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 D

Explanation

A) A heart murmur is a high-pitched sound caused by a narrowing of a heart valve:
While it's true that a narrowing of a heart valve (stenosis) can cause a murmur, the description of a heart murmur as a "high-pitched sound" due to this narrowing is overly specific and does not fully explain what a murmur is. A murmur is not always high-pitched, and it is caused by turbulent blood flow, which may occur for various reasons beyond just valve stenosis.

B) A heart murmur is an extra sound heard from blood entering a rigid heart chamber:
This description is somewhat inaccurate. While murmurs can result from turbulent blood flow through the heart chambers or valves, the idea that murmurs are "extra sounds from blood entering a rigid heart chamber" is misleading. A murmur occurs when there is turbulent blood flow, which can happen in both rigid and non-rigid chambers. The key point is that it's the turbulent flow, not just rigidity, that causes the sound.

C) A heart murmur is a sound generated by inflammation around the heart muscle:
This is incorrect. Inflammation around the heart muscle, such as in pericarditis, can cause chest pain or other symptoms but does not generate a heart murmur. A murmur is caused by turbulent blood flow, which can result from various heart valve issues (e.g., stenosis, regurgitation) or defects in the heart's structure (e.g., septal defects), not from inflammation around the heart muscle.

D) A heart murmur indicates turbulent blood flow through a valve in the heart:
This is the most accurate description. A heart murmur is typically caused by turbulent or irregular blood flow through a heart valve. This can occur for several reasons, such as valve stenosis (narrowing), valve regurgitation (leakage), or congenital heart defects that cause abnormal flow patterns. The turbulent flow disrupts the normal laminar (smooth) blood flow, creating the characteristic sound that can be heard with a stethoscope. Murmurs can vary in timing, pitch, and intensity depending on the nature of the flow disturbance.

A. Vena cava-right atrium – right ventricles pulmonary artery-lungs pulmonary vein-left atrium - left ventricle B. Aorta-• Right atrium • right ventricle-pulmonary vein-lungs-pulmonary artery-left atrium-left ventricle C. Aorta-right atrium -• right ventricle-lungs-pulmonary vein-left atrium -• left ventricle -• vena cava D. Vena cava-• right atrium-right ventricle-pulmonary vein-lungs-pulmonary artery-left atrium- left ventricle

Correct Answer is A

Explanation

A) Vena cava → right atrium → right ventricle → pulmonary artery → lungs → pulmonary vein → left atrium → left ventricle:
This is the correct answer. The accurate blood flow pattern through the heart starts with deoxygenated blood returning to the heart from the body via the vena cava into the right atrium. From there, it passes into the right ventricle, which pumps it into the pulmonary artery. The blood then travels to the lungs for oxygenation. Oxygenated blood returns to the heart via the pulmonary veins, enters the left atrium, flows into the left ventricle, and is then pumped out to the body through the aorta. This is the correct sequence of blood flow through the heart and lungs.

B) Aorta → right atrium → right ventricle → pulmonary vein → lungs → pulmonary artery → left atrium → left ventricle:
This is incorrect. The aorta is the main artery that carries oxygenated blood from the left ventricle to the body, not part of the pathway for deoxygenated blood returning to the heart. The flow pattern described here is mixed up, with oxygenated blood returning to the heart via the pulmonary veins, which is correct, but it places the pulmonary vein and pulmonary artery in an incorrect order, as the pulmonary artery carries deoxygenated blood from the heart to the lungs, not the other way around.

C) Aorta → right atrium → right ventricle → lungs → pulmonary vein → left atrium → left ventricle → vena cava:
This is incorrect. The right atrium does not receive blood from the aorta. The aorta carries oxygenated blood from the left ventricle to the body, not from the right side of the heart. Additionally, the vena cava is responsible for carrying deoxygenated blood back to the right atrium, not part of the blood flow from the heart to the lungs.

D) Vena cava → right atrium → right ventricle → pulmonary vein → lungs → pulmonary artery → left atrium → left ventricle:
This is incorrect. The pulmonary vein carries oxygenated blood back to the heart, not deoxygenated blood from the right ventricle to the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs for oxygenation. The correct sequence of flow is from the right ventricle to the pulmonary artery and then to the lungs, followed by pulmonary veins returning oxygenated blood to the left atrium.

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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?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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