The nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from her findings?

Friction rub

Tactile fremitus

Crepitus

Adventitious sounds

Answer and Explanation

The Correct Answer is C

A. Friction rub:

A friction rub is a grating or rubbing sound or sensation heard or felt during auscultation or palpation. It occurs when inflamed pleural or pericardial surfaces rub against each other during breathing or heartbeats, respectively.

B. Tactile fremitus:

Tactile fremitus refers to the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks. It is assessed by placing hands on the patient's back while the patient speaks certain words. Increased tactile fremitus can occur in conditions with lung consolidation, such as pneumonia.

C. Crepitus:

Crepitus is a crackling or grating sensation felt under the skin or heard when the ends of a broken bone rub against each other. It can also occur when air leaks into subcutaneous tissue, leading to a crackling sensation upon palpation.

D. Adventitious sounds:

Adventitious sounds refer to abnormal lung sounds heard during auscultation. These sounds include crackles (rales), wheezes, rhonchi, and pleural friction rubs. Adventitious sounds can indicate various respiratory conditions, such as pneumonia, bronchitis, or asthma.

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Correct Answer is A

Explanation

A. A slight asymmetry in breast size can be expected: This response is accurate. It acknowledges the natural variation in breast size that many women experience. It's common for one breast to be slightly larger or shaped differently than the other. It assures the client that this asymmetry is normal and not a cause for concern.

B. Asymmetry of breast size and shape is probably due to breastfeeding and is nothing to worry about: While breastfeeding can cause temporary changes in breast size and shape, not all cases of breast asymmetry are related to breastfeeding. This statement might not cover all situations, making it less accurate.

C. A sudden uneven increase in breast size is normal in adults: This statement is not accurate. Sudden changes in breast size should always be investigated, as they can indicate underlying health issues and may not be considered normal.

D. Breasts should always be symmetric: This statement is not accurate. Perfect symmetry in breast size and shape is rare. Most women have some degree of asymmetry, which is entirely normal. It's important to reassure the client that slight differences are common and not a cause for concern.

A. Indicates the beginning of diastole B. Coincides with the carotid artery pulse C. is louder than an S1 D. Is caused by the closure of the semilunar valves

Correct Answer is D

Explanation

A. Indicates the beginning of diastole: This statement is not accurate. S2, the second heart sound, indicates the end of systole and the beginning of diastole. It is specifically associated with the closure of the aortic and pulmonary valves.

B. Coincides with the carotid artery pulse: This statement is not accurate. S2 is associated with the closure of the aortic and pulmonary valves in the heart, not with the carotid artery pulse.

C. Is louder than an S1: This statement is not accurate. S1, the first heart sound, is usually louder than S2. S1 is associated with the closure of the mitral and tricuspid valves and marks the beginning of systole.

D. Is caused by the closure of the semilunar valves: This statement is accurate. S2 is caused by the closure of the aortic and pulmonary valves, which are the semilunar valves in the heart. It marks the end of systole and the beginning of diastole.

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The nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from her findings?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is performing a breast exam on a client. The client asks the nurse why the left breast is slightly larger than the right breast. Which of the following should be the appropriate response by the nurse?

Correct Answer is A

Explanation

The nurse is listening to the heart sounds of a client. The nurse recognizes that the S2:

Correct Answer is D

Explanation

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The nurse is doing an assessment of an adult client and noticed unequal chest expansion. The nurse recognizes that unequal chest expansion occurs:

The nurse is doing an examination of a client's anterior thorax. The nurse recognizes that the trachea bifurcates anteriorly at the:

The nurse recognizes that the following statement is true regarding the internal structures of the breast: The breast is made up of:

The nurse is examining a client for tactile fremitus. The nurse recognizes that when examining for tactile fremitus it is important to:

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