Chamberlain University W8 NR302 Health Assessment I Exam 3 .
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Free Chamberlain University W8 NR302 Health Assessment I Exam 3 . Questions
A nurse is planning care for a client with poorly controlled asthma who frequently misses doses of their inhaled corticosteroid. The client reports forgetting to take the medication due to a busy schedule. Which strategy should the nurse use in the client's care plan to improve medication adherence?
- Ask to switch the client to an oral corticosteroid for easier administration
- Arrange follow-up visits to provide support and feedback
- Instruct the client to take the medication only when symptoms occur
- Provide written instructions on proper inhaler technique
Explanation
Correct Answer: B) Arrange follow-up visits to provide support and feedback
Since the client's non-adherence is due to a busy schedule and forgetfulness, arranging regular follow-up visits provides accountability, ongoing support, and the opportunity to address barriers to adherence. Follow-up also allows the nurse to reinforce education and adjust strategies as needed.
Switching to an oral corticosteroid is a clinical decision outside the nurse's independent scope and is not indicated solely for convenience. Inhaled corticosteroids are controller medications that must be taken regularly, not only when symptoms occur. Written instructions on inhaler technique address a different barrier than forgetfulness.
During auscultation, which finding is supportive of left-sided atelectasis?
- Vesicular breath sounds with equal intensity throughout
- Loud bronchial breath sounds over the left lower lobe
- High-pitched wheezing over both lower lobes
- Decreased breath sounds over the affected area
Explanation
Correct Answer: D) Decreased breath sounds over the affected area
Atelectasis refers to the collapse or incomplete expansion of lung tissue, which results in reduced or absent airflow to the affected area. On auscultation, this presents as decreased or absent breath sounds over the collapsed region, as air is not moving through the affected lung segment. Equal vesicular sounds indicate normal bilateral ventilation. Bronchial sounds over the lower lobe suggest consolidation as in pneumonia. Bilateral wheezing suggests diffuse airway obstruction as in asthma.
A nurse reviews the electronic health record (EHR) of a woman who experienced shortness of breath, fatigue, and nausea. She was initially treated for anxiety before being diagnosed with acute coronary syndrome (ACS). What could explain the initial misdiagnosis?
- Women often present with non-classic ACS symptoms
- Anxiety is a primary cause of ACS in women
- Laboratory tests are always abnormal in women with ACS
- Shortness of breath is rarely a cardiac symptom
Explanation
Correct Answer: A) Women often present with non-classic ACS symptoms
Women frequently present with atypical or non-classic symptoms of acute coronary syndrome, which differ from the classic presentation of crushing chest pain radiating to the left arm seen more commonly in men. Women's ACS symptoms often include shortness of breath, fatigue, nausea, jaw pain, and back pain, which can easily be mistaken for anxiety, gastrointestinal issues, or other non-cardiac conditions. This atypical presentation is a well-recognized contributor to delayed diagnosis and misdiagnosis of ACS in women, making awareness of these gender-specific differences essential in clinical practice.
A nurse assesses a client with a history of heavy smoking and notes a persistent cough, unexplained weight loss, and hemoptysis. Which should the nurse find most concerning?
- Gradual weight loss over the past several months
- Hemoptysis reported during coughing episodes
- Dull chest pain described as intermittent
- Fatigue that has worsened over the last two weeks
Explanation
Correct Answer: B) Hemoptysis reported during coughing episodes
Hemoptysis, the coughing up of blood, is the most alarming finding in a patient with a history of heavy smoking, as it is a classic red flag symptom of lung cancer and other serious pulmonary conditions such as tuberculosis or pulmonary embolism.
While gradual weight loss, intermittent chest pain, and worsening fatigue are all concerning symptoms that warrant further evaluation, hemoptysis in a heavy smoker represents the most urgent and potentially life-threatening finding that requires immediate investigation.
The combination of persistent cough, unexplained weight loss, and hemoptysis in a heavy smoker strongly raises suspicion for lung malignancy, making hemoptysis the priority concern.
A client with left-sided heart failure complains of dyspnea on exertion and a productive cough. The nurse is performing a focused respiratory assessment. Which respiratory finding(s) should the nurse expect to observe in this client? Select all that apply.
