Which of the following conditions would produce a hyperresonant percussion note?
A) Large pneumothorax
B) Lobar pneumonia
C) Pleural effusion
D) Empyema
A) Large pneumothorax
There is a great deal of free air in the chest with a large pneumothorax, which produces a hyperresonant note. The other three conditions produce dullness by dampening the percussion note with fluid.
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A newly diagnosed cancer client is crying and states the following to the nurse: "I promised God that I will be a better person if I can just get better." What is the appropriate assessment of this comment by the nurse?
A) The client is just trying to protect self from potential loss. B) Anger directed toward nursing staff is not unusual in dealing with cancer clients. C) The cancer is viewed as a punishment from past actions. D) Loss is inevitable so client is making final plans.
Which intervention does the nurse recognize as a collaborative intervention?
A) Teach the client how to walk with a three-point crutch gait. B) Administer spironolactone (Aldactone). C) Perform tracheostomy care every eight hours. D) Straight catheterize every six hours.
The planning process is a critical element for nursing management. One consequence of planning is:
a. Vision b. Values c. Mission statement d. External assessment
The nurse is caring for a patient with myasthenia gravis who is on a ventilator. The high-pressure alarm sounds. What should the nurse consider as the cause for this alarm?
a. The patient is fatigued. b. The tubing is disconnected. c. The electricity is interrupted. d. The patient needs to be suctioned.