A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider?
a. Tympany on percussion of the abdomen
b. Liver edge 3 cm below the costal margin
c. Bowel sounds of 20/minute in each quadrant
d. Aortic pulsations visible in the epigastric area
b. Liver edge 3 cm below the costal margin
Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.
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Which of the following terms represents a disease-related focus?
a. Health promotion b. Health protection c. High level wellness d. Holistic health perspective
The nurse enters a patient's room and notes he is nauseous, vomiting, and experiencing abdominal pain, and has no bowel sounds. She concludes that the patient's symptoms may be associated with a paralytic ileus
In arriving at this conclusion, the nurse has used: a. Inductive reasoning b. Deductive reasoning c. Guesswork d. Diagnostics
Which analogy best describes the action of killer T cells?
a. A tiger slowly stalking an antigen to de-vour it. b. A mad hornet flying through circulating fluids seeking and killing antigens. c. A spider waiting in a web for an antigen to get caught in it. d. A bird dog pointing to an antigen so it can be attacked by phagocytes.
The perinatal nurse providing care to a laboring woman recognizes a category II, fetal heart rate tracing. The most appropriate initial action is to:
a. Assist the laboring woman to a left lateral position b. Decrease the intravenous solution c. Request that the physician/certified nurse-midwife come to the hospital STAT d. Document the fetal heart rate and variability