Health Assessment Denver School of Nursing
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A nurse is performing a physical examination on a client presenting with nasal congestion, sneezing, and a runny nose. The client reports that these symptoms occur seasonally and are accompanied by itchy eyes. Upon nasal inspection, the nurse notes that the turbinates are pale, swollen, and boggy, and there is clear, watery nasal discharge. Based on these physical findings, what type of rhinitis is most likely
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Allergic rhinitis, with pale, swollen turbinates and clear nasal discharge
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Infectious rhinitis, with swollen turbinates and yellow-green discharge
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Acute rhinitis, with red, inflamed turbinates and purulent discharge
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Chronic rhinitis, with thickened, dry turbinates and no discharge
Explanation
Correct Answer A: Allergic rhinitis, with pale, swollen turbinates and clear nasal discharge
Explanation:
A) Allergic rhinitis typically presents with pale, boggy, and swollen turbinates, along with clear, watery nasal discharge, sneezing, nasal congestion, and itchy or watery eyes. These symptoms often occur seasonally (in response to pollen or other allergens) and are due to a hypersensitivity reaction involving histamine release.
B) Infectious rhinitis, with swollen turbinates and yellow-green discharge:
Infectious rhinitis (commonly from a cold or virus) usually presents with mucopurulent (yellow or green) nasal discharge, and erythematous (red) turbinates, not pale ones. It is often accompanied by systemic signs such as fever or malaise.
C) Acute rhinitis, with red, inflamed turbinates and purulent discharge:
This describes the early phase of viral rhinitis, not allergic rhinitis. It includes red, swollen nasal mucosa, not pale, and the discharge may become thicker and discolored as the infection progresses.
D) Chronic rhinitis, with thickened, dry turbinates and no discharge:
Chronic rhinitis may cause dryness, crusting, and thickened nasal mucosa, but it does not present with the clear discharge and itching seen in allergic rhinitis. This option does not match the client’s reported symptoms or physical findings.
While performing a head-to-toe physical exam on a client the nurse tests CN X (cranial nerve 10). The cranial nerve was intact and the nurse would document it as
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Facial movements are voluntary and symmetrical.
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Tongue is midline with no deviation.
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Uvula and soft palate move upwards and midline.
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Sternocleidomastoid and trapezius muscles are strong and equal.
Explanation
Correct Answer C: Uvula and soft palate move upwards and midline
Explanation:
Cranial Nerve X (Vagus nerve) is responsible for motor function of the soft palate, pharynx, and larynx. When assessing CN X, the nurse asks the client to say “ahh” while observing the movement of the uvula and soft palate. A normal response is for the uvula and soft palate to rise symmetrically and remain midline, which indicates that CN X is intact.
Why the other options are incorrect:
A) Facial movements are voluntary and symmetrical:
This assesses Cranial Nerve VII (Facial nerve), which controls facial expression muscles, not CN X.
B) Tongue is midline with no deviation:
This finding is related to Cranial Nerve XII (Hypoglossal nerve), which controls tongue movement, not the vagus nerve.
D) Sternocleidomastoid and trapezius muscles are strong and equal:
This tests Cranial Nerve XI (Spinal Accessory nerve), which controls those specific muscles, not CN X.
The nurse is performing a cardiac assessment. Which technique should the nurse use to best assess for abnormal heart sounds such as S3 or S4
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Palpate the carotid arteries simultaneously and assess for strength.
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Auscultate with the bell of the stethoscope at the apex of the heart.
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Auscultate with the diaphragm of the stethoscope at the aortic area.
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Inspect the chest for visible pulsations or heaves.
Explanation
Correct Answer B: Auscultate with the bell of the stethoscope at the apex of the heart.
Explanation:
The S3 and S4 heart sounds are low-pitched and are best heard using the bell of the stethoscope. These sounds are most prominent at the apex of the heart with the patient in the left lateral position. The bell is specifically designed to pick up low-frequency sounds.
Why the other options are incorrect:
A) Palpate the carotid arteries simultaneously and assess for strength:
This assesses pulse quality, not heart sounds. Also, carotids should not be palpated simultaneously due to risk of compromising cerebral blood flow.
C) Auscultate with the diaphragm of the stethoscope at the aortic area:
The diaphragm is better for high-pitched sounds (e.g., murmurs, clicks), not for low-pitched S3 or S4 sounds.
D) Inspect the chest for visible pulsations or heaves:
This helps asses fsor cardiac enlargement or ventricular hypertrophy, not for detecting specific heart sounds.
