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WorksheetsHealth Assessment: Unit 1 & 2
Total questions: 47
Worksheet time: 24mins
1. An Asian-American woman is experiencing diarrhea, which is believed to be "cold" or "yin." What should the nurse recognize that the woman may likely try to treat it?
A. Foods that "hot" or "yang."
B. Readings and Eastern medicine meditations.
C. High doses of medicines believed to be "cold."
D. No treatment because diarrhea is an expected part of life.
2. The nurse is conducting an interview with a woman who has recently learned that she is pregnant and has come to the clinic today to begin prenatal care. The woman states that she and her husband are excited about the pregnancy but have a few questions. She looks nervously at her hands during the interview and sighs loudly. Considering the concept of communication, which statement does the nurse know to be most accurate when describing this woman?
A. Excited about her pregnancy but nervous about the labor.
B. Exhibiting verbal and nonverbal behaviors that do not match.
C. Excited about her pregnancy, but her husband is not and this is upsetting her.
D. Not excited about her pregnancy but believes the nurse will negatively respond to her if she states this.
3. Which adjustment in the physical environment would the nurse make to promote the success of an interview?
A. Arrange seating across a desk or table.
B. Reduce noise by turning off television and radios.
C. Reduce the distance between the interviewer and the patient to 2 feet or less.
D. Provide dim lighting to make the room cozy and help the patient relax.
4. A patient reports being allergic to penicillin. What is the best response by the nurse?
A. "Are you allergic to any other drugs?"
B. "How often have you received penicillin?"
C. "Describe what happens to you when you take penicillin?"
D, "I'll write your allergy on your chart so you won't receive any penicillin."
5. The nurse is conducting a patient review. Which statement made by the patient should the nurse more fully assess the mental status during the interview?
A. "I sleep like a baby."
B. "I have no health problems."
C. "I never did too good in school."
D. "I am not currently taking any medications."
6. The nurse is examining a 3-year-old who was brought to the emergency department after a fall. Which bruise, if found, would be most concern?
A. Bruises on the knee.
B. Bruises on the elbow.
C. Bruises on the abdomen.
D. Bruises on both of the shins.
7. The nurses is preparing to assess a patient's abdomen by palpation. How would the nurse proceed?
A. Avoid palpation of reportedly "tender" areas because palpation in these areas may cause pain.
B. Palpate a tender area quickly to avoid any discomfort that the patient may experience.
C. Start the assessment with deep palpation, while encouraging the patient to relax and take a deep breath.
D. Begin the assessment with light palpation to detect surface characteristics and to accustom the patient to being touched.
8. While percussing over the liver of a patient, the nurse notices a dull sound. What would the nurse do?
A. Consider this a normal finding.
B. Palpate this are for an underlying mass.
C. Reposition the hands and attempt to percuss in this area again.
D. Consider this finding as abnormal and refer the patient for additional treatment.
9. The nurse is performing a general survey. Which action is a component of the general survey?
A. Observing the patient's body stature and nutritional status.
B. Interpreting the subjective information the patient has reported.
C. Measuring the patient's temperature, pulse, respirations, and blood pressure.
D. Observing specific body systems while performing the physical assessment.
10. The nurse is taking an initial blood pressure reading on a 72-year-old patient with documented hypertension. How would the nurse proceed?
A. Cuff should be placed on the patient's arm and inflated 30 mmHg above the patient's pulse rate.
B. Cuff should be inflated to 200 mmHg in an attempt to obtain the most accurate systolic reading.
C. Cuff should be inflated 30 mmHg above the point at which the palpated pulse disappears.
D. After confirming the patient's previous blood pressure readings, the cuff should be inflated 30 mmHg above the highest systolic reading recorded.
11. A patient has had arthritic pain in the hips for several years since a hip fracture. The patient is able to move around in their hospital room and has not reported any pain so far this morning. However, when asked, the patient states that the pain is "bad this morning" and rates it at an 8 on a 1-to-10 scale. What is the likely reason for this?
A. The patient is addicted to their pain medications and cannot obtain pain relief.
B. The patient does not want to trouble the nursing staff with their complaints.
C. The patient is not in pain but rates it high to receive pain medication.
D. The patient has experienced chronic pain for years and has adapted to it.
12. A patient has been admitted to the hospital with vertebral fractures related to osteoporosis. The patient is in extreme pain. How would the nurse document this type of pain?
