Health history
Parents or caregivers accompany children to the health care setting. At what age does the interviewer start asking the child directly about his or her presenting symptoms?
A. 5 years
B. 7 years Correct
C. 9 years
D. 11 years
The correct answer is: 7 years.
Rationale: At around 7 years of age, children typically develop the cognitive and verbal skills necessary to communicate their symptoms more effectively. While younger children may not be able to fully articulate their feelings, a 7-year-old is generally able to understand questions about their health and provide a more accurate description of symptoms. However, the involvement of parents or caregivers is still crucial in gathering a complete history, particularly for younger children or those with special needs.
Due to the aging process, an older adult
A. experiences a 10-point decrease in intelligence.
B. has diminished recent and remote memory recall.
C. has a slower response time.
D. has difficulty with problem solving.
The correct answer is: has a slower response time.
Rationale: As individuals age, it is common to experience a slower response time, which can affect their ability to react quickly in various situations. This slowing down is due to changes in the nervous system, including reduced processing speed and slower neural transmission.
The other options are less accurate:
•Experiences a 10-point decrease in intelligence: While some cognitive changes can occur with aging, a significant decrease in intelligence (e.g., 10 points) is not typical or inevitable. Intelligence remains relatively stable, though some aspects of cognition may decline with age.
•Has diminished recent and remote memory recall: Older adults may experience some mild difficulty with memory, particularly with recent events, but substantial impairment is not necessarily a normal part of aging. Severe memory loss is more commonly associated with conditions such as dementia.
•Has difficulty with problem solving: Although some older adults may experience challenges with complex problem-solving, difficulty with problem-solving is not a guaranteed part of aging. Many older adults maintain strong problem-solving skills, particularly with experience and wisdom gained over time.
Which of the following may be related to increased bruising and bleeding in older adults? Select all that apply
A. Thinning of the skin
B. A reduction in the integrity of blood vessels
C. Ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Decreased fluid intake
The correct answers are:
•Thinning of the skin
•A reduction in the integrity of blood vessels
•Ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs)
Rationale:
•Thinning of the skin: As people age, the skin becomes thinner and loses its elasticity, which makes it more prone to bruising and damage, even with minor trauma.
•A reduction in the integrity of blood vessels: Aging can lead to changes in blood vessels, such as a loss of elasticity and thinning of vessel walls, which may contribute to easier bruising and bleeding.
•Ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen, can impair platelet function and interfere with blood clotting, increasing the risk of bruising and bleeding.
Decreased fluid intake: While dehydration can affect skin integrity, it is not as directly linked to increased bruising and bleeding compared to the other factors.
Which gland will the nurse examine when a patient’s laboratory data reveals an elevated thyroxine (T4) level?
A. Thyroid
B. Parotid
C. Adrenal
D. Parathyroid
A
Which of the following is included in documenting a history source?
A. Appearance, dress, and hygiene
B. Cognition and literacy level
C. Documented relationship of support systems
D. Reliability of informant
The correct answer is: Reliability of informant.
Rationale: When documenting a history source, it's essential to note the reliability of the informant. This refers to the accuracy and consistency of the information provided, especially if the patient is unable to provide their own history, or if the information is coming from family members or other sources. Evaluating the reliability helps clinicians assess the validity of the gathered history and consider any potential biases or misunderstandings.
The other options are important for overall patient assessment, but they are not directly related to documenting the history source:
•Appearance, dress, and hygiene: These relate to the general physical assessment but are not part of the history source.
•Cognition and literacy level: These factors are relevant to patient assessment but not specifically to documenting the history source.
•Documented relationship of support systems: This is part of the overall assessment, particularly in understanding the patient's social and support network, but it is not part of documenting the history source.
The mental status examination;
A. should be completed at the end of the physical examination.
B. will not be affected if the patient has a language impairment.
C. is usually not assessed in children younger than age 2 years.
D. assesses mental health strengths and coping skills and screens for any dysfunction.
The correct answer is: assesses mental health strengths and coping skills and screens for any dysfunction.
Rationale: The mental status examination (MSE) is an important tool for assessing a patient's cognitive and emotional functioning. It screens for potential mental health issues, including cognitive dysfunction, mood disorders, and psychiatric conditions. Additionally, the MSE evaluates mental health strengths, coping mechanisms, and the ability to manage stress or psychological challenges.
The other options are incorrect:
•Should be completed at the end of the physical examination: While the MSE can be conducted at any point during the patient interaction, it is typically integrated throughout the assessment process and not necessarily saved for the end.
•Will not be affected if the patient has a language impairment: Language impairments can significantly impact the MSE, as the patient's ability to communicate their thoughts, understanding, and responses is crucial for accurate assessment.
•Is usually not assessed in children younger than age 2 years: While it is true that MSEs are typically adapted for different age groups, even in infants and young children, clinicians assess developmental milestones, behavior, and signs of cognitive or emotional distress.
While the nurse is taking the health history, the patient complains of pruritus. What is a potential cause of this symptom?
A. Excessive bruising
B. Hyperpigmentation
C. Diaphoresis
D. Drug reactions
The correct answer is Drug reactions.
Rationale: Pruritus (itching) can be caused by a variety of factors, and one common cause is drug reactions. Certain medications, including antibiotics, opioids, and others, can cause allergic reactions or sensitivities that result in itching.
The other options are less likely to directly cause pruritus:
•Excessive bruising: Typically a result of trauma or clotting disorders, but not usually associated with itching.
•Hyperpigmentation: Refers to darker skin areas and is not typically associated with itching.
