Assessment of the Pediatric Patient Exam Questions
Course Introduction
Assessment of the Pediatric Patient focuses on the foundational knowledge and clinical skills necessary for evaluating infants, children, and adolescents in a healthcare setting. The course covers age-appropriate communication, developmental milestones, pediatric vital signs, and the unique physiological and psychosocial differences in pediatric patients compared to adults. Through a combination of theoretical instruction and practical application, students learn to perform systematic physical examinations, identify common pediatric illnesses, interpret assessment findings, and recognize signs of abuse or neglect. Emphasis is placed on family-centered care and cultural competence to ensure the delivery of effective, sensitive, and holistic pediatric health assessments.
Recommended Textbook
Physical Examination and Health Assessment Canadian 2nd Edition by Carolyn Jarvis
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1148 Verified Questions
1148 Flashcards
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Chapter 1: Critical Thinking and Evidence-Informed Assessment
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35 Verified Questions
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Sample Questions
Q1) When listening to a patient's breath sounds,the nurse is unsure about a sound that is heard.The nurse should:
A)notify the patient's physician immediately.
B)document the sound exactly as it was heard.
C)validate the data by asking a colleague to listen to the breath sounds.
D)assess again in 20 minutes to note whether the sound is still present.
Answer: C
Q2) Critical thinking in the expert nurse is greatly enhanced by opportunities to:
A)apply theory in real situations.
B)work with physicians to provide patient care.
C)follow physician orders in providing patient care.
D)develop nursing diagnoses for commonly occurring illnesses.
Answer: A
Q3) A teenager who was stung by a bee during a soccer match is having trouble breathing
A) first-level priority problem
B) second-level priority problem
C) third-level priority problem
Answer: C
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Chapter 2: Health Promotion in the Context of Health Assessment
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Sample Questions
Q1) Which of the following groups has the shortest life expectancy in Canada?
A)Health care providers
B)First Nations and Inuit people
C)Females in relation to males
D)Immigrant workers
Answer: B
Q2) Which of the following is an example of primary prevention?
A)Pap test
B)Immunization against polio
C)Mammography
D)Teaching foot care to a newly diagnosed diabetic
Answer: B
Q3) Which of the following is the most commonly used developmental screening tool?
A)Denver Developmental Screening Test (DDST)
B)Ages and Stages Questionnaires (ASQs)
C)Nipissing District Developmental Screen (NDDS)
D)Parents' Evaluation of Developmental Status (PEDS)
Answer: C
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Chapter 3: Cultural Competence: Cultural Care and Social
Considerations in Health Assessment
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41 Verified Questions
41 Flashcards
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Sample Questions
Q1) Expecting that all Chinese persons believe in the hot-cold theory of health and illness is an example of:
A)critical cultural perspective.
B)culturalism.
C)ethnic practice.
D)ethnicity.
Answer: B
Q2) Canada's population as a whole is aging,and for the first time in Canadian history,which age group has exceeded that of people aged 15 to 24?
A)Under 15 years of age
B)35-44 years
C)55-64 years
D)Over 65 years
Answer: C
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5
Chapter 4: The Interview
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Sample Questions
Q1) Mrs.H.has just entered the emergency department after being battered by her husband.The nurse will need to get some information from her before beginning treatment.Which of the following is the best choice for an opening statement with this patient?
A)"Nancy,my name is Mrs.C."
B)"Hello,Mrs.H. ,my name is Mrs.C.It sure is cold today!"
C)"Mrs.H. ,my name is Mrs.C.You sure look like you're in pain.Can I get you anything?"
D)"Mrs.H. ,my name is Mrs.C.I'll need to ask you a few questions about what happened."
Q2) The nurse is interviewing a patient who has a hearing impairment.What technique would be most beneficial in communicating with this patient?
A)Assess the communication method preferred by the patient.
B)Avoid using facial expressions and hand gestures because most persons with hearing impairment find this degrading.
C)Request the help of a sign language interpreter before meeting with the patient.
D)Speak loudly and with exaggerated facial movement when talking with the patient because this facilitates lip reading.
