NUR 2065 PHYSICAL ASSESSMENT FINAL EXAM REVIEW-with 100% verified solutions-2024-2025 ., Exams of Nursing

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NUR 2065 PHYSICAL ASSESSMENT FINAL

EXAM

REVIEW-with 100% verified solutions-

2024-

With 108 Q&A PHYSICAL ASSESSMENT FINAL EXAM REVIEW:

1. During an interview the nurse states, “you mentioned shortness of breath, tell me more about that”. Which verbal skill is used with this statement? - OPEN-ENDED QUESTIONS
2. Receiving is a part of the communication process. Which receiver is most likely to misinterpret a message sent by a health care professional? - A MAN WHOSE WIFE HAS JUST BEEN DIAGONSED WITH LUNG CANCER.
3. The nurse is preparing to conduct a health history. Which of these statements best describes the purpose of a health history? - TO PROVIDE A DATABASE OF SUBJECTIVE INFORMATIONABOUT THE PATIENT’S PAST AND CURRENTL HEALTH
4. The nurse is taking a family history. Important diseases or problems to ask the patient about specifically include: - MENTAL ILLNESS
5. During an assessment, the nurse uses the CAGE test. The patient answers “yes” to two of the questions. What could this be indicating? - THE NURSE SHOULD SUSPECT ALCOHOL ABUSE AND CONTINUE WITH A MORE THOROUGH SUBSTANCE ABUSE ASSESSMENT.
6. A patient has been in the intensive care unit for 10 days. He has just been moved to the medical- surgical unit, and the admitting nurse is planning to perform a mental status examination. During the tests of cognitive function, the nurse would expect that he: - WILL BE ORIENDTED TO PLACE AND PERSON, BUT THAT PATIENT MAY NOT BE CERTAIN OF THE DATE.
7. A 20-year-old construction worker has been brought into the emergency ... He has delirium as a result of a fluid and electrolyte imbalance. For the mental status examination, the nurse should first assess the patient's: - LEVEL OF CONSCIOUSNESS AND COGNITIVE ABILITIES 8. The nurse is assessing a patient who is admitted with possible delirium. Which of these are manifestations of delirium? Select all that apply. - DEVELOPS OVER A SHORT PERIOD - PERSON IS EXHIBITING MEMORY IMPAIRMENT OF DEFICITS - OCCURS AS A RESULT OF A MEDICAL CONDITION, SUCH AS SYSTEMATIC INFECTION
8. The nurse is administering a Mini-Cog test to an older adult woman. When asked to draw a clock showing the time of 10:45, the patient drew a clock with the numbers out of order and with an incorrect time. This result indicates which finding? - COGNITIVE IMPAIRMENT
9. The nurse is assessing a 75-year-old man. As the nurse begins the mental status portion of the assessment, the nurse expects that this patient: - MAY TAKE A LITTLE LONGER TO RESPOND, BUT HIS GENERAL KNOWLEDGE

AND ABILITIES SHOULD NOT HAVE DECLINED.

11. The nurse is preparing to conduct a mental status examination. Which statement is true

regarding the mental status examination?

- GATHERING MENTAL STATUS INFORMATION DURING THE HEALTH HISTORY INTERVIEW IS USUALLY SUFFICIENT.

