The nurse is assessing the lung of a patient with asthma. What should the nurse most likely hear?

Appeared in: HPSSC - 2015

Explanation

Wheezing is the hallmark sound of asthma, an obstructive airway disease.
It is a high-pitched, continuous, musical sound caused by air being forced through narrowed airways (bronchospasm).
This sound is typically more pronounced during the expiratory phase of respiration.

Option A: Crackles are discontinuous popping sounds caused by fluid or mucus in the small airways or alveoli, not by the bronchospasm characteristic of asthma.
Option B: This is likely a misnomer for 'vesicular' sounds, which are the normal, soft, low-pitched sounds of breathing heard over most of the lung fields. They are not an adventitious (abnormal) sound.
Option C: A pleural friction rub is a harsh, grating, or creaking sound caused by inflamed pleural surfaces rubbing against each other. It is not characteristic of asthma.

Clinical Relevance

Nursing practice connection: Use the key finding related to Auscultation of lung sounds in asthma to guide bedside assessment, documentation, and the next nursing action.
Accurate identification of lung sounds is a critical nursing skill for assessing respiratory status, guiding interventions (like administering bronchodilators), and evaluating treatment effectiveness.
A key patient safety concern is the 'silent chest' in a patient with a severe asthma exacerbation. The absence of wheezing can indicate minimal air movement and impending respiratory failure, which is a medical emergency requiring immediate intervention.
What if? If the nurse heard unilateral (one-sided) wheezing that did not clear with coughing, it would be more concerning for a foreign body or tumor causing a fixed obstruction, rather than generalized asthma.

How to Approach the Question

First, identify the core of the question: What is the characteristic lung sound for the disease process of asthma?
Recall the pathophysiology of asthma: it involves inflammation and narrowing of the airways (bronchospasm).
Consider how narrowed airways would affect the sound of airflow. Air being forced through a constricted tube creates a high-pitched, musical sound.
Evaluate the options based on this understanding. 'Wheezing' matches this description.
Eliminate the other options by recalling their causes: 'Crackles' are related to fluid, 'Pleural friction rub' to pleural inflammation, and 'Vascular/Vesicular sound' is normal.

Concept Tested & Keywords

Concept Tested: Auscultation of lung sounds in asthma
Stem keywords: assessing, lung, patient, asthma
Lead-in keywords: most likely hear
Clinical cues: A patient diagnosis of asthma is the key clinical cue, which points towards a specific type of adventitious lung sound.
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 2 p. 104-106

E6 Medicine Macleod Clinical Examination 15e p. 105-107

Practise the full HPSSC - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.