Exam 28: Putting It All Together

The nurse is performing a physical assessment of a male client.The nurse must assess the client's sacrococcygeal area.Which of the following positions will allow the nurse to assess this area adequately?

The nurse is interviewing the client and learns that the client has an open leg wound that has been draining a moderate amount of yellowish drainage over the last 3 days.Prior to assessing the client's wound,which of the following pieces of personal protective equipment is most important for the nurse to wear based on the principles of standard precautions?

The nurse is auscultating the client's lungs and is able to auscultate bronchovesicular sounds over the client's right lung.Identify the area where the nurse is able to auscultate these sounds by drawing an arrow to this area.

The client weighs 224 pounds.How many kilograms does the client weigh? Round to the nearest tenth. _____ kilograms

The nurse is performing a physical assessment on a client in an outpatient clinic.The nurse is inspecting and palpating the client's face,skin folds,axillae,palms,and soles of the feet.The nurse determines the client is diaphoretic.Which of the following statements by the client are expected?

The nurse prepares to palpate the client's preauricular lymph nodes.Identify the location of the preauricular lymph nodes on the following figure by drawing an arrow.

The nurse is preparing to perform an interview to obtain information about the client.Which of the following are classified as secondary sources of information?

The function of the client's cranial nerve XII (hypoglossal)is intact.The nurse is able to assess this nerve by asking the client to perform which of the following activities?

The nurse has palpated an abnormal mass within the client's scrotum.Which of the following assessment activities is appropriate for the nurse to perform next?

The nurse is interviewing the client.Which of the following may lead to communication breakdown between the nurse and client?

The student nurse is preparing to insert the otoscope into the adult client's ear.Which of the following statements indicates that the student nurse requires further education?

The student nurse percusses the client's abdomen.Which of the following statements by the student nurse indicate that tympany is present?

The client weighs 145 kilograms.The client is 1.75 meters.What is this client's body mass index (BMI)using the following formula: BMI = weight (kg)/height2 (meters)? Round to the nearest whole number.____

The nurse is performing a physical assessment of the client.Identify the location of the right costovertebral angle on the following figure by drawing an arrow to the site.

The nurse is performing an assessment of the female client's genitalia.The nurse has inserted a speculum and notices that the client has a frothy greenish-yellowish discharge present within the client's vagina.Based on the nurse's findings,the nurse believes that the client has developed which of the following conditions?

The nurse is assessing the client's cardiovascular system during the physical assessment.Identify the point of maximal impulse/apical impulse on the following figure by drawing an arrow to this site.

During the physical assessment of the client,the nurse notes that the client is able to shrug her shoulders bilaterally.The function of which of the following cranial nerves is intact?

The nurse holds the tuning fork by the handle and gently strikes the fork on the palm of his hand.Then,the nurse places the base of the fork on the client's mastoid process.The nurse requests that the client indicate when the sound can no longer be heard.Which of the following tests is the nurse performing?

The student nurse is performing a physical assessment for the client.The student nurse has identified a venous hum while auscultating the client's abdomen.Which of the following statements by the student nurse is most consistent with this type of vascular sound?

The nurse is assessing the client's cardiovascular system.The nurse is preparing to assess the client for the presence of a lift or heave.Which of the following directions should the nurse provide for the client?