NCLEX Memory Hints: Breath Sounds
Thursday, February 20, 2025
Pulmonary System: Breath Sounds
NCLEX Memory Hints © BrainyNurses.com
Cardiopulmonary assessment includes listening to heart and lung sounds, distinguishing from normal and abnormal, correlating the sounds to the clinical condition, and using clinical judgement to determine the significance. On exhalation, breath sounds are heard down to T10. On maximal inhalation, they are heard down to T12. In order to perform a complete assessment, anterior and posterior auscultation should be included.
The types of breath sounds are describe here along with audio hints and clinical conditions in which they may be heard.
Types of Breath Sounds
Vesicular are normal breath sounds which are heard over most of the lung fields.
Bronchial are louder and normally heard over the trachea. When heard over the periphery, it can indicate consolidation and a pneumonia process.
Decreased or absent can indicate pleural effusion, airway obstruction, hyperinflated lungs, or hypoventilation.
Crackles are heard on inspiration and indicates fluid or atelectasis. Crackles associated with atelectasis will clear with deep breathing and coughing. Crackles associated with heart failure or pneumonia will not clear with deep breathing and coughing.
Rhonchi are primarily heard on expiration and indicates the presence of mucus. After suctioning, the rhonchi should clear.
Stridor is a high-pitched, crowing sound that indicates upper airway obstruction.
Wheezing indicates air movement through narrowed airways. It may be heard on inspiration, expiration, on auscultation, or audibly when severe. Absence of wheezing in a patient with asthma is an ominous sign indicating a lack of air movement.
Vocal resonance is the ability to hear the spoken word clearly when listening to the chest through the stethoscope. When heard, it indicates consolidation and a pneumonia process.
Audio Hint for Breath Sounds
• Crackles and stridor are heard on inhalation.
• Rhonchi on exhalation.
• Wheezing on inhalation and/or exhalation.
• Friction rub on inhalation.
In preparing for the NCLEX exam, knowledge of breath sounds is important in recognizing various clinical conditions. Questions may be descriptive or audio. If crackles are heard, it is important to have the patient perform deep breathing exercises with coughing to determine if the crackles clear or are persistent. Rhonchi are heard on exhalation and coughing or suctioning may be indicated. Absence of wheezing in an asthma patient is a reason to call “Rapid Response”.
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