While obtaining a client’s health history related to smoking cigarettes, the nurse plans to determine the client’s smoking pack years. What information should the nurse obtain for this calculation? Select all that apply.
Packs of cigarettes smoked per day.
Number of attempts to quit smoking.
Client’s current age.
Age when the client started smoking.
Number of years the client smoked.
Correct Answer : A,D,E
Choice A rationale
Packs of cigarettes smoked per day is essential information for calculating smoking pack years.
Choice B rationale
The number of attempts to quit smoking is not required for calculating smoking pack years.
Choice C rationale
The client’s current age is not required for calculating smoking pack years.
Choice D rationale
The age when the client started smoking is necessary to determine the total number of years smoked.
Choice E rationale
The number of years the client smoked is essential for calculating smoking pack years.
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Correct Answer is B
Explanation
Choice A rationale
A 75-year-old with a pneumothorax and a chest tube may have a displaced PMI due to the pneumothorax, but it is not necessarily difficult to locate. The chest tube may also cause some displacement, but it is not the primary factor affecting PMI location.
Choice B rationale
A 54-year-old who is 5 feet (152.4 cm) tall and weighs 300 pounds (136.1 kg) is likely to have difficulty locating the PMI due to the increased adipose tissue. Obesity can make it challenging to palpate the PMI as the excess tissue can obscure the heart’s apex.
Choice C rationale
A 2-year-old who is demonstrating diaphragmatic breathing may have a PMI that is slightly higher and more medial than in adults, but it is generally not difficult to locate.
Choice D rationale
A 45-year-old long-distance runner with a body mass index (BMI) of 18 kg/m² is likely to have a more prominent PMI due to a leaner body composition and a potentially enlarged heart from athletic conditioning.
Correct Answer is C
Explanation
Choice A rationale
Documenting the presence of borborygmi is appropriate, but it does not address the need for a thorough assessment of all quadrants. Borborygmi are loud, high-pitched, almost continuous gurgling sounds that indicate hyperactive bowel sounds.
Choice B rationale
Auscultating the remaining quadrants is necessary to complete the assessment and ensure that the findings are consistent throughout the abdomen. This step helps to identify any variations in bowel sounds that may indicate different underlying conditions.
Choice C rationale
Elevating the head of the client’s bed immediately is not indicated in this situation. The primary focus should be on completing the assessment of bowel sounds in all quadrants.
Choice D rationale
Using the bell of the stethoscope to auscultate again is not necessary, as the diaphragm is the appropriate part of the stethoscope to use for assessing bowel sounds. The diaphragm is better suited for picking up high-pitched sounds like borborygmi.