A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?

Wheezes

Rhonchi

Crackles

Stridor

Answer and Explanation

The Correct Answer is A

A. Wheezes are high-pitched continuous sounds heard during exhalation, commonly associated with asthma due to narrowed airways.

B. Rhonchi are low-pitched sounds caused by airflow obstruction in the larger airways and typically clear with coughing.

C. Crackles (or rales) are high-pitched sounds heard during inhalation and are often associated with fluid in the lungs, such as in pneumonia or heart failure.

D. Stridor is a high-pitched sound heard during inspiration and is often indicative of upper airway obstruction.

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Correct Answer is B

Explanation

A. The Administration for Children and Families primarily handles welfare and family support programs, not HIPAA administrative provisions.

B. The Centers for Medicare and Medicaid Services (CMS) is responsible for implementing and administering many aspects of HIPAA related to health care providers, insurers, and payment systems.

C. The Social Security Administration manages social security programs but does not handle HIPAA administrative provisions.

D. The Health Resources and Services Administration is focused on improving access to health care for underserved populations, not directly responsible for HIPAA administration.

A. Provide the client with a diet high in protein. B. Massage bony prominences to promote circulation. C. Reposition the client every 3 hr. D. Apply cornstarch to keep the skin dry.

Correct Answer is A

Explanation

A. A diet high in protein is essential for maintaining skin integrity and promoting wound healing, as protein helps to maintain tissue strength and repair.

B. Massaging bony prominences is not recommended because it can cause further damage to the skin and underlying tissues.

C. The client should be repositioned every 2 hours to prevent pressure sores, not every 3 hours.

D. Cornstarch should not be used because it can cause skin irritation and lead to fungal infections. Powder-based products should be avoided on fragile skin.

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A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?

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Naxlex Comprehensive Predictor Exams

Which division of the United States Department of Health and Human Services is primarily responsible for the administrative provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)?

Correct Answer is B

Explanation

A nurse is caring for an older adult client who is at risk for skin breakdown. Which of the following interventions should the nurse use to help maintain the integrity of the client's skin?

Correct Answer is A

Explanation

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A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?

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