A nurse is conducting a lung assessment on a client suspected of having pneumonia. Which finding should the nurse report to the physician immediately?

Asymmetrical chest expansion

Breath sounds equal bilaterally

Bilateral symmetric vocal fremitus

Chest symmetrical

Answer and Explanation

The Correct Answer is A

During a lung assessment on a client suspected of having pneumonia, the nurse should report asymmetrical chest expansion to the physician immediately. Asymmetrical chest expansion can be a sign of a serious lung condition such as pneumonia. The other options (Breath sounds equal bilaterally, Bilateral symmetric vocal fremitus, and Chest symmetrical) are normal findings and do not need to be reported immediately.

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Correct Answer is B

Explanation

The first action the nurse should take in this situation is to rescue the client from immediate danger. This means ensuring that the client is safely removed from the room and away from the fire. The safety of the client is the top priority in this situation. Once the client is safe, the nurse can then take further actions such as activating the fire alarm system and attempting to extinguish the fire if possible.

A. Myocardial Infarction. B. Atelectasis. C. Fluid volume deficit. D. Fluid volume excess.

Correct Answer is D

Explanation

Heart failure is a condition in which the heart is unable to pump blood eﬀectively, leading to a buildup of ﬂuid in the body. This can result in edema (swelling) and ﬂuid accumulation in the lungs, causing coarse crackles when breathing. The term for this condition is ﬂuid volume excess, which refers to an excessive amount of ﬂuid in the body.

Myocardial infarction is a heart attack, atelectasis is a collapse of lung tissue, and ﬂuid volume deficit refers to a lack of ﬂuid in the body.

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A nurse is conducting a lung assessment on a client suspected of having pneumonia. Which finding should the nurse report to the physician immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse enters a client's room and sees that ashes from a cigarette are beginning to ignite trash in the wastebasket. What actions should the nurse take first?

Correct Answer is B

Explanation

The client is admitted to the nurse's unit with a diagnosis of heart failure. His heart is not pumping eﬀectively, which is resulting in edema and coarse crackles in his lungs. The term for this condition is:

Correct Answer is D

Explanation

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