Combo with Nclex Review: Urinary Tract Infection and 1 other

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine? 1. Wearing cotton underpants. 2. Increasing citrus juice intake. 3. Douching regularly with 0.25% acetic acid. 4. Using vaginal sprays.

1. A woman can adopt several health-promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncotton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increasing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.

A client has nephropathy. The physician orders that a 24-hour urine collection be done for creatinine clearance. Which of the following actions is necessary to ensure proper collection of the specimen? 1. Collect the urine in a preservative-free container and keep it on ice. 2. Inform the client to discard the last voided specimen at the conclusion of urine collection. 3. Ask the client what his weight is before beginning the collection of urine. 4. Request an order for insertion of an indwelling urinary catheter.

1. All urine for creatinine clearance determination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine collection.

Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? 1. "I can usually go 8 to 10 hours without needing to empty my bladder." 2. "I take a tub bath every evening." 3. "I wipe from front to back after voiding." 4. "I drink a lot of water during the day."

1. Stasis of urine in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day.

When teaching the client with a urinary tract infection about taking phenazopyridine hydrochloride (Pyridium), the nurse should tell the client to expect: 1. Bright orange-red urine. 2. Incontinence. 3. Constipation. 4. Slight drowsiness.

1. The client should be told that phenazopyridine hydrochloride (Pyridium) turns the urine a bright orange-red, which may stain underwear. It can be frightening for a client to see orange-red urine without having been forewarned. Other common adverse effects associated with phenazopyridine include headaches, gastrointestinal disturbances, and rash. Phenazopyridine does not cause incontinence, constipation, or drowsiness.

A nurse is assessing a client with a urinary tract infection who takes an antihypertensive drug. The nurse reviews the client's urinalysis results pH 6.8, RBC 3 per high power field, color-yellow, specific gravity-1.030 . The nurse should: 1. Encourage the client to increase fluid intake. 2. Withhold the next dose of antihypertensive medication. 3. Restrict the client's sodium intake. 4. Encourage the client to eat at least half of a banana per day.

1. The client's urine specific gravity is elevated. Specific gravity is a reflection of the concentrating ability of the kidneys. This level indicates that the urine is concentrated. By increasing fluid intake, the urine will become more dilute. Antihypertensives do not make urine more concentrated unless there is a diuretic component within them. The nurse should not hold a dose of antihypertensive medication. Sodium tends to pull water with it; by restricting sodium, less water, not more, will be present. Bananas do not aid in the dilution of urine.

What is the acceptable range for respiration?

12 - 20 RR/min

What is the average acceptable rate for blood pressure?

120/80

A client who weighs 207 lb is to receive 1.5 mg/ kg of gentamicin sulfate (Garamycin) I.V. three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number. __________________ mg.

141 mg

Nitrofurantoin (Macrodantin), 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/ 5 mL. How many milliliters should the nurse administer for each dose? ________________________ mL.

15 mL

The nurse decides to take an apical pulse instead of a radial pulse. Which of the following client conditions influenced the nurse's decision? A) The client is in shock. B) The client has an arrhythmia. C) The client underwent surgery 18 hours earlier. D) The client showed a response to orthostatic changes.

B The client has an arrhythmia.

A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply. 1. "Take the medication on an empty stomach." 2. "Your urine may become brown in color." 3. "Increase your fluid intake." 4. "Take the medication until your symptoms subside." 5. "Take the medication with an antacid to decrease gastrointestinal distress."

2, 3. Clients who are taking nitrofurantoin (Macrodantin) should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug's absorption.

What portion of the hand should be used when assessing for blood vessel pulse amplitude?

palmar surface/pads of fingertips

The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse's instructions? 1. "I will place ice packs on my perineum." 2. "I will take hot tub baths." 3. "I will drink a cup of warm tea every hour." 4. "I will void every 5 to 6 hours."

2. Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffeinated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.

