A client is brought to the emergency department by ambulance after being involved in a motor vehicle accident. The nurse finds that he has decreased breath sounds over the left lung fields. What might the nurse suspect is the cause?

Asthma exacerbation

Pulmonary embolism

Pneumothorax

Pulmonary edema

Answer and Explanation

The Correct Answer is C

A.   Asthma exacerbation typically causes wheezing or bronchospasm and would not usually cause decreased breath sounds in one lung.
B.   Pulmonary embolism may cause breathlessness or decreased oxygen levels, but it wouldn't typically cause unilateral decreased breath sounds.
C.   Pneumothorax is the most likely cause, as air in the pleural space can collapse the lung, leading to decreased or absent breath sounds on the affected side.
D.   Pulmonary edema typically causes bilateral crackles and would not cause unilateral decreased breath sounds.

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Correct Answer is C

Explanation

A. Peripheral vascular disease involves issues with blood flow to the extremities but does not typically present with jugular vein distension or a gallop heart sound.
B. Fluid and electrolyte disturbances may affect heart rhythm and fluid balance but are less likely to present with these specific findings.
C. Heart failure is the most likely cause, as jugular vein distension and a third heart sound (S3 gallop) are common signs of heart failure, particularly when the heart cannot effectively pump blood.
D. Atrial-septal defect may cause heart murmurs or irregular rhythms but is not typically associated with jugular vein distension or an S3 gallop.

A. Palpate the popliteal nodes B. Palpate the preauricular nodes C. Palpate the axillary nodes D. Palpate the submandibular nodes E. Palpate the supraclavicular nodes

Correct Answer is {"A":{"answers":"E"},"B":{"answers":"A"},"C":{"answers":"D"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Palpate the preauricular nodes (1st):

The preauricular lymph nodes are located in front of the ears, near the temple. The nurse starts at the head and neck to assess the regional nodes. Palpation of the preauricular nodes is often performed first because they are closest to the head and may be involved in infections affecting the eyes, ears, or sinuses.

Palpate the submandibular nodes (2nd):

The submandibular nodes are located beneath the jaw and are often involved in respiratory or oral infections. They are assessed after the preauricular nodes, as they are still part of the head and neck region, just below the chin.

Palpate the supraclavicular nodes (5th):

These nodes are located above the clavicle and are often associated with more serious conditions, such as cancer. Assessing them early in the examination can help identify any potential red flags.

Palpate the axillary nodes (3rd):

The axillary lymph nodes are located in the armpits and are important for breast tissue, upper limb, and chest infections. These are assessed after the head and neck nodes because they are part of the upper body region and located further down, near the chest.

Palpate the popliteal nodes (4th):

The popliteal nodes are located behind the knees. These nodes are assessed next, as part of the lower extremity examination. Palpating these nodes after the axillary nodes ensures a thorough systematic approach from upper to lower body.

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A client is brought to the emergency department by ambulance after being involved in a motor vehicle accident. The nurse finds that he has decreased breath sounds over the left lung fields. What might the nurse suspect is the cause?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a cardiac assessment of a client you observed jugular vein distension, and auscultated $3 gallop heart sound. These findings most likely suggest which of the following conditions?

Correct Answer is C

Explanation

A nurse is performing a lymphatic system assessment on a client reporting fatigue and malaise for one week. In which order should the nurse perform the head to toe assessments? Indicate the correct order from first to last. All options must be used.

Correct Answer is {"A":{"answers":"E"},"B":{"answers":"A"},"C":{"answers":"D"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

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