A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?

Choice A rationale Rhonchi are low-pitched, continuous snoring or rattling sounds caused by secretions or obstructions in the larger airways, such as the bronchi. They are often associated with conditions like chronic bronchitis or pneumonia and may clear with coughing. The description of a high-pitched, squeaking sound does not align with the characteristics of rhonchi, which are deeper and suggest the presence of thick mucus in the larger passages rather than narrowed smaller airways. Choice B rationale Crackles, also known as rales, are discontinuous, popping or bubbling sounds heard primarily during inspiration. They are caused by the sudden snapping open of small airways or alveoli that contain fluid. This occurs in conditions like heart failure or pulmonary edema. The sounds described in the question are continuous and high-pitched during exhalation, which is the opposite of the brief, non-continuous nature of crackles caused by fluid movement in distal air sacs. Choice C rationale Wheezes are high-pitched, continuous musical or squeaking sounds produced by air flowing through narrowed or constricted small airways. In asthma, bronchospasm and inflammation narrow the bronchioles, typically causing these sounds during expiration. The description of high-pitched squeaking during exhalation is the classic clinical presentation of wheezing. This indicates a significant reduction in the diameter of the airway lumen, requiring prompt assessment of the client’s respiratory effort and oxygen saturation levels. Choice D rationale Stridor is a harsh, high-pitched, vibrating sound caused by an obstruction in the upper airway, such as the larynx or trachea. It is usually loudest during inspiration and can often be heard without a stethoscope. Stridor is a medical emergency indicating a compromised upper airway. While high-pitched, it is localized to the throat area rather than the lower lung fields and sounds more like gasping or crowing than the squeaking associated with asthmatic wheezing.