Health Assessment Final Exam: Review Questions And Answers

An elderly patient is admitted to the hospital. While performing a skin assessment, the nurse discovers bruises in various stages of healing all over the patient's body. Why is it important for the nurse to promptly document and report these findings? a.The patient may have been abused. b.The patient is elderly. c.The patient may have peripheral vascular disease. d.The patient may have a cognitive deficit. - ANS a. The patient may have been abused When the nurse observes the patient for general characteristics including age, gender, and level of alertness, what aspect of assessment are you performing? a.Inspecting b.Interviewing c.Palpating d.Ausculating - ANS a. Inspecting The four areas to consider during the general survey include: a. Dress, medical history, nonverbal behavior, and mobility. b.Ethnicity, gender, age, and socioeconomic status. c.Physical appearance, gender, ethnicity, and medical history. d.Physical appearance, body structure, mobility, and behavior. - ANS d. Physical appearance, body structure, mobility, and behavior. When reading the patient's medical record, the nurse sees the following notation: Patient states, "I have had a cold for about a week, and I am having difficulty breathing." This is an example of: a.A past health history. b.A review of systems. c.A functioning assessment. d.A chief compliant. - ANS d.A chief compliant. Normal cervical lymph nodes are: a.Smaller than 1 cm b.Warm and red c.Fixed d.Firm - ANS a.Smaller than 1 cm The first step to cultural competency by a nurse is to: a.Identify the meaning of health to the patient. b.Understand their own heritage and its basis in cultural values. c.Develop a frame of reference to traditional health care practices. d.Understand how a health care delivery system works. - ANS b.Understand their own heritage and its basis in cultural values. The nurse is conducting a physical assessment of a new patient. What data does the nurse collect that are measurable? a.Objective b.Effective c.Subjective d.Affective - ANS a.Objective While assessing a patient, the nurse is asking questions that help the nurse perceive and communicate an understanding of what the patient is feeling. What is this called? a.Caring b.Therapeutic communication c.Sympathy d.Empathy - ANS d.Empathy Checking for skin temperature is best accomplished by using: a.The palms of the hands. b.The back of the hands c.The fingertips. d.The ventral surfaces of the hands. - ANS b.The back of the hands The nurse is conducting a patient interview and responds to the patient in a way that encourages the patient to more completely describe his or her problems. What is this called? a.Guided questioning b.Focusing c.Clarification d.Restatement - ANS a.Guided questioning A risk factor for melanoma is: a.Brown eyes b.Darkly pigmented skin c.Use of sunscreen products d.Skin that freckles or burns before tanning - ANS d.Skin that freckles or burns before tanning What is the nurse assessing when asking the patient, "What things seem to make it better?" a.Relieving/exacerbating factors b.Functional goal c.Pain goal d.Duration - ANS a.Relieving/exacerbating factors The nurse examines the nail beds of a patient. Which findings indicates a normal angle? a.160 degrees b.100 degrees c.60 degrees d.180 degrees - ANS a.160 degrees The nurse notes the appearance of freckles while assessing a patient's skin. What is the appropriate term to use when documenting this finding? a.Macules b.Vesicles c.Bulla d.Patches - ANS a.Macules To assess for early jaundiced, the nurse should assess: a.The lips b.The sclera and hard palate c.All visible skin surfaces d.The nail beds - ANS b.The sclera and hard palate While assessing a patient for allergies, the patient states being allergic to penicillin. Which response is best?