NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update, Exams of Nursing

Download NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update and more Exams Nursing in PDF only on Docsity! NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update Final Breast and Lymphatics Statement by the patient would indicate a need for further teaching? A. "The best time to check my breasts is a week before my cycle." B. "I will check my breasts in the shower one week after my cycle." C. "I will exam my breast in a clock-like sequence so that I don't miss any surface area." D. "I will be sure to check my arm pits." A The week before a woman's cycle is not the best time to check for lumps because the breasts become sore and tender and may also be "lumpy" a week prior to the cycle. Answer 2 is incorrect because the week after a woman's cycle is the best time to do the examination, and the shower allows for ease of palpation. Answer 3 in incorrect because a clock-like sequence is the proper way to perform a BSE. Answer 4 is incorrect because under the arms houses lymph nodes and the axillary tail of Spence, which is a common site for breast cancer. A pregnant woman who has breast implants asks the nurse if she can still breastfeed. What is the nurse's best response? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A. "You should not have any problems breast feeding because your implants do not affect milk production." B. "When the breast implants are inserted they usually affect the milk glands, and breastfeeding is not possible." C. "This would depend on which type of implants were placed and which procedure was used by the surgeon. Check with your surgeon to see if your milk production will be affected." C Milk production may vary depending on the procedure. Many women can still breastfeed after breast augmentation. The surgeon would be able to determine this ability. Answers 1 and 2 are incorrect because they may not be true. Only the surgeon can determine if milk production will be affected. Statement by the patient would indicate a need for further teaching? A. "The best time to check my breasts is a week before my cycle." B. "I will check my breasts in the shower one week after my cycle." C. "I will exam my breast in a clock-like sequence so that I don't miss any surface area." D. "I will be sure to check my arm pits." A The week before a woman's cycle is not the best time to check for lumps because the breasts become sore and tender and may also be "lumpy" a week prior to the cycle. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update these nodes? A)Central, axillary, lateral, and sternal nodes B)Pectoral, lateral, anterior, and sternal nodes C)Central, lateral, pectoral, and subscapular nodes D)Lateral, pectoral, axillary, and suprascapular nodes ANS: C The breast has extensive lymphatic drainage. Four groups of axillary nodes are present: (1) central, (2) pectoral (anterior), (3) subscapular (posterior), and (4) lateral. If a patient reports a recent breast infection, then the nurse should expect to find node enlargement. A)nonspecific B)ipsilateral axillary C)contralateral axillary D)inguinal and cervical ANS: B The breast has extensive lymphatic drainage. Most of the lymph, more than 75%, drains into the ipsilateral, or same side, axillary nodes. A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally asks, "Am I normal? I don't seem to need a bra yet, but I have some friends who do. What if I never get breasts?" NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The nurse's best response would be: A)"Don't worry, you still have plenty of time to develop." B)"I know just how you feel, I was a late bloomer myself. Just be patient and they will grow." C)"You will probably get your periods before you notice any significant growth in your breasts." D)"I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age." ANS: D Adolescent breast development usually begins between 8 and 10 years of age. The nurse should not belittle the girl's feelings by using statements like "don't worry" or by sharing personal experiences. The beginning of breast development precedes menarche by about 2 years. A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the nurse's best response? A)Tell the mother that breast development is usually fairly symmetric and she should be examined right away. B)Tell the mother that she should bring her daughter in right away because breast cancer is fairly common in preadolescent girls. C)Tell the mother that, although an examination of her daughter would rule out a problem, it is most likely normal breast development. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update D)Tell the mother that it is unusual for breasts that are first developing to feel tender because they haven't developed much fibrous tissue. ANS: C Occasionally one breast may grow faster than the other, producing a temporary asymmetry. This may cause some distress; reassurance is necessary. Tenderness is common also. A 14-year-old girl is anxious about not having reached menarche. When taking the history, the nurse should ascertain which of the following? The age: A)she began to develop breasts B)her mother developed breasts C)she began to develop pubic hair D)she began to develop axillary hair. ANS: A Full development from stage 2 to stage 5 takes an average of 3 years, although the range is 1.5 to 6 years. Pubic hair develops during this time, and axillary hair appears 2 years after the onset of pubic hair. The beginning of breast development precedes menarche by about 2 years. Menarche occurs in breast development stage 3 or 4, usually just after the peak of the adolescent growth spurt, which occurs around age 12 years. See Figure 17-6. A woman is in the family planning clinic seeking birth control information. She states that her breasts "change all month long" and that she is worried that this is unusual. What is the nurse's best NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update expected finding. After the fourth month, colostrum, a thick, yellow fluid (precursor to milk) may be expressed from the breasts. The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? A)"Your breast milk is present immediately after delivery of the baby." B)"Breast milk is rich in protein and sugars (lactose) but has very little fat." C)"The colostrum, which is present right after birth, does not contain the same nutrition as breast milk does." D)"You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy." ANS: D After the fourth month, colostrum may be expressed. This thick yellow fluid is the precursor of milk, and it contains the same amount of protein and lactose but practically no fat. The breasts produce colostrum for the first few days after delivery. It is rich with antibodies that protect the newborn against infection, so breastfeeding is importat A 65-year-old patient remarks that she just can't believe that her breasts sag so much. She states it must be from lack of exercise. What explanation should the nurse offer her? A)After menopause, only women with large breasts experience sagging. B)After menopause, sagging is usually due to decreased muscle mass within the breast. C)After menopause, a diet that is high in protein will help maintain muscle mass, which keeps the NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update breasts from sagging. D)After menopause, the glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag. ANS: D After menopause, the glandular tissue atrophies and is replaced with connective tissue. The fat envelope atrophies also, beginning in the middle years and becoming marked in the eighth and ninth decades. These changes decrease breast size and elasticity, so the breasts droop and sag, looking flattened and flabby In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Which of the following describes the nurse's best course of action? A)Recommend that he make an appointment with his physician for a mammogram. B)Ignore it; it is not unusual for men to have benign breast enlargement. C)Explain that this condition may be the result of hormonal changes and recommend that he see his physician. D)Tell him that gynecomastia in men is usually associated with prostate enlargement and recommend that he be screened thoroughly. ANS: C Gynecomastia may reappear in the aging male and may be due to testosterone deficiency. During an examination of a 7-year-old girl, the nurse notices that the girl is showing breast budding. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update What should the nurse do next? A)Ask her if her periods have started. B)Assess the girl's weight and body mass index (BMI). C)Ask the girl's mother at what age she started to develop breasts. D)Nothing; this is a normal finding. ANS: B Research has shown that girls with overweight or obese BMI levels have a higher occurrence of early onset of breast budding (before age 8 years for African-American girls and age 10 years for white girls) and early menarche. The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the United States, has the highest risk for development of breast cancer? A)African-American B)White C)Asian D)American Indian ANS: A The incidence of breast cancer varies with different cultural groups. White women have a higher incidence of breast cancer than African-American women starting at age 45 years; but African- American women have a higher incidence before age 45 years. Asian, Hispanic, and American Indian women have a lower risk for development of breast cancer (American Cancer Society, 2009-2010). NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update C)Where did it first appear—on the nipple, the areola, or the surrounding skin? D)What was she doing when she first noticed the rash, and do her actions make it worse? ANS: C It is important for the nurse to determine where the rash first appeared. Paget's disease starts with a small crust on the nipple apex and then spreads to the areola. Eczema or other dermatitis rarely starts at nipple unless it results from breastfeeding. It usually starts on the areola or surrounding skin and then spreads to the nipple. See Table 17-6. A patient is newly diagnosed with benign breast disease. The nurse recognizes that which statement about benign breast disease is true? The presence of benign breast disease: A)makes it harder to examine the breasts. B) frequently turns into cancer in a woman's later years. C)is easily reduced with hormone replacement therapy. D)is usually diagnosed before a woman reaches childbearing age. ANS: A The presence of benign breast disease (formerly fibrocystic breast disease) makes it harder to examine the breasts; the general lumpiness of the breast conceals a new lump. The other statements are not true. During an annual physical exam, a 43-year-old patient states that she doesn't perform monthly breast self-examinations (BSE). She tells the nurse that she believes that mammograms "do a much better NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update job than I ever could to find a lump." The nurse should explain to her that: A)BSEs may detect lumps that appear between mammograms. B)breast self-examination is unnecessary until the age of 50 years. C)she is correct, mammography is a good replacement for breast self-examination. D)she doesn't need to perform breast self-examination as long as a physician checks her breasts yearly. ANS: A The monthly practice of breast self-examination, along with clinical breast examination and mammograms are complementary screening measures. Mammography can reveal cancers too small to be detected by the woman or by the most experienced examiner. However, interval lumps may become palpable between mammograms. During an interview, a patient reveals that she is pregnant. She states that she is not sure whether she will breastfeed her baby and asks for some information about this. Which of these statements by the nurse is accurate with regard to breastfeeding? A)"Breastfed babies tend to be more colicky." B)"Breastfeeding provides the perfect food and antibodies for your baby." C)"Breastfed babies eat more often than infants on formula." D)"Breastfeeding is second nature and every woman can do it." ANS: B Exclusively breastfeeding for 6 months provides the perfect food and antibodies for the baby, decreases the risk of ear infections, promotes bonding, and provides relaxation NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The nurse is reviewing risk factors for breast cancer. Which of these women have risk factors that place them at a higher risk for breast cancer? A)37 year old who is slightly overweight B)42 year old who has had ovarian cancer C)45 year old who has never been pregnant D)65 year old whose mother had breast cancer ANS: D Risk factors for breast cancer include having a first-degree relative with breast cancer (mother, sister, or daughter) and being older than 50 years. Refer to Table 17- 2 for other risk factors. During an examination of a woman, the nurse notices that her left breast is slightly larger than her right breast. Which of these statements is true about this finding? A)Breasts should always be symmetric. B)This finding is probably due to breastfeeding and is nothing to worry about. C)This finding is not unusual, but the nurse should verify that this change is not new. D)This finding is very unusual and means she may have an inflammation or growth. ANS: C The nurse should notice symmetry of size and shape. It is common to have a slight asymmetry in size; often the left breast is slightly larger than the right. A sudden increase in the size of one breast signifies inflammation or new growth. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update ANS: A The nurse should help the woman to a supine position, tuck a small pad under the side to be palpated, and help the woman raise her arm over her head. These maneuvers will flatten the breast tissue and displace it medially. Any significant lumps will then feel more distinct NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update Which of these clinical situations would the nurse consider to be outside normal limits? A)A patient has had one pregnancy. She states that she believes she may be entering menopause. Her breast examination reveals breasts that are sof t and sag slightly. B)A patient has never been pregnant. Her breast examination reveals large pendulous breasts that have a firm, transverse ridge along the lower quadrant in both breasts. C)A patient has never been pregnant. She reports that she should begin her period tomorrow. Her breast examination reveals breast tissue that is nodular and somewhat engorged. She states that the examination was slightly painful. D)A patient has had two pregnancies and she breastfed both of her children. Her youngest child is now 10 years old. Her breast examination reveals breast tissue that is somewhat sof t and she has a small amount of thick yellow discharge from both nipples. ANS: D In nulliparous women, normal breast tissue feels firm, smooth, and elastic; after pregnancy, the tissue feels softer and looser. If any discharge appears, the nurse should note its color and consistency. Except in pregnancy and lactation, discharge is abnormal. Premenstrual engorgement is normal, and consists of a slight enlargement, tenderness to palpation, and a generalized nodularity. A firm, transverse ridge of compressed tissue in the lower quadrants, known as the inframammary ridge, is especially noticeable in large breasts. A patient states during the interview that she noticed a new lump in the shower a few days ago. It was on her left breast near her axilla. The nurse should plan to: NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A)palpate the lump first. B)palpate the unaffected breast first. C)avoid palpating the lump because it could be a cyst, which might rupture. D)palpate the breast with the lump first but plan to palpate the axilla last. ANS: B If the woman mentions a breast lump she has discovered herself, the nurse should examine the unaffected breast first to learn a baseline of normal consistency for this individual. The nurse has palpated a lump in a female patient's right breast. The nurse documents this as a small, round, firm, distinct, lump located at 2 o'clock, 2 cm from the nipple. It is nontender and fixed. There is no associated retraction of skin or nipple, no erythema, and no axillary lymphadenopathy. Which of these statements reveals the information that is missing from the documentation? It is missing information about: A)the shape of the lump. B)the lump's consistency. C)the size of the lump. D)whether the lump is solitary or multiple. ANS: C If the nurse feels a lump or mass, he or she should note these characteristics: (1) location, (2) size— judge in centimeters in three dimensions: width × length × thickness, (3) shape, (4) consistency, (5) NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The hormonal changes of menopause cause the breast glandular tissue to atrophy, making the breasts more pendulous, flattened, and sagging. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her physician evaluated the lump and determined that it "was nothing to worry about." The examination validates the presence of a mass in the right upper outer quadrant at 1 o'clock, approximately 5 cm from the nipple. It is firm, mobile, nontender, with borders that are not well defined. The nurse's recommendation to her is: A)"Because of the change in consistency of the lump, it should be further evaluated by a physician." B)"The changes could be related to your menstrual cycles. Keep track of changes in the mass each month." C)"This is probably nothing to worry about because it has been present for years and was determined to be noncancerous at that time." D)"Because you are experiencing no pain and the size has not changed, continue to monitor the lump and return to the clinic in 3 months." ANS: A A lump that has been present for years and is not exhibiting changes may not be serious but still should be explored. Any recent change or new lump should be evaluated. The other responses are not correct. During a discussion about breast self-examination with a 30-year-old woman, which of these statements by the nurse is most appropriate? A)"The best time to examine your breasts is during ovulation." B)"Examine your breasts every month on the same day of the month." NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update C)"Examine your breasts shortly after your menstrual period each month." D)"The best time to examine your breasts is immediately before menstruation." ANS: C The best time to conduct breast self-examination is shortly after the menstrual period when the breasts are the smallest and least congested. The nurse is discussing breast self-examination with a postmenopausal woman. The best time for postmenopausal women to perform breast self-examination is: A)the same day every month. B)daily, during the shower or bath. C)1 week after her menstrual period. D)every year with her annual gynecologic examination. ANS: A Postmenopausal women are no longer experiencing regular menstrual cycles but need to continue to perform breast self-examination on a monthly basis. Choosing the same day of the month is a helpful reminder to perform breast self-examination. While inspecting a patient's breasts, the nurse finds that the left breast is slightly larger than the right with the presence of Montgomery's glands bilaterally. The nurse should: A)palpate over the Montgomery's glands, checking for drainage. B)consider these normal findings and proceed with the examination. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A new mother calls the clinic to report that part of her left breast is red, swollen, tender, very hot, and hard. She has a fever of 101° F. She has also had symptoms of the flu, such as chills, sweating, and feeling tired. The nurse notices that she has been breastfeeding for 1 month. From her description, what condition does the nurse suspect? A)Mastitis B)Paget's disease C)Plugged milk duct D)Mammary duct ectasia ANS: A The symptoms describe mastitis, which stems from infection or stasis caused by a plugged duct. A plugged duct does not have infection present. (See Table 17-7.) Refer to Table 17-6 for descriptions of Paget's disease and mammary duct ectasia. During a breast examination on a female patient, the nurse notices that the nipple is flat, broad, and fixed. The patient states it "started doing that a few months ago." This finding suggests: A)dimpling. B)a retracted nipple. C)nipple inversion. D)deviation in nipple pointing. ANS: B NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The retracted nipple looks flatter and broader, like an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. It also may occur with benign lesions such as ectasia of the ducts. The nurse should not confuse retraction with the normal long-standing type of nipple inversion, which has no broadening and is not fixed. A 54-year-old man comes to the clinic with a "horrible problem." He tells the nurse that he has just discovered a lump on his breast and is fearful of cancer. The nurse knows that which statement about breast cancer in males is true? A)Breast masses in men are difficult to detect because of minimal breast tissue. B)Breast cancer in men rarely spreads to the lymph nodes. C)One percent of all breast cancer occurs in men. D)Most breast masses in men are diagnosed as gynecomastia. ANS: C One percent of all breast cancer occurs in men. Early spread to axillary lymph nodes occurs due to minimal breast tissue. The nurse is assessing the breasts of a 68-year-old woman and discovers a mass in the upper outer quadrant of the left breast. When assessing this mass, the nurse keeps in mind that characteristics of a cancerous mass include which of the following? Select all that apply. A)Nontender mass