2 MAXE • 152 SRUN
Penn State University
PSU Ross and Carol Nese College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Health Assessment
E X A M I N AT I O N I I • T H O R A X , LU N G S , H E A RT, P E R I P H E R A L VA S CU L A R & A B D O M I N A L A SS E SS M E N T
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (B.S.N.) ACADEMIC YEAR
EXAM TITLE Health Assessment — Exam II (Thorax, TOTAL QUESTIONS 40 Questions
Heart, Abdomen)
FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover breath sounds (bronchial, bronchovesicular, vesicular), abnormal/adventitious breath sounds, breathing
patterns, cardiac assessment (heart sounds, murmurs, landmarks), peripheral vascular assessment (DVT, arterial vs. venous
ulcers, edema), abdominal assessment (order, bowel sounds, ascites), and skin lesions (primary, secondary, pressure injuries).
▸ Pay close attention to the characteristics that distinguish fine crackles from coarse crackles, wheezes from rhonchi, and arterial
from venous ulcers.
▸ Correct answers and detailed rationales appear below each question for exam preparation.
SECTION I — RESPIRATORY, CARDIAC, VASCULAR & ABDOMINAL Questions 1 –
ASSESSMENT 40
1. Which breath sounds are heard over the trachea and larynx, with expiration longer than inspiration?
A. Vesicular breath sounds
B. Bronchovesicular breath sounds
C. Bronchial breath sounds
D. Adventitious breath sounds
CORRECT ANSWER C — Bronchial breath sounds
RATIONALE Bronchial breath sounds are loud, high-pitched sounds heard over the trachea and larynx (throat area). The
distinctive feature is that expiration is longer than inspiration — there is a pause between inspiration and
expiration. These are normal when heard over the trachea but abnormal if heard over peripheral lung fields
(indicating consolidation, as in pneumonia). In contrast, vesicular breath sounds are soft, heard over
peripheral bronchioles and alveoli, with inspiration longer than expiration. Bronchovesicular sounds are
intermediate — inspiration and expiration are equal in duration, heard over the inner parts of the chest (first
and second intercostal spaces anteriorly, between the scapulae posteriorly).
,2. Fine crackles are characterized by:
A. Loud, low-pitched, gurgling sounds that are cleared with cough
B. High-pitched, short popping sounds heard on inspiration that are NOT cleared with cough
C. Continuous, high-pitched squeaking sounds heard on expiration
D. Coarse, low-pitched grating sounds heard on both inspiration and expiration
CORRECT ANSWER B — High-pitched, short popping sounds heard on inspiration that are NOT cleared with cough
RATIONALE Fine crackles (formerly called fine rales) are discontinuous, high-pitched, short popping sounds that resemble
the sound of rubbing strands of hair together near your ear. They are heard predominantly during inspiration
and are NOT cleared by coughing. Fine crackles indicate fluid in the small airways or alveoli — common
causes include pneumonia (infectious consolidation), heart failure (pulmonary edema), and pulmonary
fibrosis. This distinguishes them from coarse crackles (loud, low-pitched, gurgling, like Velcro ripping, heard
in early inspiration and possibly expiration, and typically cleared or decreased with cough), which indicate
fluid or secretions in larger airways — common in bronchitis, resolving pneumonia, or conditions with
excessive airway secretions.
3. Which abnormal breath sound is described as continuous, high-pitched, squeaking, with multiple tones,
predominantly on expiration, and probably NOT cleared with cough?
A. Rhonchi
B. High-pitched wheezes
C. Coarse crackles
D. Pleural friction rub
CORRECT ANSWER B — High-pitched wheezes
RATIONALE High-pitched wheezes are continuous, musical, squeaking sounds with multiple tones (polyphonic). They are
heard predominantly during expiration (though may be present during inspiration in severe cases) and are
caused by airway obstruction/narrowing — the airway walls oscillate as air passes through narrowed
passages. Common causes include asthma, COPD, and bronchospasm. They are typically NOT cleared with
cough because the narrowing is due to bronchoconstriction or inflammation, not secretions. Low-pitched
wheezes (also called rhonchi) are monophonic, snoring or moaning sounds that MAY clear with cough
because they are caused by secretions in larger airways. Rhonchi are continuous, gurgling or bubbling, heard
during both inspiration and expiration, and are caused by movement and secretions in larger airways.
