The nurse completes auscultation of the heart on an older adult client. Which finding is considered normal for this client?

Murmurs.

Absent sounds.

No adventious sounds.

Adventious sounds.

Answer and Explanation

The Correct Answer is A

A. Murmurs can be a normal finding in older adults due to age-related changes in the heart valves or blood flow. They are not necessarily indicative of pathology if they are not associated with symptoms or changes in the client's condition.

B. Absent heart sounds would be abnormal and could indicate severe underlying issues such as cardiac arrest or severe hypovolemia.

C. While no adventitious sounds are generally expected, the presence of murmurs is considered normal in this age group.

D. Adventitious sounds (such as crackles or wheezes) are not normal in heart auscultation and would suggest potential pathologies.

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Correct Answer is D

Explanation

A. An older adult scheduled for foot amputation due to diabetes complications may have complex care needs requiring the expertise of an RN.

B. An adult with alcoholism, cirrhosis, and hepatic encephalopathy can present with unstable and complex health issues that require close monitoring by an RN.

C. An older client who is one day postoperative with a colostomy for colon cancer may require specialized care and education best provided by an RN.

D. An adult who is one day postoperative for a laparoscopic cholecystectomy is likely to have more predictable and routine care needs, making this client a suitable assignment for a PN under the supervision of an RN.

A. Twin siblings admitted with scarlet fever that is complicated with pneumonia. B. An older client with scabies who is admitted from an extended care facility. C. A female adolescent admitted with multiple genital Herpes simplex II lesions. D. A client with a positive Mantoux and sputum cultures results positive for acid-fast bacillus (AFB).

Correct Answer is D

Explanation

A. Scarlet fever and pneumonia do not require airborne precautions; they are primarily spread through respiratory droplets.

B. Scabies is a skin infestation that requires contact precautions, not airborne precautions.

C. Herpes simplex II lesions require contact precautions and are not airborne.

D. A positive Mantoux test and sputum cultures positive for acid-fast bacillus indicate tuberculosis, which requires airborne precautions, including a negative airflow room and the use of a particulate respirator mask.

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The nurse completes auscultation of the heart on an older adult client. Which finding is considered normal for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which client is best to assign to the practical nurse (PN) who is assisting the registered nurse (RN) with the care of a group of clients?

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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