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In order to successfully complete this online course, NU304, what must you do?

NU304 Health Assessment in Nursing

Week 1 Quiz   

Question 1In order to successfully complete this online course, NU304, what must you do?

Select one:

 

 a.Successfully pass all laboratory video demonstrations with 80% or above.

 

 b.Successfully complete all work with a grade of 75%.

 

 c.Achieve a grade of at least 70%.

 

Question 2The required text for this course is:

 

Select one:

 

 a.Hogan-Quigley, B., Palm, M. & Bickley, L. (2017) Bates nursing guide to physical examination and history taking. PA: Lippincott Williams & Wilkins.

 

 b.Bickley, L. (2017). Bates’ guide to physical examination and health assessment (12th ed.). New York: Lippincott, Williams & Wilkins.

 

 c.Dains, J.E., Baumann, L.C., & Scheibel, P. (2016) Advanced health assessment and clinical diagnosis in primary care (5th ed.). Boston: Elsevier.

 

Question 3The discussion board assignments are not mandatory and are not included in the overall grade requirements.

 

Select one:

 

 True

 

 False

 

Question 4

 

Any concerns about the course should be addressed immediately to whom?

 

Select one:

 

 a.Dean of Students

 

 b.Professor teaching the course – Dr. Dianna Jones

 

 c.Course advisor

 

Question 5If you have any technical issues or need technical assistance at any time during the course, what should you do?

 

Select one:

 

 a.Contact Regis Information Technology HelpDesk at 781-768-7177 or email helpdesk@regiscollege.edu.

 

 b.Try to figure it out on your own.

 

 c.Contact someone in your area that specializes in information technology.

 

 

 

NU304 Health Assessment in Nursing

 

Week 3 Quiz   

 

Question 1While taking the history of a patient, you develop a genogram. Why do you do this?

 

Select one:

 

 a.To identify genetic and family health problems

 

 b.To identify non-genetic conditions

 

c.To identify her chief complaint

 

 d.To identify potential acute conditions

 

Question 2A patient had a normal corneal light reflex. What does this mean?

 

Select one:

 

a.The eye focuses the image in the center of the pupil

 

 b.Constriction of both pupils occurs in response to bright light

 

 

 

c.Light is reflected at the same spot in both eyes

 

 d.The eyes converge to focus on light

 

Question 3

 

When taking the family history, it is especially important to include:

 

Select one:

 

 a.Mental illness

 

 b.Emphysema

 

 c.Fractured bones

 

 d.Head trauma

 

Question 4

 

Which of the following statements best describes the purpose of a health history?

 

Select one:

 

 a.To provide an opportunity for interaction between patient and nurse

 

 b.To document the normal and abnormal findings of a full physician assessment

 

 c.To provide a forum for obtaining the patient’s biographical information

 

 d.To provide a database of subjective information about the patient’s past and present health

 

Question 5In performing the whisper test to assess for hearing, which of the following would the nurse do?

 

Select one:

 

 a.Whisper two syllable words and ask the patient to repeat them

 

 b.Stand 4 feet away to ensure that the patient can hear at this distance

 

 c.Cover your mouth so that the sound is muffled

 

 d.Ask the patient to cover the ear you are assessing to occlude outside noise

 

Question 6You notice a solid, elevated, circumscribed lesion less than 1 cm on your patient’s arm. How would you describe this in your note?

 

Select one:

 

 a.Tumor

 

 b.Wheal

 

 c.Papule

 

 d.Nodule

 

Question 7When checking a patient for a visual acuity, which of the following assessment tools would you use?

 

Select one:

 

 a.Pupillary light reflex

 

 b.Opthalmoscope

 

 c.Corneal light reflex

 

 d.Snellen chart

 

Question 8You are doing a fundoscopic exam on a patient. When you first place the ophthalmoscope to the eye, you see a red circle. What does this mean?

 

Select one:

 

 a.The light source is functioning appropriately

 

 b.She has begun to show some signs of retinal degneration

 

 c.This is a reflection of the retina

 

 d.She has an opacity, which is causing the light to reflect back

 

Question 9When examining the nasal cavity, which finding would you consider abnormal?

