While palpating respiratory expansion on a client in the emergency room the nurse notes movement on only one side of the chest. Which of the following conditions may produce this finding? Standard Text: Select all that apply
1. Atelectasis
2. Chronic bronchitis
3. Lobar pneumonia
4. Pleural effusion
5. Congestive heart failure
1,3,4
Rationale 1: Atelectasis. Atelectasis is a condition in which there is an obstruction of airflow. Lung tissue may collapse from airway obstruction, such as a mucous plug, lack of surfactant, or a compressed chest wall. Atelectasis will result in decreased lung expansion on the client's affected side.
Rationale 2: Chronic bronchitis. Chronic inflammation of the tracheobronchial tree leads to increased mucous production and blocked airways. It does not result in decreased lung expansion on one side.
Rationale 3: Lobar pneumonia. It is due to an infection that causes fluid, bacteria, and cellular debris to fill the alveoli. It may result in decreased lung expansion on the client's affected side.
Rationale 4: Pleural effusion. This condition refers to fluid accumulating in the pleural space. It may result in decreased lung expansion on the client's affected side.
Rationale 5: Congestive heart failure. This is when increased pressure in the pulmonary veins causes interstitial edema around the alveoli and may cause edema of the bronchial mucosa. It does not result in decreased lung expansion on one side.
You might also like to view...
A nurse is taking a class on providing culturally competent care for clients with severe mental illnesses. Which response best reflects the nurse's self-awareness of the sociocultural factors influencing his or her beliefs?
1. "When I was growing up, my parents believed that mental illnesses were the work of evil spirits." 2. "All that I need to understand about the culture of mental illness is available on the Internet." 3. "My father was a psychiatrist, so I am very knowledgeable about how to work with mental illnesses." 4. "I have been through therapy, so I know what to expect from clients with mental illnesses."
A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller's Functional Consequences Theory. To actualize this theory of aging, the nurse should prioritize what task?
A) Attempting to control age-related physiological changes B) Lowering expectations for recovery from acute and chronic illnesses C) Helping older adults accept the inevitability of death D) Differentiating between age-related changes and modifiable risk factors
The charge nurse at a nursing home impresses on a visiting class of nursing assistants the importance of hand washing, because older adults have a depressed immune response. One contributor to this depressed immune response in older adults is:
A) Decreased serum activity of the thymic hormones B) Inactivation of varicella-zoster infections C) Decreased serum concentrations of IgA and IgG D) High pain sensitivity associated with inflammation
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which condition, if found in the patient, would be of most concern?
a. Diabetes mellitus b. Liver disease c. Pulmonary disease d. Bleeding disorders