Wilkes University NSG 500 Advanced Health Assessment Exam 2
(pdf) | 2026/2027 | Q&A | Health Assessment
1. A palpable vibration increased with lobar pneumonia is also known as:
A) Rhonchi
B) Resonance
C) Fremitus
D) Crackles
Correct Answer: Fremitus
Rationale: Fremitus is a palpable vibration felt on the chest wall during
speech. Increased fremitus occurs with consolidation of lung tissue, as seen
in lobar pneumonia, because denser tissue transmits vibrations more
effectively. Rhonchi and crackles are audible, not palpable; resonance is a
percussion finding.
2. A nurse is assessing tactile fremitus in a patient with suspected
pneumonia. Which technique is correct for posterior assessment?
A) Place hands anteriorly and have the patient say "99"
B) Place hands posteriorly beneath the shoulder blades and move hands
down simultaneously while the patient says "99"
C) Place hands on the lateral chest and have the patient whisper
D) Place hands on the trachea and have the patient cough
Correct Answer: Place hands posteriorly beneath the shoulder blades and
move hands down simultaneously while the patient says "99"
Rationale: Hand positioning posteriorly, feeling beneath the shoulder
blades/scapula, moving hands down simultaneously while having the patient
say "99" over and over again is the correct technique for assessing tactile
,fremitus. This allows the examiner to detect areas of increased or decreased
vibration transmission.
3. During auscultation, the nurse asks the patient to say "99" in a normal
voice. The nurse hears the sound clearly and distinctly rather than muffled.
This finding is known as:
A) Egophony
B) Bronchophony
C) Whispered pectoriloquy
D) Normal vesicular breath sounds
Correct Answer: Bronchophony
Rationale: Bronchophony is a type of pectoriloquy. A normal finding is
hearing "99" as a muffled sound. If you don't hear muffling, that would
indicate consolidation (pneumonia). Bronchophony indicates increased clarity
and loudness of spoken sounds over consolidated lung tissue.
4. While auscultating the chest, the nurse asks the patient to say the vowel
"e." Over normal lung tissue, the nurse hears "e," but over an area of
consolidation, the sound changes to a nasal "a." This finding is known as:
A) Bronchophony
B) Egophony
C) Whispered pectoriloquy
D) Fremitus
Correct Answer: Egophony
Rationale: Egophony is assessed by asking the patient to say the vowel "e"
while auscultating. Over normal lung tissues, the same "e" will be heard. If
,the lung tissue is consolidated, the "e" sound will change to a nasal "a". This
is a classic sign of lung consolidation.
5. A nurse is differentiating between crackles and rhonchi. Which action is
most helpful?
A) Asking the patient to cough
B) Having the patient take a deep breath
C) Percussing the chest
D) Palpating for fremitus
Correct Answer: Asking the patient to cough
Rationale: Auscultate lungs before and after the patient coughs. Rhonchi
clears with coughing because they are caused by secretions in the larger
airways. Crackles are more persistent and do not clear with coughing, as
they originate from small airways/alveoli opening.
6. Which of the following are considered abnormal (adventitious) breath
sounds? (Select all that apply.)
A) Crackles
B) Rhonchi
C) Wheezes
D) Friction rub
Correct Answer: A, B, C, D (All of the above)
Rationale: All listed are adventitious (abnormal) breath sounds. Crackles
indicate fluid or secretions in small airways; rhonchi suggest larger airway
secretions; wheezes indicate narrowed airways; friction rub suggests pleural
, inflammation. Mediastinal crunch (Hamman's sign) is also abnormal but less
common.
7. What sound indicates COPD/emphysema or restrictive lung disease?
A) Hyperresonance
B) Decreased diaphragmatic excursion
C) Increased fremitus
D) Egophony
Correct Answer: Decreased diaphragmatic excursion
Rationale: Decreased diaphragmatic excursion is a finding in
COPD/emphysema or restrictive lung disease. This occurs due to
hyperinflation of the lungs or reduced lung compliance, limiting
diaphragmatic movement during inspiration.
8. A nurse percusses the chest and hears a dull sound over the lung fields.
This finding may indicate:
A) Normal lung tissue
B) Atelectasis or consolidation
C) Emphysema
D) Pneumothorax
Correct Answer: Atelectasis or consolidation
Rationale: Dullness to percussion over the lung fields indicates increased
density, such as atelectasis, consolidation (pneumonia), pleural effusion, or
tumor. Resonance is heard over normal lung tissue, hyperresonance in
emphysema, and tympany in pneumothorax.
