A nurse caring for a patient on bed rest with a history of respiratory health problems should:
auscultate for bowel sounds once a shift.
auscultate lung sounds at the beginning of a shift.
monitor for skin turgor every shift.
monitor peripheral pulses once a shift.
The Correct Answer is B
A. Auscultating for bowel sounds once a shift is important but does not directly relate to the respiratory condition.
B. Auscultating lung sounds at the beginning of a shift is a priority to assess for any signs of respiratory compromise or complications.
C. Monitoring skin turgor every shift is important for hydration status but is less critical in comparison to lung sounds for a patient with respiratory problems.
D. Monitoring peripheral pulses once a shift is important but does not address the respiratory condition directly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Tapping is the first Korotkoff sound and corresponds to the systolic pressure, not the diastolic pressure.
B. Knocking does not describe any Korotkoff sound associated with the blood pressure reading.
C. Silence is typically noted after the muffling sound and indicates the cessation of Korotkoff sounds, which can be used to assess diastolic pressure in adults, but it is not used in children.
D. The muffling sound occurs before the disappearance of Korotkoff sounds and is often used to mark the diastolic pressure in both children and some adults, making it the correct answer.
Correct Answer is B
Explanation
A. Bradycardia is defined as a heart rate lower than 60 beats per minute. Therefore, 62 beats per minute is not bradycardic.
B. 59 beats per minute would be considered bradycardic, as it is below 60.
C. 64 beats per minute is within normal limits.
D. 60 beats per minute is on the threshold of bradycardia but typically is still within normal limits for some individuals.
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