As you palpate T.B.'s abdomen, you deeply palpate the costal margin in the RUQ and ask
him to take a deep breath. This causes T.B. to stop inspiration abruptly, midway, and exclaim,
"Oh, that hurts!" What does this finding indicate?
a. Rebound tenderness
b. Hepatomegaly
c. Splenomegaly
d. Murphy sign
d
A positive Murphy sign (inspiratory arrest) is indicated when there is pain on inspiration while the
examiner is deeply palpating the costal margin of the RUQ. This sign might indicate inflammation of
the gallbladder.
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What should be included in the teaching plan for the parents of a 3-year-old child who has been prescribed an opioid analgesic?
a. The opioid is likely to cause significant respiratory depression. b. The medicine is prescribed with the knowledge that addiction may occur. c. The opioid is very effective as a pain control method. d. The opioid is only to be given in cases of severe pain.
The family of an older patient with Alzheimer's disease does not want to discuss long-term care placement for at least "a few years." How should the nurse respond to the family?
1. "Long-term care placement is inevitable with this diagnosis." 2. "It often takes a year for an individual with Alzheimer's disease to be admitted." 3. "Talking about it now gives you time to think about locations and make a decision." 4. "By providing this information now, we will not need to address these concerns later."
A client has anaphylaxis. Which action by the nurse takes highest priority?
a. Administering oxygen b. Giving epinephrine c. Maintaining an open airway d. Starting an IV
When using the mnemonic OLDCARTS, the A stands for ______________________
Fill in the blank(s) with correct word