Bachelor of Science in Nursing (BScN) Health Assessment
Textbook Exam Questions
Course Introduction
The Bachelor of Science in Nursing (BScN) Health Assessment course equips students with foundational knowledge and practical skills necessary to systematically evaluate the physical, psychological, and social health status of individuals across the lifespan. Emphasizing a holistic and culturally sensitive approach, the course covers techniques for effective communication, data collection, health history taking, and comprehensive physical examination. Students learn to identify normal and abnormal findings, document assessments accurately, and utilize critical thinking to inform clinical decision-making. Through interactive lectures, hands-on laboratory sessions, and clinical practice, learners develop competencies essential for safe and effective patient care in diverse healthcare settings.
Recommended Textbook
Physical Examination and Health Assessment Canadian 2nd Edition by Carolyn Jarvis
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31 Chapters
1148 Verified Questions
1148 Flashcards
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Page 2
Chapter 1: Critical Thinking and Evidence-Informed Assessment
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35 Verified Questions
35 Flashcards
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Sample Questions
Q1) A visiting nurse is making an initial home visit to a patient who has a number of chronic medical problems.Which type of database is most appropriate to collect in this setting?
A)A follow-up database to evaluate changes at appropriate intervals
B)An episodic database because of the continuing,complex medical problems of this patient
C)A complete health database because of the nurse's primary responsibility for monitoring the patient's health
D)An emergency database because of the need to rapidly collect information and make accurate diagnoses
Answer: C
Q2) Which critical thinking skill helps the nurse recognize relationships among data?
A)Validation
B)Clustering-related cues
C)Identifying gaps in data
D)Distinguishing relevant from irrelevant
Answer: B
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3
Chapter 2: Health Promotion in the Context of Health Assessment
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15 Flashcards
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Sample Questions
Q1) Screening is based upon which of the following?
A)Age
B)Gender
C)Prevalence of disease in the population
D)Health status of a specific population
Answer: C
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) According to Pender's Health Promotion Model,which of the following is an example of behaviour-specific cognition and affect?
A)Prior related behaviour
B)Biological personal factors
C)Perceived self-efficacy
D)Immediate competing demands
Answer: C
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Chapter 3: Cultural Competence: Cultural Care and Social
Considerations in Health Assessment
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Sample Questions
Q1) "Aboriginal peoples" refers to which of the following groups?
A)First Nations
B)Métis
C)Inuit
D)First Nations,Métis,and Inuit
Answer: D
Q2) A 47-year-old woman who is a recent immigrant to Canada is being seen at the clinic today for her uncontrolled diabetes.The nurse knows that the patient lives with her husband and a large extended family.The nurse concludes that part of the patient's inability to maintain and comply with her diet and diabetic regime is the foods that this patient eats.This conclusion is an example of:
A)cultural sensitivity.
B)cultural safety.
C)cultural perspective.
D)culturalism.
Answer: D
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Page 5
Chapter 4: The Interview
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Sample Questions
Q1) Because the physical environment in which an interview takes place is an important consideration for the success of the interview,the interviewer should:
A)reduce noise by turning off televisions and radios.
B)keep a distance of about 0.6 m (2 ft)or closer between himself or herself and the patient.
C)ensure dim lighting that makes the room cozier and will help the patient relax.
D)arrange seating across a desk or table to allow the patient some personal space.
Q2) A female nurse is interviewing a male patient who is close in age to the nurse.During the interview,the patient makes an overtly sexual comment.The nurse's best response would be:
A)"Stop that immediately!"
B)"Oh,you are too funny.Let's keep going with the interview."
C)"Do you really think I'd be interested?"
D)"It makes me uncomfortable when you talk that way.Please don't."
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Chapter 5: The Complete Health History
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Sample Questions
Q1) 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?"
Q2) 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."
Q3) What question would you initially ask a patient who has a positive tuberculin test?
A)Have you recently been hospitalized?
B)Are you a member of the homeless population?
C)Have you received bacille Calmette-Guérin (BCG)?
D)Have you been out of the country over the past 3 months?
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Chapter 6: Mental Health Assessment
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Sample Questions
Q1) The nurse is assessing a 75-year-old male patient.At the beginning of the mental status portion of the assessment,the nurse expects that this patient:
A)will have no decrease in any of his abilities,including response time.