(pdf) | 2026/2027 | Q&A | Health Assessment
1. A palpable vibration increased with lobar pneumonia is also known as:
A) Rhonchi
B) Resonance
C) Fremitus
D) Crackles
Correct Answer: Fremitus
Rationale: Fremitus is a palpable vibration felt on the chest wall during
speech. Increased fremitus occurs with consolidation of lung tissue, as seen
in lobar pneumonia, because denser tissue transmits vibrations more
effectively. Rhonchi and crackles are audible, not palpable; resonance is a
percussion finding.
2. A nurse is assessing tactile fremitus in a patient with suspected
pneumonia. Which technique is correct for posterior assessment?
A) Place hands anteriorly and have the patient say "99"
B) Place hands posteriorly beneath the shoulder blades and move hands
down simultaneously while the patient says "99"
C) Place hands on the lateral chest and have the patient whisper
D) Place hands on the trachea and have the patient cough
Correct Answer: Place hands posteriorly beneath the shoulder blades and
move hands down simultaneously while the patient says "99"
Rationale: Hand positioning posteriorly, feeling beneath the shoulder
blades/scapula, moving hands down simultaneously while having the patient
say "99" over and over again is the correct technique for assessing tactile
,fremitus. This allows the examiner to detect areas of increased or decreased
vibration transmission.
3. During auscultation, the nurse asks the patient to say "99" in a normal
voice. The nurse hears the sound clearly and distinctly rather than muffled.
This finding is known as:
A) Egophony
B) Bronchophony
C) Whispered pectoriloquy
D) Normal vesicular breath sounds
Correct Answer: Bronchophony
Rationale: Bronchophony is a type of pectoriloquy. A normal finding is
hearing "99" as a muffled sound. If you don't hear muffling, that would
indicate consolidation (pneumonia). Bronchophony indicates increased clarity
and loudness of spoken sounds over consolidated lung tissue.
4. While auscultating the chest, the nurse asks the patient to say the vowel
"e." Over normal lung tissue, the nurse hears "e," but over an area of
consolidation, the sound changes to a nasal "a." This finding is known as:
A) Bronchophony
B) Egophony
C) Whispered pectoriloquy
D) Fremitus
Correct Answer: Egophony
Rationale: Egophony is assessed by asking the patient to say the vowel "e"
while auscultating. Over normal lung tissues, the same "e" will be heard. If
,the lung tissue is consolidated, the "e" sound will change to a nasal "a". This
is a classic sign of lung consolidation.
5. A nurse is differentiating between crackles and rhonchi. Which action is
most helpful?
A) Asking the patient to cough
B) Having the patient take a deep breath
C) Percussing the chest
D) Palpating for fremitus
Correct Answer: Asking the patient to cough
Rationale: Auscultate lungs before and after the patient coughs. Rhonchi
clears with coughing because they are caused by secretions in the larger
airways. Crackles are more persistent and do not clear with coughing, as
they originate from small airways/alveoli opening.
6. Which of the following are considered abnormal (adventitious) breath
sounds? (Select all that apply.)
A) Crackles
B) Rhonchi
C) Wheezes
D) Friction rub
Correct Answer: A, B, C, D (All of the above)
Rationale: All listed are adventitious (abnormal) breath sounds. Crackles
indicate fluid or secretions in small airways; rhonchi suggest larger airway
secretions; wheezes indicate narrowed airways; friction rub suggests pleural
, inflammation. Mediastinal crunch (Hamman's sign) is also abnormal but less
common.
7. What sound indicates COPD/emphysema or restrictive lung disease?
A) Hyperresonance
B) Decreased diaphragmatic excursion
C) Increased fremitus
D) Egophony
Correct Answer: Decreased diaphragmatic excursion
Rationale: Decreased diaphragmatic excursion is a finding in
COPD/emphysema or restrictive lung disease. This occurs due to
hyperinflation of the lungs or reduced lung compliance, limiting
diaphragmatic movement during inspiration.
8. A nurse percusses the chest and hears a dull sound over the lung fields.
This finding may indicate:
A) Normal lung tissue
B) Atelectasis or consolidation
C) Emphysema
D) Pneumothorax
Correct Answer: Atelectasis or consolidation
Rationale: Dullness to percussion over the lung fields indicates increased
density, such as atelectasis, consolidation (pneumonia), pleural effusion, or
tumor. Resonance is heard over normal lung tissue, hyperresonance in
emphysema, and tympany in pneumothorax.