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Chapter 5: The Complete Health History
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Sample Questions
Q1) A patient is describing his symptoms to the nurse.Which of the following statements is a description of the setting of his symptoms?
A)"It is a sharp,burning pain in my stomach."
B)"I also have the sweats and nausea when I feel this pain."
C)"I think this pain is telling me that something is wrong with me."
D)"This pain happens every time I sit down to use the computer."
Q2) A 29-year-old woman tells the nurse that she has "excruciating pain" in her back.Which of the following would be an appropriate response by the nurse?
A)"How does your family react to your pain?"
B)"That must be terrible.You probably pinched a nerve."
C)"I've had back pain myself,and I know it can be excruciating."
D)"How would you say the pain affects your ability to carry on your daily activities?"
Q3) Which of the following is the appropriate health promotion question to ask during a review of symptoms?
A)"Do you use sunscreen while outside?"
B)"I need to see if your skin is warm and dry."
C)"Have you experienced any dizziness or headaches?"
D)"When you cough,what colour is the sputum you bring up?"
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Chapter 6: Mental Health Assessment
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Sample Questions
Q1) A patient drifts off to sleep when there is no stimulation.The nurse can arouse her easily by calling her name,but she remains drowsy during the conversation.The best description of this patient's level of consciousness would be:
A)lethargic.
B)obtunded.
C)stuporous.
D)semialert.
Q2) A patient has been in the critical care unit for 10 days.He has just been moved to the medical-surgical unit,and the admitting nurse is planning to perform a mental health examination.During the cognitive function tests,the nurse would expect that he:
A)might display some disruption in thought content.
B)might state,"I am so relieved to be out of critical care."
C)might be oriented to place and person but not be certain of the date.
D)might show evidence of some clouding of consciousness.
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Chapter 7: Substance Use in the Context of Health Assessment
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25 Flashcards
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Sample Questions
Q1) Which is one of the 5 As for integrating knowledge of substance use in health assessment?
A)Assess own values and attitudes.
B)Avoid social judgement.
C)Assume that substance use is a choice.
D)Anticipate social behavioural problems.
Q2) Which of the following is a key assumption about substance use that must be challenged?
A)Cannabis should be legalized.
B)Use is a matter of personal choice.
C)The war on drugs is important.
D)Harm-reduction strategies are effective.
Q3) Who has the greatest chance of success in a substance misuse treatment program?
A)A 22-year-old female who misuses alcohol and tobacco
B)A 38-year-old male who misuses heroin and tobacco
C)A 62-year-old female who misuses alcohol and marijuana
D)A 43-year-old single mother of three school-aged children who misuses alcohol
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Chapter 8: Interpersonal Violence Assessment
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Sample Questions
Q1) The nurse is assessing an older woman and suspects elder abuse.Which of the following questions are appropriate for screening for abuse? (Select all that apply. )
A)Has anyone ever physically hurt you?
B)Are you being abused?
C)Are you alone a lot?
D)Are you afraid of anybody at home or who enters your home?
E)Has anyone ever failed to take care of you when you needed help?
Q2) When assessing bruises,which colour indicates a new bruise that is less than 2 hours old?
A)Red
B)Purple-blue
C)Greenish brown
D)Brownish yellow
Q3) The nurse is a mandatory reporter of child abuse.Which of the following must be present before authorities should be notified?
A)Statements from the victim
B)Statements from witnesses
C)Proof of abuse and neglect
D)Suspicion of child abuse and neglect
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Chapter 9: Assessment Techniques and the Clinical Setting
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Sample Questions
Q1) When preparing to perform a physical examination on an infant,the examiner should:
A)have the parent remove all clothing except the diaper on a male infant.
B)instruct the parent to feed the infant immediately before the examination.
C)encourage the infant to suck on a pacifier during the abdominal examination.
D)ask the parent to briefly leave the room when assessing the infant's vital signs.
Q2) A man is at the clinic for a physical examination.He states that he is "very anxious" about the physical examination.What steps can the examiner take to make him feel more comfortable?
