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NUR 101 Test 2 > Health Assessment > Flashcards

Health Assessment Flashcards

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1
Q

A BMI of 25 or above indicates:

A. Normal
B. Overweight
C. Obese
D. Underweight

A

B. Overweight

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2
Q

When performing a physical examination of the spine, which finding is common with aging:

A. Lordosis
B. Scolosis
C. Kyphosis
D. Ankylosis

A

C. Kyphosis

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3
Q

A Romberg test is used for which:

A. vision
B. balance
C. hearing
D. gait

A

B. balance

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4
Q

You determine cranial nerve I is intact when the patient successfully does what:

A. Sticks out his tongue
B. Hears whispered words
C. Smiles symmetrically
D. Identifies a minty scent

A

D. Identifies a minty scent

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5
Q

Wet popping sounds at the inspiratory phase during the respiratory cycles indicated which:

A. crackles
B. wheezes
C. friction rub
D. stridor

A

A. crackles

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6
Q

During a cardiovascular assessment which of the following findings is considered normal:

A. a high pitched scraping sound heard in the third intercostal space to the left of the sternum.
B. A brief thump felt over the 4th or 5th intercostal space near the left midclavicular line
C. A continuous sensation of vibration felt over the 2nd and 3rd left intercostal
spaces.
D. a whoosing or swishing sound over the 2nd intercostal space along the left sternum border.

A

B. A brief thump felt over the 4th or 5th intercostal space near the left midclavicular line

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7
Q

Over which addominal quadrant are bowel sounds most active and easiest to auscultate:

A. Left lower quadrant
B. Left upper quadrant
C. Right lower quadrant
D. Right upper quadrant

A

C. Right lower quadrant

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8
Q

What is the primary goal in performing a comprehensive physical assessment:

A. to document accurate data
B. to develop a plan of care
C. to evaluate outcomes of care
D. to validate previous data

A

B. to develop a plan of care

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9
Q

Which technique uses a stethoscope, which transmits the sounds to the nurse’s ears.

A. Palpation
B. Indirect auscultation
C. Direct auscultation
D. Percussion

A

C. Direct auscultation

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10
Q

Vital signs are obtained to:

A. Assess the patient’s health status
B. establish baseline data against which to compare future measurements.
C. Detect potential health problems
D. Both B & C

A

D. Both B & C

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11
Q

Assessment of the skin involves:

A. Inspection & Palpation
B. Palpation & Auscultation
C. Auscultation & Percussion
D. Inspection & Percussion

A

A. Inspection & Palpation

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12
Q

Pallor is a result of:

A. Low blood pressure
B. Inadequate circulation
C. Edema
D. Inadequate nutrition

A

B. Inadequate circulation

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13
Q

Jaundice may FIRST be evident in which area:

A. the sclera of the eyes
B. the muccous membranes
C. the skin
D. all of the above

A

A. the sclera of the eyes

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14
Q

When the nail bed is highly vascular, a bluish or purplish tint to the nail bed may reflect which of the following:

A. Paronychia
B. Cyanosis
C. Clubbing
D. All of the above

A

B. Cyanosis

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15
Q

What three major considerations determine the extent of a neurologic exam:

A

the chief complaints, the client’s physical condition, the client’s willingness to participate and coorperate.

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16
Q

Sensory aphasia is:

A. loss of the ability to understand the symbolic content associated with sounds. B. loss of the ability to understand printed or written figures.
C. loss of the power to express oneself by writing, making signs, or speaking.
D. the loss of the ability to comprehend written or spoken words.

A

D. the loss of the ability to comprehend written or spoken words.

17
Q

Which of the following may result from foreign bodies, chemicals, allergenic agents, bacteria, or viruses. Redness, itching tearing, and discharge occur. During sleep, the eyelids may become encrusted and matted together.

A. Dacryocystitis
B. Conjuntivitis
C. Hordeolum
D. Iritis

A

B. Conjuntivitis

18
Q

A sty is:

A. Dacryocystitis
B. Conjuntivitis
C. Hordeolum

A

C. Hordeolum

Hordeolum (sty) is a redness, swelling, and tenderness of the hair follicle and glands that empty at the edge of the eyelids.

