Health Assessment: Collecting Subjective Data

A client with scabies visits the health care facility for a follow-up appointment. Which preparation by the nurse is of greatest priority for the physical examination of this client? A. Warm, comfortable room B. Quiet area free of disturbance C. Adequate lighting D. Firm examination bed or table

C. Adequate lighting

The nurse is caring for a client exhibiting slurred speech after suffering from a cerebrovascular accident. The nurse is unable to completely understand the client. What is the nurse's best action? A. Turn the television on for distraction. B. Refer all questions to the client's family member in room. C. Ask the client to repeat the statement or question. D. Change the subject to put the client at ease.

C. Ask the client to repeat the statement or question.

A nurse is preparing to perform a physical examination on a young man who appears anxious about the procedure. Which of the following should the nurse do to ease this client's anxiety? A. Perform the genital assessment first to get it over with. B. Have him undress and put on an examination gown. C. Before performing each procedure, explain what it involves and its purpose. D. Have him urinate before the examination.

C. Before performing each procedure, explain what it involves and its purpose.

A nurse is beginning the physical examination of an elderly man with chronic obstructive pulmonary disease. In which order should the nurse implement the four physical assessment techniques with this client? A. Auscultation, percussion, palpation, inspection B. Palpation, inspection, auscultation, percussion C. Inspection, palpation, percussion, auscultation D. Percussion, palpation, inspection, auscultation

C. Inspection, palpation, percussion, auscultation

A nurse is performing percussion on a client's back to assess the lungs, and hears a loud, low-pitched, hollow sound, indicating normal lungs. Which of the following describes this finding? A. Dullness B. Hyper-resonance C. Resonance D. Tympany

C. Resonance

The nurse is beginning a health history interview with an adult client who expresses anger at the nurse. The best approach for dealing with an angry client is for the nurse to __________. A. provide structure during the interview. B. refer the client to a different health care provider. C. allow the client to verbalize his or her feelings. D. offer reasons why the client should not feel angry.

C. allow the client to verbalize his or her feelings.

During an interview with an adult client, the nurse can keep the interview from going off course by __________. A. using open-ended questions. B. rephrasing the client's statements. C. using closed-ended questions. D. inferring information.

C. using closed-ended questions.

A nurse is palpating a child's forehead for signs of fever. Which part of the hand should the nurse use? A. Ulnar surface B. Palmar surface C. Finger pads D. Dorsal surface

D. Dorsal surface

A client is unable to recall the last time an immunization was received. Which part of the client's health should the nurse realize is being the most impacted by this practice? A. compliance with treatment B. screening test completion C. risk factors D. health maintenance

D. health maintenance

What is included in personal protective equipment? Select all that apply. A. Mouth, nose, eye protection B. Special linen C. Gown D. Cleaning processes E. Gloves

A. Mouth, nose, eye protection, C. Gown, E. Gloves

Which illustrates the nurse using the technique of inspection? A. The nurse detects a fruity odor of the client's breath. B. The nurse notes increased warmth surrounding the client's incision. C. The nurse detects tympany over the client's lower abdomen. D. The nurse notes a rhythmic lub-dub over the client's anterior thorax.

A. The nurse detects a fruity odor of the client's breath.

The nurse is performing a shift assessment on a client who just received a central line. Which finding should the nurse report as a complication of central line placement? A. Temperature of 97.6 degrees Fahrenheit B. Decreased breath sounds unilaterally C. Elevated blood pressure while lying in bed D. Respiratory rate of 20 breaths per minute

B. Decreased breath sounds unilaterally

A nurse will be performing a complete physical examination of a man who has emphysema with a chronic productive cough, including an assessment of his oral cavity. Which pieces of personal protective equipment should the nurse wear? A. Gloves, gown B. Gloves, mask, protective eye goggles, gown C. Mask, protective eye goggles D. Mask, protective eye goggles, gown

B. Gloves, mask, protective eye goggles, gown

A nurse needs to obtain a pulse on a client. Which physical assessment technique should the nurse use? A. Deep palpation B. Light palpation C. Moderate palpation D. Bimanual palpation

B. Light palpation

During the interview process, the nurse uses both open-ended and closed-ended questions. During what phase of the interview process does the nurse use these specific types of questions? A. Pre-interaction B. Working C. Beginning D. Closing

B. Working