Health Assessment Denver School of Nursing

Health Assessment Denver School of Nursing

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Free Health Assessment Denver School of Nursing Questions

1.

The nurse is assessing a client's capillary refill during a physical exam. Which of the following findings would require further investigation

  •  Capillary refill of 2 seconds in the right hand and 2 seconds in the left hand.

  • Capillary refill of less than 2 seconds in the fingers and toes.

  • Capillary refill greater than 5 seconds in the fingers and toes.

  • Capillary refill of 2 seconds in both hands, but 1 second in both feet.

Explanation

Correct Answer C: Capillary refill greater than 5 seconds in the fingers and toes.

Explanation:

Normal capillary refill is less than 2 seconds. A refill time greater than 5 seconds suggests impaired peripheral perfusion, which may be due to conditions like shock, hypothermia, or vascular disease. This finding requires further evaluation and possible intervention.

Why the other options are incorrect:

A) 2 seconds in both hands:

This is normal and symmetric—no concern.

B) Less than 2 seconds in fingers and toes:

Also normal and indicates good perfusion.

D) 2 seconds in hands, 1 second in feet:

Both are within normal limits, and although there’s a slight variation, it’s not clinically significant.


2.

During a cardiac assessment, the nurse palpates the point of maximal impulse (PMI). Which of the following best describes the normal location of the PMI

  • At the midclavicular line, fifth intercostal space, left side of the chest

  • At the midclavicular line, second intercostal space, left side of the chest

  • At the left sternal border, fourth intercostal space

  • At the anterior axillary line, sixth intercostal space, right side of the chest

Explanation

Correct Answer A: At the midclavicular line, fifth intercostal space, left side of the chest

Explanation:

The point of maximal impulse (PMI) is typically found at the fifth intercostal space, along the left midclavicular line. This is where the apex of the heart touches the chest wall during contraction and is most easily felt. A displaced PMI may indicate an enlarged heart or other cardiac abnormalities.

Why the other options are incorrect:

B) Second intercostal space:

This is the aortic or pulmonic area, not the PMI.

C) Left sternal border, fourth intercostal space:

This is the tricuspid area, not where the PMI is normally felt.

D) Right side, anterior axillary line:

The PMI is not found on the right side of the chest; this would suggest abnormal anatomy or a documentation error.


3.

. The nurse is preparing to assess a client's heart rate. In which situation should the nurse assess the apical pulse instead of the radial pulse

  • The client is resting quietly with a blood pressure of 132/76 mmHg

  • The client has a regular radial pulse of 74 beats per minute

  • The client has an irregular radial pulse and reports dizziness

  • The client reports dizziness when changing position

Explanation

Correct Answer C: The client has an irregular radial pulse and reports dizziness

Explanation:

The apical pulse is more accurate than the radial pulse when a client has an irregular heart rhythm. It allows the nurse to directly assess the heartbeat at the apex of the heart, which is essential when the radial pulse is irregular or when symptoms like dizziness suggest inadequate cardiac output or arrhythmias.

Why the other options are incorrect:

A) Resting with normal BP:

A radial pulse is sufficient when vital signs are stable and regular.

B) Regular radial pulse:

If the rhythm and rate are regular, there's no need to assess the apical pulse.

D) Dizziness with position change:

This may be due to orthostatic hypotension, not necessarily an arrhythmia. Apical pulse may be checked, but orthostatic vitals would be a more immediate assessment.


4.

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

  • The client's skin appears pink, warm, and dry with no cyanosis or edema.

  • The chest appears symmetrical, with no visible pulsations.

  • The nurse observes a visible apical impulse at the 5th ICS at the left sternal border.

  • 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.


5.

The nurse is caring for a terminally ill client and observes a breathing pattern that consists of alternating periods of deep, rapid breathing followed by apnea. Which term best describes this respiratory pattern

  • Cheyne-Stokes respirations

  • Orthopnea

  • Kussmaul respirations

  • Tachypnea

Explanation

Correct Answer A: Cheyne-Stokes respirations

Explanation:

Cheyne-Stokes respirations are characterized by cyclical breathing patterns that alternate between deep, rapid breathing and periods of apnea. This pattern is commonly seen in terminally ill clients, those with heart failure, or neurological conditions, and can be a sign of worsening condition near end of life.

Why the other options are incorrect:

B) Orthopnea:

Refers to difficulty breathing while lying flat, not a breathing pattern.

C) Kussmaul respirations:

Deep, rapid, and labored breathing typically seen in metabolic acidosis, especially diabetic ketoacidosis.

D) Tachypnea:

An abnormally fast respiratory rate, but without the apneic periods characteristic of Cheyne-Stokes.


6.