The nurse is performing a cardiac health assessment. Which of the following findings during inspection would suggest a potential abnormality in the client's cardiovascular system
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The client's skin appears pink, warm, and dry with no cyanosis or edema.
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The chest appears symmetrical, with no visible pulsations.
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The nurse observes a visible apical impulse at the 5th ICS at the left sternal border.
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The client's jugular veins are not distended when sitting at a 45-degree angle.
Explanation
Correct Answer C: The nurse observes a visible apical impulse at the 5th ICS at the left sternal border.
Explanation:
A visible apical impulse at the 5th intercostal space (ICS) at the left sternal border is not in the normal location. The normal point of maximal impulse (PMI) should be at the 5th ICS at the midclavicular line. A PMI at the left sternal border may suggest cardiac enlargement or displacement, which is abnormal.
Why the other options are incorrect:
A) Skin pink, warm, dry, no cyanosis or edema:
These are all normal findings indicating adequate perfusion.
B) Chest symmetrical, no visible pulsations:
This is normal; visible pulsations elsewhere may suggest aneurysm or other abnormalities.
D) Jugular veins not distended at 45-degree angle:
This is a normal finding; jugular vein distention at this angle could indicate right-sided heart failure or elevated central venous pressure.
A nurse is conducting a routine oral health assessment on a 72-year-old client. Which of the following changes in the mouth is expected as part of the normal aging process
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Increased enamel thickness, resulting in stronger teeth.
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Decreased ability to taste, due to reduced number of taste buds.
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Increased saliva production, leading to frequent dry mouth.
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Enlargement of the gums, resulting in swollen, bleeding gums.
Explanation
Correct Answer B: Decreased ability to taste, due to reduced number of taste buds.
Explanation:
B) Decreased ability to taste, due to reduced number of taste buds:
As people age, there is a natural decline in the number and sensitivity of taste buds, which contributes to a reduced sense of taste, particularly for salty and sweet flavors. This is a normal part of aging and can affect appetite and food enjoyment in older adults.
A) Increased enamel thickness, resulting in stronger teeth:
This is incorrect. Enamel actually becomes thinner and more brittle with age, making teeth more vulnerable to wear, decay, and fracture.
C) Increased saliva production, leading to frequent dry mouth:
This is inaccurate. Saliva production tends to decrease with age, especially due to medications or chronic conditions, often causing xerostomia (dry mouth).
D) Enlargement of the gums, resulting in swollen, bleeding gums:
Swollen or bleeding gums are not part of normal aging and usually indicate periodontal disease or inflammation, not an expected physiological change.
A nurse is performing the diagnostic positions test during an eye examination. The client is asked to follow the nurse's finger as it moves in six cardinal positions of gaze. Which of the following findings would the nurse consider abnormal
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Slight convergence of the eyes as the nurse's finger moves inward.
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Mild nystagmus noted at extreme lateral gaze.
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Both eyes move smoothly in all directions with coordinated motion.
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One eye lags behind or moves in a different direction than the other.
Explanation
Correct Answer D: One eye lags behind or moves in a different direction than the other.
Explanation:
D) When one eye lags or moves differently from the other during the six cardinal positions of gaze, this is considered abnormal and may indicate extraocular muscle weakness, cranial nerve dysfunction (especially CN III, IV, or VI), or a neurological issue. The diagnostic positions test is performed to assess extraocular muscle function and cranial nerve integrity, and the eyes should move together (conjugate movement) in all directions.
Why the other options are normal:
A) Slight convergence of the eyes as the nurse's finger moves inward:
This is a normal and expected finding as part of accommodation when the eyes track a near object.
B) Mild nystagmus noted at extreme lateral gaze:
Slight or mild nystagmus at the furthest lateral points can be normal, especially during sustained gaze. Persistent or pronounced nystagmus in other directions would be considered abnormal.
C) Both eyes move smoothly in all directions with coordinated motion:
This is a normal finding, indicating intact cranial nerves and coordinated extraocular muscle movement.
The nurse is assessing a client with suspected Raynaud's disease. Which of the following findings during the physical examination would be most consistent with this condition
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Numbness and tingling in the fingers with rapid capillary refill and normal skin color.
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Pulsating masses in the wrists and forearms with warm, flushed skin.
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Bilateral swelling of the hands and fingers, with redness upon palpation.
