When systematically auscultating a client’s anterior breath sounds, the nurse should begin by placing the stethoscope over which location?

Clavicle.

Lung apex.

Aortic site.

Sternum.

Answer and Explanation

The Correct Answer is B

Choice A rationale
Placing the stethoscope over the clavicle is not the correct starting point for systematically auscultating anterior breath sounds.
Choice B rationale
The nurse should begin by placing the stethoscope over the lung apex, which is located just above the clavicle. This ensures a systematic approach to auscultation.
Choice C rationale
The aortic site is not relevant for auscultating breath sounds; it is used for cardiac auscultation.
Choice D rationale
Placing the stethoscope over the sternum is not the correct starting point for auscultating breath sounds.

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Correct Answer is C

Explanation

Choice A rationale
Painful symptoms alleviated by warmth are more indicative of conditions such as arthritis or muscle strain rather than venous insufficiency.
Choice B rationale
Cool, pale skin below the knees is more indicative of arterial insufficiency rather than venous insufficiency.
Choice C rationale
Decreased pain when legs are elevated is a common symptom of venous insufficiency. Elevating the legs helps reduce venous pressure and alleviate symptoms such as swelling and aching.
Choice D rationale
Deep, continuous pain in the calf muscles is more indicative of conditions such as deep vein thrombosis (DVT) rather than venous insufficiency.

A. Place a mark where DP pulse is auscultated. B. Use a doppler to assess an audible DP pulse. C. Assess capillary refill distal to the DP pulse. D. Review client’s history for vascular disease.

Correct Answer is B

Explanation

Choice A rationale
Placing a mark where the DP pulse is auscultated can help in future assessments but does not address the immediate need to locate the pulse.
Choice B rationale
Using a Doppler to assess an audible DP pulse is the correct answer. A Doppler ultrasound device is helpful when it is impossible or difficult to assess a pulse or when pulses are not palpable.
Choice C rationale
Assessing capillary refill distal to the DP pulse is important but should be done after attempting to locate the pulse with a Doppler.
Choice D rationale
Reviewing the client’s history for vascular disease is essential for understanding the underlying cause but does not address the immediate need to locate the pulse.

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When systematically auscultating a client’s anterior breath sounds, the nurse should begin by placing the stethoscope over which location?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While assessing the legs of an adult client, the nurse observes leathery-looking skin. The client reports aching, tired legs that swell if standing for long periods of time. To screen for venous insufficiency, the nurse should ask the client if they have experienced which subjective finding?

Correct Answer is C

Explanation

While completing an admission assessment, the nurse is unable to palpate the client’s left dorsalis pedis (DP) pulse. Which intervention is most important for the nurse to implement?

Correct Answer is B

Explanation

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