N3153 Dallas Health Assessment Exam 3 SP26
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Free N3153 Dallas Health Assessment Exam 3 SP26 Questions
A nurse is assessing a patient suspected of having hyperthyroidism. Which of the following symptoms would support this diagnosis? (Select all that apply.)
- Diarrhea
- Constipation
- Bradycardia
- Unintentional weight loss
- Heat intolerance
Explanation
Explanation:
Correct Answers: (A) Diarrhea, (D) Unintentional weight loss, (E) Heat intolerance
Hyperthyroidism results from excess thyroid hormone production, which accelerates the body's metabolic processes. This leads to increased gastrointestinal motility causing diarrhea, rapid metabolism resulting in unintentional weight loss despite increased appetite, and an inability to tolerate heat due to increased thermogenesis.
Why Other Options are Incorrect:
B. Constipation — Constipation is associated with hypothyroidism, where metabolic processes are slowed, not hyperthyroidism.
C. Bradycardia — Hyperthyroidism causes tachycardia due to the overstimulation of the cardiovascular system. Bradycardia is characteristic of hypothyroidism.
A nurse is receiving bedside shift report on four assigned patients. Using clinical judgment and priority-setting principles, which patient requires the nurse to assess first?
- A 55-year-old patient with an acute kidney injury (AKI) whose morning potassium level is 5.1 (normal 3.5-5.0) and who is waiting for the stat dose of sodium polystyrene sulfonate (Kayexalate) to be delivered from the pharmacy.
- A 72-year-old patient 4 hours post-percutaneous coronary intervention (PCI) with a non-bleeding groin puncture site and a reported dull, constant backache rated 4/10.
- A 45-year-old patient with a history of seizures who missed the 0600 dose of phenytoin (Dilantin) because it was held for a critically low albumin level.
- A 60-year-old patient with chronic obstructive pulmonary disease (COPD) and a tracheostomy whose heart rate is 105/min (baseline 88/min) and whose family member reports a sudden increase in noisy respirations.
Explanation
Explanation:
Correct Answer: (D) A 60-year-old patient with COPD and a tracheostomy whose heart rate is 105/min and whose family member reports a sudden increase in noisy respirations.
This patient presents with an acute change in respiratory status — noisy respirations, tachycardia above baseline, and a tracheostomy, which is a high-risk airway. A sudden increase in noisy breathing in a tracheostomy patient may indicate a mucus plug, partial obstruction, or tracheostomy displacement, all of which can rapidly progress to complete airway obstruction and respiratory arrest. This is an immediate life threat requiring the nurse's first assessment.
Why Other Options are Incorrect:
A. The AKI patient with a potassium of 5.1 has mild hyperkalemia slightly above the normal range. While monitoring is warranted, this is not an immediate emergency compared to an acute airway compromise.
B. A non-bleeding groin site with a mild backache post-PCI requires monitoring but does not indicate an immediately life-threatening complication at this time.
C. A missed dose of phenytoin is concerning for seizure risk, but the patient is not currently seizing. This warrants timely attention but is not as immediately critical as an acute airway issue.
Which factors are associated with cataracts? Select all that apply.
- Sudden vision loss.
- More common in young people.
- Excessive exposure to UV light is a risk factor.
- Cloudiness in the lens of the eye.
- Correctable with surgery.
Explanation
Explanation:
Correct Answers: (C) Excessive exposure to UV light is a risk factor, (D) Cloudiness in the lens of the eye, and (E) Correctable with surgery.
Cataracts are characterized by progressive clouding of the crystalline lens of the eye, which causes gradual blurring and dimming of vision. Prolonged exposure to ultraviolet light is a well-established modifiable risk factor for cataract development. Cataracts are the leading cause of correctable blindness worldwide and are treated effectively with surgical removal of the cloudy lens and replacement with an intraocular lens implant.
Why Options A and B are Incorrect:
A. Sudden vision loss is not characteristic of cataracts; cataract-related vision loss is gradual and progressive over months to years. Sudden vision loss is more indicative of retinal detachment, acute glaucoma, or vascular events.
B. Cataracts are primarily a condition of aging and are most common in older adults, not young people. While congenital cataracts can occur in children, the prevalence significantly increases with advancing age.
