A critically ill patient has faster and deeper, then slower, respirations. These are followed by a period of no breathing for 21 seconds with continuation of this cycle. This respiratory pattern is

Kussmaul's respirations.

Cheyne-Stokes respirations.

Biot's respirations.

Hyperventilation.

Answer and Explanation

The Correct Answer is B

A.   Kussmaul's respirations are rapid, deep, and labored breaths often seen in metabolic acidosis, which does not match the pattern described.
B.   Cheyne-Stokes respirations are characterized by a pattern of deep and fast breathing followed by periods of apnea. This pattern is seen in patients with severe conditions like heart failure or brain injury.
C.   Biot's respirations are irregular, but the cycle does not have a distinct pattern of fast, slow, and apnea periods.
D.   Hyperventilation refers to an increased rate of breathing but does not involve the cycles of deep, slow, and apneic phases characteristic of Cheyne-Stokes.

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Correct Answer is D

Explanation

A. Tapping is the first Korotkoff sound and corresponds to the systolic pressure, not the diastolic pressure.
B. Knocking does not describe any Korotkoff sound associated with the blood pressure reading.
C. Silence is typically noted after the muffling sound and indicates the cessation of Korotkoff sounds, which can be used to assess diastolic pressure in adults, but it is not used in children.
D. The muffling sound occurs before the disappearance of Korotkoff sounds and is often used to mark the diastolic pressure in both children and some adults, making it the correct answer.

A. push the soles of the feet against the nurse's hands. B. wiggle the toes of both feet at the same time. C. pull both feet up at the same time to stretch the Achilles tendons. D. stand up independently

Correct Answer is A

Explanation

A. Pushing the soles of the feet against the nurse's hands is a standard test to assess the strength of the lower extremities. It provides a clear indication of muscular strength and motor function.
B. Wiggling toes helps assess for sensation but does not evaluate overall strength or motor function in the lower extremities.
C. Pulling both feet up to stretch the Achilles tendons is not an appropriate method for assessing lower extremity strength.
D. Standing independently does not evaluate strength comprehensively and is more related to balance and coordination.

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A critically ill patient has faster and deeper, then slower, respirations. These are followed by a period of no breathing for 21 seconds with continuation of this cycle. This respiratory pattern is

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A type of Korotkoff sound that indicates the diastolic pressure in children and in some adults is

Correct Answer is D

Explanation

To correctly determine the strength of a patient's lower extremities during a neurological examination, the nurse asks the patient to:

Correct Answer is A

Explanation

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