A friction rub is a scratching or squeaking sound that persists throughout the respiratory cycle and does not clear with coughing. True or false?
True
False
The Correct Answer is True
Choice A reason: A friction rub is a scratching or squeaking sound from inflamed pleural surfaces, persisting throughout the respiratory cycle and unaffected by coughing, as pleural inflammation (e.g., pleurisy) causes consistent friction. Accurate recognition ensures proper reporting, guiding diagnosis and treatment of underlying conditions like pneumonia or pulmonary embolism in respiratory assessments.
Choice B reason: Assuming false is incorrect, as friction rubs indeed persist through the respiratory cycle without clearing by coughing, unlike rhonchi. Misidentifying this risks misdiagnosis, potentially overlooking pleural inflammation needing anti-inflammatory or antibiotic therapy, delaying treatment and increasing complications in patients with respiratory conditions causing friction rubs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Vital signs are objective, measurable data, not specific to musculoskeletal assessment or subjective experience. Pain, a subjective report, better fits the question. Assuming vital signs are subjective risks misclassifying data, leading to errors in prioritizing patient-reported symptoms like pain, critical for musculoskeletal care planning and intervention.
Choice B reason: Taking NSAIDs is a factual history, not a subjective assessment. Subjective data, like pain severity, reflect patient experience. Assuming medication use is subjective misaligns with assessment principles, risking neglect of patient-reported symptoms like pain, essential for evaluating musculoskeletal conditions and guiding effective pain management strategies.
Choice C reason: Pain rated 7 to 8 is subjective, based on the patient’s personal experience, central to musculoskeletal assessment for conditions like arthritis or injury. This guides pain management, like adjusting NSAIDs. Accurate identification ensures patient-centered care, addressing discomfort and improving function, critical for musculoskeletal health outcomes.
Choice D reason: Grimacing and holding a body part are objective, observable signs, not subjective reports. Pain severity, reported by the patient, is subjective. Assuming grimacing is subjective risks misclassification, potentially overlooking patient-reported pain levels, critical for tailoring interventions like analgesics in musculoskeletal assessment and care planning.
Correct Answer is C
Explanation
Choice A reason: Pain level assessment is important but unrelated to orientation, which evaluates mental state via time, place, and person questions. Assuming pain assesses orientation risks missing cognitive deficits, delaying diagnosis of delirium or dementia, critical for tailoring care and interventions in patients with altered mental status.
Choice B reason: Personal hygiene reflects self-care ability, not orientation to time, place, or person, which assesses mental state. Assuming hygiene evaluates orientation misguides assessment, risking oversight of cognitive impairments, essential for diagnosing conditions like Alzheimer’s or acute confusion, requiring targeted interventions in clinical practice.
Choice C reason: Orientation questions assess mental state, evaluating cognitive function through awareness of time, place, and person. This detects impairments in conditions like delirium or dementia, guiding care planning. Accurate assessment ensures timely interventions, critical for managing cognitive decline and supporting patient safety and communication in healthcare settings.
Choice D reason: Family medical history provides genetic context but doesn’t assess orientation, which targets mental state. Assuming history evaluates orientation risks missing cognitive issues, delaying diagnosis of acute or chronic cognitive impairments, critical for implementing cognitive support or pharmacological interventions in patients with suspected mental status changes.
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