NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated, Exams of Nursing

Download NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated and more Exams Nursing in PDF only on Docsity! NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated Exam 1: 1. The concept of health and healing has evolved in recent years. Which is the best description of health? a. Health is the absence of disease b. Health is a dynamic process toward optimal functioning c. Health depends on an interaction of mind, body and spirit within the environment d. Health is the prevention of disease 2. Which best describes evidence-based nursing practice? a. Appraising and looking at the implications of one or two articles as they related to the culture and ethnicity of the patient. b. Combining clinical expertise with the use of nursing research to provide the best care for patients while considering the patient’s values and circumstances. c. Finding value-based resources to justify nursing actions when working with patients of diverse cultural backgrounds. d. Completing a literature search to find relevant articles that use nursing research to encourage nurses to use good practice 3. One of your patients says she is very nervous and nauseated, and she feels like she will vomit. This data would be what type of data? NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated a. Objective b. Reflective c. Subjective d. Introspective 4. Which is an example of objective data? a. Patient’s history of allergies b. Patient’s use of medications at home c. Last menstrual period 1 month ago. d. 2 x 5 cm scar present on the right lower forearm 5. The nurse uses health promotion activities with a new patient. What would this focus include? a. The nurse would try to change the patient’s perception of disease b. The nurse would search for identification of biomedical model interventions c. The nurse would help to identify negative health acts of the patient d. The nurse would empower the patient to choose a healthier lifestyle 6. The major factor contributing to the need for cultural care nurse is: a. An increase birth rate b. Limited access to health care services c. Demographic change d. A decreasing rate of immigration 7. The term culturally competent implies that the nurse: a. Is prepared in nursing. NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated a. 0 – 1.5 b. 1.5 – 4 feet c. 4 – 12 feet d. 12 or more feet 13. Tom Selleck, a patient on your floor, tells you, “Everyone here ignores me.” You respond: “Ignores you?” This technique is best described as: a. Clarification b. Selective listening c. Reflecting d. Validation 14. What does active listening NOT include? a. Taking detailed notes during the interview b. Watching for clues in body language c. Repeating statements back to the person d. Asking open-ended questions to explore the person’s perspective 15. You have a reason to question the reliability of the information being provided by a patient. One way to verify the reliability within the context of the interview is to: a. Rephrase the same questions later in the interview b. Review the patient’s previous medical records c. Call the person identified as the emergency contact to verify data provided d. Provide the patient with a printed history to complete and then compart the data provided NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated 16. During the initial interview, the nurse says, “Mrs. J. Tell me what you do when your headaches occur?” This is an example of which type of information? a. The patient’s perception of the problem b. Aggravating or relieving factors c. The frequency of the problem d. The severity of the problem 17. A genogram is used for which reasons? a. Past history b. Past health history, specifically hospitalizations c. Family history d. The 8 characteristics of presenting symptoms 18. What is the best description of “review of systems” as part of the health history? a. The evaluation of the past and present health state of each body system b. A documentation of the problem as described by the patient c. The recording of the objective findings of the practitioner d. A statement that describes the overall health state of the patient 19. Which finding is considered to be subjective? a. Temperature of 101.2F b. Pulse rate of 96 beats/minute c. Measured weight loss of 20 lbs since the previous measurement d. Pain lasting 2 hours 20. During assessment, which part of the hand is best for detecting NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated vibration? a. Fingertips b. Index finger and thumb in opposition c. Dorsum of the hand d. Ulnar surface of the hand 21. The bell of the stethoscope is used: a. For soft, low-pitched sounds b. For high-pitched sounds c. To hold firmly against the skin d. To magnify sounds 22. At the conclusion of the patient examination, the examiner should: a. Document findings before leaving the examination room b. Have findings confirmed by another nurse c. Summarize findings to the patient d. Relate objective findings to the subjective findings for accuracy 23. For a health assessment, which assessment technique will you use first? a. Palpation b. Inspection c. Percussion d. Auscultation 24. You are assessing a patient’s gait. What