When assessing the maxillary sinuses for tenderness, which action should the nurse take?
- Press gently with both thumbs around the eyebrow ridges
- Have the patient lean forward and shine a light below their browbone
- Apply firm pressure with both thumbs below the cheekbones
- Have the patient breathe in and out while occluding each nostril
Explanation
Explanation:
Correct Answer: (C) Apply firm pressure with both thumbs below the cheekbones
The maxillary sinuses are located beneath the cheekbones in the facial structure. To assess for tenderness, the nurse applies firm upward pressure with both thumbs directly below the cheekbones. Tenderness upon palpation in this area suggests maxillary sinusitis or inflammation of the maxillary sinuses.
Why Other Options are Incorrect:
A. Press gently with both thumbs around the eyebrow ridges — This technique is used to assess the frontal sinuses, which are located above the eyes near the eyebrow ridges, not the maxillary sinuses.
B. Have the patient lean forward and shine a light below their browbone — Transillumination is an older assessment technique and is not the standard clinical method for assessing sinus tenderness through palpation.
D. Have the patient breathe in and out while occluding each nostril — This technique assesses nasal patency, not sinus tenderness, and is not relevant to maxillary sinus assessment.
The kindergarten student tells the school nurse that she can't hear out of her left ear. The nurse inspects the ear canal and sees a bright green object. Which condition does the nurse suspect? Select all that apply.
- Cerumen impaction
- Presbycusis
- Sensorineural hearing loss
- Conductive hearing loss
- Foreign body obstruction
Explanation
Explanation:
Correct Answers: (D) Conductive hearing loss and (E) Foreign body obstruction
A bright green object visible in the ear canal of a kindergarten-aged child is highly indicative of a foreign body obstruction, as young children frequently insert objects into their ears. This physical blockage of the ear canal prevents sound waves from reaching the middle and inner ear, resulting in conductive hearing loss, which is hearing loss caused by a mechanical obstruction rather than nerve damage.
Why Other Options are Incorrect:
A. Cerumen impaction — While cerumen can cause conductive hearing loss, the nurse visualized a bright green object, not earwax, making this an incorrect primary suspicion.
B. Presbycusis — This is age-related hearing loss that occurs in older adults and is entirely irrelevant in a kindergarten-aged child.
C. Sensorineural hearing loss — This type of hearing loss results from damage to the inner ear or auditory nerve and would not be caused by a visible foreign object in the canal.
The nurse teaches a patient to perform a breast self exam (BSE). Which finding does NOT need a follow-up with the patient's health care provider?
- Deviated nipple
- "peau d'organge" edema
- Cyclic tenderness
- Blood-tinged discharge
Explanation
Explanation:
Correct Answer: (C) Cyclic tenderness
Cyclic breast tenderness is a normal hormonal fluctuation that occurs in relation to the menstrual cycle, typically worsening before menstruation and resolving afterward. It does not indicate pathology and does not require follow-up with a healthcare provider. It is the only finding among the options that is considered a benign, expected physiological occurrence.
Why Other Options are Incorrect:
A. Deviated nipple — A newly inverted or deviated nipple can be a warning sign of an underlying mass or malignancy pulling on breast tissue and requires prompt evaluation.
B. "peau d'orange" edema — This refers to skin that resembles an orange peel due to lymphatic obstruction and is a classic sign of inflammatory breast cancer, requiring immediate follow-up.
D. Blood-tinged discharge — Bloody nipple discharge is an abnormal finding that may indicate intraductal papilloma or malignancy and always warrants further investigation.
When teaching a rehabilitation class, what would be the most critical point to teach patients with dysphagia?
- Practice pronunciation of "light, tight, dynamite."
- The condition can lead to temporomandibular joint pain.
- Thoroughly chew small amounts of food with each mouthful.
- Brush the tongue twice a day to prevent bad breath.
Explanation
Explanation:
Correct Answer: (C) Thoroughly chew small amounts of food with each mouthful.
Dysphagia refers to difficulty swallowing, which places patients at high risk for aspiration, choking, and aspiration pneumonia. Teaching patients to thoroughly chew small amounts of food reduces the risk of aspiration and ensures safer swallowing, making it the most critical and practical teaching point.
