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"My life is really out of balance." - AnswerA client is reporting chest pain. What
statement made by the client, helps the nurse to understand this client has a naturalistic
belief in the cause of illness?
.Be open to people who are different
Have a curiosity about people.
Become culturally competent. - Answer2. A nurse is working in a healthcare facility that
serves a diverse population. What action(s) by the nurse will allow the nurse to
empathize with and understand this population? (Select all that apply.)
.It must be enlarged at least three times normal size for it to be palpable. -
AnswerWhich statement is accurate about assessing the spleen?
.Posterior chest below the 3rd intercostalspace. - AnswerWhat is the best place for the
nurse to hear lower lobe lung sounds with a stethoscope?
.Place the bell on the 5th intercostal space, left midclavicular line. - AnswerThe nurse is
assessing a client who has a history of mitral stenosis. How should the nurse assess
this client with a stethoscope to listen for this condition?
.2nd intercostal space along the right sternal border. - AnswerThe nurse is assessing a
client who has a history of aortic regurgitation. Where should the nurse place the
stethoscope diaphragm to listen for this condition?
.The client works in a daycare setting that has had a scabies outbreak. - AnswerThe
client is experiencing severe pruritus and small papules and burrows on areas over one
hand and the inner thighs. Which assessment data best explains the condition the client
is experiencing?
.Level of consciousness. - AnswerA client comes to the clinic with a report of fever and
a recent exposure to someone who was diagnosed with meningitis. Which nursing
assessment should be completed during the initial examination of this client?
.Use of vitamin and iron supplements. - AnswerA client reports feeling increasingly
fatigued for several months, and the nurse observes that the client's lips are pale. Which
additional data should the nurse collect based on this presentation?
.There is no sign of associated infection. - AnswerThe nurse is assessing a client who
has experienced a sudden onset of hearing loss in the right ear. Which finding should
alert the nurse to a potentially serious medical condition that requires further
evaluation?
, .Swelling anterior to the ear lobe on one side of the face. - AnswerThe client reports to
the nurse a recent exposure to the mumps. Which assessment finding suggests the
client has contracted the mumps?
.Swelling of the left arm and non-pitting edema. - AnswerA client states that she had a
mastectomy of her left breast last year and now experiences lymphedema. What should
the nurse expect to find when examining the client?
.Ask the client specifically about any leakage of urine. - AnswerWhat is the best nursing
response to an older client who has not mentioned incontinence during a genitourinary
assessment?
.Have you experienced sudden weight loss? - AnswerA client is in the clinic for a routine
health examination. The nurse notices the client appears underweight. Which question
is most important for the nurse to ask when completing the health history of this client?
.Family history of colon cancer on mother's side. Correct - AnswerA client is in the clinic
and is reporting lower abdominal pain and constipation. Which information is of greatest
concern to the nurse when obtaining the health history from this client?
.Health history. - AnswerWhich information should the nurse obtain to identify the
client's self-perception of health status?
.Cataracts - AnswerDuring the initial assessment, the nurse notes that a client has
blurred vision with cloudy lenses. Which condition should the nurse document?
.Fibroadenoma. - AnswerWhile palpating a client's breasts, the nurse detects a
nontender, solitary, round lobular mass that is solid and firm and slides easily through
the breast tissue . The findings of this breast exam are consistent with which condition?
.Ankles. - AnswerWhich part of the body should the nurse examine when assessing for
peripheral edema in a client with heart failure?
.Fungal infection - AnswerWhich condition is indicated by a fluorescent, yellow-green
color when the nurse uses a Wood's lamp toexamine a client's skin lesions?
.Have you ever felt guilty about your drinking? - AnswerThe nurse is performing a
routine physical examination on an adult client. When gathering a health history, which
question is included in the CAGE questionnaire?
.Lying - AnswerA client has just returned from the recovery room and asks to get out of
bed to go to the bathroom. The nurse decides to obtain orthostatic vital signs first. How
will the nurse position the client to begin this procedure?