The nurse auscultates the client's lungs and prepares to document the assessment. Which breath sounds are considered abnormal and may require further intervention?
Select all that apply.
1. Crackles.
2. Vesicular.
3. Bronchovesicular.
4. Wheezes.
5. Bronchial.
Correct Answer: 1, 4
Crackles are adventitious, or abnormal, lung sounds produced by collapsed or fluid-filled alveoli. Wheezes are the result of blocked airflow as in asthma, infection, or due to a foreign body. Vesicular sounds are normal and can be heard over the apices. Bronchovesicular sounds are normal sounds that can be auscultated over the bronchi. Bronchial sounds are normal and can be heard to the right and left of the trachea over the bronchi.
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A nurse cares for a client who has type 1 diabetes mellitus. The client asks, "Is it okay for me to have an occasional glass of wine?" How should the nurse respond?
a. "Drinking any wine or alcohol will increase your insulin requirements." b. "Because of poor kidney function, people with diabetes should avoid alcohol." c. "You should not drink alcohol because it will make you hungry and overeat." d. "One glass of wine is okay with a meal and is counted as two fat exchanges."
The highest Indigenous infant mortality rate in the 2010–12 census was in:
a. South Australia. b. Northern Territory. c. South Australia. d. Western Australia.
Which example indicates a situation in which more than decision-making skills is indicated?
1. A nurse administrator needs to hold administrative staff meetings on a day when most are available. 2. The Emergency Department nurse manager is contemplating how to best schedule the staff to ensure coverage. 3. A nurse manager gets a report indicating that the narcotics count has been wrong three times in the past month. 4. A floor nurse needs to organize care activities for a team of clients for the day, including two surgeries and a discharge.
An emphasis of the American Nurses Credentialing Center (ANCC) Magnet Hospital Designation Program for Excellence in Nursing is
a. research and development of clinical practice guidelines. b. putting qualitative research into practice in clinical settings. c. using standard nursing care plans based on outcomes research. d. utilizing evidence-based practice in nursing.