The S1 may be difficult to hear in the patient with:
A) Mitral or tricuspid stenosis.
B) RBBB.
C) Emphysema.
D) Pulmonary hypertension.
C
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The nurse caring for a client with a closed head injury gathers the following data: pupils dilated and nonresponsive bilaterally, no response to vigorous stimuli, absence of corneal reflex, absence of respiratory initiation when carbon dioxide
levels elevate, and decrease in blood pressure. The nurse anticipates a diagnosis of: 1. Increased intracranial pressure. 2. Brain death. 3. Cerebrovascular accident. 4. Intracranial hemorrhage.
When using the various instruments to assess an older person's ADLs, the nurse needs to remember that a disadvantage of these instruments includes:
a. Reliability of the tools. b. Self or proxy reporting of functional activities. c. Lack of confidentiality during the assessment. d. Insufficient details concerning the deficiencies identified.
You are examining a patient with lymphedema. You would most likely discover which of the following findings?
a. fatigue c. weight loss b. swelling in the extremities d. night sweats
An adult client is brought to the emergency department (ED) and diagnosed with a thrombotic stroke. The team plans to administer alteplase (Activase)
The client makes the following comments to a nurse. Which information is critical for the nurse to relay to the health care provider? 1. "I can't believe this is happening. My baby is only a year old." 2. "I thought this was just my asthma acting up." 3. "I wonder if this was happening when I fell and hit my head last week." 4. "I had a blood clot in my leg last year after my baby was born."