A)Appear unhurried and confident during the examination.
B)Stay in the room when the patient undresses in case assistance is needed.
C)Ask the patient to change into an examining gown and then to take off his undergarments.
D)Defer measuring vital signs until the end of the examination,which allows the patient time to become comfortable.
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Chapter 10: General Survey, measurement, and Vital Signs
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Sample Questions
Q1) Which of the following statements about the force,or strength,of the pulse is true?
A)It is usually recorded on a 0- to 2-point scale.
B)It demonstrates elasticity of the vessel wall.
C)It is a reflection of the heart's stroke volume.
D)It reflects the blood volume in the arteries during diastole.
Q2) Which of the following best describes mean arterial pressure (MAP)?
A)It is the pressure of the arterial pulse.
B)It reflects the stroke volume of the heart.
C)It is the pressure forcing blood into the tissues,averaged over the cardiac cycle.
D)It is an average of the systolic and diastolic BPs and reflects tissue perfusion.
Q3) Which of the following statements about taking an axillary temperature is true?
A)A stable axillary temperature will register after 3 minutes.
B)The accuracy and reliability of this method are well established.
C)Its results are closer to the core temperature than the inguinal method.
D)The axillary method is safer and more accessible than the rectal method.
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Chapter 11: Pain Assessment
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Sample Questions
Q1) A 4-year-old boy is brought to the emergency department by his mother.She says he points to his stomach and says,"It hurts so bad." Which pain assessment tool would be the best choice when assessing this child's pain?
A)The Descriptor Scale
B)A numeric rating scale
C)The Brief Pain Inventory
D)The Faces Pain Scale
Q2) When assessing the quality of a patient's pain,which of the following questions should the nurse ask the patient?
A)"When did the pain start?"
B)"Is the pain a stabbing pain?"
C)"Is it a sharp pain or a dull pain?"
D)"What does your pain feel like?"
Q3) The nurse is assessing a patient's pain.Which of the following is considered the most reliable indicator of pain?
A)Vital signs
B)The physical examination
C)Computerized axial tomography scan findings
D)The subjective report
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Chapter 12: Nutritional Assessment and Nursing Practice
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42 Verified Questions
42 Flashcards
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Sample Questions
Q1) A patient is at the clinic on his first visit and reports no history of nutrition-related problems.Which of the following should the initial nutritional screening include?
A)Calorie count of nutrients
B)Anthropometric measures
C)Complete physical examination
D)Measurement of weight and weight history
Q2) Which of the following measurements is an early indicator of protein malnutrition?
A)Serum albumin
B)Serum creatinine
C)Nitrogen balance
D)Serum transferrin
Q3) In teaching a patient how to determine total body fat at home,the nurse includes instructions to obtain measurements of:
A)height and weight.
B)frame size and weight.
C)waist and hip circumferences.
D)mid-upper arm circumference and arm span.
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14
Chapter 13: Skin, hair, and Nails
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Sample Questions
Q1) The papule on the nose of a 52-year-old woman has rounded,pearly borders and a central red ulcer.She tells the nurse that it has been present for several months and is slowly growing larger.Which of the following conditions does the nurse suspect?
A)Acne
B)Basal cell carcinoma
C)Malignant melanoma
D)Squamous cell carcinoma
Q2) A physician has diagnosed a patient with purpura. After leaving the room, a nursing student asks the nurse what the physician saw that led to that diagnosis. The nurse should say:
A)"It is the blue dilation of blood vessels in a star-shaped pattern on the legs."
B)"It is the fiery red,star-shaped marking on the cheek that has a solid circular centre."
C)"It is the confluent and extensive patch of petechiae and ecchymoses on the feet."
D)"It is the tiny little areas of hemorrhage that are less than 2 mm,round,discrete,and dark red in colour."
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15
Chapter 14: Head and Neck, including Regional Lymphatic System
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Sample Questions
Q1) A visitor from Poland who does not speak English appears somewhat apprehensive while the nurse is examining his neck.He would probably be most comfortable if the nurse were examining his thyroid:
A)from behind,with the nurse's hands placed firmly around his neck.
