Physical Diagnosis
Final Test Solutions
Course Introduction
Physical Diagnosis is a foundational course for medical and allied health students that focuses on the systematic techniques and skills required to evaluate a patient's health through direct examination. Students learn to collect comprehensive medical histories and perform thorough physical examinations, including inspection, palpation, percussion, and auscultation of various body systems. Emphasis is placed on recognizing normal versus abnormal clinical findings, developing clinical reasoning abilities, and integrating patient communication skills. The course prepares students to identify significant signs and symptoms, make preliminary diagnoses, and determine appropriate next steps in patient care.
Recommended Textbook
Physical Examination and Health Assessment 7th Edition by Jarvis
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31 Chapters
1092 Verified Questions
1092 Flashcards
Source URL: https://quizplus.com/study-set/1000 Page 2
Chapter 1: Evidence-Based Assessment
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29 Verified Questions
29 Flashcards
Source URL: https://quizplus.com/quiz/19726
Sample Questions
Q1) Which of these would be formulated by a nurse using diagnostic reasoning?
A)Nursing diagnosis
B)Medical diagnosis
C)Diagnostic hypothesis
D)Diagnostic assessment
Answer: C
Q2) A patient is brought by ambulance to the emergency department with multiple traumas received in an automobile accident.He is alert and cooperative,but his injuries are quite severe.How would the nurse proceed with data collection?
A)Collect history information first, then perform the physical examination and institute life-saving measures.
B)Simultaneously ask history questions while performing the examination and initiating life-saving measures.
C)Collect all information on the history form, including social support patterns, strengths, and coping patterns.
D)Perform life-saving measures and delay asking any history questions until the patient is transferred to the intensive care unit.
Answer: B
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3
Chapter 2: Cultural Competence
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37 Verified Questions
37 Flashcards
Source URL: https://quizplus.com/quiz/19727
Sample Questions
Q1) The nurse manager is explaining culturally competent care during a staff meeting.Which statement accurately describes the concept of culturally competent care? "The caregiver:
A)Is able to speak the patient's native language."
B)Possesses some basic knowledge of the patient's cultural background."
C)Applies the proper background knowledge of a patient's cultural background to provide the best possible health care."
D)Understands and attends to the total context of the patient's situation."
Answer: D
Q2) When planning a cultural assessment,the nurse should include which component?
A)Family history
B)Chief complaint
C)Medical history
D)Health-related beliefs
Answer: D
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Chapter 3: The Interview
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40 Verified Questions
40 Flashcards
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Sample Questions
Q1) A female nurse is interviewing a male patient who is near the same age as the nurse.During the interview,the patient makes an overtly sexual comment.The nurse's best reaction 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 would be interested?"
D)"It makes me uncomfortable when you talk that way. Please stop."
Answer: D
Q2) In using verbal responses to assist the patient's narrative,some responses focus on the patient's frame of reference and some focus on the health care provider's perspective.An example of a verbal response that focuses on the health care provider's perspective would be:
A)Empathy.
B)Reflection.
C)Facilitation.
D)Confrontation.
Answer: D
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Page 5
Chapter 4: The Complete Health History
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34 Verified Questions
34 Flashcards
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Sample Questions
Q1) In response to a question regarding the use of alcohol,a patient asks the nurse why the nurse needs to know.What is the reason for needing this information?
A)This information is necessary to determine the patient's reliability.
B)Alcohol can interact with all medications and can make some diseases worse.
C)The nurse needs to be able to teach the patient about the dangers of alcohol use.
D)This information is not necessary unless a drinking problem is obvious.
Q2) A 59-year-old patient tells the nurse that he has ulcerative colitis.He has been having "black stools" for the last 24 hours.How would the nurse best document his reason for seeking care?
A)J.M. is a 59-year-old man seeking treatment for ulcerative colitis.
B)J.M. came into the clinic complaining of having black stools for the past 24 hours.
C)J.M. is a 59-year-old man who states that he has ulcerative colitis and wants it checked.
D)J.M. is a 59-year-old man who states that he has been having "black stools" for the past 24 hours.
