N3153 Dallas Health Assessment Exam 2
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Free N3153 Dallas Health Assessment Exam 2 Questions
The nurse is assessing an older adult who has a Glasgow Coma Score of 3. How should the nurse document the patient's level of consciousness?
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Stuporous.
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Obtunded.
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Lethargic.
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Comatose.
Explanation
Correct Answer: D) Comatose.
The Glasgow Coma Scale (GCS) ranges from 3 to 15. A score of 3 is the lowest possible score, indicating no eye opening, no verbal response, and no motor response to any stimulus — representing deep coma. This corresponds to the comatose level of consciousness where the patient is completely unresponsive to all stimuli. Stuporous patients respond to vigorous stimulation. Obtunded patients are drowsy but arousable and drift back to sleep. Lethargic patients are excessively sleepy but can be easily aroused. All three levels involve some degree of responsiveness, which is inconsistent with a GCS of 3.
A nurse is caring for a newborn diagnosed with erythema toxicum neonatorum. Which nursing action is most appropriate?
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Bathe the newborn with hypoallergenic soap twice daily to reduce the rash.
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Apply a thin layer of antibiotic ointment to prevent secondary infection.
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Educate the parents that the condition is benign and requires no treatment.
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Isolate the newborn to prevent spread to other infants.
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Give antifungal treatments to the newborn.
Explanation
Correct Answer: C) Educate the parents that the condition is benign and requires no treatment.
Erythema toxicum neonatorum is a common, self-limiting, benign skin condition affecting up to 50% of full-term newborns. It presents as blotchy red patches with small white or yellow pustules, typically appearing within the first few days of life and resolving spontaneously within 1–2 weeks without any intervention. The most important nursing role is parental reassurance and education. Twice-daily bathing is unnecessary and can dry out or further irritate a newborn's sensitive skin. Antibiotic ointment is not indicated as the condition is not bacterial. Isolation is unnecessary as it is not contagious or infectious. Antifungal treatment is not appropriate — this condition is not caused by a fungal organism and must be distinguished from neonatal candidiasis.
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.
Please match the levels of consciousness with the appropriate description.
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The patient is obtunded.
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The patient is comatose.
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The patient is lethargic.
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The patient is stuporous.
Explanation
Correct Answers:
A) Obtunded → Not fully alert, frequently drifts off to sleep. Obtunded describes a patient with dulled alertness who has difficulty staying awake and responds slowly to stimulation but can still be aroused.
B) Comatose → Unconscious, no response to pain or other stimulus. A comatose patient is in the deepest level of unconsciousness with a complete absence of response to any external stimuli, including painful ones.
C) Lethargic → Sleeps most of the time, difficult to awaken. A lethargic patient is drowsy and sluggish, sleeping excessively but can be aroused with persistent stimulation, though they quickly return to sleep.
D) Stuporous → Unconscious, responds only to persistent and vigorous shaking or shouting. A stuporous patient appears unconscious at rest but can be briefly aroused only with strong, repeated stimulation such as loud voice or vigorous movement, returning immediately to an unresponsive state when stimulation stops.
A patient who has had rheumatoid arthritis (RA) for years comes to the clinic to ask about changes in her hands. Which changes are associated with chronic RA?
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Dupuytren contractures
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Bouchard nodules
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Heberden nodules
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Swan-neck contractures
Explanation
Correct Answers: B) Bouchard nodules and D) Swan-neck contractures
Bouchard nodules are bony enlargements of the proximal interphalangeal (PIP) joints and are characteristic of RA. Swan-neck contractures — hyperextension at the PIP joint with flexion at the distal interphalangeal (DIP) joint — are classic deformities resulting from chronic RA-related joint and tendon damage.
Dupuytren contractures involve fibrous tissue of the palm causing finger flexion and are not associated with RA. Heberden nodules affect the DIP joints and are characteristic of osteoarthritis, not RA.
Which statements are true about an infant's neurologic status? Select all that apply.
