N391 Summer Exam 2 391-900 Pierre - Adelphi University
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Free N391 Summer Exam 2 391-900 Pierre - Adelphi University Questions
The nurse is teaching a client how to perform a breast self-examination. Which client statement indicates a need for further teaching?
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"I should squeeze my breast tissue firmly between my fingers to check for lumps."
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"I will use a consistent pattern so that I examine all of my breast tissue."
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"I will use the pads of my three middle fingers to feel my breast tissue."
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"I will report a new lump, skin dimpling, or unusual nipple discharge to my healthcare provider."
Explanation
Correct Answer: (A) "I should squeeze my breast tissue firmly between my fingers to check for lumps." Breast self-examination should be performed using the pads of the fingers to palpate breast tissue in small, circular motions with varying levels of pressure, not by squeezing the tissue firmly between the fingers. Squeezing can cause discomfort and is not the correct technique, indicating the client needs further teaching.
Why the other options are incorrect:
B. "I will use a consistent pattern so that I examine all of my breast tissue." Using a consistent pattern, such as a vertical strip or circular pattern, is correct technique to ensure thorough examination of all breast tissue.
C. "I will use the pads of my three middle fingers to feel my breast tissue." Using the finger pads is the correct and recommended technique for palpating breast tissue during self-examination.
D. "I will report a new lump, skin dimpling, or unusual nipple discharge to my healthcare provider." This is correct and appropriate teaching, as these findings should always be reported for further evaluation.
While assessing a woman's breasts, the nurse notes a pronounced lump on the outer aspect on the client's left breast. Follow-up care is ordered because the nurse should suspect which of the following?
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A low platelet count.
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Fibrocystic changes.
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Pregnancy.
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Malignancy.
Explanation
Correct Answer: (D) Malignancy. A pronounced, discrete lump warrants follow-up evaluation because it raises concern for malignancy. Breast masses that are new, firm, and localized require further diagnostic workup, such as imaging or biopsy, to rule out cancer.
Why the other options are incorrect:
A. A low platelet count. A low platelet count would present with bruising or petechiae rather than a discrete breast lump.
B. Fibrocystic changes. Fibrocystic changes typically present as diffuse, tender, and often bilateral lumpiness that fluctuates with the menstrual cycle, rather than a single pronounced, discrete lump.
C. Pregnancy. Pregnancy can cause diffuse breast enlargement and tenderness due to hormonal changes, but it does not typically cause a distinct, localized lump.
A 54-year-old truck driver reports "chest burning" after meals and when lying down. He has a history of working long hours on the road, is divorced, smokes 1 PPD for 17 years, drinks 3 beers nightly and eats meals from highway rest stops. He has a BMI of 36, takes Eliquis 10mg everyday for atrial fibrillation and has obstructive sleep apnea. He reports not being compliant with the CPAP machine. Which of the following increase the risk of gastroesophageal reflux disease? Select all that apply.
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Alcohol use.
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Smoking.
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Obesity.
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Regular physical activity.
Explanation
Correct Answer: (A, B, C) Alcohol use relaxes the lower esophageal sphincter, allowing stomach acid to reflux into the esophagus more easily. Smoking similarly weakens the lower esophageal sphincter and reduces saliva production, which normally helps neutralize acid, increasing GERD risk. Obesity, reflected by this client's BMI of 36, increases intra-abdominal pressure, which promotes reflux of stomach contents into the esophagus.
Why the other options are incorrect:
D. Regular physical activity. Regular physical activity is generally protective and associated with a lower risk of GERD, as it supports healthy weight management and digestion, rather than increasing risk.
The nurse is assessing three clients with shortness of breath. For each assessment finding, select the condition most commonly associated with the finding.
Expiratory wheezing with prolonged expiration. A. Asthma. B. COPD. C. Heart Failure.
Barrel-shaped chest with diminished breath sounds. A. Asthma. B. COPD. C. Heart Failure.
Bilateral crackles with orthopnea and peripheral edema. A. Asthma. B. COPD. C. Heart Failure.
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Asthma
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COPD
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Heart Failure
Explanation
Correct Matches: Asthma, COPD, Heart Failure. Expiratory wheezing with prolonged expiration is characteristic of asthma, reflecting bronchospasm and airway narrowing that makes it harder to exhale air. A barrel-shaped chest with diminished breath sounds is a classic finding in COPD, resulting from chronic hyperinflation and air trapping that flattens the diaphragm and increases the anterior-posterior chest diameter. Bilateral crackles with orthopnea and peripheral edema are hallmark findings of heart failure, reflecting fluid accumulation in the lungs and systemic venous congestion due to the heart's reduced pumping ability.
The nurse is performing the Romberg test as part of a client's focused neurological assessment. What finding would constitute a negative (normal) Romberg test?
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The client is noted to have minimal sway during the exam.
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The client experiences pain during neck flexion and extension.
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The client is unable to consistently touch their finger to their nose with eyes closed.
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The client experiences pain when clenching their teeth.
Explanation
Correct Answer:
(A) The client is noted to have minimal sway during the exam. The Romberg test assesses balance and proprioception by having the client stand with feet together and eyes closed; a negative (normal) result is indicated by only minimal swaying, demonstrating intact proprioceptive and vestibular function.