4. Stridor is a life-threatening abnormal breath sound characterized by:
A. Low-pitched, coarse grating sound heard in both inspiration and expiration
B. Continuous gurgling sound caused by secretions in larger airways
C. Really high-pitched, monophonic, inspiratory sound that is louder in the neck
D. High-pitched, short popping sounds heard on inspiration
CORRECT ANSWER C — Really high-pitched, monophonic, inspiratory sound that is louder in the neck
RATIONALE Stridor is a medical emergency — a really high-pitched, monophonic (single tone), crowing sound heard
predominantly during inspiration and louder over the neck. It indicates a life-threatening upper airway
obstruction — the airway is critically narrowed or will close completely soon. Causes include croup
(laryngotracheobronchitis in children), acute epiglottitis, foreign body aspiration, angioedema, or
anaphylaxis. Unlike other abnormal breath sounds, stridor demands immediate emergency intervention. It is
probably NOT cleared with cough. This distinguishes stridor from pleural friction rub (coarse, low-pitched,
grating quality, sounds like crackles but closer to the ear/superficial, both inspiration and expiration, NOT
cleared by cough — caused by inflamed pleural surfaces rubbing together) and from rhonchi (cleared with
cough).
, 5. Cheyne-Stokes respirations are characterized by:
A. Increased rate and depth with a feeling of being unable to catch one's breath
B. Waxing and waning in rate and depth with 30-45 seconds of breathing followed by apnea for 20 seconds
C. Shallow, irregular breathing often caused by prolonged bed rest or narcotics
D. Normal, healthy, unlabored breathing
CORRECT ANSWER B — Waxing and waning in rate and depth with 30-45 seconds of breathing followed by apnea for 20
seconds
RATIONALE Cheyne-Stokes respirations are a distinct breathing pattern characterized by a cyclical waxing and waning of
respiratory rate and depth — periods of fast, shallow breathing followed by slow, heavier breathing, with
periods of apnea (no breathing) lasting approximately 20 seconds. The cycle typically includes 30-45 seconds
of breathing followed by approximately 20 seconds of apnea. This pattern is often described as "end-of-life"
breathing and may be observed in patients with severe heart failure, brain injury, stroke, or at the end of life.
Hyperventilation is increased rate and depth with a feeling of breathlessness. Hypoventilation is shallow,
often irregular breathing (common causes: prolonged bed rest, narcotic effects, emphysema where lungs are
already partially inflated). Eupneic breathing is normal, healthy, unlabored respiration.
6. How do you assess for orthopnea?
A. Ask the patient to walk and observe for shortness of breath
B. Ask "How many pillows do you sleep on?" and "Has the number of pillows changed?"
C. Measure oxygen saturation during exercise
D. Listen to breath sounds in the sitting position only
CORRECT ANSWER B — Ask "How many pillows do you sleep on?" and "Has the number of pillows changed?"
RATIONALE Orthopnea is shortness of breath or difficulty breathing while lying flat. The assessment is done by asking the
patient how many pillows they use to sleep comfortably and whether this number has changed over recent
weeks or months. A patient who previously slept with one pillow but now requires three or four to breathe
comfortably is demonstrating progressive orthopnea — a classic sign of left-sided heart failure. As left
ventricular function declines, blood backs up into the pulmonary circulation, and lying flat increases venous
return to the heart, which the failing left ventricle cannot handle, causing pulmonary congestion and
dyspnea. The patient may also report needing to sleep in a recliner. Orthopnea is distinct from exertional
dyspnea (shortness of breath with activity) and paroxysmal nocturnal dyspnea (sudden awakening with
severe breathlessness).
7. When assessing tactile fremitus, what does DECREASED vibration indicate?
A. Large consolidation (lots of fluid in the lungs)
B. Obstructed bronchus, pleural effusion, pneumothorax, or emphysema
C. Normal lung tissue
D. Airway inflammation
CORRECT ANSWER B — Obstructed bronchus, pleural effusion, pneumothorax, or emphysema
RATIONALE Tactile (vocal) fremitus is assessed by having the patient repeat "99" or "blue moon" while the nurse palpates
the chest wall with the palmar or ulnar edge of the hands, moving from top to bottom (most prominent
between the scapulae). Decreased or absent vibration indicates that sound transmission is blocked:
obstructed bronchus (tumor, mucus plug), pleural effusion (fluid in pleural space dampens vibration),
pneumothorax (air in pleural space), or emphysema (hyperinflated lungs with decreased tissue density).
Increased fremitus indicates large consolidation — fluid-filled alveoli transmit sound more efficiently (as in
lobar pneumonia). No vibration at all suggests a complete barrier or blockage between the lung and chest
wall. This is a classic physical examination technique for detecting pulmonary pathology.
