sharp/stabbing pain worse with inspiration due to parietal pleura irritation. Lung tissue itself has no pain fibers; pleura causes the pain. 2. Percussion, auscultation, and vocal resonance cheat sheet Respiratory Exam Cram Study Guide Advanced Assessment and Diagnostic Exam - Diseases, Findings, Diagnostics, Interpretation, Exam Pearls, and Remember Cues Respiratory Exam Study Guide - built from uploaded NURS 6023 respiratory lecture PowerPoint and transcripts Assessment clue Interpretation Common examples Resonance Expected normal lung percussion note. Normal air-filled lung. Hyperresonance Too much air in lung or pleural space. COPD/emphysema, pneumothorax. Dullness Fluid or solid tissue under the chest wall. Pneumonia/consolidation, pleural effusion. Tympany over lung Air where it should not be or excessive air. Consider pneumothorax. Crackles/rales Air moving through fluid. Pneumonia, heart failure. Rhonchi Air passing over thick secretions; low-pitched and may clear after cough. Secretions in larger airways, bronchitis. Wheezes Air moving through narrowed/constricted airways; high pitched musical sound. Asthma, COPD, bronchitis. Stridor Louder over the neck than the chest; upper airway obstruction. Emergency airway concern. Pleural friction rub Inflamed pleural surfaces rubbing; heard with inspiration and expiration. If pleural, it disappears when patient holds breath. Pleurisy, pneumonia, PE, other pleural inflammation. Bronchophony Patient says "99"; positive if words sound louder/clearer instead of muffled. Lobar consolidation, pneumonia. Egophony Patient says "E"; positive if it sounds like "A". Consolidation; may occur at top of effusion. Whispered pectoriloquy Patient whispers "99"; positive if it is louder/clearer. Consolidation, pneumonia. 3. High-yield respiratory diseases: findings + tests + interpretation Disease Classic story / symptoms Physical findings Diagnostics + interpretation Remember cue COPD Long-term smoker or noxious exposure. Cardinal symptoms: dyspnea, chronic cough, sputum production. Barrel chest, tripod position, pursed-lip breathing, nasal flaring/retractions during exacerbation. Breath sounds may be decreased with wheezes/crackles. Percussion: hyperresonance. PFTs are gold standard. FEV1/FVC 0.70 supports COPD. FEV1 stages severity: mild about =80%, moderate 50-80%, severe 30-50%, very severe 30%. CXR: hyperinflation + flattened diaphragm. COPD = chronic obstruction + hyperinflation. Think "smoker + barrel + FEV1/FVC 0.70." Disease Classic story / symptoms Physical findings Diagnostics + interpretation Remember cue Asthma Hypersensitivity to inhaled allergens or exercise. Classic symptoms: wheeze, cough, shortness of breath. Acute exacerbation: tachypnea, wheezing, accessory muscle use, apprehension. Percussion usually resonance or sometimes hyperresonance. Pulmonary function studies help confirm airflow limitation and response to bronchodilator. Exam focuses on severity and triggers. Asthma = reversible/reactive airway problem. Think "trigger + wheeze + acute episodes." Respiratory Exam Study Guide - built from uploaded NURS 6023 respiratory lecture PowerPoint and transcripts Acute bronchitis Lower respiratory tract infection involving the bronchi. Usually viral. Persistent cough with or without sputum. May have wheeze, mild dyspnea, and rhonchi from secretions. CXR is usually normal and is most useful to rule out pneumonia. Acute bronchitis = cough + normal CXR. Usually viral. Chronic bronchitis Subtype of COPD. Cough lasts at least 3 months in each of 2 consecutive years. Often from long-term irritant exposure such as tobacco. Chronic cough, sputum production, hypoxemia, diminished breath sounds, prolonged expiratory phase. May have wheeze or inspiratory crackles. PFTs show obstructive pattern as part of COPD evaluation. Chronic bronchitis = "productive cough 3 months x 2 years." Disease Classic story / symptoms Physical findings Diagnostics + interpretation Remember cue Community-acquired pneumonia (CAP) Acute infection of lung parenchyma acquired outside the hospital. Fever, cough, dyspnea, malaise, chest pain, anorexia, chills, tachycardia. Crackles or rhonchi. Dullness to percussion. May have positive bronchophony, egophony, or whispered pectoriloquy. CXR: infiltrate. CBC: leukocytosis with left shift supports bacterial cause. ESR/CRP/procalcitonin may be elevated. CURB-65 helps decide outpatient vs hospital care. CAP = fever + cough + crackles/dullness + infiltrate. Remember: CAP can lead to sepsis. Hospital-acquired pneumonia (HAP) Pneumonia occurring 48 hours after hospital admission and not incubating on admission. Similar pneumonia findings: fever, cough, dyspnea, abnormal breath sounds. CXR infiltrate plus clinical infection after hospital exposure. HAP = after 48 hours in hospital. Ventilator-associated pneumonia (VAP) Type of HAP that develops 48 hours after intubation. New/worsening respiratory findings while ventilated. CXR