A 24-year-old female client comes to an ambulatory care clinic in moderate distress with a probable diagnosis of acute cystitis. When obtaining the client's history, the nurse should ask the client if she has had: 1. Fever and chills. 2. Frequency and burning on urination. 3. Flank pain and nausea. 4. Hematuria.

2. The classic symptoms of cystitis are severe burning on urination, urgency, and frequent urination. Systemic symptoms, such as fever and nausea and vomiting, are more likely to accompany pyelonephritis than cystitis. Hematuria may occur, but it is not as common as frequency and burning.

What criteria should be measured in regard to blood vessels during a health assessment?

pulse amplitude, elasticity, rate and rhythm

What criteria should be measured in regard to organs during a health assessment?

size, shape, tenderness, absence of masses

What criteria should be measured in regard to glands during a health assessment?

swelling, symmetry and mobility

A client with a urinary tract infection is to take nitrofurantoin (Macrodantin) four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client? 1. "You can wait and take the next dose when it is due." 2. "Double the amount prescribed with your next dose." 3. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose." 4. "Take a lot of water with a double amount of your prescribed dose."

3. Antibiotics have the maximum effect when a blood level of the medication is maintained. However, because nitrofurantoin (Macrodantin) is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by doubling the dose. The client should not skip a dose if she realizes that she has missed one. Additional fluids, especially water, should be encouraged, but not forced to promote elimination of the antibiotic from the body. Adequate fluid intake aids in the prevention of urinary tract infections, in addition to an acidic urine.

The client with cystitis is given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by: 1. Releasing formaldehyde and providing bacteriostatic action. 2. Potentiating the action of the antibiotic. 3. Providing an analgesic effect on the bladder mucosa. 4. Preventing the crystallization that can occur with sulfa drugs.

3. Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic that works directly on the bladder mucosa to relieve the distressing symptoms of dysuria. Phenazopyridine does not have a bacteriostatic effect. It does not potentiate antibiotics or prevent crystallization.

What is the average acceptable range for pulse pressure?

30 - 50 mm Hg

What is the average acceptable temperature taken axillary?

36.5 C or 97.7 F

What is the average acceptable temperature taken rectally?

37.5 or 99.5 F

What is the average acceptable temperature if taken orally or in the ear?

37.5C or 98.6 F

What criteria should be measured in regard to skin during a health assessment?

temperature, moisture, texture, turgor and elasticity, tenderness, thickness

Adduction is movement __________ the body.

toward

The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by: 1. Congenital strictures in the urethra. 2. An infection elsewhere in the body. 3. Urinary stasis in the urinary bladder. 4. An ascending infection from the urethra.

4. Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.

The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which would be the nurse's best approach? 1. Arrange a meeting with the client, her husband, the physician, and the nurse. 2. Insist that the client talk with her husband because good communication is necessary for a successful marriage. 3. Talk first with the husband alone and then with both of them together to share the husband's reactions. 4. Spend time with the client addressing her concerns and then stay with her while she talks with her husband.

4. As newlyweds, the client and her husband need to develop a strong communication base. The nurse can facilitate communication by preparing and supporting the client. Given the situation, an interdisciplinary conference is inappropriate and would not promote intimacy for the client and her husband. Insisting that the client talk with her husband is not addressing her fears. Being present allows the nurse to facilitate the discussion of a difficult topic. Having the nurse speak first with the husband alone shifts responsibility away from the couple.

The nurse is teaching a client how to perform a testicular self-examination. The nurse tells the client which of the following? A) "The testes are normally round, moveable, and have a lumpy consistency." B) "Contact your health care provider if you feel a painless pea-sized nodule." C) "The best time to do a testicular self-examination is before your bath or shower." D) "Perform a testicular self-examination weekly to detect signs of testicular cancer."

B Contact your health care provider if you feel a painless pea-sized nodule."

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: 1. Twice as much fluid as usual. 2. At least 1 quart more than usual. 3. A lot of water, juice, and other fluids throughout the day. 4. At least 3,000 mL of fluids daily.

