Exam Review
- Which adventitious lung sound is characterized by high-pitched musical squeaking sounds that are predominate in expiration, but may occur in both inspiration and expiration?A)StridorB)Atalectic cracklesC)Wheeze- high pitchedD)Crackles- course
- The nurse is assessing a patient who had a stroke and notes the right upper eyelid is drooping and the palpebral fissure of this eye is narrower than the left eye. What is the term for this finding?A)AnisocoriaB)PtosisC)StrabismusD)Stye
- During an examination, the patient states hearing a buzzing sound and says it is "driving me crazy!" What does this symptom indicate?A)VertigoB)PruritisC)CholesteatomaD)Tinnitus
- A home health care nurse is visiting an 80-year-old patient currently taking antihypertensives and antidepressants. The nurse notes the patient has xerostomia based upon what subjective information?A)"I am having a hard time cleaning my dentures at night."B)"I need to add more salt to my food than I used to."C)"I am eating hard candy because I have a dry mouth."D)"I can't eat as many raw vegetables as I would like."
Exam Review
- Which is considered a normal (expected) breath sound?A)RhonchiB)VesicularC)WheezesD)Crackles
- During inspection, what would a nurse expect to observe about a patient's tonsils if they are graded as 3+?A)Tonsils are (barely) visible.B)Tonsils are halfway between the tonsillar pillars and uvula.C)Tonsils are touching each other.D)Tonsils are touching the uvula.
- A nurse is teaching a Health Promotion class at a local Senior Center. The nurse shares that typical changes of the ear related to the aging adult include which of the following options? (Select all that apply)(SATA)A)Increased moisture of cerumenB)PresbyopiaC)PresbycusisD)A high-tone frequency lossE)Increased elasticity of the pinna
- Which options are expected assessment findings over the healthy adult lungs? (Select all that apply):(SATA)A)Symmetrical chest expansionB)CrepitusC)Increased tactile fremitusD)Adventitious soundsE)Resonant percussion tones
Exam Review
- The nurse is performing the diagnostic positions test. Which result is a normal finding?A)Parallel movement of both eyesB)Slight amount of lid lag when moving the eyesC)Nystagmus in downward gazeD)Convergence of the eyes
- A 92-year-old patient has had a stroke. The right side of the patient's face is drooping. What other assessment finding might the nurse suspect?A)EpistaxisB)XerostomiaC)DysphagiaD)Rhinorrhea
- A patient reports frontal face pain, chronic runny nose, and headaches. The patient has a history of sinusitis. In assessing this patient, what two sinuses should be palpated for tenderness?A)Maxillary and frontalB)Ethmoid and sphenoidC)Frontal and sphenoidD)Maxillary and ethmoid
- Which assessment variations in the thorax and lungs of the older adult may be present? (Select all that apply)(SATA)A)Changes associated with kyphosisB)Increased elasticity/mobilityC)Increased vital capacityD)Increased dyspnea on exertionE)Decreased risk of lung infection
Exam Review
- While doing an abdominal assessment, a patient reports sudden-onset of severe midline pain. With light palpation of the abdomen the nurse detects an enlarged pulsation in the midline approximately 7 cm in width. What does the nurse suspect this may be?A)A ruptured appendixB)An aortic aneurysmC)Pulsatile flatusD)A distended bladder
- In performing a voice test to assess hearing, which action would the nurse perform?A)Shield the lips so that the sound is muffled.B)Whisper a set of random numbers and letters, and then ask the patient to repeat them.C)Stand approximately 4 feet away to ensure that the patient can really hear at this distance.D)Ask the patient to place a finger in his/her ear to occlude outside noise.
- How should the normal (expected) location of the trachea be described?A)MidlineB)AnteriorC)SubmentalD)Lateral
- When assessing a patient's lungs, what would the nurse recall about the left lung?A)is divided by the horizontal fissureB)Is shorter than the right lung because of the underlying stomachC)Consists of two lobesD)Primarily consists of an upper lobe on the posterior chest
Exam Review
- What are typical changes in the vision of the aging adult?A)PresbycusisB)Increased extraocular muscle functionC)Decreased night visionD)Increased near vision
- What assessment technique would the nurse use to assess if a patient has altered bowel motility while taking pain medications?A)Palpate the entire abdomenB)Inspect the abdomen for symmetryC)Auscultate the abdomen in all four quadrantsD)Percuss the abdomen in all four quadrants
- The nurse notes the following respiratory pattern when caring for a patient with a fever. The nurse notes shallow breathing and an increase in the rate of the patient's respiratory pattern. Which respiratory pattern is the nurse noting with this patient?A)Biot's respirationsB)Cheyne-StokesC)HypoventilationD)Tachypnea
- What is the most important technique when progressing from one auscultatory site on the thorax to another?A)Interspace-to-interspace comparisonB)Posterior to anterior comparisonC)Top to bottom comparisonD)Side-to-side comparison