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Chapter 5: Mental Status Assessment
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39 Verified Questions
39 Flashcards
Source URL: https://quizplus.com/quiz/19730
Sample Questions
Q1) The nurse is planning to assess new memory with a patient.The best way for the nurse to do this would be to:
A)Administer the FACT test.
B)Ask him to describe his first job.
C)Give him the Four Unrelated Words Test.
D)Ask him to describe what television show he was watching before coming to the clinic.
Q2) A patient is admitted to the unit after an automobile accident.The nurse begins the mental status examination and finds that the patient has dysarthric speech and is lethargic.The nurse's best approach regarding this examination is to:
A)Plan to defer the rest of the mental status examination.
B)Skip the language portion of the examination, and proceed onto assessing mood and affect.
C)Conduct an in-depth speech evaluation, and defer the mental status examination to another time.
D)Proceed with the examination, and assess the patient for suicidal thoughts because dysarthria is often accompanied by severe depression.
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Chapter 6: Substance Use Assessment
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13 Verified Questions
13 Flashcards
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Sample Questions
Q1) The nurse has completed an assessment on a patient who came to the clinic for a leg injury.As a result of the assessment,the nurse has determined that the patient has at-risk alcohol use.Which action by the nurse is most appropriate at this time?
A)Record the results of the assessment, and notify the physician on call.
B)State, "You are drinking more than is medically safe. I strongly recommend that you quit drinking, and I'm willing to help you."
C)State, "It appears that you may have a drinking problem. Here is the telephone number of our local Alcoholics Anonymous chapter."
D)Give the patient information about a local rehabilitation clinic.
Q2) The nurse is conducting a class on alcohol and the effects of alcohol on the body.How many standard drinks (each containing 14 grams of alcohol)per day in men are associated with increased deaths from cirrhosis,cancers of the mouth,esophagus,and injuries?
A)2
B)4
C)6
D)8
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Page 8
Chapter 7: Domestic and Family Violence Assessments
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14 Verified Questions
14 Flashcards
Source URL: https://quizplus.com/quiz/19732
Sample Questions
Q1) The nurse assesses an older woman and suspects physical abuse.Which questions are appropriate for screening for abuse? Select all that apply.
A)"Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically?"
B)"Are you being abused?"
C)"Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?"
D)"Have you been upset because someone talked to you in a way that made you feel shamed or threatened?"
E)Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?
Q2) When documenting IPV and elder abuse,the nurse should include:
A)Photographic documentation of the injuries.
B)Summary of the abused patient's statements.
C)Verbatim documentation of every statement made.
D)General description of injuries in the progress notes.
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Chapter 8: Assessment Techniques and Safety in the Clinical Setting
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43 Verified Questions
43 Flashcards
Source URL: https://quizplus.com/quiz/19733
Sample Questions
Q1) The nurse is examining a patient's lower leg and notices a draining ulceration.Which of these actions is most appropriate in this situation?
A)Washing hands, and contacting the physician
B)Continuing to examine the ulceration, and then washing hands
C)Washing hands, putting on gloves, and continuing with the examination of the ulceration
D)Washing hands, proceeding with rest of the physical examination, and then continuing with the examination of the leg ulceration
Q2) The nurse is preparing to perform a physical assessment.The correct action by the nurse is reflected by which statement? The nurse:
A)Performs the examination from the left side of the bed.
B)Examines tender or painful areas first to help relieve the patient's anxiety.
C)Follows the same examination sequence, regardless of the patient's age or condition.
D)Organizes the assessment to ensure that the patient does not change positions too often.
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Chapter 9: General Survey, Measurement, Vital Signs
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52 Verified Questions
52 Flashcards
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Sample Questions
Q1) The nurse is examining a patient who is complaining of "feeling cold." Which is a mechanism of heat loss in the body?
A)Exercise
B)Radiation
C)Metabolism
D)Food digestion
Q2) A 70-year-old man has a blood pressure of 150/90 mm Hg in a lying position,130/80 mm Hg in a sitting position,and 100/60 mm Hg in a standing position.How should the nurse evaluate these findings?
A)These readings are a normal response and attributable to changes in the patient's position.
B)The change in blood pressure readings is called orthostatic hypotension.
C)The blood pressure reading in the lying position is within normal limits.
