1. . A nurse completed the review of systems of a client’s ears….

Question 1. . A nurse completed the review of systems of a client’s ears…. 1. . A nurse completed the review of systems of a client’s ears. The client has a negative history. The nurse should document.a. Ears negative b. The presence or absence of all symptomsc. Ears within normal limitsd. That there are no problems related to the ears 2. A school nurse performs an eye examination on an 8-year-old child.In assessing the child’s extraocular movements, the nurse should ask the child toa. Stare at a fixed object.b. Look at a bouncing ball.c. Follow an object to six positions.d. Focus on four quadrants.3. To assess a client’s axilla, the nurse should place the client in which of these positions?a. Standingb. Prone c. Sittingd. Supine 4. Which aspect of an 85-year-old client’s orientation would be the first indicator of a decreasing level of consciousness?a. inability to repeat sequential numbersb. difficulty in identifying familiar objectsc. loss of recent memoryd. disorientation to time 5. A client on the extended care unit reports headaches and weakness. The nurse notes that client has slurred speech. To help establish a nursing diagnosis, it is most appropriate for the nurse to a. perform a complete neurologic assessmentb. assess the psychosocial status of the clientc. refer the client to a physical therapistd. make a diagnosis based on the history 6. When performing a physical examination of the head and neck a nurse needs to consider normal age- related age variations. The nurse should remember when assessing a a. 12- month – old, that the anterior fontanel will be closedb. 79-year-old, that an enlarged thyroid gland is considered a normal variationc. 71-year-old, that presbyopia is considered a normal variationd. 3- month-old infant, that the infant will focus with both eyes 7. A nurse should understand that there are several main areas to be assessed in the general survey (inspection) of a client. Which of these main areas are to be included in the assessment?a. Present, past, and family historyb. Body structure, mobility, and speech patterns c. Complete laboratory examination and diagnostic testsd. Current medications and other treatments 8. While auscultating the chest of an elderly client, the nurse hears an extra heart sound.      Which of these findings should the nurse report to the client’s physician?a. An S1 heart sound that is clearest in the left lower sternal border.b. An S3 heart sound at the apex.c. A split S2 heart sound heard upon inspiration.d. An S2 heart sound heard loudest in the 2nd intercoastal spaces. 9. When conducting a physical examination, a nurse observes a skin ulcer on the client’s lower leg. What information is essential to discuss with the client during the visit?a. The ulcer is a type of secondary lesionb. The ulcer should have been treated soonerc. How to recognize the characteristics of cancerous ulcersd. How to prevent the ulcer from becoming infected. 10. When assessing a client’s carotid pulses, the nurse should palpate thema. close to the area of arterial bifurcationb. in the client’s neck above the angle of the jawc. individuallyd. simultaneously 11. To accurately assess a client’s cerebellar function, the nurse should instruct the client toa. Raise one arm over the head and touch the nose with the other finger b. Walk forward using a wide based gait c. Stand with the feet together and eyes closed d. Sit with the ankle of one foot resting on the opposite knee 12. 79. Using a four-point scale, the nurse assesses the client’s peripheral pulses as a +2  Which of these characteristics would be the nurse use to describe the client’s pulses?a. Non-palpateb. Boundingc. Hard to palpate and obliterated with slight pressured. Easily palpate and obliterated by strong pressure. 13. When performing an otoscopic examination of an adult client’s ears, the nurse should?a. Pull the pinnae of the client’s ears down.b. Use the largest size speculum that will fit in the canal comfortablyc. Advance the speculum quickly to dilate the canal.d. Release traction on the ear prior to completing the examination. 14.Which of these statements describes the characteristics of a grade III murmur?a. The ability to hear it is variable muffledb. It is difficult to hear barely audible.c. It is easy to hear moderately loud.d. It is very easy to hear loud with a thrill 15. A nurse assesses a client’s heart by palpating the apical impulse.   The client should be referred to the physician if the client has an apical impulse thata. Measures 3 cm x 3 cmb. Is present during systolec. Is felt as a short gentle tapd. Occupies one intercostal space. Health Science Science Nursing NURS 622 Share QuestionEmailCopy link Comments (0)