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The nurse is describing how to perform a testicular self-examination to a patient. Which
statement is most appropriate?
a. "A good time to examine your testicles is just before you take a shower."
b. "If you notice an enlarged testicle or a painless lump, call your health care provider."
c. "The testicle is egg shaped and movable. It feels firm and has a lumpy consistency."
d. "Perform a testicular examination at least once a week to detect the early stages of
testicular cancer."
During an interview, a patient reveals that she is pregnant. She states that she is not sure
whether she will breastfeed her baby and asks for some information about this. Which
of these statements by the nurse is accurate?
a. "Breastfed babies tend to be more colicky."
b. "Breastfeeding provides the perfect food and antibodies for your baby."
c. "Breastfed babies eat more often than infants on formula."
d. "Breastfeeding is second nature, and every woman can do it."
The nurse recognizes that categories such as ethnicity, gender, and religion illustrate the
concept of:
a. Family.
b. Cultures.
c. Spirituality.
d. Subcultures.
The nurse should measure rectal temperatures in which of these patients?
a. School-age child
b. Older adult
c. Comatose adult
d. Patient receiving oxygen by nasal cannula
A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby
checkup. How would the nurse proceed with the genital examination?
a. Eliciting the cremasteric reflex is recommended.
b. The glans is assessed for redness or lesions.
c. Retracting the foreskin should be avoided until the infant is 3 months old.
d. Any dirt or smegma that has collected under the foreskin should be noted.
The nurse is assessing a 3 year old for "drainage from the nose." On assessment, a
purulent drainage that has a very foul odor is noted from the left naris and no drainage
is observed from the right naris. The child is afebrile with no other symptoms. What
should the nurse do next?
a. Refer to the physician for an antibiotic order.
b. Have the mother bring the child back in 1 week.
c. Perform an otoscopic examination of the left nares.
d. Tell the mother that this drainage is normal for a child of this age.
During an interview the patient states, "I can feel this bump on the top of both of my
shouldersit doesn"t hurt but I am curious about what it might be." The nurse should tell
the patient that it is his:
a. Subacromial bursa.
b. Acromion process.
c. Glenohumeral joint.
d. Greater tubercle of the humerus.
The nurse is assessing an 80-year-old patient. Which of these findings would be
expected for this patient?
a. Hypertrophy of the gums
b. Increased production of saliva
c. Decreased ability to identify odors
d. Finer and less prominent nasal hair
The nurse is assessing the abdomen of an older adult. Which statement regarding the
older adult and abdominal assessment is true?
a. Abdominal tone is increased.
b. Abdominal musculature is thinner.
c. Abdominal rigidity with an acute abdominal condition is more common.
d. The older adult with an acute abdominal condition complains more about pain than
the younger person.
The nurse is assessing an 8-year-old child whose growth rate measures below the third
percentile for a child his age. He appears significantly younger than his stated age and
is chubby with infantile facial features. Which condition does this child have?
a. Hypopituitary dwarfism
b. Achondroplastic dwarfism
c. Marfan syndrome
d. Acromegaly
When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when
which sound is heard?
a. Low humming sound
b. Regular "lub, dub" pattern
c. Swishing, whooshing sound
d. Steady, even, flowing sound
The mother of a 5-year-old girl tells the nurse that she has noticed her daughter
'scratching at her bottom a lot the last few days." During the assessment, the nurse finds
redness and raised skin in the anal area. This finding most likely indicates:
a. Pinworms.
b. Chickenpox.
c. Constipation.
d. Bacterial infection.
While auscultating heart sounds on a 7-year-old child for a routine physical
examination, the nurse hears an S3, a soft murmur at the left midsternal border, and a
venous hum when the child is standing. What would be a correct interpretation of these
findings?
a. S3 is indicative of heart disease in children.
b. These findings can all be normal in a child.
c. These findings are indicative of congenital problems.
d. The venous hum most likely indicates an aneurysm.
The nurse is assessing the forms of support an older patient has before she is
discharged. Which of these examples is an informal source of support?
a. Local senior center
b. Patient's Medicare check
c. Meals on Wheels meal delivery service
d. Patient's neighbor, who visits with her daily
The nurse is assessing a 75-year-old man. As the nurse begins the mental status portion
of the assessment, the nurse expects that this patient:
a. Will have no decrease in any of his abilities, including response time.
b. Will have difficulty on tests of remote memory because this ability typically
decreases with age.
c. May take a little longer to respond, but his general knowledge and abilities should not
have declined.
d. Will exhibit had a decrease in his response time because of the loss of language and a
decrease in general knowledge.
While measuring a patient's blood pressure, the nurse uses the proper technique to
obtain an accurate reading. Which of these situations will result in a falsely high blood
pressure reading? Select all that apply.
a. The person supports his or her own arm during the blood pressure reading.
b. The blood pressure cuff is too narrow for the extremity.
c. The arm is held above level of the heart.
d. The cuff is loosely wrapped around the arm.
e. The person is sitting with his or her legs crossed.
f. The nurse does not inflate the cuff high enough.
A patient is able to flex his right arm forward without difficulty or pain but is unable to
abduct his arm because of pain and muscle spasms. The nurse should suspect:
a. Crepitation.
b. Rotator cuff lesions.
c. Dislocated shoulder.
d. Rheumatoid arthritis.
