The nurse is preparing to complete a physical examination on a client. What should the nurse realize as being the
purpose for this examination?
Standard Text: Select all that apply.
1. Obtain baseline data.
2. Obtain data to help determine nursing diagnoses.
3. Identify areas for disease prevention.
4. Identify the client’s employment status.
5. Obtain data about the client’s leisure activities.
Question 18
Type: MCMA
A client has been receiving a new medication to address specific symptoms. The nurse will perform a physical
examination to determine
Standard Text: Select all that apply.
1. the progress of the client’s health problem.
2. the physiological impact of the prescribed medication.
3. baseline data.
4. data to support nursing diagnoses.
5. areas for health promotion.
Question 19
Type: MCMA
The nurse is utilizing the technique of inspection during a physical examination with a client. When using this
technique, the nurse will take which actions?
Standard Text: Select all that apply.
1. Visually observe a body area.
2. Obtain information through the sense of smell.
3. Obtain information through the sense of hearing.
4. Examine the body through the use of touch.
5. Strike the body to elicit a sound from a body part.
Question 20
Type: MCMA
The nurse is planning to perform indirect percussion on an area of a client’s body during a physical examination.
Which actions should the nurse take to use this assessment technique?
Standard Text: Select all that apply.
1. Place the middle finger of the nondominant hand on the client’s skin.
2. Use the tip of the flexed middle finger of the other hand to strike the middle finger of the nondominant hand.
3. Perform a striking motion by moving the wrist.
4. Perform short, rapid, firm blows.
5. Use a stethoscope to transmit sounds to the ears.
Question 21
Type: MCMA
The nurse is assessing the nose and sinuses of a client. Which findings should the nurse identify as being within
normal limits?
Standard Text: Select all that apply.
1. Nose straight
2. Nares symmetrical
3. No tenderness over the bridge
4. Air movement restricted in one nare
5. Clear drainage from one nare
Question 22
Type: MCSA
The nurse is planning a physical examination of a client following a head-to-toe format. In which order should the
nurse conduct this assessment?
1. Head, upper extremities, abdomen, lower extremities
2. Neck, head, vital signs, chest and back
3. Lower extremities, abdomen, upper extremities, chest and back
4. Head, neck, lower extremities, abdomen
Question 23
Type: MCSA
The nurse is assessing the peripheral vascular status of an older client. Which finding should the nurse consider as
being normal for this client?
1. Easy to palpate upper extremity arteries
2. Easy to palpate lower extremity arteries
3. Reduction in the number of varicosities
4. Increase in diastolic blood pressure
Question 24
Type: MCMA
The nurse is preparing to perform an eye assessment. What equipment should the nurse have available to
complete this assessment?
Standard Text: Select all that apply.
1. Penlight
2. Snellen’s chart
3. Sterile gloves
4. Gauze square
5. Millimeter ruler
Question 25
Type: MCMA
The nurse is preparing to conduct an assessment of the heart. Where should the nurse place the stethoscope to
auscultate heart sounds?
Standard Text: Select all that apply.
1. Aortic region
2. Pulmonic region
3. Tricuspid valve region
4. Abdomen
5. Mitral valve region
Question 26
Type: MCMA
The nurse is preparing to assess a client with the Glasgow Coma Scale. Which areas is the nurse assessing in this
patient?
Standard Text: Select all that apply.
1. Eye response
2. Motor response
3. Verbal response
4. Orientation
5. Musculoskeletal response
Question 27
Type: MCMA
A client is experiencing abdominal pain. What assessments should the nurse perform to assess this complaint?
Standard Text: Select all that apply.
1. Inspect the abdomen.
2. Auscultate the abdomen.
3. Palpate the abdomen.
4. Assess vital signs.
5. Assess peripheral pulses.
Question 28
Type: MCMA
The nurse is assessing the musculoskeletal status of a 4-year-old child. What findings should the nurse consider as
being expected in this client?
Standard Text: Select all that apply.
1. Lordosis
2. Genu valgus
3. Genu varum
4. Pronation of the feet
5. Asymmetric leg abduction
Question 29
Type: MCMA
The nurse is concerned that an older client has nutritional deficiencies. What did the nurse find when assessing
this client’s nails to make this clinical decision?
Standard Text: Select all that apply.
1. White spots
2. Curved nails
3. Deep purple areas
4. Spoon-shaped nails
5. Bands across the nails
