A nursing student asked the respiratory floor nurse why the adventitious wheezing breath sounds are present in asthmatic patients. The nurse should respond:

this is an abnormal breath sound due to bronchial airways being narrowed, bronchoconstriction

this is a normal breath sound due to normal gas exchanged

this is an abnormal breath sound due to bronchial airways being dilated, bronchodilation

this is a normal breath sound due to the alveoli being fluid-filled

Answer and Explanation

The Correct Answer is A

A) This is an abnormal breath sound due to bronchial airways being narrowed, bronchoconstriction: Wheezing is an abnormal breath sound characterized by a high-pitched whistling noise produced during breathing. It occurs when the bronchial airways are narrowed due to bronchoconstriction, inflammation, or mucus, common in conditions like asthma. This narrowing of the airways creates turbulent airflow, leading to the wheezing sound.

B) This is a normal breath sound due to normal gas exchange: Wheezing is not a normal breath sound and is indicative of an obstruction or narrowing in the airways. Normal breath sounds, such as vesicular breath sounds, are smooth and do not include wheezing.

C) This is an abnormal breath sound due to bronchial airways being dilated, bronchodilation: Wheezing results from airway narrowing, not dilation. Bronchodilation, which is the widening of the airways, would typically reduce or resolve wheezing rather than cause it.

D) This is a normal breath sound due to the alveoli being fluid-filled: Wheezing is related to airway narrowing rather than fluid in the alveoli. Fluid in the alveoli would more commonly cause crackles or rales, not wheezing.

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Correct Answer is C

Explanation

A) 2: A muscle strength grade of 2 indicates that the muscle can move when gravity is eliminated, such as when the limb is supported. However, it does not have enough strength to move against gravity. This grade is not appropriate for the client described, as they can move both lower legs against gravity.
B) 3: A muscle strength grade of 3 means that the muscle can move the joint against gravity but without any additional resistance. This is less than the client’s described ability, as they can move their legs against some resistance.
C) 4: A muscle strength grade of 4 indicates that the muscle can move against gravity and moderate resistance. This matches the client’s ability to actively move both lower legs against gravity and some resistance, making it the correct documentation of their muscle strength.
D) 5: A muscle strength grade of 5 indicates normal muscle strength, where the muscle can move against gravity and full resistance without any signs of fatigue. Since the client is described as moving against some resistance but not full resistance, a grade of 5 would overestimate their current muscle strength.

A. Diabetic Neuropathy B. Chronic Arterial insufficiency C. Lymphedema D. Chronic Venous Insufficiency

Correct Answer is A

Explanation

A) Diabetic Neuropathy: Diabetic neuropathy is a common complication of diabetes that affects the nerves, particularly in the extremities. Symptoms include decreased sensation, numbness, and the development of non-healing ulcers on the feet due to loss of protective sensation and poor wound healing. This condition aligns with the patient's symptoms of decreased sensation and non-healing foot ulcers.
B) Chronic Arterial Insufficiency: Chronic arterial insufficiency typically presents with symptoms such as intermittent claudication (pain or cramping in the legs during activity), cold or pale extremities, and ulcers on the toes or feet that often have a more well-defined border. The non-healing ulcers and decreased sensation described are more characteristic of diabetic neuropathy than arterial insufficiency.
C) Lymphedema: Lymphedema is characterized by swelling due to lymph fluid accumulation, often affecting the lower extremities. While it can cause skin changes and ulcers, it is less commonly associated with decreased sensation and is more likely to present with swelling and skin changes rather than the specific combination of symptoms described.
D) Chronic Venous Insufficiency: Chronic venous insufficiency involves issues with blood return from the legs to the heart, leading to symptoms such as swelling, varicose veins, and ulcers typically around the ankles. It is usually associated with aching, heaviness, and swelling rather than the decreased sensation and non-healing ulcers seen in diabetic neuropathy.

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A nursing student asked the respiratory floor nurse why the adventitious wheezing breath sounds are present in asthmatic patients. The nurse should respond:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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