ADVANCED HEALTH ASSESSMENT BASIC
PHYSICAL EXAM WITH QUESTIONS &
CORRECT ANSWERS GRADED A+
A nurse is caring for a client who has experienced an acute exacerbation of Crohn's
disease. Which assessment best indicates that the disease is under control? -
ANSWER-The client exhibits signs of adequate GI perfusion with normal bowel
sounds.
An older adult reports being cold in the room even though the thermostat is set at
75°F (24°C). The nurse can tell the client that older adults may feel cold for which
reason? - ANSWER-decreased ability to thermoregulate.
An older adult client is admitted to the hospital with a diagnosis of pneumonia. The
nurse learns that the client lives alone and has not been eating or drinking properly.
Upon physical assessment, the nurse notes tachycardia, hypotension, and
hyperthermia. Which admission order would the nurse implement first? -
ANSWER-intravenous fluid hydration
When teaching a group of middle-aged women, what would the nurse include
when discussing primary prevention? - ANSWER-prevention of osteoporosis, the
importance of regular breast self-examinations, and Pap smears
The nurse notes serous discharge when an abdominal dressing is changed. The
nurse would document this drainage as which of the following? - ANSWER-clear,
watery, yellow-tinged drainage
The nurse is assessing a client's respiratory status. Which assessment data indicate
a problem? - ANSWER-28 breaths/min and audible
,A client arrives at the emergency department with chest and stomach pain and a
report of black, tarry stools for several months. Which diagnostic testing would the
nurse anticipate? - ANSWER-ECG (electrocardiogram), complete blood count,
testing for occult blood, and comprehensive serum metabolic panel
The nurse is conducting an admission interview with a client and is assessing for
risk factors related to the client's safety. The nurse should include which targeted
assessments? Select all that apply. - ANSWER-suicide or self-harm ideation
recent use of substances of abuse
allergic reactions or adverse drug reactions
The nurse receives morning lab work after shift hand-off. Based on the analysis of
lab values, which client would the nurse assess first? - ANSWER-a client
diagnosed with renal disease and a serum potassium level of 6.1 mEq/dL (6.1
mmol/L) who has limited output
A client is on complete bed rest. The nurse should initiate measures to prevent
which complication of bed rest? - ANSWER-thrombophlebitis
A nurse prepares to auscultate a client's carotid arteries for bruits. For this
procedure, the nurse should - ANSWER-use the bell of the stethoscope.
A client is 12 hours post abdominal inguinal hernia repair done under general
anesthesia. The practitioner orders to progress diet as tolerated. Which tray should
the nurse choose for this client? - ANSWER-broth, gelatin cubes, and tea
A client's face, neck, and chest have been burned in a fire 1 hour ago. What is the
nurse's priority assessment at this time? - ANSWER-airway obstruction
, The nurse is caring for a postoperative client who has not voided since before
surgery. Which is the nurse's most appropriate action? - ANSWER-Palpate for the
bladder above the symphysis pubis.
Which finding in a client who recently underwent a total hip replacement would
require a nurse to take immediate action? - ANSWER-red painful area on the calf
of the affected leg
For which client is the nursing assessment of pain most likely to result in
undertreatment? - ANSWER-an older adult who grimaces and states no pain after a
gastrostomy tube placement
The most appropriate way for the nurse to assess a client's ability to perform
activities of daily living is to: observe client performing varied activities of daily
living. - ANSWER-observe client performing varied activities of daily living.
To assess the effectiveness of cardiac compressions during adult cardiopulmonary
resuscitation (CPR), a nurse should palpate which pulse site? - ANSWER-carotid
When assessing a dark-skinned client for cyanosis, what area of the body will best
reveal cyanosis? - ANSWER-oral mucous membranes
A client was brought to the emergency department following a motor vehicle
accident and has phrenic nerve involvement. The nurse should assess the client for
which nursing problem? - ANSWER-ineffective breathing pattern
A client in the postanesthesia care unit is being actively rewarmed with an external
warming device. How often should the nurse monitor the client's body
temperature? - ANSWER-every 15 minutes
PHYSICAL EXAM WITH QUESTIONS &
CORRECT ANSWERS GRADED A+
A nurse is caring for a client who has experienced an acute exacerbation of Crohn's
disease. Which assessment best indicates that the disease is under control? -
ANSWER-The client exhibits signs of adequate GI perfusion with normal bowel
sounds.