 

Select one:

 

 a.Pink, moist mucosa

 

 b.Large amounts of cilia

 

 c.Boggy, pale turbinates

 

 d.Patent nares

 

Question 10

 

Conductive type hearing loss involves:

 

Select one:

 

 a.Inflammation of the labyrinth

 

 b.Pathology of the inner ear or CNVIII

 

 c.A gradual nerve degeneration

 

 d.A mechanical dysfunction of the external or middle ear

 

Question 11When examining the inner ears of a patient, which of the following would be an abnormal finding?

 

Select one:

 

 a.Sticky, honey colored cerumen in the canal

 

 b.Presence of a cone of light bilaterally

 

 c.Gray tympanic membrane slightly concave

 

 d.A pink, tympanic membrane with injections and slight bulging

 

Question 12Which superficial group of nodes is palpated during the assessment of HEENT?

 

Select one:

 

 a.Inguinal nodes

 

 b.Cervical nodes

 

 c.Epitrochlear nodes

 

 d.Axillary nodes

 

Question 13The confrontation test is a gross measure of:

 

Select one:

 

 a.Visual acuity

 

 b.Extra ocular movements

 

 c.Eye strength and muscle movement

 

 d.Peripheral vision

 

Question 14You are in the process of assessing your patient’s thyroid gland. It is located:

 

Select one:

 

 a.Anterior to the uvula

 

 b.Above the hyoid bone

 

 c.Between occipital nodes

 

 d.Below the cricoid cartilage

 

Question 15A thorough skin assessment is very important because the skin holds information about:

 

Select one:

 

 a.Circulatory status

 

 b.Psychological wellness

 

 c.Support system

 

 d.Socioeconomic status

 

Question 16The temporomandibular joint is just below the temporal artery and anterior to the:

 

Select one:

 

 a.Tragus

 

 b.Mandible

 

 c.Hyoid bone

 

 d.Vagus nerve

 

Question 17You are assessing the ears of a two year old patient. The proper technique for using the otoscope is:

 

Select one:

 

 a.Pull the pinna down and back

 

 b.Pull the pinna up and back

 

 c.Insert speculum without manipulation of the pinna

 

 d.Pull the tragus forward

 

Question 18A normal response when assessing for extraocular movements (EOMs) is:

 

Select one:

 

 a.Asymmetry of the light reflex

 

 b.Conjunctival injection

 

 c.Parallel tracking of an object with both eyes

 

 d.Unequal pupillary response

 

Question 19During the neck exam, the nurse completed a lymph node assessment on a healthy 30 year old female patient. The nurse understands that most lymph nodes in healthy adults are:

 

Select one:

 

 a.Irregular shaped and mobile

 

 b.Not palpable or slightly palpable and mobile

 

 c.Large, firm and fixed

 

 d.Palpable and very tender

 

Question 20Which of the following statements best describes the purpose of history of present illness?

 

Select one:

 

 a.To provide a database of subjective information about the patient’s symptoms and chief complaint

 

 b.To document the normal and abnormal findings of a physical assessment

 

 c.To provide a forum for obtaining the patient’s biographical information

 

 d.To provide an opportunity for the interaction between patient and nurse

 

 

 

NU304 Health Assessment in Nursing

 

Week 5 Quiz   

 

Question 1While auscultating a patient’s lung sounds, what sound would you expect to hear in the peripheral lung?

 

Select one:

 

 a.Vesicular

 

 b.Tracheal

 

 c.Bronchovesicular

 

 d.Bronchial

 

Question 2You are assessing the carotid arteries for the presence of a bruit. A bruit is a:

 

Select one:

 

 a.Loud, whooshing, blowing sound best heard with the bell of the stethoscope

 

 b.Soft, rattling sound best heard with the diaphragm of the stethoscope

 

 c.High-pitched tinkling sound best heard with the diaphragm of the stethoscope

 

 d.Low gurgling sound best heard with the diaphragm of the stethoscope

 

Question 3 The expected normal assessment findings in your patient’s lungs include the presence of:

 

Select one:

 

 a.Clear lung fields with limited chest expansion

 

 b.Symmetrical expansion and tactile fremitus

 

 c.Absent voice sounds and hyperresonant percussion tones

 

 d.Increased tactile fremitus and dull percussion tones

 

Question 4Which of the following is true about the left lung?