do you expect to find? a. Gait is varied, depending on the height of the person b. Gait is equal to the length of the arm c. Gait is as wide as the shoulder width d. Gait is half the height of the person NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. Hyperactive bowel sounds d. Tachycardia 34. Checking for skin temperature is best accomplished by using: a. The palmar surface of the hands b. The ventral surface of the hands c. The fingertips d. The dorsal surface of the hand 35. Assessing a patient’s skin turgor is done to assess which clinical findings? a. Edema b. Dehydration c. Vitiligo d. Scleroderma 36. You note a lesion during a skin assessment. Which is the best way to document this finding? a. Raised, irregular lesion the size of a quarter, located on the dorsum of left hand b. Open lesion with no drainage, no odor, approximately ¼ inch in diameter c. Pedunculated lesion below left scapula with consistent red color and no drainage or odor d. Dark brown raised lesion, with irregular border, on dorsum of right foot, 3 cm in size, with no drainage 37. You examine the nail beds of a patient. Which finding indicates a normal angle? a. 60 degrees NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated b. 100 degrees c. 160 degrees d. 180 degrees 38. An area of thin shiny skin with decreased visibility of normal skin markings is most likely: a. Lichinification b. Plaque c. Atrophy d. Keloid 39. A configuration of individual lesions arranged in circles or arcs, as occurs with ringworm is described as: a. Linear lesion b. Clustered lesion c. Annular lesion d. Gyrate lesion 40. A risk for melanoma is: a. Brown eyes b. Darkly pigmented skin c. Skin that freckles or burns before tanning d. Use of sunscreen products 41. Herpes zoster (shingles) is characterized by: a. A bacterial cause b. Lesion on only one side of body; does not cross midline c. Absence of pain or edema NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. “The top number is the systolic blood pressure and reflects the pressure of the blood against the arteries when the heart contracts” d. “The concept of blood pressure is difficult to understand. The primary thing to be concerned about is the top number, or the systolic blood pressure.” 50. The nurse will perform a palpated pressure before auscultating blood pressure. The reason for this is to: a. Detect the presence of an auscultatory gap b. More clearly hear the Korotkoff sounds c. Avoid missing a falsely elevated blood pressure d. More readily identify phase IV of the Korotkoff sounds NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated Exam II  Most common blood test in health care a. Hemoglobin and hematocrit b. Platelet count c. Complete Blood Count d. Blood chemistry  The congenital displacement of the urethral meatus to the inferior surface of penis: a. Hypospadias b. Epispadias c. Hyposthesia d. Hpophysis  Select the best description of the anal canal: a. A 12-cm long portion of the large intestine b. Involuntary control of the parasympathetic nervous system c. A 3.8 cm outlet of the gastrointestinal tract d. S-shaped portion of the colon  Which of the finding in the prostate gland suggest prostate cancer? a. Symmetric, smooth, enlargement b. Extreme tenderness to palpation c. Boggy, soft, enlargement d. Diffuse hardness  A patient states that he has frothy foul-smelling stools that float on the surface of the water in the toilet. What type of stool is this NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated patient describing? a. Steatorrhea b. Melena c. Dyschezia d. A parasitic infection  Which is structure that secretes a thin milky alkaline fluid to enhance the viability of sperm? a. Cowper’s gland b. Prostate gland c. Median sulcus d. Bulbourethal gland  Vaginal lubrication is provided during intercourse by: a. Labia minor b. Sebacious follicles c. Skene glands d. Bartholin glands  A women has come for her first GYN exam. Because she has not had any children, the examiner expects the cervical os to appear: a. Smooth and circular b. Irregular and slit like c. Irregular and circular d. Smooth and enlarged  A women has come for health care reporting a thick white discharge with intense itching. These symptoms are suggestive of: a. Atrophic vaginitis b. Trichomoniasis NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. Infertility and weight gain d. Urinary tract infections and increased risk of skin cancers  The cremasteric response: a. Is positive when disease of the pyramidal tract is present b. Is positive when the ipsilateral testicle elevates on stroking of the inner aspect of the thigh c. Is a reflex of the receptors in the muscles of the abdomen d. Is not a valid neurologic examination  A positive Babinski reflex: a. Dorsiflexion of the big toe and fanning of all toes b. Plantar flexion of the big toes with fanning of all toes c. The expected response in healthy adults d. Withdrawal of the stimulated extremity from the stimulus  Cells circulating in the blood include a. Leukocytes, erythrocytes, thrombocytes b. Monocytes, eosinophils, plasma c. Neutrophils, sodium, potassium d. Eosinophils, plasma, fat globules  Eosinophils: a. Are the largest of blood cells b. Increase with parasitic and allergic conditions