D)The change in blood pressure readings is considered within normal limits for the patient's age.
Q3) What is the pulse pressure for a patient whose blood pressure is 158/96 mm Hg and whose pulse rate is 72 beats per minute?
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Chapter 10: Pain Assessment: The Fifth Vital Sign
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17 Verified Questions
17 Flashcards
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Sample Questions
Q1) A patient has had arthritic pain in her hips for several years since a hip fracture.She is able to move around in her room and has not offered any complaints so far this morning.However,when asked,she states that her pain is "bad this morning" and rates it at an 8 on a 1-to-10 scale.What does the nurse suspect? The patient:
A)Is addicted to her pain medications and cannot obtain pain relief.
B)Does not want to trouble the nursing staff with her complaints.
C)Is not in pain but rates it high to receive pain medication.
D)Has experienced chronic pain for years and has adapted to it.
Q2) The nurse is reviewing the principles of pain.Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system?
A)Visceral
B)Referred
C)Cutaneous
D)Neuropathic
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Chapter 11: Nutritional Assessment
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33 Verified Questions
33 Flashcards
Source URL: https://quizplus.com/quiz/19736
Sample Questions
Q1) The nurse is reviewing the nutritional assessment of an 82-year-old patient.Which of these factors will most likely affect the nutritional status of an older adult?
A)Increase in taste and smell
B)Living alone on a fixed income
C)Change in cardiovascular status
D)Increase in gastrointestinal motility and absorption
Q2) A patient tells the nurse that his food simply does not have any taste anymore.The nurse's best response would be:
A)"That must be really frustrating."
B)"When did you first notice this change?"
C)"My food doesn't always have a lot of taste either."
D)"Sometimes that happens, but your taste will come back."
Q3) The nurse is evaluating patients for obesity-related diseases by calculating the waist-to-hip ratios.Which one of these patients would be at increased risk?
A)29-year-old woman whose waist measures 33 inches and hips measure 36 inches
B)32-year-old man whose waist measures 34 inches and hips measure 36 inches
C)38-year-old man whose waist measures 35 inches and hips measure 38 inches
D)46-year-old woman whose waist measures 30 inches and hips measure 38 inches
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Chapter 12: Skin, Hair, and Nails
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48 Verified Questions
48 Flashcards
Source URL: https://quizplus.com/quiz/19737
Sample Questions
Q1) A newborn infant is in the clinic for a well-baby checkup.The nurse observes the infant for the possibility of fluid loss because of which of these factors?
A)Subcutaneous fat deposits are high in the newborn.
B)Sebaceous glands are overproductive in the newborn.
C)The newborn's skin is more permeable than that of the adult.
D)The amount of vernix caseosa dramatically rises in the newborn.
Q2) A few days after a summer hiking trip,a 25-year-old man comes to the clinic with a rash.On examination,the nurse notes that the rash is red,macular,with a bull's eye pattern across his midriff and behind his knees.The nurse suspects:
A)Rubeola.
B)Lyme disease.
C)Allergy to mosquito bites.
D)Rocky Mountain spotted fever.
Q3) The nurse is assessing for clubbing of the fingernails and expects to find:
A)Nail bases that are firm and slightly tender.
B)Curved nails with a convex profile and ridges across the nails.
C)Nail bases that feel spongy with an angle of the nail base of 150 degrees.
D)Nail bases with an angle of 180 degrees or greater and nail bases that feel spongy.
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Chapter 13: Head, Face, and Neck, Including Regional Lymphatics
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41 Verified Questions
41 Flashcards
Source URL: https://quizplus.com/quiz/19738
Sample Questions
Q1) A male patient with a history of acquired immunodeficiency syndrome (AIDS)has come in for an examination and he states,"I think that I have the mumps." The nurse would begin by examining the:
A)Thyroid gland.
B)Parotid gland.
C)Cervical lymph nodes.
D)Mouth and skin for lesions.
Q2) A patient's laboratory data reveal an elevated thyroxine (T?)level.The nurse would proceed with an examination of the _____ gland.
A)Thyroid
B)Parotid
C)Adrenal
D)Parathyroid
Q3) During an examination of a 3-year-old child,the nurse notices a bruit over the left temporal area.The nurse should:
A)Continue the examination because a bruit is a normal finding for this age.