B)from the side,with the nurse's eyes averted toward the ceiling and the thumbs on his neck.
C)from the front,with the nurse's thumbs placed on either side of his trachea and his head tilted forward.
D)from the front,with the nurse's thumbs placed on either side of his trachea and his head tilted backward.
Q2) The nurse is performing an assessment on a 7-year-old child who has the following symptoms: chronic watery eyes,sneezing,and clear nasal drainage.The nurse notes the presence of a transverse line across the bridge of the nose,dark blue shadows under the eyes,and a double crease on the lower eyelids.These findings are characteristic of:
A)allergies.
B)a sinus infection.
C)nasal congestion.
D)an upper respiratory infection.
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Chapter 15: Eyes
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Sample Questions
Q1) When performing the corneal light reflex assessment,the nurse notes that the light is reflected at the 2 o'clock position in each eye.The nurse would:
A)consider this a normal finding.
B)refer the individual for further evaluation.
C)document this as an asymmetrical light reflex.
D)perform the confrontation test to validate the findings.
Q2) A 2-week-old infant can fixate on an object but not follow a light or bright toy.The nurse would:
A)consider this a normal finding.
B)assess the pupillary light reflex for possible blindness.
C)continue with the examination and assess visual fields.
D)expect that a 2-week-old infant should be able to fixate and follow an object.
Q3) Intraocular pressure is determined by the:
A)thickness or bulging of the lens.
B)posterior chamber as it accommodates an increase in fluid.
C)contraction of the ciliary body in response to the aqueous humor within the eye.
D)amount of aqueous humor produced and resistance to its outflow at the angle of the anterior chamber.
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Chapter 16: Ears
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Sample Questions
Q1) Which of the following signs would the nurse expect to find on assessment of an individual with otitis externa?
A)Rhinorrhea
B)Periorbital edema
C)Pain over the maxillary sinuses
D)Enlarged regional lymph nodes
Q2) A 31-year-old patient tells the nurse that he is experiencing a progressive loss of hearing.He says that it does seem to help when people speak more loudly or if he turns up the volume.The most likely cause of his hearing loss is:
A)otosclerosis.
B)presbycusis.
C)trauma to the bones.
D)frequent ear infections.
Q3) The nurse is preparing to do an otoscopic examination on a 2-year-old child.Which of the following reflects correct procedure?
A)Pull the pinna down.
B)Pull the pinna up and back.
C)Tilt the child's head slightly toward the examiner.
D)Have the child touch his chin to his chest.
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Page 18
Chapter 17: Nose, mouth, and Throat
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Sample Questions
Q1) The nurse is unable to suction the nares of a newborn immediately following delivery.The attempt to pass a catheter through both nasal cavities has met with no success.What would be the nurse's best action in this situation?
A)Attempt to suction again with a bulb syringe.
B)Wait for a few minutes and try again once the infant stops crying.
C)Recognize that this situation requires immediate intervention.
D)Request the physician's assistance as soon as possible.
Q2) The nurse is obtaining history for a 3-month-old infant.During the interview,the mother states,"I think she is getting her first tooth because she has started drooling a lot."
The nurse's best response would be:
A)"You're right,drooling is usually a sign of the eruption of the first tooth."
B)"It would be unusual for a 3-month-old to be getting her first tooth."
C)"This could be the sign of a problem with the salivary glands."
D)"She is just starting to salivate and hasn't learned to swallow the saliva."
Q3) Which of the following about a newborn infant is true?
A)The sphenoid sinuses are at full size at birth.
B)The maxillary sinuses reach full size after puberty.
C)The frontal sinuses are fairly well developed at birth.
D)The maxillary and ethmoid sinuses are the only ones present at birth.
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Page 19
Chapter 18: Breasts and Regional Lymphatic System
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Sample Questions
Q1) If a patient reports a recent infection in the breast,the nurse would expect to find:
A)nonspecific node enlargement.
B)ipsilateral axillary node enlargement.