Why Other Options are Incorrect:
A. Practice pronunciation of "light, tight, dynamite" — This is a technique used in speech therapy for articulation, not a safety measure for managing dysphagia during eating.
B. The condition can lead to temporomandibular joint pain — TMJ pain is not a recognized complication of dysphagia and is not a priority teaching point for this condition.
D. Brush the tongue twice a day to prevent bad breath — While oral hygiene is important, it is not the most critical teaching point for patients with dysphagia whose primary concern is safe swallowing.
The school nurse teaches a group of school-age girls about sexual development. Which statement is most accurate?
- Menstruation precedes breast development by about 4 years
- Breast development precedes menstruation by about 4 years
- Breast development precedes menstruation by about 2 years
- Menstruation precedes breast development by about 2 years
Explanation
Explanation:
Correct Answer: (C) Breast development precedes menstruation by about 2 years
In female puberty, breast development (thelarche) is typically the first sign of sexual maturation and generally begins around ages 8 to 10. Menstruation (menarche) usually follows approximately 2 years later. This sequence is a well-established pattern in normal female pubertal development.
Why Other Options are Incorrect:
A. Menstruation precedes breast development by about 4 years — This is entirely incorrect. Menstruation does not precede breast development; it follows it.
B. Breast development precedes menstruation by about 4 years — While the sequence is correct, the 4-year timeframe is inaccurate. The average interval is approximately 2 years, not 4.
D. Menstruation precedes breast development by about 2 years — The timeframe of 2 years is correct, but the order is reversed. Breast development always precedes menstruation, not the other way around.
The registered nurse working in a COVID-19 triage unit reads vital signs taken by the patient care technician (PCT). Which patient should the nurse assess first?
- Mr. Grey: T 37.3°C P 96 R 18 BP 138/90 O2 Sat 97%
- Mr. Silver: T 37.4°C P 108 R 14 BP 102/74 O2 Sat 95%
- Mr. Green: T 36.8°C P 96 R 28 BP 118/68 O2 Sat 92%
- Mr. Brown: T 38°C P 100 R 16 BP 120/78 O2 Sat 99%
Explanation
Explanation:
Correct Answer: (C) Mr. Green: T 36.8°C P 96 R 28 BP 118/68 O2 Sat 92%
Mr. Green presents with a respiratory rate of 28 breaths per minute (tachypnea) and an oxygen saturation of 92%, both of which are critically abnormal, especially in a COVID-19 setting where respiratory compromise is the primary concern. Low O2 saturation combined with tachypnea signals impending respiratory failure and demands immediate assessment and intervention.
Why Other Options are Incorrect:
A. Mr. Grey — His vital signs are largely within normal limits. A slightly elevated blood pressure of 138/90 and O2 sat of 97% do not indicate an immediate emergency.
B. Mr. Silver — While his pulse of 108 is mildly elevated and O2 sat of 95% is slightly low, these findings are less critical compared to Mr. Green's respiratory distress indicators.
D. Mr. Brown — His temperature is slightly elevated but his O2 sat is 99% and all other vitals are within acceptable range, posing no immediate threat.
Patients with chronic allergies may have small, pale, round, firm overgrowths on the nasal mucosa. Which term should be used to describe this physical assessment finding?
- Perforated septum
- Chronic sinusitis
- Polyps
- Turbinates
Explanation
Explanation:
Correct Answer: (C) Polyps
Nasal polyps are small, pale, round, firm, noncancerous growths that develop on the lining of the nasal mucosa. They are commonly associated with chronic allergies, asthma, and recurrent sinus inflammation. Their pale color and smooth, round shape distinguish them from other nasal structures during physical assessment.
Why Other Options are Incorrect:
A. Perforated septum — A perforated septum refers to a hole in the nasal septum and is not described as an overgrowth on the mucosa.
B. Chronic sinusitis — Chronic sinusitis is an inflammatory condition of the sinuses, not a physical structure or growth visualized on the nasal mucosa.
D. Turbinates — Turbinates are normal bony structures within the nasal cavity that help filter and humidify air. They are not overgrowths and are not abnormal findings.
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