Chapter 28

Which components are included in the functional assessment? Select all that apply. Social assessment Injury assessment Physical examination Evaluation of activities of daily living Comprehensive history

Social assessment Social assessment is one of the components of a functional assessment. Physical examination Physical examination is one of the components of a functional assessment. Evaluation of activities of daily living Evaluation of activities of daily living is one of the components of a functional assessment. Comprehensive history A comprehensive history is one of the components of a functional assessment.

The assessment of financial resources and health insurance is included in which element of the functional examination? Social situation Review of systems Physical examination Activities of daily living

Social situation The assessment of financial resources and health insurance is included in the social situation element of the functional examination

Which elements should be performed after light palpation of all quadrants of the abdomen in the adult patient? Percussion of all quadrants Auscultation for bowel sounds Deep palpation of all quadrants Inspection of abdominal contour

Deep palpation of all quadrants Deep palpation is the element of the abdominal assessment that should be performed after light palpation of all quadrants; deep palpation should be done last because it is the maneuver most likely to cause discomfort or pain.

Which element of the assessment should be performed with the patient seated and wearing a gown? Percussion of the posterior chest Inspection of facial symmetry Auscultation of heart and lungs Palpation of axillary lymph nodes

Inspection of facial symmetry Inspection of facial symmetry should be performed after the patient has been assisted onto the examination table in the seated position.

Palpation of the thyroid and cervical lymph nodes is included in examination of which part of the body? Eyes Neck Mouth Pharynx

Neck Palpation of the thyroid and cervical lymph nodes is included in examination of the neck.

Observing the patient's gait and testing balance are included in which element of the adult head-to-toe examination with patient standing? Spinal Abdominal Neurologic Musculoskeletal

Neurologic Observing the patient's gait and testing balance are included in the neurologic element of the adult head-to-toe examination with the patient standing.

Which element of the assessment should be performed after assessment of the patient's back, posterior chest, and lungs? Weber test Palpation of apical pulse Palpation of posterior chest Inspection of spine and scapula

Palpation of apical pulse After assessment of the patient's back, posterior chest, and lungs has been performed, the nurse should move to the front of the patient to begin examining the left side of the chest, which includes palpating the apical pulse.

Which examination component should be performed while the adult patient is supine with the legs exposed? Palpation of breast tissue Palpation of popliteal pulse Palpation for inguinal hernia Palpation for aortic pulsation

Palpation of popliteal pulse Palpation of the popliteal pulse should be performed while the adult patient is supine with the legs exposed.

The healthcare provider palpates the prostate gland and seminal vesicles with the patient standing as part of which element of the examination? Spinal Rectal Neurologic Abdominal/Genital

Abdominal/Genital Palpating the prostate gland and seminal vesicles is included in the examination of the abdomen/genitalia with the patient standing.

Which element is included in the physical examination component of the functional assessment? Reviewing health insurance coverage Determining existence of advance directives Assessing the skin for signs of decubitus ulcers Asking the patient about activities of daily living

Assessing the skin for signs of decubitus ulcers Assessing the skin for signs of decubitus ulcers is an element of the functional assessment physical examination.

On which elements should the nurse focus when performing the physical examination component of the functional assessment? Select all that apply. Determining caregiver's abilities Evaluating coordination and gait Assessing for dyspnea with exertion Asking about use of a cane or walker Measuring blood pressure while the patient is seated and standing

Evaluating coordination and gait Evaluating coordination and gait is an element the nurse should focus on in the physical examination. Assessing for dyspnea with exertion Assessing for dyspnea with exertion is an element the nurse should focus on in the physical examination. Measuring blood pressure while the patient is seated and standing Measuring blood pressure while the patient is seated and standing is an element the nurse should focus on in the physical examination.

Which element of the examination is best performed while the adult patient is reclining at 45 degrees? Testing range of motion of feet, ankles, and knees Inspecting jugular venous distention and pulsation Performing bimanual palpation of uterus and cervix Observing the patient move from lying down to a seated position

Inspecting jugular venous distention and pulsation Inspecting jugular venous distention and pulsation is best performed while the adult patient is reclining at 45 degrees.

Which element of the examination would the nurse perform while the adult patient is in a standing position? Auscultating lungs Inspecting the spine Testing stereognosis Palpating the carotid pulse

Inspecting the spine Inspecting the spine should be performed while the adult patient is in a standing position.

Which elements are included in the review of systems for the functional assessment? Select all that apply. Nutritional status Memory changes Urinary incontinence Prior falls or fear of falling Identification of caregivers

Nutritional status Assessment of nutritional status is an element of the review of systems for the functional assessment. Memory changes Assessment of memory changes is an element of the review of systems for the functional assessment. Urinary incontinence Assessment of urinary incontinence is an element of the review of systems for the functional assessment. Prior falls or fear of falling Assessment of prior falls or fear of falling is an element of the review of systems for the functional assessment.

Which element is performed after inspection and palpation of the patient's spine while the patient is standing? Test abdominal reflexes Palpate axillary lymph nodes Assess radial and brachial pulses Observe the patient walk heel to toe

Observe the patient walk heel to toe Observing the patient walk heel to toe is the next element that should be performed after inspection and palpation of the patient's spine.

Which position should be used to inspect the back and auscultate the posterior lungs? Patient reclining at 45 degrees Patient supine with chest exposed Patient seated with back exposed Patient seated with chest exposed

Patient seated with back exposed Seated with back exposed is the position that should be used to inspect the back and auscultate the posterior lungs.

Which element of the functional assessment should be included during the review of systems? Blood pressure Ability to bathe Neurologic function Signs of dementia

Signs of dementia Assessing for signs of dementia is an element that should be included in the review of systems.

Which elements are included in the assessment of the hips of an adult patient? Select all that apply. Testing range of motion Palpating popliteal pulse Auscultating systematically Percussing for finger bone dullness Palpating for stability of joint

Testing range of motion Testing range of motion is an element included in the assessment of the hips of the adult patient. Palpating for stability of joint Palpating for joint stability is an element included in the assessment of the hips of the adult patient.

Which elements are included in the assessment of the mouth and pharynx? Palpating the thyroid Testing the gag reflex Inspecting the septum Assessing the carotid pulse

Testing the gag reflex Testing the gag reflex is an element included in the assessment of the mouth and pharynx.

Which assessment element of the adult head-to-toe examination is best performed with the patient standing? Palpating the abdomen Testing plantar reflexes Assessing jugular pulsation The Romberg test

The Romberg test The Romberg test is best performed while the patient is standing.