The nurse begins auscultating bowel sounds in a client with no prior abdominal surgery. Where should the nurse begin?
During auscultation of the right carotid artery, the nurse h…
During auscultation of the right carotid artery, the nurse hears a blowing, swishing sound. How should this finding be interpreted?
While auscultating the posterior lung bases of a healthy adu…
While auscultating the posterior lung bases of a healthy adult, the nurse hears soft, low-pitched sounds during inspiration that fade during expiration. How should the nurse properly confirm these are normal vesicular breath sounds?
During an abdominal assessment, the nurse percusses the left…
During an abdominal assessment, the nurse percusses the left lower quadrant (LLQ) and notes a predominantly dull sound rather than tympany. The client reports no acute pain and has not had a bowel movement for 2 days. What is the most appropriate interpretation of this finding?
During abdominal percussion of a client with mild constipati…
During abdominal percussion of a client with mild constipation, the nurse notes: Predominanttympany in the RLQ Localizeddullness in the LLQ The client denies pain, fever, or acute symptoms. Which interpretation is most accurate?
A client who completed a comprehensive admission assessment…
A client who completed a comprehensive admission assessment 8 hours ago reports new chest tightness. The nurse immediately evaluates respiratory effort, oxygen saturation, heart sounds, and pain characteristics. Which assessment type is most appropriate in this situation?
The nurse auscultates a low-pitched extra sound immediately…
The nurse auscultates a low-pitched extra sound immediately after S2 in a 68-year-old client with dyspnea and peripheral edema. What is the most accurate interpretation?
The nurse does not hear bowel sounds during the first two mi…
The nurse does not hear bowel sounds during the first two minutes of auscultation. What is the most appropriate action?
Match each client statement with the correct component of th…
Match each client statement with the correct component of the comprehensive assessment.
A nurse is preparing to administer digoxin to an adult clien…
A nurse is preparing to administer digoxin to an adult client. Which pulse site is most appropriate to assess before medication administration?