B)Check for the bruit again in 1 hour.
C)Notify the parents that a bruit has been detected in their child.
D)Stop the examination, and notify the physician.
Page 15
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Chapter 14: Eyes
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40 Verified Questions
40 Flashcards
Source URL: https://quizplus.com/quiz/19739
Sample Questions
Q1) A 68-year-old woman is in the eye clinic for a checkup.She tells the nurse that she has been having trouble reading the paper,sewing,and even seeing the faces of her grandchildren.On examination,the nurse notes that she has some loss of central vision but her peripheral vision is normal.These findings suggest that she may have:
A)Macular degeneration.
B)Vision that is normal for someone her age.
C)The beginning stages of cataract formation.
D)Increased intraocular pressure or glaucoma.
Q2) During an examination of the eye,the nurse would expect what normal finding when assessing the lacrimal apparatus?
A)Presence of tears along the inner canthus
B)Blocked nasolacrimal duct in a newborn infant
C)Slight swelling over the upper lid and along the bony orbit if the individual has a cold
D)Absence of drainage from the puncta when pressing against the inner orbital rim
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16
Chapter 15: Ears
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40 Verified Questions
40 Flashcards
Source URL: https://quizplus.com/quiz/19740
Sample Questions
Q1) The nurse assesses the hearing of a 7-month-old by clapping hands.What is the expected response? The infant:
A)Turns his or her head to localize the sound.
B)Shows no obvious response to the noise.
C)Shows a startle and acoustic blink reflex.
D)Stops any movement, and appears to listen for the sound.
Q2) The nurse is preparing to do an otoscopic examination on a 2-year-old child.Which one of these reflects the correct procedure?
A)Pulling the pinna down
B)Pulling the pinna up and back
C)Slightly tilting the child's head toward the examiner
D)Instructing the child to touch his chin to his chest
Q3) The nurse is performing an ear examination of an 80-year-old patient.Which of these findings would be considered normal?
A)High-tone frequency loss
B)Increased elasticity of the pinna
C)Thin, translucent membrane
D)Shiny, pink tympanic membrane
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17
Chapter 16: Nose, Mouth, and Throat
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42 Verified Questions
42 Flashcards
Source URL: https://quizplus.com/quiz/19741
Sample Questions
Q1) A mother brings her 4-month-old infant to the clinic with concerns regarding a small pad in the middle of the upper lip that has been there since 1 month of age.The infant has no health problems.On physical examination,the nurse notices a 0.5-cm,fleshy,elevated area in the middle of the upper lip.No evidence of inflammation or drainage is observed.What would the nurse tell this mother?
A)"This area of irritation is caused from teething and is nothing to worry about."
B)"This finding is abnormal and should be evaluated by another health care provider."
C)"This area of irritation is the result of chronic drooling and should resolve within the next month or two."
D)"This elevated area is a sucking tubercle caused from the friction of breastfeeding or bottle-feeding and is normal."
Q2) The tissue that connects the tongue to the floor of the mouth is the:
A)Uvula.
B)Palate.
C)Papillae.
D)Frenulum.
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Chapter 17: Breasts and Regional Lymphatics
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45 Verified Questions
45 Flashcards
Source URL: https://quizplus.com/quiz/19742
Sample Questions
Q1) During a physical examination,a 45-year-old woman states that she has had a crusty,itchy rash on her breast for approximately 2 weeks.In trying to find the cause of the rash,which question would be important for the nurse to ask?
A)"Is the rash raised and red?"
B)"Does it appear to be cyclic?"
C)"Where did the rash first appear-on the nipple, the areola, or the surrounding skin?"
D)"What was she doing when she first noticed the rash, and do her actions make it worse?"
Q2) During a health history interview,a female patient states that she has noticed a few drops of clear discharge from her right nipple.What should the nurse do next?
A)Immediately contact the physician to report the discharge.
B)Ask her if she is possibly pregnant.
C)Ask the patient some additional questions about the medications she is taking.
D)Immediately obtain a sample for culture and sensitivity testing.