4. Instructions should be as specific as possible, and the nurse should avoid general statements such as "a lot." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 quart more than she usually drinks if her intake was inadequate to begin with.

The nurse is teaching an 80-year-old client with a urinary tract infection about the importance of increasing fluids in the diet. Which of the following puts this client at a risk for not obtaining sufficient fluids? 1. Diminished liver function. 2. Increased production of antidiuretic hormone. 3. Decreased production of aldosterone. 4. Decreased ability to detect thirst.

4. The sensation of thirst diminishes in those greater than 60 years of age; hence, fluid intake is decreased and dissolved particles in the extracellular fluid compartment become more concentrated. There is no change in liver function in older adults, nor is there a reduction of ADH and aldosterone as a normal part of aging.

The nurse should assist the client to a sitting position to provide the best position to examine which of the following? A) Heart B) Lungs C) Abdomen D) Pulse sites

B Lungs

The ___________________ nerve is a sensory and motor nerve enervating the side of the face and jaw.

trigeminal

What is the acceptable range for pulse?

60 - 100 bpm

Using an oral electronic thermometer, the nurse checks the early morning temperature of a client. The client's temperature is 36.1° C (97° F). The client's remaining vital signs are in the normally acceptable range. What should the nurse do next? A) Check the client's temperature history. B) Document the results; temperature is normal. C) Recheck the temperature every 15 minutes until it is normal. D) Get another thermometer; the temperature is obviously an error.

A Check the client's temperature history.

The nurse conducts a general survey of an adult client, which includes: A) Checking appearance and behavior B) Measuring vital signs C) Observing specific body systems D) Conducting a detailed health history

A Checking appearance and behavior

To auscultate the client's lung fields, the nurse uses a systematic pattern comparing: A) Side to side B) Top to bottom C) Anterior to posterior D) Interspace to interspace

A Side to side

So that breast tissue will be spread evenly over the chest wall during an examination, the nurse asks the client to lie supine with: A) The ipsilateral arm behind the head B) Hands clasped just above the umbilicus C) Both arms overhead with palms upward D) The dominant arm straight alongside the body

A The ipsilateral arm behind the head

What is affect?

A person's outward expression of their inner mood. Example: smiling

A complete health assessment includes which of the following: A. Health History B. Doctor's Orders C. Behavioral Exam D. Physical Exam E. Nursing Diagnoses

A, C, D

A pulse of 104 bpm could indicate which of the following: A. anxiety B. heart problem C. increased blood pressure D. shock

A. anxiety B. heart problem

The S2 (dub) sound is the second heart sound and indicates closure of the _______________ and ________________ valves.

Aortic; pulmonic

The client's respiratory assessment reveals loud, low-pitched, rumbling, coarse sounds heard during inspiration and expiration. The nurse interprets these sounds as: A) Normal B) Rhonchi C) Crackles D) Wheezes

B Rhonchi

Besides high blood pressure values, what other signs and symptoms may the nurse observe if hypertension is present? A) Unexplained pain and hyperactivity B) Headache, flushing of the face, and nosebleed C) Dizziness, mental confusion, and mottled extremities D) Restlessness and dusky or cyanotic skin that is cool to the touch

B headache, flushing of the face, and nosebleed

While auscultating heart sounds, the nurse documents that S2 is best heard at the base. This sound (S2) correlates with closure of which of the following? A) Aortic and mitral valves B) Mitral and tricuspid valves C) Aortic and pulmonic valves D) Tricuspid and pulmonic valves

C Aortic and pulmonic valves

A common abnormality encountered during inspection of the skin is pallor. Pallor is easily seen in the face, mucosa of the mouth, and nail beds. How would pallor appear in a brown-skinned client? A) As shiny skin B) As bluish skin C) As yellowish skin D) As ashen gray skin

