NursGuru

    Exam Review

    1. The nurse is performing a middle ear assessment on a 15-year-old patient who has had a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 o'clock and landmarks visible. What should the nurse do?
      A)
      Be concerned about a genetic abnormality on the tympanic membrane.
      B)
      Refer the patient for the possibility of a fungal infection.
      C)
      Recognize that these are scars caused from frequent ear infections.
      D)
      Consider that these findings may represent the presence of blood in the middle ear.
    2. The nurse is assessing a 12 year old with new onset of double vision. The nurse notes the child's right eye is positioned down and out. The nurse knows these findings are suggestive of damage to cranial nerve
      A)
      II
      B)
      VI
      C)
      III
      D)
      IV
    3. Which of the following tests could be used to assess the acoustic nerve? (Select All that Apply.)
      (SATA)
      A)
      Forlani
      B)
      Rinne
      C)
      Weber
      D)
      Kinecki
      E)
      Whisper Test
      F)
      Audiogram (formal hearing test)
    4. The nurse is performing an assessment on a 7-year-old child who has symptoms of chronic watery eyes, sneezing, and clear nasal drainage. The nurse notices the presence of a transverse line across the bridge of the nose, dark blue shadows below the eyes, and a double crease on the lower eyelids. What does the nurse suspect is the cause of these signs and symptoms?
      A)
      Lymphadenopathy
      B)
      Nasal congestion
      C)
      Upper respiratory infection
      D)
      Chronic allergies

    Exam Review

    1. When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration being longer than expiration. How should the nurse interpret these findings?
      A)
      Bronchial breath sounds that are normal in that location.
      B)
      Bronchovesicular breath sounds that are normal in that location.
      C)
      Normal sounds auscultated over the trachea.
      D)
      Vesicular breath sounds that are normal in that location.
    2. Which sequence does the electrical stimulus of the cardiac cycle follow?
      A)
      SA node AV node → bundle branches → purkinje fibers
      B)
      AV node SA node → purkinje fibers → bundle branches
      C)
      Bundle branches → AV node → SA node → purkinje fibers
      D)
      AV node → SA node → bundle branches→ purkinje fibers
    3. During ocular examinations, what should the nurse keep in mind regarding the movement of the extraocular muscles?
      A)
      Is impaired in a patient with cataracts.
      B)
      Is always decreased in the older adult.
      C)
      Is stimulated by cranial nerves (CNS) I and II.
      D)
      Is stimulated by CNS III, IV, and VI.
    4. A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?
      A)
      Anteroposterior-to-transverse diameter ratio of 1:1
      B)
      Unequal chest expansion
      C)
      Atrophied neck and trapezius muscles
      D)
      Increased tactile fremitus

    Exam Review

    1. A mother brings her 3-month-old infant to the clinic for evaluation of a cold. She tells the nurse that he has had "a runny nose for a week." When performing the physical assessment, the nurse notes that the child has nasal flaring and sternal and intercostal retractions. What should the nurse do next?
      A)
      Perform a complete cardiac assessment because these signs are probably indicative of early heart failure.
      B)
      Have the mother attempt to bottle feed the infant.
      C)
      Assure the mother that these signs are normal symptoms of a cold.
      D)
      Recognize that these are serious signs, and contact the physician.
    2. The nurse is reviewing the development of the newborn infant. Regarding the sinuses, which statement is true in relation to a newborn infant?
      A)
      Maxillary sinuses reach full size after puberty.
      B)
      Maxillary and ethmoid sinuses are the only sinuses present at birth.
      C)
      Frontal sinuses are fairly well developed at birth.
      D)
      Sphenoid sinuses are full size at birth.
    3. A patient has been diagnosed with strep throat. The nurse is aware that without treatment, which complication may occur?
      A)
      Rubella
      B)
      Leukoplakia
      C)
      Rheumatic fever
      D)
      Scarlet fever
    4. In performing a voice test to assess hearing, which of these actions would the nurse perform?
      A)
      Whisper a set of random numbers and letters, and then ask the patient to repeat them.
      B)
      Shield the lips so that the sound is muffled.
      C)
      Stand approximately 6 feet away to ensure that the patient can really hear at this distance.
      D)
      Ask the patient to place his or her finger in their ears to occlude outside noise.