Why Other Options are Incorrect:
B. Pain during neck flexion and extension relates to cervical spine or musculoskeletal findings, not the Romberg test, which assesses balance.
C. Inability to consistently touch the finger to the nose with eyes closed relates to the finger-to-nose test, which assesses cerebellar coordination, not the Romberg test.
D. Pain when clenching the teeth relates to temporomandibular joint or cranial nerve V (trigeminal) assessment, not the Romberg test.
Which of the following describes a behavior that is most often seen when a nurse is conducting a functional assessment of an elderly adult client?
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Activities of daily living
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Quality of life
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Feelings about aging
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Recent personal losses
Explanation
Correct Answer:
A
Why the other options are incorrect:
B. Quality of life — This is a broader, more subjective concept that falls under psychosocial or holistic assessment rather than a functional assessment.
C. Feelings about aging — This relates to psychosocial assessment, not functional status.
D. Recent personal losses — This is relevant to psychosocial or grief assessment, not the client's functional abilities.
A nurse is assessing a client's thorax after the client reports chest trauma from a fall. Which technique should the nurse use to assess for crepitus?
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Inspect the chest for symmetrical expansion during inspiration.
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Percuss over the ribs, comparing sounds bilaterally.
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Auscultate the chest with the diaphragm of the stethoscope while the client takes deep breaths.
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Gently palpate the chest wall with the fingertips, feeling for a crackling sensation beneath the skin.
Explanation
Correct Answer: (D) Gently palpate the chest wall with the fingertips, feeling for a crackling sensation beneath the skin. Crepitus is assessed through palpation, where the nurse feels for a crackling or grating sensation under the skin caused by subcutaneous air, often resulting from trauma such as a rib fracture or pneumothorax.
Why the other options are incorrect:
A. Inspect the chest for symmetrical expansion during inspiration. Inspection assesses chest wall movement and symmetry, but it does not detect the crackling sensation associated with crepitus.
B. Percuss over the ribs, comparing sounds bilaterally. Percussion assesses underlying tissue density and air/fluid content, not the presence of subcutaneous air causing crepitus.
C. Auscultate the chest with the diaphragm of the stethoscope while the client takes deep breaths. Auscultation is used to assess breath sounds, not to detect crepitus, which is a palpable finding rather than an auditory one.
A nurse is preparing to review Sexually Transmitted Infection prevention with a group of students. Choose from the list below what needs to be included in this session. Choose four that apply.
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Abstaining from all forms of sexual activity is the only way to completely avoid an STI
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Education regarding signs and symptoms of STI such as vaginal or penile discharge
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Using condoms correctly
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Education that multiple sexual partners will not increase your risk of STI
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Getting vaccinated for HPV and Hepatitis B
Explanation
Correct Answers: (A) Abstaining from all forms of sexual activity is the only way to completely avoid an STI, (B) Education regarding signs and symptoms of STI such as vaginal or penile discharge, (C) Using condoms correctly, (E) Getting vaccinated for HPV and Hepatitis B
These are all evidence-based components of comprehensive STI prevention education: abstinence is factually the only 100% effective prevention method, recognizing signs/symptoms enables early detection and treatment, correct condom use reduces transmission risk, and HPV/Hepatitis B vaccination provides protection against specific viral STIs.
Why Other Options are Incorrect:
D. Education that multiple sexual partners will not increase your risk of STI — This statement is factually incorrect; having multiple sexual partners does increase the statistical risk of STI exposure and transmission, so this should not be taught.
The nurse is preparing to assess the thyroid gland of an adult client. Select which actions the nurse will take during the thyroid assessment process from the drop down options in the statements below. The nurse would position themselves (1) Behind the client. The nurse will identify landmarks by (2) palpation.
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(1) Behind the client, (2) Palpation
Explanation
The posterior approach to thyroid assessment involves the nurse standing behind the client and using the fingers of both hands to palpate the neck, identifying landmarks such as the cricoid cartilage and thyroid isthmus, then palpating for the thyroid lobes as the client swallows.
Why the other options are incorrect:
With the client prone / On the left side of the client — These positions do not allow the nurse proper bimanual access to both sides of the neck for thyroid palpation.
Percussion / Auscultation — Percussion is not used to identify neck landmarks, and while auscultation may be used afterward to check for bruits, palpation is the primary technique used to identify anatomical landmarks in this context.
Which two aspects of visual function can the nurse assess by asking the patient to stand 20 feet from the Snellen chart that is mounted on a wall in the clinic? Select two answers from the choices below.
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Distant (far vision) visual acuity
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Near vision
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Extraocular muscle function
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Peripheral vision
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Red/Green color discrimination
Explanation
Correct Answer:
(A, E) Distant (far vision) visual acuity; Red/Green color discrimination. The Snellen chart is specifically designed to assess distant visual acuity by having the patient read progressively smaller letters from 20 feet away, and it also incorporates a red/green bar or similar color elements that allow the nurse to screen for red/green color discrimination during the same test.
Why Other Options are Incorrect:
B. Near vision is assessed using a handheld near vision card held at reading distance, not the distance Snellen chart.
C. Extraocular muscle function is assessed through the six cardinal fields of gaze test, not the Snellen chart.
D. Peripheral vision is assessed through visual field testing (such as confrontation testing), not the Snellen chart.
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