C As yellowish skin

The nurse's documentation indicates that a client has a pulse deficit of 14 beats. The pulse deficit is measured by: A) Subtracting 60 (bradycardia) from the client's pulse rate and reporting the difference B) Subtracting the client's pulse rate from 100 (tachycardia) and reporting the difference C) Assessing the apical pulse and the radial pulse for the same minute and subtracting the difference D) Assessing the apical pulse and 30 minutes later assessing the carotid pulse and subtracting the difference

C Assessing the apical pulse and the radial pulse for the same minute and subtracting the difference

To correctly palpate the client's skin for temperature, the nurse uses which of the following? A) Base of the hands B) Fingertips of the hands C) Dorsal surface of the hands D) Palmar surface of the hands

C Dorsal surface of the hands

The nurse teaches the client to inspect all skin surfaces and to report pigmented skin lesions that: A) Are symmetrical B) Are uniform in color C) Have irregular borders D) Are smaller than 6 mm in diameter

C Have irregular borders

While the nurse was palpating the calf muscles of the client's right leg, the client complained of tenderness. Further assessment by the nurse should include which of the following? A) Observation for reduced hair growth and ulceration B) Observation for venous distention while the client is standing C) Observation of the area for swelling, warmth, redness, and a positive Homans' sign D) Observation for cyanosis, pallor, and change in pigmentation around the ankles

C Observation of the area for swelling, warmth, redness, and a positive Homans' sign

The client, who has been on bed rest for 2 days, asks to get out of bed to go to the bathroom. He has new orders for "up ad lib." What action should the nurse take? A) Give him some slippers and tell him where the bathroom is located. B) Ask the nursing assistant to assist him to the bathroom. C) Obtain orthostatic blood pressure measurements. D) Tell him it is not a good idea and provide a urinal.

C Obtain orthostatic blood pressure measurements.

In assessing the client's lungs, the nurse notes that the lungs are normal upon percussion. This means that the nurse detected: A) Dullness B) Tympany C) Resonance D) Hyperresonance

C Resonance

In assessing the client's lungs the nurse hears adventitious breath sounds that are high-pitched, continuous musical sounds, such as a squeak heard continuously during inspiration or expiration, usually louder on expiration. These adventitious breath sounds are known as: A) Crackles B) Rhonchi C) Wheezes D) Pleural friction rub

C Wheezes

An increased respiratory rate could indicate a possible: A. Liver problem B. Lung problem C. Heart problem D. Infection

C. Heart problem

If a blood pressure is high or low, what should you do first: A. Chart the blood pressure and retake B. Chart the blood pressure and move on C. Retake the blood pressure D. Check other vitals to see if a pattern can be determined.

C. Retake the blood pressure

Using an otoscope, the nurse can inspect the tympanic membrane. A normal tympanic membrane appears: A) Round and white B) Pink and bulging C) Dark yellow and sticky D) Translucent, shiny, and pearly gray

D

Delegation of some tasks may become one of the decisions the nurse will make while on duty. For which of the following clients would it be most appropriate for unlicensed assistive personnel to measure the client's vital signs? A) A client who recently started taking an antiarrhythmic medication B) A client with a history of transfusion reactions who is receiving a blood transfusion C) A client who has frequently been admitted to the unit with asthma attacks D) A client who is being admitted for elective surgery who has a history of stable hypertension

D A client who is being admitted for elective surgery who has a history of stable hypertension

The nurse asks the client to interpret the saying, "Don't count your chickens before they're hatched." The client's response provides information about the client's: A) Judgment B) Knowledge C) Association D) Abstract reasoning

D Abstract reasoning

The nurse asks the client to shrug the shoulders and turn the head side to side against the resistance of the examiner's hand. These actions allow the nurse to evaluate which cranial nerve? A) VII—Facial B) V—Trigeminal C) XII—Hypoglossal D) Abstract reasoning

