NUR 211 FINAL EXAM QUESTIONS AND ANSWERS
Explain the correct way to palpate the breast. p. 359-361 - CORRECT ANSWER✅✅Pt supine with arm
over head -
There are several different techniques to assess for lumps. It is important that the nurse has a
systematic search pattern to thoroughly assess each breast, the tail of Spence, and axillary lymph nodes.
Circular pattern for palpation - CORRECT ANSWER✅✅starts by palpating the areola first and moving in
a circular motion from the areola to the outer perimeter of the breast
Radial spoke pattern for palpation - CORRECT ANSWER✅✅also known as the wedge pattern, divides
the breast into wedges; starts at the periphery of the breast and palpates toward the nipple
Vertical strip pattern for palpation - CORRECT ANSWER✅✅starts at the sternum palpating up and down
in straight lines toward the outer perimeter of the breast, ending up in the axillary area
Describe the correct positioning for conducting a pap smear. p.363-364 - CORRECT ANSWER✅✅Ask the
patient to undress from the waist down, but tell her that she may leave her socks on; provide a gown,
draping, and privacy for the patient.
■ Tell the patient that she can sit at the end of the examination table until the healthcare provider is
ready to perform the assessment; the healthcare provider will assist the patient into the lithotomy
position.
When the healthcare provider is ready to begin, assist the patient into the lithotomy position by having
the patient move her buttocks down to the end of the examination table; ask the patient to place the
heels of her feet into the stirrups; assist the patient as needed for comfort and safety. Provide a sheet
over her legs and knees for privacy until the assessment begins.
Explain the needed patient teaching to treat and prevent constipation - CORRECT ANSWER✅✅Eat a
High fiber Diet, Eat fruits, veg and whole grains
Avoid high fat foods like meat, eggs and cheese (dairy)
Stay hydrated but avoid caffeine and alcohol (these will dehydrate you)
keep moving around and exercise
If needed- stool softener or laxatives
,Do not read or be on phone while on toilet
Discuss the causes of projectile vomiting in adults. p.247 - CORRECT ANSWER✅✅Projectile vomiting
without nausea is a sign of central stimulation of the medulla; could be a sign of brain pathology or head
trauma.
Identify the 3 organs located at the midline. p.251 - CORRECT ANSWER✅✅Aorta
Uterus
Bladder
Describe how the jugular vein changes with congestive heart failure. p.272 - CORRECT
ANSWER✅✅Visible distention is a sign of venous pressure elevation, commonly seen in congestive
heart failure and fluid overload.
Identify where the brachial, carotid, femoral and tibial pulses are located and palpated. - CORRECT
ANSWER✅✅Brachial Pulse : Medial side of arm at the antecubital fossa space.
Carotid Pulse: between the trachea and sternocleidomastoid muscle.
Femoral Pulse:along the crease midway between the pubic bone and the anterior iliac crest.
Tibial Pulse: behind and below the medial malleolus.
Explain the rationale for the elderly's noncompliance with prescribed medicines. - CORRECT
ANSWER✅✅Most cases (75%) of nonadherence among older adults are intentional due to cost or side
effects of drugs
Identify the sound of percussion of the abdomen when there is air, fluid, or a hematoma present. -
CORRECT ANSWER✅✅Air-hollow, fluid - thudding sound, hematoma - (there would be visual
representation)
Explain all the steps for starting any physical assessment on a patient. (Accept the abdomen) - CORRECT
ANSWER✅✅inspection, palpation, percussion, auscultation
, Explain the necessary teaching for male patients with a family history of breast cancer. - CORRECT
ANSWER✅✅most common presentation of male breast cancer is painless, palpable, subareolar lump or
mass. may also present as erythema of skin, scaling of the nipple, or nipple discharge
List the health screenings recommended for male patients and their frequency. - CORRECT
ANSWER✅✅testicular exam by doctor annually and self exams routinely
prostate screenings annually for men over age 50 or high risk men age 40+
male breast exam - self exam . for men with fam hx of breast cancer semiannual clinical exam (starting
at age 35) baseline mamogram at age 40
Identify the elements of good patient care documentation. - CORRECT ANSWER✅✅documentation
should be clear, concise, and detailed. subjective data should be documented using the patients exact
words and quotation marks
Identify the purpose of health assessment for nurses. - CORRECT ANSWER✅✅Health assessment is an
essential skill to nursing practice. Assessing patients and being able to identify normal from abnormal
findings is an essential role of the RN. Nurses must be able to use learned skills to collect information
about patients' health and physical well-being.
Health assessment means assessing the whole patient. This includes:
A method to establish a baseline health history by collecting pertinent patient health status data
An organized, systematic, ongoing process of collecting, validating, and clustering data
Collecting different types of data about the individual's past and present health
Assessing factors influencing health and well-being, including
physical health
behavioral aspects of health
spirituality
social factors
economic-political aspects of health
cultural variations
lifespan and developmental considerations
Performing a physical examination.