B)will have difficulty on tests of remote memory because this typically decreases with age.
C)may take a little longer to respond,but his general knowledge and abilities should not have declined.
D)will have had a decrease in his response time because of language loss and a decrease in general knowledge.
Q2) A patient has been diagnosed with schizophrenia.During a recent interview,he shows the nurse a picture of a man holding a decapitated head.He describes this picture as horrifying but laughs loudly when looking at it.This behaviour is a display of:
A)confusion.
B)ambivalence.
C)depersonalization.
D)inappropriate affect.
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Chapter 7: Substance Use in the Context of Health Assessment
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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) According to the Canadian Nurses Association,which of the following is a principle of harm reduction?
A)Harm reduction focuses on reducing harm associated with a narrow range of substances.
B)Harm reduction requires abstinence and discontinuation of substance use.
C)Harm reduction is the opposite of prevention and treatment approaches.
D)Harm reduction requires substance users to participate in policy making and program development.
Q3) An example of a harm-reduction strategy is:
A)posted speed limit signs.
B)tobacco advertising.
C)helmet use on bicycles.
D)raising the legal age for alcohol consumption.
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Chapter 8: Interpersonal Violence Assessment
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Sample Questions
Q1) When documenting IPV and elder abuse,the nurse should include:
A)photographic documentation of injuries.
B)a summary of the abused person's statements.
C)verbatim documentation of every statement made by the abused person.
D)a general description of injuries in the progress notes.
Q2) During an examination,the nurse notices a patterned injury on a patient's back.Which of the following would cause such an injury?
A)Blunt force
B)Friction abrasion
C)Stabbing with a kitchen knife
D)Whipping from an extension cord
Q3) In which following situation is the nurse required to perform intimate partner violence (IPV)screening?
A)When IPV is suspected
B)When a woman has an unexplained injury
C)As a routine part of each health care encounter
D)When there is a known history of abuse in the family
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10
Chapter 9: Assessment Techniques and the Clinical Setting
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Sample Questions
Q1) The nurse hears bilateral,louder,longer,and lower pitched tones when percussing over the lungs of a 4-year-old child.What should the nurse do next?
A)Palpate over the area to identify increased pain and tenderness.
B)Ask the child to take shallow breaths,and percuss over the area again.
C)Refer the child immediately because of suspicion of an increased amount of air in the lungs.
D)Consider this a normal finding for a child this age,and proceed with the examination.
Q2) Which of the following assessment techniques is used to determine the presence of crepitus,swelling,and pulsations?
A)Palpation
B)Inspection
C)Percussion
D)Auscultation
Q3) Fingers and thumb in a grasping action
A)Should be used to detect the shape and consistency of a mass in the axilla
B)Best for evaluating skin texture over the abdomen.
C)Used to determine the temperature of the patient's skin.
D)Best for detecting vibration over the thorax and abdomen.
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Chapter 10: General Survey, measurement, and Vital Signs
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Sample Questions
Q1) In which of the following patients should the nurse measure rectal temperatures?
A)A school-age child
B)An older adult
C)A comatose adult
D)A patient who is receiving oxygen through a nasal cannula
Q2) A 75-year-old man has a history of hypertension and was recently prescribed a new antihypertensive drug.He reports feeling dizzy at times.How should the nurse evaluate his BP?
A)Assess BP and pulse with the patient in the supine,sitting,and standing positions.
B)Have him walk around the room,and assess his BP after the activity.
C)Assess BP and pulse at the beginning as well as at the end of the examination.
D)Take the BP on the right arm and then 5 minutes later on the left arm.
Q3) 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.
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Chapter 11: Pain Assessment
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Sample Questions
Q1) When assessing the intensity of a patient's pain,which of the following questions by the nurse would be appropriate?
A)"What makes your pain better or worse?"
B)"How much pain do you have now?"
C)"How does pain limit your activities?"
D)"What does your pain feel like?"
Q2) Which statement about pain experienced by infants is true?
A)Pain in infants can only be assessed through findings of physiological changes,such as increased heart rate.
B)The Faces Pain Scale can be used to assess pain in infants.
C)A procedure that induces pain in adults will also induce pain in infants.
D)Infants feel pain less than adults do.