B)Dull, heavy pain on palpation C)Rubbery texture and mobile NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update D)Hard, dense, and immobile E)Regular border F) Irregular, poorly delineated border ANS: A, D, F Cancerous breast masses are solitary, unilateral, nontender, masses. They are solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive. Their borders are irregular and poorly delineated. They are often painless, although the person may have pain. They are most common in upper outer quadrant. A dull, heavy pain on palpation and a mass with a rubbery texture and a regular border are characteristics of benign breast disease. The nurse is examining a 62-year-old man and notes that he has gynecomastia bilaterally. The nurse should explore his history for which related conditions? Select all that apply. A)Obesity B)Malnutrition C)Hyperthyroidism D)Type 2 diabetes mellitus E)Liver disease F)History of alcohol abuse ANS: A, C, E, F Gynecomastia occurs with obesity, Cushing's syndrome, liver cirrhosis, adrenal disease, NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A. HIV B. Syphilis C. pneumonia D. chancroid Remember early HIV looks like the flu. How long does it take a patient with HIV to serconvert? A. 6 months to 1 year B. 3 months to 1 year C. 3 weeks to 6 months D. Over one year C. 3 weeks to 6 months - that is why everyone that has had a needle stick will have an initial test then the person will come back in 6 months to retest. What is a normal T-cell (CD4) count? A. 800 B. 400 C. 200 D. None - A. 800 NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update In a patient with HIV if the viral load is high and the CD4 is low you know: A. That they are stable B. That they are severely immunocomprimised C. There immune response is high. - B. These patients have no immunity to fight infection and the virus is running rampant. Chancroid is a: A. Gram positive organism B. Gram negative bacillus C. Co-factor for HIV transmission D. Both B and C - B. Gram negative bacillus (hemophylus ducreyi). High rate of HIV identified among individuals with chancroid. Estimated 10% of patients are also infected with syphilis and HIV. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The degree to which those who have a disease screen/test positive is known as: A. Specificity B. Sensitivity - B. Sensitivity: Think how many people are positive. Don't get tricked. This has nothing to do with how many people might be negative. If a patient complains of pain upon urination and does not have a urinary tract infection you suspect: A. Chlamydia B. Syphilus C. PID D. Trichimoniasis - A. Chlamydia: Remember the two sexually transmitted diseases that cause pain upon urination (dysuria) are chlamydia and gonorrhea. Patients who are diagnosed with gonorrhea are also treated for following because of high rates of coinfection: A. Mycoplasma pneumoniae B. Chlamydia trachomatis C. Syphilis NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update any risk factors for HIV. The ELISA and Western Blot tests are both used to test for the HIV virus. Which of the following statements is correct. A. They are both tests to detect viral RNA B. A positive ELISA screening does not mean the person has HIV infection C. They are both tests used to detect for antibodies against HIV virus. D. They are both the best diagnostic tests for HIV - B. A positive ELISA screening does not mean the person has HIV infection. The ELISA test is always followed by Western blot test to confirm diagnosis. All of the following are infections affecting the vagina or labia except: A. Bacterial Vaginosis B. Candidiasis C. Trichomoniasis D. Chlamydia Trachomatis - D. Chlamydia Trachomatis: Initially infects the cervix and urethra. Signs of infection include vaginal discharge or a burning sensation with urination. The KOH prep (potassium hydroxide) will help you diagnose all NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update of the following conditions except: A. Tinea infections B. Candida albicans infections of the skin C. Bacterial vaginosis D. Atypical bacterial infections - D. Atypical bacterial infections: A KOH test is done to determine whether a fungus is causing the skin infection. Samples from an infected area are treated with KOH which disolves skin cells a nd leaves behind fungus cells that can be seen on a microscope. It is used to diagnose thrush, tinea vesicolor, ringworm, and bacterial vaginosis. KOH potassium hydroxide skin scraping will reveal - hyphae Trichomoniasis characteristics of vaginal discharge - foul, frothy, grayish, strawberry spots, motile porotozoa Bacterial vaginosis characteristics - fishy, white-yellow, creamy, clue cells and whiff test on wet prep Chlamydia characteristics/gonorrhea NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update - yellowish, no odor, purulent discharge, numerous white cells on wet prep All of the following are reportable diseases except: A. Lyme disease B. Gonorrhea C. Nongonococcal urethritis D. Syphilis - C. Nongonococcal urethritis A 20 year old woman who is sexually active complains of copious milk like vaginal discharge. On microscopy the slide reveals a large number of mature squamous epithelial cells. The vaginal pH is 5.o. There are very few leukocytes and no red blood cells seen on the wet smear. Which of the following is most likely. A. Atrophic vaginits B. Bacterial Vaginosis C. Trichomoniasis D. This is a normal finding NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A. Hepatitis B Vaccination B. Hepatitis B immuno globulin C. Hepatitis B vaccination and hepatitis immune globulin D. No vaccination is needed at this time. - C. Hepatitis B surface antigen (HBsAg) is a marker for infectivity. If positive it indicates either an acute or chronic hepatitis B infection. Antibody to hepatitis surface antigen (anti-HBs) is a marker of immunity. Antibody to hapatitis B core antigen (anti-HBc) is a marker of acute, chronic, or resolved HBV infection. It may be used in prevaccination testing to determine previous exposure to HBV. Interpretation of the hepatitis B panel for test results: A negative HBsAg and a negative anti-HBc and a negative anti-HBs indicates the patient is susceptible - not immune has not been infected and is still at risk for future infection - need vaccination. Interpretation of the hepatitis C anti HCV screening test that is negative indicates that the patient is not infected. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update Which of the following is recommended for the treatment of a patient with bacterial vaginosis? A. Azithromycin (Zithromax) B. Doxycyline (Dynapin) C. Ceftriaxone (Rocephin) D. Metronidazole (Flagyl) - D. Treatment for BV is flagyl either orally or vaginally or treatment with clindamycin (cleocin) either orally or vaginally. Treatment for the partner is not recommended by the CDC, since there is no decrease recurrences with partner treatment and no effect on cure rates. All of the following sexually transmitted diseases can become disseminated if not treated except: A. Neissieria gonorrhoeae B. Treponema pallidum C. HIV D. Chlamydia Trahomatis - D. The key to answering this question is to understand the meaning behind disseminated - think wide spread or systemic. Although chlamydia seems like an obvious candidate since it can NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update ascend to the uterus and affect a variety of sites including the eyes and the rectum, the specific type of chlamydia that causes genital infections is not generally thought to cause systemic infection. The predominant infections are urethritis, cervicitis, and proctititis, but chlamydia infection can spread locally to the bartholin glands, endosapinges, or epididymis. Up to 40% of untreated chlamydial cervicitis cases will ascend into the upper genital tract where considerable tubal damage can occur with very few symptoms. A homeless middle aged male complains of migratory arthritis and dysuria. Currently, his right knee is swollen and painful. On examination, green colored purulent discharge is noted. Which of the following do you most likely suspect? A. Gonorrhea B. Chlamydia C. Nongonococcal urethritis D. Acute epididymitis - A. Symptoms of gonorrhea usually appear 3-5 days after the infection however in men symptoms may take up to one month to appear. Early symptoms include dysuria, increased urination, frequency, urgency, white/yellow/or green penile drainage, red or NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update women treated with oral therapy are similar o those treated with perenteral therapy. RECOMMENDED REGIMEN: Ceftriaxone 250 mg I.M. in a single dose coupled with doxycylcine 100 mg orally twice a day for 14 days with or without metronidazole 500 mg orally twice daily for 14 days. A 25 year old woman comes into your office complaining of dysuria, pruritis, and purulent vaginal dischage. Pelvic examination reveals a cervix with punctate superficial petechiae (strawberry cervix) and irritated reddened vulvar area, with frothy discharge. Microscopic examination of the discharge reveals unicellular organisms. The correct pharmacological treatment for this condition is: A. Oral metronidazole (Flagyl) B. Ceftriaxone sodium (Rocephin) injection C. Doxycycline hyclate (vibramycin) D. Clotrimazole (Gyne-Lotrimin) cream or suppositories - A. A single dose of metronidazole is effective in the majority of cases of trichomonas infections. The strawberry cervix is considered to be selectively associated with Trichomonas. The etiology is the parastitic protozoan flagellate, T. vaginalis. Symptoms include: fouls smelling vaginal discharge (often fishy), burning and soreness of the NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update vulva, perineum, and thighs, dyspareunia and dysuria. Wet prep microscopic examination should reveal highly motile cells, slightly larger than leukocytes, smaller than epithelial cells. Prophylaxis for pneumocystis carinii pneumonia includes all of the following drugs except: A. Trimethoprim-sulfamethoxazole (Bactrim) B. Dapsone C. Aerosolized pentamidine D. Nedocromil sodium Tilade - D. Nedocromil sodium is a mast cell stabilizer used for the treatment of moderate inflammation of the bronchial tubes and other allergy symptoms. Pneumocystis pneumonia is the most common opportunitic infection in people with HIV. Drugs used to treat PCP include bactrim (first line to treat pnumocystis pneumonia), dapson (antibiotic traditionally used to treat leprosy), pentamidine (antimicrobial used to prevent pneumoystis pneumonia), and atovaquone (naphthoquinones used to treat pneumoystis pneumonia, toxoplasmosis, malaria, and babesia). Which of the following is recommended for treatment by the CDC for a case of uncomplicated gonorrheal and chlamydia infection? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A. Metronidazole 250 mg po three times daily for seven days B. Valacylcovir 500 mg po bid for 10 days C. Azithromycin 1 g orally or Doxyclycline 100 mg twice daily for seven days D. One dose of oral Fluconazole 150 mg - C. Azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days is based on the CDC 2010 guidelines for treatment. A patient diagnosed with bacterial vaginosis should be advised that her sexual partner be treated with: A. Ceftriazone (Rocephin) 250 mg with doxycycline 100 mg po bid x 14 days B. Flagyl 500 mg BID x 7 days with 1 dose of azithromycin C. Her partner does not need to be treated D. Lotrimin cream to the penis twice daily for 14 days - C. The usual medical regimen for treatment is the antibiotic flagyl 400 mg twice daily every 12 hours for seven days. Treatment of sexual partners is not warranted. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update D. Clinical findings only - C. Generally wet preps use 1 to 2 slides to evaluate candida. under a microscope observe for presence and number of wbc's, trichomonads, candidal hphea, or clue cells. Yeast and hyphae may also be present on a wet prep. KOH prep is made by adding a drop of saline suspension of vaginal discharge to a drop of KOH solution. The KOH lyses epithelial cells in 5 to 15 minutes and allows easier visualization of candidal hyphae. *Tzanck test is scraping of an ulcer base to look for tazanck cells, sometimes also called the chickenpox skin test and the herpes skin test. For which diagnosis is the consideration of whether the patient has a bubo necessary. A. Chancroid B. Syphilis C. Genital herpes D. Gonorrhea - A. Remember a Bubo is a swollen lymph node in the genital area often seen with chancroid. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A 21 year old Latino male comes into your office presenting with a sore on his penis x2 weeks. On exam, you note an indurated chancre that is painless, along with mild regional lymphadenopathy. Based on your diagnosis, which of the following is your most appropriate order? A. Ceftriaxone B. PCN G C. Azithromycin D. Acylcolovir - B. PCN the nurse practitioner knows that asymptomatic shedding should be considered with which STD/STI? A. Syphilis B. Chlamydia C. HSV-2 D. Gonorrhea - C. HSV-2 In teaching a patient about seroconversion with HIV the nurse practitioner knows: NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A. Most patients seroconvert within 3-4 weeks of exposure B. Once seroconversion occurs the diagnosis of AIDS is usually made and medication is started in most patients C. Enough antigens have built up in the blood by 6 months to usually detect a virus D. Once seroconversion occurs, the patient may or may not show symptoms. - D All of these are considered part of HIV/AIDS except: A. Fatigue/vague abdominal pain B. Weight loss C. Night Sweats D. Fever - A. Fatigue/vague abdominal pain The pap smear result on a 20 year old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up? A. The NP needs to do cervical cultures to verify the presence of gonorrhea B. Treat the patient with metronidazole vaginal cream NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update best explanation why this occurs is which one of these statements? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The sensory cortex does not have the ability to localize pain in the heart; consequently, the pain is felt elsewhere. The ability that humans have to perform very skilled movements such as writing is controlled by the: Corticospinal tract. A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. Which area of the brain that is related to these findings would concern the nurse? Cerebellum Which of these statements about the peripheral nervous system is correct? The peripheral nerves carry input to the central nervous system by afferent fibers and away from the central nervous system by efferent fibers. A patient has a severed spinal nerve as a result of trauma. Which statement is true in this situation? The adjacent spinal nerves will continue to carry sensations for the dermatome served by the severed nerve. A 21-year-old patient has a head injury resulting from trauma and is unconscious. There are no other injuries. During the assessment what NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update would the nurse expect to find when testing the patient's deep tendon reflexes? Reflexes will be normal. A mother of a 1-month-old infant asks the nurse why it takes so long for infants to learn to roll over. The nurse knows that the reason for this is: Myelin is needed to conduct the impulses, and the neurons of a newborn are not yet myelinated. During an assessment of an 80-year-old patient, the nurse notices the following: an inability to identify vibrations at her ankle and to identify the position of her big toe, a slower and more deliberate gait, and a slightly impaired tactile sensation. All other neurologic findings are normal. The nurse should interpret that these findings indicate: Normal changes attributable to aging. A 70-year-old woman tells the nurse that every time she gets up in the morning or after she's been sitting, she gets "really dizzy" and feels like she is going to fall over. The nurse's best response would be: "You need to get up slowly when you've been lying down or sitting." During the taking of the health history, a patient tells the nurse that NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update Positive Romberg sign. The nurse is performing an assessment on a 29-year-old woman who visits the clinic complaining of "always dropping things and falling down." While testing rapid alternating movements, the nurse notices that the woman is unable to pat both of her knees. Her response is extremely slow and she frequently misses. What should the nurse suspect? Dysfunction of the cerebellum During the taking of the health history of a 78-year-old man, his wife states that he occasionally has problems with short-term memory loss and confusion: "He can't even remember how to button his shirt." When assessing his sensory system, which action by the nurse is most appropriate? Before testing, the nurse would assess the patient's mental status and ability to follow directions. The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception, the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin on his arm several times, he is only able to identify these as one "very sharp prick." What would be the most accurate explanation for this? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update This response is most likely the result of the summation effect. The nurse is performing a neurologic assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patellae. Given this information, what would the nurse suspect? Peripheral neuropathy The nurse places a key in the hand of a patient and he identifies it as a penny. What term would the nurse use to describe this finding? Astereognosis (inability to identify objects correctly, and it occurs in sensory cortex lesions) The nurse is testing the deep tendon reflexes of a 30-year-old woman who is in the clinic for an annual physical examination. When striking the Achilles heel and quadriceps muscle, the nurse is unable to elicit a reflex. The nurse's next response should be to: Ask the patient to lock her fingers and pull. In assessing a 70-year-old patient who has had a recent NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update cerebrovascular accident, the nurse notices right-sided weakness. What might the nurse expect to find when testing his reflexes on the right side? Hyperactive reflexes When the nurse is testing the triceps reflex, what is the expected response? Extension of the forearm The nurse is testing superficial reflexes on an adult patient. When stroking up the lateral side of the sole and across the ball of the foot, the nurse notices the plantar flexion of the toes. How should the nurse document this finding? Plantar reflex present In the assessment of a 1-month-old infant, the nurse notices a lack of response to noise or stimulation. The mother reports that in the last week he has been sleeping all of the time, and when he is awake all he does is cry. The nurse hears that the infant's cries are very high pitched and shrill. What should be the nurse's appropriate response to these findings? Refer the infant for further testing. Which of these tests would the nurse use to check the motor coordination of an 11-month-old infant? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update description suggests: Chorea. During an assessment of a 62-year-old man, the nurse notices the patient has a stooped posture, shuffling walk with short steps, flat facial expression, and pill-rolling finger movements. These findings would be consistent with: Parkinsonism. During an assessment of a 32-year-old patient with a recent head injury, the nurse notices that the patient responds to pain by extending, adducting, and internally rotating his arms. His palms pronate, and his lower extremities extend with plantar flexion. Which statement concerning these findings is most accurate? This patient's response: Is a very ominous sign and may indicate brainstem injury. A 78-year-old man has a history of a cerebrovascular accident. The nurse notes that when he walks, his left arm is immobile against the body with flexion of the shoulder, elbow, wrist, and fingers and adduction of the shoulder. His left leg is stiff and extended and circumducts with each step. What type of gait disturbance is this individual experiencing? Spastic hemiparesis NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update In a person with an upper motor neuron lesion such as a cerebrovascular accident, which of these physical assessment findings should the nurse expect? Hyperreflexia A 59-year-old patient has a herniated intervertebral disk. Which of the following findings should the nurse expect to see on physical assessment of this individual? Hyporeflexia A patient is unable to perform rapid alternating movements such as rapidly patting her knees. The nurse should document this inability as: Presence of dysdiadochokinesia. The nurse knows that determining whether a person is oriented to his or her surroundings will test the functioning of which structure(s)? Cerebrum During an examination, the nurse notices severe nystagmus in both eyes of a patient. Which conclusion by the nurse is correct? Severe nystagmus in both eyes: May indicate disease of the cerebellum or brainstem. The nurse knows that testing kinesthesia is a test of a person's: Position sense. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The nurse is reviewing a patient's medical record and notes that he is in a coma. Using the Glasgow Coma Scale, which number indicates that the patient is in a coma? 6 A man who was found wandering in a park at 2 AM has been brought to the emergency department for an examination; he said he fell and hit his head. During the examination, the nurse asks him to use his index finger to touch the nurse's finger, then his own nose, then the nurse's finger again (which has been moved to a different location). The patient is clumsy, unable to follow the instructions, and overshoots the mark, missing the finger. The nurse should suspect which of the following? Acute alcohol intoxication The nurse is assessing the neurologic status of a patient who has a late- stage brain tumor. With the reflex hammer, the nurse draws a light stroke up the lateral side of the sole of the foot and inward, across the ball of the foot. In response, the patient's toes fan out, and the big toe shows dorsiflexion. The nurse interprets this result as: Positive Babinski sign, which is abnormal for adults. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update an injury to the rotator cuff involves which shoulder joint glenohumeral joint which enclosed by a group of four powerful muscles and tendons that support and stabilize it- other definitions are: the nucleus pulposus is located in the center of each intervertebral disk. The articular processes are projections in each vertebral disk that lock onto the next vertebra, thereby stabilizing the spinal column. The medial epicondyle is located at the elbow. A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and that he is unable to remove his wedding ring. This joint is called the joint. metacarpophalangeal joint. 2. The interphalangeal joint is located distal to the metacarpophalangeal joint. 3. The tarsometatarsal and tibiotalar joints are found in the foot and ankle. The nurse is assessing a patient's ischial tuberosity. To palpate the ischial tuberosity, the nurse knows that it is best to have the patient: NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed. The nurse is examining the hip area of a patient and palpates a flat depression on the upper, lateral side of the thigh when the patient is standing. The nurse interprets this finding as the: The greater trochanter of the femur is palpated when the person is standing, and it appears as a flat depression on the upper lateral side of the thigh. 2. The iliac crest is the upper part of the hip bone; 3.the ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed; and the gluteus muscle is part of the buttocks. The ankle joint is the articulation of the tibia, fibula, and: The ankle or tibiotalar joint is the articulation of the tibia, fibula, and talus. The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. Where does lengthening of the bones occur? Lengthening occurs at the epiphyses, or growth plates. The other options are not correct. A woman who is 8 months pregnant comments that she has noticed a change in her posture and is having lower back pain. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The nurse tells her that during pregnancy, women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as: Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance, in turn, creates a strain on the low back muscles, felt as low back pain during late pregnancy by some women. 2. Scoliosis is lateral curvature of portions of the spine; 3. ankylosis is extreme flexion of the wrist, as observed with severe rheumatoid arthritis; and 4. kyphosis is an enhanced thoracic curvature of the spine. An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because: 1. Postural changes are evident with aging; decreased height is most noticeable and is due to shortening of the vertebral column. 2. Long bones do not shorten with age. 3. Intervertebral disks actually get thinner with age. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The nurse should suspect: Rotator cuff lesions may limit range of motion and cause pain and muscle spasms during abduction, whereas forward flexion remains fairly normal. A professional tennis player comes into the clinic complaining of a sore elbow. The nurse will assess for tenderness at the: The epicondyles, the head of the radius, and the tendons are common sites of inflammation and local tenderness, commonly referred to as tennis elbow. The other locations are not affected. The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test. To perform this test, the nurse should instruct the patient to: For the Phalen test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand. The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome. An 80-year-old woman is visiting the clinic for a checkup. She states, "I can't walk as much as I used to." The nurse is observing for motor dysfunction in her hip and should ask her to: NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update abduct her hip while she is lying on her back. Limited abduction of the hip while supine is the most common motion dysfunction found in hip disease. The nurse has completed the musculoskeletal examination of a patient's knee and has found a positive bulge sign. The nurse interprets this finding to indicate: A positive bulge sign confirms the presence of swelling caused by fluid in the suprapatellar pouch. During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, the patient complains of a pain going down his buttock into his leg. The nurse suspects: Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus. The nurse is examining a 3-month-old infant. While the nurse holds his or her thumbs on the infant's inner mid thighs and the fingers on the outside of the infant's hips, touching the greater trochanter, the nurse adducts the legs until the his or her thumbs touch and then abducts the legs until the infant's knees touch the table. The nurse does not notice any "clunking" sounds and is confident to record a: NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update 1. negative ortolans sign. Normally, this maneuver feels smooth and has no sound. 2. With a positive Ortolani sign, however, the nurse will feel and hear a "clunk," as the head of the femur pops back into place. A positive Ortolani sign also reflects hip instability. 3. The Allis test also tests for hip dislocation but is performed by comparing leg lengths. During a neonatal examination, the nurse notices that the newborn infant has six toes. This finding is documented as: 1. Polydactyly is the presence of extra fingers or toes. 2. Syndactyly is webbing between adjacent fingers or toes. A mother brings her newborn baby boy in for a checkup; she tells the nurse that he does not seem to be moving his right arm as much as his left and that he seems to have pain when she lifts him up under the arms. The nurse suspects a fractured clavicle and would observe for: For a fractured clavicle, the nurse should observe for limited arm range of motion and unilateral response to the Moro reflex. A 40-year-old man has come into the clinic with complaints of extreme pain in his toes. The nurse notices that his toes are slightly NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her fingers. The nurse will assess for signs of what problems? Changes in the fingers caused by chronic rheumatoid arthritis include swan- neck and boutonniere deformities. 2. Heberden nodes and Bouchard nodules are associated with osteoarthritis. 3. Dupuytren contractures of the digits occur because of chronic hyperplasia of the palmar fascia A patient's annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine; however, this curvature disappears with forward bending. The nurse knows that this abnormality of the spine is called: 1. Functional scoliosis - it is flexible and apparent with standing but disappears with forward bending. 