12. A woman brings her husband to the clinic for an examination. She is particularly worried because after a recent fall, he seems to have lost a great deal of his memory of recent events. Which statement reflects the nurse's best course of action? - PERFORM A COMPLETE MENTAL STATUS EXAMINATION.
13. A woman who has just discovered that she is pregnant is in the clinic for her first obstetric visit. She asks the nurse, "How many drinks a day is safe for my baby?" The nurse's best response is: - “NO AMOUNT OF ALCOHOL HAS BEEN DETERMINED TO BE SAFE DURING PREGNANCY.”
14. The nurse is aware that intimate partner violence (IPV) screening should occur with which situation? - AS A ROUTINE PART OF EACH HEALTH CARE ENCOUNTER
15. Which term refers to a wound produced by the tearing or splitting of body tissue, usually from blunt impact over a bony surface? - LACERATION
16. A female patient has denied any abuse when answering the Abuse Assessment Screen, but the nurse noticed some other conditions that are associated with IPV. Examples of such conditions include: - DEPRESSION
17. When performing a physical assessment, the first technique the nurse will always use is: - INSPECTION
18. When performing a physical examination, safety must be considered to protect the examiner and the patient against the spread of infection. Which of these statements describes the most appropriate action the nurse should take when performing a physical examination? - HANDS ARE WASHED BEFORE AND AFTER EVERY PHYSICAL PATIENT ENCOUNTER
19. The nurse is providing instructions to newly hired graduates for the Mini-Mental State Examination (MMSE). Which statement best describes this examination? - THIS EXAMINATION IS A GOOD TOOL TO DETECT DELIRIUM AND DEMENTIA AND TO DIFFERENTITATE THESE FROM PSYCHIATRIC MENTAL ILLNESS.
20. When assessing a 75-year-old patient who has asthma, the nurse notes that he assumes a tripod position, leaning forward with arms braced on the chair. On the basis of this observation, the nurse should: - RECONGIZE THAT A TRIPOD POSTION IS OFTEN USED WHEN A PATIENT IS HAVING RESPIRATORY DIFFICULITIES.
21. A 75-year-old man has a history of hypertension and was recently changed to a new antihypertensive drug. He reports feeling dizzy at times. How should the nurse evaluate his blood pressure? - ASSESS BLOOD PRESSURE AND PULSE IN THE SUPINE, SITTING, AND STANDING POSITIONS.
22. The nurse has collected the following information on a patient: palpated blood pressure– 180 mm Hg; auscultated blood pressure–170/100 mm Hg; apical pulse–60 beats per minute; radial pulse–70 beats per minute. How should the nurse record this patient's blood pressure? - 70

23. A 70-year-old man has a blood pressure of 150/90 mm Hg in a lying position, 130/80 mm Hg in a sitting position, and 100/60 mm Hg in a standing position. How should the nurse evaluate these findings? - THE CHANGE IN BLOOD PRESSURE READINGS IS CALLED ORTHOSTATIC HYPOTENSION
24. The patient has an order to be off the floor for 15 minutes to smoke a cigarette. The patient has just returned from his "cigarette break." The nurse is about to take the patient's temperature orally and should? - WAIT ABOUT 15 MINUTES BEFORE TAKING HIS TEMPERTURE 25. Which of these individuals would the nurse consider at highest risk for a suicide attempt? - OLDER ADULT MAN WHO TELLS THE NURSE THAT HE S GOING TO “JOIN HIS WIFE IN HEAVEN TOMORROW” AND PLANS TO USE A GUN
25. The direction of blood flow through the heart is best described by which of these? - RIGHT ATRIUM, RIGHT VENTRICLE, PULMONARY ARTERY, LUNGS, PULMONARY VEIN, LEFT ATRIUM, LEFT VENTRICLE.
26. Which of the following examples would be a hallucination? - A MAN BELIEVES THAT HIS DEAD WIFE IS TALKING TO HIM
27. The nurse is preparing to assess a patient’s abdomen by palpation. How should the nurse proceed? - THE ASSESSMENT BEGINS WITH LIGHT PALPATION TO DETECT SURFACE CHARACTERISTICS AND TO ACCUSTOM THE PATIENT TO BEING TOUCHED.
28. The nurse is preparing to use an otoscope for an examination. Which statement is true regarding the otoscope? The otoscope: **- DIRECTS LIGHT INTO THE EAR CANAL AND ONTO THE TYMPANIC MEMBRANE
29. TO HEAR FOR MURMURS? USE THE BELL**
30. A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow- up appointment. On assessment, the nurse might expect to see which of the following? - CLUBBING OF THE NAILS
31. While performing an assessment of a 65-year-old man with a history of hypertension and coronary artery disease, the nurse notices that presence of bilateral pitting edema in the lower legs. The skin is puffy and tight but normal in color. No increased redness or tenderness is observed over his lower legs, and peripheral pulses are equal and strong. In this situation, the nurse suspects that the likely Cause of edema is which condition? - HEART FAILURE
32. Which of these statements concerning areas of the brain is true? - THE HYPOTHALAMUS CONTROLS TEMPERATURE AND REGULATES SLEEP.
33. During an assessment of an 80-year-old patient, the nurse notices the following: inability to identify vibrations at the ankle and to identify position of big toe, slower and more deliberate gait, and slightly impaired tactile sensation. All other neurologic findings are normal. The nurse should interpret that these findings indicate? - NORMAL CHANGES DUE TO AGING.
34. A 50-year-old woman is in the clinic for weakness in her left arm and leg that she has noticed for the past week. The nurse should perform which type of neurologic examination? - COMPLETE NEUROLOGIC EXAMINATION