Q3) Which of the following statements indicates that the nurse understands the pain experience in older adults?
A)"Older persons must learn to tolerate pain."
B)"Pain is a normal process of aging and is to be expected."
C)"Pain indicates pathology or injury and is not a normal process of aging."
D)"Older adults perceive pain to a lesser degree than do younger individuals."
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13
Chapter 12: Nutritional Assessment and Nursing Practice
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Sample Questions
Q1) During nutritional assessment,why is it important for the nurse to ask a patient what medications he or she is taking?
A)Certain medications can affect the metabolism of nutrients.
B)The nurse needs to assess the patient for allergic reactions.
C)Medications must be documented on the patient record for the physician's review.
D)Medications can affect one's memory and ability to identify foods eaten in the last 24 hours.
Q2) Which of the following persons does the nurse recognize to be at greatest risk for undernutrition?
A)A 5-month-old infant
B)A 50-year-old woman
C)A 20-year-old community college student
D)A 30-year-old hospital administrator
Q3) A 40-year-old woman with a waist-hip ratio of 1.2 is considered:
A)to be underweight.
B)to be within normal limits of weight.
C)to have upper body obesity.
D)to be malnourished and low on fat stores.
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Chapter 13: Skin, hair, and Nails
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Sample Questions
Q1) A 32-year-old female patient complains that she has noticed several small, slightly raised, bright-red dots on her chest. On examination, the nurse thinks that the spots are probably:
A)anasarca.
B)scleroderma.
C)senile angiomas.
D)latent myeloma.
Q2) During the examination,the patient tells the nurse,"I sure sweat a lot,especially on my face and feet,but it doesn't have an odour." The nurse knows that this could be related to:
A)the eccrine glands.
B)the apocrine glands.
C)a disorder of the stratum corneum.
D)a disorder of the stratum germinativum.
Q3) When assessing inflammation in a dark-skinned person,the nurse may need to:
A)assess the skin for cyanosis and swelling.
B)assess the oral mucosa for generalized erythema.
C)palpate the skin for edema and increased warmth.
D)palpate for tenderness and local areas of ecchymosis.
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Chapter 14: Head and Neck, including Regional Lymphatic System
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Sample Questions
Q1) A mother who has brought her newborn infant for assessment tells the nurse that she has noticed that whenever her newborn's head is turned to the right side,the baby straightens out the arm and leg on the same side and flexes the opposite arm and leg.After confirming this on examination,the nurse would tell the mother that this is:
A)abnormal and is called the atonic neck reflex.
B)normal and should disappear by the first year of life.
C)normal and should disappear between 3 and 4 months of age.
D)abnormal.The baby should be flexing the arm and leg on the right side of his body when the head is turned to the right.
Q2) Which of the following findings during examination would indicate Paget's disease?
A)Positive MacEwen's sign
B)Premature closure of the sagittal suture
C)Headache,vertigo,tinnitus,and deafness
D)Elongated head with heavy eyebrow ridge
Q3) Newborn infant
A)Head circumference equal to chest circumference
B)Head circumference greater than chest circumference
C)Head circumference less than chest circumference
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Chapter 15: Eyes
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Sample Questions
Q1) In assessing the sclera of a patient of African descent,which of the following would be an expected finding?
A)Yellow fatty deposits over the cornea
B)Pallor near the outer canthus of the lower lid
C)Yellow colour of the sclera that extends up to the iris
D)The presence of small brown macules on the sclera
Q2) During ocular examinations,the nurse keeps in mind that movement of the extraocular muscles is:
A)decreased in the older adult.
B)impaired in a patient with cataracts.
C)stimulated by cranial nerves (CNs)I and II.
D)stimulated by CNs III,IV,and VI.
Q3) The nurse notes the presence of periorbital edema when performing eye assessment on a 70-year-old patient.The nurse will:
A)check for the presence of exophthalmos.
B)suspect that the patient has hyperthyroidism.
C)ask the patient if he or she has a history of heart failure.
D)assess for blepharitis because this is often associated with periorbital edema.
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17
Chapter 16: Ears
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Sample Questions
Q1) When performing an otoscopic examination on a 5-year-old child with a history of chronic ear infections,the nurse sees that his right tympanic membrane is amber-yellow in colour and there are air bubbles behind the tympanic membrane.The child reports occasional hearing loss and a popping sound with swallowing.The preliminary analysis based on this information would be that:
A)this is most likely serous otitis media.
