Chapter 25- Health Assessment Nursing School Test Banks

 

1.

Conducting a health assessment involves collecting, validating, and analyzing subjective data and objective data. Which of the following is an example of subjective data?

A)

pain

B)

rash

C)

perspiration

D)

fever

2.

A nurse is conducting a health assessment. How will the information collected from the patient be used?

A)

as a basis for the nursing process

B)

to illustrate nursing competence

C)

to facilitate nursepatient caring

D)

as one component of medical care

3.

A home health nurse is visiting a patient who recently was hospitalized for repair of a fractured hip. The patient tells the nurse, I have had a lot of pain in my abdomen. What type of assessment would the nurse conduct?

A)

comprehensive

B)

ongoing partial

C)

focused

D)

emergency

4.

An adolescent comes to a community health clinic with complaints of vaginal itching and discharge. She believes it is from having sex with her boyfriend. Which of the following responses should the nurse use during the health history to elicit information?

A)

Tell me about sexual activity with your boyfriend.

B)

Why did you ever have sex with someone you dont know?

C)

You are old enough to know to use condoms.

D)

I dont understand how you could be so careless.

5.

A nurse is preparing a patient for a physical assessment. The patient appears anxious about the assessment. Which statement by the nurse would be most appropriate?

A)

This is nothing to worry about. I wont hurt you.

B)

Some of the examination may be painful, but I will be gentle.

C)

Let me tell you what I will be doing. It should not be painful.

D)

I have to do this, so just relax and it wont last long.

6.

What would a nurse ensure before beginning a health assessment?

A)

that the time needed for the assessment fits into the nurses work schedule

B)

that the room is private, quiet, warm, and has adequate light

C)

that family members are present to answer specific questions

D)

that there is a written physicians order for the assessment

7.

A nurse working in a clinic is planning to conduct vision screenings for a group of low-income women. What equipment would be needed to test vision?

A)

Snellen chart

B)

stethoscope

C)

ophthalmoscope

D)

otoscope

8.

When using assessment equipment that will touch the patient, what should the nurse do before conducting the assessment?

A)

Describe the equipment and how it works.

B)

Show pictures of functions of the equipment.

C)

Draw pictures of the anatomy to be assessed.

D)

Warm the equipment with hands or warm water.

9.

A school nurse is preparing to test the auditory function of grade school students. What equipment will be needed for this examination?

A)

tuning fork

B)

percussion hammer

C)

speculum

D)

ophthalmoscope

10.

A nurse is preparing to examine the breasts of a patient. In what position should the nurse place the patient?

A)

prone

B)

standing

C)

dorsal recumbent

D)

lithotomy

11.

Which of the following positions should not be used to assess the abdomen?

A)

supine

B)

dorsal recumbent

C)

kneechest

D)

Sims

12.

A nurse is using inspection as an assessment technique. What does the nurse use during inspection?

A)

equipment such as a stethoscope

B)

both hands to produce sounds

C)

light palpation to detect surfaces

D)

senses of vision, hearing, smell

13.

Which of the following can a nurse assess by palpation?

A)

heart sounds, lung sounds, blood pressure

B)

temperature, turgor, moisture

C)

vision, hearing, cranial nerves

D)

tissue density, gait, reflexes

14.

A nurse is conducting a physical examination and is percussing the gastric area of a patient. What percussion tone is normally heard in this area?

A)

flat

B)

dull

C)

resonant

D)

tympany

15.

When auscultating a patients abdomen, a nurse notes gurgling sounds. What characteristic of sound would the nurse document?

A)

resonance

B)

turgor

C)

quality

D)

texture

16.

A nurse is performing a general survey of a patient admitted to the hospital. Which of the following actions is an element of this procedure?

A)

taking vital signs

B)

palpating the integument

C)

identifying risk factors for altered health

D)

assessing the head and neck

17.

When inspecting the skin of a patient, the nurse notes a bluish tinge to the skin. What condition would the nurse document?

A)

jaundice

B)

cyanosis

C)

erythema

D)

pallor

18.

The nurse palpating the skin of a patient documents a firm 1.5 cm mass on the lower right leg. What type of skin lesion does this describe?

A)

macule

B)

wheal

C)

vesicle

D)

nodule

19.

A nurse assesses a patients eyes by testing the cardinal fields of vision for coordination and alignment. What eye characteristic is being assessed by this process?

A)

visual acuity

B)

extraocular movements

C)

peripheral vision

D)

existence of cataracts

20.

A nurse performing physical assessments of residents in a long-term care facility describes to the student nurse common head and neck variations in the older adult. Which of the following accurately defines these variations? Select all that apply.

A)

decreased color vision and peripheral vision

B)

increased adaptation to light and dark

C)

a blue ring around the cornea (arcus senilis)

D)

entropion and ectropion

E)

impaired conductive hearing

F)

larger, more easily palpated lymph glands

21.

While conducting a physical examination of the thorax, a nurse notes and documents breath sounds as moderate blowing sounds with equal inspiration and expiration. What type of breath sounds are these?

A)

bronchial

B)

bronchovesicular

C)

vesicular

D)

adventitious

22.

A nurse is conducting a health assessment for an African American patient. What should the nurse consider in terms of cultural sensitivity?

A)

All individuals, regardless of culture, have the same anatomy and physiology.

B)

asking specific questions about race during the health history

C)

cultural risk factors for alterations in health and normal racial variations

D)

differences in emotional, social, and spiritual basic human needs

23.

When conducting a physical assessment, what should the nurse assess and document about size and shape of body parts?

A)

actual measurements in centimeters

B)

symmetry (comparison of bilateral body parts)

C)

indications of general health status

D)

vital signs of all extremities (arms and legs)

24.

A nurse is inspecting the ear canals and tympanic membranes of an 18-month-old child. How would the pinna be moved to achieve better visualization?

A)

There is no need to move the pinna.

B)

Gently pull the pinna up and back.

C)

Gently pull the pinna down and back.

D)

Pull the pinna parallel to the side of the head.

25.

While assessing breath sounds, a nurse hears crackles. What causes these abnormal sounds?

A)

air in the lungs

B)

a narrowing of the upper airway

C)

narrowed small air passages

D)

moisture in air passages

26.

When assessing the abdomen, which assessment technique is used last?

A)

inspection

B)

auscultation

C)

percussion

D)

palpation

27.

What is one purpose of documentation of the health assessment?

A)

to identify the nurses role in healthcare

B)

to identify actual and potential health problems

C)

to expand nursing knowledge and skills

D)

to provide a basis for evidence-based nursing

28.

While giving a patient a bath, a student nurse observes the color of the patients skin as having a yellowish tinge. What term would be used to document this assessment?

A)

cyanosis

B)

pallor

C)

jaundice

D)

erythema

29.

A nurse is preparing a patient for a barium enema. Which one of the following is a nurses responsibility for diagnostic procedures and tests?

A)

writing the order for the procedure or test

B)

delegating care during a procedure to others

C)

ensuring results of diagnostic tests are recorded

D)

providing emotional and physical preparation

Answer Key

1.

A

2.

A

3.

C

4.

A

5.

C

6.

B

7.

A

8.

D

9.

A

10.

C

11.

B

12.

D

13.

B

14.

D

15.

C

16.

A

17.

B

18.

D

19.

B

20.

A, D, E

21.

B

22.

C

23.

B

24.

C

25.

D

26.

D

27.

B

28.

C

29.

D

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