NBRC FULL REVIEW CRT/RRT NEWEST ACTUAL EXAM
COMPLETE TESTBANK 342 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) | ALREADY
GRADED A+.
QUESTION
A patient presents with a high-pitched musical sound heard during auscultation. The
clinician suspects this finding is due to bronchospasm. What is the name of this breath
sound and what is the appropriate treatment?
CORRECT ANS: Wheeze - due to bronchospasm - bronchodilator Tx - unilateral wheeze
indicative of a foreign body obstruction
EXPERT RATIONALE
Wheezes are continuous, high-pitched musical sounds produced by air flowing through
narrowed or constricted airways. The most common cause is bronchospasm, which is
typically treated with bronchodilators such as beta-agonists. A unilateral wheeze is
particularly concerning as it may indicate a foreign body obstruction in one mainstem
bronchus, requiring bronchoscopy for removal. While bilateral wheezes are commonly
associated with asthma or COPD exacerbations, a unilateral wheeze should prompt
immediate investigation for an obstructive foreign body. The absence of wheezing in a
patient with respiratory distress can be a sign of severe obstruction with poor air
movement ("silent chest") requiring emergent intervention.
QUESTION
A pediatric patient presents with a harsh, high-pitched sound during inspiration. The
clinician suspects upper airway obstruction. What is this sound called, what are potential
causes, and what is the appropriate intervention?
CORRECT ANS: Stridor - upper airway obstruction - supraglottic swelling (epiglottitis)
(thumb sign) - subglottic swelling (croup, postextubation) (steeple sign) - foreign body
aspiration - Racemic epinephrine - intubation if MARKED stridor - Lateral neck X-ray for
confirmation
,EXPERT RATIONALE
Stridor is a harsh, high-pitched inspiratory sound caused by turbulent airflow through a
narrowed upper airway. It is a critical finding that requires immediate evaluation.
Supraglottic swelling is typically seen in epiglottitis (characterized by the "thumb sign"
on lateral neck X-ray), while subglottic swelling is associated with croup or
postextubation edema (characterized by the "steeple sign"). Foreign body aspiration can
also cause stridor. Treatment depends on the cause and severity. Racemic epinephrine is
used for croup to reduce mucosal edema. Intubation is indicated if there is marked
stridor with respiratory distress. A lateral neck X-ray can help confirm the diagnosis.
Epiglottitis is a medical emergency requiring immediate airway management.
QUESTION
A patient presents with a coarse grating or crunching sound heard during auscultation.
The clinician suspects visceral and parietal pleura rubbing together. What is this sound
and what conditions are associated with it?
CORRECT ANS: Pleural friction rub - coarse grating or crunching sound - visceral and
parietal pleura rubbing together - associated with TB, pneumonia, pulmonary infarction,
cancer - steroids and antibiotics
EXPERT RATIONALE
A pleural friction rub is a coarse, grating, or crunching sound heard during inspiration
and expiration, caused by inflammation of the pleural surfaces (visceral and parietal
pleura) rubbing together. This finding indicates pleural inflammation or irritation.
Common associated conditions include tuberculosis, pneumonia, pulmonary infarction,
and pleural malignancy. Treatment is directed at the underlying cause; steroids may be
used for inflammatory conditions and antibiotics for infectious etiologies. A pleural
friction rub may be intermittent and can be differentiated from other adventitious
sounds by its superficial quality and the fact that coughing does not clear it.
QUESTION
What heart sound is associated with the closure of the mitral and tricuspid valves at the
beginning of ventricular contraction?
,CORRECT ANS: Heart Sound S₁ - closure of the mitral and tricuspid valves at the
beginning of ventricular contraction
EXPERT RATIONALE
The first heart sound (S₁) is produced by the closure of the atrioventricular valves (mitral
and tricuspid) at the onset of ventricular systole. It marks the beginning of ventricular
contraction and is best heard at the apex of the heart. S₁ is typically described as "lub"
and corresponds to the first part of the "lub-dub" cycle. The intensity of S₁ can be
affected by various factors, including the PR interval, valvular pathology, and cardiac
contractility.
QUESTION
What heart sound is associated with the closure of the pulmonic and aortic valves when
systole ends and ventricles relax?
CORRECT ANS: Heart Sound S₂ - closure of pulmonic and aortic valves - occurs when
systole ends; ventricles relax
EXPERT RATIONALE
The second heart sound (S₂) is produced by the closure of the semilunar valves (aortic
and pulmonic) at the end of ventricular systole when the ventricles begin to relax. It
marks the beginning of diastole and is typically described as "dub." S₂ is best heard at
the base of the heart. Physiologic splitting of S₂ can occur during inspiration due to
delayed closure of the pulmonic valve, which is a normal finding. Wide, fixed, or
paradoxical splitting may indicate various cardiac pathologies.
