Question 1

The nurse is asking a patient for his reason for seeking care and asks about the signs and symptoms he is experiencing.Which of these is an example of a symptom?

Accepted Answer

A) Chest pain 
B) Clammy skin 
C) Serum potassium level at 4.2 mEq/L 
D) Body temperature of 100° F 
A) Chest pain 
B) Clammy skin 
C) Serum potassium level at 4.2 mEq/L 
D) Body temperature of 100° F

Question 2

During an assessment, the nurse uses the CAGE test.The patient answers "yes" to two of the questions.What could this be indicating?

Accepted Answer

A) The patient is an alcoholic. 
B) The patient is annoyed at the questions. 
C) The patient should be thoroughly examined for possible alcohol withdrawal symptoms. 
D) The nurse should suspect alcohol abuse and continue with a more thorough substance abuse assessment. 
A) The patient is an alcoholic. 
B) The patient is annoyed at the questions. 
C) The patient should be thoroughly examined for possible alcohol withdrawal symptoms. 
D) The nurse should suspect alcohol abuse and continue with a more thorough substance abuse assessment.

Question 3

When the nurse is evaluating the reliability of a patient's responses, which of these statements would be correct? The patient:

Accepted Answer

A) Has a history of drug abuse and therefore is not reliable. 
B) Provided consistent information and therefore is reliable. 
C) Smiled throughout interview and therefore is assumed reliable. 
D) Would not answer questions concerning stress and therefore is not reliable. 
A) Has a history of drug abuse and therefore is not reliable. 
B) Provided consistent information and therefore is reliable. 
C) Smiled throughout interview and therefore is assumed reliable. 
D) Would not answer questions concerning stress and therefore is not reliable.

Question 4

The mother of a 16-month-old toddler tells the nurse that her daughter has an earache.What would be an appropriate response?

Accepted Answer

A) "Maybe she is just teething." 
B) "I will check her ear for an ear infection." 
C) "Are you sure she is really having pain?" 
D) "Describe what she is doing to indicate she is having pain." 
A) "Maybe she is just teething." 
B) "I will check her ear for an ear infection." 
C) "Are you sure she is really having pain?" 
D) "Describe what she is doing to indicate she is having pain."

Question 5

A female patient tells the nurse that she has had six pregnancies, with four live births at term and two spontaneous abortions.Her four children are still living.How would the nurse record this information?

Accepted Answer

A) P-6, B-4, (S)Ab-2 
B) Grav 6, Term 4, (S)Ab-2, Living 4 
C) Patient has had four living babies 
D) Patient has been pregnant six times 
A) P-6, B-4, (S)Ab-2 
B) Grav 6, Term 4, (S)Ab-2, Living 4 
C) Patient has had four living babies 
D) Patient has been pregnant six times

Question 6

Which of these statements represents subjective data the nurse obtained from the patient regarding the patient's skin?

Accepted Answer

A) Skin appears dry. 
B) No lesions are obvious. 
C) Patient denies any colour change. 
D) Lesion is noted on the lateral aspect of the right arm. 
A) Skin appears dry. 
B) No lesions are obvious. 
C) Patient denies any colour change. 
D) Lesion is noted on the lateral aspect of the right arm.

Question 7

The nurse is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic.Which instruction would be appropriate for the parents before the interview begins?

Accepted Answer

A) "Please stay during the interview; you can answer for her if she does not know the answer." 
B) "It would help to interview the three of you together." 
C) "While I interview your daughter, will you please stay in the room and complete these family health history questionnaires?" 
D) "While I interview your daughter, will you step out to the waiting room and complete these family health history questionnaires?" 
A) "Please stay during the interview; you can answer for her if she does not know the answer." 
B) "It would help to interview the three of you together." 
C) "While I interview your daughter, will you please stay in the room and complete these family health history questionnaires?" 
D) "While I interview your daughter, will you step out to the waiting room and complete these family health history questionnaires?"

Question 8

In response to a question about stress, a 39-year-old woman tells the nurse that her husband and her mother both died in the past year.Which response by the nurse is most appropriate?

Accepted Answer

A) "This has been a difficult year for you." 
B) "I don't know how anyone could handle that much stress in 1 year!" 
C) "What did you do to cope with the loss of both your husband and your mother?" 
D) "That is a lot of stress; now let's go on to the next section of your history." 
A) "This has been a difficult year for you." 
B) "I don't know how anyone could handle that much stress in 1 year!" 
C) "What did you do to cope with the loss of both your husband and your mother?" 
D) "That is a lot of stress; now let's go on to the next section of your history."

Question 9

A patient tells the nurse that he is allergic to penicillin.What would be the nurse's best response to this information?

Accepted Answer

A) "Are you allergic to any other drugs?" 
B) "How often have you received penicillin?" 
C) "I'll write your allergy on your chart so you won't receive any penicillin." 
D) "Describe what happens to you when you take penicillin." 
A) "Are you allergic to any other drugs?" 
B) "How often have you received penicillin?" 
C) "I'll write your allergy on your chart so you won't receive any penicillin." 
D) "Describe what happens to you when you take penicillin."

