A nurse is auscultating a client's heart sounds and hears a low-pitched whooshing or blowing sound over the apex of the heart. The nurse should identify which of the following?

Correct Answer: B

Rationale: The correct answer is B: Murmur. A low-pitched whooshing or blowing sound over the apex of the heart indicates the presence of a murmur, which is an abnormal heart sound caused by turbulent blood flow. This sound can be indicative of a valve disorder or structural heart abnormality. Tachycardia (A) refers to an abnormally fast heart rate and would manifest as rapid heartbeats, not as a low-pitched whooshing sound. Gallop (C) refers to abnormal heart sounds resembling the sounds of a galloping horse and is typically associated with heart failure. Stroke Volume (D) is the amount of blood pumped out of the heart with each contraction and is not related to the specific sound heard during auscultation.

Correct Answer: A

Rationale: The correct sequence for using a metered-dose inhaler (MDI) for the first time is A: Shake the inhaler, exhale fully, press the inhaler while inhaling deeply, hold breath for 10 seconds. Rationale: 1. Shake the inhaler: This helps to mix the medication properly. 2. Exhale fully: Emptying the lungs before inhaling ensures better medication delivery. 3. Press the inhaler while inhaling deeply: This allows the medication to reach deep into the lungs. 4. Hold breath for 10 seconds: Holding the breath allows the medication to be absorbed effectively. Summary of other choices: B: Incorrect because inhaling quickly may lead to improper medication delivery. C: Incorrect because pressing the inhaler before inhaling may result in less effective medication delivery. D: Incorrect because shaking the inhaler after pressing it may disrupt the medication dispersion.

Correct Answer: C

Rationale: The correct answer is C: Peak inspiratory pressure of 35 cm H2O. A peak inspiratory pressure of 35 cm H2O indicates high airway pressure, which can lead to barotrauma and further lung damage in a client with ARDS. Immediate action is needed to prevent complications. A: Oxygen saturation of 92% is slightly low but not critically concerning in this context. B: Tidal volume of 450 mL is within the normal range and does not indicate an immediate issue. D: Respiratory rate of 18 breaths per minute is within normal limits and does not require immediate action.

Correct Answer: B

Rationale: The correct answer is B because using sterile technique for tracheostomy care helps prevent infections. Sterile technique minimizes the risk of introducing harmful bacteria into the tracheostomy site, reducing the chance of complications. Changing tracheostomy ties daily (Option A) may not be necessary unless they are soiled or wet. Avoiding humidification (Option C) can lead to mucus buildup and blockage, causing breathing difficulties. Cleaning the stoma site with alcohol daily (Option D) can irritate the skin and increase the risk of infection.

Correct Answer: B

Rationale: The correct answer is B: Rinse your mouth after each use. This is important because corticosteroid inhalers can increase the risk of developing oral thrush, a fungal infection in the mouth. Rinsing the mouth after each use helps to reduce this risk. Choice A is incorrect because corticosteroid inhalers are not just for asthma attacks but are meant for regular use in chronic conditions like bronchitis. Choice C is incorrect because taking the inhaler with meals is not necessary for its effectiveness. Choice D is incorrect because while using a spacer can improve medication delivery, rinsing the mouth is more crucial for preventing oral thrush.