A nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from these findings?

Tactile fremitus

Adventitious sounds

Friction rub

Crepitus

Answer and Explanation

The Correct Answer is D

A) Tactile fremitus:
Tactile fremitus refers to the vibrations felt on the chest wall when a patient speaks. It is assessed by placing the hands on the chest while the patient says "ninety-nine" or a similar phrase. Tactile fremitus is used to detect changes in lung density, such as consolidation or fluid. It does not describe a crackling sensation on the skin surface. A coarse, crackling sensation is more indicative of a different condition.

B) Adventitious sounds:
Adventitious sounds are abnormal lung sounds, such as crackles, wheezes, or rhonchi, heard during auscultation. These sounds are typically related to lung conditions, such as pneumonia, asthma, or fluid accumulation in the lungs. While adventitious sounds are significant findings during auscultation, they do not describe the physical sensation of crackling felt on the skin surface. Therefore, adventitious sounds are not the correct diagnosis for a tactile sensation over the chest.

C) Friction rub:
A friction rub is a harsh, grating sound heard during auscultation and is caused by inflammation of the pleura (the lining around the lungs). It occurs when the inflamed pleural surfaces rub together during breathing. While it is a distinct sound, a friction rub is not a tactile or palpable sensation. The crackling sensation described in the question is not related to the sounds produced by a pleural friction rub.

D) Crepitus:
Crepitus is the correct answer. It refers to a coarse, crackling sensation felt on the skin surface when air or gas is trapped under the skin, often due to conditions such as subcutaneous emphysema. This can occur when there is air leaking from the lungs or other parts of the respiratory system, often following trauma (e.g., rib fractures or surgery) or infection (e.g., gas gangrene). The crackling sensation felt during palpation of the chest wall is characteristic of crepitus, making this the most appropriate finding in this scenario.

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Correct Answer is C

Explanation

A) S2 indicates the beginning of diastole:
While S2 does coincide with the end of systole and the beginning of diastole, this statement is not the most specific or accurate way to describe the S2 heart sound. S2 marks the closure of the semilunar valves (the aortic and pulmonic valves), which occurs at the end of systole, just before diastole begins. While it is true that the S2 sound occurs as the heart transitions from systole to diastole, the closure of the semilunar valves is the more specific cause of S2.

B) S2 coincides with the carotid artery pulse:
This statement is not accurate. S2 does not exactly coincide with the carotid pulse. The S2 sound is heard slightly after the pulse due to the time it takes for the mechanical contraction of the heart to produce the sound. The carotid pulse typically corresponds more closely with the closure of the atrioventricular (AV) valves and the beginning of systole (S1), not S2. The timing of S2 and the carotid pulse can be close, but they are not perfectly synchronized.

C) S2 is caused by the closure of the semilunar valves:
This is the correct explanation. S2 is the heart sound produced by the closure of the semilunar valves (the aortic and pulmonic valves). The closing of these valves marks the end of systole and the beginning of diastole. S2 is typically described as having two components: the A2 sound (closure of the aortic valve) and the P2 sound (closure of the pulmonic valve). In some cases, particularly during inspiration, A2 and P2 may be heard separately, producing a split S2 sound.

D) S2 is louder than an S1:
This statement is not accurate. In general, S1 is louder than S2 at the apex of the heart (the lower part of the chest). S2 is louder than S1 at the base of the heart (near the sternum), particularly over the aortic and pulmonic areas. The loudness of heart sounds varies based on the location of auscultation, but it is not universally true that S2 is always louder than S1. The intensity of each sound depends on various factors, including the position of the listener and the health of the heart valves.

A. The third heart sound (S3) B. The fourth heart sound (S4) C. A split-second heart sound S2 D. A friction nub

Correct Answer is B

Explanation

A) The third heart sound (S3): The third heart sound (S3) occurs early in diastole, immediately following S2. It is often associated with conditions that cause increased volume and pressure in the ventricles, such as heart failure or dilated cardiomyopathy. S3 is not heard late in diastole, so it does not match the described timing of the extra heart sound.

B) The fourth heart sound (S4): The fourth heart sound (S4) is heard late in diastole, just before S1. It is caused by the atria contracting forcefully to push blood into a non-compliant or stiff ventricle, often associated with conditions like left ventricular hypertrophy or ischemic heart disease. The timing of S4, occurring just before S1, makes it the correct identification of the described extra heart sound.

C) A split second heart sound S2: A split S2 occurs when the aortic and pulmonic valves do not close simultaneously, causing the second heart sound (S2) to be heard as two distinct components. This split can vary with respiration but does not occur late in diastole. Therefore, it does not align with the extra heart sound heard just before S1.

D) A friction rub: A friction rub is a sound associated with pericarditis, caused by the rubbing of inflamed pericardial layers. It has a distinct, grating quality and can be heard throughout the cardiac cycle. A friction rub is not a late diastolic sound, making it an incorrect identification for the extra heart sound described.

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A nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from these findings?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is listening to the heart sounds of a client. What information about S2 sounds should the nurse recognize as accurate?

Correct Answer is C

Explanation

A nurse is auscultating heart sounds on a client and hears an extra sound late in diastole, just before the S1. How should the nurse document this finding?

Correct Answer is B

Explanation

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