A client with congestive heart failure presents with edema of the ankles. When conducting a physical examination of this client, the nurse requires a gooseneck lamp for which purpose?
to check radial pulses
to assess pedal pulses
to assess jugular filling pressure
to auscultate lung sounds
The Correct Answer is C
A) To check radial pulses: Radial pulses are typically assessed by palpation at the wrist. A gooseneck lamp is not necessary for this task; standard lighting and direct palpation are usually sufficient.
B) To assess pedal pulses: Pedal pulses are assessed by palpation on the top of the foot. A gooseneck lamp is not needed for this purpose, as the lighting conditions are generally adequate for palpation in a well-lit room.
C) To assess jugular filling pressure: Assessing jugular venous pressure (JVP) requires good lighting to clearly see the pulsations in the jugular veins. A gooseneck lamp provides focused and adjustable lighting, which is helpful for this assessment. This ensures accurate observation of the jugular veins and helps in evaluating the severity of heart failure.
D) To auscultate lung sounds: Auscultating lung sounds involves using a stethoscope and does not typically require a gooseneck lamp. Proper lighting is not essential for auscultation, as the focus is on auditory assessment rather than visual inspection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Multiple myeloma: The HPV vaccine is not related to the prevention of multiple myeloma, which is a type of cancer that affects plasma cells in the bone marrow. Prevention strategies for multiple myeloma focus on managing risk factors, but HPV vaccination is not one of these strategies.
B) Cervical cancer: The HPV vaccine is specifically designed to prevent human papillomavirus (HPV) infection, which is a major risk factor for cervical cancer. By protecting against HPV, the vaccine helps prevent the development of cervical cancer, making it a form of primary prevention for this type of cancer.
C) Ovarian cancer: HPV vaccination is not related to the prevention of ovarian cancer. Ovarian cancer prevention strategies do not include the HPV vaccine, as HPV primarily affects the cervical region and some other genital areas, but not the ovaries.
D) Hodgkin's lymphoma: HPV vaccination is not used to prevent Hodgkin's lymphoma, a type of cancer that affects the lymphatic system. The prevention of Hodgkin's lymphoma typically involves addressing general cancer risk factors and monitoring for early symptoms, but it does not include the HPV vaccine.
Correct Answer is D
Explanation
A) Light palpation of the abdominal right lower quadrant: While light palpation is generally the first step in an abdominal examination to assess for tenderness or abnormalities, the presence of pain with deep palpation of the right kidney indicates a more specific concern. This may warrant further investigation related to the kidney rather than focusing on the lower quadrant.
B) Auscultate sounds in the abdominal left lower quadrant: Auscultation is typically done before palpation to assess bowel sounds and other abnormalities. However, given the specific complaint of pain in the right kidney area, the priority should be addressing the suspected kidney issue rather than auscultating another quadrant.
C) Deep palpation of the abdominal left upper quadrant: Deep palpation in another quadrant is not immediately relevant to the complaint of pain in the right kidney. Instead, it’s crucial to focus on assessing the area directly related to the client's symptoms.
D) First percussion of the costovertebral angles: Percussion of the costovertebral angles (CVA) is a specific technique used to assess kidney tenderness and is appropriate for evaluating the potential causes of the pain in the right kidney. This examination can help determine if the pain is due to conditions like kidney infection or inflammation. Therefore, it is the most relevant next step in this situation.
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