N3153 Dallas Health Assessment Exam 2
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Free N3153 Dallas Health Assessment Exam 2 Questions
- Match the following skin lesion terms to their correct definitions.
A) A flat, discolored area of skin with no change in texture.
B) A small fluid-filled blister less than 0.5 cm.
C) A raised, itchy, irregular area of skin caused by localized edema.
D) Lesions arranged in a circular or ring-shaped pattern.
E) Lesions clustered together in one area.
F) Lesions distributed along a nerve pathway, as seen in shingles.
Which term matches "A raised, itchy, irregular area of skin caused by localized edema"?
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Zosterform.
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Vesicle.
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Wheal.
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Macule.
Explanation
Correct Answer: C) Wheal.
A wheal is a raised, irregularly shaped area of localized skin edema (swelling) that is typically pale in the center with a red flare at the borders. It is characteristically seen in allergic reactions and urticaria (hives) and is transient, often disappearing within hours. A zosterform pattern describes lesions that follow a nerve pathway, as seen in herpes zoster (shingles). A vesicle is a small, fluid-filled blister under 0.5 cm in diameter. A macule is a flat, non-palpable discolored spot on the skin with no surface elevation or depression, such as a freckle.
The patient's posture is stooped and he walks with shuffling steps. Starting, stopping, and turning are difficult. Which gait pattern is likely?
- Steppage.
- Cerebellar ataxia.
- Spastic hemiparesis.
- Parkinsonian.
Explanation
Correct Answer: D) Parkinsonian.
The Parkinsonian gait is characterized by a stooped posture, short shuffling steps, difficulty initiating movement (freezing), and difficulty stopping and turning — all classic features of Parkinson's disease caused by dopamine deficiency in the basal ganglia affecting motor control. Steppage gait involves high knee lifting to clear a foot that cannot dorsiflex, seen in foot drop. Cerebellar ataxia presents with a wide-based, staggering, uncoordinated gait. Spastic hemiparesis produces a stiff, circumducting (swinging outward) leg movement typically seen after stroke.
Which neurologic finding is most concerning?
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The aging adult who has fine tremors of the hand.
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The patient with one pupil that is non-reactive to light.
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The newborn who extends his arms when startled.
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The patient who sways during the Romberg test.
Explanation
Correct Answer: B) The patient with one pupil that is non-reactive to light.
A unilateral non-reactive (fixed and dilated) pupil is a critical neurological emergency indicating potential brainstem compression, uncal herniation, or cranial nerve III (oculomotor nerve) damage. It requires immediate emergency intervention as it can signal life-threatening intracranial pressure elevation. Fine hand tremors in an aging adult are a common, expected age-related finding. A newborn extending arms when startled is the normal Moro reflex. Swaying during the Romberg test indicates mild balance impairment but is not an immediate emergency.
You witness your elderly neighbor fall on her driveway while raking leaves. She reports "feeling funny." She is oriented to person and place, but is unsure of the date or why she fell. Her speech is slurred, and her pulse is over 100 bpm and irregular. What is the most likely potential condition?
- Intoxication.
- Myocardial infarction.
- Stroke.
- Dehydration.
Explanation
Correct Answer: C) Stroke.
The combination of sudden slurred speech, confusion, disorientation, and an unexplained fall in an elderly patient are classic warning signs of an acute stroke. These findings directly align with the BE-FAST criteria (Balance, Eyes, Face, Arms, Speech, Time), which is the standard tool used to rapidly identify stroke symptoms in the community setting. Immediate action should be to call 911 as stroke is a time-critical emergency. Intoxication could cause slurred speech but does not explain the irregular pulse or sudden fall without a history of drinking. Myocardial infarction typically presents with chest pain, shortness of breath, and diaphoresis — not slurred speech or confusion as primary symptoms. Dehydration may cause dizziness and confusion but would not specifically cause slurred speech or an irregular pulse in this acute presentation.
The nurse is caring for an aging adult who reports constipation. Which intervention may provide relief for the patient? Select all that apply.
- Restrict fluid intake at night.
- Ensure easy access to the toilet.
- Eat raw fruits and vegetables.
- Increase physical activity.
Explanation
Correct Answers: B, C, and D.
Easy access to the toilet (B) is particularly important for older adults who may have mobility limitations — removing barriers encourages timely response to the urge to defecate, preventing stool retention. Raw fruits and vegetables (C) are high in dietary fiber, which adds bulk to stool and stimulates peristalsis, directly relieving constipation. Increasing physical activity (D) stimulates intestinal motility and reduces gut transit time, both of which help resolve constipation in older adults. Restricting fluid intake (A) would worsen constipation — adequate hydration is essential to keep stool soft and promote regular bowel movements. Older adults should be encouraged to maintain good fluid intake throughout the day.
The nurse cares for a patient who is one day post-op surgery. The nurse checks the patient's oral temperature and notes that it is 38° Celsius. Which action by the nurse is appropriate? Select all that apply.
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Document the oral temperature in the health care record.
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Offer a blanket to prevent patient shivering.
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Inspect the surgical incision for redness, swelling, heat, and pain.
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Administer acetaminophen as ordered prn to reduce fever.
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Notify the Health Care Provider (HCP).
Explanation
Correct Answers: A, C, and D.