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Fingers that change color, turning white, then blue, and finally red with certain triggers.
Explanation
Correct Answer D: Fingers that change color, turning white, then blue, and finally red with certain triggers.
Explanation:
Raynaud’s disease is a condition characterized by vasospasm of small arteries, usually in the fingers, often triggered by cold or stress. This leads to a triphasic color change:
White (pallor): due to lack of blood flow,
Blue (cyanosis): from prolonged oxygen deprivation,
Red (hyperemia): as blood flow returns.
These episodes are typically accompanied by numbness, tingling, or pain.
Why the other options are incorrect:
A) Numbness and tingling with normal skin color and rapid capillary refill:
These findings are not consistent with Raynaud’s, which includes noticeable color changes.
B) Pulsating masses with flushed skin:
This may indicate an aneurysm or vascular abnormality, not Raynaud’s disease.
C) Bilateral swelling and redness on palpation:
This suggests inflammatory conditions such as rheumatoid arthritis, not Raynaud’s.
When assessing a client with chronic obstructive pulmonary disease (COPD), which of the following should the nurse consider
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Target oxygenation saturation for these clients is generally 88–92%.
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These clients do not need respiratory assessments due to their diagnosis.
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High-flow oxygen should be administered to maintain oxygen saturations above 95%
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A respiratory rate of 10–20 breaths per minute should be maintained in these clients
Explanation
Correct Answer A: Target oxygenation saturation for these clients is generally 88–92%.
Explanation:
For clients with COPD, especially those with chronic CO₂ retention, the goal is to maintain an oxygen saturation between 88–92%. Giving too much oxygen can suppress their hypoxic drive to breathe, potentially leading to respiratory depression. Oxygen therapy should be carefully titrated and monitored.
Why the other options are incorrect:
B) No need for respiratory assessments:
This is incorrect. Clients with COPD require regular respiratory assessments to monitor for exacerbation or deterioration.
C) Maintain O₂ saturations above 95% with high-flow oxygen:
This can be dangerous in COPD clients, as excessive oxygen may reduce their respiratory drive.
D) Maintain a respiratory rate of 10–20 breaths per minute:
While this range is normal for healthy adults, COPD clients may have slightly higher baseline rates, and the focus should be on overall respiratory effort and effectiveness—not just rate.
A nurse is assessing an elderly client who reports experiencing a blind spot in the center of their vision. Which condition is most likely present
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Macular degeneration
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Glaucoma
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Diabetic retinopathy
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Cataracts
Explanation
Correct Answer A: Macular degeneration
Explanation:
A) Macular degeneration affects the macula, the central portion of the retina responsible for sharp, central vision. In age-related macular degeneration (AMD), clients often report a central blind spot, blurring, or distortion, especially when reading or focusing on fine details. Peripheral vision typically remains intact.
Why the other options are incorrect:
B) Glaucoma:
Glaucoma damages the optic nerve, often leading to peripheral vision loss first. It typically does not cause central blind spots until the disease is advanced.
C) Diabetic retinopathy:
This condition causes patchy or fluctuating vision, blurred vision, or floaters, but it does not typically present with a single central blind spot early on.
D) Cataracts:
Cataracts cause generalized blurring, glare, and cloudy vision, but not a distinct blind spot. The lens becomes opaque, leading to overall vision reduction rather than localized loss.
The nurse is assessing a client with suspected right-sided heart failure. Which of the following findings would most likely be present in this client
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Elevated blood pressure and decreased peripheral pulses
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Increased jugular venous distention and edema in the lower extremities
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Hyperresonance on percussion and increased respiratory rate
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Crackles in the lungs and a dry, nonproductive cough
Explanation
Correct Answer B: Increased jugular venous distention and edema in the lower extremities
Explanation:
Right-sided heart failure leads to a back-up of blood into the systemic circulation. This results in jugular venous distention (JVD), peripheral edema, hepatomegaly, and ascites. The heart is unable to efficiently pump blood into the lungs, so pressure builds in the venous system.
Why the other options are incorrect:
A) Elevated blood pressure and decreased peripheral pulses:
These findings are more typical of arterial disease or left-sided heart failure with decreased cardiac output.
C) Hyperresonance on percussion and increased respiratory rate:
These findings are associated with pulmonary conditions such as emphysema or asthma, not heart failure.
D) Crackles in the lungs and a dry, nonproductive cough:
These are classic signs of left-sided heart failure, due to fluid backing up into the pulmonary circulation.
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