NURSING II: QUIZ 1

Question 0

True/False:

During a physical assessment, the nurse establishes a (1) __ __ to which future (2) __ __ can be compared.

Answer 0

1. data base

2. data collected

Question 1

True/False:

During a physical assessment, the nurse monitors for adverse reactions.

Answer 1

FALSE

Question 2

The assessment technique that involves the use of tactile sensation:

a. auscultation
b. inspection
c. percussion
d. palpation

Answer 2

d. palpation

Question 3

If nurses suspect abuse or neglect, most states mandate a report to a __ __ __.

Answer 3

social service center.

Question 4

A parent calls the school nurse with questions regarding the recent school vision screening. Snellen chart examination revealed 20/60 for both eyes. Considering the poor visual acuity results, the nurse informs the parent that the child:

Answer 4

should have an optometric examination to further assess the problem.

Question 5

Standing 20 ft away, patient can read a line that a person with normal vision can read from 60 ft away. The patient’s visual acuity is __/__.

Answer 5

20/60.

Question 6

Lumps found on the male testis is a potential sign of:

a. inguinal hernia
b. sexually transmitted infection
c. testicular cancer
d. diuretic use

Answer 6

c. testicular cancer

Question 7

Testicular cancer is the most common form of cancer in men between the ages of ___.

Answer 7

15-35 years.

Question 8

A hernia presents with a bulging in the ___.

Answer 8

scrotum.

Question 9

Sexually transmitted infections often present with __ __.

Answer 9

genital lesions.

Question 10

How long should you listen to bowel sounds before stating they are absent?

a. 3 minutes
b. 10 seconds
c. 5 minutes
d. 10 minutes

Answer 10

c. 5 minutes

Question 11

Skin turgor is most useful in assessing ___.

a. polyps
b. edema
c. dehydration
d. skin fold thickness

Answer 11

c. dehydration

Question 12

Normal respirations that are quiet, effortless, and rhythmical.

Answer 12

eupnea

Question 13

You are caring for a client with a respiratory rate of 36 breaths per minute. This would be documented as ___.

a. bradypnea
b. eupnea
c. tachypnea
d. orthopnea

Answer 13

tachypnea.

Question 14

Rate of breathing is regular but abnormally slow (< 12 bpm).

Answer 14

bradypnea

Question 15

Rate of breathing is regular but abnormally rapid (> 20 bpm).

Answer 15

tachypnea

Question 16

Fifth intercostal space, midclavicular line, just below the left nipple: locates the ___ pulse.

Answer 16

apical

Question 17

Females that are at a higher risk for cervical cancer are those who (4):

Answer 17

1. smoke
2. 21+ yrs old with weak immune systems
3. multiple sex partners
4. history of sexually transmitted infections

Question 18

Subjective data obtained during assessment comes from ___.

a. physician’s progress notes
b. other members of health care team
c. past entries in the patient’s chart
d. the patient

Answer 18

d. the patient

Question 19

Lateral curvature the spine best describes ___.

a. Arthritis
b. Lordosis
c. Scoliosis
d. Kyphosis

Answer 19

c. Scoliosis

Question 20

Exaggeration of the posterior curvature of the thoracic spine.

Answer 20

Kyphosis, or hunchback

Question 21

An increased lumbar curvature.

Answer 21

Lordosis, or swayback

Question 22

Normal pulse rate is ___ - ___ bpm.

Answer 22

60-100 bpm.

Question 23

Patient is complaining of lower abdominal pain. The proper order of the comprehensive abdominal examination is ___, ___, ___.

Answer 23

inspection, auscultation, palpation.

Question 24

In abdominal examination, palpation before auscultation ___ the chance of altering the frequency and character of bowel sounds.

Answer 24

INCREASES!

Question 25

Two types of aphasia:

Answer 25

1. Sensory (or, receptive)

2. Motor (or, expressive)

Question 26

Patient cannot understand written of verbal speech.

Answer 26

Receptive aphasia

Question 27

Patient understands written and verbal speech, but cannot write of speak appropriately when attempting to communicate.

Answer 27

Expressive aphasia

Question 28

Identifying nursing diagnoses occurs during the ___ phase of the nursing process.

Answer 28

Diagnosis phase

Question 29

The nurse carries out interventions during the ___ phase of the nursing process.

Answer 29

Implementation phase

Question 30

Determining whether the outcomes have been achieved takes place during the ___ phase of the nursing process.

Answer 30

Evaluation phase

Question 31

Data collected to complete a thorough patient database occurs during the ___ phase of the nursing process.

Answer 31

Assessment phase

Question 32

Questions that elicit simple yes or no answers are _____ questions.

Answer 32

close-ended

Question 33

True/False:

Eliciting a matter-of-fact response from the patient will prompt them to elaborate on complaints.

Answer 33

False

Question 34

Components of a nursing health history include (4):

Answer 34

1. physical examination findings
2. patient expectations
3. environmental history
4. diagnostic data

Question 35

Place the tips of the first two fingers over the groove along the thumb side of the patient’s wrist to obtain a ___ ___ from the patient.

Answer 35

radial pulse

Question 36

The pulse is more accurately assessed with ___ pressure.

Answer 36

moderate

Question 37

Smoking immediately ___ BP.

a. increases
b. decreases

Answer 37

a. increases

Question 38

Caffeine increases BP for up to ____ hours.

Answer 38

3

Question 39

The nurse must __ __ __ __ as a result of vital sign measurement.

Answer 39

document any interventions initiated

Question 40

Abnormal findings from vital sign assessment must bee documented and reported to the ___ or the ___.

Answer 40

nurse in charge

health care provider

Question 41

A nasal decongestant works by

a. vasodilation
b. vasoconstriction
c. causing dryness
d. increasing blood supply to the area

Answer 41

b. vasoconstriction

Question 42

Afrin is an example of a ___.

Answer 42

decongestant.

Question 43

Tussin is an example of a(n) ___.

Answer 43

expectorant

Question 44

digoxin (Lanoxin) is a example of a (1)__.

It is used for (2) __ and (3) __.

Answer 44

1. Cardiotonic
2. HF
3. atrial fibrillation

Question 45

Toxic level of digoxin is __.

Answer 45

> 2.0

Question 46

Overuse of nasal decongestant can lead to

a. puritis
b. urticaria
c. rebound congestion
d. nausea and vomiting

Answer 46

c. rebound congestion