- Pleural friction rub
- Use of accessory muscles for breathing
- Cough with white, frothy sputum
- S3 gallop on cardiac auscultation
- Increased anteroposterior chest diameter
- Bilateral basal crackles
Explanation
Correct Answer: B) Use of accessory muscles for breathing, C) Cough with white, frothy sputum, D) S3 gallop on cardiac auscultation, and F) Bilateral basal crackles
Left-sided heart failure causes fluid to back up into the pulmonary circulation, leading to pulmonary congestion. Bilateral basal crackles result from fluid accumulation in the alveoli. A cough producing white, frothy sputum is characteristic of pulmonary edema from left-sided heart failure. Use of accessory muscles reflects increased work of breathing due to pulmonary congestion. An S3 gallop is a classic cardiac finding in heart failure indicating ventricular volume overload.
A client asks the nurse to explain the benefits of weight management. How should the nurse respond?
- "Weight management helps reduce heart disease by increasing Low-Density Lipoprotein (LDL) cholesterol levels."
- "Weight management helps reduce heart disease by reducing the need for physical activity."
- "Weight management helps reduce heart disease by promoting the buildup of fatty deposits in the arteries."
- "Weight management helps reduce heart disease by lowering blood pressure and reducing heart strain."
Explanation
Correct Answer: D) "Weight management helps reduce heart disease by lowering blood pressure and reducing heart strain."
Maintaining a healthy weight reduces the workload on the heart by lowering blood pressure, improving lipid profiles, and reducing overall cardiovascular strain. Excess body weight is a major risk factor for hypertension, dyslipidemia, and heart disease, and effective weight management directly addresses these risk factors to reduce the likelihood of cardiovascular complications.
A nurse is precepting a new nurse on respiratory assessments. Which statement by the new nurse indicates an understanding of what should be felt during the assessment when placing hands on the posterior lateral chest during deep breathing?
- Symmetrical rise and fall of the rib cage
- Pain during chest expansion
- Crepitus sensation across the rib cage
- No movement of the rib cage
Explanation
Correct Answer: A) Symmetrical rise and fall of the rib cage
When placing hands on the posterior lateral chest during deep breathing to assess chest excursion, the normal expected finding is a symmetrical rise and fall of the rib cage, indicating equal and adequate bilateral lung expansion. Asymmetrical expansion, crepitus, pain, or absent movement are all abnormal findings that would require further investigation.
Where are bronchovesicular breath sounds auscultated?
- Over the major bronchi, where fewer alveoli are located
- At the bases of the lungs, on the anterior and lateral thorax
- Over the manubrium on the anterior thorax
- Just above the clavicles on each side of the sternum
Explanation
Correct Answer: A) Over the major bronchi, where fewer alveoli are located
Bronchovesicular breath sounds are normal breath sounds heard over the major bronchi, specifically between the scapulae posteriorly and at the first and second intercostal spaces anteriorly, where fewer alveoli are present. They have a medium pitch and intensity, with equal inspiratory and expiratory phases. Bronchial breath sounds are heard over the manubrium. Vesicular sounds are heard at the lung bases. Tracheal breath sounds are heard just above the clavicles near the sternum.
What does the S1 heart sound indicate?
- The beginning of diastole
- Closure of the aortic valve
- Closure of the mitral valve
- A systolic heart murmur
Explanation
Correct Answer: C) Closure of the mitral valve
S1 is produced by the simultaneous closure of the mitral and tricuspid (atrioventricular) valves at the beginning of ventricular systole. It represents the "lub" in the "lub-dub" of the heartbeat and signals the start of systole, not diastole. The closure of the aortic and pulmonic valves produces S2, which marks the beginning of diastole.
The nurse assesses a pregnant client for cardiac complications. Which maternal report should prompt the nurse to further investigate potential cardiac complications in pregnancy?
- "I have been gaining weight and my ankles are swelling."
- "I have occasional heartburn and mild indigestion after spicy foods."
- "I have to nap in the afternoon and sometimes rest after lunch."
- "I get tired and short of breath when I walk up two flights of stairs."
Explanation
Correct Answer: D) "I get tired and short of breath when I walk up two flights of stairs."
Dyspnea on exertion, such as becoming tired and short of breath when climbing two flights of stairs, is a significant symptom that warrants further cardiac investigation in a pregnant client.
While some degree of breathlessness is common in pregnancy due to the growing uterus and increased circulatory demands, exertional dyspnea that limits normal activity may indicate an underlying cardiac condition such as peripartum cardiomyopathy or valvular disease.
Weight gain and ankle swelling are common normal findings in pregnancy. Heartburn and indigestion are typical gastrointestinal complaints during pregnancy. Afternoon fatigue and rest are also common and expected in pregnancy.
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