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 A

Explanation

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.

A. When the client is obese B. When part of the lung is obstructed or collapsed C. When accessory muscles are used to facilitate respiratory effort D. When bulging of the intercostal spaces is present

Correct Answer is B

Explanation

A) When the client is obese:
While obesity can affect the overall ease of breathing due to increased fat tissue around the chest and abdomen, it is not a direct cause of unequal chest expansion. Obesity can limit the depth of breath and potentially make it harder for the chest to expand fully, but it would not typically cause asymmetry in the movement of the chest on one side. Unequal chest expansion is more likely to occur due to underlying respiratory or structural issues.

B) When part of the lung is obstructed or collapsed:
This is the most accurate reason for unequal chest expansion. If part of the lung is obstructed (such as with a mucous plug or foreign body) or collapsed (as in the case of pneumothorax or atelectasis), it prevents that area of the lung from fully expanding during inspiration. As a result, the affected side of the chest will expand less than the opposite side. This can be a critical finding and warrants immediate further investigation to determine the cause and ensure appropriate treatment.

C) When accessory muscles are used to facilitate respiratory effort:
While the use of accessory muscles (e.g., the sternocleidomastoid, scalene, and intercostal muscles) often occurs during labored breathing, it does not specifically result in unequal chest expansion. Accessory muscle use typically occurs in conditions like severe asthma, chronic obstructive pulmonary disease (COPD), or respiratory distress, where there is an increased effort to breathe, but it doesn't cause asymmetry in the chest's movement. Unequal chest expansion is usually related to a localized problem in the lung or pleura, not the general use of muscles.

D) When bulging of the intercostal spaces is present:
Bulging of the intercostal spaces may suggest increased pressure in the pleural space, such as in the case of a pleural effusion or severe respiratory distress. However, while bulging intercostal spaces can be a sign of a respiratory condition, it is not typically associated with unequal chest expansion. Instead, bulging could indicate that the lung or chest wall is under stress or that there is fluid accumulation, which would lead to other physical findings like decreased breath sounds or dullness to percussion, but it does not directly cause unequal expansion. Unequal expansion is more likely to occur when part of the lung is obstructed or collapsed

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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

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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