NURSING 110 EXAM 1 STUDY GUIDE AND REVIEW QUESTIONS
40
The nurse is visiting the patient for the first time this shift. She introduces herself and asks the
patient several questions related to his condition. While doing so, and without being obvious,
she is looking at the color of his eyes and is assessing his ears and nose for discharge and the
symmetry of his mouth. Which assessment technique is the nurse using?
A: palpation
B: percussion
C: inspection
D: auscultation - Correct answer ✔✔✔ C: inspection
The patient is admitted with fever and acute lower abdominal pain. He has taken tylenol but
says he still feels feverish. Before taking the patient's temperature, the nurse may:
A: touch the patients skin with the dorsal of her hand
B: touch the patients skin with the pads of her finger
C: palpate the skin using the bimanual method
D: touch the patients skin with the palmar side of her hand - Correct answer ✔✔✔ A: touch the
patients skin with the dorsal of her hand
What should the nurse do when preparing to complete an assessment for a 16 year old patient?
A: focus on the illness behaviors
B: plan for a diminished energy level
C: treat the patient as an individual
D: have the parents present throughout - Correct answer ✔✔✔ C: treat the patient as an
individual
,The general survey begins with a review of the patient's primary health problems and an
evaluation of the patient's vital signs, height and weight, general behavior, and appearance. It
also provides information about the patient's illness, hygiene, skin condition, body image, and
emotional state. Which of the following cannot be delegated to nursing assistive personnel?
A: reporting subjectives signs and symptoms
B: measuring the patients height and weight
C: monitoring I&O
D: obtaining initial vital signs - Correct answer ✔✔✔ D: obtaining initial vital signs
The nurse is preparing to examine a patient who has chronic lung disease. She realizes that the
patient most likely will need to be in which position for the examination?
A: high fowlers
B: supine
C: side-lying
D: prone - Correct answer ✔✔✔ A: High fowlers
Nursing diagnoses meet specific criteria so they accurately reflect both the celints problem and
the possible etiology involved. Of the following statements, which one is an example of an
appropriately written nursing diagnosis?
A: cardiac output decreased related to motor vehicle accidents
B: potential for injury related to improper teaching in the use of crutches
C: ineffective airway clearance related to increased secretions
D: risk for change in body image related to cancer - Correct answer ✔✔✔ C: ineffective airway
clearance related to increased secretions
Where is the pulmonic area for auscultation found?
A: second intercostal space on the right side
B: second intercostal space on the left side
,C: third intercostal space
D: fourth intercostal space along the sternum - Correct answer ✔✔✔ B: second intercostal
space on the left side
While performing a cardiovascular assessment on a patient with suspected left-sided congestive
heart failure, the nurse is unable to palpate the PMI with the patient lying supine. What might
her next step be?
A: have the patient turn onto his left side
B: have the patient lean forward
C: have the patient move to a sitting position
D: palpate the PMI to the right of the midclavicular line - Correct answer ✔✔✔ A: have the
patient turn onto his left side
Which of the following should the nurse implement for assessment of the carotid artery?
A: massaging the arteries briskly
B: using the diaphragm of the stethoscope
C: palpating each carotid artery separately
D: placing the patient in a supine position - Correct answer ✔✔✔ C: Palpating each carotid
artery separately
Which of the following is an unexpected finding after a cardiac assessment?
A: a pulse rate of 72 beats per minute.
B: jugular vein pulsation with the patient supine.
C: PMI found at the midclavicular line.
D: a sustained swishing sound during systole or diastole. - Correct answer ✔✔✔ D: a sustained
swishing sound during systole or diastole
, How should the nurse document an exaggeration of the posterior curvature of the thoracic
spine found during the assessment of a 90 year old patient?
A: lordosis.
B: osteoporosis.
C: scoliosis.
D: kyphosis. - Correct answer ✔✔✔ D: kyphosis
A nurse is documenting a patient's breath sounds. Crackles are heard as:
A: loud, low-pitched, coarse sounds.
B: high-pitched, musical squeaks.
C: dry, granting sounds on inspiration.
D: high-pitched, fine sounds at the end of inspiration - Correct answer ✔✔✔ D: high-pitched,
fine sounds at the end of inspiration
A 53 year old client is seen at the clinic for a yearly physical examination. In evaluating the
client's weight, the nurse also considers the age and height. This is an example of:
A: defining the client problem.
B: recognizing gaps in data assessment.
C: comparing data with normal health patterns.
D: drawing conclusions about the client's response. - Correct answer ✔✔✔ C: comparing data
with normal health patterns
The nurse is preparing to perform a focused respiratory assessment on a client. The nurse
should be cognizant of what anatomical characteristic of the lungs?
A: the left lung is approximately one-third larger than the right lung.
B: the right lung has three lobes, while the left lung has two lobes.