QUESTION
What abnormal heart sound may suggest congestive heart failure?
CORRECT ANS: Heart Sound S₃ - abnormal and may suggest CHF
EXPERT RATIONALE
The third heart sound (S₃) is an abnormal low-frequency sound heard in early diastole,
shortly after S₂. It is associated with rapid ventricular filling and decreased compliance of
the ventricles. In adults, S₃ is often indicative of congestive heart failure (CHF),
, particularly with volume overload and decreased left ventricular function. It is
sometimes referred to as a "ventricular gallop" and is best heard at the apex with the
patient in the left lateral decubitus position. In children and young adults, S₃ may be a
normal finding.
QUESTION
What abnormal heart sound may indicate cardiac abnormality such as myocardial
infarction or cardiomegaly?
CORRECT ANS: Heart Sound S₄ - abnormal and indicative of cardiac abnormality such
as myocardial infarction or cardiomegaly
EXPERT RATIONALE
The fourth heart sound (S₄) is an abnormal low-frequency sound heard in late diastole,
just before S₁. It is caused by atrial contraction forcing blood into a stiff or non-
compliant ventricle. S₄ is associated with conditions that decrease ventricular
compliance, such as myocardial infarction, cardiomegaly, and hypertrophic
cardiomyopathy. It is often referred to as an "atrial gallop" and is best heard at the apex.
S₄ is almost always pathological in adults and may indicate significant cardiac
dysfunction.
QUESTION
What are the sounds caused by turbulent blood flow, often due to heart valve defects or
congenital heart abnormalities?
CORRECT ANS: Heart murmurs - sounds caused by turbulent blood flow - heart valve
defects or congenital heart abnormalities - can occur when blood is pushed through an
abnormal opening (ASD, PDA)
EXPERT RATIONALE
Heart murmurs are abnormal sounds caused by turbulent blood flow within the heart or
great vessels. They can result from valvular stenosis or regurgitation, congenital heart
defects (such as atrial septal defect or patent ductus arteriosus), or other structural
abnormalities. Murmurs are characterized by their timing (systolic, diastolic, or
continuous), location, intensity, and quality. While many murmurs are innocent
COMPLETE TESTBANK 342 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) | ALREADY
GRADED A+.
QUESTION
A patient presents with a high-pitched musical sound heard during auscultation. The
clinician suspects this finding is due to bronchospasm. What is the name of this breath
sound and what is the appropriate treatment?
CORRECT ANS: Wheeze - due to bronchospasm - bronchodilator Tx - unilateral wheeze
indicative of a foreign body obstruction
EXPERT RATIONALE
Wheezes are continuous, high-pitched musical sounds produced by air flowing through
narrowed or constricted airways. The most common cause is bronchospasm, which is
typically treated with bronchodilators such as beta-agonists. A unilateral wheeze is
particularly concerning as it may indicate a foreign body obstruction in one mainstem
bronchus, requiring bronchoscopy for removal. While bilateral wheezes are commonly
associated with asthma or COPD exacerbations, a unilateral wheeze should prompt
immediate investigation for an obstructive foreign body. The absence of wheezing in a
patient with respiratory distress can be a sign of severe obstruction with poor air
movement ("silent chest") requiring emergent intervention.
QUESTION
A pediatric patient presents with a harsh, high-pitched sound during inspiration. The
clinician suspects upper airway obstruction. What is this sound called, what are potential
causes, and what is the appropriate intervention?
CORRECT ANS: Stridor - upper airway obstruction - supraglottic swelling (epiglottitis)
(thumb sign) - subglottic swelling (croup, postextubation) (steeple sign) - foreign body
aspiration - Racemic epinephrine - intubation if MARKED stridor - Lateral neck X-ray for
confirmation
,EXPERT RATIONALE
Stridor is a harsh, high-pitched inspiratory sound caused by turbulent airflow through a
narrowed upper airway. It is a critical finding that requires immediate evaluation.
Supraglottic swelling is typically seen in epiglottitis (characterized by the "thumb sign"
on lateral neck X-ray), while subglottic swelling is associated with croup or
postextubation edema (characterized by the "steeple sign"). Foreign body aspiration can
also cause stridor. Treatment depends on the cause and severity. Racemic epinephrine is
used for croup to reduce mucosal edema. Intubation is indicated if there is marked
stridor with respiratory distress. A lateral neck X-ray can help confirm the diagnosis.