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19
Chapter 18: Thorax and Lungs
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41 Verified Questions
41 Flashcards
Source URL: https://quizplus.com/quiz/19743
Sample Questions
Q1) When assessing tactile fremitus,the nurse recalls that it is normal to feel tactile fremitus most intensely over which location?
A)Between the scapulae
B)Third intercostal space, MCL
C)Fifth intercostal space, midaxillary line (MAL)
D)Over the lower lobes, posterior side
Q2) A patient comes to the clinic complaining of a cough that is worse at night but not as bad during the day.The nurse recognizes that this cough may indicate:
A)Pneumonia.
B)Postnasal drip or sinusitis.
C)Exposure to irritants at work.
D)Chronic bronchial irritation from smoking.
Q3) When assessing a patient's lungs,the nurse recalls that the left lung:
A)Consists of two lobes.
B)Is divided by the horizontal fissure.
C)Primarily consists of an upper lobe on the posterior chest.
D)Is shorter than the right lung because of the underlying stomach.
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Chapter 19: Heart and Neck Vessels
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42 Verified Questions
42 Flashcards
Source URL: https://quizplus.com/quiz/19744
Sample Questions
Q1) The electrical stimulus of the cardiac cycle follows which sequence?
A)AV node ?SA node ? bundle of His
B)Bundle of His ?AV node ? SA node
C)SA node ? AV node ? bundle of His ? bundle branches
D)AV node ? SA node ? bundle of His ? bundle branches
Q2) Which of these findings would the nurse expect to notice during a cardiac assessment on a 4-year-old child?
A)S3 when sitting up
B)Persistent tachycardia above 150 beats per minute
C)Murmur at the second left intercostal space when supine
D)Palpable apical impulse in the fifth left intercostal space lateral to midclavicular line
Q3) The nurse is preparing for a class on risk factors for hypertension and reviews recent statistics.Which racial group has the highest prevalence of hypertension in the world?
A)Blacks
B)Whites
C)American Indians
D)Hispanics
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21
Chapter 20: Peripheral Vascular System and Lymphatic System
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39 Verified Questions
39 Flashcards
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Sample Questions
Q1) During an assessment,the nurse uses the profile sign to detect:
A)Pitting edema.
B)Early clubbing.
C)Symmetry of the fingers.
D)Insufficient capillary refill.
Q2) During an assessment,the nurse notices that a patient's left arm is swollen from the shoulder down to the fingers,with nonpitting brawny edema.The right arm is normal.The patient had a left-sided mastectomy 1 year ago.The nurse suspects which problem?
A)Venous stasis
B)Lymphedema
C)Arteriosclerosis
D)Deep-vein thrombosis
Q3) A 65-year-old patient is experiencing pain in his left calf when he exercises that disappears after resting for a few minutes.The nurse recognizes that this description is most consistent with _______ the left leg.
A)Venous obstruction of
B)Claudication due to venous abnormalities in
C)Ischemia caused by a partial blockage of an artery supplying
D)Ischemia caused by the complete blockage of an artery supplying
Page 22
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Chapter 21: Abdomen
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40 Flashcards
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Sample Questions
Q1) The nurse is reviewing the assessment of an aortic aneurysm.Which of these statements is true regarding an aortic aneurysm?
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) A 40-year-old man states that his physician told him that he has a hernia.He asks the nurse to explain what a hernia is.Which response by the nurse is appropriate?
A)"No need to worry. Most men your age develop hernias."
B)"A hernia is a loop of bowel protruding through a weak spot in the abdominal muscles."
C)"A hernia is the result of prenatal growth abnormalities that are just now causing problems."
D)"I'll have to have your physician explain this to you."
Q3) A nurse notices that a patient has ascites,which indicates the presence of:
A)Fluid.
B)Feces.
C)Flatus.
D)Fibroid tumors.
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Page 23
Chapter 22: Musculoskeletal System
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51 Verified Questions
51 Flashcards
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Sample Questions
Q1) A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms.The nurse should suspect:
A)Crepitation.
B)Rotator cuff lesions.
C)Dislocated shoulder.
D)Rheumatoid arthritis.
