A client with a history of COPD is being assessed. When the nurse percusses the client's chest, which characteristic sound is expected?

Tympany

Hyperresonance

Resonance

Dullness

Answer and Explanation

The Correct Answer is B

Choice a reason:
Tympany is a drum-like, resonant sound that is typically heard over air-filled structures, such as the gastric bubble, not the chest. It is not a sound associated with the lungs, especially in the context of COPD.

Choice b reason:
Hyperresonance is an abnormally loud, lower-pitched sound than normal resonance heard over hyperinflated areas of the lung, such as in cases of COPD. This is due to the increased air content within the lungs, often because of overdistension or destruction of alveolar tissue, as seen in emphysema, a common type of COPD.

Choice c reason:
Resonance is the normal sound heard over healthy lung tissue when percussed. However, in the case of COPD, particularly emphysema, the destruction of lung tissue leads to hyperinflation and thus a hyperresonant sound rather than the normal resonance.

Choice d reason:
Dullness is heard when fluid or solid tissue replaces air in the lung or occupies the pleural space, as in the case of pneumonia or pleural effusion. This is not characteristic of COPD, where there is an increase in air due to the breakdown of alveolar walls.

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Correct Answer is D

Explanation

Choice a reason:
Exophthalmos, or protrusion of the eyeballs, is not a typical finding in hypothyroidism. It is more commonly associated with hyperthyroidism, particularly Graves' disease, which is characterized by an overactive thyroid gland.

Choice b reason:
Photophobia, or light sensitivity, is not a common symptom of hypothyroidism. While it can be associated with other conditions, it is not directly related to the function of the thyroid gland.

Choice c reason:
Weight loss is typically not associated with hypothyroidism. In fact, individuals with hypothyroidism often experience weight gain due to a slowed metabolism, which is the opposite of weight loss.

Choice d reason:
Lethargy is a common symptom of hypothyroidism. The condition can lead to a decrease in thyroid hormone production, which can slow down the body's metabolism, resulting in feelings of fatigue, sluggishness, and lethargy.

A. To gather information about the health status of the client. B. To help the physician diagnose illness without further testing. C. To decide on the best way to manage a client's illness based on the nurse's own views and beliefs. D. To make judgments about the client's lifestyle and behaviors that contribute to the client's illness.

Correct Answer is A

Explanation

Choice A reason:
The primary purpose of health assessment is to collect, analyze, and interpret data to identify the patient’s health status and needs, as well as to develop and implement appropriate nursing interventions to address these needs. It is a systematic process that is fundamental in promoting the health and well-being of patients. This involves a comprehensive evaluation of the patient's physical, psychological, and social health. Gathering this information is crucial for creating a care plan that addresses the individual needs of the client.
Choice B reason:
While health assessments can aid physicians in diagnosing illness, they are not solely for the purpose of diagnosis without further testing. Health assessments may indicate the need for additional tests to confirm a diagnosis. The nurse's role includes supporting the diagnostic process, but it is not the primary purpose of health assessment.
Choice C reason:
Health assessments are not meant to be subjective or based on the nurse's personal views and beliefs. The assessments are conducted to objectively determine the health status of a client, which then informs evidence-based practice and care planning. Personal biases should not influence the management of a client's illness.
Choice D reason:
Making judgments about a client's lifestyle and behaviors is not the primary purpose of health assessment. While lifestyle and behaviors may be assessed as part of understanding the client's overall health status, the goal is not to judge but to understand how these factors may impact the client's health and to provide education and support for healthy changes if needed.

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A client with a history of COPD is being assessed. When the nurse percusses the client's chest, which characteristic sound is expected?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has hypothyroidism. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

The clinical nurse is precepting a group of students, and one student questions the nurse, "What is the primary purpose of health assessment?" What is the most appropriate response by the clinical nurse?

Correct Answer is A

Explanation

The nurse is preparing to examine a client's mouth floor. To move the tongue to one side for this examination, which tool should the nurse use?

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