1 Inquire through: | Professional | Confidential Support
Health Assessment Questions and Answers
(100% Correct Answers)
An adolescent patient appears reluctant to discuss sensitive issues with her parents
present. What is the nurse's most appropriate intervention?
Ans: Provide time when the adolescent is alone with the nurse.
What does the nurse teach to parents to prevent sudden infant death syndrome
(SIDS)?
Ans: Place the baby on back to sleep.
In taking a history from an adolescent girl about diet and nutrition, a nurse
specifically asks which question?
Ans: "Do you have any food restrictions or diet routines?"
A nurse is assessing a child who is able to dress herself, jump rope, identify colors,
and follow rules when playing games. These are expected developmental
achievements of a child of what age?
Ans: 5 years old
A 4-year-old child has had a tonsillectomy and the nurse is preparing to ask him
about his pain. Which technique is the most appropriate method for pain assessment
for this patient?
Ans: Using the Wong/Baker FACES rating scale
Which assessment technique is appropriate to measure the 8-month-old's vital signs
during a well-baby check?
Ans: Observe the infant's abdomen when counting respirations.
An American Indian mother expresses concern about an irregularly shaped, dark area
over her neonate's sacrum and buttocks. What is the nurse's most appropriate
response to this mother?
Ans: "This is a birth mark and they usually disappear by age 1 or 2 years."
How does a nurse document a large, flat bluish capillary area on a neonate's cheek?
Ans: Port-wine stain (nevus flammeus)
How does a nurse collect baseline measurements of a 6-month-old infant?
Ans: Measure the head just above the ears and eyebrows.
How does a nurse assess the head circumference of an infant?
Ans: Places a measuring tape around the head above the eyebrows and occipital
prominence.
, 2 Inquire through: | Professional | Confidential Support
During a well-baby check for several 4-month-old infants, a nurse recognizes that
which infant needs further assessment of an abnormal finding?
Ans: The infant whose head circumference and chest circumference are equal
Which finding indicates to a nurse that a neonate has a cephalhematoma?
Ans: Well-defined edematous area over one cranial bone
During assessment of an infant, the nurse notes that when the infant cries, the
fontanelles bulge slightly. What is the most appropriate action for the nurse at this
time?
Ans: Assess the fontanelles again when the child is not crying.
A mother who sees her newborn just after vaginal delivery is distraught because the
child's head is elongated. Which response is most appropriate by the nurse?
Ans: "This is not unusual after a vaginal delivery and will go away in about a week."
A nurse shines the light from the ophthalmoscope into the eyes of a newborn and
observes a bright, round, red-orange glow seen through both pupils. How does the
nurse document this finding?
Ans: An expected red reflex
What finding does a nurse expect when assessing a one-month old's eyes and vision?
Ans: The newborn following a bright toy or light
Which finding rules out defects in the cornea, lens, and vitreous chamber of an
infant?
Ans: Bilateral red reflex
In assessing the eyes of a 4-month-old infant, a nurse shines a penlight in the infant's
eyes and notices that the light reflection is not in the same location in each eye. What
is the nurse's most appropriate response to this finding?
Ans: Document it as an expected finding at this age.
What technique does a nurse use to inspect the ear canal of a 1-year-old child?
Ans: Uses an assistant to hold the child's arms down and keep the child's head
turned to one side
In inspecting the eyes and ears of an infant, the nurse documents which finding as
normal?
Ans: The external ear is in direct line with the outer margin of the eyelid.
Which behavior would be most indicative of hearing impairment in a 1-year-old
child?
Ans: Failure to respond to mother's voice
Health Assessment Questions and Answers
(100% Correct Answers)
An adolescent patient appears reluctant to discuss sensitive issues with her parents
present. What is the nurse's most appropriate intervention?
Ans: Provide time when the adolescent is alone with the nurse.
What does the nurse teach to parents to prevent sudden infant death syndrome
(SIDS)?
Ans: Place the baby on back to sleep.
In taking a history from an adolescent girl about diet and nutrition, a nurse
specifically asks which question?
Ans: "Do you have any food restrictions or diet routines?"
A nurse is assessing a child who is able to dress herself, jump rope, identify colors,
and follow rules when playing games. These are expected developmental
achievements of a child of what age?
Ans: 5 years old
A 4-year-old child has had a tonsillectomy and the nurse is preparing to ask him
about his pain. Which technique is the most appropriate method for pain assessment
for this patient?
Ans: Using the Wong/Baker FACES rating scale
Which assessment technique is appropriate to measure the 8-month-old's vital signs
during a well-baby check?
Ans: Observe the infant's abdomen when counting respirations.
An American Indian mother expresses concern about an irregularly shaped, dark area
over her neonate's sacrum and buttocks. What is the nurse's most appropriate
response to this mother?
Ans: "This is a birth mark and they usually disappear by age 1 or 2 years."
How does a nurse document a large, flat bluish capillary area on a neonate's cheek?
Ans: Port-wine stain (nevus flammeus)
How does a nurse collect baseline measurements of a 6-month-old infant?
Ans: Measure the head just above the ears and eyebrows.
How does a nurse assess the head circumference of an infant?
Ans: Places a measuring tape around the head above the eyebrows and occipital
prominence.
, 2 Inquire through: | Professional | Confidential Support
During a well-baby check for several 4-month-old infants, a nurse recognizes that
which infant needs further assessment of an abnormal finding?
Ans: The infant whose head circumference and chest circumference are equal
Which finding indicates to a nurse that a neonate has a cephalhematoma?
Ans: Well-defined edematous area over one cranial bone
During assessment of an infant, the nurse notes that when the infant cries, the
fontanelles bulge slightly. What is the most appropriate action for the nurse at this
time?
Ans: Assess the fontanelles again when the child is not crying.
A mother who sees her newborn just after vaginal delivery is distraught because the
child's head is elongated. Which response is most appropriate by the nurse?
Ans: "This is not unusual after a vaginal delivery and will go away in about a week."
A nurse shines the light from the ophthalmoscope into the eyes of a newborn and
observes a bright, round, red-orange glow seen through both pupils. How does the
nurse document this finding?
Ans: An expected red reflex
What finding does a nurse expect when assessing a one-month old's eyes and vision?
Ans: The newborn following a bright toy or light
Which finding rules out defects in the cornea, lens, and vitreous chamber of an
infant?
Ans: Bilateral red reflex
In assessing the eyes of a 4-month-old infant, a nurse shines a penlight in the infant's
eyes and notices that the light reflection is not in the same location in each eye. What
is the nurse's most appropriate response to this finding?
Ans: Document it as an expected finding at this age.
What technique does a nurse use to inspect the ear canal of a 1-year-old child?
Ans: Uses an assistant to hold the child's arms down and keep the child's head
turned to one side
In inspecting the eyes and ears of an infant, the nurse documents which finding as
normal?
Ans: The external ear is in direct line with the outer margin of the eyelid.
Which behavior would be most indicative of hearing impairment in a 1-year-old
child?
Ans: Failure to respond to mother's voice
