The nurse auscultates coarse rhonchi in the anterior upper lung fields bilaterally that clears with coughing. Which condition would the nurse associate with these sounds?

• A. Turbulence due to muscular spasm and mucus in the larger airways
• B. Crackles in the alveoli due to fluid
• C. Pleural friction rub
• D. Cardiac wheeze due to edema

Answer: (A)

Coarse rhonchi arise from secretions in the larger airways that create turbulent airflow. They’re low-pitched and gurgling, often described as snoring-like sounds. Because they sit in the bigger passages, coughing helps move and clear the mucus, so these sounds frequently improve or disappear after a productive cough. This pattern fits conditions where mucus and bronchial irritation affect the larger airways, such as bronchitis or bronchial secretions, rather than the tiny air spaces or pleural surfaces.

Crackles would suggest fluid in the alveoli and usually don’t clear with coughing. A pleural friction rub is a distinct sound from inflamed pleural surfaces and isn’t tied to mucus in the airways. Cardiac edema can cause other types of sounds, like a wheeze or crackles from interstitial or alveolar fluid, but not the coarse rhonchi pattern described here.