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 A

Explanation

Choice A Reason:
Vertigo is a common complication associated with inner ear infections, such as labyrinthitis or vestibular neuritis. The inner ear is responsible for balance, and when it is infected, it can lead to a sensation of spinning or dizziness. Interventions may include medications like meclizine or dimenhydrinate to alleviate symptoms, as well as safety measures to prevent falls.

Choice B Reason:
Rhinorrhea, or a runny nose, is not typically a direct complication of an inner ear infection. It may be associated with upper respiratory infections that can precede or accompany an ear infection but is not a result of the inner ear infection itself.

Choice C Reason:
Fever may be present if the inner ear infection is part of a systemic infection, such as the flu or bacterial meningitis. However, fever is not a direct result of an isolated inner ear infection. If fever is present, the nurse should monitor the patient's temperature and may administer antipyretics as ordered.

Choice D Reason:
Headache can be a symptom experienced by individuals with inner ear infections due to the general discomfort and pressure changes in the ear. However, it is not as specific or as common as vertigo when it comes to inner ear infections. If headaches are present, pain management strategies can be included in the care plan.

A. Eye malalignment B. Eye turning outward C. Eye oscillating D. Eye turning inward

Correct Answer is D

Explanation

Choice a reason:
Eye malalignment is a general term that refers to any form of misalignment of the eyes, which can include esotropia but is not specific to it. Esotropia is a type of strabismus where there is a specific pattern of eye malalignment.

Choice b reason:
Eye turning outward is known as exotropia, which is the opposite of esotropia. In exotropia, one or both eyes turn outward away from the nose, which is not characteristic of esotropia.

Choice c reason:
Eye oscillating refers to nystagmus, a condition where the eyes make repetitive, uncontrolled movements, often resulting in reduced vision and depth perception. While nystagmus can occur in conjunction with esotropia, it is not a defining characteristic of esotropia itself.

Choice d reason:
Eye turning inward is the hallmark of esotropia. In this condition, one or both eyes turn inward towards the nose. It can be constant or intermittent and may affect one eye or alternate between both eyes. Esotropia can be comitant, meaning the degree of deviation is the same in every direction of gaze, or incomitant, where the deviation varies with gaze direction.

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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?

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Correct Answer is D

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