HEALTH ASSESSMENT I EXAM 3
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Johns Hopkins University
School of Nursing
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HEALTH ASSESSMENT - EXAM 3 REVIEW QUESTIONS
An 86-year-old woman has been admitted to the Shadow General surgical floor
after a knee replacement. She has a history of degenerative joint disease
(DJD). What physical exam findings would you expect to find?
A) Joint deformity
B) Shuffling gait
C) Postural instability
D) Humpback
A) Joint deformity
Persons with DJD have limitations in strength and range of motion, joint crepitus,
and pain with activity that is relieved with rest. Humpback, or kyphosis, is commonly
due to osteoporosis, while shuffling gait and postural instability are commonly seen
in those with Parkinson's disease.
Humpback (kyphosis) is commonly caused by
Osteoporosis
Shuffling gait and postural instability is commonly seen in patients with
Parkinson's Disease
If Tina had displayed limited abduction of the left shoulder, it would mean that:
A) She has limited movement forward
B) She has limited movement in a circular motion
C) She has limited movement toward her body
D) She has limited movement away from her body
D) She has limited movement away from her body
Abduction is defined as a motion in which a body part is moved away from the body's
midline.
Suppose you noted that Tina's left knee was swollen. Which of the following
tests should be done?
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A) Balloon test
B) Fluid wave
C) Bulge sign
D) Tinel's sign
C) Bulge sign
The bulge sign is a test for excess fluid accumulation in the knee. It is performed by
rubbing the knee capsule in upward strokes to displace fluid and observing for the
creation of a bulge when the fluid returns to its original position.
Imagine that Tina was unable to move her right ankle. You notice that her
muscles contract as she attempts to dorsiflex her ankle, but no movement
occurs. How would you grade her ankle strength?
A) 1/5
B) 2/5
C) 4/5
D) 3/5
A) 1/5
According to the Oxford Scale, a muscle group that has no mobility but displays
visible muscle contraction is graded as a 1/5 strength.
The first heart sound (S1) is produced by the:
A) closure of the semilunar valves.
B) closure of the AV valves.
C) opening of the semilunar valves.
D) opening of the AV valves.
B) closure of the AV valves. Correct
S1 occurs with closure of the atrioventricular valves.
The second heart sound (S2) occurs with closure of the semilunar valves.
Normally opening of the semilunar valves is silent, but in aortic or pulmonic stenosis,
an ejection click may be heard. An ejection click occurs early in systole at the start of
ejection because it results from opening of the semilunar valves.
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A third heart sound (S3) can be heard when the ventricles are resistant to filling
during the early rapid filling phase. S3 is heard when the AV valves open and atrial
blood first pours into the ventricles.
Which of the following guidelines may be used to identify which heart sound is
S1?
A) S1 is louder than S2 at the base of the heart.
B) S1 coincides with the A wave of the jugular venous pulse wave.
C) S1 coincides with the carotid artery pulse.
D) S1 coincides with the Q wave of the QRS electrocardiogram complex.
C) S1 coincides with the carotid artery pulse.
S1 coincides with the carotid artery pulse.
S1 is loudest at the apex of the heart.
S1 coincides with the C wave of the jugular venous pulse wave.
S1 coincides with the R wave (the upstroke of the QRS complex).
Which of the following cardiac alterations occurs during pregnancy?
A) An increase in cardiac output and blood pressure
B) An increase in cardiac volume and a decrease in blood pressure
C) An increased heart rate and increased blood pressure
D) An increased stroke volume and decreased cardiac output
B) An increase in cardiac volume and a decrease in blood pressure
During pregnancy the blood volume increases by 30% to 40%; this creates an
increase in stroke volume and cardiac output and an increased pulse rate of 10 to 15
beats per minute. The arterial blood pressure decreases in pregnancy as a result of
peripheral vasodilation.
Which of the following is an appropriate position to have the patient assume
when auscultating for extra heart sounds or murmurs?
A) Roll toward the left side
B) Roll toward the right side
C) Trendelenburg position
D) Recumbent position
A) Roll toward the left side