Chapter 26 – Health Assessment: Actual Questions and Verified Answers (Complete Study Material)

CHAPTER 26 HEALTH ASSESSMENT ACTUAL
QUESTIONS AND VERIFIED ANSWERS

UponAenteringAtheAclient'sAroomAatAtheAbeginningAofAaAshiftAandAthroughoutAtheAshift,AtheAnurseAa
ssessesAtheAclient.AThe

nurseAconsidersAtheAclient'sAplanAofAcareAandAresponseAtoAnursingAinterventionsAduringAtheAassess
ments.AWhatAtypeAofA1.AassessmentAisAtheAnurseAperforming?

A)AOngoingApartialAassessment

B)AComprehensiveAassessment

C)AFocusedAassessment

D)AEmergencyAassessmentA-ACORRECTAANSWER-Ans:AA

Feedback:

AnAongoingApartialAassessmentAisAconductedAatAregularAintervalsAduringAcareAofAtheAclientAandAco
ncentratesAonAidentifiedAhealthAproblemsAandAtheAeffectivenessAofAinterventions.AAAcomprehensi
veAassessmentAincludesAaAhealthAhistoryAandAcompleteAphysicalAexaminationAandAisAusuallyAcond
uctedAwhenAaAclientAfirstAentersAaAhealthAcareAsetting.AAAfocusedAassessmentAisAconductedAtoAass
essAaAspecificAproblem.AAnAemergencyAassessmentAisAaAtypeAofArapidAfocusedAassessmentAconduc
tedAtoAdetermineAaApotentiallyAfatalAsituation.

AnAolderAadultAasksAtheAnurseAaboutAtheAappearanceAofAflatAbrownAageAspotsAonAtheAhands.AAfter
AexaminingAtheAclient's



hands,AtheAnurseArecognizesAtheseAskinAcharacteristicsAasAaAcommonAskinAvariationAinAtheAolderAa
dultAandAdocumentsAtheA2.AvariationsAasAwhichAofAtheAfollowing?

A)ASenileAlentigines

B)ALanugo

C)ASenileAkeratosis

D)ACherryAangiomasA-ACORRECTAANSWER-Ans:AA

Feedback:

, SenileAlentiginesAareAflat,AbrownAageAspots,AsenileAkeratosisAareAraised,AdarkAareas,AandAcherryAan
giomasAareAsmall,AroundAredAspots.AAllAareAcommonAskinAvariationsAinAtheAolderAadult.ALanugoAisA
aAfineAdownyAhairAthatAappearsAonAtheAnewbornAforAtheAfirstAtwoAweeksAofAlife.

TheAnurseAisAperformingAanAassessmentAonAanAinfant.AWhichAfindingAisAconsideredAanAabnormalAc
ardiovascularAassessmentA3.AthatAshouldAbeAdocumentedAandAreportedAtoAtheAphysician?

A)ADecreasedAheartArate

B)AVisibleApulsationAthroughAaAthinAchestAwall

C)ASinusAdysrhythmiaAthatAincreasesAwithAinspirationAandAdecreasesAwithAexpirationA

D)APresenceAofAanASAheartAsoundA-ACORRECTAANSWER-Ans:AA

Feedback:

InfantsAandAchildrenAshouldAhaveAaAmoreArapidAheartArate,AinsteadAofAaAdecreasedAheartArate,Aunti
lAaboutAageA8Ayears.ACommonAcardiovascularAfindingsAincludeAvisibleApulsationAifAtheAchestAwallAis
Athin,AsinusAdysrhythmiaA(theArateAincreasesAwithAinspirationAandAdecreasesAwithAexpiration),Aand


AtheApresenceAofAanASAheartAsound.



TheAnurseAisAconductingAanAassessmentAonAtheAintegumentaryAsystemAofAaAclientAageA74Ayears.AW
hichAofAtheAfollowingA4.AfindingsAshouldAtheAnurseAdocumentAasAanAanomalyAthatAmayAwarrantAfol
low-up?

A)ATheAclientAstatesAthatAaAmoleAonAhisAforeheadAhasAbecomeAlargerAinArecentAmonths.

B)ADecreasedAskinAturgorAisAevidentAwhenAtheAskinAisAfoldedAandAthenAreleased.

C)ASmall,Around,AredAspotsAareApresentAonAtheAclient'sAforearmsAbilaterally.

D)AThereAareAsomeAraised,AbrownAareasAonAtheAbacksAofAtheAclient'sAhands.A-ACORRECTAANSWER-
Ans:AA

Feedback:

ChangesAinAtheAsizeAorAappearanceAofAaAmoleAalwaysArequireAfurtherAassessmentAandAfollow-
upAdueAtoAtheirAassociationAwithAskinAcancer.ADecreasedAskinAturgorAisAanAexpectedAfindingAinAold
erAadults,AasAareAdiffuseAredAspotsA(cherryAangioma)AandAraised,AdarkAareasA(senileAlentigines).

AsAaAcomponentAofAaAheadAtoAtoeAassessment,AtheAnurseAisApreparingAtoAassessAconvergenceAofAt
heAclient'sAeyes.AHowA5.AshouldAtheAnurseAconductAthisAassessment?

A)AAskAtheAclientAtoAfollowAherAfingerAasAsheAslowlyAmovesAitAtowardsAtheAclient'sAnose.