Health Assessment NCLEX Questions I
1.The nurse is caring for a client with respiratory insufficiency. The arterial blood gas
results indicate a pH of 7.50 and a Pco2 of 30mm Hg, and the nurse is told that the client
is experiencing respiratory alkalosis. Which additional laboratory value should the nurse
expect to note?
1. A sodium level of 145 mEq/L
2. A potassium level of 3.2 mEq/L
3. A magnesium level of 2.4 mg/dL
4. A phosphorus level of 4.0 mg/dL
2.The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease
(COPD). The nurse should monitor the client for which acid–base imbalance?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
3.The nurse is caring for a client with a nasogastric tube that is attached to low suction. The
nurse monitors the client closely for which acid–base disorder that is most likely to occur
in this situation?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
4.A client has the following laboratory values: a pH of 7.55, an HCO3 – level of 22mm Hg,
and a Pco2 of 30 mm Hg. Which action should the nurse take?
1. Perform Allen’s test.
2. Prepare the client for dialysis.
3. Administer insulin as prescribed.
4. Encourage the client to slow down breathing.
, 5.The clinic nurse is assisting to perform a focused data collection process on a client who
is com- plaining of symptoms of a cold, a cough, and lung congestion. Which should the
nurse include for this type of data collection? Select all that apply.
1. Auscultating lung sounds
2. Obtaining the client’s temperature
3. Checking the strength of peripheral pulses
4. Obtaining information about the client’s respirations
5. Performing a musculoskeletal and neurological examination
6. Asking the client about a family history of any illness or disease
6.A client with a diagnosis of asthma is admitted to the hospital with respiratory distress.
Which type of adventitious lung sounds should the nurse expect to note documented in
the health record when collecting data related to the respiratory system for this client?
1. Stridor
2. Wheezes
3. Diminished
4. Pleural friction rub
7.The nurse notes documentation that a client has conductive hearing loss. The nurse
understands that which is a cause of this type of hearing loss?
1.A defect in the cochlea
2.A defect in the 8th cranial nerve
3.A physical obstruction to the transmission of sound waves
4.A defect in the sensory fibers that lead to the cerebral cortex
8.The nurse is preparing to assist the health care provider to test the extraocular movements
in a client for muscle weakness in the eyes. The nurse anticipates that which physical
assessment technique will be done to assess for muscle weakness in the eye?
1. Testing sensory function
2. Testing the corneal reflexes
3. Testing the six cardinal positions of gaze
4. Testing visual acuity using a Snellen eye chart
9.A client with myocardial infarction suddenly becomes tachycardic, shows signs of air
hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath
sounds, expecting to hear which breath sounds bilaterally?
1. Rhonchi
2. Crackles
3. Wheezes
4. Diminished breath sounds
1.The nurse is caring for a client with respiratory insufficiency. The arterial blood gas
results indicate a pH of 7.50 and a Pco2 of 30mm Hg, and the nurse is told that the client
is experiencing respiratory alkalosis. Which additional laboratory value should the nurse
expect to note?
1. A sodium level of 145 mEq/L
2. A potassium level of 3.2 mEq/L
3. A magnesium level of 2.4 mg/dL
4. A phosphorus level of 4.0 mg/dL
2.The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease
(COPD). The nurse should monitor the client for which acid–base imbalance?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
3.The nurse is caring for a client with a nasogastric tube that is attached to low suction. The
nurse monitors the client closely for which acid–base disorder that is most likely to occur
in this situation?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
4.A client has the following laboratory values: a pH of 7.55, an HCO3 – level of 22mm Hg,
and a Pco2 of 30 mm Hg. Which action should the nurse take?
1. Perform Allen’s test.
2. Prepare the client for dialysis.
3. Administer insulin as prescribed.
4. Encourage the client to slow down breathing.
, 5.The clinic nurse is assisting to perform a focused data collection process on a client who
is com- plaining of symptoms of a cold, a cough, and lung congestion. Which should the
nurse include for this type of data collection? Select all that apply.
1. Auscultating lung sounds
2. Obtaining the client’s temperature
3. Checking the strength of peripheral pulses
4. Obtaining information about the client’s respirations
5. Performing a musculoskeletal and neurological examination
6. Asking the client about a family history of any illness or disease
6.A client with a diagnosis of asthma is admitted to the hospital with respiratory distress.
Which type of adventitious lung sounds should the nurse expect to note documented in
the health record when collecting data related to the respiratory system for this client?
1. Stridor
2. Wheezes
3. Diminished
4. Pleural friction rub
7.The nurse notes documentation that a client has conductive hearing loss. The nurse
understands that which is a cause of this type of hearing loss?
1.A defect in the cochlea
2.A defect in the 8th cranial nerve
3.A physical obstruction to the transmission of sound waves
4.A defect in the sensory fibers that lead to the cerebral cortex
8.The nurse is preparing to assist the health care provider to test the extraocular movements
in a client for muscle weakness in the eyes. The nurse anticipates that which physical
assessment technique will be done to assess for muscle weakness in the eye?
1. Testing sensory function
2. Testing the corneal reflexes
3. Testing the six cardinal positions of gaze
4. Testing visual acuity using a Snellen eye chart
9.A client with myocardial infarction suddenly becomes tachycardic, shows signs of air
hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath
sounds, expecting to hear which breath sounds bilaterally?
1. Rhonchi
2. Crackles
3. Wheezes
4. Diminished breath sounds