 

Select one:

 

 a.It is divided by horizontal fissure

 

 b.It is shorter than the right lung because of the underlying stomach

 

 c.It consists primarily of an upper lobe on the posterior chest

 

 d.It consists of two lobes

 

Question 5Functions of the respiratory system include:

 

Select one:

 

 a.Supplying oxygen to the body for energy production

 

 b.All of the above

 

 c.Removing carbon dioxide as a waste product of energy reactions

 

 d.Maintaining homeostasis (acid-base balance)

 

Question 6Which of the following is the  sequence for auscultating heart sounds?

 

Select one:

 

 a.Aortic area, pulmonic area, mitra area, Erb’s point, tricuspid area

 

 b.Pulmonic area, aortic area, Erb’s point, tricuspid area, mitral area

 

 c.Pulmonic area, mitral area, aortic area, Erb’s point, tricuspid area

 

 d.Aortic area, pulmonic area, Erb’s point, tricuspid area, mitral area

 

Question 7In your assessment of a normal adult, where would you expect to palpate the apical impulse?

 

Select one:

 

 a.Fifth right intercostal space at the midclavicular line

 

 b.Fifth left intercostal space at the midclavicular line

 

 c.Fourth left intercostal space at the sternal border

 

 d.Third left intercostal space at the sternal border

 

Question 8The normal sound elicited when percussing the lungs is:

 

Select one:

 

 a.A high-pitched tinkling sound

 

 b.Resonance

 

 c.Dullness

 

 d.Hyperresonance

 

Question 9When percussing the abdomen, tympany is present:

 

Select one:

 

 a.Over fluid or a mass

 

 b.Over adipose tissue

 

 c.When there is a gastric distension

 

 d.Over a small amount of air/gas

 

Question 10A patient is complaining of tenderness along the costovertebral angle. This is most often indicative of:

 

Select one:

 

 a.Ovulation pain

 

 b.Liver enlargement

 

 c.Spleen enlargement

 

 d.Kidney inflammation

 

Question 11 The arteries in the arm include the:

 

Select one:

 

 a.Brachial, ulnar and radial

 

 b.Superficial, radial and ulnar

 

 c.Superficial, ulnar and saphenous

 

 d.Brachial, ulnar and posterial tibial

 

Question 12The deep veins run alongside the deep arteries and conduct most of the venous return from the leg. The deep veins include the:

 

Select one:

 

 a.Great saphenous and small saphenous

 

 b.Thoracic duct and saphenous

 

 c.Femoral and popliteal

 

 d.Jugular veins and thoracic duct

 

Question 13Which of the following describes the superficial group of nodes that are accessible to inspection and palpation and give clues to the status of the lymphatic system?

 

Select one:

 

 a.Cervical, thoracic, axillary and inguinal

 

 b.Cervical, axillary, epitrochlear and inguinal

 

 c.Axillary, epitrochlear, saphenous and inguinal

 

 d.Cervical, superficial, axillary and inguinal

 

Question 14The two atrioventricular valves that separate the atria and ventricles are called:

 

Select one:

 

 a.Tricuspid and mitral

 

 b.Tricuspid and aortic

 

 c.Aortic and mitral

 

 d.Pulmonic and aortic

 

Question 15Systole is the part of the heart cycle in which:

 

Select one:

 

 a.The heart is in contraction

 

 b.The extra heart sounds 53 and 54 may be heard

 

 c.The pressure in the atria is higher than that in the ventricles

 

 d.The heart is at rest

 

Question 16Right upper quadrant tenderness may indicate pathology in the:

 

Select one:

 

 a.Pancreas and descending colon

 

 b.Stomach and spleen

 

 c.Liver and gall bladder

 

 d.Appendix and ileocecal valve

 

Question 17To check for liver tenderness/enlargement, the provider places his/her fingers or hand under the right rib cage and asks the patient to take a deep breath. A normal response is:

 

Select one:

 

 a.Pain in the right upper quad

 

 b.To complete the deep breath with pain that radiates to the right shoulder

 

 c.Pain that radiates to the left upper quad

 

 d.To complete the deep breath without pain

 

Question 18The proper order of assessing the abdomen is:

 

Select one:

 

 a.Inspection, palpation, auscultation, percussion

 

 b.Palpation, percussion, auscultation, inspection

 

 c.Inspection, auscultation, percussion, palpation

 

d.Percussion, auscultation, inspection, palpation

 

Question 19The main reason auscultation precedes percussion and palpation of the abdomen is:

 

Select one:

 

 a.To prevent distortion of bowel sounds that might occur after percussion and palpation

 

 b.To determine areas of tenderness before employing percussion and palpation

 

 c.To prevent distortion of vascular sounds such as bruits and hums that might occur after percussion and palpation

 

 d.To allow the patient more time to relax and become comfortable with the physical exam

 

Question 20The pulmonary artery delivers un-oxygenated blood to the lungs.