Penn State University
PSU Ross and Carol Nese College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Health Assessment
E X A M I N AT I O N I I • T H O R A X , LU N G S , H E A RT, P E R I P H E R A L VA S CU L A R & A B D O M I N A L A SS E SS M E N T
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (B.S.N.) ACADEMIC YEAR
EXAM TITLE Health Assessment — Exam II (Thorax, TOTAL QUESTIONS 40 Questions
Heart, Abdomen)
FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover breath sounds (bronchial, bronchovesicular, vesicular), abnormal/adventitious breath sounds, breathing
patterns, cardiac assessment (heart sounds, murmurs, landmarks), peripheral vascular assessment (DVT, arterial vs. venous
ulcers, edema), abdominal assessment (order, bowel sounds, ascites), and skin lesions (primary, secondary, pressure injuries).
▸ Pay close attention to the characteristics that distinguish fine crackles from coarse crackles, wheezes from rhonchi, and arterial
from venous ulcers.
▸ Correct answers and detailed rationales appear below each question for exam preparation.
SECTION I — RESPIRATORY, CARDIAC, VASCULAR & ABDOMINAL Questions 1 –
ASSESSMENT 40
1. Which breath sounds are heard over the trachea and larynx, with expiration longer than inspiration?
A. Vesicular breath sounds
B. Bronchovesicular breath sounds
C. Bronchial breath sounds
D. Adventitious breath sounds
CORRECT ANSWER C — Bronchial breath sounds
RATIONALE Bronchial breath sounds are loud, high-pitched sounds heard over the trachea and larynx (throat area). The
distinctive feature is that expiration is longer than inspiration — there is a pause between inspiration and
expiration. These are normal when heard over the trachea but abnormal if heard over peripheral lung fields
(indicating consolidation, as in pneumonia). In contrast, vesicular breath sounds are soft, heard over
peripheral bronchioles and alveoli, with inspiration longer than expiration. Bronchovesicular sounds are
intermediate — inspiration and expiration are equal in duration, heard over the inner parts of the chest (first
and second intercostal spaces anteriorly, between the scapulae posteriorly).
,2. Fine crackles are characterized by:
A. Loud, low-pitched, gurgling sounds that are cleared with cough
B. High-pitched, short popping sounds heard on inspiration that are NOT cleared with cough
C. Continuous, high-pitched squeaking sounds heard on expiration
D. Coarse, low-pitched grating sounds heard on both inspiration and expiration
CORRECT ANSWER B — High-pitched, short popping sounds heard on inspiration that are NOT cleared with cough
RATIONALE Fine crackles (formerly called fine rales) are discontinuous, high-pitched, short popping sounds that resemble
the sound of rubbing strands of hair together near your ear. They are heard predominantly during inspiration
and are NOT cleared by coughing. Fine crackles indicate fluid in the small airways or alveoli — common
causes include pneumonia (infectious consolidation), heart failure (pulmonary edema), and pulmonary
fibrosis. This distinguishes them from coarse crackles (loud, low-pitched, gurgling, like Velcro ripping, heard
in early inspiration and possibly expiration, and typically cleared or decreased with cough), which indicate
fluid or secretions in larger airways — common in bronchitis, resolving pneumonia, or conditions with
excessive airway secretions.
3. Which abnormal breath sound is described as continuous, high-pitched, squeaking, with multiple tones,
predominantly on expiration, and probably NOT cleared with cough?
A. Rhonchi
B. High-pitched wheezes
C. Coarse crackles
D. Pleural friction rub
CORRECT ANSWER B — High-pitched wheezes
RATIONALE High-pitched wheezes are continuous, musical, squeaking sounds with multiple tones (polyphonic). They are
heard predominantly during expiration (though may be present during inspiration in severe cases) and are
caused by airway obstruction/narrowing — the airway walls oscillate as air passes through narrowed
passages. Common causes include asthma, COPD, and bronchospasm. They are typically NOT cleared with
cough because the narrowing is due to bronchoconstriction or inflammation, not secretions. Low-pitched
wheezes (also called rhonchi) are monophonic, snoring or moaning sounds that MAY clear with cough
because they are caused by secretions in larger airways. Rhonchi are continuous, gurgling or bubbling, heard
during both inspiration and expiration, and are caused by movement and secretions in larger airways.