C: the lower lobes of both lungs are primarily located toward the anterior chest wall.
40
The nurse is visiting the patient for the first time this shift. She introduces herself and asks the
patient several questions related to his condition. While doing so, and without being obvious,
she is looking at the color of his eyes and is assessing his ears and nose for discharge and the
symmetry of his mouth. Which assessment technique is the nurse using?
A: palpation
B: percussion
C: inspection
D: auscultation - Correct answer ✔✔✔ C: inspection
The patient is admitted with fever and acute lower abdominal pain. He has taken tylenol but
says he still feels feverish. Before taking the patient's temperature, the nurse may:
A: touch the patients skin with the dorsal of her hand
B: touch the patients skin with the pads of her finger
C: palpate the skin using the bimanual method
D: touch the patients skin with the palmar side of her hand - Correct answer ✔✔✔ A: touch the
patients skin with the dorsal of her hand
What should the nurse do when preparing to complete an assessment for a 16 year old patient?
A: focus on the illness behaviors
B: plan for a diminished energy level
C: treat the patient as an individual
D: have the parents present throughout - Correct answer ✔✔✔ C: treat the patient as an
individual
,The general survey begins with a review of the patient's primary health problems and an
evaluation of the patient's vital signs, height and weight, general behavior, and appearance. It
also provides information about the patient's illness, hygiene, skin condition, body image, and
emotional state. Which of the following cannot be delegated to nursing assistive personnel?
A: reporting subjectives signs and symptoms
B: measuring the patients height and weight
C: monitoring I&O
D: obtaining initial vital signs - Correct answer ✔✔✔ D: obtaining initial vital signs
The nurse is preparing to examine a patient who has chronic lung disease. She realizes that the
patient most likely will need to be in which position for the examination?
A: high fowlers
B: supine
C: side-lying
D: prone - Correct answer ✔✔✔ A: High fowlers
Nursing diagnoses meet specific criteria so they accurately reflect both the celints problem and
the possible etiology involved. Of the following statements, which one is an example of an
appropriately written nursing diagnosis?
A: cardiac output decreased related to motor vehicle accidents
B: potential for injury related to improper teaching in the use of crutches
C: ineffective airway clearance related to increased secretions
D: risk for change in body image related to cancer - Correct answer ✔✔✔ C: ineffective airway
clearance related to increased secretions
Where is the pulmonic area for auscultation found?
A: second intercostal space on the right side
B: second intercostal space on the left side
,C: third intercostal space
D: fourth intercostal space along the sternum - Correct answer ✔✔✔ B: second intercostal
space on the left side
While performing a cardiovascular assessment on a patient with suspected left-sided congestive
heart failure, the nurse is unable to palpate the PMI with the patient lying supine. What might
her next step be?
A: have the patient turn onto his left side
B: have the patient lean forward
C: have the patient move to a sitting position
D: palpate the PMI to the right of the midclavicular line - Correct answer ✔✔✔ A: have the
patient turn onto his left side
Which of the following should the nurse implement for assessment of the carotid artery?
A: massaging the arteries briskly
B: using the diaphragm of the stethoscope
C: palpating each carotid artery separately
D: placing the patient in a supine position - Correct answer ✔✔✔ C: Palpating each carotid
artery separately
Which of the following is an unexpected finding after a cardiac assessment?
A: a pulse rate of 72 beats per minute.
B: jugular vein pulsation with the patient supine.
C: PMI found at the midclavicular line.
D: a sustained swishing sound during systole or diastole. - Correct answer ✔✔✔ D: a sustained
swishing sound during systole or diastole
, How should the nurse document an exaggeration of the posterior curvature of the thoracic
spine found during the assessment of a 90 year old patient?
A: lordosis.
B: osteoporosis.
C: scoliosis.
D: kyphosis. - Correct answer ✔✔✔ D: kyphosis
A nurse is documenting a patient's breath sounds. Crackles are heard as:
A: loud, low-pitched, coarse sounds.
B: high-pitched, musical squeaks.
C: dry, granting sounds on inspiration.
D: high-pitched, fine sounds at the end of inspiration - Correct answer ✔✔✔ D: high-pitched,
fine sounds at the end of inspiration
A 53 year old client is seen at the clinic for a yearly physical examination. In evaluating the
client's weight, the nurse also considers the age and height. This is an example of:
A: defining the client problem.
B: recognizing gaps in data assessment.
C: comparing data with normal health patterns.
D: drawing conclusions about the client's response. - Correct answer ✔✔✔ C: comparing data
with normal health patterns
The nurse is preparing to perform a focused respiratory assessment on a client. The nurse
should be cognizant of what anatomical characteristic of the lungs?
A: the left lung is approximately one-third larger than the right lung.
B: the right lung has three lobes, while the left lung has two lobes.
C: the lower lobes of both lungs are primarily located toward the anterior chest wall.