Question 10

The nurse is performing a review of systems on a 76-year-old patient.Which of these statements is correct for this situation?

Accepted Answer

A) The questions asked are identical for all ages. 
B) The interviewer will start incorporating different questions for patients 70 years of age and older. 
C) Questions that are reflective of the normal effects of aging are added. 
D) At this age, a review of systems is not necessary-the focus should be on current problems. 
A) The questions asked are identical for all ages. 
B) The interviewer will start incorporating different questions for patients 70 years of age and older. 
C) Questions that are reflective of the normal effects of aging are added. 
D) At this age, a review of systems is not necessary-the focus should be on current problems.

Question 11

During an assessment of a patient's family history, the nurse constructs a genogram.Which statement best describes a genogram?

Accepted Answer

A) List of diseases present in a person's near relatives 
B) Graphic family tree that uses symbols to depict the gender, relationship, and age of immediate family members 
C) Drawing that depicts the patient's family members up to five generations back 
D) Description of the health of a person's children and grandchildren 
A) List of diseases present in a person's near relatives 
B) Graphic family tree that uses symbols to depict the gender, relationship, and age of immediate family members 
C) Drawing that depicts the patient's family members up to five generations back 
D) Description of the health of a person's children and grandchildren

Question 12

The nurse is assessing a new patient who has recently immigrated to Canada.Which question is appropriate to add to the health history?

Accepted Answer

A) "Why did you come to Canada?" 
B) "When did you come to Canada, and from what country?" 
C) "What made you leave your native country?" 
D) "Are you planning to return to your home country?" 
A) "Why did you come to Canada?" 
B) "When did you come to Canada, and from what country?" 
C) "What made you leave your native country?" 
D) "Are you planning to return to your home country?"

Question 13

The nurse is taking a family history.Important diseases or problems about which the patient should be specifically asked include:

Accepted Answer

A) Emphysema 
B) Head trauma 
C) Mental illness 
D) Fractured bones 
A) Emphysema 
B) Head trauma 
C) Mental illness 
D) Fractured bones

Question 14

A patient tells the nurse that she has had abdominal pain for the past week.What would be the nurse's best response?

Accepted Answer

A) "Can you point to where it hurts?" 
B) "We'll talk more about that later in the interview." 
C) "What have you had to eat in the past 24 hours?" 
D) "Have you ever had any surgeries on your abdomen?" 
A) "Can you point to where it hurts?" 
B) "We'll talk more about that later in the interview." 
C) "What have you had to eat in the past 24 hours?" 
D) "Have you ever had any surgeries on your abdomen?"

Exam 5: The Complete Health History

The nurse is asking a patient for his reason for seeking care and asks about the signs and symptoms he is experiencing.Which of these is an example of a symptom?

During an assessment, the nurse uses the CAGE test.The patient answers "yes" to two of the questions.What could this be indicating?

When the nurse is evaluating the reliability of a patient's responses, which of these statements would be correct? The patient:

The mother of a 16-month-old toddler tells the nurse that her daughter has an earache.What would be an appropriate response?

A female patient tells the nurse that she has had six pregnancies, with four live births at term and two spontaneous abortions.Her four children are still living.How would the nurse record this information?

Which of these statements represents subjective data the nurse obtained from the patient regarding the patient's skin?

The nurse is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic.Which instruction would be appropriate for the parents before the interview begins?

In response to a question about stress, a 39-year-old woman tells the nurse that her husband and her mother both died in the past year.Which response by the nurse is most appropriate?

A patient tells the nurse that he is allergic to penicillin.What would be the nurse's best response to this information?

The nurse is performing a review of systems on a 76-year-old patient.Which of these statements is correct for this situation?

During an assessment of a patient's family history, the nurse constructs a genogram.Which statement best describes a genogram?

The nurse is assessing a new patient who has recently immigrated to Canada.Which question is appropriate to add to the health history?

The nurse is taking a family history.Important diseases or problems about which the patient should be specifically asked include:

A patient tells the nurse that she has had abdominal pain for the past week.What would be the nurse's best response?

Evidence-Based Assessment

Health Promotion in the Context of Health Assessment

Cultural Competence: Cultural Care

The Interview

Mental Health Assessment

Substance Use and Health Assessment

Interpersonal Violence Assessments

Assessment Techniques and the Clinical Setting

General Survey, Measurement, Vital Signs

Pain Assessment

Nutritional Assessment

Skin, Hair, and Nails

Head, Face, and Neck, Including Regional Lymphatics

Eyes

Ears

Nose, Mouth, and Throat

Breasts and Regional Lymphatics

Thorax and Lungs

Heart and Neck Vessels

Peripheral Vascular System and Lymphatic System

Abdomen

Anus, Rectum, and Prostate

Musculoskeletal System

Neurological System

Male Genitourinary System

Female Genitourinary System

The Complete Health Assessment: Adult, Infant, Child, and Adolescent

Bedside Assessment of the Hospitalized Patient

The Pregnant Woman

Functional Assessment of the Older Adult

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