N3153 Dallas Health Assessment Exam 2
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Free N3153 Dallas Health Assessment Exam 2 Questions
The school nurse is screening the kindergarten students. She notices many of the children are scratching their heads. Which is a common sign of head lice?
- White flakes that are easily removed from hair shaft.
- Patchy bald spots over the scalp.
- Light brown colored dots attached to hair at nape of neck.
- Thick yellow crusts on the scalp.
Explanation
Correct Answer: C) Light brown colored dots attached to hair at nape of neck.
Head lice (pediculosis capitis) are characterized by the presence of nits (lice eggs), which appear as tiny light brown to yellowish-white oval dots firmly cemented to the hair shaft, most commonly found at the nape of the neck and behind the ears where warmth promotes hatching. Unlike dandruff, nits cannot be easily flicked off the hair shaft — this is a key distinguishing feature. White flakes that are easily removed (A) describe dandruff (seborrheic dermatitis), not lice — the key distinction is that nits are firmly attached. Patchy bald spots (B) are more characteristic of tinea capitis (ringworm) or alopecia areata. Thick yellow crusts (D) are associated with impetigo or severe seborrheic dermatitis, not head lice infestation.
The nurse notes that the patient has been diagnosed with arterial insufficiency. The patient has a dark-skinned complexion. Which assessment finding would support this diagnosis?
- Orange-yellow tinge on soles of feet.
- Vitiligo.
- Warm to palpation.
- Ashen gray skin.
Explanation
Correct Answer: D) Ashen gray skin.
In patients with dark skin tones, cyanosis and poor perfusion from arterial insufficiency are best assessed in areas with less melanin, such as the palms, soles, and mucous membranes. Ashen gray or dull skin coloring in these areas indicates reduced oxygenated blood flow, consistent with arterial insufficiency. Limbs are also typically cool, pale, and pulseless in arterial disease. An orange-yellow tinge on the soles suggests carotenemia from excess beta-carotene intake, not arterial disease. Vitiligo is an autoimmune depigmentation disorder unrelated to vascular insufficiency. Warmth on palpation would actually suggest venous insufficiency or inflammation — arterial insufficiency characteristically produces cool, cold extremities.
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?
- Stuporous.
- Obtunded.
- Lethargic.
- 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.
Please match the levels of consciousness with the appropriate description.
- The patient is obtunded.
- The patient is comatose.
- The patient is lethargic.
- 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.
The patient has been admitted to the hospital for an acute myocardial infarction (heart attack). She reports pain in her neck and left arm. Which type of pain is this?
- Cutaneous pain.
- Referred pain.
- Somatic pain.
- Visceral pain.
Explanation
Correct Answer: B) Referred pain.
Referred pain occurs when pain originating from a deep internal organ is perceived at a distant body surface location. During a myocardial infarction, pain signals from the ischemic heart travel through shared spinal cord pathways (dermatomes) and are misinterpreted by the brain as coming from the neck, left arm, or jaw. This is one of the most classic examples of referred pain taught in clinical practice. Cutaneous pain originates from the skin and is well-localized. Somatic pain arises from muscles, bones, and joints — not internal organs. Visceral pain is the deep, poorly localized pain arising from the organ itself (the heart in this case) — the neck and arm pain specifically represents the referred component of the cardiac pain pattern.
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.
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"?
- Zosterform.
- Vesicle.
- Wheal.
- 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 nurse suspects that the patient has carpal tunnel syndrome and wants to perform the Phalen test. How should the nurse instruct the patient?
- Hold hands back to back while flexing the wrists to 90 degrees for 60 seconds.
- Press the palms together for 2–3 seconds.
- Interlace the metacarpals for 2–3 seconds.
- 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.
- 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"?
-
Zosterform.
-
Vesicle.
-
Wheal.
-
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 states, "I hear a crunching, grating sound when I kneel." What is the likely cause?
- Fluid in the knee joint.
- A loose tendon.
- A bone spur.
- Crepitation.
Explanation
Correct Answer: D) Crepitation.
Crepitation (or crepitus) is the term used to describe a crunching, grating, or crackling sound and sensation produced when roughened or damaged joint surfaces rub against each other during movement. It is commonly associated with osteoarthritis, cartilage deterioration, and joint degeneration, and is a classic physical assessment finding elicited during range of motion evaluation. Fluid in the knee joint (effusion) typically produces a feeling of fullness, swelling, or a ballottement sign — not a grating sound. A loose tendon may produce a snapping sensation but not a grating sound. A bone spur could contribute to crepitus but is the structural cause, not the term for the sound itself — crepitation is the correct clinical descriptor for this finding.
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