RRT RRT Patient Assessment 2 — Questions and Answers
Question 1: Crackles (rales) heard on auscultation are most commonly caused by:
- Bronchospasm narrowing the lower airways
- Sudden opening of collapsed alveoli or fluid in small airways (Correct answer)
- Pleural surfaces rubbing against each other
- Turbulent airflow through a narrowed upper airway
Correct answer: Sudden opening of collapsed alveoli or fluid in small airways
Crackles are discontinuous, non-musical sounds produced by the sudden popping open of collapsed small airways or alveoli, or by movement of secretions in peripheral airways.
Question 2: Dullness to percussion over a lung field is most consistent with:
- Pneumothorax with air in the pleural space
- Emphysema with hyperinflation
- Pleural effusion or pulmonary consolidation (Correct answer)
- Hyperresonant lung from air trapping
Correct answer: Pleural effusion or pulmonary consolidation
Dullness on percussion indicates reduced air content, which occurs when fluid (pleural effusion) or solid material (consolidation in pneumonia) replaces normal aerated lung tissue.
Question 3: A patient with a left-sided tension pneumothorax would most likely demonstrate:
- Tracheal deviation to the left and absent breath sounds on the left
- Tracheal deviation to the right and absent breath sounds on the left (Correct answer)
- Tracheal deviation to the left and absent breath sounds on the right
- Bilateral absent breath sounds with central trachea
Correct answer: Tracheal deviation to the right and absent breath sounds on the left
In left-sided tension pneumothorax, the increasing pressure shifts the mediastinum (and trachea) away from the affected side—toward the right—while breath sounds are absent on the left.
Question 4: Egophony, used to assess for pulmonary consolidation, is best described as:
- The change of a spoken 'E' sound to an 'A' sound heard over consolidated tissue (Correct answer)
- Disappearance of breath sounds over a pleural effusion
- Increased resonance of whispered words over hyperinflated lung
- Transmission of bowel sounds into the lung field
Correct answer: The change of a spoken 'E' sound to an 'A' sound heard over consolidated tissue
Egophony is the transformation of a spoken 'E' into an 'A' sound when auscultated over consolidated lung tissue, because solid tissue changes the acoustic properties of transmitted sound.
Question 5: Which assessment finding would be LEAST expected in a patient with advanced COPD?
- Prolonged expiratory phase
- Decreased breath sound intensity bilaterally
- Inspiratory stridor (Correct answer)
- Barrel chest
Correct answer: Inspiratory stridor
Inspiratory stridor is associated with upper airway obstruction (e.g., croup, foreign body), not COPD, which is a lower airway disease characterized by air trapping, prolonged expiration, and decreased breath sounds.
Question 6: Which combination of findings is most consistent with a pleural effusion on physical assessment?
- Hyperresonance to percussion and decreased tactile fremitus
- Dullness to percussion and decreased or absent breath sounds (Correct answer)
- Dullness to percussion and markedly increased tactile fremitus
- Tympany to percussion and bronchial breath sounds
Correct answer: Dullness to percussion and decreased or absent breath sounds
Pleural effusion produces dullness to percussion (fluid displaces air) and decreased or absent breath sounds because the fluid layer blocks transmission of lung sounds to the chest wall.
Question 7: During inspection, skin visibly sinking inward between the ribs during inspiration is correctly termed:
- Subcostal retractions
- Intercostal retractions (Correct answer)
- Suprasternal retractions
- Substernal retractions
Correct answer: Intercostal retractions
Intercostal retractions are the visible inward movement of skin between the ribs during inspiration, indicating elevated work of breathing and highly negative intrathoracic pressure.
RRT RRT Patient Assessment 2
Crackles (rales) heard on auscultation are most commonly caused by: