The nurse begins to assess the patient's respiratory system. Which assessment by the nurse best determines the patient's diaphragmatic excursion?
a. Observation of respiratory effort
b. Percussion over air-filled regions
c. Auscultation of thorax symmetrically
d. Palpation of chest inspiratory movement
D
The nurse palpates the patient's thoracic movement by placing hands on each side of the spine with thumbs adjacent to one another and instructs the patient to breathe deeply. On inspiration the nurse observes or measures the respiratory excursion, a reflection of the patient's inspiratory volume. Observing respiratory effort reveals data on the work of breathing. The nurse percusses over areas of suspected fluid accumulation to determine the size of the fluid from consolidation from pneumonia or a pleural effusion. The nurse symmetrically auscultates the thorax to compare bilateral breath sounds.
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A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement indicates the need for additional teaching?
A) "We should give this drug before he eats anything." B) "We need to keep a close eye for possible infection." C) "The drug should not be stopped suddenly." D) "He might gain some weight with this drug."
The nurse is caring for a patient with an electrical injury. The nurse understands that patients with electrical injury are at a high risk for acute kidney injury secondary to:
a. hypervolemia from burn resuscitation. b. increased incidence of ureteral stones. c. nephrotoxic antibiotics for prevention of infection. d. release of myoglobin from injured tissues.
When administering which of the following enemas is the nurse using a hypertonic solution?
a. kayexalate c. soap suds b. normal saline d. tap water
Leininger and McFarland provided ethnographers with a four-phase ethno nursing data analysis guide. What is the first phase?
A) Collecting and recording data B) Categorizing descriptors C) Searching for repetitive patterns D) Abstracting major themes