C)contralateral axillary node enlargement.
D)inguinal and cervical node enlargement.
Q2) During breast palpation,which of the following positions is most likely to clearly delineate significant lumps?
A)Supine,with arms raised over her head
B)Sitting,with arms relaxed at the sides
C)Supine,with arms relaxed at the sides
D)Sitting,with arms flexed and fingertips touching shoulders
Q3) During assessment of a woman's axillary lymph system,the nurse will assess the:
A)central,axillary,lateral,and sternal nodes.
B)pectoral,lateral,anterior,and sternal nodes.
C)central,lateral,pectoral,and subscapular nodes.
D)lateral,pectoral,axillary,and suprascapular nodes.
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Chapter 19: Thorax and Lungs
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Sample Questions
Q1) Which statement about the apices of the lungs is true? The apices of the lungs:
A)are at the level of the second rib anteriorly.
B)extend 3 to 4 cm above the inner third of the clavicles.
C)are located at the sixth rib anteriorly and the eighth rib laterally.
D)rest on the diaphragm at the fifth intercostal space in the midclavicular line.
Q2) The person says "ninety-nine" repeatedly while the chest wall is being auscultated.Normally,a sound will be heard,but the examiner will not be able to distinguish exactly what is being said.
A)Bronchophony
B)Egophony
C)Whispered pectoriloquy
Q3) A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure.Which of the following is the nurse most likely to observe in this patient?
A)Shortness of breath,orthopnea,paroxysmal nocturnal dyspnea,ankle edema
B)Rasping cough,thick mucoid sputum,wheezing
C)Productive cough,dyspnea,weight loss,anorexia
D)Fever,dry nonproductive cough,bronchial breath sounds
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Page 21
Chapter 20: Heart and Neck Vessels
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Sample Questions
Q1) During assessment of a patient,the nurse notes that the apical impulse is displaced laterally and is palpable over a wide area.This indicates:
A)systemic hypertension.
B)pulmonic hypertension.
C)pressure overload,as in aortic stenosis.
D)volume overload,as in mitral regurgitation.
Q2) The mother of a 10-month-old baby tells the nurse that she has noticed that her son turns blue whenever he is crying and that this is happening more and more frequently.He is also not crawling yet.During examination,the nurse identifies a thrill at the left lower sternal border as well as a loud systolic murmur.What would be the most likely cause of these findings?
A)Tetralogy of Fallot
B)Atrial septal defect
C)Patent ductus arteriosus
D)Ventricular septal defect
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22
Chapter 21: Peripheral Vascular System and Lymphatic System
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Sample Questions
Q1) When auscultating over a patient's femoral arteries,the nurse notes a bruit on the left side.The nurse knows that:
A)bruits are often associated with venous disease.
B)bruits occur in the presence of lymphadenopathy.
C)hypermetabolic states will cause bruits in the femoral arteries.
D)bruits occur with turbulent blood flow,indicating partial occlusion.
Q2) During a routine visit to the clinic,a patient takes off his shoes and shows the nurse
"this awful sore that won't heal." On examination,the nurse notes on the left great toe a 3-cm round ulcer with a pale ischemic base,well-defined edges,and no drainage.The nurse will assess for other signs and symptoms of:
A)varicosities.
B)a venous stasis ulcer.
C)an arterial ischemic ulcer.
D)pitting edema.
Q3) The nurse is aware that a positive Homan's sign in a patient:
A)occurs with venous insufficiency.
B)is indicative of possible thrombophlebitis.
C)is seen in the presence of severe edema.
D)indicates problems with arterial circulation.
Page 23
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Chapter 22: Abdomen
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Sample Questions
Q1) A patient is suspected of having cholecystitis (inflammation of the gallbladder).The nurse will conduct which of the following to assess for this condition?
A)Obturator test
B)Murphy's sign
C)Assessment for rebound tenderness
D)Iliopsoas muscle test
Q2) A 22-year-old man falls with his motorcycle and lands on the handlebars on his left side.He comes to the clinic for an examination.The nurse suspects that he may have injured his spleen.Which of the following is true regarding assessment of the spleen in this situation?