Documenting the temperature (A) is always required as part of accurate and complete nursing records. Inspecting the surgical incision (C) is essential because post-operative fever on day one can indicate early surgical site infection, and assessing for signs of redness, swelling, warmth, and pain helps identify the source. Administering acetaminophen as ordered prn (D) is appropriate to manage the fever and promote patient comfort. Offering a blanket (B) would be appropriate for a patient who is cold or shivering, but is counterproductive for a febrile patient as it traps heat and can worsen the fever. A temperature of 38°C (100.4°F) one day post-op is common and does not automatically require notifying the HCP (E) unless it persists, worsens, or is accompanied by other concerning symptoms.
Marcus Lee is a 34-year-old male admitted after a motorcycle accident resulting in a thoracic spinal cord injury (T6). He reports paralysis from the waist down and relies on staff for turning and transfers. Marcus reports decreased sensation in the buttocks and lower extremities. Over the last 48 hours, Marcus has had multiple episodes of bowel and bladder incontinence due to neurogenic dysfunction. His linens were noted to be damp overnight. Marcus has not been eating well, consuming only 30–40% of meals. His albumin level is low, and he has lost weight over the past month. During the nurse's skin assessment of the sacral area, the following is observed: a shallow open area with a pink wound bed, partial-thickness skin loss involving the epidermis and part of the dermis, no slough visible, and surrounding erythema. Medical history includes: newly diagnosed neurogenic bladder and bowel, paraplegia, and MVA. Based on the Braden Scale, which factors place Marcus at increased risk for developing a pressure injury? Select all that apply.
- Moisture from bowel and bladder incontinence
- High sensory perception in the lower body
- Paralysis with limited mobility
- Poor nutritional intake
- Strong ability to reposition independently
- Decreased sensation
Explanation
Correct Answers: A) Moisture from bowel and bladder incontinence, C) Paralysis with limited mobility, D) Poor nutritional intake, and F) Decreased sensation
The Braden Scale assesses pressure injury risk across six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Marcus scores poorly in multiple domains. Bowel and bladder incontinence keeps his skin constantly moist, increasing tissue breakdown risk. His paralysis means he cannot reposition himself, creating prolonged pressure over bony prominences. Consuming only 30–40% of meals with a low albumin level reflects severely compromised nutrition, impairing tissue repair. Decreased sensation due to his T6 injury means he cannot feel pain or discomfort that would normally prompt repositioning.
High sensory perception and strong ability to reposition independently are the opposite of what Marcus presents — he has decreased sensation and is fully dependent on staff for movement, making B and E incorrect.
The nurse is performing a health history and physical assessment on a patient with chronic rheumatoid arthritis (RA). Which symptom(s) should the nurse anticipate?
- Non-tender osteophytes of the finger joints
- Deterioration of articular cartilage surfaces
- Joint pain that is worse later in the day
- Bilateral swelling and tenderness of joints
Explanation
Correct Answers: B) Deterioration of articular cartilage surfaces and D) Bilateral swelling and tenderness of joints
RA is a systemic autoimmune disease that causes symmetric, bilateral inflammation of synovial joints, leading to progressive deterioration of articular cartilage. Bilateral swelling and tenderness are hallmark clinical features. The inflammatory pannus erodes cartilage and bone over time, explaining the articular cartilage deterioration.
Non-tender osteophytes are bony outgrowths characteristic of osteoarthritis, not RA. RA joint pain is typically worse in the morning (morning stiffness lasting more than one hour), not later in the day — making option C incorrect.
An adult female patient reports black stools. Which follow up question is most important for the nurse to ask?
- "Are you taking iron supplements?"
- "How frequent are the stools?"
- "Are others in your family similarly affected?"
- "Is the consistency tarry (tar-like)?"
Explanation
Correct Answer: D) "Is the consistency tarry (tar-like)?"
Tarry, tar-like (melena) black stools are the hallmark of upper gastrointestinal bleeding, a potentially life-threatening condition requiring immediate investigation. Distinguishing true melena from dark stools caused by other factors is the most clinically urgent priority.
While iron supplements can cause dark/black stools, that is a secondary consideration after ruling out a serious bleed. Frequency and family history are relevant but not the most urgent follow-up in this context.
The emergency room nurse is caring for an adolescent who briefly lost consciousness following a collision with another player on the soccer field. Which sign is concerning? Select all that apply.
- Patient's pupillary reaction is sluggish.
- Patient asks "Where am I?"
- Patient successfully performs the finger-nose-finger test.
- Patient states "At least we won the game!"
- Patient has a positive Romberg test.
Explanation
Correct Answers: A, B, and E.
Sluggish pupillary reaction (A) following head trauma suggests increased intracranial pressure or brainstem involvement, which requires immediate neurological evaluation. Disorientation to place — asking "Where am I?" (B) — indicates altered mental status and is a red flag for traumatic brain injury (TBI) or concussion. A positive Romberg test (E) indicates impaired balance and proprioception, consistent with cerebellar or vestibular disruption from head trauma. Successfully performing the finger-nose-finger test (C) is a normal finding demonstrating intact cerebellar coordination — this is reassuring, not concerning. Stating "At least we won the game!" (D) shows intact long-term memory and appropriate emotional response, both of which are normal neurological findings.
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