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A positive Babinski (fanning of the toes) is a normal reflex at birth.
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The newborn's rooting and sucking reflexes help the baby feed.
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The newborn who suddenly extends his arms in the air when he hears a loud noise is displaying the Moro reflex.
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An infant will learn to sit up before he learns to roll over.
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Head lag beyond 4 months may indicate brain damage.
Explanation
Correct Answers: A, B, C, and E.
A positive Babinski reflex (A) — fanning and dorsiflexion of the toes — is normal in infants up to 12–24 months due to an immature corticospinal tract; it only becomes pathological in adults. The rooting and sucking reflexes (B) are primitive survival reflexes present at birth that facilitate breastfeeding and bottle feeding. The Moro reflex (C) — sudden arm extension and abduction in response to a startling stimulus — is a normal primitive reflex present from birth until approximately 4–6 months. Head lag persisting beyond 4 months (E) is a red flag for neurological impairment or hypotonia. Option D is incorrect — developmentally, infants learn to roll over (around 4–5 months) before they learn to sit up independently (around 6–7 months), not the other way around.
The nurse suspects that the patient has carpal tunnel syndrome and wants to perform the Phalen test. How should the nurse instruct the patient?
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Hold hands back to back while flexing the wrists to 90 degrees for 60 seconds.
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Press the palms together for 2–3 seconds.
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Interlace the metacarpals for 2–3 seconds.
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Internally rotate the shoulders, pressing the hands into the back.
Explanation
Correct Answer: A) Hold hands back to back while flexing the wrists to 90 degrees for 60 seconds.
The Phalen test is performed by having the patient press the dorsal surfaces of both hands together (back to back) with wrists flexed at 90 degrees and holding this position for 60 seconds. A positive test is indicated by reproduction of numbness, tingling, or pain in the distribution of the median nerve (thumb, index, middle, and radial half of the ring finger), suggesting carpal tunnel syndrome caused by compression of the median nerve at the wrist. Pressing palms together describes a prayer position, which is not the Phalen maneuver. Interlacing metacarpals and internally rotating shoulders describe unrelated maneuvers not used for carpal tunnel assessment.
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?
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Intoxication.
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Myocardial infarction.
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Stroke.
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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.
A nurse is assessing a patient's mole and is concerned it may be cancerous. Which of the following findings align with the ABCDE rule and should be reported to the healthcare provider? Select all that apply.
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The mole has patches of black, brown, and red colors within it.
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The mole is 5mm in size.
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The mole is asymmetrical, with one half different in shape from the other.
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The mole has an irregular and notched border.
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The mole is uniform in color with a light brown shade throughout.
Explanation
Correct Answers: A, C, and D.
The ABCDE rule for melanoma assessment stands for Asymmetry, Border irregularity, Color variation, Diameter greater than 6mm, and Evolution. Option A is correct because multiple colors (black, brown, red) within a mole represent abnormal color variation (C). Option C is correct because asymmetry — one half not matching the other — is a direct red flag (A). Option D is correct because an irregular, notched border is a hallmark warning sign (B). Option B is incorrect because 5mm is actually below the concerning threshold of greater than 6mm. Option E is incorrect because uniform light brown coloring is a normal, benign characteristic and does not meet any ABCDE criteria.
The nurse is percussing the patient's abdomen. Which percussion tone should be heard over the liver?
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Hyperresonance.
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Borborygmus.
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Dullness.
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Tympany.
Explanation
Correct Answer: C) Dullness.
The liver is a solid, dense organ with no air content, so percussion over it produces a dull, thudlike sound. Dullness on abdominal percussion indicates a solid or fluid-filled structure beneath, which is the expected and normal finding over the liver span (right upper quadrant). Hyperresonance is heard over air-filled or hyperinflated areas such as emphysematous lungs. Borborygmus refers to audible bowel sounds (gurgling) heard on auscultation, not percussion. Tympany is the drum-like sound heard over gas-filled structures such as the stomach and intestines.
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