A. Referred
B. Cutaneous
C. Visceral
D. Deep Somatic
13. During a class on the aspects of culture, the nurse shares that culture has four basic characteristics. Which statement correctly reflects one of the characteristics of culture?
A. Static and Unchanging
B. Members share similar physical characteristics.
C. Members share a common geographic origin and religion.
D. Adapted to specific conditions related to environmental and technical factors.
14. During an assessment, the nurse notices that a patient is handling a small charm that is tied to a leather strip around their neck. Which action by the nurse is appropriate?
A. Ask the patient about the item and its significance.
B. Ask the patient to lock the item with other valuables in the hospital's safe.
C. Tell the patient that a family member should take valuables home.
D. No action is necessary.
15. The nurse is conducting a heritage assessment. Which question is most appropriate for this assessment?
A. "Do you smoke?"
B. "What is your religion?"
C. "Do you have a history of heart disease?"
D. "How many years have you lived in the United States?"
16. What should the nurse, who is caring for an American Indian woman seeking help to regulate her diabetes, anticipate or expect of the patient?
A. Will comply with the treatment prescribed.
B. Has given up her belief in naturalistic causes of disease.
C. May also be seeking the assistance of a shaman or medicine man.
D. Will need extra help in dealing with her illness and may be experiencing a crisis of faith.
17. A 59-year-old patient tells the nurse that he has ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse best document his reason for seeking care?
A. J.M. is a 59-year-old man seeking treatment for ulcerative colitis.
B. J.M. came into the clinic reporting black stools for the past 24 hours.
C. J.M. is a 59-year-old man who states that he has ulcerative colitis and wants it checked.
D. J.M. is a 59-year-old man who states that he has been having "black stools" for the past 24 hours.
18. A patient reports having bad abdominal pain for the past week . What would be the nurse's best response?
A. "Can you point to where it hurts?"
B. "What have you had to eat in the last 24 hours?"
C. "Have you ever had any surgeries on your abdomen?"
D. "We'll talk more about that later in the interview."
19. A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which response by the nurse would be appropriate?
A. "How does your family react to your pain?"
B. "The pain must be terrible. You probably pinched a nerve."
C. "I've had back pain myself, and it can e excruciating."
D. "How would you say the pain affects your ability to do your daily activities?"
20. When assessing aging adults, what is one of the first things the nurse should assess before making judgments about the aging person's mental status?
A. Presence of phobias
B. General intelligence
C. Sensory-perceptive abilities
D. Presence of irrational thinking patterns
21. A woman brings her husband to the clinic for an examination. She is particularly worries because after a recent fall, he seems to have a lost a great deal of his memory of recent events. Which statement reflects the nurse's best course of action?
A. Perform a complete mental status examination.
B. Refer him to a psychometrician.
C. Plan to integrate the mental status examination into the history and physical examination.
D. Reassure his wife that memory loss after a physical shock is normal and will soon subside.
22. Which of these individuals would the nurse consider at highest risk for a suicide attempt?
A. A man who jokes about death.
B. A woman who, during a past episode of major depression, attempted suicide.
C. A adolescent who just broke up with her boyfriend and states that she would like to kill herself.
D. An older adult man who tells the nurse that he is going to "join his wife in heaven" tomorrow and plans to use a gun.
23. A 23-year-old patient in the clinic appears anxious. Her speech is rapid, and she is fidgety and in constant motion. Which of these questions or statements would be most appropriate for the nurse to use in this situation?
A. "How do you usually feel? Is normal behavior for you?"
B. "I am going to say four words. In a few minutes, I will ask you to recall them."
C. "Describe the meaning of the phrase, 'Looking through rose-colored glasses.'"
D. "Pick up the pencil in your left hand, move it to your right hand, and place it on the table."
24. Receiving is a part of the communication process. Which receiver is most likely to misinterpret a message sent by a health care professional?
A. Well-adjusted adolescent who came in for a sports physical.
B. Recovering alcoholic who came in for a basic physical examination.
C. Man who came in with his wife who was just diagnosed with lung cancer.
D. Man with a hearing impairment who has an interpreter with him who came in for a follow-up blood pressure check.
25. A pregnant woman states, "I just know labor will be so painful that I won't be able to stand it. I know it sounds awful, but I really dread going into labor." The nurse responds by stating, "Oh, don't worry about labor so much. I have been through it, and although it is painful, many good medications are available to decrease the pain." Which statement is true regarding the nurse's response?
