Complete the sentence using the drop-down lists. A nurse is completing a physical assessment of a client's respiratory system. The nurse should first use the
dropdown
technique and end with the
dropdown
technique.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Inspection: Inspection is the first step in a respiratory assessment because it allows the nurse to observe the client’s overall respiratory effort, chest symmetry, use of accessory muscles, and breathing pattern. It is noninvasive and provides essential visual information about the client’s respiratory status before performing any physical manipulation.

• Percussion: Percussion is performed last because it involves tapping the chest to assess underlying tissue density and lung sounds, which can be uncomfortable for the client if done first. It provides additional information about areas of consolidation, fluid, or air in the lungs. Percussion is best completed after inspection, palpation, and auscultation, ensuring the assessment progresses from least to most invasive.

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Correct Answer is C

Explanation

A. Focus the client on how the medical treatment prescribed by the healthcare provider will help their condition: Emphasizing only medical treatment may dismiss the client’s cultural or spiritual beliefs, potentially damaging rapport and trust. Respecting the client’s values is important for holistic care.

B. Inform the client that hanging the amulet in the hospital is not permitted and remove all other personal effects: Removing personal items without consent is disrespectful and violates the client’s autonomy and right to personal expression. This approach can lead to conflict and decreased satisfaction with care.

C. Find an appropriate place within the client's room to hang the amulet so that it will not interfere with treatment: Accommodating the client’s request while ensuring safety demonstrates cultural sensitivity and respect for autonomy. This approach supports both holistic care and adherence to medical treatment.

D. Explain to the client the importance of evidence-based practice and suggest they meet with pastoral care: While education about evidence-based practice and spiritual support is helpful, it should be done in a supportive, nonjudgmental way. The priority is to respect the client’s beliefs while ensuring safety and treatment efficacy.

A. Offer comfort measures to the client B. Verify that two bedside rails are raised C. Ensure the bed is in the lowest position D. Thank the client before leaving the room E. Check that the bed is in the locked position

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

Explanation

A. Offer comfort measures to the client: Providing comfort measures, such as adjusting pillows, blankets, or positioning, helps prevent discomfort and reduces the risk of the client attempting unsafe movements, promoting overall safety.

B. Verify that two bedside rails are raised: Raising only two bedside rails is not considered a safe practice for preventing falls. Safety guidelines recommend either following facility policy for rail use or using alternative safety measures rather than arbitrarily raising two rails.

C. Ensure the bed is in the lowest position: Keeping the bed in the lowest position reduces the risk of injury if a client attempts to get out of bed independently, helping prevent falls and enhancing safety.

D. Thank the client before leaving the room: While expressing courtesy is important for rapport and communication, it does not directly contribute to the physical safety of the client.

E. Check that the bed is in the locked position: Locking the bed prevents unintentional movement, especially when the client attempts to get in or out, which is essential for fall prevention and safety.

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Complete the sentence using the drop-down lists. A nurse is completing a physical assessment of a client's respiratory system. The nurse should first use the dropdown technique and end with the dropdown technique.

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Naxlex Comprehensive Predictor Exams

A client requests to hang an amulet above their bed for protection while in the hospital. The nurse believes that the only thing that will help the client is medical treatment. Which action should the nurse take?

Correct Answer is C

Explanation

The nurse prepares to leave the room after completing a client assessment. What action(s) should a nurse plan to take to promote safety before leaving a client's room? Select all that apply.

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

Explanation

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The nurse is caring for a client who is of a different culture than that of the nurse. When the nurse begins the physical assessment, the client seems apprehensive. What action should the nurse take?

Complete the sentence using the drop-down lists. A nurse is completing a physical assessment of a client's respiratory system. The nurse should first use the
dropdown
technique and end with the
dropdown
technique.