 

Select one:

 

 a.False

 

 b.True

 

 

 

NU304 Health Assessment in Nursing

 

Week 7 Quiz   

 

When the patient moves her right shoulder, a grating, cracking sound is heard in the joint. It can also be felt upon palpation. This is known as:

 

Select one:

 

 a.Crepitus

 

 b.Repetitus

 

 c.Calcificus

 

 d.Fremitus

 

Question 2To assess range of motion in the neck, the patient is asked to perform:

 

Select one:

 

 a.Flexion, expansion, rotation and lateral movements

 

 b.Flexation, extension, rotation and lateral movements

 

 c.Flexion, extension, rotation and lateral movements

 

 d.Flexion, extension, rotation and medial movements

 

Question 3 The patient is asked to point her toe downward towards the ground. The movement she is performing is described as:

 

Select one:

 

 a.Plantarflexion

 

 b.Extension

 

 c.Inversion

 

 d.Dorsiflexion

 

Question 4When a patient is asked to move a body part such as a leg towards the midline of the body, they would be:

 

Select one:

 

 a.Circumducting the leg

 

 b.Abducting the leg

 

 c.Adducting the leg

 

 d.Retroducting the leg

 

Question 5Which of the following cranial nerve is responsible for sense of smell?

 

Select one:

 

 a.Acoustic CN VIII

 

 b.Olfactory CN I

 

 c.Facial CN VIII

 

 d.Hypoglossal CN XII

 

Question 6When assessing triceps reflex, what is the expected response?

 

Select one:

 

 a.Pronation of the hand

 

 b.Flexion and supination of the forearm

 

 c.Flexion of the hand

 

 d.Extension at the elbow

 

Question 7Which cranial nerve is used to assess tongue movement?

 

Select one:

 

 a.CN VI

 

 b.CN XII

 

 c.CN IX

 

 d.CN VII

 

Question 8During the neurological exam, you are assessing a patient standing with his feet together, arms by his side and eyes closed. He begins to sway and move his feet father apart. You would document this as:

 

Select one:

 

 a.Negative Homan’s sign

 

 b.Positive Romberg’s sign

 

 c.Ataxia

 

 d.Lack of coordination

 

Question 9Which of the following cranial nerves would be used to assess the gag reflex, swallowing and the “ahh” reflex?

 

Select one:

 

 a.Glossopharyngeal CNIX and Vagus CNX

 

 b.Vagus CNX and Hypoglossal CNXII

 

 c.Spinal accessory CNXI and Vagus CNX

 

 d.Hypoglossal CN XII and Spinal accessory CN XI

 

Question 10When a patient is asked to move a body part such as bending forward at the waist, they would be producing the movement flexion. Which of the following is responsible for that type of movement?

 

Select one:

 

 a.Smooth muscle

 

 b.Ligaments

 

 c.Skeletal muscle

 

 d.Tendons

 

Question 11When assessing the range of motion of the wrist, the nurse asks the patient to move his/her forearms so the palms of the hands are facing up. This movement would create a position known as:

 

Select one:

 

 a.Inversion

 

 b.Pronation

 

 c.Palmation

 

 d.Supination

 

Question 12 Mrs. T. is 8 months pregnant and she is complaining of a change in posture and lower back pain. You tell her that during pregnancy, women have a posture shift to compensate for the enlarging fetus. This shift in posture is called:

 

Select one:

 

 a.Ankylosis

 

 b.Lordosis

 

 c.Scoliosis

 

 d.Kyphosis

 

Question 13Which of the following cranial nerves is not responsible for eye movement?

 

Select one:

 

 a.Trochlear (CN IV)

 

 b.Abducens (CN VI)

 

 c.Oculomotor (CN III)

 

 d.Trigeminal (CN V)

 

Question 14You are testing the function of the cranial nerve XI. Which of the following best describes the response you would expect if the nerve is intact?