B)the child has acute purulent otitis media.
C)there is evidence of a resolving cholesteatoma.
D)the child is experiencing the early stages of perforation.
Q2) During ear examination,the patient reports that he is hears a buzzing sound that is "driving me crazy!" The nurse recognizes that this symptom is:
A)vertigo.
B)pruritus.
C)tinnitus.
D)cholesteatoma.
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18
Chapter 17: Nose, mouth, and Throat
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Sample Questions
Q1) The nurse is assessing a patient with a history of intravenous drug abuse.While assessing his mouth,the nurse notices a dark red confluent macule on the hard palate.This could be an early sign of:
A)acquired immunodeficiency syndrome (AIDS).
B)measles.
C)leukemia.
D)carcinoma.
Q2) When using an otoscope to assess the nasal cavity,which of the following would the nurse need to do?
A)Insert the speculum at least 3 cm into the vestibule.
B)Avoid touching the nasal septum with the speculum.
C)Gently displace the nose to the side that is being examined.
D)Keep the speculum tip medial to avoid touching the floor of the nares.
Q3) A patient has been diagnosed with "strep throat." Which complication may occur without treatment?
A)Rubella
B)Leukoplakia
C)Rheumatic fever
D)Scarlet fever
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Page 19
Chapter 18: Breasts and Regional Lymphatic System
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Sample Questions
Q1) The nurse is assessing the breasts of a 68-year-old woman and discovers a mass in the upper outer quadrant of the left breast.When assessing this mass,the nurse keeps in mind certain characteristics of a cancerous mass.(Select all that apply. )
A)Nontender mass
B)Dull,heavy pain on palpation
C)Rubbery texture and mobile
D)Hard,dense,and immobile
E)Regular border
F)Irregular,poorly delineated border
Q2) Which of the following statements about the internal structures of the breast is true?
A)The breast is mainly muscle,with very little fibrous tissue.
B)The breast is composed of fibrous,glandular,and adipose tissues.
C)The breast is composed mostly of milk ducts,known as lactiferous ducts.
D)The breast is composed of glandular tissue,which supports the breast by being attached to the chest wall.
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Chapter 19: Thorax and Lungs
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Sample Questions
Q1) A patient has a long history of chronic emphysema.During assessment,the nurse is most likely to observe:
A)unequal chest expansion.
B)increased tactile fremitus.
C)atrophied neck and trapezius muscles.
D)an anteroposterior-to-transverse diameter ratio of 1:1.
Q2) A mother brings her 3-month-old infant with a cold to the clinic.The mother tells the nurse that the baby has had "a runny nose for a week." When performing the physical assessment,the nurse notes that the child has nasal flaring as well as sternal and intercostal retractions.The nurse's next action should be to:
A)reassure the mother that these are normal symptoms of a cold.
B)recognize that these are serious signs and contact the physician.
C)recognize that these are symptoms of rachitic rosary and refer the infant to be seen by a physician within the week.
D)perform a complete cardiac assessment because these are probably signs of early heart failure.
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Chapter 20: Heart and Neck Vessels
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Sample Questions
Q1) Normal splitting of the second heart sound is associated with:
A)expiration.
B)inspiration.
C)exercise state.
D)low resting heart rate.
Q2) The nurse is performing cardiac assessment on a 65-year-old patient 3 days after the patient had a myocardial infarction.Heart sounds are normal when she is supine,but while the patient is sitting and leaning forward,the nurse hears a high-pitched,scratchy sound at the apex with the diaphragm of the stethoscope.The sound disappears on inspiration.The nurse suspects:
A)increased cardiac output.
B)another myocardial infarction.
C)inflammation of the precordium.
D)ventricular hypertrophy resulting from muscle damage.
Q3) Which ethnic group in Canada has the highest prevalence of heart disease and stroke?
A)People of African descent
B)People of European descent
C)Aboriginal people
D)People of Asian descent
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Chapter 21: Peripheral Vascular System and Lymphatic System
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Sample Questions
Q1) Which of the following sounds is heard when using a Doppler ultrasonic stethoscope to recognize venous flow?
