A nurse is preparing to teach clients. Which client finding will cause the nurse to postpone a teaching session? (Select all that apply)

The client is currently febrile with an oral temperature of 101.2°F

The client is mildly anxious about their condition.

The client is reporting feeling nauseated

The client's pain rated 8 out of 10 on a numerical scale

The client is asking questions about their health status.

Answer and Explanation

Correct Answer : A,C,D

A. A febrile state indicates that the client may not be in an optimal condition to learn effectively, so postponing the session is appropriate.
B. Mild anxiety may not require postponement, as it can be addressed during teaching.
C. Nausea can significantly impair concentration and engagement in learning, warranting a delay.
D. A pain level of 8 out of 10 suggests significant discomfort, making it challenging for the client to focus on learning.
E. Asking questions indicates engagement and a readiness to learn, so this does not warrant postponing the session.

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Correct Answer is ["A","B"]

Explanation

A. Inquiring about personal and family cardiac history provides essential subjective information on potential hereditary risks and the client’s own cardiac health.
B. Asking about fatigue and chest pain allows the nurse to assess symptoms that may suggest cardiac issues, making it critical subjective data.
C. Inspecting for intercostal retractions and nasal flaring is part of the objective assessment rather than subjective data.
D. Palpating the chest for thrills and heaves is also an objective action, assessing physical findings rather than subjective symptoms.
E. Auscultating the heart with the diaphragm and bell of the stethoscope is an objective assessment to detect sounds rather than gathering subjective information from the client.

A. pulmonic B. tricuspid C. aortic D. mitral

Correct Answer is ["A","C"]

Explanation

A. Pulmonic valve closure is best heard at the base of the heart, near the second intercostal space at the left sternal border.
B. Tricuspid valve sounds are best heard at the lower left sternal border, near the apex rather than the base of the heart.
C. Aortic valve closure is also best heard at the base of the heart, near the second intercostal space on the right sternal border.
D. Mitral valve sounds are heard best at the apex of the heart, near the fifth intercostal space in the midclavicular line, not the base.

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A nurse is preparing to teach clients. Which client finding will cause the nurse to postpone a teaching session? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What subjective data should the nurse obtain about a client's cardiac status? Select all that apply.

Correct Answer is ["A","B"]

Explanation

When listening to heart sounds, which valve closures are heard best at the base of the heart. Select all that apply.

Correct Answer is ["A","C"]

Explanation

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