 

Select one:

 

 a.Sticks tongue out midline without tremors or deviation

 

 b.Demonstrates full range of motion of the wrist

 

 c.Follows an object with eyes without nystagmus

 

 d.Should shrug against resistance

 

Question 15When assessing reflexes on a patient, you document them all to be 1+. This would be considered:

 

Select one:

 

 a.Normal

 

 b.Mildly hyperactive

 

 c.Absent

 

 d.Slightly dimished

 

Question 16To assess your patient’s range of motion in her upper extremities, you ask her to raise her arms outward up over her head. The movement she is performing is called:

 

Select one:

 

 a.Eversion

 

 b.Abduction

 

 c.Extension

 

 d.Flexion

 

Question 17The patient is asked to point her toe upwards towards her nose. The movement she is performing is described as:

 

Select one:

 

 a.Extension

 

 b.Plantarflexion

 

 c.Inversion

 

 d.Dorisflexion

 

Question 18When assessing reflexes on a patient, you document them all to be 3+. This would be considered:

 

Select one:

 

 a.Slightly diminished

 

 b.Absent

 

 c.Normal

 

 d.Mildly hyperactive

 

Question 19Joints are divided into two categories: nonsynovial and synovial. The following is an example of a nonsynovial joint:

 

Select one:

 

 a.Hips

 

 b.Knee

 

 c.Cranium

 

 d.Shoulder

 

Question 20Which of the following cranial nerves would be used to assess the tuning fork tests, Weber and Rinne, and the whisper test?

 

Select one:

 

 a.CN XI

 

 b.CN III

 

 c.CN V

 

 d.CN VIII

 

 

 

NU304 Health Assessment in Nursing

 

Week 8 Quiz   

 

Question 1A 50-year old patient is seen in the clinic for annual physical examination and screening.  The patient has no known health problems.  This type of care is referred to as:

 

Select one:

 

 a.Tertiary prevention

 

 b.Healthy prevention

 

 c.Primary prevention

 

 d.Promotion prevention

 

Question 2A 62 year-old man states that his doctor told him that he has an “inguinal hernia”.  He asks the nurse to explain what a hernia is.  The nurse should:

 

Select one:

 

 a.Refer him to his physician for additional consultation because the physician made the initial diagnosis.

 

 b.Explain that a hernia is often the result of prenatal growth and abnormalities

 

 c.Explain that a hernia is a loop of bowel coming through a weak spot in the abdominal muscles

 

 d.Tell him not to worry and that most men his age develop hernias

 

Question 3A Nodule is:

 

Select one:

 

 a.Solid, elevated hard or soft mass, larger than 1 cm

 

b.Elevated cavity containing more than 1 cm of free fluid

 

 c.A hypertrophic scar

 

 d.A solid, elevated mass smaller than 1 cm

 

Question 4A normal pupillary light reflex indicates:

 

Select one:

 

 a.Light is reflected at the same spot in both eyes

 

 b.The eyes converge to focus on the light

 

 c.The eye focuses the image in the center of the pupil

 

 d.Constriction of both pupils occurs in response to bright light

 

 Question 5A nurse is assessing her patient with a diagnosis of dehydration.  How would the nurse assess the patient’s skin turgor?

 

Select one:

 

 a.Pinch a fold of skin on the patient’s abdomen

 

 b.Pinch a fold of skin on the patient’s cheek

 

 c.Pinch a fold of skin on the patient’s upper thigh

 

 d.Pinch a fold of skin on the patient’s forearm or dorsal surface of hand

 

Question 6A patient is anxious, dyspneic, pale and using accessory muscles to breathe.  The nurse should initially perform which type of assessment?

 

Select one:

 

 a.Acute assessment

 

b.General exam

 

 c.Health history

 

 d.Subjective assessment

 

Question 7A patient is unable to shrug her shoulders against the nurse’s resistant hands.  What cranial nerve is involved with successful shoulder shrugging?

 

Select one:

 

 a.XII (Hypoglossal)

 

 b.VII (Facial)

 

 c.XI (Spinal)

 

 d.IX (Glossopharygeal)

 

Question 8A patient presents with complaint of a popping sensation in front of his ears when he ‘s opening and closing his mouth.  To further examine this, the nurse would:

 

Select one:

 

 a.Place the stethoscope over the temporomandibular joint and listen for bruits.

 

 b.Place the hands over his ears and ask him to open his mouth “really wide”.

 

 c.Place one hand on his forehead and the other on his jaw and ask him to try to open his mouth.

