A nurse is caring for a child who is having difficulty breathing due to an asthma exacerbation. Which of the following areas should the nurse determine if the child is experiencing subcostal retractions? (You will find hot spots to select in the artwork below. Select only the hot corresponds to your answer.)
The Correct Answer is "{\"xRanges\":[232.4270782470703,272.4270782470703],\"yRanges\":[382.1666450500488,422.1666450500488]}"
To determine if the child is experiencing subcostal retractions, check the area beneath the ribcage.
D - Subcostal Area:
Subcostal retractions occur below the ribs and are a sign of respiratory distress, indicating increased effort to breathe.
Observing this area can reveal inward movement during inspiration, suggesting difficulty in breathing, often seen in asthma exacerbations.
Rationale
A - Incorrect:
This area is near the clavicle and not related to subcostal retractions.
B - Incorrect:
This is the intercostal area, which can also show retractions but is not subcostal.
C - Incorrect:
This area is too central and does not correspond with subcostal retractions.
Focusing on D allows the nurse to assess the presence of subcostal retractions effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) "Limit fluids that contain electrolytes":
For a client with gastroenteritis, it is crucial to maintain hydration due to the risk of dehydration from diarrhea and vomiting. However, fluids containing electrolytes can help replenish lost electrolytes and are beneficial. The instruction to "limit" these fluids might be misunderstood as a need to avoid them, which is not appropriate. The aim should be to encourage adequate hydration with fluids that contain electrolytes.
B) "Eliminate sources of probiotics from the diet":
Probiotics can help restore the balance of gut bacteria and may be beneficial in managing gastroenteritis. Eliminating probiotics from the diet is not typically recommended and may not support the recovery process.
C) "Take docusate sodium twice daily":
Docusate sodium is a stool softener, generally used to relieve constipation. In the context of gastroenteritis, which typically involves diarrhea, this medication is not appropriate and could worsen the condition.
D) "Avoid foods high in simple sugars":
Foods high in simple sugars can exacerbate diarrhea by increasing osmotic load in the intestines, leading to more water being drawn into the gut. Avoiding these foods can help manage and reduce symptoms of gastroenteritis.
Correct Answer is D
Explanation
A) "I will remain in the hospital until my treatment is completed.": Hospitalization is not typically required for the entire duration of tuberculosis (TB) treatment. Most patients with TB can continue their treatment at home with proper medication and infection control measures, unless they have severe disease or complications.
B) "I will wear a surgical mask around my family.": A surgical mask is not sufficient to protect others from TB. Patients with active TB should wear an N95 respirator mask to reduce the risk of spreading the infection, especially in situations where close contact is unavoidable.
C) "I will need medication to treat my condition for the rest of my life.": TB treatment generally involves a course of medication lasting 6 to 9 months. Long-term, lifelong medication is not required; however, adherence to the full course of prescribed antibiotics is crucial to ensure the infection is fully eradicated.
D) "I will need to provide a sputum specimen every 4 weeks until I test negative.": Monitoring sputum samples every 4 weeks is a standard practice to assess the effectiveness of TB treatment and confirm that the patient is no longer infectious. This statement indicates an understanding of the ongoing evaluation needed during treatment.
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