NURS 612 Exam 2 Questions and Answers Already Passed
Crackles - Answers 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 - Answers 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 - Answers Loud/grating lung sound. Inflamed pleura, pneumonia, pleuritis,
malignancy. Happens outside tree.
Rhochi - Answers 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 - Answers 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? - Answers Results from compromised respiration as in chronic asthma, cystic
fibrosis, or emphysema.
Resonance percussion chest - Answers loud, low pitch, long duration, hollow quality (expected lung
sound, can usually be heard over all areas of lungs).
Dullness percussion - Answers medium intensity, medium to high pitch, medium duration, dull thud
quality (suggests pneumonia, pleural effusion)
Tympany percussion - Answers loud intensity, high pitch, medium duration, drumlike quality
Hyperresonance percussion - Answers very loud intensity, very low pitch, longer duration, booming
quality (associated with hyperinflation and may indicate emphysema, pneumothorax, or asthma).
Differential diagnoses for cough? - Answers bronchitis, pleural effusion, URI, influenza, pneumonia,
croup, bronchiectasis, emphysema, GERD
Normal vs abnormal findings of chest and skin including inspection, auscultation, palpation? - Answers
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 - Answers heard over trachea; high pitch; loud and long expirations; sometimes
a bit longer than inspiration
Vesicular breath sounds - Answers low-pitched, low-intensity sounds heard over healthy tissue
Bronchovesicular breath sounds - Answers typically moderate in intensity; heard over the major bronchi
Where is the diaphragmatic excursion? - Answers 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 - Answers Pigeon chest
Clubbed fingers - Answers enlargement of terminal phalanges of the fingers/toes associated with
emphysema, lung ca, the cyanosis of congenital heart disease, and cystic fibrosis.
Barrel chest - Answers 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.
Retractions - Answers Seen when the chest wall caves in at the sternum, between the ribs, at the
suprasternal notch, above the clavicles, and at the lowest point in the respiratory tract. Suggestive of
obstruction to inspiration at any point in the respiratory tract.
Why are lesions transluminated? - Answers Used to determine the presence of fluid in cysts and masses.
Crackles - Answers 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 - Answers 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 - Answers Loud/grating lung sound. Inflamed pleura, pneumonia, pleuritis,
malignancy. Happens outside tree.
Rhochi - Answers 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 - Answers 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? - Answers Results from compromised respiration as in chronic asthma, cystic
fibrosis, or emphysema.
Resonance percussion chest - Answers loud, low pitch, long duration, hollow quality (expected lung
sound, can usually be heard over all areas of lungs).
Dullness percussion - Answers medium intensity, medium to high pitch, medium duration, dull thud
quality (suggests pneumonia, pleural effusion)
Tympany percussion - Answers loud intensity, high pitch, medium duration, drumlike quality
Hyperresonance percussion - Answers very loud intensity, very low pitch, longer duration, booming
quality (associated with hyperinflation and may indicate emphysema, pneumothorax, or asthma).
Differential diagnoses for cough? - Answers bronchitis, pleural effusion, URI, influenza, pneumonia,
croup, bronchiectasis, emphysema, GERD
Normal vs abnormal findings of chest and skin including inspection, auscultation, palpation? - Answers
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 - Answers heard over trachea; high pitch; loud and long expirations; sometimes
a bit longer than inspiration
Vesicular breath sounds - Answers low-pitched, low-intensity sounds heard over healthy tissue
Bronchovesicular breath sounds - Answers typically moderate in intensity; heard over the major bronchi
Where is the diaphragmatic excursion? - Answers 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 - Answers Pigeon chest
Clubbed fingers - Answers enlargement of terminal phalanges of the fingers/toes associated with
emphysema, lung ca, the cyanosis of congenital heart disease, and cystic fibrosis.
Barrel chest - Answers 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.
Retractions - Answers Seen when the chest wall caves in at the sternum, between the ribs, at the
suprasternal notch, above the clavicles, and at the lowest point in the respiratory tract. Suggestive of
obstruction to inspiration at any point in the respiratory tract.
Why are lesions transluminated? - Answers Used to determine the presence of fluid in cysts and masses.