 

 d.Place first and second fingers just anterior to the tragus of the patient’s ear and ask him to open and close his mouth.

 

Question 9A patient’s annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine standing and when forward bending.  This curvature indicates:

 

Select one:

 

 a.Kyphosis

 

 b.Scoliosis

 

 c.Lordosis

 

d.Herniated nucleus pulposus

 

Question 10A thorough skin assessment is very important because the skin holds information about:

 

Select one:

 

 a.Circulatory status

 

 b.Support systems

 

 c.Psychological wellness

 

 d.Socioeconomic status

 

Question 11Adventitious breath sounds are heard when auscultating a patient’s lungs.  Which of the following would be an important part of the subjective assessment of this patient?

 

Select one:

 

 a.Send the patient for a chest x-ray because this is indicative of a potentially serious condition

 

 b.Question the patient about his/her lifestyle regarding smoking habits

 

 c.No more information  is needed because adventitious breath sounds in the lower lobes are normal

 

 d.Assess the thoracic area both anterior and posterior again and have the patient cough prior to auscultation

 

Question 12After teaching a group of students about age-related changes in the lungs, the instructor determines that the teaching was successful when the students identify which of the following:

 

Select one:

 

 a.Increased functional capillaries

 

 b.Increased resiliency

 

 c.Loss of subcutaneous fat

 

 d.Loss of elasticity

 

Question 13

 

An elderly man has come in for a physical examination, he tells you that he has been ill with a productive cough for the past week.  This information would be written under the section that covers:

 

Select one:

 

 a.Mood and affect

 

 b.General survey

 

 c.Objective data

 

 d.History of present illness

 

Question 14 An important technique used when auscultating the thorax is moving the stethoscope back and forth from one side to the other.  This is done for:

 

Select one:

 

 a.Side to side comparison

 

b.Interspace by interspace comparison

 

 c.Posterior to anterior comparison

 

 d.Top to bottom comparison

 

Question 15Cyanosis or pallor occurs with:

 

Select one:

 

 a.Low cardiac output states as a result of decreased tissue perfusion

 

b. Increased heart rate in the person who is ambulatory during the day

 

 c.Elevation of the legs

 

 d.Increased fatigue from standing all day

 

Question 16During an assessment of a healthy adult, where would the nurse expect to palpate the point of maximal impulse (PMI)?

 

Select one:

 

 a.Fourth left intercostal space at the anterior axillary line

 

 b.Fourth left intercostal space at the sternal border

 

 c.Fifth left intercostal space at the midclavicular line

 

 d.Third left intercostal space at the midclavicular line

 

Question 17During an examination, the nurse notices that a patient is unable to stick out his tongue.  Which cranial nerve is involved with successful performance of this action?

 

Select one:

 

 a.IX (Spinal)

 

b.V (Trigeminal)

 

 c.IX (Glossopharyngeal)

 

 d.XII (Hypoglossal)

 

Question 18During the abdominal assessment, your patient is complains of tenderness along the costovertebral angle.  This is most often indicative of:

 

Select one:

 

 a.Liver enlargement

 

 b.Spleen enlargement

 

 c.Kidney inflammation

 

 d.Ovulation pain

 

Question 19During the examination of a patient, the nurse notes that the patient has several small, <1cm raised, solid lesions on her posterior thorax. What is another name for this type of lesion?

 

Select one:

 

 a.Freckles

 

 b.Bullas

 

 c.Nodules

 

 d.Papules

 

Question 20For the abdominal assessment, what are the last two assessment techniques?

 

Select one:

 

 a.Palpation – light and deep and percussion

 

 b.Percussion and assessing for CVA tenderness

 

 c.Auscultation and palpation – light and deep

 

 d.Percussion and palpation – light and deep

 

Question 21For the abdominal assessment, what is the second assessment technique?

 

Select one:

 

 a.Percussion

 

 b.Palpation, light and deep

 

 c.Inspection

 

 d.Auscultation

 

 Question 22For the abdominal assessment, what is the third assessment technique?

 

Select one:

 

 a.Auscultation

 

 b.Palpation – deep first and then light

 

 c.Palpation – light first and then deep

 

d.Percussion

 

Question 23For the abdominal

 

assessment, what is the first step to the assessment?

