NSG 3160 Health Assessment Exam 2 Actual Verified
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During the assessment of an 80-year-old patient, the
nurse notices that his hands show tremors when he
reaches for something and his head is always nodding. No
associated rigidity is observed with movement. Which of
these statements is most accurate?
A These findings are normal, resulting from aging.
B These findings could be r/t hyperthyroidism.
C These findings are the result of Parkinson disease.
D This patient should be evaluated for a cerebellar lesion.
- Answer-A These findings are normal, resulting from
aging.
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
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instructions, and overshoots the mark, missing the finger.
What does the nurse suspect?
A Cerebral injury
B Peripheral neuropathy
C Cerebrovascular accident
D Acute alcohol intoxication - Answer-D Acute alcohol
intoxication
When assessing the intensity of a patient's pain, which
question by the nurse is appropriate?
A "How does pain limit your activities?"
B "What does your pain feel like?"
C "How much pain do you have now?"
D "What makes your pain better or worse?" - Answer-C
"How much pain do you have now?"
The nurse is teaching a class on pain at a local retirement
community. Which statement about the pain experienced
by older adults should the nurse include in the
instructions?
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A "Pain is a normal process of aging and is to be
expected."
B "Pain indicates a pathologic condition or an injury and is
not a normal process of aging."
C "Older adults must learn to tolerate pain."
D "Older individuals perceive pain to a lesser degree than
do younger individuals." - Answer-B "Pain indicates a
pathologic condition or an injury and is not a normal
process of aging."
The nurse is conducting an interview with an adult male
patient. Which statement made by the patient indicates an
alcohol use disorder?
A "I usually stay out longer and drink more than I intended
but I still make it into work on time."
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B "I've been late to work a few times so now I limit myself
to 2 drinks/day and stick to it."
C "I have a strong urge to drink and I've tried to stop
drinking several times but it doesn't last long."
D "I crave alcohol but have successfully cut down on my
alcohol consumption." - Answer-C "I have a strong urge to
drink and I've tried to stop drinking several times but it
doesn't last long."
The nurse has completed an assessment on a patient who
came to the clinic for a leg injury. As a result of the
assessment, the nurse has determined that the patient
has at-risk alcohol use. Which action by the nurse is most
appropriate at this time?
A State, "You are drinking more than is medically safe. I
strongly recommend that you quit drinking, and I'm willing
to help you."
B Give the patient information about a local rehabilitation
clinic.