A nurse is assessing a client who presents with ear pain, fever, and a feeling of fullness in the ear. The client also reports difficulty hearing. Upon examination, the nurse notes that the ear canal is clear and there is no redness or swelling. The tympanic membrane is red, bulging, and there is fluid behind the ear drum. Based on these findings, which condition does the nurse most likely suspect

  • Otitis media

  • Otitis externa

  • Sinusitis

  • Mastoiditis

Explanation

Correct Answer A: Otitis media

Explanation:

Otitis media is an infection or inflammation of the middle ear. It is commonly characterized by:

Ear pain (otalgia)

Fever

Sensation of fullness

Hearing difficulty

Red, bulging tympanic membrane

Presence of fluid behind the eardrum

In this case, the clear ear canal and bulging red tympanic membrane with fluid behind it are classic signs of acute otitis media.

Why the other options are incorrect:

B) Otitis externa:

Also known as "swimmer’s ear," this is an inflammation of the external auditory canal, often presenting with redness, swelling, and tenderness of the canal itself, which is not present here.

C) Sinusitis:

Sinusitis involves inflammation of the sinuses, not the ear. While it can cause referred ear pressure or pain, it does not involve tympanic membrane changes.

D) Mastoiditis:

A complication of untreated otitis media, mastoiditis involves infection of the mastoid bone behind the ear. It typically presents with swelling and tenderness over the mastoid process, which is not noted in this case.


7.

A nurse is assessing a client who reports that their skin feels unusually oily and they are sweating more than usual, even when resting. The nurse explains that certain glands in the skin may be overactive. Based on this information, which layer of the skin is responsible for this change

  • Basement membrane

  • Subcutaneous layer

  • Dermis

  • Epidermis

Explanation

Correct Answer C: Dermis

Explanation:

C) Dermis: The dermis is the middle layer of the skin and contains sebaceous (oil) glands and sweat glands. These glands are responsible for producing sebum (oil) and sweat, respectively. Overactivity of these glands can lead to oily skin and excessive sweating, as reported by the client.

Why the other options are incorrect:

A) Basement membrane:

This is a thin layer that separates the epidermis from the dermis. It plays a structural role but does not contain glands involved in oil or sweat production.

B) Subcutaneous layer:

Also called the hypodermis, this layer is mainly composed of fat and connective tissue. It provides insulation and cushioning, but it does not contain sebaceous or sweat glands.

D) Epidermis:

The outermost layer of the skin. While it serves as a barrier, it does not house the glands responsible for oil and sweat production—those are located in the dermis.


8.

The nurse is reviewing the echocardiogram results of a client with a history of heart failure. The report shows an ejection fraction (EF) of 35%. Based on this finding, which type of cardiac dysfunction does the client most likely have

  • Diastolic dysfunction

  • Right-sided heart failure

  • Normal cardiac function

  • Systolic dysfunction

Explanation

Correct Answer D: Systolic dysfunction

Explanation:

An ejection fraction (EF) measures the percentage of blood the left ventricle pumps out with each contraction. A normal EF is 55%–70%. An EF of 35% indicates reduced pumping ability, which is characteristic of systolic dysfunction, also known as heart failure with reduced ejection fraction (HFrEF).

Why the other options are incorrect:

A) Diastolic dysfunction:

Occurs when the heart has normal EF but impaired filling due to stiff ventricles—EF usually remains within normal limits.

B) Right-sided heart failure:

Can occur with or without a reduced EF and typically relates to symptoms like peripheral edema and JVD. EF is a measure of left ventricular function, so a low EF specifically points to left-sided systolic dysfunction.

C) Normal cardiac function:

An EF of 35% is significantly below normal, indicating abnormal function.


9.

. A client returning to the medical-surgical unit calls the nurse for a new complaint of "9/10 leg pain and swelling" after a surgical procedure. What other priority assessment findings should the nurse look for

  • Observe for atrophy of the lower leg muscles.

  • Inspect for elevational claudication bilaterally.

  • Check ankle-brachial index (ABI) on the affected leg.

  • Evaluate for pain with dorsiflexion of the foot.

Explanation

Correct Answer D: Evaluate for pain with dorsiflexion of the foot.

Explanation:

Pain with dorsiflexion of the foot, known as a positive Homan's sign, may indicate deep vein thrombosis (DVT). While Homan’s sign is not definitive on its own, in the presence of unilateral leg pain, swelling, and recent surgery, it is a priority assessment for possible venous thromboembolism, a potentially life-threatening complication.

Why the other options are incorrect:

A) Observe for atrophy of the lower leg muscles:

Muscle atrophy develops over time, not acutely post-surgery, and is not a priority in this context.

B) Inspect for elevational claudication bilaterally:

Claudication is associated with arterial insufficiency, not venous problems like DVT.

C) Check ankle-brachial index (ABI) on the affected leg:

ABI assesses arterial circulation, not venous thromboembolism. This is not the priority concern here.


10.

 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

  • Elevated blood pressure and decreased peripheral pulses

  • Increased jugular venous distention and edema in the lower extremities

  • Hyperresonance on percussion and increased respiratory rate

  • 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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