Author Question: A nurse is conducting a physical examination using palpation. Which assessments might the nurse ... (Read 87 times)

pragya sharda

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A nurse is conducting a physical examination using palpation. Which assessments might the nurse note? (Select all that apply.)
 
  a. Rebound tenderness: tenderness long after palpation
  b. Crepitation: crackling or rubbing
  c. Guarding: holding the nurse's hands away from the body
  d. Turgor: tension caused by fluid content
  e. Consistency: organ location and size

Question 2

A new nurse is conducting a patient interview. What behaviors observed by the experienced nurse require education on this process? (Select all that apply.)
 
  a. Typing intently on a keyboard when asking questions.
  b. Allowing family to accompany the patient as requested.
  c. Using gestures and eye contact to demonstrate interest.
  d. Closing the door to the room to ensure privacy.
  e. Providing non-verbal cues to negative thoughts.



katheyjon

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Answer to Question 1

ANS: B, D, E
Crepitation is crackling or rubbing felt (and perhaps heard) during palpation. Turgor is the amount of tension in body tissues caused by fluid content. Consistency compares organs for their location and size related to the norms. Rebound tenderness occurs after the stimulation is discontinued. Guarding is positioning to prevent movement of a painful body part.

Answer to Question 2

ANS: A, E
During the interview process, the nurse needs to demonstrate interest in the patient by leaning slightly toward him/her, allowing requested family or friends to accompany the patient, and closing the door to the room to ensure privacy. Typing intently when the patient is talking can be interpreted as lack of interest. Providing non-verbal cues to the nurse's negative thoughts (such as scowling when the patient mentions something negative) does not promote comfort or trust.



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