•Diaphoresis (sweating): While excessive sweating can cause skin irritation, it is more likely to lead to discomfort or rash rather than pruritus.
Which statement reflects aging and bones becoming more noticeable in the face?
Correct answer is
C
When taking the health history from an adolescent, the interviewer should:
A. ask about violence and abuse before asking about alcohol and drug use.
B. have at least one parent present during the interview.
C. interview the youth alone, with the parent(s) waiting in the waiting area.
D. ask about the use of condoms.
The correct answer is:
Interview the youth alone, with the parent(s) waiting in the waiting area.
Rationale:
When taking a health history from an adolescent, it's important to create a safe and confidential environment that encourages honest communication. Interviewing the adolescent alone helps to build trust and allows the youth to feel more comfortable discussing sensitive topics like substance use, mental health, sexual health, and experiences of abuse. Adolescents may be more likely to open up when their parents are not present.
•Asking about violence and abuse before alcohol and drug use can be important, but the approach should focus on providing a safe space for the adolescent to express concerns about any issue in their life. The order of questions can depend on the situation.
•Having a parent present can hinder open communication, as adolescents may feel uncomfortable discussing certain topics in front of them.
•Asking about the use of condoms is important, but this would be part of a broader sexual health assessment, typically after establishing a rapport and ensuring the adolescent feels comfortable discussing these topics alone.
Which element is essential for a nurse to establish with a patient when conducting a mental health assessment?
A. Communication
B. Therapeutic relationship
C. Rapport
D. Positive outcomes
Correct answer:
C
A patient presents with primary concern of unexpected weight loss. Integumentary findings consistent with unexplained weight loss and malnutrition include (select all that apply):
A. Moist, warm skin
B. Brittle, dry nails
C. Terminal hair loss
D. Adequate skin turgor
The answer is
B & C
Dry, brittle nails and terminal hair loss are integumentary signs of dietary deficiencies and malnutrition.
Which assessment finding will the nurse likely notice when assessing a patient has an enlarged, rather thick skull, likely due to acromegaly?
A. Exophthalmos
B. Sunken eyes
C. Coarse facial features
D. Rounded moonlike face
Correct answer is
C.
At the end of the examination, the examiner should_____________ and __________. (Choose two answers)
A. complete the documentation before leaving the examination room.
B. have the findings confirmed by another provider.
C. compare objective and subjective data for discrepancies.
D. review the findings with the patient.
The two correct answers are:
•Compare objective and subjective data for discrepancies.
•Review the findings with the patient.
Rationale:
•Compare objective and subjective data for discrepancies: It's essential to review both sets of data to ensure consistency and accuracy before finalizing the examination findings. Discrepancies should be clarified before documenting or making a diagnosis.
•Review the findings with the patient: Discussing the findings with the patient helps ensure understanding, allows for clarification of any concerns, and provides an opportunity for shared decision-making in care planning.
These steps help ensure that the examination is thorough and the information is accurately communicated.
Which statement about the force or strength of a patient’s pulse is correct?
A. It is usually recorded on a 0-2–2-point scale.
B. Demonstrates elasticity of the vessel wall.
C. Reflects the heart’s stroke volume.
D. Indicates the blood volume in the arteries during diastole.
Correct answer is
C
A patient presents to the clinic with primary concern of a change in a mole on the left upper leg. What assessments of the mole will you perform?
A. Color, asymmetry, borders, diameter
B. Elevation, depression, shape, location
C. Location, surrounding skin, palpation
D. Location, elevation, color, pattern
The correct answer is
A.
ABCDE assessment for suspect moles (asymmetry, borders, color, diameter, evolution)
Which clinical presentation will the nurse most likely note when examining a child with Down syndrome (trisomy 21)?
A. Misshapen ears
B. Long, thin neck
C. Thin tongue sticking out
D. Narrow and raised nasal bridge
Correct answer is
A
When conducting a health history and investigating the patient's chief concern, which question will a nurse ask when the patient reports, “I have had abdominal pain for the past week.”
A. “Can you point to where it hurts?”
B. “What have you had to eat in the past 24 hours?”
C. “Have you had any surgeries?”
D. “Why do you think it hurts?”
Correct answer:
A.
Which of the following is true regarding pain in children? Select the best two responses.
A. Infants have the same capacity for pain as adults.
B. Preverbal infants do not remember pain.
C. Children older than 2 years of age are able to rate pain intensity accurately.
D. Children will exaggerate their descriptions of pain in the presence of a healthcare provider.
The best two answers are:
•Infants have the same capacity for pain as adults.
•Children older than 2 years of age are able to rate pain intensity accurately.
Rationale:
•Infants have the same capacity for pain as adults: While infants may lack the cognitive ability to express pain as adults do, they have the physiological capacity to experience and respond to pain in a similar way.
•Children older than 2 years of age are able to rate pain intensity accurately: By the age of 2, children can begin to understand and express pain using tools such as the Wong-Baker FACES scale, allowing them to rate pain intensity accurately.
The other options are not as accurate in the context of child pain perception.
Which information will a nurse share with an adolescent about the cause of acne?
A. It can spread through skin-to-skin contact
B. Has no known cause.
C. Is caused by increased sebum production.
D. Has been found to be related to poor hygiene.
Correct answer is
C
A patient has come in for an examination and states, “I have this spot in front of my ear lobe on my cheek that seems to be getting bigger and is tender. What do you think it is?” The nurse notes swelling below the angle of the jaw and suspects that it could be an inflammation of his:
A. thyroid gland.
B. parotid gland.
C. occipital lymph node.
D. submental lymph node.
Correct answer is
B