D Abstract reasoning

The nurse should use which anatomical sites for the auscultatory assessment of cardiac function? A) Inner costal, outer costal, and sternal B) Aortic, carotid, coronary, and jugular C) Apical, lateral, anterior, and posterior D) Aortic, pulmonic, tricuspid, and mitral

D Aortic, pulmonic, tricuspid, and mitral

The nurse is to measure vital signs as part of the preparation for a test. The client is talking with a visiting pastor. How should the nurse handle measuring the rate of respiration? A) Count respirations during the time the client is not talking to the visitor. B) Wait at the client's bedside until the visit is over and then count respirations. C) Tell the client it is very important to end the conversation so the nurse can count respirations. D) Document the respiration rate as "deferred" and measure the rate later, since the talking client is obviously not in respiratory distress.

D Document the respiration rate as "deferred" and measure the rate later, since the talking client is obviously not in respiratory distress.

During general inspection of the musculoskeletal system of an older client, the nurse notes kyphosis. Kyphosis is: A) Lateral spinal curvature B) Loss of or decrease in muscle tone C) Increased lumbar curvature D) Exaggeration of the posterior curvature of the thoracic spine

D Exaggeration of the posterior curvature of the thoracic spine

To assess a client's superficial lymph nodes, the nurse: A) Deeply palpates using the entire hand B) Deeply palpates using a bimanual technique C) Lightly palpates using a bimanual technique D) Gently palpates using the pads of the index and middle fingers

D Gently palpates using the pads of the index and middle fingers

The techniques of physical assessment are inspection, palpation, percussion, and auscultation. The order in which these techniques are used is slightly different during abdominal examination than during examination of other body areas. The nurse should perform which two of the following first? A) Palpation and inspection B) Inspection and percussion C) Palpation and auscultation D) Inspection and auscultation

D Inspection and auscultation

To assess the client's dorsalis pedis pulse, the nurse palpates: A) Behind the knee B) Over the lateral malleolus C) In the groove behind the medial malleolus D) Lateral to the extensor tendon of the great toe

D Lateral to the extensor tendon of the great toe

Turgor is the skin's elasticity, which can be diminished by edema or dehydration. Which is the best place for the nurse to assess skin turgor in the older adult? A) Side of the neck B) Back of the hand C) Palm of the hand D) Over the sternal area

D Over the sternal area

The nurse finds that the systolic blood pressure of an adult client is 88 mm Hg. What are the appropriate nursing interventions? A) Check other vital signs. B) Recheck the blood pressure and give the client orange juice. C) Recheck the blood pressure after ambulating the client safely. D) Recheck the blood pressure, make sure the client is safe, and report the findings.

D Recheck the blood pressure, make sure the client is safe, and report the findings.

The client has an oral temperature of 39.2° C (102.6° F). What are the most appropriate nursing interventions? A) Provide an alcohol sponge bath and monitor laboratory results. B) Remove excess clothing, provide a tepid sponge bath, and administer an analgesic. C) Provide fluids and nutrition, keep the client's room warm, and administer an analgesic. D) Reduce external coverings and keep clothing and bed linens dry; administer antipyretics as ordered.

D Reduce external coverings and keep clothing and bed linens dry; administer antipyretics as ordered.

The nurse observes that a client's breathing pattern represents Cheyne-Stokes respiration. Which statement best describes the Cheyne-Stokes pattern? A) Respirations cease for several seconds. B) Respirations are abnormally shallow for two to three breaths followed by irregular periods of apnea. C) Respirations are labored, with an increase in depth and rate (more than 20 breaths per minute); the condition occurs normally during exercise. D) Respiration rate and depth are irregular, with alternating periods of apnea and hyperventilation; the cycle begins with slow breaths and climaxes in apnea.

D Respiration rate and depth are irregular, with alternating periods of apnea and hyperventilation; the cycle begins with slow breaths and climaxes in apnea.

