NUR 101 - Test 3 - Physical Assessment From Fundamentals Of Success

21 Questions | Total Attempts: 213

SettingsSettingsSettings
Please wait...
Study Guide Quizzes & Trivia

Questions from Fundamental of Success by Patricia Nugent and Barbara Vitale


Questions and Answers
  • 1. 
    Most indicative of shock?
    • A. 

      Hyperemia

    • B. 

      Hypotension

    • C. 

      Irregular pulse

    • D. 

      Slow Respiration

  • 2. 
    When the patient has an irregular pulse the nurse should first monitor the pulse
    • A. 

      At the carotid

    • B. 

      With a doppler

    • C. 

      For a full minute

    • D. 

      At two different sites

  • 3. 
    At what time of day could we have the highest temperature? 
    • A. 

      12-2 am

    • B. 

      6-8 am

    • C. 

      4-6 pm

    • D. 

      8-10 pm

  • 4. 
    When assessing for borborygmi (noise caused by movement of gas in the intestines), which physical examination method  should be used? 
    • A. 

      Auscultation

    • B. 

      Percussion

    • C. 

      Inspection

    • D. 

      Palpation

  • 5. 
    A patient has a temperature of 102 degrees F and complains of feeling cold. Which additional adaptation would the nurse expect during this onset stage of fever?
    • A. 

      Flushed skin

    • B. 

      Dehydration

    • C. 

      Diaphoresis

    • D. 

      Shivering

  • 6. 
    Method of examination to take a radial pulse
    • A. 

      Palpation

    • B. 

      Inspection

    • C. 

      Percussion

    • D. 

      Auscultation

  • 7. 
    Which nursing action is common to all instruments when taking a temperature?
    • A. 

      Identify that the reading is below 96 degrees F before insertion

    • B. 

      Wash with cool soap and water after use

    • C. 

      Place a disposable sheath over the probe

    • D. 

      Ensure that the instrument is clean

  • 8. 
    It would be most important to assess vital signs when a patient:...
    • A. 

      Sits on the side of the bed after surgery for the first time

    • B. 

      Finish ambulating in the hallway

    • C. 

      Is coughing and sneezing

    • D. 

      Complains of pressure in the chest

  • 9. 
    What is a defining characteristic associated with the nursing diagnosis of hyperthermia?
    • A. 

      Mental confusion

    • B. 

      Increased appetite

    • C. 

      Decreased heart rate

    • D. 

      Rectal temperature of 101 degrees Fahrenheit

  • 10. 
    Which assessment takes priority when engaging in an emergency assessment of a patient?
    • A. 

      Blood pressure

    • B. 

      Airway clearance

    • C. 

      Breathing Pattern

    • D. 

      Circulatory Status

  • 11. 
    What should the nurse do before obtaining a urine specimen from a patient with a urinary retention (Foley) catheter? 
    • A. 

      Cleanse the exit tube at the bottom of the drainage bag with an alcohol swab

    • B. 

      Clamp the tubing immediately distal to the collection port

    • C. 

      Position the patient in a semi-Fowler's position

    • D. 

      Wear a pair of clean gloves

  • 12. 
    Most important to document when taking a blood pressure. 
    • A. 

      Staff member who took the blood pressure

    • B. 

      Patient's tolerance to having the blood pressure taken

    • C. 

      Position of the patient if the patient is not in a sitting position

    • D. 

      Difference between the palpated and auscultated systolic readings

  • 13. 
    Which is a recommended cancer screening guideline for people?
    • A. 

      Prostate-specific antigens yearly lor men 30 years of age and older

    • B. 

      Mammograms annually for women 30 years of age and older

    • C. 

      Pap smears annually for females 13 years of age and older

    • D. 

      Sigmoidoscopies every 5 years for patients 50 years of age and older

  • 14. 
    Which would increase heat production?
    • A. 

      Vasodilation

    • B. 

      Evaporation

    • C. 

      Shivering

    • D. 

      Radiation

  • 15. 
    Which series of vital signs is most reflective of hypovolemic shock?
    • A. 

      P 100, R 24, BP 140/170

    • B. 

      P 80, R 22, BP 110/80

    • C. 

      P 60, R 20, BP 100/170

    • D. 

      P 110, R 26, BP 80/60

  • 16. 
    Which pulse site should not be assessed on both sides of the body at the same time?
    • A. 

      Radial

    • B. 

      Carotid

    • C. 

      Femoral

    • D. 

      Brachial

  • 17. 
    Who would most likely have the highest temperature?
    • A. 

      A newborn infant

    • B. 

      A person with a blood infection

    • C. 

      An adolescent who has been doing aerobic exercises

    • D. 

      All older adult who just spent 10 minutes in a warm shower

  • 18. 
    A recurrence of symptoms associated with a chronic disease
    • A. 

      Variance

    • B. 

      Remission

    • C. 

      Adaptation

    • D. 

      Exacerbation

  • 19. 
    A rectal temperature is used best for which of these patients?
    • A. 

      A mouth breather

    • B. 

      History of vomiting

    • C. 

      An adult with an IQ of a 7 year old

    • D. 

      Someone who cannot tolerate a semi-Fowler's position

  • 20. 
    When assessing for cyanosis in a dark-skinned person, the nurse should assess the:
    • A. 

      Sclera of the eyes

    • B. 

      Nail beds of the toes

    • C. 

      Lining of the eye lids

    • D. 

      Color of the lower legs

  • 21. 
    What action could result in a blood pressure error?
    • A. 

      Placing the diaphragm of the stethoscope over the brachial artery

    • B. 

      Applying the center of the bladder of the cuff directly over an artery

    • C. 

      Ensuring that the bladder of the cuff encircles less than 25% of the arm

    • D. 

      Inserting the ear pieces of the stethoscope so that they tilt slightly forwards

Back to Top Back to top