Answers
Question 1
The nurse educator is preparing an education module for the nursing staff on the dermis layer
of skin. Which of these statements would be included in the module? The dermis:
a. Contains mostly fat cells.
b. Consists mostly of keratin.
c. Is replaced every 4 weeks.
d. Contains sensory receptors.
Correct Answer
d. Contains sensory receptors.
Question 2
A mother brings her 2-month-old daughter in for an examination and says, My daughter rolled
over against the wall, and now I have noticed that she has this spot that is soft on the top of her
head. Is something terribly wrong? The nurses best response would be:
a. Perhaps that could be a result of your dietary intake during pregnancy.
b. Your baby may have craniosynostosis, a disease of the sutures of the brain.
c. That soft spot may be an indication of cretinism or congenital hypothyroidism.
d. That soft spot is normal, and actually allows for growth of the brain during the first year of
your
babys life.
Correct Answer
d. That soft spot is normal, and actually allows for growth of the brain during the first year of
your
babys life.
Question 3
The nurse is reviewing the technique of palpating for tactile fremitus with a new graduate.
Which statement by the graduate nurse reflects a correct understanding of tactile fremitus?
Tactile fremitus:
,a. Is caused by moisture in the alveoli.
b. Indicates that air is present in the subcutaneous tissues.
c. Is caused by sounds generated from the larynx.
d. Reflects the blood flow through the pulmonary arteries.
Correct Answer
c. Is caused by sounds generated from the larynx.
Question 4
The nurse is reviewing the characteristics of breath sounds. Which statement about
bronchovesicular breath sounds is true? Bronchovesicular breath sounds are:
a. Musical in quality.
b. Usually caused by a pathologic disease.
c. Expected near the major airways.
d. Similar to bronchial sounds except shorter in duration.
Correct Answer
c. Expected near the major airways.
Question 5
The primary muscles of respiration include the:
a. Diaphragm and intercostals.
b. Sternomastoids and scaleni.
c. Trapezii and rectus abdominis.
d. External obliques and pectoralis major.
Correct Answer
a. Diaphragm and intercostals.
Question 6
,A clinic nurse is preparing to evaluate the peripheral vision of a client by the confrontational
method. Which method describes the accurate procedure to perform this test?
a. The client is asked to discriminate numbers from a chart composed of colored dots.
b. The room is darkened, and the client is asked to identify colored blocks and shapes when
they appear in the visual field.
c. The examiner and client cover their right eyes and stare at each other's left eyes, and a small
object is brought into the visual field.
d. The examiner and client cover the eyes directly opposite to one another and stare at each
other's uncovered eye, and a small object is brought into the visual field.
Correct Answer
The examiner and client cover the eyes directly opposite to one another and stare at each
other's uncovered eye, and a small object is brought into the visual field.
Question 7
The nurse is assessing color vision of a male child. Which statement is correct? The nurse
should:
a. Check color vision annually until the age of 18 years.
b. Ask the child to identify the color of his or her clothing.
c. Test for color vision once between the ages of 4 and 8 years.
d. Begin color vision screening at the childs 2-year checkup.
Correct Answer
c. Test for color vision once between the ages of 4 and 8 years.
Question 8
The nurse is performing an otoscopic examination on an adult. Which of these actions is
correct?
a. Tilting the persons head forward during the examination
b. Once the speculum is in the ear, releasing the traction
c. Pulling the pinna up and back before inserting the speculum
d. Using the smallest speculum to decrease the amount of discomfort
Correct Answer
, c. Pulling the pinna up and back before inserting the speculum
Question 9
A patient with a middle ear infection asks the nurse, What does the middle ear do? The nurse
responds by telling the patient that the middle ear functions to:
a. Maintain balance.
b. Interpret sounds as they enter the ear.
c. Conduct vibrations of sounds to the inner ear.
d. Increase amplitude of sound for the inner ear to function
Correct Answer
c. Conduct vibrations of sounds to the inner ear.
Question 10
During an assessment of an adult, the nurse has noted unequal chest expansion and recognizes
that this occurs in which situation?
a. In an obese patient
b. When part of the lung is obstructed or collapsed
c. When bulging of the intercostal spaces is present
d. When accessory muscles are used to augment respiratory effort
Correct Answer
b. When part of the lung is obstructed or collapsed
Question 11
The nurse is making initial rounds on the nursing unit to check the condition of assigned clients.
One client complains of discomfort at the intravenous (IV) site, and the nurse notes that the site
is cool, pale, and swollen and that the solution is infusing slowly. What action would the nurse
take first?
a. Stop the IV infusion.
b. Apply ice to the catheter site.