 

Select one:

 

 a.Percussion

 

 b.Inspection

 

 c.Auscultation

 

 d.Palpation

 

Question 24In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:

 

Select one:

 

 a.Instruct patient to take slow, deep breaths during auscultation

 

 b.Auscultate with the bell of the stethoscope to assess for bruits

 

 c.Inspect while you instruct the patient to swallow a sip of water

 

 d.Palpate both arteries simultaneously to compare amplitude

 

Question 25In assessing the tonsils of a 24-year old patient, the nurse notes that the tonsils are erythematous with exudates bilaterally, and they are touching each other.  How would you grade the tonsils?

 

Select one:

 

 a.4+

 

 b.1+

 

 c.2+

 

 d.3+

 

Question 26In performing a breast examination, the nurse knows that it is especially important for the healthcare provider to examine the upper, outer quadrant of the breast (Tail of Spence). The reason for this is that the upper, outer quadrant is:

 

Select one:

 

 a.More prone to injury and calcifications than other locations in the breast

 

b.The largest quadrant of the breast

 

 c.The location of most breast tumors

 

 d.Where most of the suspensory ligaments attach

 

Question 27In performing an examination of a 2-year old with a suspected ear infection, the nurse would:

 

Select one:

 

 a.Pull the pinna down and back before inserting the speculum

 

 b.Omit the otoscopic exam if the child has a fever

 

 c.Ask the mother to leave the room while examining the child

 

 d.Pull the ear up and back before inserting the speculum

 

Question 28In performing auscultation of heart sounds, which sequence would the nurse use?

 

Select one:

 

 a.Aortic area – pulmonic area – Erb’s point – tricuspid area – mitral area

 

b.Aortic area – tricuspid area – Erb’s point – mitral area – pulmonic area

 

 c.Pulmonic area – aortic area – Erb’s point – tricuspid area – mitral area

 

 d.Pulmonic area – Erb’s point – tricuspid area – pulmonic area – mitral area

 

Question 29Select the best description of “review of systems” as part of the health history.

 

Select one:

 

 a.The recording of the objective findings of the practitioner

 

 b.A documentation of the problem as described by the patient

 

 c.A statement that describes the overall health state of the patient

 

 d.The evaluation of the past and present health state of each body system

 

Question 30The confrontation test is a gross measure of:

 

Select one:

 

 a.Eye strength and muscle movement

 

 b.Accommodation

 

 c.Visual acuity

 

 d.Peripheral vision

 

Question 31The main reason auscultation precedes percussion and palpation of the abdomen it to:

 

Select one:

 

 a.Determine areas of tenderness before using percussion and palpation

 

 b.Prevent distortion of vascular sounds such as bruits and hums that might occur after percussion and palpation

 

 c.Allow the patient more time to relax and therefore be more comfortable with the physical examination

 

 d.Prevent distortion of bowel sounds that might occur after percussion and palpation

 

Question 32The nurse assesses a patient presenting with nausea, vomiting and diarrhea.  What initial assessment is most appropriate for this patient?

 

Select one:

 

 a.Palpate abdomen, percuss abdomen, auscultate heart

 

 b.Blood draw, auscultate lungs and auscultate heart

 

 c.Auscultate abdomen, palpate abdomen and check cranial nerves

 

 d.Vital signs and assessing for dehydration

 

Question 33The nurse is assessing a patient with left ear conductive hearing loss. During the assessment the nurse performs the Weber test.  The nurse knows that:

 

Select one:

 

a.Sound will be louder in the affected ear

 

 b.Sound will be diminished in both ears

 

 c.Sound will be louder in the good ear

 

d.Sound will lateralize equally in both ears

 

Question 34The nurse is caring for a patient with a nursing diagnosis of impaired skin integrity related to a stage III decubitus ulcer.  What would be the most important assessment tool for the nurse to use in caring for this patient?

 

Select one:

 

 a.The Braden Scale

 

b.The Visual analog Scale

 

 c.Brief Pain Inventory

 

 d.McGill Pain Questionnaire

 

Question 35The nurse is caring for an 88 year-old man hospitalized with a fractured hip.  Assessment findings indicate that the patient is malnourished.  In conducting a comprehensive dietary assessment during the history, what would be the method of choice for determining this patient’s dietary intake?

