Chamberlain University W8 NR302 Health Assessment I Exam 3 .
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Free Chamberlain University W8 NR302 Health Assessment I Exam 3 . Questions
The nurse received shift report on several clients. Which client should the nurse assess first?
- A client with post-operative atelectasis who becomes suddenly short of breath
- A client with lung cancer who has fatigue, nausea, weight loss, and mild cough
- A client with pneumonia is being discharged and needs an influenza vaccination
- A client with chronic obstructive pulmonary disease (COPD) with a barrel chest
Explanation
Correct Answer: A) A client with post-operative atelectasis who becomes suddenly short of breath
A sudden onset of shortness of breath in a post-operative client with atelectasis represents an acute change in respiratory status that requires immediate assessment, as it may indicate progression to a more serious condition such as pulmonary embolism, pneumothorax, or severe hypoxia.
Sudden changes in a client's condition always take priority over chronic or stable findings. The lung cancer client's symptoms are chronic and expected. The discharge client's vaccination is a non-urgent administrative task. The COPD client's barrel chest is a chronic, expected finding that does not require immediate intervention.
A nurse is planning to assess the point of maximal impulse (PMI). What client position should the nurse use to enhance palpation of the PMI?
- Prone with the arms overhead
- Trendelenburg position
- Supine and left lateral positions
- Sitting upright with arms crossed
Explanation
Correct Answer: C) Supine and left lateral positions
The PMI is best palpated with the client in the supine position or in the left lateral decubitus (left side-lying) position. The left lateral position brings the heart closer to the anterior chest wall, making the apical impulse easier to locate and palpate, particularly in clients where it may not be easily felt in the supine position. The prone position would make cardiac palpation impossible. The Trendelenburg position is used for hypotension management. Sitting upright with arms crossed does not facilitate optimal cardiac palpation.
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Left-sided facial droop
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Neck pain noted with movement
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Crepitation in the jaw
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Exophthalmos of the eyes
Explanation
Correct Answer: (A) Left-sided facial droop
Unilateral facial droop is a potential sign of a stroke or serious neurological event and requires immediate reporting and intervention. It is one of the classic warning signs identified in stroke screening tools such as the FAST acronym (Face, Arms, Speech, Time), making it the highest priority finding.
Why Other Options are Incorrect:
B. Neck pain noted with movement — While neck pain with movement can indicate conditions such as meningitis or musculoskeletal injury, it does not carry the same immediate life-threatening urgency as facial droop suggestive of stroke.
C. Crepitation in the jaw — Jaw crepitation is commonly associated with temporomandibular joint dysfunction, which is not an emergency finding.
D. Exophthalmos of the eyes — Exophthalmos can indicate hyperthyroidism or orbital conditions and warrants follow-up, but it is not an acute emergency requiring immediate prioritization over a potential stroke sign.
A nurse cares for a group of clients with respiratory conditions. Which client should the nurse see first?
- A client with a pneumothorax with absent lung sounds on the left side
- A client with asthma who requests a refill of their inhaler before discharge
- A client with emphysema who is on 2 L/min of oxygen via nasal cannula
- A client with pneumonia who was just started on intravenous antibiotics
Explanation
Correct Answer: A) A client with a pneumothorax with absent lung sounds on the left side
A pneumothorax with absent lung sounds on the left side is a life-threatening emergency that requires immediate assessment and intervention. Absent breath sounds indicate a significant collapse of the affected lung, which can rapidly progress to a tension pneumothorax, causing mediastinal shift, cardiovascular compromise, and respiratory failure if not treated promptly.
The asthma client requesting an inhaler refill is a non-urgent discharge need. The emphysema client on 2 L/min of oxygen is receiving treatment and is stable. The pneumonia client recently started on IV antibiotics is being appropriately managed.
Therefore, the pneumothorax client with absent lung sounds represents the highest priority due to the immediate threat to airway and breathing.
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.
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.
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The client has supraventricular tachycardia.
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The client has bradycardia.
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The client has tachycardia.
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The client has a normal pulse rate.
Explanation
Correct Answer: (B) The client has bradycardia.
The normal adult heart rate range is 60 to 100 beats per minute. A heart rate of 52 beats per minute falls below the lower limit of normal and is classified as bradycardia. Bradycardia may be asymptomatic in well-conditioned athletes or may indicate pathological causes such as heart block, hypothyroidism, medication effects, or vagal stimulation that require further assessment.
Why the other options are incorrect:
A. The client has supraventricular tachycardia — Supraventricular tachycardia (SVT) is a rapid heart rhythm originating above the ventricles, typically presenting with heart rates of 150 to 250 beats per minute. A rate of 52 bpm is the complete opposite of tachycardia.
C. The client has tachycardia — Tachycardia is defined as a heart rate greater than 100 beats per minute. A rate of 52 bpm does not meet this criterion and cannot be classified as tachycardia.
D. The client has a normal pulse rate — The normal adult pulse range is 60 to 100 beats per minute. A rate of 52 bpm falls below this range and is abnormal, not within the expected normal reference range.
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.
Which 3 respiratory conditions are assessed by auscultation? Select three conditions.
- Course crackles
- Pleural friction rub
- Crepitus
- Fremitus
- Fine crackles
Explanation
Correct Answer: A) Coarse crackles, B) Pleural friction rub, and E) Fine crackles
Coarse crackles, pleural friction rub, and fine crackles are all abnormal breath sounds detected through auscultation with a stethoscope. Coarse crackles are loud, low-pitched sounds associated with secretions in large airways. Fine crackles are soft, high-pitched sounds heard in conditions like pulmonary fibrosis or early heart failure.
A pleural friction rub is a grating sound caused by inflamed pleural surfaces rubbing together. Crepitus is a crackling sensation felt on palpation of the skin, not heard on auscultation. Fremitus is a vibration assessed through palpation of the chest wall, not auscultation.
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Otitis media
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Scarred tympanic membrane
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Perforated tympanic membrane
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Otitis externa
Explanation
Correct Answer: (A) Otitis media
A bulging, red tympanic membrane is the classic presentation of acute otitis media, where fluid and pus accumulate in the middle ear, causing the eardrum to appear inflamed and pushed outward.
Why Other Options are Incorrect:
B. Scarred tympanic membrane — Scarring typically appears as white patches or thickening on the eardrum, not as redness or bulging.
C. Perforated tympanic membrane — A perforation would present as a visible hole or tear in the eardrum, often accompanied by discharge, rather than a bulging appearance.
D. Otitis externa — This is an infection of the outer ear canal and does not typically cause changes in the appearance of the tympanic membrane itself.
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