Epiglottitis is a medical emergency requiring immediate airway management.
QUESTION
A patient presents with a coarse grating or crunching sound heard during auscultation.
The clinician suspects visceral and parietal pleura rubbing together. What is this sound
and what conditions are associated with it?
CORRECT ANS: Pleural friction rub - coarse grating or crunching sound - visceral and
parietal pleura rubbing together - associated with TB, pneumonia, pulmonary infarction,
cancer - steroids and antibiotics
EXPERT RATIONALE
A pleural friction rub is a coarse, grating, or crunching sound heard during inspiration
and expiration, caused by inflammation of the pleural surfaces (visceral and parietal
pleura) rubbing together. This finding indicates pleural inflammation or irritation.
Common associated conditions include tuberculosis, pneumonia, pulmonary infarction,
and pleural malignancy. Treatment is directed at the underlying cause; steroids may be
used for inflammatory conditions and antibiotics for infectious etiologies. A pleural
friction rub may be intermittent and can be differentiated from other adventitious
sounds by its superficial quality and the fact that coughing does not clear it.
QUESTION
What heart sound is associated with the closure of the mitral and tricuspid valves at the
beginning of ventricular contraction?
,CORRECT ANS: Heart Sound S₁ - closure of the mitral and tricuspid valves at the
beginning of ventricular contraction
EXPERT RATIONALE
The first heart sound (S₁) is produced by the closure of the atrioventricular valves (mitral
and tricuspid) at the onset of ventricular systole. It marks the beginning of ventricular
contraction and is best heard at the apex of the heart. S₁ is typically described as "lub"
and corresponds to the first part of the "lub-dub" cycle. The intensity of S₁ can be
affected by various factors, including the PR interval, valvular pathology, and cardiac
contractility.
QUESTION
What heart sound is associated with the closure of the pulmonic and aortic valves when
systole ends and ventricles relax?
CORRECT ANS: Heart Sound S₂ - closure of pulmonic and aortic valves - occurs when
systole ends; ventricles relax
EXPERT RATIONALE
The second heart sound (S₂) is produced by the closure of the semilunar valves (aortic
and pulmonic) at the end of ventricular systole when the ventricles begin to relax. It
marks the beginning of diastole and is typically described as "dub." S₂ is best heard at
the base of the heart. Physiologic splitting of S₂ can occur during inspiration due to
delayed closure of the pulmonic valve, which is a normal finding. Wide, fixed, or
paradoxical splitting may indicate various cardiac pathologies.
QUESTION
What abnormal heart sound may suggest congestive heart failure?
CORRECT ANS: Heart Sound S₃ - abnormal and may suggest CHF
EXPERT RATIONALE
The third heart sound (S₃) is an abnormal low-frequency sound heard in early diastole,
shortly after S₂. It is associated with rapid ventricular filling and decreased compliance of
the ventricles. In adults, S₃ is often indicative of congestive heart failure (CHF),
, particularly with volume overload and decreased left ventricular function. It is
sometimes referred to as a "ventricular gallop" and is best heard at the apex with the
patient in the left lateral decubitus position. In children and young adults, S₃ may be a
normal finding.
QUESTION
What abnormal heart sound may indicate cardiac abnormality such as myocardial
infarction or cardiomegaly?
CORRECT ANS: Heart Sound S₄ - abnormal and indicative of cardiac abnormality such
as myocardial infarction or cardiomegaly
EXPERT RATIONALE
The fourth heart sound (S₄) is an abnormal low-frequency sound heard in late diastole,
just before S₁. It is caused by atrial contraction forcing blood into a stiff or non-
compliant ventricle. S₄ is associated with conditions that decrease ventricular
compliance, such as myocardial infarction, cardiomegaly, and hypertrophic
cardiomyopathy. It is often referred to as an "atrial gallop" and is best heard at the apex.
S₄ is almost always pathological in adults and may indicate significant cardiac
dysfunction.
QUESTION
What are the sounds caused by turbulent blood flow, often due to heart valve defects or
congenital heart abnormalities?
CORRECT ANS: Heart murmurs - sounds caused by turbulent blood flow - heart valve
defects or congenital heart abnormalities - can occur when blood is pushed through an
abnormal opening (ASD, PDA)
EXPERT RATIONALE
Heart murmurs are abnormal sounds caused by turbulent blood flow within the heart or
great vessels. They can result from valvular stenosis or regurgitation, congenital heart
defects (such as atrial septal defect or patent ductus arteriosus), or other structural
abnormalities. Murmurs are characterized by their timing (systolic, diastolic, or
continuous), location, intensity, and quality. While many murmurs are innocent
