When auscultating over a patient's carotid arteries, the nurse notices the presence of a bruit on the left side.
The nurse knows that bruits:
Occur in the presence of lymphadenopathy.
Are caused by hypermetabolic states.
Occur with turbulent blood flow, indicating partial occlusion.
Are often associated with venous disease.
The Correct Answer is C
Choice A rationale
Lymphadenopathy refers to enlarged lymph nodes, which are palpable structures of the immune system. Bruits are vascular sounds, specifically turbulent blood flow, and are entirely unrelated to the presence or size of lymph nodes. Lymphadenopathy indicates an immune response or lymphatic system issue, whereas bruits indicate arterial pathology.
Choice B rationale
Hypermetabolic states, such as hyperthyroidism, can increase cardiac output and blood flow velocity, potentially leading to flow murmurs in the heart. However, they do not directly cause bruits in the carotid arteries. Carotid bruits are typically indicative of localized arterial narrowing or disease, not a systemic increase in metabolism.
Choice C rationale
Bruits are audible vascular sounds, often described as a "whooshing" or "swishing" sound, that result from turbulent blood flow through a narrowed or partially occluded artery. In the carotid arteries, a bruit strongly suggests atherosclerotic plaque formation, which reduces the arterial lumen and disrupts the smooth, laminar flow of blood, creating turbulence.
Choice D rationale
Bruits are arterial sounds, reflecting turbulence within arteries. Venous disease primarily involves veins, and while some venous conditions like arteriovenous fistulas can produce continuous murmurs, typical bruits heard over carotid arteries are characteristic of arterial narrowing and compromise, not venous pathology. Venous hums can occur but are distinctly different from arterial bruits.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Asking which client is supposed to have medications compromises patient privacy and could lead to medication errors if an incorrect patient self-identifies. Proper patient identification is a fundamental safety measure, requiring objective verification to ensure the right medication is administered to the right patient.
Choice B rationale
Stating the patient's name and expecting a confirmation ("You are Mrs. Wilson, aren't you?") is a leading question and does not independently verify identity. A patient could respond affirmatively without truly being Mrs. Wilson, increasing the risk of medication errors by not adhering to objective verification protocols.
Choice C rationale
Asking if anyone knows Mrs. Wilson is an inappropriate and unprofessional method for patient identification. It breaches patient confidentiality and does not provide a reliable or direct means of verifying the intended recipient of medication, potentially leading to significant medication safety issues.
Choice D rationale
Checking the client's identification bracelets while the client states their name provides two independent identifiers, which is a standard and highly reliable method for patient identification. This dual verification minimizes the risk of medication errors by confirming both physical identification and the patient's verbal confirmation before administration.
Correct Answer is ["75"]
Explanation
Step 1 is 1.5 L × 1000 mL/L = 1500 mL.
Step 2 is 1500 mL ÷ 20 hours = 75 mL/hour.
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