Exam Review
- The traditional areas of auscultation of heart sounds include Erb's point, which is located at?A)Second or third intercostal space at the left sternal borderB)The second intercostal space at the right sternal borderC)Fifth intercostal space near the left midclavicular lineD)Third intercostal space at the left sternal border
- When the nurse is obtaining a health history of the urinary system, the client reports "leaking" urine when coughing or laughing. Which of the following problems is the client likely experiencing?A)Stress incontinenceB)Obstructive incontinenceC)Overflow incontinenceD)Urge incontinence
- The nurse is auscultating a client's abdomen and is unable to discern any bowel sounds. How should the nurse proceed with assessment?A)Perform abdominal percussion, and then repeat auscultation.B)Palpate the client's abdomen to stimulate bowel motility.C)Repeat auscultation in four to six hours.D)Listen for five minutes before documenting an absence of bowel sounds.
- While the nurse is assessing a 56-year-old male with concerns about his peripheral vascular health, the nurse would educate the patient about which risk factors that can influence his peripheral vascular system? (Select all that apply)(SATA)A)SmokingB)DiabetesC)Elevated Cholesterol LevelsD)Hypertension
Exam Review
- A 42-year-old woman reveals an intake of medications. Which medication if reported by the client would alert the nurse to the need to assess the client for thrombophlebitis?A)AntidepressantB)AntihypertensiveC)Oral contraceptiveD)Antilipid agent
- While auscultating heart sounds, asking the client to turn onto a left lying position would help the nurse assess the presence of which of the following?A)Aortic murmursB)Atrial repolarizationC)The first heart soundD)Mitral stenosis
- The nurse knows screening test(s) for colorectal cancer detection according to recommendations from the American Cancer Society (2018) includes? (Select all that apply.)(SATA)A)Flexible sigmoidoscopyB)Double contrast barium enemaC)Fecal occult blood testD)Upper endoscopyE)Colonoscopy
- A group of students is preparing for their clinical experience, during which they are required to demonstrate the techniques for assessing the abdomen. The students demonstrate understanding of the proper sequence when they demonstrate the techniques in which order?A)Percuss, inspect, auscultate, palpateB)Auscultate, inspect, palpate, percussC)Palpate, percuss, inspect, auscultateD)Inspect, auscultate, percuss, palpate
Exam Review
- The nurse is planning care for a client recovering from orthopedic surgery. Interventions should be included to address which contributing factor to deep vein thrombosis development?A)SmokingB)HypertensionC)ObesityD)Immobility
- While completing the cardiovascular system health history, a client reports difficulty falling asleep unless she is in an upright position. Which of the following potential problems should the nurse further investigate?A)Chest painB)OrthopneaC)EdemaD)Palpitations
- When auscultating a client's heart sounds, the nurse hears a louder S2 when listening at the 2nd intercostal space right sternal border. The nurse determines that this finding is consistent with the closure of which heart valves?A)Pulmonic and tricuspidB)Mitral and aorticC)Aortic and pulmonicD)Tricuspid and mitral
- What is responsible to move the blood supply from the feet toward the inferior vena cava?A)Thigh musclesB)Arterial pulsationsC)Venous flowD)Calf muscles
Exam Review
- During chest auscultation, the nurse hears a quiet murmur immediately upon placing the stethoscope on the client's chest. The nurse interprets this as which grade?A)IB)XC)IID)III
- A positive Murphy's sign is indicative of?A)DiverticulosisB)Acute CholecystitisC)AppendicitisD)Nephrolithiasis
- During the physical assessment of the peripheral vascular system, a client's foot is pale when elevated and dark red when in the dependent position. The nurse is concerned that this client is at risk for developing:A)Venous insufficiency ulcersB)Arterial insufficiency ulcersC)Neuropathic ulcersD)Deep vein thrombosis
- During the cardiac cycle heart sounds correlate with events of the cycle. Which is being associated with systole?A)S3B)S1C)S2D)S4
Exam Review
- Aortic insufficiency/regurgitation murmur is classified as a:A)Systolic murmurB)Diastolic murmurC)Absent murmurD)Very faint murmur
- The nurse assesses the client as shown. What pulse is the nurse assessing?A)Posterior tibialB)FemoralC)PoplitealD)Dorsalis pedis
- The nurse is preparing to assess a client's apical impulse. The nurse would palpate at which location?A)Fourth intercostal space, left sternal borderB)Second intercostal space, left sternal borderC)Fifth intercostal space, left midclavicular lineD)Third intercostal space left axillary line
- After teaching a group of students about blood flow through the heart, the instructor determines that the teaching was successful when the students state that after being received by the atria, the blood goes to which of the following?A)Chordae tendineaeB)PrecordiumC)VentriclesD)Semilunar valves
Exam Review
- On examination, the nurse would expect what finding if a client is in right-sided heart failure?A)Increased jugular venous pressureB)Decreased right-sided volumeC)Decreased stroke volumeD)Decreased central venous pressure
- While performing an assessment, the nurse presses the client's arm with the tip of her thumb, holds for a few seconds, and releases. The nurse observes the client as shown. What is the nurse assessing?A)Pitting edemaB)Capillary refillC)Skin temperatureD)Peripheral pulses
- When assessing for appendicitis, what signs might the nurse look for? (Select all that apply.)A)Rovsing signB)Obturator signC)Murphy signD)Psoas sign
- A group of nurses is reviewing several electrocardiograms (ECGs). The students demonstrate an understanding of the waveforms when they identify which component as indicating ventricular repolarization (relaxation).A)ST segmentB)QRS complexC)T waveD)P wave