A)A low humming sound
B)A regular "lub,dub" pattern
C)A swishing,whooshing sound
D)A steady,even,flowing sound
Q2) Which of the following statements about assessment of the ankle-brachial index (ABI)is true?
A)Normal ABI indices are from 0.50 to 1.0.
B)The normal ankle pressure is slightly lower than the brachial pressure.
C)The ABI is a reliable measurement of peripheral vascular disease in diabetic individuals.
D)An ABI of 0.90 to 0.70 indicates the presence of peripheral vascular disease and mild claudication.
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) Which of the following statements about aortic aneurysm is true?
A)A bruit is absent.
B)Femoral pulses are increased.
C)A pulsating mass is usually present.
D)Most are located below the umbilicus.
Q2) Which of the following is a normal finding in an abdominal assessment?
A)The presence of a bruit in the femoral area
B)A tympanic percussion note in the umbilical region
C)A palpable spleen between the ninth and eleventh ribs in the left midaxillary line
D)A dull percussion note in the left upper quadrant (LUQ)at the midclavicular line
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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Chapter 23: Anus,rectum and Prostate
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Sample Questions
Q1) During a health history of a patient who complains of chronic constipation,she asks the nurse about high-fibre foods.The nurse relates that an example of a high-fibre food would be:
A)broccoli.
B)hamburger.
C)iceberg lettuce.
D)white dinner rolls.
Q2) The structure that secretes a thin,milky alkaline fluid to enhance the viability of sperm is the:
A)Cowper's gland.
B)prostate gland.
C)median sulcus.
D)seminal vesicle.
Q3) Which of the following statements about the anal canal is true?
A)The anal canal is about 2 cm long in the adult.
B)The anal canal slants backward toward the sacrum.
C)The anal canal contains hair and sebaceous glands.
D)The anal canal is the outlet for the gastrointestinal tract.
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Chapter 24: Musculoskeletal System
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Sample Questions
Q1) The nurse is examining a 6-month-old baby and places the baby's feet flat on the table and flexes his knees up.The nurse notes that the right knee is significantly lower than the left.Which of the following is true of this finding?
A)This is a positive Allis sign and suggests hip dislocation.
B)The infant probably has a dislocated patella on the right knee.
C)This is a normal finding for the Allis test for an infant of this age.
D)The infant should return to the clinic in 2 weeks to see if this has changed.
Q2) The nurse is explaining to a patient that there are "shock absorbers" in his back to cushion the spine and to help it move.The nurse is referring to his:
A)costal facets.
B)nucleus pulposus.
C)vertebral foramen.
D)intervertebral discs.
Q3) The nurse knows that the incidence of osteoporosis is greatest in which group?
A)Males of African descent
B)Females of African descent
C)Females of European descent
D)Aboriginal males
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Chapter 25: Neurological System
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Sample Questions
Q1) During an assessment of an 80-year-old patient,the nurse notes the patient's inability to identify vibrations at the ankle and to identify the position of the big toe,a slower and more deliberate gait,and slightly impaired tactile sensation.All other neurological findings are normal.The nurse knows that these findings indicate:
A)cranial nerve dysfunction.
B)a lesion in the cerebral cortex.
C)normal changes due to aging.
D)demyelination of nerves due to a lesion.
Q2) The area of the nervous system that is responsible for mediating reflexes is the:
A)medulla.
B)cerebellum.
C)spinal cord.
D)cerebral cortex.
Q3) Which of the following statements concerning areas of the brain is accurate?
A)The cerebellum is the center for speech and emotions.
B)The hypothalamus controls temperature and regulates sleep.
C)The basal ganglia are responsible for controlling voluntary movements.
D)Motor pathways of the spinal cord and brain stem synapse in the thalamus.
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Chapter 26: Male Genitourinary System
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Sample Questions
Q1) A 2-month-old uncircumcised boy has been brought to the clinic for a well-baby checkup.How would the nurse proceed with his genital examination?
A)Elicit the cremasteric reflex.
B)Assess the glans for redness or lesions.
C)Avoid retracting the foreskin until the infant is 3 months old.
D)Note any dirt or smegma that has collected under the foreskin.
Q2) When performing a genitourinary assessment,the nurse notes that the urethral meatus is positioned ventrally.This finding is:
A)called hypospadias.