c. Are the 2nd cell to respond to infection d. Are considered the first line of defense during an acute infection NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated  Neutrophils: a. Considered bodies first line of defense during an acute infection b. Still immature when released from bone marrow c. Are the 2nd cell to respond to infection d. Also known as mast cells  Which of the following can be noted on the inspection of a patient’s abdomen? a. Fluid waves and abdominal rigidity b. Umbilical eversion and Murphy’s sign c. Venous pattern, peristaltic waves, abdominal contour d. Peritoneal irritation, general tympany, and peristaltic waves  If patients presents with right upper quadrant tenderness it may be in the: a. Liver, pancreas or ascending colon b. Liver and stomach c. Sigmoid colon, spleen or rectum d. Appendix or ileocecal valve  Hyperactive bowel sounds are: a. High-pitched b. Rushing c. Tinkling d. All of the above  Absence of bowel sounds is established after listening for: a. 1 full minute b. 3 full minutes c. 5 full minutes NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated d. None of the above  Auscultation of abdomen may reveal bruits of arteries. a. Aortic, renal, iliac and femoral b. Jugular, aortic, carotid and femoral c. Pulmonic, aortic and portal d. Renal, iliac, internal jugular and basilica NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated  Trigeminal a. Mastication and sensation of face, scalp and cornea b. Taking, swallowing and sensory information from the pharynx and carotid sinus c. Phonation, swallowing, tasting posterior third of the tongue d. Hearing and equilibrium  Abducens a. Downward and inward movement of the eye b. Vision c. Closing of the eyes d. Lateral movement of the eyes  Facial a. Extraocular movement, pupil constriction, downward and inward movement of the eye b. Tasting of anterior two thirds of tongue; closing eyes c. Mastication and sensation of face, scalp and cornea d. Phonation, swallowing, tasting posterior third of the tongue  Acoustic a. Mastication and sensation of face, scalp and cornea b. Hearing and equilibrium c. Movement of the tongue d. Phonation, swallowing, tasting posterior third of the tongue  Glossopharyngeal a. Mastication and sensation of the face, scalp and cornea b. Hearing and equilibrium NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. Movement and equilibrium d. Movement of the tongue e. Phonation, swallowing, tasting posterior third of tongue  Vagus a. Movement of the trapezius and sternomastoid muscles b. Mastication and sensation of face, scalp and cornea c. Talking, swallowing and sensory information from pharynx and carotid sinus d. Hearing and equilibrium  Spinal a. Downward and inward movement of the eye b. Movement of the trapezius and sternomastoid muscles c. Tasting of anterior two thirds of tongue; closing eyes d. Phonation, swallowing, tasting posterior third of the tongue  Hypoglossal a. Movement of the tongue b. Tasting of anterior two thirds of tongue; closing eyes c. Vision d. Smell  Hematopoiesis occurs in the a. Liver b. Kidneys c. Spleen NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated d. Bone Marrow  To test for sterognosis, you would: a. Have a person close his or her eyes, and then raise a person’s arm and ask the person to describe its location b. Touch the person with a tuning fork c. Place a coin in the person’s hand and ask him or her to identify it d. Touch the person with a cold object  Cerebral function is tested by which of the following a. Muscle size and strength assessment b. Cranial nerve examination c. Coordination- hopping on one foot d. Spinothalamic test  To elicit the Babinski reflex: a. Gently tap the Achilles tendon b. Stroke the lateral aspect of the sole of the foot from heel to across the base c. Present a noxious odor to the person d. Observe the person walking heel to toe  The examiner is going to inspect and palpate hernia. During this examination, the man is instructed to: a. Hold his breath during palpation b. Cough after the examiner has gently inserted the examination finger into the rectum c. Bear down when the examiner’s finger is at the inguinal canal d. Relax in a supine position while the examination finger is inserted NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated should include which assessment? a. Diaphragmatic excursion b. Symmetric chest expansion c. Presence of breath sounds d. Shape and configuration of the chest wall 5. During an assessment of an adult, the nurse has noted unequal chest expansion and recognizes that this occurs in which situation? a. In an obese patient b. When part of the lung is obstructed or collapsed c. When bulging of the intercostal spaces is present d. When accessory muscles are sued to augment respiratory effort 6. A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these? a. Unequal chest expansion b. Increased tactile fremitus c. Atrophied neck and trapezius muscles d. Anterioposterior-to-transverse diameter ratio of 1:1 7. During auscultation of the lungs of an adult patient, the nurse notices the presence of bronchophony. The nurse should assess for signs of which condition? a. Airway obstruction b. Emphysema c. Pulmonary consolidation d. Asthma 8. In assessing