Carol, age 68, was brought to the emergency department by her husband when she was having difficulty breathing. She had also developed a cough and fever, and her husband noticed that her symptoms seemed to occur suddenly. Based on the information available, you assess Carol for pneumonia. Which of the following assessment results would indicate Carol may have pneumonia? Select all that apply.

- Hyperresonance of some lung fields with percussion
- Crackles
- Whispered sounds clear and distinct over some lung fields
- Increased tactile fremitus
- Lack of accessory muscle involvement in breathing

crackles or rales are the characteristic symptom of pneumonia, indicating the alveoli are opening and closing against fluid. whispered sounds and tactile fremitus are heard and felt, respectively, more clearly when pneumonia is present. hyperresonance of lung fields occurs in emphysema, not pneumonia. as carol is struggling to breathe, she would have increased used of accessory muscles, not less.

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