The hypothalamus controls body temperature. The anterior hypothalamus controls heat loss, and the posterior hypothalamus controls heat production. What heat conservation mechanisms will the posterior hypothalamus initiate when it senses that the client's body temperature is lower than comfortable? A) Vasodilation and redistribution of blood to surface vessels B) Sweating, vasodilation, and redistribution of blood to surface vessels C) Vasoconstriction, sweating, and reduction of blood flow to extremities D) Vasoconstriction, reduction of blood flow to extremities, and shivering

D Vasoconstriction, reduction of blood flow to extremities, and shivering

Which of the following values for vital signs would the nurse address first? A) Heart rate = 72 beats per minute B) Respiration rate = 28 breaths per minute C) Blood pressure = 160/86 D) Oxygen saturation by pulse oximetry = 89% E) Temperature = 37.2° C (99° F), tympanic

D oxygen saturation by pulse oximetry = 89%

An 82-year-old widower brought via ambulance is admitted to the emergency department with complaints of shortness of breath, anorexia, and malaise. He recently visited his health care provider and was put on an antibiotic for pneumonia. The client indicates that he also takes a diuretic and a beta blocker, which helps his "high blood." Which vital sign value would take priority in initiating care? A) Respiration rate = 20 breaths per minute B) Oxygen saturation by pulse oximetry = 92% C) Blood pressure = 138/84 D) Temperature = 39° C (102° F), tympanic

D) Temperature = 39° C (102° F), tympanic

The client is being assessed for range of joint movement. The nurse asks the client to move the arm toward the body to evaluate: A) Flexion B) Extension C) Abduction D) Adduction

DAdduction

On the chart, the health assessment is found under ____________________.

H&P

_______________ muscle has little tone and feels flabby, usually because of atrophy of muscle mass.

Hypotonic

Is light or deep palpitation needed to assess for masses, lumps and bumps?

Light

___________________ are loud, low-pitched, rumbling, coarse sounds heard most often during inspiration or expiration.

Rhonchi

_________________ is lateral spinal curvature.

Scoliosis

_________________ is the high-pitched, drumlike sound heard over a gastric air bubble

Tympany

________________ are high-pitched continuous muscles sounds such as a squeak heard continuously during inspiration and expiration.

Wheezes

If a doctor's order only indicates a minimum, can more be done or given?

Yes.

If listening for the S1 sound (mitral valve closing),adhere would you hear the sound the best with auscultated?

at the left fifth intercostal space along the mid-clavicular line.

Abduction is movement __________ from the body.

away

________________ are moist sounds heard during inspiration that are not cleared with coughing.

crackles

The movement of the head and shoulders is controlled by ______________, also known as the spinal accessory nerve.

cranial nerve XI

What portion of the hand should be used when assessing temperature?

dorsum of hand/fingers

What portion of the hand should be used when assessing for organ size?

entire palmar surface of hand or palmar surface of fingers

How often should a health assessment be performed?

every shift, unless in ICU (then every 2 hours)

What criteria should be measured in regard to the thorax during a health assessment?

excursion, tenderness and fremitus

What portion of the hand should be used when assessing for thorax tenderness?

finger pads/palmar surface of fingers

_________________________ can be heard over emphysematous lungs as a booming sound

hyperresonance

The ____________________ nerve innervates portions of the tongue.

hypoglossal

During a physical assessment, what can a sweet, heavy, thick odor indicate?

infection

During a physical assessment, what can a sweet/fruity odor indicate?

ketones/diabetes

The S2 (dub) sound is the second heart sound and indicates closure of the _________________ and ____________________ valves.

mitral; tricuspid

What are the two most accurate routes for taking a temperature?

oral and rectal

What portion of the hand should be used when assessing for gland swelling?

pads of fingers

During a physical assessment always perform ____________ procedures last.

painful

What portion of the hand should be used when assessing for thorax fremitus?

palmar or ulnar surface of entire hand.

What portion of the hand should be used when assessing for skin moisture?

palmar surface

What portion of the hand should be used when assessing for thorax excursion?

palmar surface


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