HA EXAM 6 EAQS

Which instruction would the nurse give to a patient while performing the Romberg test?

"Stand with feet together and eyes open then closed."

The parent of a 12-year-old child asks why the human papillomavirus (HPV) vaccine is given to a child who is not sexually active. What is the nurse's best response?

"This gives time for immunity to develop before a child becomes sexually active."

Which statement, if made by the nurse while instructing the patient about testicular self-examination, is appropriate?

"You should perform self-examination monthly."

At what age does a child develop voluntary control over the external anal sphincter?

18 months

Which assessment finding indicates a normal cervix?

2 to 3 cm in diameter

During testing of two-point discrimination in a patient's fingertips, what distance to distinguish between the two points would be normal?

2 to 8 mm

While assessing the deep tendon reflexes in a patient, the nurse finds that the responses are very brisk and hyperactive, with clonus. Which grade should the nurse enter in the patient's medical record?

4+

When would the nurse first observe the softening of the uterus in a pregnant patient who has missed her first menstrual period?

6 to 8 weeks

Which patient is at highest risk for developing prostate cancer?

A 68-year-old African American patient who has a brother with prostate cancer

A male patient expresses discomfort with a female nurse performing a genitalia examination. What action should the nurse take?

Arrange to have a male nurse perform the physical assessment.

The nurse is caring for a patient who is taking iron supplements. Which finding should the nurse expect in the patient?

Black, nontarry stool

The nurse is assessing an elderly female patient who has diabetes mellitus. The patient reports to the nurse that she has night sweats, vaginal dryness, itching, and numbness. What should the nurse infer from these findings?

The patient is at increased risk of vaginitis.

While assessing a patient, the nurse finds that the patient has a body temperature of 102.2° F (39° C), suprapubic pain, and purulent discharge from the cervix. The nurse finds it difficult to palpate the bilateral adnexal masses, because the patient complains of having severe pain during the palpation. What should the nurse infer from these findings?

The patient may have acute salpingitis.

A patient reports frequent urination, pain, and burning during urination. The nurse finds an elevated prostate-specific antigen (PSA) level in the patient's laboratory reports. While palpating the prostate, the nurse finds a hard, fixed nodule on the posterior surface of the prostate gland. What complication should the nurse suspect in the patient?

The patient may have prostate cancer.

To what does "version" refer in the female genitourinary system?

The position of the uterus in a female body

During a physical assessment, which finding would be considered abnormal?

The prostate is tender to palpation with the central groove obliterated.

Which assessment finding in a patient would indicate a third-degree uterine prolapse?

The whole uterus is outside the introitus.

Which developmental change should the nurse expect to find in a 9-year-old female child?

Thickened mons pubis

While examining the feces of a patient, the nurse notices that the feces are soft and brown in color. What does the nurse infer from this finding?

This is a normal assessment finding.

While assessing a patient, the nurse finds that the patient has difficulty swallowing and some ingested fluids are regurgitated through the nose. What does the nurse infer about the patient's neurologic condition from these findings?

The patient has bilateral lesions on cranial nerve X.

A female patient reports to the nurse of having pain during her menstrual period and a feeling of being bloated. On further assessment, the nurse also finds that the patient has breast tenderness. What should the nurse conclude from these findings?

The patient has dysmenorrhea.

What does the nurse instruct the patient to do during the speculum examination?

"Bear down so that the perineal muscles can relax."

The nurse assesses the prostate gland of an adult patient and documents the findings. What should the nurse infer from these findings?

The patient has normal development.

The nurse teaches a student nurse about obtaining a female patient's reproductive health history. Which statement, if made by the student nurse, indicates effective learning?

"It should include the pattern of menstruation and sexual satisfaction."

A female patient reports to the nurse about having pelvic and abdominal pain. On reviewing the diagnostic reports, the nurse finds that the patient has a heavy, solid, fixed, and poorly defined mass on the ovary. What does the nurse infer from these findings?

The patient has ovarian cancer.

A patient with diabetes mellitus has perianal itching and red, raised, thickened, excoriated skin around the anus. The patient's anus is swollen, moist, and dull grayish-pink in color. The microscopic tape test report indicates the presence of translucent eggs. What do these findings indicate?

The patient has pruritus ani.

While doing an assessment of the external genitalia, the nurse finds that the patient has a posteriorly swollen labia, tenderness, and a palpable mass on the labia. Which condition should the nurse expect to find in the patient?

