For which patient condition would you most likely expect a capillary refill time longer than two seconds?
Malignant melanoma.
Inflammatory bowel disease.
Peripheral vascular disease.
Multiple sclerosis. - Answers Peripheral vascular disease
Which of the following is incorrect about pain in the older adult?
Opioids are often the drug of choice.
Older patients may have more than one source of pain.
There is a greater likelihood of having developed a pathological condition accompanied by pain.
Elderly people who are confused or cognitively impaired do not experience pain. - Answers Elderly
people who are confused or cognitively impaired do not experience pain.
Where is the correct location to auscultate the apical pulse?
Fourth intercostal space, left midclavicular line.
Second intercostal space, right midclavicular line.
Third intercostal space, mid axilla.
Fifth intercostal space, left midclavicular line. - Answers Fifth intercostal space, left midclavicular line.
Which of the following would be the most appropriate for you as the student nurse to do next, after a
patient LOC?
Leave the patient to go and talk to the other residents about what happened.
Perform a Glasgow Coma Score.
Refer the patient for immediate follow-up.
Ask if the patient has ever had a seizure. - Answers Perform a Glasgow Coma Score.
When performing a physical examination, which of the following would be most appropriate?
Allow the patient to remain dressed.
Omit intrusive parts of the exam.
,Dim the room light.
Try to minimize position changes for the patient. - Answers Try to minimize position changes for the
patient.
Which test would be most appropriate to perform when assessing the patient eye muscle strength and
cranial nerve function?
Visual fields test.
Cover test.
Corneal light reflex test.
Extra ocular movement test. - Answers Extra ocular movement test.
Which of the following nursing assessments will give you objective data relating to the functioning of the
patient's cerebellum?
Vital signs.
Coordination.
Glasgow Coma Score
Cardiac function. - Answers Coordination.
The registered nurse is having difficulty eliciting a patellar reflex. Which of the following would be most
appropriate for the nurse to have the patient do?
Lock the fingers together and pull against each other.
Stretch the arms over head.
Squeeze a thigh with the opposite hand.
Clench the jaw tightly. - Answers Lock the fingers together and pull against each other.
The patient's patellar reflex is normal. Which of the following is the correct number to document this?
2+.
3+.
4+.
5+. - Answers 2+
Which of the following would be the most likely sign of a frontal lobe contusion?
, Inability to hear high‐pitched sounds.
Difficulty speaking.
Blurred vision.
Loss of tactile sensation. - Answers Difficulty speaking.
Which of the following represents the break in sounds between the first and second sounds when
auscultating blood pressure?
Diastolic value.
Korotkoff sounds.
Auscultatory gap.
Phase V. - Answers Auscultatory gap.
You are having difficulty auscultating heart sounds, specifically S1 and S2. Which of the following would
help?
Use the bell of the stethoscope to help distinguish the sounds.
Palpate the apical impulse.
Palpate the carotid pulse while auscultating the heart.
Determine the pulse deficit. - Answers Palpate the carotid pulse while auscultating the heart.
Which type of pain would be associated with arthritis?
Somatic.
Chronic.
Visceral.
Cutaneous. - Answers Chronic.
Which of the following would lead you to suspect that the patient is experiencing pain?
Regular, unlaboured breathing.
Alert, talkative demeanor.
Facial grimacing, leaning forward.
Sitting upright, hands on lap. - Answers Facial grimacing, leaning forward.