HESI PATHO, PRACTICE QUESTIONS AND ANSWERS + RATIONALES PART 2 A+ GRADE

HESI PATHO, PRACTICE QUESTIONS AND ANSWERS + RATIONALES PART 2 A+ GRADE The nurse hears short, high-pitched sounds just before the end of inspiration in the right and left lower lobes when auscultating a client's lungs. How should this finding be recorded? A. Inspiratory wheezes in both lungs B. Crackles in the right and left lower lobes C. Abdominal lung sounds in the bases of both lungs D. Pleural friction rub in the right and left lower lobes - ANS-B Fine crackles are short, high pitched sounds heard just before the end of inspiration that are the result of rapid equalization of pressure when collapsed alveoli or terminal bronchioles suddenly snap open. Wheezing (A) is a continuous high pitched squeaking or musical sound caused by rapid vibration of bronchial walls that are first evident on expiration and may be audible. Although (C) describes an adventitious lung sound, the documentation is vague. (D) is a creaking or grating sound from roughened, inflamed surfaces of the pleura rubbing together heard during inspiration, expiration, and with no change during coughing. The nurse is assessing an older client and determines that the client's left upper eyelid droops, covering more of the iris than the right eyelid. Which description should the nurse use to document this finding? A. Ptosis on the left eyelid B. A nystagmus on the left C. Astigmatism on the right D. Exophthalmos on the right - ANS-A Ptosis is the term used to describe an eyelid droop that covers a large portion of the iris, which may result from oculomotor nerve or eyelid muscle disorder. (B) is characterized by rapid, rhythmic movement of both eyes. (C) is a distortion of the lens of the eye, causing decreased visual acuity. (D) is a term used to describe a protrusion of the eyeballs that occurs with hyperthyroidism A client's family asks why their mother with heart failure needs a pulmonary artery catheter now that she is in the ICU. What information should the nurse include in the explanation to the family? CONTINUES...