The nurse expects to observe the following manifestations of ...

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The nurse expects to observe the following manifestations of metabolic acidosis upon physical assessment of the client:
 
  1. Carpopedal spasm
  2. Convulsions
  3. Kussmaul's breathing
  4. Hyperventilation

Question 2

The nurse preparing to auscultate the apical heart rate on the client having an annual physical examination would do what first?
 
  1. Document client response.
  2. Remove the cover sheet from the client.
  3. Warm the bell of the stethoscope.
  4. Observe respiratory effort.

[prumorgan]

Answer to Question 1

3
Rationale:

Answer to Question 2

3
Rationale: The nurse would use the bell of the stethoscope, warmed in the hand for client comfort. The drape need only be removed enough to bare the apical area of the chest. Respiratory effort would be performed when assessing respiratory rate, and documentation would be done after auscultating heart rate.

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Gracias!

[tranoy]

TYSM