infiltrate plus infection signs after intubation timeline. VAP = 48 hours after intubation. Aspiration pneumonia Aspiration of food, saliva, liquids, or vomit. Most often affects right middle or right lower lobe. Cough, dyspnea, fever possible. Findings depend on extent of inflammation/obstruction. CXR may show infiltrate in dependent/right-sided lung regions. Right main bronchus is shorter, wider, and more vertical - aspiration likes the right side. Disease Classic story / symptoms Physical findings Diagnostics + interpretation Remember cue Pneumothorax Air/gas in pleural cavity. Sudden dyspnea and pleuritic chest pain. Can be spontaneous or from trauma. Unilateral decreased chest excursion, diminished breath sounds, absent tactile fremitus, hyperresonance on affected side. Tracheal deviation away from affected side is late. CXR: white visceral pleural line. Severity depends on size, symptoms, and cause. PTX = sudden + one-sided + hyperresonance + absent fremitus. Pulmonary embolism (PE) Obstruction in pulmonary artery/branch from thrombus, tumor, air, or fat. Dyspnea, chest pain, cough, possible DVT symptoms. Tachycardia, hypoxia, crackles or diminished breath sounds, increased JVP may occur. CTA chest or V/Q scan. D-dimer is nonspecific. ABG may show hypoxia and/or respiratory alkalosis. Normal CXR + unexplained hypoxia = think PE. PE = normal CXR can fool you. Use Virchow: stasis + endothelial injury + hypercoagulability. Disease Classic story / symptoms Physical findings Diagnostics + interpretation Remember cue Pleural effusion Abnormal fluid in pleural space from excess production or decreased lymphatic absorption. Dyspnea, pleuritic chest pain, cough. Depends on volume. Dullness to percussion, decreased tactile fremitus, asymmetric expansion, diminished breath sounds. Egophony may be at superior aspect. Possible friction rub. CXR or ultrasound confirms fluid. Larger effusions produce more symptoms and findings. Effusion = fluid outside lung: dull + decreased movement + decreased fremitus. Tuberculosis (TB) Inflammatory response to inhaled tubercle bacilli. Chronic cough, weight loss, hemoptysis, fever, night sweats, fatigue. May have chronic/systemic illness appearance; lung exam can vary. CXR may be normal or show hilar adenopathy, pleural effusion, or pulmonary infiltrates. TB = chronic cough + night sweats + weight loss + hemoptysis. Respiratory Exam Study Guide - built from uploaded NURS 6023 respiratory lecture PowerPoint and transcripts Upper airway cough syndrome Often related to postnasal drip. Hoarseness, persistent throat clearing, allergic rhinitis symptoms. Hyperemia or cobblestoning of posterior pharynx. Usually clinical based on upper-airway/postnasal drip pattern. Do not forget HEENT when the complaint is cough. 4. Diagnostic tests: what to order and how to interpret Test Best use Interpretation pearls Chest X-ray (CXR) First-line imaging for many respiratory complaints; helps evaluate pneumonia, pneumothorax, pleural effusion, and COPD changes. COPD: hyperinflation/flattened diaphragm. Pneumonia: infiltrate. Pneumothorax: white visceral pleural line. TB may be normal or show hilar adenopathy, effusion, or infiltrates. CT chest More detailed lung imaging when CXR is unclear or more detail is needed. Useful for complex lung findings, masses, trauma, or complications. CTA chest Key test for suspected pulmonary embolism. Looks for clot/obstruction in pulmonary arteries. Use especially with unexplained hypoxia and risk factors. V/Q scan Alternative PE evaluation when CTA is not ideal or contraindicated. Compares ventilation and perfusion; mismatch supports PE. D-dimer Screening support for PE in appropriate low-risk situations. Nonspecific. Elevated does not diagnose PE; many conditions can increase it. Pulmonary function tests (PFTs) Gold standard for COPD; also useful for asthma evaluation. COPD: FEV1/FVC 0.70. FEV1 percent predicted stages COPD severity. Bronchodilator response helps evaluate reversibility. ABGs Assess oxygenation, ventilation, and acid-base status in sick respiratory patients. PE may show hypoxia and/or respiratory alkalosis. Basic read: pH tells acid/base, PaCO2 tells respiratory effect, HCO3 tells metabolic effect. CBC Evaluate infection or inflammatory pattern. Leukocytosis with left shift supports bacterial pneumonia more than viral process. Test Best use Interpretation pearls ESR, CRP, procalcitonin Support inflammatory/infectious process, especially pneumonia workup. Elevation can support infection/inflammation; procalcitonin may support bacterial process. Ultrasound Helpful for pleural effusion evaluation. Identifies fluid and can guide procedures if drainage is needed. CURB-65 Clinical decision tool for community-acquired pneumonia disposition. C = confusion, U = urea/BUN elevation, R = RR =30, B = low BP, 65 = age =65. Higher score suggests higher risk/hospitalization need. 5. Pattern recognition: quick quiz table