While assessing a patient who is hospitalized and bedridden, the nurse notices that
the patient has been incontinent of stool. The stool is loose and gray-tan in color. The
nurse recognizes that this finding indicates which of the following?
Occult blood
Inflammation
Absent bile pigment
Ingestion of iron preparations
Give this one a try later!
Absent bile pigment
The presence of gray-tan stool indicates absent bile pigment, which can
occur with obstructive jaundice. The ingestion of iron preparations and the
presence of occult blood turns the stools to a black color. Jellylike mucus
shreds mixed in the stool would indicate inflammation.
,The nurse is examining a 35-year-old female patient. During the health history, the
nurse notices that she has had two term pregnancies, and both babies were delivered
vaginally. During the internal examination, the nurse observes that the cervical os is a
horizontal slit with some healed lacerations and that the cervix has some nabothian
cysts that are small, smooth, and yellow. In addition, the nurse notices that the
cervical surface is granular and red, especially around the os. Finally, the nurse
notices the presence of stringy, opaque, odorless secretions. Which of these findings
are abnormal?
Nabothian cysts are present.
The cervical os is a horizontal slit.
The cervical surface is granular and red.
Stringy and opaque secretions are present.
Give this one a try later!
The cervical surface is granular and red.
Normal findings: Nabothian cysts may be present on the cervix after
childbirth. The cervical os is a horizontal, irregular slit in the parous woman.
Secretions vary according to the day of the menstrual cycle, and may be
clear and thin or thick, opaque, and stringy. The surface is normally smooth,
but cervical eversion, or ectropion, may occur where the endocervical
canal is rolled out. Abnormal finding: The cervical surface should not be
reddened or granular, which may indicate a lesion.
While the nurse is taking the history of a 68-year-old patient who sustained a head
injury 3 days earlier, he tells the nurse that he is on a cruise ship and is 30 years old.
The nurse knows that this finding is indicative of a(n):
Great sense of humor.
Uncooperative behavior.
,Inability to understand questions.
Decreased level of consciousness.
Give this one a try later!
Decreased level of consciousness.
A change in consciousness may be subtle. The nurse should notice any
decreasing level of consciousness, disorientation, memory loss,
uncooperative behavior, or even complacency in a previously combative
person. The other responses are incorrect.
The nurse is reviewing the nutritional assessment of an 82-year-old patient. Which of
these factors will most likely affect the nutritional status of an older adult?
Increase in taste and smell
Living alone on a fixed income
Change in cardiovascular status
Increase in gastrointestinal motility and absorption
Give this one a try later!
Living alone on a fixed income
Socioeconomic conditions frequently affect the nutritional status of the
aging adult; these factors should be closely evaluated. Physical limitations,
income, and social isolation are frequent problems that interfere with the
acquisition of a balanced diet. A decrease in taste and smell and decreased
gastrointestinal motility and absorption occur with aging. Cardiovascular
status is not a factor that affects an older adults nutritional status.
, The nurse is presenting teaching sessions to a group of residents in a home for long-
term physical rehabilitation. Which client exhibits the highest motivation?
1. An individual who has been struggling with following nursing directives regarding
discharge goals
2. The client who has just moved in and is already waiting for discharge
3. A client who is excited to learn about his new prosthesis
4. A client who has been there the longest and is a great "coach" for newcomers
Give this one a try later!
A client who is excited to learn about his new prosthesis
While performing an assessment of the perianal area of a patient, the nurse notices
that the pigmentation of anus is darker than the surrounding skin, the anal opening is
closed, and a skin sac that is shiny and blue is noted. The patient mentioned that he
has had pain with bowel movements and has occasionally noted some spots of
blood. What would this assessment and history most likely indicate?
Anal fistula
Pilonidal cyst
Rectal prolapse
Thrombosed hemorrhoid
Give this one a try later!
the patient has been incontinent of stool. The stool is loose and gray-tan in color. The
nurse recognizes that this finding indicates which of the following?
Occult blood
Inflammation
Absent bile pigment
Ingestion of iron preparations
Give this one a try later!
Absent bile pigment
The presence of gray-tan stool indicates absent bile pigment, which can
occur with obstructive jaundice. The ingestion of iron preparations and the
presence of occult blood turns the stools to a black color. Jellylike mucus
shreds mixed in the stool would indicate inflammation.
,The nurse is examining a 35-year-old female patient. During the health history, the
nurse notices that she has had two term pregnancies, and both babies were delivered
vaginally. During the internal examination, the nurse observes that the cervical os is a
horizontal slit with some healed lacerations and that the cervix has some nabothian
cysts that are small, smooth, and yellow. In addition, the nurse notices that the
cervical surface is granular and red, especially around the os. Finally, the nurse
notices the presence of stringy, opaque, odorless secretions. Which of these findings
are abnormal?
Nabothian cysts are present.
The cervical os is a horizontal slit.
The cervical surface is granular and red.
Stringy and opaque secretions are present.
Give this one a try later!
The cervical surface is granular and red.
Normal findings: Nabothian cysts may be present on the cervix after
childbirth. The cervical os is a horizontal, irregular slit in the parous woman.
Secretions vary according to the day of the menstrual cycle, and may be
clear and thin or thick, opaque, and stringy. The surface is normally smooth,
but cervical eversion, or ectropion, may occur where the endocervical
canal is rolled out. Abnormal finding: The cervical surface should not be
reddened or granular, which may indicate a lesion.
While the nurse is taking the history of a 68-year-old patient who sustained a head
injury 3 days earlier, he tells the nurse that he is on a cruise ship and is 30 years old.
The nurse knows that this finding is indicative of a(n):
Great sense of humor.
Uncooperative behavior.
,Inability to understand questions.
Decreased level of consciousness.
Give this one a try later!
Decreased level of consciousness.
A change in consciousness may be subtle. The nurse should notice any
decreasing level of consciousness, disorientation, memory loss,
uncooperative behavior, or even complacency in a previously combative
person. The other responses are incorrect.
The nurse is reviewing the nutritional assessment of an 82-year-old patient. Which of
these factors will most likely affect the nutritional status of an older adult?
Increase in taste and smell
Living alone on a fixed income
Change in cardiovascular status
Increase in gastrointestinal motility and absorption
Give this one a try later!
Living alone on a fixed income
Socioeconomic conditions frequently affect the nutritional status of the
aging adult; these factors should be closely evaluated. Physical limitations,
income, and social isolation are frequent problems that interfere with the
acquisition of a balanced diet. A decrease in taste and smell and decreased
gastrointestinal motility and absorption occur with aging. Cardiovascular
status is not a factor that affects an older adults nutritional status.
, The nurse is presenting teaching sessions to a group of residents in a home for long-
term physical rehabilitation. Which client exhibits the highest motivation?
1. An individual who has been struggling with following nursing directives regarding
discharge goals
2. The client who has just moved in and is already waiting for discharge
3. A client who is excited to learn about his new prosthesis
4. A client who has been there the longest and is a great "coach" for newcomers
Give this one a try later!
A client who is excited to learn about his new prosthesis
While performing an assessment of the perianal area of a patient, the nurse notices
that the pigmentation of anus is darker than the surrounding skin, the anal opening is
closed, and a skin sac that is shiny and blue is noted. The patient mentioned that he
has had pain with bowel movements and has occasionally noted some spots of
blood. What would this assessment and history most likely indicate?
Anal fistula
Pilonidal cyst
Rectal prolapse
Thrombosed hemorrhoid
Give this one a try later!
