The nurse working in the emergency department is assessing the lung sounds of a patient with asthma. Which of the following sounds is the nurse most likely to hear?

1. A

   Murmurs

2. B

   Korotkoff sounds

3. C

   Wheezing

4. D

   Pleural friction rub

Appeared in: DSSSB 14 August 2024

Explanation

• Wheezing is a high-pitched, continuous musical sound produced by airflow through narrowed or obstructed airways.
• Asthma is an obstructive airway disease characterized by bronchospasm, mucosal inflammation, and increased mucus production, all of which narrow the airways.
• This narrowing causes air to move at a high velocity, creating the characteristic wheezing sound, which is most often heard on expiration.
• Therefore, wheezing is the hallmark lung sound a nurse would expect to hear when assessing a patient with asthma.

Why Other Options Were Wrong

• Option A: Murmurs are abnormal sounds originating from the heart, not the lungs. They are caused by turbulent blood flow across heart valves.
• Option B: Korotkoff sounds are the arterial sounds heard through a stethoscope during manual blood pressure measurement. They are not respiratory sounds.
• Option D: A pleural friction rub is a grating or creaking sound caused by the rubbing of inflamed pleural surfaces. It is not characteristic of asthma.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Identification of adventitious lung sounds in an asthma patient in acute care settings.
• Accurate identification of lung sounds is a critical nursing skill for differentiating between respiratory conditions and guiding appropriate interventions.
• In an asthma exacerbation, the presence, intensity, and location of wheezing help gauge the severity of airway obstruction and the patient's response to treatment.
• A sudden absence of wheezing in a patient who was previously wheezing and is in severe distress can be an ominous sign (silent chest), indicating critical airway obstruction and impending respiratory failure.

How to Approach the Question

• First, identify the core clinical concept in the question: assessing a patient with asthma.
• Recall the pathophysiology of asthma, which is primarily an obstructive disease involving inflammation and narrowing of the airways (bronchoconstriction).
• Connect the pathophysiology to the expected clinical finding. Think: 'What sound does air make when forced through a narrow tube?' This leads to the concept of a high-pitched, musical sound.
• Evaluate each option based on this understanding. 'Wheezing' directly matches the expected sound.
• Eliminate the other options by identifying their correct context: Murmurs are heart sounds, Korotkoff sounds are for blood pressure, and a pleural friction rub is related to inflamed pleura, not airway obstruction.

Concept Tested & Keywords

• Concept Tested: Identification of adventitious lung sounds in an asthma patient.
• Stem keywords: lung sounds, asthma, emergency department
• Lead-in keywords: most likely
• Clinical cues: A patient with a known diagnosis of asthma presenting to the emergency department, suggesting an acute exacerbation.

Question ID

Quhx4cTCY-fz-K9DshkUaJ

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 95-97

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

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 397-399