The nurse is assessing a 1-day post-operative client and discovers fine crackles at the bases of the right lung on inspiration. What does the nurse suspect is the cause of the adventitious lung sounds in the right lung?

Asthma

Pneumothorax

Atelectasis

Emphysema

Bronchitis

Answer and Explanation

The Correct Answer is C

A. Asthma typically presents with wheezing, not fine crackles.
B. Pneumothorax usually presents with decreased or absent breath sounds rather than crackles.
C. Atelectasis, which is common after surgery, can cause fine crackles at the lung bases due to collapsed alveoli reopening during inspiration.
D. Emphysema generally results in diminished breath sounds and hyper-resonance rather than crackles.
E. Bronchitis typically produces coarse crackles or rhonchi, not fine crackles.

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

Explanation

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.

A. Auscultate for any cardiac murmurs B. Compare the apical and radial pulse rates C. Palpate the quality of the peripheral pulses D. Find the point of maximal impulse E. Check capillary refill time

Correct Answer is A

Explanation

A. Auscultate for any cardiac murmurs is correct, as a thrill often indicates turbulent blood flow, which may correlate with murmurs that can be heard upon auscultation.
B. Comparing apical and radial pulse rates is useful in assessing pulse deficits but does not directly address the cause of the thrill.
C. Palpating the quality of the peripheral pulses does not provide specific information about the thrill's origin.
D. Finding the point of maximal impulse is a useful cardiac assessment but does not directly explain the cause of the thrill.
E. Checking capillary refill time assesses peripheral perfusion but does not relate to the thrill's cause.

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The nurse is assessing a 1-day post-operative client and discovers fine crackles at the bases of the right lung on inspiration. What does the nurse suspect is the cause of the adventitious lung sounds in the right lung?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

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

Explanation

When assessing a newly admitted client, the nurse notes a thrill along the left sternal border. To obtain more information about the cause of the thrill, which action will the nurse take next?

Correct Answer is A

Explanation

When performing a respiratory assessment on a patient, the nurse notices a costal vertebral angle (CVA) of approximately 160 degrees. How would finding?

When the nurse manager is evaluating the care of a client receiving oxygen through a nasal cannula, which finding indicates a need for more staff education about oxygen therapy?

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A client with pneumonia is admitted to the medical/surgical floor. Which activity is most important for the nurse to include in the plan of care?

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

The nurse obtains information when performing a focused assessment of a client with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea (shortness of breath) over the last 3 days. Which finding is most important to report to the health care provider?

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