a patient’s major risk factors for heart disease, which NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated would the nurse want to include when taking a history? a. Family history, hypertension, stress and age b. Personality type, high cholesterol, diabetes and smoking NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. Smoking, hypertension, obesity, diabetes and high cholesterol d. Alcohol consumption, obesity, diabetes, stress and high cholesterol 9. During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse? a. Third left intercostal space at the midclavicular line b. Fourth left intercostal space at the sternal border c. Fourth left intercostal space at the anterior axillary line d. Fifth left intercostal space at the midclavicular line 10. When listening to heart sounds, the nurse knows that the S1: a. Is louder than the S2 at the base of the heart b. Indicated the beginning of diastole c. Coincides with the carotid artery pulse d. Is caused by the closure of the semilunar valves 11. During the cardiac auscultation, the nurse hears a sounds immediately occurring after the S2 at the second left intercostal space. To further assess this sounds, what should the nurse do? a. Have the patient turn to his left side while the nurse listens with the bell of the stethoscope b. Ask the patient to hold his or her breath while the nurse listens again c. No further assessment is needed because the nurse knows this sound is an S3 d. Watch the patient’s respiration while listening for the effect on the sound. 12. The nurse knows that normal splitting of the S2 is associated with: NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated margins approximate completely. The nurse recognizes that the assessment finding: a. Is expected b. May indicate a problem with extraocular muscles c. May result in problems with tearing d. Indicated increased intraocular pressure 21. During ocular examination, the nurse keeps in mind that movement of the extraocular muscles is: a. Decreased in the older adult b. Impaired in a patient with cataracts c. Stimulated by cranial nerves (CNs) I and II d. Stimulated by CNs III, IV and VI 22. The nurse is performing an external eye examination. Which statement regarding the outer layer of the eye is true? a. The outer layer of the eye is very sensitive to touch b. The outer layer of the eye is darkly pigmented to prevent light from reflecting internally c. The trigeminal nerve (CN V) and the trochlear nerve (CN IV) are stimulated when the outer surfaces of the sys are stimulated d. The visual receptive layer of the eye in which light waves are changed into nerves impulses is located in the outer layer of the eye 23. When examining a patient’s eyes, the nurse recalls that stimulation of the sympathetic branch of the autonomic nervous system: NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated a. Causes pupillary constriction b. Adjusts the eye for near vision c. Elevates the eyelid and dilates the pupil d. Causes contraction of the ciliary body 24. The nurse is reviewing causes of increased intraocular pressure. Which of these factors determines intraocular pressure? a. Thickness or buldging of the lens b. Posterior chamber as it accommodates increased fluid c. Contraction of the ciliary body in response to the aqueous within the eye d. Amount of aqueous produced and resistance to its outflow at the angle of the anterior chamber 25. The nurse is conducting a visual examination. Which of these statement regarding visual pathways and visual fields is true? a. The right side of the brain interprets the vision for the right eye b. The image formed on the retina is upside down and reversed from it’s actual appearance in the outside world c. Light rays are refracted through the transparent media of the eye before striking the pupil. d. Light impulses are conducted through the optic nerve to the temporal lobes of the brain 26. The nurse is testing a patient’s visual accommodation, which refers to which action? a. Pupillary constriction when looking at a near object b. Pupillary dilation when looking at a far object NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. Changes in peripheral vision in response to light d. Involuntary blinking in the presence of bright light 27. A patient has normal pupillary light reflex. The nurse recognizes that this reflex indicated that: a. The eyes converge to focus on the light b. Light is reflected at the same spot in both eyes c. The eye focuses on the image in the center of the pupil d. Constriction of both pupils occurs in response to bright light 28. The nurse is reviewing in age-related changes in the eye for a class. Which of these physiologic changes is responsible for presbyopia? a. Degeneration of the cornea b. Loss of lens elasticity c. Decreased adaptation to darkness d. Decreased distance vision abilities 29. A patient has been diagnosed with venous stasis. Which of these findings would the nurse most likely observe? a. Unilaterally cool foot b. Thin, shiny, atrophic skin c. Pallor of the toes and cyanosis of the nail beds d. Brownish discoloration to the kin of the lower leg 30. The nurse is attempting to assess the femoral pulse in a patient who is obese. Which of these actions would be