36. A patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The nurse suspects: - DAMAGE TO THE TRIGEMINAL NERVE
37. During an assessment of the cranial nerves the nurse finds the following from: when the patient smiles or frowns, uneven lifting of eyebrows, sagging of the lower eyelids, and escape of air when the nurse presses against the right puffed cheek. This would indicate dysfunction of which of these cranial nerves? - MOTOR COMPONENT OF VII
38. When the nurse asks a 68-year-old patient to stand with feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. The nurse would document this finding as a(n): - POSITIVE ROMBERG SIGN
39. A 30-year-old woman tells the nurse that she has been unsteady and has had difficulty in maintain her balance. Which area of the brain that is related to these findings would concern the nurse? - CEREBELLUM
40. The nurse is caring for a patient who just had a neurosurgery. To assess for increased intracranial pressure, what would the nurse include in the assessment? - LEVEL OF CONSCIOUSNESS - MOTOR FUNCTION - PUPILLARY RESPONSE - VITAL SIGNS
41. The nurse is reviewing a patient's medical record and notes that he is in a coma. Using the Glasgow Coma Scale, which number indicates that the patient is in a coma? - 6
42. When examining a patient’s CN function, the nurse remembers that the muscles in the neck that are innervated by CN XI are the: - STERNOMASTOID & TRAPEZIUS
43. A patient comes to the clinic complaining of neck and shoulder pan and is unable to turn her head. The nurse suspects damage to CN and proceeds with the examination by. - XI - ASKING THE PATIENT TO SHRUG HER SHOULDERS AGAINST RESISTENCE
44. A patient’s laboratory data reveal an elevated thyroxine (T4) level. The nurse would proceed with an examination of the gland. - THYROID 45. The nurse is assessing the breasts of a 68-year-old woman and discovers a mass in the upper outer quadrant of the left breast. When assessing this mass, the nurse keeps in mind that characteristics of a cancerous mass includes which of the following? Select all that apply. - NONTENDER MASS - HARD, DENSE, AND IMMOBILE - IRREGULAR BORDER
45. Not cancerous? - SOFT, TENDER, NON PALPABLE

47. A patient, an 85-year-old woman, is complaining about the fact that the bones in her face have become more noticeable. What explanation should the nurse give her? - IT IS PROBABLY DUE TO A COMBINATION OF FACTORS REALTED TO AGING, SUCH AS DECREASED ELEASTICITY, SUBCUNTANEOUS FAT, AND MSITURE IN HER SKIN.
48. The nurse needs to palpate the temporomandibular joint for crepitation. This joint is located just below the temporal artery and anterior to the? - TRAGUS

49. What is a bruit?

**- A SOFT, PULSATILE

• WHOOSHING
• BLOWING SOUND**

50. The nurse is conducting a class about breast self-examination (BSE). Which of

these statements indicates proper BSE technique?

- THE BEST TME TO PERFORM BSE IS 4 TO 7 DAYS AFTER THE FIRST DAY OF

THE MENSTRUAL PERIOD.

51. When assessing the pupillary light reflex, the nurse should use which technique? - SHINE A LIGHT ACROSS THE PUPIL FROM THE SIDE AND OBSERVE FOR DIRECT AND CONSENUAL PUPILLARY CONSTRICTION.
52. The nurse is performing the diagnostic positions test. Normal findings would be which of these results? - PARALLEL MOVEMENT OF BOTH EYES
53. In using the ophthalmoscope to assess a patient's eyes, the nurse notices a red glow in the patient's pupils. On the basis of this finding, the nurse would: - CONSIDER THE RED GLOW A NORMAL REFLECTION OF THE OPHTHALMOSCOPE LIGHT OFF THE INNER RETINA
54. A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble with reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that: - SHE MAY HAVE MACULAR DEGENERATION
55. A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He says that it does seem to help when people speak louder or f he turns up the volume of a television or radio. The most likely cause of his hearing loss is? - OTOSCLEROSIS
56. A patient has been admitted after an accident at work. During the assessment, the patient is having trouble hearing and states, “I don't know what the matter is. All of a sudden, I can't hear you out of my left ear!” What should the nurse do next? - NOTIFY THE PATIENT’S HEALTH CARE PROVIDER
57. A nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition?
    • PERCUSS AND PALPATE THE MIDLINE AREA ABOVE THE SUPRAPUBIC BONE
58. While examining a patient, the nurse observes abdominal pulsations between the xiphold and umbilicus. The nurse would suspect that these are? - NORMAL ABDOMINAL AORTIC PULSATIONS

