Question 1

A student nurse is preparing to auscultate a patient's lungs. What action by the student leads the instructor to intervene?

Accepted Answer

A)  Student asks to turn the television volume down. 
B)  Student warms the bell of the stethoscope before use. 
C)  Student uses the stethoscope bell to listen to bowel sounds. 
D)  Student places the stethoscope diaphragm on the patient's skin. 
A)  Student asks to turn the television volume down. 
B)  Student warms the bell of the stethoscope before use. 
C)  Student uses the stethoscope bell to listen to bowel sounds. 
D)  Student places the stethoscope diaphragm on the patient's skin.

Question 2

A nurse conducting the general survey of a patient includes which items? (Select all that apply.)

Accepted Answer

A)  Hygiene and grooming 
B)  Affect and mood 
C)  Sex and gender orientation 
D)  Sexual preferences and practices 
E)  Age 
A)  Hygiene and grooming 
B)  Affect and mood 
C)  Sex and gender orientation 
D)  Sexual preferences and practices 
E)  Age

Question 3

A nurse is educating women on breast cancer risk reduction. What topics does the nurse include in the presentation? (Select all that apply.)

Accepted Answer

A)  Exercise 
B)  Limiting alcohol 
C)  Low-fat diet 
D)  Breast self exams 
E)  Milk intake 
A)  Exercise 
B)  Limiting alcohol 
C)  Low-fat diet 
D)  Breast self exams 
E)  Milk intake

Question 4

A nurse is told in handoff report that a patient opens eye spontaneously, is confused but able to answer questions, and demonstrates purposeful movement to painful stimuli. What does the nurse calculate the patient's Glasgow Coma Scale to be?

Accepted Answer

A)  7 
B)  9 
C)  11 
D)  13 
A)  7 
B)  9 
C)  11 
D)  13

Question 5

The nurse is assessing a patient whose chart indicates a Grade 3 heart murmur. What action is best in order to hear the murmur?

Accepted Answer

A)  Ensure that the room is extremely quiet. 
B)  Use a specialized stethoscope with amplification. 
C)  Auscultate the patient's chest with a stethoscope. 
D)  Place the stethoscope diaphragm on the patient's back. 
A)  Ensure that the room is extremely quiet. 
B)  Use a specialized stethoscope with amplification. 
C)  Auscultate the patient's chest with a stethoscope. 
D)  Place the stethoscope diaphragm on the patient's back.

Exam 20: Health History and Physical Assessment

A student nurse is preparing to auscultate a patient's lungs. What action by the student leads the instructor to intervene?

A nurse conducting the general survey of a patient includes which items? (Select all that apply.)

A nurse is educating women on breast cancer risk reduction. What topics does the nurse include in the presentation? (Select all that apply.)

A nurse is told in handoff report that a patient opens eye spontaneously, is confused but able to answer questions, and demonstrates purposeful movement to painful stimuli. What does the nurse calculate the patient's Glasgow Coma Scale to be?

The nurse is assessing a patient whose chart indicates a Grade 3 heart murmur. What action is best in order to hear the murmur?

Nursing, Theory, and Professional Practice

Values, Beliefs, and Caring

Communication

Critical Thinking in Nursing

Introduction to the Nursing Process

Assessment

Nursing Diagnosis

Planning

Implementation and Evaluation

Documentation, Electronic Health Records, and Reporting

Ethical and Legal Considerations

Leadership and Management

Evidence-Based Practice and Nursing Research

Health Literacy and Patient Education

Nursing Informatics

Health and Wellness

Human Development: Conception through Adolescence

Human Development Young Adult to Older Adult

Vital Signs

Ethnicity and Cultural Assessment

Spiritual Health

Public Health, Community Base, and Home Health Care

Human Sexuality

Safety

Asepsis and Infection Control

Hygiene and Personal Care

Activity, Immobility, and Safe Movement

Skin Integrity and Wound Care

Nutrition

Cognitive and Sensory Alterations

Stress and Coping

Sleep

Diagnostic Testing

Medication Administration

Pain Management

Perioperative Nursing Care

Oxygenation and Tissue Perfusion

Fluid, Electrolytes, and Acid-Base Balance

Bowel Elimination

Urinary Elimination

Death and Loss

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