Exam Review
- During a physical examination, a client demonstrates difficulty swallowing. Which cranial nerve should the nurse consider assessing for dysfunction?A)Cranial nerve VII (facial)B)Cranial nerve IX (glossopharyngeal)C)Cranial nerve V (trigeminal)D)Cranial nerve I (olfactory)
- A client is assessed for sensory deficits. Which part of the nervous system is primarily responsible for carrying sensory information from the periphery to the central nervous system?A)Parasympathetic nervous systemB)Central nervous systemC)Peripheral nervous systemD)Somatic nervous system
- A nurse is caring for a client who has a moderate vision impairment. Which of the following actions should the nurse take?A)Open shades on windows in the client's room to provide direct lighting.B)Speak loudly when talking to the client.C)Face the client when speaking to them.D)Use gestures to communicate with the client.
- When auscultating Erb’s point using a systematic Z-pattern approach, where should the nurse place the stethoscope?A)Right sternal border at the second intercostal spaceB)Left sternal border at the fourth intercostal spaceC)Left sternal border at the third intercostal spaceD)Left midclavicular line at the fifth intercostal space
Exam Review
- A nurse is teaching a client about managing opioid-induced constipation. Which statement by the client indicates a correct understanding of the role of dietary fiber?A)Increasing fiber intake alone is sufficient to prevent opioid-induced constipation without considering fluid intake.B)Most dairy products are good sources of dietary fiber and should be increased.C)Fiber decreases peristalsis, which helps prevent diarrhea caused by opioids.D)Fiber absorbs water in the intestines, creating softer and bulkier stool that is easier to pass.
- While auscultating a client's heart sounds, the nurse hears turbulence between the S1 and S2 heart sounds. The nurse should document this finding as which of the following?A)A systolic murmurB)An expected heart soundC)A third heart sound (S3)D)A fourth heart sound (S4)
- A nurse is preparing to palpate a client's abdomen. Which of the following findings is an expected abdominal characteristic?A)Palpable enlarged liver edge extending 4 cm below the costal marginB)Soft, non-tender abdomen with no masses or rigidityC)Visible pulsations in the epigastric regionD)Firm, rigid abdomen with rebound tenderness
- A nurse is assessing a client who has pneumonia. Which of the following findings should the nurse expect?A)Pulse deficitB)TachypneaC)HypothermiaD)Bradycardia
Exam Review
- A nurse is caring for a client who has constipation and is bearing down to have a bowel movement. The nurse should monitor the client for which of the following?A)Decreased exhaled carbon dioxideB)Increased respirationsC)Decreased heart rateD)Increased temperature
- Which chamber of the heart receives oxygenated blood from the pulmonary veins?A)Right ventricleB)Right atriumC)Left ventricleD)Left atrium
- A nurse is caring for a client who has an oxygen saturation of 88%. Which of the following actions should the nurse take?A)Encourage the client to take deep breaths.B)Request a prescription for an opioid analgesic.C)Ask the client to cough every 4 hours.D)Decrease the head of the client's bed.
- During a respiratory assessment, which breath sound would you expect to hear that is soft and low-pitched, resembling the sound of wind blowing through trees?A)RalesB)Tracheal breath soundsC)Bronchial breath soundsD)Vesicular breath sounds
Exam Review
- Which of the following layers of the heart is most involved in the pumping action?A)EndocardiumB)MyocardiumC)EpicardiumD)Pericardium
- A nurse is assessing a client and notes that the spine is straight and the movement upon inspiration is symmetrical. Which location best describes where the nurse is documenting these findings?A)Posterior chestB)AbdomenC)Anterior chestD)Lateral chest
- A nurse is caring for a client who recently had a stroke. The client requires assistance with strengthening the affected side. Which of the following referrals should the nurse anticipate the provider to make?A)Physical therapistB)Occupational therapistC)Respiratory therapistD)Social worker
- A 70-year-old male presents to the emergency department with confusion and shortness of breath. Upon assessment, the nurse notes decreased breath sounds on auscultation. What is the most appropriate first action for the nurse to take?A)Administer a bronchodilator to alleviate airflow obstruction.B)Administer supplemental oxygen to the patient.C)Order a chest X-ray to evaluate for pneumonia.D)Reassess the patient’s respiratory status in one hour.
Exam Review
- Which auscultation site is best located at the fifth intercostal space along the left midclavicular line?A)Aortic valveB)Mitral valveC)Pulmonic valveD)Erb's Point
- A nurse is teaching a client about maintaining taste and smell. Which of the following statements should the nurse make?A)Brush your teeth twice per day.B)Avoid using spices to season foods.C)Chew your foods quickly.D)See your dentist every 2 years.
- During an assessment, a pediatric client displays scoliosis symptoms. Which anatomical structure is primarily implicated in scoliosis?A)VertebraeB)Spinal cordC)LigamentsD)Muscle fibers
- When assessing a pediatric client with suspected pneumonia, the nurse notes wheezing and retractions. Which physiological explanation correlates with these findings?A)Airway obstruction from foreign objects creates localized wheezing.B)The presence of fluid in the alveoli reduces oxygen exchange.C)Increased surface tension in alveoli prevents full expansion.D)Narrowing of airways from inflammation increases resistance to airflow.
Exam Review
- When assessing a pediatric client with suspected pneumonia, the nurse notes wheezing and retractions. Which physiological explanation correlates with these findings?A)Airway obstruction from foreign objects creates localized wheezing.B)The presence of fluid in the alveoli reduces oxygen exchange.C)Increased surface tension in alveoli prevents full expansion.D)Narrowing of airways from inflammation increases resistance to airflow.
- Which stethoscope component is appropriate for auscultating high-pitched heart sounds such as S1, S2, and some murmurs?A)The bellB)The tubingC)The earpiecesD)The diaphragm
- When assessing a patient with suspected gastric ulcers, which symptom is most indicative of this diagnosis?A)Sudden intense abdominal painB)Burning pain that improves with eatingC)Sharp pain in the upper left abdomenD)Burning pain worsened by meals
- The endocardium is the innermost layer of the heart. What is its primary function?A)To separate the atria from the ventricles.B)To line the innermost layer of the heart and blood vessels.C)To protect the heart from external forces.D)To provide the pumping action of the heart.