59. Which of these statements is true regarding the vertebra prominens? The vertebra prominens is: - THE SPINOUS PROCESS OF C
60. Of the 33 vertebrae in the spinal column, there are? - 5 LUMBAR
61. A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for a while, and then gets worse again if he sits for long periods of time. The nurse suspects that he may have? - RHEUMATOID ARTHRITIS
62. During the assessment of an 80-year-old patient, the nurse notices that his hands show tremors when he reaches for something and his head is always nodding. There is no associated rigidity with movement. Which of these statements is most accurate? - THESE ARE NORMAL FINDINGS RESULTING FROM AGING.
63. During an assessment of a 22-year-old woman who has a head injury from a car accident 4 hours ago, the nurse notices the following change: pupils were equal, but now the right pupil is fully dilated and nonreactive, left pupil is 4 mm and reacts to light. What does the finding suggest? **- INCREASED INTRACRANLA PRESSURE
64. Tell me if venous or arterial? Pad vs. ppd**

65. A patient has been admitted with chronic arterial symptoms. During the assessment,

the nurse should except which findings? Select all that apply.

• THE PATIENT HAS A HISTORY OF DIABETES AND CIGARETTE SMOKING

• THE PATIENT’S SKIN IS PALE AND COOL

• THE PATIENT STATES THAT THE PAIN GETS WORSE WHEN WALKING

66. A 70-year-old man is visiting the clinic for “difficulty in passing urine.” In the history, he indicates he has to urinate frequently, especially at night. He experiences burning when he urinates and has noticed pain in his back. Given this history, what might the nurse expect to find during the physical assessment? - ASYMMETRIC, HARD, FIXED, PROSTATE GLAND
67. During report, the student nurse hears that a patient has “hepatomegaly” and recognizes that this term refers to? - AN ENLARGED LIVER
68. The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5cm above the sternal angle when the head of his bed is elevated 45 degrees. The nurse knows that this finding indicates? - ELEVATED PRESSURE RELATED TO HEART FAILURE
69. When performing a respiratory assessment on a patient, the nurse notices a coastal angle of approximately 90 degrees? - A NORMAL FINDING IN A HEATHY ADULT
70. Which Statement about the apices of the lungs is true? The apices of the lungs: - EXTEND 3 TO 4 CM ABOVE THE INNER THRID OF THE CLAVICLES
71. When assessing tactile fremitus, the nurse recalls that it is normal to feel tactile fremitus most intensely over which location? - BETWEEN THE SCAPULAE

72. During an annual physical examination, a 43-year-old patient states that she’s not does perform monthly breast self-examinations (BSEs). She tells the nurse that she believes that mammograms do a much better job than I ever could to find a lump. The nurse should explain to her that: - BSES MAY DETECT LUMPS THAT APPEAR BETWEEN MAMMOGRAMS
73. A 62-year-old man is experiencing fever, chills, malaise, urinary frequency, and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. These symptoms are most consistent with which condition? - PROSTATITITS
74. During a history, the patient states, “It really hurts back there, and sometimes it itches too. I have even seen blood on the tissue when I have a bowel movement. Is there something?” The nurse should except to see which of these upon examination of the anus? - EXTERNAL HEMORRIHOID THAT IS THROMBOSED
75. During a bimanual examination, the nurse detects a solid tumor on the ovary that is heavy, fixed with poorly defined mass. This finding is suggestive of: - OVARIAN CANCER
76. During an internal examination, the nurse notices that the cervix bulges outside the introitus when the patient is asked to strain. The nurse will document this as: - UTERINE PROLAPSE, GRADED SECOND DEGREE
77. When performing a genital assessment on a middle-aged man, the nurse notices multiple soft, moist, painless, papules in the shape of cauliflower-like patches scattered across the shaft of the penis? These lesions are characteristic of: - GENTIAL WARTS
78. The nurse is performing a genitourinary assessment on a 50-year-old obese male laborer. One examination, the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. These findings are most consistent with a(n) hernia. - DIRECT INGUINAL
79. During a physical examination, the nurse finds that a male patient's foreskin is fixed and tight and will not retract over the glans. The nurse recognizes that this condition is: - PHIMOSIS
80. A woman has just been diagnosed with HPV or genital warts. The nurse should counsel her to receive regular examinations because this virus makes her at a higher risk for cancer. - CERVICAL
81. A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts and wonders if these changes could be attributable to the hormone replacement therapy (HRT) she started 3 months earlier. The nurse should tell her: - “HRT HAS SEVERAL SIDE EFFECTS, INCLUDING FLUID RETNETION, BREAST TENDERNESS, AND VAGINAL BLEEDING.”
82. While assessing a hospitalized, bedridden patient, 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? - ABSENT BILE PIGMENT