A. Therapeutic response. By sharing something personal, the nurse gives hope to this woman.
B. Non-therapeutic response. By providing false reassurance, the nurse actually cut-off further discussion of the woman's fears.
C. Therapeutic response. By providing information about the medications available, the nurse is giving information to the woman.
D. Non-therapeutic response. The nurse is essentially giving the message to the woman that labor cannot be tolerated without medication.
26. During a follow-up visit, the nurse discovers that a patient has not been taking their insulin on a regular basis. The nurse asks, "Why haven't you taken your insulin?" Which statement is an appropriate evaluation of this situation?
A. This question may place the patient on the defensive.
B. This question is an effective way to search for information.
C. Discussing their behavior with their spouse would have been better.
D. A direct question is the best way to discover the reasons for the patient's behavior.
27. During an assessment, the nurse asks a female patient. "How many alcoholic drinks do you have a week?" Which answer by the patient would indicate at-risk drinking?
A. "I may have one or two drinks a week."
B. "I usually have three or four drinks a week."
C. "I'll have a glass or two of wine every now and then."
D. "I have eight to ten drinks a week, but I never get drunk."
28. The nurse is asking an adolescent about illicit substance abuse. The adolescent answers, "Yes, I've used marijuana at parties with my friends." What is the next question the nurse should ask?
A. "Who are these friends?"
B. "Is this a regular habit?"
C. "Do your parents know about this?"
D. "When was the last time you used marijuana?"
29. The nurse has completed an assessment on an older adult patient who came to the clinic for a leg injury. As a result of the assessment, the nurse has determined that the patient has at-risk alcohol use. Which action by the nurse is most appropriate at this time?
A. Record the results of the assessment and notify the physician on call.
B. State, "You're drinking more than is medically safe. I strongly recommend that you quit drinking, and I'm willing to help you."
C. State, "It appears that you may have a drinking problem. Here is the telephone number of our local Alcoholics Anonymous chapter."
D. Give the patient information about a local rehabilitation clinic.
30. A patient is brought to the emergency department. He is restless, has dilated pupils, is sweating, has a runny nose and tearing eyes, and reports muscle and joint pains. His girlfriend thought he had influenza, but she became concerned when his temperature went up to 39.4 C. She admits that he has been a heavy drug user, but he has been trying to stop on his own. The nurse suspects that the patient is experiencing withdrawal symptoms from which substance?
A. Alcohol
B. Heroin
C. Cocaine
D. Sedatives
31. During a home visit, the nurse notices that an older adult woman is caring for her bedridden husband. The woman states that this is her duty, she does the best she can, and her children come to help when they are in town. Her husband is unable to care for himself, and she appears thin, weak, and exhausted. The nurse notices that several of his prescription medication bottles are empty. What term best describes this situation?
A. Physical Abuse
B. Financial Exploitation
C. Psychological Abuse
D. Neglect
32. The nurse is caring for a 17-year-old female patient. In which situation would the nurse screen the patient for intimate partner violence (IPV)?
A. When intimate partner violence is suspected.
B. When a history of abuse in the family is known.
C. As a routine part of each health care encounter.
D. As part of the exam for a female with an unexplained injury.
33. The nurse is caring for an 8-year-old child who has several bruises of varying colors (some red, some bluish-green, and some brownish-yellow) the size of a hand on the buttocks. What action would the nurse take next?
A. Notify the child's caregivers of the findings.
B. Document that the bruises appear to be caused by spanking.
C. When the child is alone, ask "How did you get these sore areas on your butt?"
D. Inform the child, "You can tell me who did this to you and we will not allow them to see or hurt you again."
34. The nurse is caring for several patients. Which patient is at highest risk for Intimate Partner Violence (IPV)?
A. An Asian female who speaks no English.
B. A female multi-racial illegal immigrant.
C. A non-hispanic white female living in poverty.
D. A female American Indian living above the poverty line.
35. The nurse is reviewing percussion techniques with a new graduate nurse. Which action performed by the graduate nurse while percussing requires the nurse to intervene?
