HEALTH
Following abdominal auscultation of a client who is
admitted for signs of splenomegaly, which
additional assessment should the nurse use to
verify splenomegaly?
Rebound tenderness.
Percussion.
Deep palpation.
Inspection. - ANSWER>>>Percussion.
When splenomegaly is suspected, percussion of the
spleen produces a dull sound and is a safe method
of verifying enlargement. A normal-sized spleen is
positioned above the percussion point even when it
descends during inspiration, and the percussion
tone is tympanic on both expiration and inspiration.
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
,HEALTH
The nurse is assessing a healthy young adult
during an annual physical examination. Which
assessment technique should the nurse implement
when palpating the abdominal aorta?
Deep palpation above and to the left of the
umbilicus. Palpation of the abdomen as the client
completes a deep breath.
With the client standing, compress the abdomen as
the nurse stands behind the client.
With the palm of one hand, compress the abdomen
2 fingerbreaths below xiphoid process. -
ANSWER>>>Deep palpation above and to the left
of the umbilicus.
Deep palpation above and to the left of the
umbilicus is effective in sensing the pulsation of
the aorta.
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
,HEALTH
During a health history interview, a male client
reports that he smokes cigarettes and does not
plan to quit. Which action is most important for the
nurse to take?
Document the client's statement verbatim.
Calculate the client's pack year history.
Express support for the client's right to choose.
Ask about family history of lung cancer. -
ANSWER>>>Calculate the client's pack year
history
Calculation of cigarette pack year history provides
useful screening data regarding the client's risk for
health problems, which serves as the basis for the
plan of care.
How should the nurse assess for lower extremity
edema in a client who has been diagnosed with
heart failure?
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
, HEALTH
Measure bilateral ankle circumference with a non-
stretchable tape measure.
Press skin over the tibia and report edema
according to the grading scale.
Ask if the client feels the bilateral edema has
changed and to what extent.
Inspect the lower extremities together to compare
the amount of swelling. - ANSWER>>>Measure
bilateral ankle circumference with a non-
stretchable tape measure.
An accurate assessment of lower extremity edema
is required when a client is treated for heart failure.
Measuring ankle circumference is more accurate
than other objective measures that can rely on
individual interpretation, such as measuring pitting
edema.
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
Following abdominal auscultation of a client who is
admitted for signs of splenomegaly, which
additional assessment should the nurse use to
verify splenomegaly?
Rebound tenderness.
Percussion.
Deep palpation.
Inspection. - ANSWER>>>Percussion.
When splenomegaly is suspected, percussion of the
spleen produces a dull sound and is a safe method
of verifying enlargement. A normal-sized spleen is
positioned above the percussion point even when it
descends during inspiration, and the percussion
tone is tympanic on both expiration and inspiration.
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
,HEALTH
The nurse is assessing a healthy young adult
during an annual physical examination. Which
assessment technique should the nurse implement
when palpating the abdominal aorta?
Deep palpation above and to the left of the
umbilicus. Palpation of the abdomen as the client
completes a deep breath.
With the client standing, compress the abdomen as
the nurse stands behind the client.
With the palm of one hand, compress the abdomen
2 fingerbreaths below xiphoid process. -
ANSWER>>>Deep palpation above and to the left
of the umbilicus.
Deep palpation above and to the left of the
umbilicus is effective in sensing the pulsation of
the aorta.
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
,HEALTH
During a health history interview, a male client
reports that he smokes cigarettes and does not
plan to quit. Which action is most important for the
nurse to take?
Document the client's statement verbatim.
Calculate the client's pack year history.
Express support for the client's right to choose.
Ask about family history of lung cancer. -
ANSWER>>>Calculate the client's pack year
history
Calculation of cigarette pack year history provides
useful screening data regarding the client's risk for
health problems, which serves as the basis for the
plan of care.
How should the nurse assess for lower extremity
edema in a client who has been diagnosed with
heart failure?
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
, HEALTH
Measure bilateral ankle circumference with a non-
stretchable tape measure.
Press skin over the tibia and report edema
according to the grading scale.
Ask if the client feels the bilateral edema has
changed and to what extent.
Inspect the lower extremities together to compare
the amount of swelling. - ANSWER>>>Measure
bilateral ankle circumference with a non-
stretchable tape measure.
An accurate assessment of lower extremity edema
is required when a client is treated for heart failure.
Measuring ankle circumference is more accurate
than other objective measures that can rely on
individual interpretation, such as measuring pitting
edema.
HEALTH ASSESSMENT ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS VERIFIED ANSWERS ALREADY.