most appropriate? a. The patient is asked to assume a prone position NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated 37. A 70 year-old patient tells the nurse that he has noticed that he is having trouble hearing especially in large groups. He says that he “can’t always tell where the sound is coming NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated from” and words often sound “mixed up”. What might the nurse suspect as the cause for this change? a. Atrophy of the apocrine glands b. Cilia becoming coarse and stiff c. Nerve degeneration in the inner ear d. Scarring of the tympanic membrane 38. A patient in her first trimester of pregnancy is diagnosed with rubella. Which of these statements is CORRECT regarding the significance of this in relation to the infant’s hearing? a. Rubella may affect the mother’s hearing, but not the infant’s b. Rubella can damage the infant’s organ of Corti, which will impair hearing c. Rubella is only dangerous to the infant in the second trimester of pregnancy d. Rubella can impair the development of the CN VIII and thus affect hearing. 39. In performing a brest examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason for this is that the upper outer quadrant is: a. The largest quadrant of the breast b. The location of most breast tumors c. Where most of the suspensory ligaments attach d. More prone to injury and calcifications than other locations in the breast 40. A woman is in the hospital. She tells the nurse that her breasts NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated “change all month long” and that she is worried that this is unusual. What is the nurse’s best response? The nurse should tell her that: a. Continual changes in her breast are unusual. The breast of nonpregnant women usually stay pretty much the same all month long b. Breast changes in response to stress are very common and that she should assess her life for stressful events c. Because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common d. Breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time. 41. In examining a 70-year-old male patient, the nurse notices that he has bilateral Gynecomastia. Which of the following describes the nurse’s best course of action? a. Recommend that he make an appointment with his physician for a mammogram b. Ignore it. Benign breast enlargement in men is not unusual. c. Explain that this condition may be the result of hormonal changes and recommend that he see his health care provider. d. Explain that gynecomastic in men is usually associated with prostate enlargement and recommend that he be thoroughly screened 42. The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the U.S. has the highest risk for developing breast cancer? a. Black NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. Shift from supine position to a standing position, note any lag or retraction d. Slowly lift her arms above her head, and note any retraction or lag in movement 46. The nurse is preparing to conduct a mental status examination. Which statement is true regarding the mental status examination? a. A patient’s family is the best resource for information about the patient’s coping skills b. Gathering mental status information during the health history interview is usually sufficient c. Integrating the mental status examination into the health history interview takes an enormous amount of extra time d. To get a good idea of the patient’s level of functioning, performing a complete mental status examination is usually necessary 47. 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? a. Perform a complete mental status examination b. Refer him to a psychmetrician c. Plan to integrate the mental status examination into the history and physical examination d. Reassure his wife that memory loss after a physical shock is normal and will soon subside 48. You are conducting a patient interview. Which statement made to NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated you by the patient should you explore more fully during the interview? a. “I sleep like a baby” b. “I have no health problems” NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated c. “I am not currently taking any medications” d. “I never did too god in school” 49. A 19-year-old woman comes into the clinic at the insistence of her brother. She is wearing black combat boots, a black lace nightgown over the top of her other clothes. Her hair is dyed pink with black streaks throughout. She has several pierced holes in her nares and ear and is wearing an earring through her eyebrows and heavy black makeup. The nurse concludes that: a. She probably does not have any problems b. She is only trying to shock people and that her dress should be ignored c. More information should be gathered to decide whether or not her dress is appropriate d. She has a maniac syndrome because of her abnormal dress and grooming 50. The nruse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: a. Administer the FACT test b. Ask him to describe his first job c. Give him the Four Unrelated Words Test d. Ask him to describe what television show he was watching before coming to the clinic. NURS 20263 Health Assessment Final Exam 1-3 (150Questions &Answers) Guide Updated