During a routine physical examination of a client, chest palpation is determined to be normal except for a 2 inch (5.1 cm) diameter area of crepitus over the upper right anterior chest. Which interpretation is the most accurate for this finding?
Trapped subcutaneous air causing crepitus will be absorbed, so the finding is not significant.
Since this client has only a small area of crepitus, it probably is not a significant finding.
Crepitus is always abnormal and should be followed-up with a more detailed assessment.
Since a fractured rib often creates crepitus, a chest x-ray should be scheduled immediately.
The Correct Answer is C
A. Trapped subcutaneous air causing crepitus will be absorbed, so the finding is not significant. While trapped air can be absorbed, crepitus can indicate underlying issues such as a pneumothorax or other trauma, so it should not be dismissed as insignificant.
B. Since this client has only a small area of crepitus, it probably is not a significant finding. The size of the area does not necessarily correlate with the severity of the underlying condition. Even a small area of crepitus should be investigated.
C. Crepitus is always abnormal and should be followed-up with a more detailed assessment. This is the most accurate interpretation. Crepitus indicates the presence of air in the subcutaneous tissues, which is always abnormal and warrants further investigation.
D. Since a fractured rib often creates crepitus, a chest x-ray should be scheduled immediately. While a chest x-ray can be part of the assessment, stating that a fractured rib "often" creates crepitus might be misleading. Crepitus can arise from other conditions, and a thorough assessment is needed before determining the exact cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["9"]
Explanation
To determine the Apgar score for the newborn infant, we assess five parameters: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each parameter is scored from 0 to 2, with 2 being the highest score. Let's evaluate each parameter:
- Heart rate: 150 beats/minute --> Score of 2.
- Respiratory effort: Vigorous cry present --> Score of 2.
- Muscle tone: Good muscle tone with total flexion --> Score of 2.
- Reflex irritability: Quick reflex irritability noted --> Score of 2.
- Color: Dusky and cyanotic skin color --> Score of 1.
Now, we sum up the scores: 2+2+2+2+1=92+2+2+2+1=9
Therefore, the Apgar score for this infant is 9.
Correct Answer is D
Explanation
A. Triceps skin fold and mid-arm circumference. These measurements can provide some indication of nutritional status, but they may not be as reliable in older adults due to changes in body composition and skin elasticity.
B. Twenty-four-hour food recall, preferences, and allergies. While dietary information is important, it may not accurately reflect the client's current nutritional status.
C. Weight loss history and body surface area (BSA). While weight loss history is relevant, BSA is not typically used to assess nutritional status.
D. Body mass index (BMI) and serum albumin level. BMI is a commonly used indicator of nutritional status, and serum albumin level reflects protein status, which is important for assessing malnutrition.
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