A. Percussing oncer over each area.
B. Striking with the fingertip, not the finger pad.
C. Using the wrist to make the strikes, not the arm.
D. Quickly lifting the striking finger after each stroke.
36. The nurse is unable to identify any changes in sound when percussing over the abdomen of an obese patient. What would the nurse do next?
A. Ask the patient to take deep breaths to relax the abdominal musculature.
B. Consider this finding as normal and proceed with the abdominal assessment.
C. Increase the amount of strength used when attempting to percussion over the abdomen.
D. Decrease the amount of strength used when attempting to percuss over the abdomen.
37. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient?
A. Count the patient's respirations.
B. Bilaterally percuss the thorax, noting any differences in percussion tones.
C. Call for a chest x-ray and wait for the results before beginning an assessment.
D. Inspect the thorax for any new masses and bleeding associated with respirations.
38. Which of these guidelines would a nurse follow when measuring a patient's weight?
A. The patient is always weighed wearing only his or her undergarments.
B. The type of scale does not matter, as long as the weights are similar from day to day.
C. The patient may leave on his or her jacket and shoes as long as these are documented next to the weight.
D. Attempts should be made to weigh the patient at approximately the same time of day if a sequence of weights is necessary.
39. When performing an examination, the nurse would consider a child's physical growth to be the best indicator of which aspect of health?
A. General Health
B. Genetic Makeup
C. Nutritional Status
D. Activity and Exercise patterns
40. A 1-month-old infant has a head measurement of 34 cm and has a chest circumference of 32 cm. Based on the interpretation of these findings, what action would the nurse take?
A. Refer the infant to a physician for further evaluation.
B. Consider these findings normal for a 1-month-old infant.
C. Expect the chest circumference to be greater than the head circumference.
D. Ask the parent to return in 2 weeks to re-evaluate the head and chest circumference.
41. When assessing a 75-year-old patient who has asthma, the nurse notes that the patient assumes a tripod position, leaning forward with arms braced on the chair. How would the nurse interpret these findings?
A. Assume that the patient is eager and interested in participating in the interview.
B. Evaluate the patient for abdominal pain, which may be exacerbated in the sitting position.
C. Assume that the patient is having difficulty breathing and assist him to a supine position.
D. Recognize that a tripod position is often used when a patient is having respiratory difficulties.
42. When assessing the pulse of a 6-year-old patient, the nurse notices that the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration. What action would the nurse take next?
A. Notify the physician.
B. Record these findings as normal.
C. Check the child's blood pressure and note any variation with respiration.
D. Document that this child has bradycardia and continue with the assessment.
43. The nurse is assessing the vital signs of a 20-year-old marathon runner and document the following vital signs: temperature 36C; pulse 48 beat per minute; respirators 14 breaths per minute, blood pressure 104/68 mmHg. Which statement is true concerning these results?
A. The patient is experiencing tachycardia.
B. These are normal vital signs for a healthy, athletic adult.
C. The patient's pulse rate is not normal - his physician should be notified.
D. On the basis of these readings, the patient should return to the clinic in 1 week.
44. A nurse is helping at a health fair at a local mall. What would the nurse keep in mind when taking blood pressure on a variety of people?
A. After menopause, blood pressure readings in women are usually lower than those taken in men.
B. The blood pressure of an African-American adult is usually higher than that of a non-hispanic white adult of the same age.
C. Blood pressure measurements in people who are overweight should be the same as those of people who are at a normal weight.
D. A teenager's blood pressure reading will be lower than that of an adult.
45. The nurse has collected the following information on a patient: palpated blood pressure - 180 mmHg; auscultated blood pressure - 170/100 mmHg; apical pulse - 60 beats per minute; radial pulse - 70 beats per minute. What is the patient's pulse pressure?
A. 10
B. 70
C. 80
D. 100
46. The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system?
A. Visceral
B. Referred
C. Cutaneous
D. Neuropathic
47. A patient is reporting severe knee pain after twisting it during a basketball game and is requesting pain medication. Which action by the nurse is appropriate?
A. Completing the physical examination first and then giving the pain medication.
B. Telling the patient that the pain medication must wait until after the x-ray images are completed.
C. Evaluating the full range of motion of the knee and then medicating for pain.
D. Administering pain medication and then proceeding with the assessment.