4. Stridor is a life-threatening abnormal breath sound characterized by:
A. Low-pitched, coarse grating sound heard in both inspiration and expiration
B. Continuous gurgling sound caused by secretions in larger airways
C. Really high-pitched, monophonic, inspiratory sound that is louder in the neck
D. High-pitched, short popping sounds heard on inspiration
CORRECT ANSWER C — Really high-pitched, monophonic, inspiratory sound that is louder in the neck
RATIONALE Stridor is a medical emergency — a really high-pitched, monophonic (single tone), crowing sound heard
predominantly during inspiration and louder over the neck. It indicates a life-threatening upper airway
obstruction — the airway is critically narrowed or will close completely soon. Causes include croup
(laryngotracheobronchitis in children), acute epiglottitis, foreign body aspiration, angioedema, or
anaphylaxis. Unlike other abnormal breath sounds, stridor demands immediate emergency intervention. It is
probably NOT cleared with cough. This distinguishes stridor from pleural friction rub (coarse, low-pitched,
grating quality, sounds like crackles but closer to the ear/superficial, both inspiration and expiration, NOT
cleared by cough — caused by inflamed pleural surfaces rubbing together) and from rhonchi (cleared with
cough).
, 5. Cheyne-Stokes respirations are characterized by:
A. Increased rate and depth with a feeling of being unable to catch one's breath
B. Waxing and waning in rate and depth with 30-45 seconds of breathing followed by apnea for 20 seconds
C. Shallow, irregular breathing often caused by prolonged bed rest or narcotics
D. Normal, healthy, unlabored breathing
CORRECT ANSWER B — Waxing and waning in rate and depth with 30-45 seconds of breathing followed by apnea for 20
seconds
RATIONALE Cheyne-Stokes respirations are a distinct breathing pattern characterized by a cyclical waxing and waning of
respiratory rate and depth — periods of fast, shallow breathing followed by slow, heavier breathing, with
periods of apnea (no breathing) lasting approximately 20 seconds. The cycle typically includes 30-45 seconds
of breathing followed by approximately 20 seconds of apnea. This pattern is often described as "end-of-life"
breathing and may be observed in patients with severe heart failure, brain injury, stroke, or at the end of life.
Hyperventilation is increased rate and depth with a feeling of breathlessness. Hypoventilation is shallow,
often irregular breathing (common causes: prolonged bed rest, narcotic effects, emphysema where lungs are
already partially inflated). Eupneic breathing is normal, healthy, unlabored respiration.
6. How do you assess for orthopnea?
A. Ask the patient to walk and observe for shortness of breath
B. Ask "How many pillows do you sleep on?" and "Has the number of pillows changed?"
C. Measure oxygen saturation during exercise
D. Listen to breath sounds in the sitting position only
CORRECT ANSWER B — Ask "How many pillows do you sleep on?" and "Has the number of pillows changed?"
RATIONALE Orthopnea is shortness of breath or difficulty breathing while lying flat. The assessment is done by asking the
patient how many pillows they use to sleep comfortably and whether this number has changed over recent
weeks or months. A patient who previously slept with one pillow but now requires three or four to breathe
comfortably is demonstrating progressive orthopnea — a classic sign of left-sided heart failure. As left
ventricular function declines, blood backs up into the pulmonary circulation, and lying flat increases venous
return to the heart, which the failing left ventricle cannot handle, causing pulmonary congestion and
dyspnea. The patient may also report needing to sleep in a recliner. Orthopnea is distinct from exertional
dyspnea (shortness of breath with activity) and paroxysmal nocturnal dyspnea (sudden awakening with
severe breathlessness).
7. When assessing tactile fremitus, what does DECREASED vibration indicate?
A. Large consolidation (lots of fluid in the lungs)
B. Obstructed bronchus, pleural effusion, pneumothorax, or emphysema
C. Normal lung tissue
D. Airway inflammation
CORRECT ANSWER B — Obstructed bronchus, pleural effusion, pneumothorax, or emphysema
RATIONALE Tactile (vocal) fremitus is assessed by having the patient repeat "99" or "blue moon" while the nurse palpates
the chest wall with the palmar or ulnar edge of the hands, moving from top to bottom (most prominent
between the scapulae). Decreased or absent vibration indicates that sound transmission is blocked:
obstructed bronchus (tumor, mucus plug), pleural effusion (fluid in pleural space dampens vibration),
pneumothorax (air in pleural space), or emphysema (hyperinflated lungs with decreased tissue density).
Increased fremitus indicates large consolidation — fluid-filled alveoli transmit sound more efficiently (as in
lobar pneumonia). No vibration at all suggests a complete barrier or blockage between the lung and chest
wall. This is a classic physical examination technique for detecting pulmonary pathology.