Q2) A 40-year-old man has come into the clinic with complaints of extreme pain in his toes.The nurse notices that his toes are slightly swollen,reddened,and warm to the touch.His complaints would suggest:
A)Osteoporosis.
B)Acute gout.
C)Ankylosing spondylitis.
D)Degenerative joint disease.
Q3) The ankle joint is the articulation of the tibia,fibula,and: A)Talus.
B)Cuboid.
C)Calcaneus.
D)Cuneiform bones.
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Chapter 23: Neurologic System
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56 Flashcards
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Sample Questions
Q1) The nurse places a key in the hand of a patient and he identifies it as a penny.What term would the nurse use to describe this finding?
A)Extinction
B)Astereognosis
C)Graphesthesia
D)Tactile discrimination
Q2) When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side with his eyes closed,he starts to sway and moves his feet farther apart.The nurse would document this finding as:
A)Ataxia.
B)Lack of coordination.
C)Negative Homans sign.
D)Positive Romberg sign.
Q3) To test for gross motor skill and coordination of a 6-year-old child,which of these techniques would be appropriate? Ask the child to:
A)Hop on one foot.
B)Stand on his head.
C)Touch his finger to his nose.
D)Make "funny" faces at the nurse.
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Page 25
Chapter 24: Male Genitourinary System
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Sample Questions
Q1) An older man is concerned about his sexual performance.The nurse knows that in the absence of disease,a withdrawal from sexual activity later in life may be attributable to:
A)Side effects of medications.
B)Decreased libido with aging.
C)Decreased sperm production.
D)Decreased pleasure from sexual intercourse.
Q2) When performing a scrotal assessment,the nurse notices that the scrotal contents show a red glow with transillumination.On the basis of this finding the nurse would:
A)Assess the patient for the presence of a hernia.
B)Suspect the presence of serous fluid in the scrotum.
C)Consider this finding normal, and proceed with the examination.
D)Refer the patient for evaluation of a mass in the scrotum.
Q3) An accessory glandular structure for the male genital organs is the:
A)Testis.
B)Scrotum.
C)Prostate.
D)Vas deferens.
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Chapter 25: Anus,Rectum,and Prostate
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Sample Questions
Q1) During the taking of a health history,the patient states,"It really hurts back there,and sometimes it itches,too.I have even seen blood on the tissue when I have a bowel movement.Is there something there?" The nurse should expect to see which of these upon examination of the anus?
A)Rectal prolapse
B)Internal hemorrhoid
C)External hemorrhoid that has resolved
D)External hemorrhoid that is thrombosed
Q2) A patient who is visiting the clinic complains of having "stomach pains for 2 weeks" and describes his stools as being "soft and black" for approximately the last 10 days.He denies taking any medications.The nurse is aware that these symptoms are mostly indicative of:
A)Excessive fat caused by malabsorption.
B)Increased iron intake, resulting from a change in diet.
C)Occult blood, resulting from gastrointestinal bleeding.
D)Absent bile pigment from liver problems.
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Chapter 26: Female Genitourinary System
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Sample Questions
Q1) A 25-year-old woman comes to the emergency department with a sudden fever of 38.3° C and abdominal pain.Upon examination,the nurse notices that she has rigid,boardlike lower abdominal musculature.When the nurse tries to perform a vaginal examination,the patient has severe pain when the uterus and cervix are moved.The nurse knows that these signs and symptoms are suggestive of:
A)Endometriosis.
B)Uterine fibroids.
C)Ectopic pregnancy.
D)Pelvic inflammatory disease.
Q2) During an internal examination,the nurse notices that the cervix bulges outside the introitus when the patient is asked to strain.The nurse will document this as:
A)Uterine prolapse, graded first degree.
B)Uterine prolapse, graded second degree.
C)Uterine prolapse, graded third degree.
D)A normal finding.
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Chapter 27: The Complete Health Assessment: Adult
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Sample Questions
Q1) During inspection of the posterior chest,the nurse should assess for:
A)Symmetric expansion.
B)Symmetry of shoulders and muscles.
C)Tactile fremitus.
D)Diaphragmatic excursion.
Q2) A patient tells the nurse,"Sometimes I wake up at night and I have real trouble breathing.I have to sit up in bed to get a good breath." When documenting this information,the nurse would note:
A)Orthopnea.
