A nurse is auscultating the lungs of a sleeping client and hears short, popping, crackling breath sounds that stop after a few breaths. How should the nurse document these breath sounds in the client's medical record?

Atelectatic crackles that do not have a pathologic cause

Fine crackles that may be a sign of impending pneumonia

Vesicular breath sounds

Fine wheezes

Answer and Explanation

The Correct Answer is A

A) Atelectatic crackles that do not have a pathologic cause:
Atelectatic crackles are short, popping, crackling sounds heard during auscultation, typically occurring at the end of inspiration. These crackles are often heard in the bases of the lungs, particularly when the client is in a supine position, and are not associated with any pathological condition. Atelectatic crackles are a normal finding, especially in a sleeping or newly awakened client, as they result from the temporary collapse of small airways that quickly re-expand. Since they disappear after a few breaths and are not indicative of disease, they should be documented as atelectatic crackles without a pathological cause.

B) Fine crackles that may be a sign of impending pneumonia:
Fine crackles are high-pitched, popping sounds that are often heard during inspiration, especially at the lung bases. They are commonly associated with conditions like pneumonia, heart failure, or pulmonary fibrosis. However, in this case, the crackles heard stopped after a few breaths, which is characteristic of atelectatic crackles rather than fine crackles associated with pathological conditions. Fine crackles that last and occur consistently may suggest pathology, but in this scenario, the transient nature of the sounds points to atelectatic crackles, not pneumonia.

C) Vesicular breath sounds:
Vesicular breath sounds are normal lung sounds heard over the peripheral lung fields, characterized by a soft, low-pitched sound during inspiration, with a shorter expiration. These sounds are different from crackles, which are brief, popping sounds. Vesicular breath sounds do not refer to abnormal or adventitious sounds, such as the crackles heard in this client. Therefore, the nurse should not document the breath sounds as vesicular.

D) Fine wheezes:
Wheezes are continuous musical sounds produced by the narrowing of the airways, typically heard during exhalation. They are usually caused by conditions like asthma, chronic obstructive pulmonary disease (COPD), or bronchitis. The crackling sounds described in the question are not wheezes, as they are short, popping sounds rather than musical, continuous sounds. The transient nature of the sounds makes them more consistent with atelectatic crackles, not wheezes.

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Correct Answer is B

Explanation

A) Bronchial sounds:
Bronchial breath sounds are normal over the trachea and large bronchi but are considered abnormal if heard over the peripheral lung fields. In the case of pneumonia or other types of lung consolidation, bronchial sounds may be transmitted to more peripheral areas of the lungs where they are typically not heard. However, bronchial sounds themselves are not the specific adventitious sound produced by lung consolidation, though their presence can suggest consolidation.

B) Crackles:
Crackles (also known as rales) are the adventitious sounds most commonly associated with lung consolidation, such as in pneumonia. Crackles occur when air bubbles move through the fluid or mucus in the alveoli and small airways. In pneumonia, the inflammation and accumulation of fluid or pus in the alveoli (consolidation) causes crackling or popping sounds during inspiration. Crackles are a key indicator of consolidation in the lungs, making this the correct choice.

C) Whispered pectoriloquy:
Whispered pectoriloquy is a type of vocal fremitus that can be heard during auscultation when the patient whispers a phrase. It is an abnormal finding that can occur in the presence of lung consolidation, where the whispered sounds are heard more clearly or louder than normal. While it is related to lung consolidation, it is not an adventitious sound like crackles. Instead, it is a sign that can indicate the presence of consolidation when paired with other findings like bronchophony.

D) Bronchophony:
Bronchophony is the increased clarity and intensity of spoken sounds during auscultation, which occurs in areas of lung consolidation. When a patient says "99," the sound may become more distinct and louder when consolidation is present. Although bronchophony is another finding that may suggest consolidation, it is a vocal sound rather than an adventitious breath sound. Bronchophony refers specifically to changes in voice transmission, not to the crackling or popping sounds caused by consolidation itself.

A. Inspection of the shape and configuration of the chest during normal breathing B. Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10 C. Percussion of the posterior chest to initiate vibration of the lung structures D. Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety nine’’

Correct Answer is B

Explanation

A) Inspection of the shape and configuration of the chest during normal breathing:
While inspecting the shape and configuration of the chest can provide important information about potential deformities or abnormalities (such as a barrel chest or scoliosis), it does not directly assess the symmetry of chest expansion. Inspection primarily focuses on the external appearance rather than the physiological movement of the chest wall during respiration. Symmetry of chest expansion requires more than visual observation; it involves assessing the movement of the chest during inhalation and exhalation.

B) Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10:
This technique is the most effective for confirming symmetric expansion of the chest. The nurse places their hands on the patient's back, with the thumbs positioned at the level of T9 or T10, and asks the patient to take a deep breath. As the patient inhales, the nurse assesses the expansion of both sides of the chest by observing whether the thumbs move apart symmetrically. This test directly evaluates the expansion of the lungs and chest wall during respiration and is the most accurate way to assess symmetry.

C) Percussion of the posterior chest to initiate vibration of the lung structures:
Percussion is a technique used to assess the underlying lung tissue and the presence of conditions like pneumonia, fluid accumulation, or air trapping. It does not directly assess the symmetry of chest expansion. While percussion may provide valuable diagnostic information about the lungs, it does not help in determining how evenly the chest is expanding during normal breathing.

D) Placing the palmar surface of the fingers of one hand against the chest and having the client repeat "ninety-nine":
This technique refers to vocal fremitus, where the nurse places their hands on the client's chest while the client repeats "ninety-nine." It helps assess the transmission of sound vibrations through the chest wall, which can be used to detect areas of consolidation or fluid in the lungs. However, it does not directly evaluate the symmetry of chest expansion. The vibration felt on both sides of the chest may be different in cases of lung disease, but this test does not assess the movement of the chest during breathing.

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A nurse is auscultating the lungs of a sleeping client and hears short, popping, crackling breath sounds that stop after a few breaths. How should the nurse document these breath sounds in the client's medical record?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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