Abscess on the Bartholin gland

While examining a female child, the nurse finds an enlarged clitoris and a fused labia. Which condition should the nurse document in the child's examination report based on these findings?

Ambiguous genitalia

The nurse is assessing a patient who has a sensory cortex lesion. The nurse instructs the patient to close the eyes and places a key in the patient's hand. The nurse finds that the patient is unable to identify the object by touch. Which clinical sign does the patient's response indicate?

Astereognosis

A patient complains of vaginal pruritus and burning. The nurse notes a fishy smell and watery gray drainage. What does this finding indicate?

Bacterial vaginosis

When do the testes enlarge and pubic hair appears in males?

Between 12 and 16 years of age

How would an adult patient normally respond to the plantar reflex?

By flexing the toes

Where is the erectile tissue located in males?

Corpora cavernosa

While assessing neurologic function, the nurse touches a cotton wisp on the patient's forehead, cheeks, and chin. Which cranial nerve is the nurse testing?

Cranial nerve V

While assessing a patient with lower motor neuron lesion, the nurse sees that the patient has an asymmetric smile and is unable to wrinkle the forehead. Damage to which cranial nerve could cause these findings?

Cranial nerve VII (facial nerve)

Which structure controls the size of the scrotum?

Cremaster muscle

While examining a patient who has stress incontinence, the nurse observes that the patient's bladder is prolapsed into the vagina. Which condition does this finding suggest?

Cystocele

Which areas of consciousness would a nurse rate while assessing a patient with the Glasgow Coma Scale? Select all that apply.

Eye opening verbal response motor response

What should the patient's response be when the nurse tests the cremasteric reflex?

Elevation of the scrotum

The nurse is assessing an older adult patient who has tremors. During the interview, the nurse observes the patient's tremors worsening due to emotional stress. Which medication would be beneficial for the patient?

Diazepam (Valium)

Which is the most common sign in patients having acute cystitis, prostatitis, and urethritis?

Dysuria

While examining a patient's penis, the nurse finds that the patient has a narrow, red, and edematous urethral meatus with purulent discharge. What does the nurse infer from these findings?

The patient has urethritis.

While examining the external genitalia of a patient, the nurse notices pink-colored, soft, pointed papules around the anus and vulva. Which abnormality would the nurse document in the patient's examination report?

Genital warts

Which medication does the primary health care provider prescribe to a patient who is at risk of developing an HPV-related cervical cancer?

HPV4 (Gardasil)

Which characteristic feature does the nurse observe in a patient with a pilonidal cyst?

Hair containing cysts over the coccyx

A patient who had a stroke is experiencing a severe throbbing headache, vomiting, and focal seizures. After reviewing the medical reports of the patient, the nurse confirms that the patient had a hemorrhagic stroke. Which condition could have caused the stroke?

Hemophilia

Which symptoms should the nurse expect to find in a menopausal patient? Select all that apply.

Hot flashes Night sweats Mood swings

While assessing a female adolescent patient, the nurse finds that the patient's hymen is bluish in color and bulging. The patient reports to the nurse that she has not started her menses. For which condition should the nurse screen in this patient?

Imperforate hymen

How would a patient respond normally to the brachioradialis reflex test?

The patient is able to flex and supinate the forearm.

A patient reports intense itching around the perineum. While assessing, the nurse sees dull grayish pink, thickened excoriated skin around the anus. Which treatment strategy would be most beneficial for the patient?

Instruct the patient to use topical steroid cream.

Before assessment, the health care provider instructs the nurse to perform a careful examination of the inguinal area of a 6-month-old child. What is the most likely reason for this instruction?

It is a potential site for a hernia.

Which statement best describes the clitoris?

It is composed of erectile tissue.

Which finding does the nurse consider abnormal when inspecting the patient's cervix and its opening?

Lateral position of the cervix

Which position would be suitable to assess the rectal area and genitalia in a female patient?

Lithotomy

The nurse is doing a vaginal examination in a patient with menorrhagia. In which position should the patient be placed to best assess the vagina?

Lithotomy position

When doing a genital assessment of a patient who has a genital infection, the nurse finds small, round, solitary, and silvery papules with yellowish serous discharge. Upon palpation, the nurse notes nontender, button-like structures, and enlarged lymph nodes. Which condition should the nurse expect in the patient?

Syphilitic chancre

Which signs would the nurse observe in a patient with Alzheimer disease? Select all that apply.