A)The spleen can be enlarged as a result of trauma.
B)The spleen is normally felt upon routine palpation.
C)If an enlarged spleen is noted,palpate it thoroughly to determine size.
D)An enlarged spleen should not be palpated because it can rupture easily.
Q3) The nurse knows that a potential cause of hypoactive bowel sounds is:
A)diarrhea.
B)peritonitis.
C)laxative use.
D)gastroenteritis.
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Page 24
Chapter 23: Anus,rectum and Prostate
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Sample Questions
Q1) The nurse notes that a patient has had a pale,yellow,greasy stool,or steatorrhea,and recalls that this is caused by:
A)occult bleeding.
B)absent bile pigment.
C)increased fat content.
D)ingestion of bismuth preparations.
Q2) A 30-year-old woman is visiting the clinic for a complaint of "pain in my bottom when I have a bowel movement." The nurse should assess for which problem?
A)Pinworms
B)Hemorrhoids
C)Food poisoning
D)Fecal incontinence
Q3) While performing a rectal examination,the nurse notes a firm,irregularly shaped mass.What should the nurse do next?
A)Continue with the exam,and note the finding in the chart.
B)Instruct the patient to return for a repeat assessment in 1 month.
C)Tell the patient that a mass was felt,but that it is nothing to worry about.
D)Report the finding,and refer the patient to a specialist for further examination.
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Chapter 24: Musculoskeletal System
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Sample Questions
Q1) When performing a musculoskeletal assessment,the nurse knows that the correct approach for the examination should be head to toe and:
A)proximal to distal.
B)distal to proximal.
C)posterior to anterior.
D)anterior to posterior.
Q2) The knee joint is the articulation of the femur,the tibia,and the: A)fibula.
B)radius.
C)patella.
D)humerus.
Q3) The nurse is explaining the growth of long bones to a mother of a toddler.The nurse knows that bones increase in width or diameter by deposition of new bony tissue around the shafts.The nurse also knows that lengthening occurs at the: A)bursa.
B)calcaneus.
C)epiphyses.
D)tuberosities.
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Chapter 25: Neurological System
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Sample Questions
Q1) The nurse is performing a neurological assessment for a 41-year-old woman with a history of diabetes.When testing her ability to feel the vibrations of a tuning fork,the nurse notes that the woman is unable to feel vibrations on the great toe or ankle bilaterally but is able to feel vibrations on both patellae.Given this information,what would the nurse suspect?
A)Hyperalgesia
B)Hyperesthesia
C)Peripheral neuropathy
D)Lesion of sensory cortex
Q2) A patient is not able to perform rapid,alternating movements such as patting her knees quickly.The nurse would document this as:
A)ataxia.
B)astereognosis.
C)the presence of dysdiadochokinesia.
D)a probable abnormality in the cerebellum.
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Chapter 26: Male Genitourinary System
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Sample Questions
Q1) Which of the following findings is considered normal when the nurse is performing a testicular examination on a 25-year-old man?
A)Nontender subcutaneous plaques
B)A scrotal area that is dry,scaly,and nodular
C)Testes that feel oval and movable,and are slightly sensitive to compression
D)A single,hard,circumscribed,movable mass,less than 1 cm under the surface of the testes
Q2) The nurse is performing a genital examination on a male patient and notes urethral drainage.When collecting urethral discharge for microscopic examination and culture,the nurse should:
A)ask the patient to urinate into a sterile cup.
B)ask the patient to obtain a specimen of semen.
C)insert a cotton-tipped applicator into the urethra.
D)compress the glans between the examiner's thumb and forefinger,and collect any discharge.
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Chapter 27: Female Genitourinary System
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Sample Questions
Q1) An 11-year-old girl is in the clinic for a sports physical.The nurse notes that she has begun to develop breasts,and during the conversation the girl reveals that she is unsure about the progression of development.The nurse should use which of the following to best assist the young girl in understanding the expected sequence for development?
A)The nurse should use Tanner's table on the five stages of sexual development.
