The nurse is percussing a client's abdomen during a physical assessment. The nurse observes an area of dullness above the right costal margin of approximately 11 cm. Which of the following actions should the nurse take?

Recognizes this dullness as indicative of an enlarged liver, and refers the client to a provider

Document the presence of hepatomegaly

Ask additional health history questions regarding alcohol intake

Recognizes this finding as normal, and proceed with the examination

Answer and Explanation

The Correct Answer is A

A.   Dullness above the right costal margin could indicate an enlarged liver. Referring the client to a healthcare provider is crucial for further evaluation and diagnosis.
B.   Documenting hepatomegaly without further investigation or confirmation by a healthcare provider could be premature.
C.   While alcohol intake can be a factor in liver conditions, additional history alone may not confirm the cause of the dullness. Direct evaluation by a healthcare provider is necessary.
D.   Finding an area of dullness above the right costal margin, particularly of such magnitude, should prompt further investigation rather than being considered normal.

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Correct Answer is C

Explanation

A. Plantarflexion and dorsiflexion refer to movements of the foot and are unrelated to the Phalen test.
B. Hyperextension of the wrists with the palmar surfaces touching is not the correct maneuver for the Phalen test.
C. The Phalen test involves holding both hands back to back while flexing the wrists at a 90- degree angle for about 60 seconds, which may induce symptoms of carpal tunnel syndrome in those affected.
D. Hyperextending the wrists with the palms together doesn’t simulate the stress on the median nerve in the same way as the Phalen test.

A. paralysis. B. hemiparesis. C. paraphasia. D. paresthesia.

Correct Answer is D

Explanation

A. Paralysis refers to the loss of muscle function in part of your body.
B. Hemiparesis is weakness on one side of the body.
C. Paraphasia is a language disorder where words get jumbled and sentences don't make sense.
D. Paresthesia is an abnormal sensation like tingling, burning, or numbness in the extremities often associated with nerve-related issues.

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The nurse is percussing a client's abdomen during a physical assessment. The nurse observes an area of dullness above the right costal margin of approximately 11 cm. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse suspects that a client has carpal tunnel syndrome and prepares to conduct the Phalen test. What instructions should the nurse give the client to perform the Phalen test?

Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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