B)the result of phimosis.
C)probably due to a stricture.
D)often associated with aging.
Q3) During a physical examination,the nurse finds that a male patient's foreskin is fixed and tight,and will not retract over the glans.The nurse recognizes that this condition is: A)phimosis.
B)epispadias.
C)urethral stricture.
D)Peyronie's disease.
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Chapter 27: Female Genitourinary System
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Sample Questions
Q1) A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts,and wonders if they could be due to the estrogen replacement therapy she started 3 months ago.The nurse should tell her:
A)"Estrogen replacement therapy is at such a low dose that side effects are very unusual."
B)"Estrogen replacement therapy has several side effects,including fluid retention,breast tenderness or enlargement,and vaginal bleeding."
C)"It would be very unusual to have breast tenderness with estrogen replacement therapy,and I suggest you contact your doctor immediately to have this evaluated."
D)"It sounds as if your dose of estrogen is too high.I think you should decrease the amount you are taking and should call me back in a month to let me know how you're feeling."
Q2) Third degree prolapse is:
A)Cervix bulges outside the introitus with straining.
B)The whole uterus protrudes,even without straining.
C)Cervix appears at introitus with straining.
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Chapter
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Sample Questions
Q1) Which of the following is an appropriate location for eliciting deep tendon reflexes?
A)Achilles
B)Femoral
C)Scapular
D)Abdominal
Q2) During inspection of a patient's face,the nurse notes that the facial features are symmetrical.This finding indicates that which cranial nerve is intact?
A)VII
B)IX
C)XI
D)XII
Q3) After the health history has been obtained,and before beginning the physical examination,the nurse should ask the patient to first:
A)empty the bladder.
B)completely disrobe.
C)lie on the examination table.
D)walk around the room.
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Page 30
Chapter 29: Bedside Assessment of the Hospitalized Patient
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Q1) The nurse is assessing the IV infusion at the beginning of the shift.Which of the following should be included in the assessment of the infusion? (Select all that apply. )
A)The proper IV solution is infusing,according to physician's orders.
B)Infusion is occurring at the proper rate,according to physician's orders.
C)The infusion solution and rate are proper,according to the nurse's own assessment of the patient's needs.
Q2) 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.
Q3) When assessing a patient's general appearance,the nurse will include which of the following assessments?
A)Is the patient's muscle strength equal in both arms?
B)Is ptosis or facial droop present?
C)Does the patient respond appropriately to questions?
D)Are the pupils equal in reaction and size?
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Chapter 30: Pregnancy
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Q1) When the nurse is assessing the deep tendon reflexes (DTRs)of a woman who is 32 weeks pregnant,which of the following findings would be considered normal,on a 0-4+ scale?
A)Absent DTRs
B)2+
C)4+
D)Brisk reflexes and the presence of clonus
Q2) When performing an examination of a woman who is 34 weeks pregnant,the nurse notes that as the woman raises her head and shoulders off of the bed,there is a midline linear protrusion in the abdomen over the area of the rectus abdominis muscles.The nurse would:
A)document the presence of diastasis recti.
B)discuss this condition with the physician,because it will most likely need to be surgically repaired.
C)suspect that the woman has a hernia from the increased pressure within the abdomen from pregnancy.
D)tell the woman that she may have a difficult time with delivery because of the weakness in her abdominal muscles.
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Chapter 31: Functional Assessment of the Older Adult
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Q1) Which of the following tests is recommended as the most valid and reliable for assessing the physical performance of the older adult?
A)The Timed Up and Go Test
B)The Performance Activities of Daily Living
C)The Physical Performance Test
D)Tinetti Gait and Balance Evaluation
Q2) The nurse is assessing the forms of support an older patient has before she is discharged.Which of the following illustrates an informal source of support?
A)The local senior centre
B)Her cleaning lady
C)Her Meals on Wheels meal delivery service
D)Her neighbour,who visits with her daily
Q3) The nurse is preparing to perform a functional assessment of an older patient and knows that a good approach would be to:
A)observe the patient's ability to perform tasks.
B)ask the patient's wife how well he performs tasks.
C)review the medical record for information about the patient's abilities.
D)ask the patient's physician for information about the patient's abilities.
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