Question 1

The nurse should use which location for eliciting deep tendon reflexes?

Accepted Answer

A)  Achilles
B)  Femoral
C)  Scapular
D)  Abdominal A

Question 2

A patient's uvula raises midline when she says "ahh," and she has a positive gag reflex.The nurse has just tested which cranial nerves?

Accepted Answer

A)  IX and X
B)  IX and XII
C)  X and XII
D)  XI and XII A

Question 3

When the nurse performs the confrontation test,the nurse has assessed:

Accepted Answer

A)  Extraocular eye muscles (EOMs) .
B)  Pupils (pupils equal, round, reactive to light, and accommodation [PERRLA]) .
C)  Near vision.
D)  Visual fields. D

Question 4

During examination,the nurse finds that a patient is unable to distinguish objects placed in his hand.The nurse would document:

Accepted Answer

A)  Stereognosis.
B)  Astereognosis.
C)  Graphesthesia.
D)  Agraphesthesia.

Question 5

After assessing a female patient,the nurse notices flesh-colored,soft,pointed,moist,papules in a cauliflower-like patch around her introitus.This finding is most likely:

Accepted Answer

A)  Urethral caruncle.
B)  Syphilitic chancre.
C)  Herpes simplex virus.
D)  Human papillomavirus.

Question 6

An 85-year-old man has come in for a physical examination,and the nurse notices that he uses a cane.When documenting general appearance,the nurse should document this information under the section that covers:

Accepted Answer

A)  Posture.
B)  Mobility.
C)  Mood and affect.
D)  Physical deformity.

Question 7

Which of these is included in an assessment of general appearance?

Accepted Answer

A)  Height
B)  Weight
C)  Skin color
D)  Vital signs

Question 8

The nurse has just completed an examination of a patient's extraocular muscles.When documenting the findings,the nurse should document the assessment of which cranial nerves?

Accepted Answer

A)  II, III, and VI
B)  II, IV, and V
C)  III, IV, and V
D)  III, IV, and VI

Question 9

After the health history has been obtained and before beginning the physical examination,the nurse should first ask the patient to:

Accepted Answer

A)  Empty the bladder.
B)  Completely disrobe.
C)  Lie on the examination table.
D)  Walk around the room.

Question 10

The nurse will measure a patient's near vision with which tool?

Accepted Answer

A)  Snellen eye chart with letters
B)  Snellen "E" chart
C)  Jaeger card
D)  Ophthalmoscope

Question 11

The nurse is performing a vision examination.Which of these charts is most widely used for vision examinations?

Accepted Answer

A)  Snellen
B)  Shetllen
C)  Smoollen
D)  Schwellon

Question 12

The nurse has just recorded a positive iliopsoas test on a patient who has abdominal pain.This test is used to confirm a(n):

Accepted Answer

A)  Inflamed liver.
B)  Perforated spleen.
C)  Perforated appendix.
D)  Enlarged gallbladder.

Question 13

During a complete health assessment,how would the nurse test the patient's hearing?

Accepted Answer

A)  Observing how the patient participates in normal conversation
B)  Using the whispered voice test
C)  Using the Weber and Rinne tests
D)  Testing with an audiometer

Question 14

During the examination of a patient,the nurse notices that the patient has several small,flat macules on the posterior portion of her thorax.These macules are less than 1 cm wide.Another name for these macules is:

Accepted Answer

A)  Warts.
B)  Bullae.
C)  Freckles.
D)  Papules.

Question 15

The nurse should wear gloves for which of these examinations?

Accepted Answer

A)  Measuring vital signs
B)  Palpation of the sinuses
C)  Palpation of the mouth and tongue
D)  Inspection of the eye with an ophthalmoscope

Question 16

After the examination of an infant,the nurse documents opisthotonos.The nurse recognizes that this finding often occurs with:

Accepted Answer

A)  Cerebral palsy.
B)  Meningeal irritation.
C)  Lower motor neuron lesion.
D)  Upper motor neuron lesion.

Question 17

A patient states,"Whenever I open my mouth real wide,I feel this popping sensation in front of my ears." To further examine this,the nurse would:

Accepted Answer

A)  Place the stethoscope over the temporomandibular joint, and listen for bruits.
B)  Place the hands over his ears, and ask him to open his mouth "really wide."
C)  Place one hand on his forehead and the other on his jaw, and ask him to try to open his mouth.
D)  Place a finger on his temporomandibular joint, and ask him to open and close his mouth.

Question 18

During an examination,the nurse notices that a patient is unable to stick out his tongue.Which cranial nerve is involved with the successful performance of this action?

Accepted Answer

A)  I
B)  V
C)  XI
D)  XII

Question 19

A patient tells the nurse,"Sometimes I wake up at night and I have real trouble breathing.I have to sit up in bed to get a good breath." When documenting this information,the nurse would note:

Accepted Answer

A)  Orthopnea.
B)  Acute emphysema.
C)  Paroxysmal nocturnal dyspnea.
D)  Acute shortness of breath episode.

Question 20

A patient is unable to shrug her shoulders against the nurse's resistant hands.What cranial nerve is involved with successful shoulder shrugging?

Accepted Answer

A)  VII
B)  IX
C)  XI
D)  XII

Exam 27: The Complete Health Assessment: Adult