NUR 309 Exam #3 Study Guide 2024 (A+ Guaranteed)

The nurse is assessing the ankle-brachial index (ABI) of a patient with peripheral arterial disease (PAD). The nurse would be suspect of an ABI of: a) 1.1 b) 1.0 c) -1.1 d) 0.5 correct answers b A 22-year-old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handlebars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding assessment of the spleen in this situation? a) The spleen is normally felt upon routine palpation b) An enlarged spleen should not be palpated because it can rupture easily correct answers b A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is: a) peritonitis b) diarrhea c) laxative use d) gastroenteritis correct answers a The nurse is watching a new graduate nurse perform auscultation of a patient's abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen? a) "We need to determine areas of tenderness before using percussion and palpation." b) "It prevents distortion of bowel sounds that might occur after percussion and palpation." c) "It allows the patient more time to relax and therefore be more comfortable with the physical examination." d) "This prevents distortion of vascular sounds such as bruits and hums that might occur after percussion and palpation." correct answers b The nurse notices that a patient has had a black, tarry stool and recalls that a possible cause would be: a) gallbladder disease b) overuse of laxatives c) gastrointestinal bleeding d) localized bleeding around the anus correct answers c To detect diastasis recti, the nurse should have the patient perform which of these maneuvers? a) Relax in the supine position b) Raise the arms in the left lateral position c) Raise the arms over the head while supine d) Raise the head while remaining supine correct answers d