    Exam Review

    1. During an examination of a female patient, the nurse notes lymphadenopathy and suspects an acute infection. How do acutely infected lymph nodes typically appear?
      A)
      Clumped
      B)
      Unilateral
      C)
      Soft and nontender
      D)
      Firm, tender, but freely movable
    2. When assessing a patient's lungs, what should the nurse recall about the left lung?
      A)
      Is shorter than the right lung because of the underlying stomach.
      B)
      Primarily consists of an upper lobe on the posterior chest.
      C)
      Is divided by the horizontal fissure.
      D)
      Consists of two lobes.
    3. The nurse understands that the four unrelated words test provides information related to which cognitive function?
      A)
      Thought content
      B)
      Attention span
      C)
      Distant memory
      D)
      New memory
    4. While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex is abnormal. What do these findings indicate?
      A)
      An otitis media
      B)
      Cholesteatoma
      C)
      A fungal infection
      D)
      A perforation of the eardrum

    Exam Review

    1. The nurse is performing the diagnostic positions test (6 Cardinal Gazes). Which result is a normal finding?
      A)
      Nystagmus in extreme superior gaze
      B)
      Slight amount of lid lag when moving the eyes from a superior to an inferior position
      C)
      Convergence of the eyes
      D)
      Parallel/synchronized movement of both eyes
    2. A patient has been admitted to the emergency department for a suspected drug overdose. His respirations are shallow, with an irregular pattern, at a rate of 12 respirations per minute. The nurse interprets this respiration pattern as which of the following?
      A)
      Bradypnea
      B)
      Agonal respirations
      C)
      Chronic obstructive breathing
      D)
      Hypoventilation
    3. The nurse is performing an eye-screening clinic at a daycare center. When examining a 2-year-old child, the nurse suspects that the child has a "lazy eye". What should the nurse do next?
      A)
      Assess child's ability to read.
      B)
      Consider this a normal finding.
      C)
      Assess the child's visual fields with the confrontation test.
      D)
      Test for strabismus by performing the corneal light reflex test (Sparkle Test).
    4. The mother of a 2-year-old toddler is concerned about the upcoming placement of tympanostomy tubes in her son's ears. The nurse would include which of these statements in the teaching plan?
      A)
      The purpose of the tubes is to decrease the pressure and allow for drainage.
      B)
      The tubes are permanently inserted during a surgical procedure.
      C)
      The tubes are placed in the inner ear.
      D)
      The tubes are used in children with sensorineural loss.

    Exam Review

    1. The nurse is observing the auscultation technique of a student nurse. What is the correct method to use when progressing from one auscultatory site on the thorax to another?
      A)
      Top-to-bottom comparison
      B)
      Side-to-side comparison
      C)
      Posterior-to-anterior comparison
      D)
      Interspace-by-interspace comparison
    2. The nurse is performing an otoscopic examination on an adult. Which of these actions is correct?
      A)
      Once the speculum is in the ear, releasing the traction.
      B)
      Pulling the pinna up and back before inserting the speculum.
      C)
      Tilt the person's head forward during the examination.
      D)
      Using the smallest speculum to decrease the amount of discomfort.
    3. The nurse asks the patient to stick out their tongue while performing an assessment of the mouth and throat. The nurse knows this provides information about what cranial nerve?
      A)
      XI
      B)
      V
      C)
      XII
      D)
      VII
    4. What is the tissue that connects the tongue to the floor of the mouth called?
      A)
      Papillae
      B)
      Uvula
      C)
      Palate
      D)
      Frenulum