B)The nurse should describe her development and compare it with that of other girls her age.
C)Jacobsen's table on expected development on the basis of height and weight data should be used.
D)The nurse should reassure her that her development is within normal limits and tell her not to worry about the next step.
Q2) A nonpregnant patient tells the nurse that she has had three pregnancies and two live births.How would the nurse record this information?
A)G2 P2 A1
B)G3 P2 A0
C)G3 P2 A1
D)G3 P3 A1
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Page 29
Chapter
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Sample Questions
Q1) During an examination,the nurse finds that a patient is unable to distinguish objects placed in his hand.The nurse would document: (This question reflects the results an examiner may find during a complete physical examination.Content in this question is not necessarily addressed directly in Jarvis' Physical Examination & Health Assessment. )
A)stereognosis.
B)astereognosis.
C)graphesthesia.
D)agraphesthesia.
Q2) During an examination,a patient has successfully completed the finger-to-nose and the rapid-alternating-movements tests,and is able to run each heel down the opposite shin.The nurse will conclude that the patient's:
A)occipital function is intact.
B)cerebral function is intact.
C)temporal function is intact.
D)cerebellar function is intact.
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Chapter 29: Bedside Assessment of the Hospitalized Patient
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Q1) The nurse has administered a pain medication to a patient by IV infusion.The nurse should reassess the patient's response to the pain medication within:
A)5 minutes.
B)15 minutes.
C)30 minutes.
D)60 minutes.
Q2) During an assessment,the nurse is unable to palpate pulses in the left lower leg.The nurse should:
A)document that the pulses are not palpable.
B)reassess the pulses in 1 hour.
C)have the patient turn to the side,and then palpate for the pulses again.
D)use a Doppler device to assess the pulses.
Q3) During an assessment of a hospitalized patient,the nurse pinches a fold of skin under the clavicle or on the forearm to note:
A)mobility and turgor.
B)the patient's response to pain.
C)the percentage of the patient's fat-to-muscle ratio.
D)the presence of edema.
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Chapter 30: Pregnancy
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Sample Questions
Q1) During auscultation of fetal heart tones (FHTs),the nurse determines that the rate is 136 beats per minute.The nurse's next action should be to:
A)document the results,which are within normal range.
B)take the maternal pulse to verify these findings as the uterine souffle.
C)have the patient change positions and count the FHTs again.
D)notify the physician immediately for possible fetal distress.
Q2) During the health history of a woman who is pregnant with her first child,the woman states,"I just cannot stop crunching on ice! What's wrong with me?" The nurse recognizes that:
A)she is experiencing a common food intolerance.
B)the woman is experiencing pica,or craving for nonfood items,which is sometimes associated with anemia.
C)she may be experiencing gastrointestinal changes associated with pregnancy.
D)she probably craved ice before her pregnancy,and this is nothing new.
Q3) The nurse knows that classic symptoms associated with pre-eclampsia include:
A)proteinuria,headaches,and seizures.
B)elevated blood pressure and proteinuria.
C)elevated liver enzymes and high platelet count.
D)neurological signs,elevated blood pressure,and edema.
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Page 32
Chapter 31: Functional Assessment of the Older Adult
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Q1) The nurse is preparing to assess an older adult and discovers that he is in severe pain.Which of the following statements about pain and the older adult is true?
A)Pain is inevitable with aging.
B)Older adults with cognitive impairment feel less pain.
C)Alleviating pain should take priority over other aspects of the assessment.
D)The assessment should take priority so that care decisions can be made.
Q2) During an assessment of a newly admitted 92-year-old woman,the nurse notes that her son does not want to leave the room.The woman has signs of old bruises and healed cuts that happened "last week," according to the son.Which of the following actions by the nurse is appropriate?
A)Ask the son for details about the nature of the patient's injuries.
B)Recognize that older people are often unsteady on their feet and that falls do occur.
C)Notify the authorities of a potential abusive situation.
D)Recognize that these findings do not necessarily indicate that abuse has occurred but are signs that further assessment is needed.
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