2. Structural scoliosis is fixed; the curvature shows both when standing and when bending forward. A 14-year-old boy who has been diagnosed with Osgood-Schlatter disease reports painful swelling just below the knee for the past 5 months. Which response by the nurse is appropriate? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update "Your disease is due to repeated stress on the patellar tendon. It is usually self-limited, and your symptoms should resolve with rest." Osgood-Schlatter disease is a painful swelling of the tibial tubercle just below the knee and most likely due to repeated stress on the patellar tendon. It is usually self- limited, occurring during rapid growth and most often in boys. The symptoms resolve with rest. The other responses are not appropriate. When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What grade of muscle strength should the nurse record using a 0- to 5-point scale? Complete range of motion against gravity is normal muscle strength and is recorded as grade 5 muscle strength. The nurse is examining a 6-month-old infant and places the infant's feet flat on the table and flexes his knees up. The nurse notes that the right knee is significantly lower than the left. Which of these statements is true of this finding? Finding one knee significantly lower than the other is a positive Allis sign and suggests hip dislocation. Normally, the tops of the knees are at the same elevation. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The nurse is assessing a 1-week-old infant and is testing his muscle strength. The nurse lifts the infant with hands under the axillae and notices that the infant starts to "slip" between the hands. The nurse should asses that An infant who starts to "slip" between the nurse's hands shows weakness of the shoulder muscles. An infant with normal muscle strength wedges securely between the nurse's hands. nurse is examining a 2-month-old infant and notices asymmetry of the infant's gluteal folds. The nurse should assess for other signs of what disorder? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update patient. you determine that the patient's knee strength is fair and exhibits active motion with gravity. you should document the patient's muscle strength as: 3/5 you are assessing your patient for range of motion movement. you ask him to move his arm in towards the center of his body. this movement is called: adduction a female patient is 8 months pregnant. she comments that she has noticed a change in posture and is having lower back pain. the nurse tells her that during pregnancy women have a posture shift to NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update compensate for the enlarging fetus. this shift is posture is known as: lordosis the nurse is checking the range of motion in a patient's knee and knows that the knee is capable of which movements? flexion and extension the nurse notes that there is an audible clicking sound when the patient opens and closes the mouth. what is the appropriate response of the nurse at this time? documenting this finding as expected if no other signs or symptoms are found the nurse asks the patient to rest the left arm on a table and to move the lower arm so that the palm of the hand is up and then down. what motion is the nurse testing? supination and pronation of the elbow upon inspection of a patient's hands, the nurse notices ulnar deviation and swan-neck deformities bilaterally. the nurses correlates this finding with which disorder? NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update rheumatoid arthritis when performing a musculoskeletal assessment, the nurse knows the correct approach for the examination should be: proximal to distal a patient is able to flex his right arm forward without difficulty or pain; but is unable to abduct his arm because of pain and muscle spasms. the nurse should suspect: rotator cuff injury the nurse is assessing the joints of a woman who has stated, "I have a long family history of arthritis, and my joints hurt." the nurse suspects that she has osteoarthritis. which of these is a symptom of osteoarthritis? Terms in this set (47) Original two parts of the nervous system are the: ANS: central and peripheral. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update The ability that humans have to perform very skilled movements such as writing is controlled by the: ANS: corticospinal tract. Corticospinal fibers mediate voluntary movement, particularly very skilled, discrete, purposeful movements, such as writing. A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. ANS: Cerebellum coordinates movement, maintains equilibrium, and helps maintain posture. Which of these statements about the peripheral nervous system is correct? ANS: The peripheral nerves carry input to the central nervous system by afferent fibers and away by efferent fibers. A patient has a severed spinal nerve as a result of trauma. ANS: The adjacent spinal nerves will continue to carry sensations for the dermatome. A dermatome is a circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve. NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update A 21-year-old patient has a head injury resulting from trauma. what is expected when testing the patient's deep tendon reflexes? ANS: Reflexes will be normal. A reflex is a defense mechanism of the nervous system. A mother of a 1-month-old infant asks the nurse why it takes so long for infants to learn to roll over. ANS: myelin is needed to conduct the impulses, and the neurons of a newborn are not yet myelinated. During an assessment of an 80-year-old patient, the nurse notices slightly impaired tactile sensation. All other neurologic findings are normal. ANS: normal changes due to aging. A 70 yr woman tells the nurse that every time she gets up in the morning. she gets "really dizzy" ANS: "You need to get up slowly when you've been lying or sitting." During the history, a patient tells the nurse that "it feels like the room is spinning around me." The nurse would document this as: ANS: vertigo. Dizziness is a lightheaded, Syncope is a sudden loss of consciousness. . NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update When taking the history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. ANS: "Do you have any warning sign before your seizure starts?" Aura is a subjective sensation that precedes a seizure; it could be auditory, visual, or motor. While obtaining a history of a 3-month-old infant, the nurse asks about the infant's ability to suck and grasp mother's finger. ANS: Reflexes In 74-year-old patient the nurse notes that he drinks alcohol daily and that he has noticed a tremor in his hands. ANS: "Does the tremor change when you drink the alcohol?" Senile tremor is relieved by alcohol, although this is not a recommended treatment. the nurse finds the following: asymmetry when the patient smiles uneven lifting of eyebrows, sagging of the lower eyelids, and escape of air when the nurse presses against the right puffed cheek. ANS: Motor component of VII NSG 6020 Health Assessment FINAL EXAM questions and answers with elaborations 2022 update