NCLEX 4000 Questions with answers Health Assessment Exam Questions And Answers 100% Verified

NCLEX 4000 Questions with answers Health Assessment Exam Questions And Answers 100% Verified A nurse determines that a client has 20/40 vision. Which statement about this clients vision is true? a) the client can read the entire vision chart at a distance of 40' b) the client can read from a distance of 20' what a person with normal vision can read at 40' c) the client can read the vision chart from a distance of 20' with the right eye and from 40' with the left eye d) the client can read at a distance of 30' what a person can read at a distance of 40' - answerB) the client can read from a distance of 20' what a person with normal vision can read at 40' the smaller the denominator the worse the vision the numerator is always 20, the distance in feet between the chart and person the denominator indicates what distance normal vision can read the chart location of aortic stenosis - answer2nd intercostal R When assessing a clients abdomen which finding should the nurse report as abmormal a) dullness over the liver b) bowel sounds occuring every 10 seconds c) shifting dullness over the abdomen d) vascular sound over the renal arteries - answerc) shifting dullness over the abdomen would indicate ascites which is abnormal dullness over the liver, bowel sounds every 10 seconds and vascular sounds over the renal arteries are all normal sounds in the abdomen A nurse is assesing a 47 year old client who has come to the clinic for his annual physical. One of the first physical signs of aging is a) having more frequent aches and pains b) failing eyesight, especially close vision c) increasing loss of muscle tone d) accepting limitations while developing assets - answerb) failing eyesight, especially close vision is one of the first signs of aging in middle life more frequent aches and pains occur around age 65 loss of muscle tone increases around age 80 accepting limitations while developing assets occurs around age 31-45 A nurse is assessing a clients pulse. Which pulse feature should the nurse document? a) timing in the cycle b) amplitude c) pitch d) intensity - answerB) amplitude (ARR) Amplitude, Rate, Rhythm When ausculating a clients abdomen, a nurse detects high pitched gurgles over the lower Right quadrant. Based on this finding,m the nurse suspects a) decreased bowel motility b) increased bowel motility c) nothing abnormal d) abdominal cramping - answerc) nothing abnormal high pitch gurgles are normal findings While performing an abdominal assessment a nurse should follow which examination sequence a) inspection, ausculation, percussion, palpation b) inspection, ausculation, palpation, percussion c) inspection, percussion, palpation, ausculation d) inspection, palpation, percussion, ausculation - answera) inspection, ausculation, percussion, palpation all other sequencing would be inspection, palpation, percussion and then ausculation A nurse prepares to perform an otoscopic examination on an adult. For proper visualization the nurse should position the clients ear by pullung the: a) lobule down and forward b) auricle up and back c) auricle up and forward d) lobule down and back` - answerb) auricle up and back for the child pull the auricle down Ausculatory gap - answera silent internal that may be present between the systolic and diastolic pressures; may lead to serious underestimation of systolic pressure; can be associated with arterial stiffness and atherosclerotic disease absence of Kortotkoff sounds between phase 1 and phase 2 while obtaining blood pressure readings A nurse is taking a clients blood pressure and fails to recognize an ausculatory gap. What should the nurse do to avoid recording a low systolic blood pressure a) have the client lie down while taking their blood pressure b) inflate the cuff to at least 200 mm Hg c) take blood pressure readings in both clients arms d) inflate the cuff at least 30 mm Hg after she cannot palpate the radial pulse - answerd) inflate the cuff at least 30 mm Hg after she cannot palpate the radial pulse A nurse is caring for a client who is exhibiting signs and symptoms charachteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a) assess the clients level of pain and administer prescribed analgesics b) assess the clients level of anxiety and provide emotional support c) prepare the client for pulmonary artery catheterization d) ensure that the clients family is kept informed of his status - answera) assess the pain level and administer prescribed analgesics When assessing the facial lacerations of a middle aged client admitted into the facility 1 week earlier, a nurse observes scabs around the lacerations. Scabs indicate which phase of wound healing? a) contraction b) fibronoplastic c) lag d) inflammation - answerc) lag the fibrin network dries out and forms a scab When a nurse enters a clients room, the client complains that she is spitting up blood when she coughs. When the nurse takes a quick health history it will include: a) history of the present problem, medications, review of symptoms and major recent operations b) history of the present problem, medications, allergies, and recent major surgeries c) history of the present problem, medications, psychosocial history, and review of systems d) history of the present problem, allergies, medications, review of symptoms, and recent major operatoins - answerb) history of the present problem, allergies, medications and recent major operations When percussing a clients chest, the nurse should expect to hear: a) hyperresonance b) tympany c) resonance d) dullness - answerc) resonance is a normal finding over the lung tissue in the chest