Answers
Which situation illustrates a screening assessment?
a. a client visits an obstetric clinic for the first time and the nurse conducts a detailed
history and physical examination
b. a hospital sponsors a health fair at a local mall and provides cholesterol and blood
pressure checks to mall patrons
c. a client that is having a rash reevaluated after 10 days of using topical ointment
d. a hospitalized client that had a left hip replacement yesterday - answer B. a
hospital sponsors a health fair at a local mall and provides cholesterol and blood
pressure checks to mall patrons
The nurse documents which information in the patient's history as subjective data?
a. the patient's skin feels warm to the touch
b. the patient is scratching his arm
c. the patient's temperature is 100*F
d. the patient complains of itching - answer D. the patient complains of itching
Which activity illustrates the concept of primary prevention?
a. influenza vaccine
b. blood pressure screening
c. education on living with diabetes mellitus
d. cardiac rehabilitation after coronary artery bypass surgery - answer A. influenza
vaccine
When interviewing a client with dementia, the nurse should say which of the following?
a. i see you are confused so i will get your information later
b. i cannot obtain information from anyone else so please answer
c. i need to ask you a few questions. If you do not know the answer, I will ask your
family
d. I've had the same symptoms that you've described - answer C. i need to ask you a
few questions. If you do not know the answer, I will ask your family
Nurses are responsible for which of the below regarding cultural sensitivity?
a. recognizing that people of the same race have a shared culture
b. complying with the stated plan of treatment regardless of the patient's culture
c. asking the patients their dietary preferences
d. helping patients of different cultures adopt the beliefs and behaviors of the dominant
culture - answer C. asking the patients their dietary preferences
A nurse suspects that a large skin lesion on the patient's forearm is a fungal infection.
Which device does the nurse use to confirm his suspicion?
, a. pen light
b. magnification device
c. transilluminator
d. wood lamp - answer D. wood lamp
A patient admitted with pneumonia reports that she takes insulin for diabetes mellitus. In
which section of the history does the nurse document the insulin and diabetes?
a. past health history
b. present health status
c. reason for seeking care (chief complaint)
d. history of present illness - answer B. present health status
What symptoms is the nurse assessing when asking the patient to describe the pain?
a. onset
b. duration
c. characteristics
d. severity - answer C. Characteristics
The nurse is taking a patient's blood pressure and releases the valve 6-8
mmHg/second. What will the reading likely be?
a. accurate, the actual value
b. higher than the actual value
c. lower than the actual value
d. unable to determine accuracy with available data - answer C. lower than the
actual value
Which statement is correct regarding taking or interpreting axillary temperature?
a. it is preferred temperature measurement for adults
b. readings may be less accurate
c. axillary temperature readings are approximately 3 degrees higher than the oral
temperature readings
d. the thermometer is placed in the axilla with the shoulder abducted - answer B.
readings may be less accurate
Nurses understand that a patient's diastolic pressure represents which physiologic
function?
a. The pressure needed to open the aortic and pulmonic valves
b. The pressure in blood vessels when the ventricles contract
c. The pressure of the blood returning to the heart from the venous system
d. The pressure in blood vessels when the ventricles are relaxed - answer D. the
pressure in blood vessels when the ventricles are relaxed
The client states they are allergic to penicillin. What should the nurse do next?
a. ensure the client that many people are allergic to penicillin
b. ask what happens when they take penicillin
c. document the allergy in the electronic medical record (EMR)