The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? (Select All that Apply)

As the patient says a long "ee-ee ee" sound, the examiner hears a long "aaaaaa" sound.

When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said

As the patient says a long "ee-ee-ee sound, the examiner also hears a long "ee-ee-ee" sound.

As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninetynine."

Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice

Answer and Explanation

Correct Answer : C,D

A.   As the patient says a long "ee-ee-ee" sound, the examiner hears a long "aaaaaa" sound. - This indicates a possible consolidation in the lungs, which is abnormal.
B.   When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said. - This suggests abnormal voice transmission and could indicate lung consolidation or other issues.
C.   As the patient says a long "ee-ee-ee" sound, the examiner also hears a long "ee-ee-ee" sound. - This is normal, indicating clear and symmetrical transmission of voice sounds.
D.   As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninety-nine." - This is also normal, as it indicates normal transmission of sound and no lung consolidation.
E.   Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice. - This is normal for whispered voice sounds and is not a sign of abnormal lung findings.

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Correct Answer is ["A","C","E"]

Explanation

A. Poor dental health can be linked to hypothyroidism, as it may cause a decrease in oral health.
B. Skin should be dry and cool in hypothyroidism, making this finding abnormal.
C. Client states, "I can't seem to get warm lately." Cold intolerance is a hallmark symptom of hypothyroidism due to slowed metabolism.
D. Weight gain of five pounds in two months. Mild weight gain can occur in hypothyroidism but may not be significant enough to consider abnormal without other symptoms.
E. Periorbital non-pitting edema. This finding is common in hypothyroidism and indicates water retention around the eyes.

A. Herniated nucleus pulposus. B. Meniscus tear. C. Scoliosis D. Spasm of paravertebral muscles

Correct Answer is A

Explanation

A. A herniated disc can cause pain that radiates down the leg (sciatica) when the leg is raised, along with lateral tilting of the spine as the patient attempts to relieve pressure.
B. A meniscus tear is usually associated with knee pain rather than back or leg pain.
C. Scoliosis refers to a lateral curvature of the spine but does not cause radiating leg pain as described in this case.
D. While muscle spasms can cause back pain, they are not typically associated with radiating leg pain or lateral spinal tilting.

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The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? (Select All that Apply)

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Naxlex Comprehensive Predictor Exams

Which assessment finding(s) for a client with hypothyroidism should the nurse document as abnormal? Select all that apply.

Correct Answer is ["A","C","E"]

Explanation

During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, the patient complains of a pain going down his buttock into his leg. The nurse suspects:

Correct Answer is A

Explanation

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