Explain the correct way to palpate the breast. p. 359-361 - CORRECT ANSWER✅✅Pt supine with arm
over head -
There are several different techniques to assess for lumps. It is important that the nurse has a
systematic search pattern to thoroughly assess each breast, the tail of Spence, and axillary lymph nodes.
Circular pattern for palpation - CORRECT ANSWER✅✅starts by palpating the areola first and moving in
a circular motion from the areola to the outer perimeter of the breast
Radial spoke pattern for palpation - CORRECT ANSWER✅✅also known as the wedge pattern, divides
the breast into wedges; starts at the periphery of the breast and palpates toward the nipple
Vertical strip pattern for palpation - CORRECT ANSWER✅✅starts at the sternum palpating up and down
in straight lines toward the outer perimeter of the breast, ending up in the axillary area
Describe the correct positioning for conducting a pap smear. p.363-364 - CORRECT ANSWER✅✅Ask the
patient to undress from the waist down, but tell her that she may leave her socks on; provide a gown,
draping, and privacy for the patient.
■ Tell the patient that she can sit at the end of the examination table until the healthcare provider is
ready to perform the assessment; the healthcare provider will assist the patient into the lithotomy
position.
When the healthcare provider is ready to begin, assist the patient into the lithotomy position by having
the patient move her buttocks down to the end of the examination table; ask the patient to place the
heels of her feet into the stirrups; assist the patient as needed for comfort and safety. Provide a sheet
over her legs and knees for privacy until the assessment begins.
Explain the needed patient teaching to treat and prevent constipation - CORRECT ANSWER✅✅Eat a
High fiber Diet, Eat fruits, veg and whole grains
Avoid high fat foods like meat, eggs and cheese (dairy)
Stay hydrated but avoid caffeine and alcohol (these will dehydrate you)
keep moving around and exercise
If needed- stool softener or laxatives
,Do not read or be on phone while on toilet
Discuss the causes of projectile vomiting in adults. p.247 - CORRECT ANSWER✅✅Projectile vomiting
without nausea is a sign of central stimulation of the medulla; could be a sign of brain pathology or head
trauma.
Identify the 3 organs located at the midline. p.251 - CORRECT ANSWER✅✅Aorta
Uterus
Bladder
Describe how the jugular vein changes with congestive heart failure. p.272 - CORRECT
ANSWER✅✅Visible distention is a sign of venous pressure elevation, commonly seen in congestive
heart failure and fluid overload.
Identify where the brachial, carotid, femoral and tibial pulses are located and palpated. - CORRECT
ANSWER✅✅Brachial Pulse : Medial side of arm at the antecubital fossa space.
Carotid Pulse: between the trachea and sternocleidomastoid muscle.
Femoral Pulse:along the crease midway between the pubic bone and the anterior iliac crest.
Tibial Pulse: behind and below the medial malleolus.
Explain the rationale for the elderly's noncompliance with prescribed medicines. - CORRECT
ANSWER✅✅Most cases (75%) of nonadherence among older adults are intentional due to cost or side
effects of drugs
Identify the sound of percussion of the abdomen when there is air, fluid, or a hematoma present. -
CORRECT ANSWER✅✅Air-hollow, fluid - thudding sound, hematoma - (there would be visual
representation)
Explain all the steps for starting any physical assessment on a patient. (Accept the abdomen) - CORRECT
ANSWER✅✅inspection, palpation, percussion, auscultation
, Explain the necessary teaching for male patients with a family history of breast cancer. - CORRECT
ANSWER✅✅most common presentation of male breast cancer is painless, palpable, subareolar lump or
mass. may also present as erythema of skin, scaling of the nipple, or nipple discharge
List the health screenings recommended for male patients and their frequency. - CORRECT
ANSWER✅✅testicular exam by doctor annually and self exams routinely
prostate screenings annually for men over age 50 or high risk men age 40+
male breast exam - self exam . for men with fam hx of breast cancer semiannual clinical exam (starting
at age 35) baseline mamogram at age 40
Identify the elements of good patient care documentation. - CORRECT ANSWER✅✅documentation
should be clear, concise, and detailed. subjective data should be documented using the patients exact
words and quotation marks
Identify the purpose of health assessment for nurses. - CORRECT ANSWER✅✅Health assessment is an
essential skill to nursing practice. Assessing patients and being able to identify normal from abnormal
findings is an essential role of the RN. Nurses must be able to use learned skills to collect information
about patients' health and physical well-being.
Health assessment means assessing the whole patient. This includes:
A method to establish a baseline health history by collecting pertinent patient health status data
An organized, systematic, ongoing process of collecting, validating, and clustering data
Collecting different types of data about the individual's past and present health
Assessing factors influencing health and well-being, including
physical health
behavioral aspects of health
spirituality
social factors
economic-political aspects of health
cultural variations
lifespan and developmental considerations
Performing a physical examination.
