When performing a respiratory assessment on a patient, the nurse notices a costal angle of approximately 90 degrees. This characteristic is:
a. Observed in patients with kyphosis.
b. Indicative of pectus excavatum.
c. A normal finding in a healthy adult.
d. An expected finding in a patient with a barrel chest.
ANS: C
The right and left costal margins form an angle where they meet at the xiphoid process. Usually, this angle is 90 degrees or less. The angle increases when the rib cage is chronically overinflated, as in emphysema.
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When taking a health history from a patient during the period of chronic HIV, the nurse would expect to find:
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The nurse would stress to the ancillary staff that the most important means of preventing the spread of infection in the burn unit is
a. prophylactic antibiotics. b. restricting visitors with respiratory tract infections. c. strict hand-washing. d. using clean gowns, gloves, and masks.
The nurse is caring for a 3-week-old boy born at 29 weeks of gestation. While taking vital signs and changing his diaper after stooling, the nurse observes his color is pink but slightly mottled, his arms and legs are limp and extended, he has the hiccups
a. Stress b. Subtle seizures c. Preterm behaviors d. Onset of respiratory distress
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a. Encouraging her to participate in self-care activities b. Suggesting that she change the channel to an intellectually stimulating program c. Giving her privacy until she becomes accustomed to the long-term care facility d. Arranging for a meal tray rather than having her eat in the dining room