B)Acute emphysema.
C)Paroxysmal nocturnal dyspnea.
D)Acute shortness of breath episode.
Q3) When the nurse performs the confrontation test,the nurse has assessed:
A)Extraocular eye muscles (EOMs).
B)Pupils (pupils equal, round, reactive to light, and accommodation [PERRLA]).
C)Near vision.
D)Visual fields.
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Chapter 28: The Complete Physical Assessment: Infant,
Child, and Adolescent
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Q1) Which statement is true regarding the recording of data from the history and physical examination?
A)Use long, descriptive sentences to document findings.
B)Record the data as soon as possible after the interview and physical examination.
C)If the information is not documented, then it can be assumed that it was done as a standard of care.
D)The examiner should avoid taking any notes during the history and examination because of the possibility of decreasing the rapport with the patient.
Q2) The nurse is documenting the assessment of an infant.During the abdominal assessment,the nurse noticed a very loud splash auscultated over the upper abdomen when the nurse rocked her from side to side.This finding would indicate:
A)Epigastric hernia.
B)Pyloric obstruction.
C)Hypoactive bowel sounds.
D)Hyperactive bowel sounds.
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Chapter 29: Bedside Assessment of the Hospitalized Patient
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Q1) The nurse is giving report to the next shift and is using the situation,background,assessment,recommendation (SBAR)framework for communication.Which of these statements reflects the Background portion of the report?
A)"I'm worried that his gastrointestinal bleeding is getting worse."
B)"We need an order for oxygen."
C)"My name is Ms. Smith, and I'm giving the report on Mrs. X in room 1104."
D)"He is 4 days postoperative, and his incision is open to air."
Q2) During a morning assessment,the nurse notices that a patient's urine output is below the expected amount.What should the nurse do next?
A)Obtain an order for a Foley catheter.
B)Obtain an order for a straight catheter.
C)Perform a bladder scan test.
D)Refer the patient to an urologist.
Q3) During an assessment,the nurse is unable to palpate pulses in the left lower leg.What should the nurse do next?
A)Document that the pulses are nonpalpable.
B)Reassess the pulses in 1 hour.
C)Ask the patient turn to the side, and then palpate for the pulses again.
D)Use a Doppler device to assess the pulses.
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Chapter 30: The Pregnant Woman
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Q1) Which of these correctly describes the average length of pregnancy?
A)38 weeks
B)9 lunar months
C)280 days from the last day of the last menstrual period
D)280 days from the first day of the last menstrual period
Q2) When auscultating the anterior thorax of a pregnant woman,the nurse notices the presence of a murmur over the second,third,and fourth intercostal spaces.The murmur is continuous but can be obliterated by pressure with the stethoscope or finger on the thorax just lateral to the murmur.The nurse interprets this finding to be:
A)Murmur of aortic stenosis.
B)Most likely a mammary souffle.
C)Associated with aortic insufficiency.
D)Indication of a patent ductus arteriosus.
Q3) A 25-year-old woman is in the clinic for her first prenatal visit.The nurse will prepare to obtain which laboratory screening test at this time?
A)Urine toxicology
B)Complete blood cell count
C)Alpha-fetoprotein
D)Carrier screening for cystic fibrosis
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Chapter 31: Functional Assessment of the Older Adult
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Q1) The nurse is preparing to use the Lawton IADL instrument as part of an assessment.Which statement about the Lawton IADL instrument is true?
A)The nurse uses direct observation to implement this tool.
B)The Lawton IADL instrument is designed as a self-report measure of performance rather than ability.
C)This instrument is not useful in the acute hospital setting.
D)This tool is best used for those residing in an institutional setting.
Q2) The nurse is assessing an older adult's advanced activities of daily living (AADLs),which would include:
A)Recreational activities.
B)Meal preparation.
C)Balancing the checkbook.
D)Self-grooming activities.
Q3) When beginning to assess a person's spirituality,which question by the nurse would be most appropriate?
A)"Do you believe in God?"
B)"How does your spirituality relate to your health care decisions?"
C)"What religious faith do you follow?"
D)"Do you believe in the power of prayer?"
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