Mood swings Disorientation Loss of initiative

Which statement precisely describes the efferent fibers?

Motor neurons carrying impulses to the muscles, organs, and glands

The nurse finds that a patient has crossed knees, fatigue, nystagmus, and diplopia. During the assessment, the nurse also observes that the patient is unable to maintain balance with the eyes closed. Which complication is present in the patient?

Multiple sclerosis

While assessing a patient with myasthenia gravis, the nurse sees that the patient has drooping upper eyelids. Damage to which cranial nerve could cause this finding?

Oculomotor

While doing a genital examination, the nurse finds that a part of the rectum is covered by the vaginal mucosa and is prolapsed into the vagina. What should the nurse infer from this finding?

The patient has a rectocele.

What is the shape of the uterus of a patient who is 24 weeks pregnant?

Oval

On reviewing a patient's laboratory results, the nurse finds that the patient has chlamydia. What potential complication should the nurse explain to the patient to ensure treatment compliance?

Pelvic inflammatory disease

While examining a patient's genitals, the nurse finds that the patient has a swollen, shiny, blue mass below the anorectal junction. What does the nurse conclude from these findings?

The patient has a thrombosed hemorrhoid.

While palpating the anus of a patient, the nurse notes increased muscle tone. What should the nurse infer from this finding?

The patient has anxiety.

Where is the urethral meatus located?

Posterior to the clitoris

A patient reports an involuntary, sustained, painful erection that is not associated with sexual arousal. Which condition does the patient have?

Priapism

Which finding does the nurse expect to see in the patient with a rectal prolapse?

Rounded tissue located near the anus

What is the function of the fibers present in the posterior column?

Sensations of position and vibration

The nurse asks the patient to close the eyes and then traces the number 5 on the patient's palm. The patient is unable to identify the number even after repeated attempts. This finding could indicate damage to what part of the patient's brain?

Sensory cortex

The nurse is examining the genitourinary system of a female patient. Which procedures should the nurse include when doing a vaginal examination? Select all that apply.

Situate the patient in the lithotomy position. Put an examination glove on each of the stirrups. Elevate the end of the exam table near the head.

Which change may occur during sexual maturation in females?

Spread of pubic hair onto inner aspects of upper thighs

The nurse asks the patient to close the eyes and then places a paper clip on the patient's palm. The patient is asked to recognize the object. Which test is the nurse performing?

Stereognosis

The nurse flashes light into the eyes of a 5-year-old child and observes ocular misalignment and a deviated gaze. What condition does the nurse expect to find in the child?

Strabismus

A 20-year-old white male has a history of undescended testes. Which condition is this patient at high risk of developing?

Testicular cancer

Which is an abnormal assessment finding in a female patient?

The cervix and uterus are fixed and tender on internal palpation.

The nurse pinches the nose of an infant to assess the functioning of cranial nerve XII (hypoglossal). Which response of the infant indicates a normally functioning cranial nerve XII?

The infant opens the mouth and raises the tongue.

The nurse is preparing to palpate the anus and rectum of a patient during an examination. In which direction should the nurse insert the finger into the anus?

Toward the umbilicus

A patient tells the nurse, "I am experiencing severe pain in the lower abdomen for the past 3 months during menses." Which test should the nurse advise the patient to undergo?

Transvaginal ultrasound imaging

A female patient complains of watery, bubbly, malodorous, yellowish green discharge. Which condition does the nurse suspect in the patient?

Trichomoniasis

A patient reports black, tarry stools with a distinct malodor. For which complication does the nurse screen in this patient?

Upper gastrointestinal bleeding

The nurse instructs a student nurse to palpate the rectum of an infant to evaluate for hemorrhoids. Which action done by the student nurse needs correction?

Using the middle finger for rectal palpation

What does the nurse use to lubricate the speculum to obtain a Pap smear?

Warm water

Which disease is best detected using a Pap smear?

cervical cancer

Which structure is highly sensitive to tactile stimulation?

clitoris

Which position would the nurse consider best to examine the genitalia of a toddler?

frog-legged

Which assessment technique reveals the presence of a nontender nodule during the physical assessment of a patient with a syphilitic chancre?

palpation

Which condition is caused by mutations in the BRCA2 gene?

prostate cancer

What is the major function of the glossopharyngeal nerve?

swallowing & gagging

Which lobe of the brain is associated with language comprehension?

temporal lobe