Which assessment finding would the nurse expect in a patient diagnosed with acute pericarditis?

Muffled heart sound

Narrow pulse pressure

Pulses paradoxus

Pericardial friction rub

Answer and Explanation

The Correct Answer is D

A. Muffled heart sounds are more commonly associated with pericardial effusion or cardiac tamponade, where fluid accumulation in the pericardial sac muffles the heart sounds. Acute pericarditis, however, typically does not cause muffled heart sounds.
B. Narrow pulse pressure (a small difference between systolic and diastolic blood pressure) is not a typical finding in acute pericarditis. It is more commonly seen in conditions such as cardiac tamponade or severe heart failure.
C. Pulses paradoxus, a significant decrease in systolic blood pressure during inspiration, is more commonly associated with conditions like cardiac tamponade, not acute pericarditis.
D. A pericardial friction rub is a hallmark sign of acute pericarditis. It occurs due to the inflammation of the pericardial layers, which rub against each other, producing a characteristic high-pitched, scratchy sound heard on auscultation.

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Correct Answer is D

Explanation

A. Offering reassurance is important for addressing anxiety, but it is not the immediate priority in this situation. The patient's difficulty in clearing thick respiratory secretions should be addressed first to prevent further complications.
B. Applying humidification to the oxygen may help loosen secretions over time, but it does not provide immediate relief. The priority is to clear the airway to ensure adequate oxygenation and prevent aspiration.
C. Encouraging the patient to increase oral fluid intake is helpful in the long term for thinning secretions, but it does not address the immediate problem of difficulty in coughing up thick secretions.
D. Suctioning the tracheostomy is the priority action. The patient is unable to clear thick secretions, and suctioning is necessary to remove the obstruction and improve airway patency, which will also alleviate anxiety and improve oxygenation.

A. Enlarged distal extremities B. Loss of color discrimination C. Hepatomegaly D. Coarse facial features E. Moon Face

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

Explanation

A. Enlarged distal extremities, such as enlarged hands and feet, are a classic sign of acromegaly. This occurs due to excess growth hormone, leading to the growth of bones and soft tissues.
B. Loss of color discrimination is not typically associated with acromegaly. This symptom is more commonly linked to other conditions, such as optic nerve disorders or macular degeneration.
C. Hepatomegaly, or an enlarged liver, is a common manifestation of acromegaly. The excess growth hormone can affect various organs, including the liver, causing them to enlarge.
D. Coarse facial features are another hallmark sign of acromegaly. The excess growth hormone causes the bones of the face, such as the jaw, nose, and brow, to enlarge, resulting in a more pronounced and coarse appearance.
E. Moon face is a characteristic of Cushing's syndrome, not acromegaly. It refers to a round, puffy face caused by excess cortisol, not growth hormone.

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Which assessment finding would the nurse expect in a patient diagnosed with acute pericarditis?

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Naxlex Comprehensive Predictor Exams

Which action would the nurse take first for a patient with a tracheostomy who appears anxious and is having difficulty in coughing up thick respiratory secretion?

Correct Answer is D

Explanation

A nurse is caring for a client who is being evaluated for acromegaly. Which of the following manifestations should the nurse expect to find during assessment? (Select all that apply.)

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

Explanation

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