83. During a digital examination of the rectum, the nurse notices that the patient has heard feces in the rectum. The patient complains of feeling “full”, has a distended abdomen, and states that she has not had a bowel movement “for several days.” The nurse suspects which condition? - FECAL IMPACTION
84. A 46-year-old man requires assessment of his sigmoid colon. The nurse is aware that which of these is most appropriate for this examination? - COLONOSCOPE
85. A patient report excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that has lasted approximately ½ to 2 hours, occurring once or twice each day. The nurse should suspect: - CLUSTER HEADACHES
86. During a breast examination on a female patient, the nurse notices that the nipple is flat, broad, and fixed. The patient states it “started doing that a few months ago.” This finding suggests: - RETRACTED NIPPLE
87. A patient is unable to read even the largest letters on the Snellen chart. The nurse should take which action next? - SHORTEN THE DISTANCE BETWEEN THE PATIENT AND THE CHART UNTIL THE LETTERS ARE SEEN, AND RECORD THAT DISTANCE.
88. A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that? - THE PATIENT CAN READ AT 20 FEET WHAT A PERSON WTH NORMAL VISION CAN READ AT 30 FEET.
89. The nurse is preparing to assess the visual acuity of a 16-year-old patient. How should the nurse proceed? - USE THE SNELLEN CHART POSITIONED 20 FEET AWAY FROM THE PATIENT.
90. During ocular examinations, the nurse keeps in mind that movement of the extraocular muscles is? - STIMULATED BY CNS III, IV, AND VI
91. The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent? **- “RIGHT TIME”
92. How do you document when you collect data? Out side of the room, face to face, and tell** the pateitn to wait and you document, and you type after you’ve got all your information
93. In an interview, the nurse may find it necessary to take notes to aid his or her memory later. Which statement is true regarding note-taking? - NOTE-TAKE MAY IMPEDE THE NURSES OBSERVATION OF THE PATIENTS NONVERBAL BEHAVIORS
94. The nurse makes which adjustment in the physical environment to promote the success of an interview? - REDUCE NOISE BY TURNING OFF TELEVISION AND RADIOS
95. The nurse is interviewing a male patient who has a hearing impairment. What techniques would be most beneficial in communicating with this patient? - DETERMINE THE CMMUNICATION METHOD HE PREFERS.

96. The nurse assesses an older woman and suspects physical abuse. Which questions are appropriate for screening for abuse? Select all that apply. - “HAS ANYONE MADE YOU AFRAID, TOUCHED YOU IN WAYS THAT YOU DID NOT WANT, OR HURT YOU PHYSICALLY?” - “HAVE YOU RELIED ON PEOPLE FOR ANY OF THE FOLLOWING: BATHING, DRESSING, SHOPPING, BANKING, OR MEALS?” - “HAVE YOU BEEN UPSET BECAUSE SOMEONE TALKED TO YOU IN A WAY THAT MADE YOU FEEL ASHAMED OR THREATENED?” - “HAVE YOU RELIED ON PEOPLE FOR ANY OF THE FOLLOWING: BATHING, DRESSING, SHOPPING, BANKING, OR MEALS?’ 97. A patient with a known history of heavy alcohol use has been admitted to the intensive care unit after he was found unconscious outside a bar. The nurse monitors him closely for symptoms of withdrawal. Which of these symptoms may occur during this time? Select all that apply. - COARSE TREMOR OF THE HANDS - TRANSIENT HALLUCINATIONS - SWEATING (DIAPHORESIS) 98. A 69-year-old patient has been admitted to an adult psychiatric unit because his wife thinks he is getting more and more confused. He laughs when he is found to be forgetful, saying “I’m just getting old!” After the nurse completes a thorough neurologic assessment, which findings would be indicative of Alzheimer’s disease? Select all that apply. - DIFFICULTY PERFORMING FAMILIAR TASKS, SUCH AS PLACING A TELEPHONE CALL - MISPLACING ITEMS, SUCH AS PUTTNG DISH SOAP IN THE REFRIGERATOR - RAPID MOOD SWNGS, FROM CALM TO TEARS, OR NO APPARENT REASON - GETTING LOST IN ONE’S OWN NEIGHBORHOOD 99. During an examination, a patient states that she was diagnosed with open-angle glaucoma 2 years ago. The nurse assesses for characteristics of open-angle glaucoma. Which of these are characteristics of open angle glaucoma? Select all that apply. - THEY EXPERIENCE TUNNEL VISION IN THE LATE STAGES. - VISION LOSS BEGINS WITH PERIPHERAL VISION - VIRTUALLY NO SYMPTOMS ARE EXHIBITED 100. The nurse is preparing for a certification course in skin care and needs to be familiar with the various lesions that may be identified on assessment of the skin. Which of the following definitions are correct? Select all that apply. - PETECHIAE: TINY PUNCTATE HEMORRHAGES, 1 TO 3 MM, ROUND AND DISCRETE, DARK RED, PURPLE, OR BROWN IN COLOR. - VESICLE: KNOWN AS A FRICITION BLISTER - NODULE: SOLID, ELEVATED, AND HARD OR SOFT GROWTH THAT IS LARGER THAN 1 CM 101. The nurse is examining a 62-year-old man and notes that he has bilateral gynecomastia. The nurse should explore his health history for which related conditions. Select all the apply. - HYPERTHYROIDISM - LIVER DISEASE - HISTORY OF ALCOHOL ABUSE 102. The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? Select all that apply.

