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To assess a rectal temperature accurately in an adult, the nurse would:
a. Use a lubricated blunt tip thermometer.
b. Insert the thermometer 2 to 3 inches into the rectum.
c. Leave the thermometer in place up to 8 minutes if the patient is febrile.
d. Wait 2 to 3 minutes if the patient has recently smoked a cigarette.
Give this one a try later!
a. Use a lubricated blunt tip thermometer.
,The nurse knows that one advantage of the tympanic membrane thermometer (TMT)
is that:
a. Rapid measurement is useful for uncooperative younger children.
b. Using the TMT is the most accurate method for measuring body temperature in
newborn infants.
c. Measuring temperature using the TMT is inexpensive.
d. Studies strongly support the use of the TMT in children under the age 6 years.
Give this one a try later!
a. Rapid measurement is useful for uncooperative younger children.
What is a heave or thrill detected upon examination of the precordium?
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Heave: palpable impulse that noticeably lifts your hand, usually due to right
ventricular hypertrophy
Thrill: humming vibration felt during palpation, usually followed by a loud,
harsh murmur
The mother of a 2-year-old is concerned because her son has had three ear
infections in the past year. What
would be an appropriate response by the nurse?
a. It is unusual for a small child to have frequent ear infections unless something else is
wrong.
b. We need to check the immune system of your son to determine why he is having so
many ear infections.
c. Ear infections are not uncommon in infants and toddlers because they tend to have
more cerumen
in the external ear.
,d. Your sons eustachian tube is shorter and wider than yours because of his age,
which allows for infections to develop more easily.
Give this one a try later!
d. Your sons eustachian tube is shorter and wider than yours because of his
age, which allows for infections to develop more easily.
A patient has suddenly developed shortness of breath and appears to be in
significant respiratory distress. After calling the physician and placing the patient on
oxygen, which of these actions is the best for the nurse to
take when further assessing the patient?
a. Count the patients respirations.
b. Bilaterally percuss the thorax, noting any differences in percussion tones.
c. Call for a chest x-ray study, and wait for the results before beginning an assessment.
d. Inspect the thorax for any new masses and bleeding associated with respirations.
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b. Bilaterally percuss the thorax, noting any differences in percussion tones.
What is included in the second level priority?
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Mental status change
Acute pain
Infection risk
Abnormal values
Climate
, A 60-year-old woman has developed reflexive sympathetic dystrophy after
arthroscopic repair of her
shoulder. A key feature of this condition is that the:
a. Affected extremity will eventually regain its function.
b. Pain is felt at one site but originates from another location.
c. Patients pain will be associated with nausea, pallor, and diaphoresis.
d. Slightest touch, such as a sleeve brushing against her arm, causes severe and
intense pain.
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d. Slightest touch, such as a sleeve brushing against her arm, causes severe
and intense pain.
What does the occipital lobe control?
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Vision, visual processing and interpretation, color identification
In a patient with acromegaly, the nurse will expect to discover which assessment
findings?
a. Heavy, flattened facial features
b. Growth retardation and a delayed onset of puberty
c. Overgrowth of bone in the face, head, hands, and feet
d. Increased height and weight and delayed sexual development
Give this one a try later!
To assess a rectal temperature accurately in an adult, the nurse would:
a. Use a lubricated blunt tip thermometer.
b. Insert the thermometer 2 to 3 inches into the rectum.
c. Leave the thermometer in place up to 8 minutes if the patient is febrile.
d. Wait 2 to 3 minutes if the patient has recently smoked a cigarette.
Give this one a try later!
a. Use a lubricated blunt tip thermometer.
,The nurse knows that one advantage of the tympanic membrane thermometer (TMT)
is that:
a. Rapid measurement is useful for uncooperative younger children.
b. Using the TMT is the most accurate method for measuring body temperature in
newborn infants.
c. Measuring temperature using the TMT is inexpensive.
d. Studies strongly support the use of the TMT in children under the age 6 years.
Give this one a try later!
a. Rapid measurement is useful for uncooperative younger children.
What is a heave or thrill detected upon examination of the precordium?
Give this one a try later!
Heave: palpable impulse that noticeably lifts your hand, usually due to right
ventricular hypertrophy
Thrill: humming vibration felt during palpation, usually followed by a loud,
harsh murmur
The mother of a 2-year-old is concerned because her son has had three ear
infections in the past year. What
would be an appropriate response by the nurse?
a. It is unusual for a small child to have frequent ear infections unless something else is
wrong.
b. We need to check the immune system of your son to determine why he is having so
many ear infections.
c. Ear infections are not uncommon in infants and toddlers because they tend to have
more cerumen
in the external ear.
,d. Your sons eustachian tube is shorter and wider than yours because of his age,
which allows for infections to develop more easily.
Give this one a try later!
d. Your sons eustachian tube is shorter and wider than yours because of his
age, which allows for infections to develop more easily.
A patient has suddenly developed shortness of breath and appears to be in
significant respiratory distress. After calling the physician and placing the patient on
oxygen, which of these actions is the best for the nurse to
take when further assessing the patient?
a. Count the patients respirations.
b. Bilaterally percuss the thorax, noting any differences in percussion tones.
c. Call for a chest x-ray study, and wait for the results before beginning an assessment.
d. Inspect the thorax for any new masses and bleeding associated with respirations.
Give this one a try later!
b. Bilaterally percuss the thorax, noting any differences in percussion tones.
What is included in the second level priority?
Give this one a try later!
Mental status change
Acute pain
Infection risk
Abnormal values
Climate
, A 60-year-old woman has developed reflexive sympathetic dystrophy after
arthroscopic repair of her
shoulder. A key feature of this condition is that the:
a. Affected extremity will eventually regain its function.
b. Pain is felt at one site but originates from another location.
c. Patients pain will be associated with nausea, pallor, and diaphoresis.
d. Slightest touch, such as a sleeve brushing against her arm, causes severe and
intense pain.
Give this one a try later!
d. Slightest touch, such as a sleeve brushing against her arm, causes severe
and intense pain.
What does the occipital lobe control?
Give this one a try later!
Vision, visual processing and interpretation, color identification
In a patient with acromegaly, the nurse will expect to discover which assessment
findings?
a. Heavy, flattened facial features
b. Growth retardation and a delayed onset of puberty
c. Overgrowth of bone in the face, head, hands, and feet
d. Increased height and weight and delayed sexual development
Give this one a try later!
