NURS 4455 QUIZ 3 | QUESTIONS AND ANSWERS

NURS 4455 QUIZ 3 A patient has an exaggerated lumbar curve to the lower spine. This would be documented as: Selected Answer: Lordosis You note from the patient's history that she has had pain with internal rotation of her right shoulder. This will most likely affect which of the following activities? Reaching an item off the top shelf of her closet, over her head. True or False: When assessing for a patient's response to painful stimuli, the nurse should always begin with the least noxious stimulus first, before proceeding to more painful means. True A woman brings her 69-year-old husband to the clinic for an evaluation because he has become increasingly forgetful. Which of the following would lead the nurse to suspect that the client has Alzheimer's disease? Select the one answer that does notindicate that he may have Alzheimer’s disease. A. “He got lost walking to the pharmacy around the corner the other day.” C. “I have to balance the checkbook now because he just won't do it.” D. “If I don't tell him when to shower, he won't and will fight me on it.” E. “He repeats the same story, word for word, over and over again.” A female in Tanner stage 5 would have which sexual characteristics? Adult Configuration; projection of nipple, areola receded When the nurse palpates the abdomen of a preschool boy, he begins to giggle and draw his legs up onto his abdomen, and says you’re tickling him. Which of the following would be most appropriate for the nurse to do? Palpate with the child’s hand under the nurse’s hand As part of a mental status assessment, the nurse asks a client to draw the face of a clock. This will allow the nurse to assess which of the following domains of mental status? Visual perceptual + Constructional Ability A client's recent episode of becoming lost near his home has prompted the nurse to use the Saint Louis University Mental Status (SLUMS) Assessment Tool. The nurse should begin this assessment by asking what question? “Can I ask you some questions about yourmemory?” An emergency department nurse has utilized the Confusion Assessment Method (CAM) in the assessment of a 79-year-old client with a new onset of urinary incontinence. This assessment tool will allow the nurse to confirm the presence of what health problem? Delirium When auscultating the left carotid artery, the nurse notes a swishing sound. What would thissuggest? A narrowed vessel A nurse assesses a client's capillary refill and finds it to be less than 2 seconds. Which of the following should the nurse do next? Document this finding as normal. The nurse is assessing the various lobes of the client's lungs. To gather accurate data, the nurse must assess which lobe anteriorly, since this lobe does not extend to the posterior chest? Right middle lobe The nurse is listening to the precordium, and identifies a heart murmur so loud it can be heard with the stethoscope not in full contact with the chest. What rating would this murmur merit? Grade 5/6 The nurse is analyzing the data from the assessment of a client's heart and neck vessels. The client's first heart sound corresponds with what event in the cardiac cycle? Closure of the atrioventricular valves Assessment of a client's radial pulse reveals that it is bounding and does not disappear with moderate pressure. The nurse documents the pulse amplitude as which of the following? +3 On auscultation of valvular sounds over the precordium, what area is auscultated at the third to fifth intercostal space at the left sternal border? Erb's Point On auscultation of valvular sounds over the precordium, what area is auscultated at the second or third intercostal space at the left sternal border? Pulmonic