NUR 6001 Exam 2 Study Guide 2026 | Respiratory &
Cardiac Assessments, Advanced Health Assessment
Review | Complete Solutions PDF-WPU
● Respiratory
○ Different breath sounds
■ Decreased Breath Sounds
● Decreased breath sounds occur in airway disease or obstruction,
diaphragm paralysis, or impairment of sound transmission through
the chest wall
● Worsening symptoms may lead to absent breath sounds. Absent
lung sounds usually indicate no air moving in the lung tissue.
■ Increased Breath Sounds
● A common abnormal finding is hearing bronchial or broncho
vesicular sounds, which are louder and harsher, in peripheral lung
tissue where vesicular sounds are normally heard. This occurs
when underlying lung tissue is filled with liquid or solid material,
rather than air.
■ Crackles (fine, medium, coarse)
● Heard more often during inspiration
● Short duration and lasts a few milliseconds
● Crackles (Fine)
○ high-pitched crackling sounds that occur when inhaled air
meets deflated alveoli, causing them to pop open
○ Short popping sounds, High-pitched
○ Location: usually bases of lower lobes
○ Tip: fine crackles sound like the noise created by rolling a
strand of hair between your thumb and index finger.
○ Fine crackles in a vesicular region likely indicate
Pneumonia - an inflammatory lung condition usually
caused by an infection. Pneumonia is a major cause of
death among all age groups, resulting in 4 million deaths
yearly.
● Crackles (Coarse)
○ Loud, low-pitched bubbling sounds that are caused when
air meets secretions in the large airways
○ Short crackling sounds, low-pitched
○ Location: trachea and large bronchi
○ Tip: coarse crackles sound like separating a velcro
fastener
■ Rhonchi
● Tend to disappear after coughing
● Continuous, low-pitched snoring sounds caused by airway
obstruction from solid or thick secretions, muscular constriction, or
, masses.
● Long snoring sounds (more likely to be prolonged), low-pitched
● Location: Bronchi
● Tip: Rhonchi can sound like snoring or moaning.
■ Wheezes
● Caused by air flowing through constricted passageways.
● Typically heard during inspiration or expiration
● Continuous, high-pitched, musical sounds that are created by the
narrowing of airways from swelling, secretions, or masses
● Long musical sounds, high-pitched
● Location: All lung fields
■ Friction rub
● Caused by inflammation of the pleural or pericardial tissue
● Dry, crackling, rubbing, low-pitched sounds that are heard in both
inhalation and exhalation.
■ Mediastinal crunches (Hamman’s sign)
● *Pneumothorax
■ Succession splashes
■ Stridor
● A loud, continuous, high-pitched crowing sound that is caused by
upper airway obstruction
● This is the most serious of the adventitious sounds and it requires
immediate attention
● Long crowing sounds, high-pitched
● Location: trachea
● Tip: Stridor is usually audible without a stethoscope
○ Assessment findings for
■ Pneumothorax
● Involves air in the pleural cavity
● Can occur spontaneously in healthy individuals or can be
secondary to trauma or intrinsic lung disease.
● S&S: sudden onset of SOB, chest pain, tachycardia, tachypnea,
splinting the chest
● Decreased fremitus, increased hyperresonance on the affected
side; Diminished or absent lung sounds
● Trachea may shift away from the affected side if a large PTX is
present
● Diagnostic: Plain chest films reveal PTX with an absence of lung
markings in the affected area and a shift of the mediastinum
● Needle/catheter aspiration or chest tube placement may be
indicated
■ Pneumonia
● Involves inflammation and consolidation of lung disease
● Community-acquired PNA (outside of the hospital)
○ Confusion of new-onset
○ BUN >20 mg/dL
○ Respiratory rate of >30 breaths/min
○ BP <90 mm Hg systolic or diastolic <60 mm Hg
, ○ Age 65 or older
● or within the hospital (nosocomial, or hospital-acquired, PNA)
● The cause is Streptococcus pneumoniae, Haemophilus
influenzae, or Staphylococcus aureus.
● S&S: cough, fever, malaise, shaking chills, rigors, chest discomfort
● Tachycardia, tachypnea, and fever
● Uneven fremitus, an area over the consolidation percusses dully,
bronchial breath sounds often with crackles
● Bronchophony, egophony, and whispered pectoriloquy are present
● Diagnostic: chest film reveals an area of infiltrate
● It is a red flag if a pleural effusion is visualized. Follow-up to
exclude the development of an emphyema is mandatory. Referral
for possible thoracentesis.
● Elevated WBCs
■ Asthma
● Chronic inflammation involves inflammation of the airways, with
varying degrees of airway obstruction and hyperresponsiveness.
● S&S: intermittent sensation of chest tightness, nonproductive
cough, SOB, wheezing
● Symptoms worsen with activity, vital infections, exposure to
allergens, or other triggers
● Often have other signs of atopy, including allergic rhinitis or atopic
dermatitis.
● Diagnosis: pulmonary function tests or spirometry
○ Diminished forced expiratory volume in 1 second
(FEV1)/forced vital capacity (FVC) ratio and diminished
FEV1 indicate obstructed outflow.
○ Some degree of reversibility occurs with the administration
of bronchodilators.
○ Chest films are generally within normal limits unless there
is significant air trapping.
○ Peak flow meters should not be used as diagnostic tools
but to monitor ongoing symptoms and determine the
response to therapy.
■ Pleurisy
● Involves inflammation of the pleura & is often related to underlying
infectious processes
● S&S
○ severe & sharp pleuritic pain with acute onset
○ Pain may be noted only with coughing, respiration, or
maneuvers that cause chest motion.
