QUESTIONS AND DETAILED ANSWERS
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The nurse is assessing the posterior pharynx during a physical
examination. Which technique should the nurse use?
A. Press the tongue down one side at a time with a tongue
depressor.
B. Ask the client to open the mouth and say "ah"
C. Listen for hoarseness after asking the client to speak
D. Palpate the neck and ask the client to swallow. - correct
answer > A. Press the tongue down one side at a time with a
tongue depressor.
A nurse is completing a nutritional assessment with a client.
What is the easiest method for the nurse to use to get
information about the client's nutritional intake?
,A. 24-hour dietary recall
B. Food diary
C. Intake and output record
D. Lab information (albumin, pre-albumin) - correct answer >
A. 24-hour dietary recall
The nurse is preparing to assess the hearing of a client with a
history of prolonged exposure to occupational noise. Which
hearing test provides the most reliable assessment of hearing
status?
A. Audiometry
B. Whispered voice
C. Weber.
D. Rinne - correct answer > A. Audiometry
The nurse palpates a weak pedal pulse in the client's right foot.
Which assessment findings should the RN document that are
consistent with diminished peripheral circulation? (Select all
that apply.)
A. Diminished hair on legs
, B. Bruising on extremities
C. Skin cool to touch
D. Capillary refill less than 3 seconds
E. Darkened skin on extremities - correct answer > A.
Diminished hair on legs
C. Skin cool to touch
Which findings can the nurse determine by palpating a client's
skin? (Select all that apply.)
A. Pruritis
B. Diaphoresis
C. Pallor
D. Jaundice
E. Scaling - correct answer > B. Diaphoresis
E. Scaling
The RN is caring for an Asian client who refuses to make eye
contact during conversations. How should the RN assess this
client's response?