• VOICE SOUNDS ARE FAINT, MUFFLED, AND ALMOST INAUDIBLE WHEN THE

PATIENT WHISPERS “ONE, TWO, THREE” IN A VERY SOFT VOICE.

• WHEN THE PATIENT SPEAKS IN A NORMAL VOICE, THE EXAMINER CAN HEAR A

SOUND BUT CANNOT DISINGUISH EXACTLY WHAT IS BEING SAID.

• AS THE PATIENT SAYS A LONG “EE-EE-EE” SOUND, THE EXAMINER ALSO HEARS A

LONG “EE-EE-EE” SOUND.

103. The nurse is presenting a class on risk factors for cardiovascular disease. Which of these are considered modifiable risk factors for myocardial infraction (MI)? Select all that apply. - ABNORMAL LIPIDS - SMOKING - HYPERTENSION - DIABETES 104. A patient is recovering from several hours of orthopedic surgery. During an assessment of the patient’s lower legs, the nurse will monitor for signs of acute venous symptoms. Signs of acute venous symptoms include which of the following? Select all that apply. - INTENSE, SHARP PAIN, WITH THE DEEP MUSCLE TENDER TO TOUCH - SUDDEN ONSET - WARM, RED, SWOLLEN CALF 105. The nurse is assessing the joints of a woman of a who has stated, “I have a long family history of arthritis, and my joints hurt.” The nurse suspects that she has osteoarthritis. Which of the following are symptoms of osteoarthritis? Select all that apply. - ASYMMETRIC - PAIN WITH MOTION OF AFFECTED JOINTS - AFFECTED JOINTS SWOLLEN WITH HARD, BONY PROTUBERANCES 106. The nurse is performing a digital examination of a patient’s prostate gland and notices that a normal prostate gland includes which of the following characteristics? Select all that apply. - 1 CM PROTRUSION INTO THE RECTUM - HEART-SHAPED WITH A PALPABLE CENTRAL GROVE - SMOOTH SURFACE, ELASTIC, AND RUBBERY CONSISTENCY 107. A 16-year-old boy is brought to the clinic for a problem that he refused to let his mother see. The nurse examines him and finds that he has scrotal swelling on the left side. He had the mumps the previous week, and the nurse suspects that he has orchitis. Which of the following assessment findings support this diagnosis? Select all that apply. - SWOLLEN TESTIS - MASS THAT DOES NOT TRANSILLUMNATE - SCROTUM THAT IS TENDER UPON PALPATION - SCROTAL SKIN THAT IS REDDENED 108. While measuring a patient's blood pressure, the nurse uses proper technique to obtain an accurate reading. Which of these situations will result in a falsely high blood pressure reading? Select all that apply. - THE PERSON SUPPORTS HIS OR HER OWN ARM DURING THE BLOOD PRESSURE READING

• THE BLOOD PRESSURE CUFF IS TOO NARROW FOR THE EXTREMITY

• THE CUFF IS WRAPPED LOOSELY AROUND THE ARM

• THE PERSON IS SITTING WITH HIS OR HER LEGS CROSSED