○ Patient often splints the chest & attempts shallow
respirations to limit the discomfort
○ Pleural friction rub may be auscultated
Cardiac Assessments, Advanced Health Assessment
Review | Complete Solutions PDF-WPU
● Respiratory
○ Different breath sounds
■ Decreased Breath Sounds
● Decreased breath sounds occur in airway disease or obstruction,
diaphragm paralysis, or impairment of sound transmission through
the chest wall
● Worsening symptoms may lead to absent breath sounds. Absent
lung sounds usually indicate no air moving in the lung tissue.
■ Increased Breath Sounds
● A common abnormal finding is hearing bronchial or broncho
vesicular sounds, which are louder and harsher, in peripheral lung
tissue where vesicular sounds are normally heard. This occurs
when underlying lung tissue is filled with liquid or solid material,
rather than air.
■ Crackles (fine, medium, coarse)
● Heard more often during inspiration
● Short duration and lasts a few milliseconds
● Crackles (Fine)
○ high-pitched crackling sounds that occur when inhaled air
meets deflated alveoli, causing them to pop open
○ Short popping sounds, High-pitched
○ Location: usually bases of lower lobes
○ Tip: fine crackles sound like the noise created by rolling a
strand of hair between your thumb and index finger.
○ Fine crackles in a vesicular region likely indicate
Pneumonia - an inflammatory lung condition usually
caused by an infection. Pneumonia is a major cause of
death among all age groups, resulting in 4 million deaths
yearly.
● Crackles (Coarse)
○ Loud, low-pitched bubbling sounds that are caused when
air meets secretions in the large airways
○ Short crackling sounds, low-pitched
○ Location: trachea and large bronchi
○ Tip: coarse crackles sound like separating a velcro
fastener
■ Rhonchi
● Tend to disappear after coughing
● Continuous, low-pitched snoring sounds caused by airway
obstruction from solid or thick secretions, muscular constriction, or
, masses.
● Long snoring sounds (more likely to be prolonged), low-pitched
● Location: Bronchi
● Tip: Rhonchi can sound like snoring or moaning.
■ Wheezes
● Caused by air flowing through constricted passageways.
● Typically heard during inspiration or expiration
● Continuous, high-pitched, musical sounds that are created by the
narrowing of airways from swelling, secretions, or masses
● Long musical sounds, high-pitched
● Location: All lung fields
■ Friction rub
● Caused by inflammation of the pleural or pericardial tissue
● Dry, crackling, rubbing, low-pitched sounds that are heard in both
inhalation and exhalation.
■ Mediastinal crunches (Hamman’s sign)
● *Pneumothorax
■ Succession splashes
■ Stridor
● A loud, continuous, high-pitched crowing sound that is caused by
upper airway obstruction
● This is the most serious of the adventitious sounds and it requires
immediate attention
● Long crowing sounds, high-pitched
● Location: trachea
● Tip: Stridor is usually audible without a stethoscope
○ Assessment findings for
■ Pneumothorax
● Involves air in the pleural cavity
● Can occur spontaneously in healthy individuals or can be
secondary to trauma or intrinsic lung disease.
● S&S: sudden onset of SOB, chest pain, tachycardia, tachypnea,
splinting the chest
● Decreased fremitus, increased hyperresonance on the affected
side; Diminished or absent lung sounds
● Trachea may shift away from the affected side if a large PTX is
present
● Diagnostic: Plain chest films reveal PTX with an absence of lung
markings in the affected area and a shift of the mediastinum
● Needle/catheter aspiration or chest tube placement may be
indicated
■ Pneumonia
● Involves inflammation and consolidation of lung disease
● Community-acquired PNA (outside of the hospital)
○ Confusion of new-onset
○ BUN >20 mg/dL
○ Respiratory rate of >30 breaths/min
○ BP <90 mm Hg systolic or diastolic <60 mm Hg
, ○ Age 65 or older
● or within the hospital (nosocomial, or hospital-acquired, PNA)
● The cause is Streptococcus pneumoniae, Haemophilus
influenzae, or Staphylococcus aureus.
● S&S: cough, fever, malaise, shaking chills, rigors, chest discomfort
● Tachycardia, tachypnea, and fever
● Uneven fremitus, an area over the consolidation percusses dully,
bronchial breath sounds often with crackles
● Bronchophony, egophony, and whispered pectoriloquy are present
● Diagnostic: chest film reveals an area of infiltrate
● It is a red flag if a pleural effusion is visualized. Follow-up to
exclude the development of an emphyema is mandatory. Referral
for possible thoracentesis.
● Elevated WBCs
■ Asthma
● Chronic inflammation involves inflammation of the airways, with
varying degrees of airway obstruction and hyperresponsiveness.
● S&S: intermittent sensation of chest tightness, nonproductive
cough, SOB, wheezing
● Symptoms worsen with activity, vital infections, exposure to
allergens, or other triggers
● Often have other signs of atopy, including allergic rhinitis or atopic
dermatitis.
● Diagnosis: pulmonary function tests or spirometry
○ Diminished forced expiratory volume in 1 second
(FEV1)/forced vital capacity (FVC) ratio and diminished
FEV1 indicate obstructed outflow.
○ Some degree of reversibility occurs with the administration
of bronchodilators.
○ Chest films are generally within normal limits unless there
is significant air trapping.
○ Peak flow meters should not be used as diagnostic tools
but to monitor ongoing symptoms and determine the
response to therapy.
■ Pleurisy
● Involves inflammation of the pleura & is often related to underlying
infectious processes
● S&S
○ severe & sharp pleuritic pain with acute onset
○ Pain may be noted only with coughing, respiration, or
maneuvers that cause chest motion.
○ Patient often splints the chest & attempts shallow
respirations to limit the discomfort
○ Pleural friction rub may be auscultated
