An individual who takes the magicoreligious perspective of illness and disease is likely
to believe that his or her illness was caused by:
a. Germs and viruses.
b. Supernatural forces.
c. Eating imbalanced foods.
d. An imbalance within his or her spiritual nature.
The nurse will perform a palpated pressure before auscultating blood pressure. The
reason for this is to:
a. More clearly hear the Korotkoff sounds.
b. Detect the presence of an auscultatory gap.
c. Avoid missing a falsely elevated blood pressure.
d. More readily identify phase IV of the Korotkoff sounds.
At the beginning of rounds when entering the room, what should the nurse do first?
a. Check the intravenous (IV) infusion site for swelling or redness.
b. Check the infusion pump settings for accuracy.
c. Make eye contact with the patient, and introduce him or herself as the patient’s nurse.
d. Offer the patient something to drink.
A 55-year-old man is experiencing severe pain of sudden onset in the scrotal area. It is
somewhat relieved by elevation. On examination the nurse notices an enlarged, red
scrotum that is very tender to palpation. Distinguishing the epididymis from the testis is
difficult, and the scrotal skin is thick and edematous. This description is consistent with
which of these?
a. Varicocele
b. Epididymitis
c. Spermatocele
d. Testicular torsion
The nurse is performing a physical assessment on a newly admitted patient. An example
of objective information obtained during the physical assessment includes the:
a. Patient’s history of allergies.
b. Patient’s use of medications at home.
c. Last menstrual period 1 month ago.
d. 2 5 cm scar on the right lower forearm.
The nurse is incorporating a person’s spiritual values into the health history. Which of
these questions illustrates the “community” portion of the FICA (faith and belief,
importance and influence, community, and addressing or applying in care) questions?
a. “Do you believe in God?”
b. “Are you a part of any religious or spiritual congregation?”
c. “Do you consider yourself to be a religious or spiritual person?”
d. “How does your religious faith influence the way you think about your health?”
The primary purpose of the ciliated mucous membrane in the nose is to:
a. Warm the inhaled air.
b. Filter out dust and bacteria.
c. Filter coarse particles from inhaled air.
d. Facilitate the movement of air through the nares.
The nurse knows that testing kinesthesia is a test of a person’s:
a. Fine touch.
b. Position sense.
c. Motor coordination.
d. Perception of vibration.
A 32-year-old woman is at the clinic for “little white bumps in my mouth.” During the
assessment, the nurse notes that she has a 0.5 cm white, nontender papule under her
tongue and one on the mucosa of her right cheek. What would the nurse tell the patient?
a. “These spots indicate an infection such as strep throat.”
b. “These bumps could be indicative of a serious lesion, so I will refer you to a
specialist.”
c. “This condition is called leukoplakia and can be caused by chronic irritation such as
with smoking.”
d. “These bumps are Fordyce granules, which are sebaceous cysts and are not a serious
condition.”
The nurse has completed the musculoskeletal examination of a patient’s knee and has
found a positive bulge sign. The nurse interprets this finding to indicate:
a. Irregular bony margins.
b. Soft-tissue swelling in the joint.
c. Swelling from fluid in the epicondyle.
d. Swelling from fluid in the suprapatellar pouch.
A mother is concerned because her 18-month-old toddler has 12 teeth. She is wondering
if this is normal for a child of this age. The nurse’s best response would be:
a. “How many teeth did you have at this age?”
b. “All 20 deciduous teeth are expected to erupt by age 4 years.”
c. “This is a normal number of teeth for an 18 month old.”
d. “Normally, by age 2 years, 16 deciduous teeth are expected.”
When assessing the neurologic system of a hospitalized patient during morning rounds,
the nurse should include which of these during the assessment?
a. Blood pressure
b. Patient’s rating of pain on a scale of 1 to 10
c. Patient’s ability to communicate
d. Patient’s personal hygiene level
Which statement is true regarding the recording of data from the history and physical
examination?
a. Use long, descriptive sentences to document findings.
b. Record the data as soon as possible after the interview and physical examination.
c. If the information is not documented, then it can be assumed that it was done as a
standard of care.
d. The examiner should avoid taking any notes during the history and examination
because of the possibility of decreasing the rapport with the patient.
In assessing the tonsils of a 30 year old, the nurse notices that they are involuted,
granular in appearance, and appear to have deep crypts. What is correct response to
these findings?
a. Refer the patient to a throat specialist.
b. No response is needed; this appearance is normal for the tonsils.
c. Continue with the assessment, looking for any other abnormal findings.
d. Obtain a throat culture on the patient for possible streptococcal (strep) infection.
While examining a 75-year-old woman, the nurse notices that the skin over her right
breast is thickened and the hair follicles are exaggerated. This condition is known as:
a. Dimpling.
b. Retraction.
c. Peau d”orange.
d. Benign breast disease.
