HA
A nurse is taking a health history on a client with musculoskeletal dysfunction what should the nurse prioritize during the phase of the assessment
Evaluating the effects of muscular skeletal disorders on the clients function
SLUMS test
20-27 high school
In delivering a presentation on osteoporosis to a high school gym class the nurse should include the fact that
A moderate strenuous
The T&j located
Pre athrio by ear by treach
Patient pubic hair disperse near scrotum
Older adult expected findings
Muscle strength elevation in a client with rheumatoid arthritis reveals a great 04 place this finding indicates
Some resistance
Seven-year-old patient enlarge breasts
Tell him to have a consult with a physician
The nurse is assessing the genitalia of a older male client what were the nurse document
Testes hanging in the scrotum
A mother visit the clinic for a routine visit with her 11-year-old daughter the mother tells the nurse that her daughter has just started puberty the mother asked her nurse when she can expect her daughter to begin ministration the nurse should explain to the mother demonstration usually begins
2.5 years
When evaluating a clients risk for cebrovascular accident Which client with the nurse identify as being at the highest risk
68 year old African American with hypertension
The nurse asked the client to explain the saying people in glass houses should not throw stones which of the following was a nurse assessing
Abstract reasoning
A nurse is performing a nursing assessment of a client suspected of having a musculoskeletal disorder which should a nurse prioritize the assessment of the client who has a muscular skeletal disorder
Activities of daily living
The nurse came for eight-year-old client knows the client has pre-existing history of filled tactile sensations The nurse should first consider what possible causes of the clients diminish tactile sensation
Age related neurological changes
The nurse is assessing a client using glassgow scale and obtained a score of 14 the nurse interpreted as indicating
Alert and oriented
An 88 year old woman has been admitted to the acute medical unit for the treatment of urinary tract infection that is thought to be progressing to uroseosis When assessing the clients orientation how should the nurse best gauge the clients orientation of time
Are you able to tell me today's date
ED (erectile dysfunction)
Ask patient with medication they are taking
A client has presented to the emergency department with a lower leg laceration that she suffered in a motor vehicle accident the nurse recognizes that the screen for alcohol use and will implement the CAGE questionnaire which question with the nurse asked during the assessment
Cut, annoyed, guilty, eye opener
The nurse is performing a neurological assessment of a client whose injuries have rendered her ability to follow verbal commands how should the nurse proceed with assessing the clients level of consciousness
Assessing the client eye-opening and response to stimuli
While inspecting the vagina the nurse observes a thin grayish white vaginal discharge with a fishy odor which with the nurse suspects
Bacterial vaginosis
The nurse is caring for a client who responds within appropriate words the nurse understands which area of the brain integrate the understanding of spoken and written words
Broca's area
The nurse is assessing a client for dietary factors that may influence her race for osteoporosis Inertia? Lei about her intake what nutrients
Calcium and vitamin D
While bathing a client the nurse observes a thick white cheesy discharge what with the nurse suspects
Candidiasis
Foot range of motion
Cerebellar function
A nurse notices a client is unable to jump rope in order to jump rope the shoulder must be capable of which skeletal muscle movement
Circumduction
While inspecting the penis of a client the nurse suspects herpes progenitalis based on which assessment finding
Clear vesicles that erupt
When explaining how A nurse test graphesthesia Which of the following with the nurse include
Client will close the eyes and identify what number the nurse right in the palm of the clients hand with a blunt ended object
Assessment of a client who suffered a recent stroke revealed that he is unresponsive to all stimuli in his eyes remain close the nurse document to the clients level of consciousness as which of the following
Coma
A client has sustained an injury to the brain stem which area would be the primary area for the assessment
Coordination
During the health history of client reports a decrease in his ability to see during the physical assessment the nurse will make sure to Assess which cranial nerve
Cranial nerve 1
The nurse asked the client to move his job Ford in sideways against resistance and to open his mouth against resistance this test the integrity of
Cranial nerve 5
What cranial nerve is the nurse assessing
Cranial nerve 7
When assessing an adult clients range of motion the client is not able to shrugged her shoulders against resistance the nurse was suspect a lesion of the cranial nerve
Cranial nerve XI
During the Nursing Musculoskeletal assessment The nurse assessed the joint movements on the nurse instructions a patient flakes the ankles in the toes toward the shin
Dorsiflexion
The nurse is assessing the sexual reproductive functional health pattern of a 32 year old woman which question is most effective in determining the client sexual orientation in related risk factors
Do you have sex with men women or both
When reviewing a clients chart the nurse notes a diagnosis of pes planus the nurse would anticipate the client has
Flat feet
Nurse notes in order for a client to be able to move her hand to her mouth she must be able to perform which movement
Flexion
During a mental health assessment, how can the nurse obtain subjective data? Select all that apply.(Select all that apply.)