19
Q

What is the most frequent cause of blindness in people of age 40. It can be controlled if diagnosed early. Danger signs include blurred or foggy vision, loss of peripheral vision, difficulty focusing on close objects, difficulty adjusting to dark rooms, and seeing rainbow colored rings around lights.

A. Cataracts
B. Glaucoma
C. Hematoma
D. Iritis

A

B. Glaucoma

20
Q

Absence of breath sounds over some lung areas is also a significant finding that is associated with:

A. collapsed lung
B. sugically removed lobes
C. severe pneumonia
D. all of the above

A

D. all of the above

21
Q

What area of the chest overlying the heart, is inspected and palpated for the presence of abnormal pulsations or lifts or heaves.

A

Pericardium

22
Q

The first heart sound, S1, occurs when:

A. the atrioventricular (AV) valves close
B. the atrioventricular (AV) valves open
C. the tricuspid valve close
D. the tricuspid valve open

A

A. the atrioventricular (AV) valves close

23
Q

The two heart sounds are audible anywhere on the precordial area, but they are best heard over which areas?

A

the aortic, pulmonic, tricuspid, and apical areas.

24
Q

The nurse records bowel sounds as normal when the sounds are:

A. Low pitched and regular
B. occuring every 30-40 seconds
C. soft and muffled
D. High pitched and irregular

A

A. Low pitched and regular

25
Q

The interval between heart beats while taking a pulse is:

A. pulse quality
B. pulse volume
C. pulse rhythm
D. pulse rate

A

C. pulse rhythm

26
Q

Name three assessments for pulse

A

rate, rhythm, and volume

27
Q

The pressure difference between the diastolic and systolic blood pressure is known as:

A. pulse pressure
B. dysrhythmia
C. pulse deficit
D. pulse oximetry

A

C. pulse deficit

28
Q

A respiratory rate that is gradually increasing in depth with periods of apnea is which of the following:

A. Eupnea
B. Biot’s respirations
C. Cheyne-Stokes respiration
D. Kussmaul respirations

A

D. Kussmaul respirations

29
Q

A client was hospitalized after several days of diarrhea. Following this she developed a urinary tract infection caused by E. coli. The UTI is considered:

A. primary infection
B. chronic infection
C. secondary infection
D. antibody/antigen response

A

C. secondary infection

30
Q

The body’s normal bacteria flora is beneficial because it:

A. triggers the release of histamine
B. engulfs and destroys pathogens
C. prevents opportunistic organisms form proliferating
D. stimulates cell-mediated responses

A

C. prevents opportunistic organisms form proliferating

31
Q

An increase in core body temperature:

A. inhibits multiplication of pathogens
B. lowers client defenses
C. reduces metabolism
D. stimulates the body’s response

A

A. inhibits multiplication of pathogens

32
Q

Phagocytosis is best described as a process in the:

A. first line of defense
B. tertiary line of defense
C. decrease of WBCs
D. secondary line of defense

A

D. secondary line of defense

33
Q

The client’s history reveals she is having a secondary infectious process. This means that the client:

A. has a latent infection
B. has an acute infection
C. has overcome the primary infection
D. could be immunosuppressed

A

D. could be immunosuppressed

34
Q

In order to hold rectal dressings in place the nurse chooses to use:

A. T binder
B. Montgomery binder
C. Adhesive tape
D. A circular bandage

A

A. T binder

35
Q

When nurses explain the concept of normal flora to clients, they teach that normal flora:

A. maintains health
B. causes illness
C. creates cell destruction
D. stimulates antibody production

A

C. creates cell destruction

36
Q

Clients are described as carriers of a disease when they harbor the pathogen and:

A. have symptoms of the disease
B. have no ability to fight the disease
C. do not come down with the disease
D. cannot transfer the disease to others

A

C. do not come down with the disease

NUR 101 Test 2 (2 decks)

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