NUR2092 Health Assessment Exam 2 Quiz
Bank | Questions and Answers with Rationale
2024
When assessing a patient the nurse is unable to palpate the left dorsalis pedis pulse.
What should the nurse do first?
A. document the finding
B. use the doppler to assess the pulse
C. call the physician and tell them the patient has no pulse.
D. start assessing the next patient - B. use the doppler to assess the pulse
The first thing that you should do is find a doppler and see if the pulse can be heard
through ultrasound
Pulse rating system:
O = absent
1+ = weak
2+ = normal
3+ increased, full, bounding
A 67-year old patient states that he recently began to have pain in his left calf when
climbing the 10 stairs to his apartment. This pain is relieved by sitting for approximately
2 minutes; then he is able to resume his activities. the nurse interprets that this patient
is most likely experiencing:
A. intermittent claudication.
B. sore muscles
C. muscle cramps
D. venous insufficiency - A. intermittent claudication
The pain is brought on by activity and relieved with rest.
The nurse is preparing to perform a modified Allen test. Which is an appropriate reason
for this test?
A. to measure the rate of lymphatic drainage.
B. To evaluate the adequacy of capillary patency before venous blood draws.
C. To evaluate the adequacy of collateral circulation before cannulating the radial artery
,D. to evaluate the venous refill rate that occurs after the ulnar and radial arteries are
temporarily occluded. - C. to evaluate the adequacy of collateral circulation before
cannulating the radial artery
Modified Allen test is used to evaluate the adequacy of collateral circulation before the
radial artery is cannulated. The other responses are not reasons for a modified Allen
test
In assessing the carotid arteries of an older patient with cardiovascular disease, the
nurse would
A. palpate the artery in the upper one third of the neck.
B. listen with the bell of the stethoscope to assess for bruits
C. palpate both arteries simultaneously to compare amplitude.
D. instruct patient to take slow, deep breaths during auscultation. - B. listen with the bell
of the stethoscope to assess for bruits.
If cardiovascular disease is suspected, then the nurse should auscultate each carotid
artery for the presence of a bruit. The nurse should avoid compressing the artery
because this could create an artificial bruit and it could compromise circulation if the
carotid artery is already narrowed by atherosclerosis. Avoid excessive pressure on the
carotid sinus area higher in the neck, excessive vagal stimulation here could slow down
the heart rate, especially in older adults. Palpate only on e carotid artery at a time to
avoid compromising arterial blood to the brain.
When auscultating over a patient's femoral arteries, the nurse notices the presence of a
bruit on the left side. The nurse knows that bruits
A. are often associated with venous disease
B. occur in the presence of lymphadenopathy
C. in the femoral arteries are caused by hypermetabolic states
D. occur with turbulent flow, indicating partial occlusion - D. occur with turbulent flow,
indicating partial occlusion
Bruits occur with turbulent blood flow, indicating partial occlusion. A bruit is audible
when the artery is occluded by 1/2 to 2/3, it's loudness increases as atherosclerosis
worsens and disappears when the lumen is completely occluded
You are caring for a 36 year old female patient admitted with c/o nausea and vomiting
(N/V). What questions are appropriate to ask the patient to elicit health history
information regarding her GI system?
A. any changes in bowel habits?
B. how long have you experienced this N/V?
C None of the above.
D. both a and b. - D. both A and B
These are examples of subjective data obtained to elicit GI history
, True or false? A 24-hour recall of dietary intake is considered subjective data collected
during a GI assessment. - True
You would want to know what the patient has eaten for the last 24 hours to determine if
his or her symptoms have to do with what they have eaten in their daily diet.
You are caring for a 32 year old male patient with complaints of abdominal pain. After
inspecting the patient's abdomen, you would be correct in performing what assessment
technique next?
A. deep palpation
B. percussion
C. light palpation
D. auscultation - D. auscultation
You must perform the least invasive things first. if the person is having abdominal pain,
deep palpation will most likely hurt and you will not be able to get through the whole
examination if your perform this first.
You are watching another student perform auscultation of a patient's abdomen. Which
statement by the other student demonstrates her understanding of the reason
auscultation precedes percussion and palpation of the abdomen?
A. "We need to determine areas of tenderness before using percussion and palpation."
B. "It prevents distortion of bowel sounds that might occur after percussion and
palpation."
C. "It allows the patient more time to relax and therefore be more comfortable with the
physical examination."
D. "This prevents distortion of vascular sounds such as bruits and hums that might
occur after percussion and palpation." - B. "It prevents distortion of bowel sounds that
might occur after percussion and palpation."
Auscultation is performed first (after inspection) because percussion and palpation can
increase peristalsis, which would give a false interpretation of bowel sounds.
Which of the following observations should you make when inspecting a patient's
abdomen?
A. contour, symmetry and demeanor
B. appearance of umbilicus
C. skin and hair distribution
D. all of the above - D. all of the above
during inspection you should observe
contour (flat, rounded, concave, and distended),
symmetry (any bulges or masses)
appearance of umbilicus (midline, inverted, can be everted with pregnancy)
skin (should be smooth and even, note any striae)
pulsation or movement
Bank | Questions and Answers with Rationale
2024
When assessing a patient the nurse is unable to palpate the left dorsalis pedis pulse.
