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

Answer and Explanation

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.

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Correct Answer is C

Explanation

A) Tricuspid and mitral: The tricuspid and mitral valves are best auscultated over the areas where the heart's valves are closest to the chest wall, specifically at the lower left sternal border and the apex, respectively. A louder S2 in the 2nd intercostal space right sternal border does not indicate the closure of these valves.
B) Mitral and aortic: The mitral valve is auscultated at the apex, and the aortic valve is best heard at the 2nd intercostal space right sternal border. While a louder S2 may be associated with the aortic valve, it is not consistent with the mitral valve.
C) Aortic and pulmonic: The aortic valve and pulmonic valve are located in the areas where S2 (second heart sound) is predominantly heard. The aortic valve is located at the 2nd intercostal space right sternal border, and the pulmonic valve is heard at the 2nd intercostal space left sternal border. A louder S2 in the 2nd intercostal space right sternal border indicates a louder closure of the aortic valve and potentially the pulmonic valve as well.
D) Pulmonic and tricuspid: The pulmonic valve is auscultated at the 2nd intercostal space left sternal border, while the tricuspid valve is heard best at the lower left sternal border. A louder S2 in the 2nd intercostal space right sternal border does not indicate the closure of the tricuspid valve.

A. Sigmoid colon B. Appendix C. Right Fallopian Tube D. Ascending Colon E. Right kidney F. Right side of the prostate

Correct Answer is ["B","C","D"]

Explanation

A) Sigmoid colon: The sigmoid colon is located in the Left Lower Quadrant (LLQ) of the abdomen. Therefore, a bulging area in the Right Lower Quadrant (RLQ) would not be associated with the sigmoid colon.
B) Appendix: The appendix is located in the Right Lower Quadrant and is a common site for abdominal masses, especially in cases of appendicitis. A bulging area in the RLQ could very well be related to issues with the appendix.
C) Right Fallopian Tube: The right fallopian tube is located in the RLQ of the abdomen. Conditions affecting the fallopian tube, such as an ectopic pregnancy or tubo-ovarian abscess, could cause a bulging area in this quadrant.
D) Ascending Colon: The ascending colon is also situated in the RLQ. A mass or bulge in this area could be related to conditions affecting the ascending colon, such as colonic obstruction or tumors.
E) Right kidney: The right kidney is located in the upper abdominal area and is more likely to cause tenderness or discomfort in the upper quadrants rather than a bulging mass in the RLQ.
F) Right side of the prostate: The prostate gland is located in the pelvic area, specifically in the male pelvis, and would not typically be associated with a bulging mass in the RLQ of a female patient.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When auscultating a client's heart sounds, the nurse hears a louder S2 when listening at the 2nd intercostal space right sternal border. The nurse determines that this finding is consistent with the closure of which heart valves?

Correct Answer is C

Explanation

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Correct Answer is ["B","C","D"]

Explanation

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