A mother brings her 2-month-old daughter in for an examination and says, “My
daughter rolled over against the wall, and now I have noticed that she has this spot that
is soft on the top of her head. Is something terribly wrong?” The nurse’s best response
would be:
a. “Perhaps that could be a result of your dietary intake during pregnancy.”
b. “Your baby may have craniosynostosis, a disease of the sutures of the brain.”
c. “That ‘soft spot” may be an indication of cretinism or congenital hypothyroidism.”
d. “That ‘soft spot” is normal, and actually allows for growth of the brain during the first
year of your baby’s life.”
The nurse is assessing a patient who is admitted with possible delirium. Which of these
are manifestations of delirium? Select all that apply.
a. Develops over a short period.
b. Person is experiencing apraxia.
c. Person is exhibiting memory impairment or deficits.
d. Occurs as a result of a medical condition, such as systemic infection.
e. Person is experiencing agnosia.
After completing an initial assessment of a patient, the nurse has charted that his
respirations are eupneic and his pulse is 58 beats per minute. These types of data would
be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
The primary muscles of respiration include the:
a. Diaphragm and intercostals.
b. Sternomastoids and scaleni.
c. Trapezii and rectus abdominis.
d. External obliques and pectoralis major.
The nurse has just recorded a positive iliopsoas test on a patient who has abdominal
pain. This test is used to confirm a(n):
a. Inflamed liver.
b. Perforated spleen.
c. Perforated appendix.
d. Enlarged gallbladder.
During reporting, the student nurse hears that a patient has hepatomegaly and
recognizes that this term refers to:
a. Enlarged liver.
b. Enlarged spleen.
c. Distended bowel.
d. Excessive diarrhea.
A woman in her second trimester of pregnancy complains of heartburn and indigestion.
When discussing this with the woman, the nurse considers which explanation for these
problems?
a. Tone and motility of the gastrointestinal tract increase during the second trimester.
b. Sluggish emptying of the gallbladder, resulting from the effects of progesterone,
often causes heartburn.
c. Lower blood pressure at this time decreases blood flow to the stomach and
gastrointestinal tract.
d. Enlarging uterus and altered esophageal sphincter tone predispose the woman to have
heartburn.
During an examination, the nurse notices a patterned injury on a patient’s back. Which
of these would cause such an injury?
a. Blunt force
b. Friction abrasion
c. Stabbing from a kitchen knife
d. Whipping from an extension cord
During an examination, the nurse asks the patient to perform the Valsalva maneuver and
notices that the patient has a moist, red, doughnut-shaped protrusion from the anus. The
nurse knows that this finding is consistent with a:
a. Rectal polyp.
b. Hemorrhoid.
c. Rectal fissure.
d. Rectal prolapse.
A 63-year-old Chinese-American man enters the hospital with complaints of chest pain,
shortness of breath, and palpitations. Which statement most accurately reflects the
nurse’s best course of action?
a. The nurse should focus on performing a full cardiac assessment.
b. The nurse should focus on psychosomatic complaints because the patient has just
learned that his wife has cancer.
c. This patient is not in any danger at present; therefore, the nurse should send him
home with instructions to contact his physician.
d. It is unclear what is happening with this patient; consequently, the nurse should
perform an assessment in both the physical and the psychosocial realms.
During a checkup, a 22-year-old woman tells the nurse that she uses an
over-the-counter nasal spray because of her allergies. She also states that it does not
work as well as it used to when she first started using it. The best response by the nurse
would be:
a. “You should never use over-the-counter nasal sprays because of the risk of
addiction.”
b. “You should try switching to another brand of medication to prevent this problem.”
c. “Continuing to use this spray is important to keep your allergies under control.”
d. “Using these nasal medications irritates the lining of the nose and may cause rebound
swelling.”
A 45-year-old farmer comes in for a skin evaluation and complains of hair loss on his
head. His hair seems to be breaking off in patches, and he notices some scaling on his
head. The nurse begins the examination suspecting:
a. Tinea capitis.
b. Folliculitis.
c. Toxic alopecia.
d. Seborrheic dermatitis.
While inspecting a patient’s breasts, the nurse finds that the left breast is slightly larger
than the right with the bilateral presence of Montgomery glands. The nurse should:
a. Palpate over the Montgomery glands, checking for drainage.
b. Consider these findings as normal, and proceed with the examination.
c. Ask extensive health history questions regarding the woman’s breast asymmetry.
d. Continue with the examination, and then refer the patient for further evaluation of the
Montgomery glands.
With which of these patients would it be most appropriate for the nurse to use games
during the assessment, such as having the patient “blow out” the light on the penlight?
a. Infant
b. Preschool child
c. School-age child
d. Adolescent
The mother of a 16-month-old toddler tells the nurse that her daughter has an earache.
What would be an appropriate response?
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.”