Question 1

When the nurse flexes the patient's knee and gently compresses the gastrocnemius muscle anteriorly against the tibia,the patient indicates that he is having calf pain.The nurse should document _____ sign.

Accepted Answer

A)   positive Allen's
B)   negative Allen's
C)   positive Homans'
D)   negative Homans' C

Question 2

The nurse has just recorded a positive obturator test on a patient who has abdominal pain.This test is used to confirm a(n):

Accepted Answer

A)   inflamed liver.
B)   perforated spleen.
C)   perforated appendix.
D)   enlarged gallbladder. C

Question 3

The nurse documents that a patient has coarse,thickened skin and brown discoloration over the lower legs.Pulses are present.This finding is probably the result of:

Accepted Answer

A)   lymphedema.
B)   Raynaud's disease.
C)   chronic arterial insufficiency.
D)   chronic venous insufficiency. D

Question 4

The nurse is performing a vision examination.Which of these charts is most widely used for vision examinations?

Accepted Answer

A)   Snellen
B)   Shetllen
C)   Smoollen
D)   Schwellon

Question 5

During an examination,a patient has just 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 ____ function is intact.

Accepted Answer

A)   occipital
B)   cerebral
C)   temporal
D)   cerebellar

Question 6

Which of these actions is most appropriate to perform on a 9-month-old infant at a well-child checkup?

Accepted Answer

A)   Testing for Ortolani's sign
B)   Assessment for stereognosis
C)   Blood pressure measurement
D)   Assessment for the presence of the startle reflex

Question 7

During a complete health assessment,how would the nurse test the patient's hearing?

Accepted Answer

A)   By observing how the patient participates in normal conversation
B)   Using the whispered voice test
C)   Using the Weber and Rinne tests
D)   Testing with an audiometer

Question 8

Which of these is included in assessment of general appearance?

Accepted Answer

A)   Height
B)   Weight
C)   Skin color
D)   Vital signs

Question 9

During the examination of a patient,the nurse notices that the patient has several small,flat macules on the posterior portion of her thorax.These macules are less than 1 cm wide.Another name for these macules is:

Accepted Answer

A)   warts.
B)   bullae.
C)   freckles.
D)   papules.

Question 10

After the health history has been obtained,and before beginning the physical examination,the nurse should ask the patient to first:

Accepted Answer

A)   empty the bladder.
B)   completely disrobe.
C)   lie on the examination table.
D)   walk around the room.

Question 11

For the abdominal assessment,place these assessment techniques in the correct order,with A being performed first and E being performed last. 
A)Deep palpation, all quadrants
B)Light palpation, all quadrants
C)Auscultate bowel sounds
D)Inspect abdomen for contour, skin characteristics, and pulsations
E)Percuss all quadrants

Accepted Answer

The answer of For the abdominal assessment,place these assessment techniques...

Question 12

A female patient tells the nurse that she has four children and has had three pregnancies.How should the nurse document this?

Accepted Answer

A)   Gravida 3, para 4
B)   Gravida 4, para 3
C)   This information cannot be documented using the terms gravida and para.
D)   "The patient seems to be confused about how many times she has been pregnant."

Question 13

While recording in a patient's medical record,the nurse notices that a patient's Hematest results are positive.This means that there:

Accepted Answer

A)   are crystals in his urine.
B)   are parasites in his stool.
C)   is occult blood in his stool.
D)   are bacteria in his sputum.

Question 14

A patient tells the nurse that "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:

Accepted Answer

A)   orthopnea.
B)   acute emphysema.
C)   paroxysmal nocturnal dyspnea.
D)   acute shortness of breath episode.

Question 15

The nurse should wear gloves for which of these examinations?

Accepted Answer

A)   Measuring vital signs
B)   Palpation of the sinuses
C)   Palpation of the mouth and tongue
D)   Inspection of the eye with an ophthalmoscope

Question 16

During inspection of the posterior chest,the nurse should assess for:

Accepted Answer

A)   symmetric expansion.
B)   symmetry of shoulders and muscles.
C)   tactile fremitus.
D)   diaphragmatic excursion.

Question 17

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

Accepted Answer

A)   VII
B)   IX
C)   XI
D)   XII

Question 18

While examining a 48-year-old patient's eyes,the nurse notices that he had to move the handheld vision screener farther away from his face.The nurse would suspect:

Accepted Answer

A)   myopia.
B)   omniopia.
C)   hyperopia.
D)   presbyopia.

Question 19

A patient states,"Whenever I open my mouth real wide,I feel this popping sensation in front of my ears." To further examine this,the nurse would:

Accepted Answer

A)   place the stethoscope over the temporomandibular joint and listen for bruits.
B)   place the hands over his ears and ask him to open his mouth "really wide."
C)   place one hand on his forehead and the other on his jaw and ask him to try to open his mouth.
D)   place a finger on his temporomandibular joint and ask him to open and close his mouth.

Question 20

After the examination of an infant,the nurse documents opisthotonos.The nurse recognizes that this finding often occurs with:

Accepted Answer

A)   cerebral palsy.
B)   meningeal irritation.
C)   a lower motor neuron lesion.
D)   a upper motor neuron lesion.

Exam 27: The Complete Health Assessment: Putting It All Together