The client complains of difficulty breathing. What will the nurse most likely assess in this client?
1. Use of accessory muscles.
2. Increased respiratory depth.
3. Increased respiratory rate.
4. Decreased respiratory depth.
5. Decreased respiratory rate.
Correct Answer: 1,2,3,4
Rationale 1: Use of accessory muscles is an assessment finding associated with difficulty breathing.
Rationale 2: Increased respiratory depth is an assessment finding associated with difficulty breathing.
Rationale 3: Increased respiratory rate is an assessment finding associated with difficulty breathing.
Rationale 4: The depth of respirations can be deeper (tidal volume greater than 500 mL of air) or more shallow if partial obstruction is present in conditions such as asthma. Respiratory rate is generally increased.
Rationale 5: Respiratory rate is generally increased.
You might also like to view...
Questions regarding CAM therapies exist because
1. There are so many herbal products 2. Conventional medicine does not understand CAMs 3. Well-designed scientific studies and research need to be done 4. Few people utilize alternate healthcare 5.
The nurse is caring for a preterm infant born 2 weeks ago at 28 weeks' gestation. The infant is not eating well, is lethargic, and vomits after eating in the morning. Later that morning, the infant begins to have mild respiratory distress
The nurse suspects: 1. Gastritis. 2. Intraventricular hemorrhage. 3. Infection. 4. Gastric virus.
A patient receiving blood after an abdominal surgery notified the nurse that the IV pump was alarming. The nurse checked the pump and determined that the tubing was kinked. The tubing was straightened out and the nurse left the room
Five minutes later the IV pump again alarmed. The nurse returned to find the tubing was again kinked. On further investigation, the nurse dis-covered that the IV tubing had become twisted. This is an example of which behavior on the part of the nurse? a. Effective problem solving b. Diagnostic reasoning c. Scientific method d. Commitment level of critical thinking
The population health nurse assists neighborhood residents to form a neighborhood watch to help control gang crimes. This best describes:
1. Vertical empowerment. 2. Internal empowerment. 3. Horizontal empowerment. 4. External empowerment.