 

Select one:

 

 a.Direct observation

 

 b.Patient’s weight

 

 c.24-hour recall

 

 d.BMI

 

Question 36The nurse is palpating the lymph nodes of a 25-year old man and notes an enlarged node on the back of his neck near the hairline.  The nurse recognizes this lymph node as the:

 

Select one:

 

 a.Infraclavicular

 

 b.Posterior cervical

 

 c.Submental

 

 d.Occipital

 

Question 37The nurse knows that bronchovesicular breath sounds are:

 

Select one:

 

 a.Expected near the major airways

 

 b.Similar to bronchial sounds except that they are shorter in duration

 

 c.Usually pathological

 

 d.Musical in quality

 

Question 38The sinuses that are not accessible to palpation include:

 

Select one:

 

 a.Occipital and mental

 

 b.Frontal and maxillary

 

 c.Ethmoid and sphenoid

 

d.Parotid and jugulodigastric

 

Question 39When assessing for CVA tenderness, you would tap on:

 

Select one:

 

 a.Area of the back overlying the kidneys

 

 b. Scapula area of posterior thorax

 

 c.Left lower quadrant

 

 d.Right upper quadrant

 

Question 40When assessing the lower extremities, it is critical for the examiner to:

 

Select one:

 

 a.Evaluate the venous system and then the arterial system

 

 b.Start at the femoral area

 

 c.Start at the head and work his/her way down

 

 d.Compare side to side

 

Question 41When assessing the range of motion of the wrist, the nurse asks the patient to move their forearms  so that the hands are facing up.  This movement would create a position known as:

 

Select one:

 

 a.Supination

 

b.Palmation

 

 c.Inversion

 

 d.Pronation

 

Question 42When listening to heart sounds, the nurse knows that which of the following statements concerning S1 is true?

 

Select one:

 

 a.S1 is caused by closure of the pyloric valve

 

 b.S1 is louder than S2 at the base

 

 c.S1 results from the closure of mitral and tricuspid valves

 

d.S1 indicates the beginning of diastole

 

 Question 43When one is testing the triceps reflex, what is the expected response?

 

Select one:

 

 a.Extension of the forearm

 

 b.Pronation of the hand

 

 c.Flexion and rotation of the forearm

 

 d.Flexion of the hand and wrist

 

Question 44When palpating the abdomen of a 20-year old patient, the nurse notes the presence of tenderness in the left, upper quadrant with deep palpation.  Which of the following structures is most likely to be involved?

 

Select one:

 

 a.Gallbladder

 

b.Spleen

 

 c.Sigmoid

 

d.Appendix

 

Question 45When performing the corneal light reflex assessment, the nurse notes that the light is reflected in the same spot in each eye.  The nurse would:

 

Select one:

 

 a.Document this as an asymmetric light reflex

 

 b.Refer the individual for further evaluation

 

 c.Consider this a normal finding

 

 d.Perform the confrontation test to validate the findings

 

Question 46When the nurse asks a 68-year old patient to stand with feet together and arms at his side with his eyes

 

closed, he starts to sway and moves his feet further apart.  The nurse would document this finding as:

 

Select one:

 

 a.Positive Romberg’s sign

 

b.Negative Homan’s sign

 

 c.Lack of coordination

 

 d.Positive Pronator drift

 

Question 47Which of the following are appropriate locations for eliciting reflexes?

 

Select one:

 

 a.Femoral and Popliteal

 

 b.Abdominal and Thoracic area

 

 c.Scapular and Femoral

 

 d.Patellar and Achilles

 

Question 48Which of the following cranial nerves are used to assess swallowing, voice, gag reflex and tongue movement?

 

Select one:

 

 a.CN IX, X XI

 

 b.CN VII, X, IX

 

 c.CN IX, X, XII

 

 d.CN VII, X, XI

 

Question 49Which of the following statements would be considered subjective data?

 

Select one:

 

 a.Thyroid palpable

 

b.Rash after a bee sting

 

 c.Denies edema or difficulty breathing after bee sting

 

 d.Suggest allergy work-up for bee sting allergy

 

Question 50You are describing how to perform a testicular self examination to a patient.  Which of the following statements is most appropriate?

 

Select one:

 

 a.A good time to examine your testicles is just before you take a shower

 

 b.If you notice enlarged testicles or a painless mass, call your healthcare provider

 

 c.The testicle is egg shaped and movable.  It feels firm and has a lumpy consistency

 

 d.Perform testicular exam at least once a week to detect early stages of testicular cancer

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