A nurse is assessing a client who has a possible right pneumothorax.
Which of the following findings should the nurse expect?
                            
                                                                                                    Paradoxical chest movement.
Reduced right-sided breath sounds.
High-pitched stridor.
Intercostal retractions.
The Correct Answer is B
Choice A rationale:
Paradoxical chest movement refers to the abnormal inward movement of the chest during inhalation and outward movement during exhalation. It is not a typical finding in pneumothorax. Instead, paradoxical chest movement is often observed in conditions such as flail chest.
Choice B rationale:
Reduced right-sided breath sounds are a common finding in right pneumothorax. Air in the pleural space can cause lung collapse, leading to decreased or absent breath sounds on the affected side.
Choice C rationale:
High-pitched stridor is a sound heard during inspiration and indicates upper airway obstruction, often due to conditions like croup or epiglottitis. It is not a characteristic finding in pneumothorax.
Choice D rationale:
Intercostal retractions occur when the tissues between the ribs are pulled inward during inspiration. While retractions can be seen in various respiratory distress conditions, they are not specific to pneumothorax.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Clients with dementia often experience difficulties with memory, cognition, and orientation, which can lead to increased risk of falls and injuries, especially when trying to perform activities of daily living such as using the toilet. Assisting the client to the toilet frequently helps prevent accidents and reduces the risk of injury from falls. Timely toileting can also improve the client's comfort and overall quality of life.
Choice B rationale:
Raising the side rails up when the client is in bed can create a physical barrier, but it is not a recommended method to prevent falls in clients with dementia. In fact, it can pose a risk by confining the client and may lead to attempts to climb over the rails, resulting in falls and injuries.
Choice C rationale:
Placing the bedside table at the foot of the bed does not directly address the client's safety needs. While it might be a matter of personal preference or convenience, it does not significantly impact the client's risk of injury.
Choice D rationale:
Keeping the television on during the night does not address the client's physical safety. While it may provide entertainment or a familiar environment, it does not mitigate the risk of falls or injuries, which is the primary concern when caring for clients with dementia.
Correct Answer is A
Explanation
Choice A rationale:
Consuming foods high in bran fiber can help regulate bowel movements and alleviate symptoms of irritable bowel syndrome (IBS). Fiber adds bulk to the stool and can prevent constipation, a common symptom in IBS patients. Adequate dietary fiber intake is generally recommended for individuals with IBS.
Choice B rationale:
Increasing intake of foods high in gluten might worsen symptoms in individuals with gluten sensitivity or celiac disease. Gluten-containing foods can trigger gastrointestinal distress in susceptible individuals and should be avoided if gluten intolerance is present.
Choice C rationale:
Some individuals with IBS are lactose intolerant, which means they have difficulty digesting milk products. Increasing intake of milk products can exacerbate symptoms such as bloating, gas, and diarrhea in these individuals. It is important to assess the client's tolerance to lactose-containing foods before recommending their consumption.
Choice D rationale:
Sweetening foods with fructose corn syrup may worsen symptoms in individuals with IBS. Fructose is a type of sugar that can cause gastrointestinal distress in some people, especially those with fructose malabsorption. Recommending sweeteners with low fructose content would be more appropriate for individuals with IBS.
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