What should the nurse do first?
A. document the finding
B. use the doppler to assess the pulse
C. call the physician and tell them the patient has no pulse.
D. start assessing the next patient - B. use the doppler to assess the pulse
The first thing that you should do is find a doppler and see if the pulse can be heard
through ultrasound
Pulse rating system:
O = absent
1+ = weak
2+ = normal
3+ increased, full, bounding
A 67-year old patient states that he recently began to have pain in his left calf when
climbing the 10 stairs to his apartment. This pain is relieved by sitting for approximately
2 minutes; then he is able to resume his activities. the nurse interprets that this patient
is most likely experiencing:
A. intermittent claudication.
B. sore muscles
C. muscle cramps
D. venous insufficiency - A. intermittent claudication
The pain is brought on by activity and relieved with rest.
The nurse is preparing to perform a modified Allen test. Which is an appropriate reason
for this test?
A. to measure the rate of lymphatic drainage.
B. To evaluate the adequacy of capillary patency before venous blood draws.
C. To evaluate the adequacy of collateral circulation before cannulating the radial artery
,D. to evaluate the venous refill rate that occurs after the ulnar and radial arteries are
temporarily occluded. - C. to evaluate the adequacy of collateral circulation before
cannulating the radial artery
Modified Allen test is used to evaluate the adequacy of collateral circulation before the
radial artery is cannulated. The other responses are not reasons for a modified Allen
test
In assessing the carotid arteries of an older patient with cardiovascular disease, the
nurse would
A. palpate the artery in the upper one third of the neck.
B. listen with the bell of the stethoscope to assess for bruits
C. palpate both arteries simultaneously to compare amplitude.
D. instruct patient to take slow, deep breaths during auscultation. - B. listen with the bell
of the stethoscope to assess for bruits.
If cardiovascular disease is suspected, then the nurse should auscultate each carotid
artery for the presence of a bruit. The nurse should avoid compressing the artery
because this could create an artificial bruit and it could compromise circulation if the
carotid artery is already narrowed by atherosclerosis. Avoid excessive pressure on the
carotid sinus area higher in the neck, excessive vagal stimulation here could slow down
the heart rate, especially in older adults. Palpate only on e carotid artery at a time to
avoid compromising arterial blood to the brain.
When auscultating over a patient's femoral arteries, the nurse notices the presence of a
bruit on the left side. The nurse knows that bruits
A. are often associated with venous disease
B. occur in the presence of lymphadenopathy
C. in the femoral arteries are caused by hypermetabolic states
D. occur with turbulent flow, indicating partial occlusion - D. occur with turbulent flow,
indicating partial occlusion
Bruits occur with turbulent blood flow, indicating partial occlusion. A bruit is audible
when the artery is occluded by 1/2 to 2/3, it's loudness increases as atherosclerosis
worsens and disappears when the lumen is completely occluded
You are caring for a 36 year old female patient admitted with c/o nausea and vomiting
(N/V). What questions are appropriate to ask the patient to elicit health history
information regarding her GI system?
A. any changes in bowel habits?
B. how long have you experienced this N/V?
C None of the above.
D. both a and b. - D. both A and B
These are examples of subjective data obtained to elicit GI history
, True or false? A 24-hour recall of dietary intake is considered subjective data collected
during a GI assessment. - True
You would want to know what the patient has eaten for the last 24 hours to determine if
his or her symptoms have to do with what they have eaten in their daily diet.
You are caring for a 32 year old male patient with complaints of abdominal pain. After
inspecting the patient's abdomen, you would be correct in performing what assessment
technique next?
A. deep palpation
B. percussion
C. light palpation
D. auscultation - D. auscultation
You must perform the least invasive things first. if the person is having abdominal pain,
deep palpation will most likely hurt and you will not be able to get through the whole
examination if your perform this first.
You are watching another student perform auscultation of a patient's abdomen. Which
statement by the other student demonstrates her understanding of the reason
auscultation precedes percussion and palpation of the abdomen?
A. "We need to determine areas of tenderness before using percussion and palpation."
B. "It prevents distortion of bowel sounds that might occur after percussion and
palpation."
C. "It allows the patient more time to relax and therefore be more comfortable with the
physical examination."
D. "This prevents distortion of vascular sounds such as bruits and hums that might
occur after percussion and palpation." - B. "It prevents distortion of bowel sounds that
might occur after percussion and palpation."
Auscultation is performed first (after inspection) because percussion and palpation can
increase peristalsis, which would give a false interpretation of bowel sounds.
Which of the following observations should you make when inspecting a patient's
abdomen?
A. contour, symmetry and demeanor
B. appearance of umbilicus
C. skin and hair distribution
D. all of the above - D. all of the above
during inspection you should observe
contour (flat, rounded, concave, and distended),
symmetry (any bulges or masses)
appearance of umbilicus (midline, inverted, can be everted with pregnancy)
skin (should be smooth and even, note any striae)
pulsation or movement