The nurse is performing a well-child checkup on a 5-year-old boy. He has no current
condition that would lead the nurse to suspect an illness. His health history is
unremarkable, and he received immunizations 1 week ago. Which of these findings
should be considered normal in this patient?
a. Enlarged, warm, and tender nodes
b. Lymphadenopathy of the cervical nodes
c. Palpable firm, small, shotty, mobile, and nontender lymph nodes
d. Firm, rubbery, and large nodes, somewhat fixed to the underlying tissue
While examining a 48-year-old patient's eyes, the nurse notices that he had to move the
handheld vision screener farther away from his face. The nurse would suspect:
a. Myopia.
b. Omniopia.
c. Hyperopia.
d. Presbyopia.
A 6-month-old infant has been brought to the well-child clinic for a check-up. She is
currently sleeping. What should the nurse do first when beginning the examination?
a. Auscultate the lungs and heart while the infant is still sleeping.
b. Examine the infant's hips, because this procedure is uncomfortable.
c. Begin with the assessment of the eye, and continue with the remainder of the
examination in a head-to-toe approach.
d. Wake the infant before beginning any portion of the examination to obtain the most
accurate assessment of body systems.
During a physical education class, a student is hit in the eye with the end of a baseball
bat. When examined in the emergency department, the nurse notices the presence of
blood in the anterior chamber of the eye. This finding indicates the presence of:
a. Hypopyon.
b. Hyphema.
c. Corneal abrasion.
d. Pterygium.
A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The
nurse should conduct which of these techniques to assess for this condition?
a. Obturator test
b. Test for Murphy sign
c. Assess for rebound tenderness
d. Iliopsoas muscle test
During a functional assessment of an older person's home environment, which
statement or question by the nurse is most appropriate regarding common
environmental hazards?
a. "These low toilet seats are safe because they are nearer to the ground in case of falls."
b. "Do you have a relative or friend who can help to install grab bars in your shower?"
c. "These small rugs are ideal for preventing you from slipping on the hard floor."
d. "It would be safer to keep the lighting low in this room to avoid glare in your eyes."
When performing a scrotal assessment, the nurse notices that the scrotal contents show
a red glow with transillumination. On the basis of this finding the nurse would:
a. Assess the patient for the presence of a hernia.
b. Suspect the presence of serous fluid in the scrotum.
c. Consider this finding normal, and proceed with the examination.
d. Refer the patient for evaluation of a mass in the scrotum.
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:
a. Warts.
b. Bullae.
c. Freckles.
d. Papules.
A pregnant woman states that she is concerned about her gums because she has noticed
they are swollen and have started bleeding. What would be an appropriate response by
the nurse?
a. "Your condition is probably due to a vitamin C deficiency."
b. "I"m not sure what causes swollen and bleeding gums, but let me know if it's not
better in a few weeks."
c. "You need to make an appointment with your dentist as soon as possible to have this
checked."
d. "Swollen and bleeding gums can be caused by the change in hormonal balance in
your system during pregnancy."
An older patient has been diagnosed with pernicious anemia. The nurse knows that this
condition could be related to:
a. Increased gastric acid secretion.
b. Decreased gastric acid secretion.
c. Delayed gastrointestinal emptying time.
d. Increased gastrointestinal emptying time.
A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has
been having trouble reading the paper, sewing, and even seeing the faces of her
grandchildren. On examination, the nurse notes that she has some loss of central vision
but her peripheral vision is normal. These findings suggest that she may have:
a. Macular degeneration.
b. Vision that is normal for someone her age.
c. The beginning stages of cataract formation.
d. Increased intraocular pressure or glaucoma.
The structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm
is the:
a. Cowper gland.
b. Prostate gland.
c. Median sulcus.
d. Bulbourethral gland.
The nurse makes which adjustment in the physical environment to promote the success
of an interview?
a. Reduces noise by turning off televisions and radios
b. Reduces the distance between the interviewer and the patient to 2 feet or less
c. Provides a dim light that makes the room cozy and helps the patient relax
d. Arranges seating across a desk or table to allow the patient some personal space
While obtaining a health history from the mother of a 1-year-old child, the nurse notices
that the baby has had a bottle in his mouth the entire time. The mother states, "It makes
a great pacifier." The best response by the nurse would be:
a. "You"re right. Bottles make very good pacifiers."
b. "Using a bottle as a pacifier is better for the teeth than thumb-sucking."
c. "It's okay to use a bottle as long as it contains milk and not juice."
d. "Prolonged use of a bottle can increase the risk for tooth decay and ear infections."
An 85-year-old patient comments during his annual physical examination that he seems
to be getting shorter as he ages. The nurse should explain that decreased height occurs
with aging because:
a. Long bones tend to shorten with age.
b. The vertebral column shortens.
c. A significant loss of subcutaneous fat occurs.
d. A thickening of the intervertebral disks develops.
The direction of blood flow through the heart is best described by which of these?
a. Vena cava right atrium right ventricle lungs pulmonary artery left
atrium left ventricle
b. Right atrium right ventricle pulmonary artery lungs pulmonary vein
left atrium left ventricle
c. Aorta right atrium right ventricle lungs pulmonary vein left atrium
left ventricle vena cava
d. Right atrium right ventricle pulmonary vein lungs pulmonary artery
left atrium left ventricle
