The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?

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Vital Signs and Pain Assessment Questions

Question 1 of 5

The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?

Correct Answer: C

Rationale: Studies show that percussed cardiac borders do not correlate well with the true cardiac border. Percussion is of limited usefulness with the female breast tissue, in a person who is obese, or in a person with a muscular chest wall. Chest x-ray images or echocardiographic examinations are significantly more accurate in detecting heart enlargement.

Question 2 of 5

When performing an assessment of a patient, the nurse notices the presence of an enlarged right epitrochlear lymph node. What should the nurse do next?

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 3 of 5

The nurse is preparing to assess the ankle-brachial index (ABI) of a patient. Which statement about the ABI is true?

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 4 of 5

Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except:

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 5 of 5

For the following situations, state the type of data collection you would perform (i.e., complete database, focused or problem-centered database, follow-up database, emergency database). d. recently placed on antihypertensive medication

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

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