An older adult reports being cold in the room even though the thermostat is set at
75°F (24°C). The nurse can tell the client that older adults may feel cold for which
reason? - ANSWER-decreased ability to thermoregulate.
An older adult client is admitted to the hospital with a diagnosis of pneumonia. The
nurse learns that the client lives alone and has not been eating or drinking properly.
Upon physical assessment, the nurse notes tachycardia, hypotension, and
hyperthermia. Which admission order would the nurse implement first? -
ANSWER-intravenous fluid hydration
When teaching a group of middle-aged women, what would the nurse include
when discussing primary prevention? - ANSWER-prevention of osteoporosis, the
importance of regular breast self-examinations, and Pap smears
The nurse notes serous discharge when an abdominal dressing is changed. The
nurse would document this drainage as which of the following? - ANSWER-clear,
watery, yellow-tinged drainage
The nurse is assessing a client's respiratory status. Which assessment data indicate
a problem? - ANSWER-28 breaths/min and audible
,A client arrives at the emergency department with chest and stomach pain and a
report of black, tarry stools for several months. Which diagnostic testing would the
nurse anticipate? - ANSWER-ECG (electrocardiogram), complete blood count,
testing for occult blood, and comprehensive serum metabolic panel
The nurse is conducting an admission interview with a client and is assessing for
risk factors related to the client's safety. The nurse should include which targeted
assessments? Select all that apply. - ANSWER-suicide or self-harm ideation
recent use of substances of abuse
allergic reactions or adverse drug reactions
The nurse receives morning lab work after shift hand-off. Based on the analysis of
lab values, which client would the nurse assess first? - ANSWER-a client
diagnosed with renal disease and a serum potassium level of 6.1 mEq/dL (6.1
mmol/L) who has limited output
A client is on complete bed rest. The nurse should initiate measures to prevent
which complication of bed rest? - ANSWER-thrombophlebitis
A nurse prepares to auscultate a client's carotid arteries for bruits. For this
procedure, the nurse should - ANSWER-use the bell of the stethoscope.
A client is 12 hours post abdominal inguinal hernia repair done under general
anesthesia. The practitioner orders to progress diet as tolerated. Which tray should
the nurse choose for this client? - ANSWER-broth, gelatin cubes, and tea
A client's face, neck, and chest have been burned in a fire 1 hour ago. What is the
nurse's priority assessment at this time? - ANSWER-airway obstruction
, The nurse is caring for a postoperative client who has not voided since before
surgery. Which is the nurse's most appropriate action? - ANSWER-Palpate for the
bladder above the symphysis pubis.
Which finding in a client who recently underwent a total hip replacement would
require a nurse to take immediate action? - ANSWER-red painful area on the calf
of the affected leg
For which client is the nursing assessment of pain most likely to result in
undertreatment? - ANSWER-an older adult who grimaces and states no pain after a
gastrostomy tube placement
The most appropriate way for the nurse to assess a client's ability to perform
activities of daily living is to: observe client performing varied activities of daily
living. - ANSWER-observe client performing varied activities of daily living.
To assess the effectiveness of cardiac compressions during adult cardiopulmonary
resuscitation (CPR), a nurse should palpate which pulse site? - ANSWER-carotid
When assessing a dark-skinned client for cyanosis, what area of the body will best
reveal cyanosis? - ANSWER-oral mucous membranes
A client was brought to the emergency department following a motor vehicle
accident and has phrenic nerve involvement. The nurse should assess the client for
which nursing problem? - ANSWER-ineffective breathing pattern
A client in the postanesthesia care unit is being actively rewarmed with an external
warming device. How often should the nurse monitor the client's body
temperature? - ANSWER-every 15 minutes