From an overhead conversation the client has with somebody else from the clients family and from the client
The wife of a 65 year old man tells the nurse that she is concerned because she has noted the change in her husband's personality and the ability to understand he also cries and becomes angry easy the nurse recalls that the cerebral lobe is responsible for these behaviors in which of the following
Frontal
Client reports having knock knees the nurse document the medical term for this is
Genus valgum
mild weakness
Grade 3
Is a class project a group of student nurses are developing a care plan for patient being screamed for cervical cancer when teaching patients about the risk factors of cervical cancer which would the nurse identify as the most important risk factor
HPV
While completing a neurological examination on the client the nurse assess the cranial nerve V111 The nurse will be correct and identifying the function of this nervous what
Hearing an equilibrium
Modifiable factors of breast cancer
History of childbirth, hormone therapy, obesity, physical activity
The nurse suspects the patient has carpal tunnel syndrome and asked the patient to perform the Phalens test to perform this test the patient would
Hold both hands back to back while flexing the wrist 90° for 60 seconds
The nurse is collecting subjective data from an 11 year old girl after some initial signs she finallyI I don't seem to need a bra yet and all of my friends do what if I never get breast
I understand it is hard to feel different from your friends birds usually develop between age 8 and 10
The nurse is describing how to perform a testicular self examination for a patient which of the following statements is most appropriate
If you notice a enlarged testicle or painless lump call the health provider
The client records state A client has heberden and brochure nodes The nurse understands that these are
Interphalangeal joints
A group of students is preparing for a quiz on breast cancer and coming finding associated with breast cancer examination the students demonstrate the understanding of material when they identify which of the following
Irregular firm and hard lumps Dimpling in Nipples retraction Orange peel like appearance
The nurse explained to a woman who is eight months pregnant that her posture shift to compensate for the large fetus is called
Lordosis
Pregnant women
Lower dosage
A 25 year old male presents to a clinic with complaints of pain in the right knee and locking of the joints he states he fell and bumped his knee the day before the nurse suspects a torn meniscus and performed which of the following test
McMurry's test
A group of students is review a material about assessing mental status the students demonstrate an understanding of the material when they identify which of the following is a cognitive ability to be assessed
Memory ,thought processes ,orientation
A client is brought to the emergency department following a motor vehicle accident in which he is staying here trauma assessment reveals a vision deficit in the clients left eye the nurse associate this finding with trauma in which cerebral lobe
Occipital
A 85 year old client comments during his annual physical that he seems to be getting shorter as he ages the nurse explains that decrease height occurs with aging because
Of the shortening of the vertebrae column
Patient's foot fans out
Positive and unexpected findings
The nurse observing a clients gait would observe for which of the following
Posture base of support arm swing ability to bear weight
50 year old patient
Prostate exam
A teenage boys embarrassed by his tinder and in large breast what was the most appropriate nursing intervention to help the teen Manage his problem
Reassuring the team that this is both expected and temporary
A nurse planning the neurological assessment of an aging adult which are age related changes the nurse should be aware of
Reduction in cerebral blood flow
In assessing a client for a range of motion of the spine the nurse would observe for flexion hyper extension lateral bending and
Rotation
A group of students is reviewing information about the male genitalia in preparation for tears the student demonstrates understanding of the material when they identify which of the following
Scrotum
An aging client is being discharged home the client lives alone and has the atrophy of his olfactory organs The nurse tells the clients family that it was essential that the client has were installed in the home
Smoke detector
In adult client has asked the nurse about actions that she can take to reduce her future risk of stroke which health promotion activity should the nurse prioritize
Smoking cessation
The nurse will document the diagram as which gait
Spastic hemiparesis
The nurse is performing the Romberg's test as a part of the clients focus neurological assessment which finding would constitute a positive Romberg test
The client moves her feet apart to prevent herself from falling
The nurse is providing care it's an older adult female who remarks that she Just can't believe that her breast SAG so much she states it must be from a lack of exercise which exclamation should you all offer her
The glandular and fat tissue atrophies causing breast size and elasticity to diminish resulting in breast sag
A woman has accompanied her 80-year-old husband to scheduled clinic visit and expresses concerns about suitable declines in his congnition which principles would guide the nurses assessment of the clients mental status
The nurse must differentiate between age related changes in signs and symptoms of dementia
A 72-year-old man has been brought to his primary care by his daughter who claims he has been experiencing uncharacterize lapses in memory what principle should the nurse consider in the assessment of this client
Though assessment is necessary with changes in congnition
A nurse instructor is teaching a group of students about assessing a client orientation the instructor determines that teaching was success when a student states that the ability to identify which of the following is usually last the first
Time
A client who has rheumatoid arthritis for many years finds her fingers are drifting to the side
Ulnar deviation
Nonpregnant patient cervix blue
Unexpected finding
The nurse knows that the majority of breast cancer is located in which breasts quadrant
Upper outer quadrant
The nurse is taking the sexual history of an analysis who came into a free clinic what questions best assess the clients need for further information
What questions or concerns you have about sexual health
And performing a range of motion with the client the nurse put each joint through it's for movement which joints is capable of abduction and adduction
Wrist hip thumb
Clay colored stools may indicate
biliary obstruction liver
