NR 414 Exam 4 - Revised Curriculum M.B Regis University.
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Free NR 414 Exam 4 - Revised Curriculum M.B Regis University. Questions
During a digital examination of the rectum, the nurse notes that the patient has hard feces in the rectum. The patient complains of feeling "full," has a distended abdomen, and states that they have not had a bowel movement "for several days." What condition does the nurse suspect?
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Rectal abscess
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Fecal impaction
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Rectal prolapsed
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Fecal polyp
Explanation
Correct Answer: B. Fecal impaction
Fecal impaction is characterized by a large, hardened mass of stool that becomes stuck in the rectum and cannot be expelled. Classic signs include hard feces palpable on digital rectal exam, abdominal distension, feeling of fullness, and absence of normal bowel movements for several days, all of which are present in this scenario.
Why Other Options are Incorrect:
A. A rectal abscess presents with localized pain, swelling, redness, and fever due to infection, not hard feces and absence of bowel movements. C. Rectal prolapse involves the protrusion of the rectal wall through the anus and presents with visible tissue protruding, not retained hard stool. D. Fecal polyps are growths on the rectal mucosa and would not cause the sudden presentation of hard retained stool and absence of bowel movements.
Why do many older adults often use laxatives inappropriately?
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Doctors advise their older adult patients they should have a bowel movement twice every day.
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Constipation is common in this group due to decreased GI motility, weaker abdominal muscles, and decreased physical activity.
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The increased salivation and gastric secretions of older adults leads to constipation.
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The increased liver size in older adults blocks GI motility.
Explanation
Correct Answer: B. Constipation is common in this group due to decreased GI motility, weaker abdominal muscles, and decreased physical activity.
Older adults commonly experience constipation due to age-related physiological changes including slowed gastrointestinal motility, weakened abdominal and pelvic floor muscles, decreased physical activity, reduced fluid intake, and polypharmacy. These factors lead many older adults to rely on laxatives, often inappropriately, to manage bowel regularity.
Why Other Options are Incorrect:
A. There is no standard medical recommendation that older adults must have a bowel movement twice daily. Normal bowel frequency ranges from three times per day to three times per week. C. Salivation and gastric secretions actually decrease with aging, not increase. Furthermore, reduced secretions contribute to slower digestion but are not the primary reason for laxative misuse. D. The liver does not increase in size with normal aging and does not block GI motility. Liver size typically decreases slightly with age.
When the nurse is conducting a sexual history from a male adolescent, which statement or question would be most appropriate to use at the beginning of the interview?
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"Have you had sex in the last 6 months?"
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"Tell me what you think about masturbation."
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"Often boys your age have questions about sexual activity."
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"Do you use condoms?"
Explanation
Correct Answer: C. "Often boys your age have questions about sexual activity."
Beginning a sexual history interview with a normalizing statement such as this creates a safe, nonjudgmental environment for the adolescent. It acknowledges that sexual questions are common and expected at his age, reducing embarrassment and encouraging open communication before more direct questions are asked.
Why Other Options are Incorrect:
A. Asking directly about sexual activity before establishing rapport is too abrupt and may cause the adolescent to become defensive or reluctant to share information.
B. Asking about masturbation at the beginning of the interview is inappropriate, too personal, and likely to make the adolescent extremely uncomfortable before any rapport is established.
D. Asking about condom use is a specific and direct question that is more appropriate later in the interview after rapport and comfort have been established.
Which position will most likely make significant lumps more distinct during breast palpation during an examination?
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Supine with arms relaxed at the sides
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Sitting with arms relaxed at the sides
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Sitting with arms flexed and fingertips touching shoulders
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Supine with arms raised over her head
Explanation
Correct Answer: D. Supine with arms raised over her head
When a patient lies supine with arms raised over her head, the breast tissue flattens evenly across the chest wall, making the tissue thinner and more uniform. This position allows lumps and abnormalities to become more distinct and easier to palpate against the underlying chest wall.
Why Other Options are Incorrect:
A. Supine with arms relaxed at the sides does not fully flatten the breast tissue, making deeper lumps harder to detect. B. Sitting with arms relaxed causes breast tissue to hang, which can obscure lumps rather than make them more distinct. C. Sitting with arms flexed and fingertips touching shoulders is useful for inspecting the breast contour and detecting skin changes but is not optimal for palpating lumps.
What would be the best question to assess whether a patient with a history of a seizure disorder has an aura?
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"Does your muscle tone seem tense or limp?"
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"Do you experience any color change or incontinence during the seizure?"
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"Do you have any warning sign before your seizure starts?"
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"After the seizure, do you spend a lot of time sleeping?"
Explanation
Correct Answer: C. "Do you have any warning sign before your seizure starts?"
An aura is a sensory or perceptual warning sign that occurs immediately before a seizure, such as seeing lights, smelling unusual odors, feeling tingling, or experiencing a sense of déjà vu. Asking about warning signs before the seizure directly and clearly assesses whether the patient experiences an aura in language that is easily understood.
Why Other Options are Incorrect:
A. Asking about muscle tone during the seizure assesses the type of seizure activity (tonic vs. atonic), not whether an aura is present.
B. Asking about color change or incontinence during the seizure assesses ictal (during seizure) symptoms, not the pre-seizure aura phase.
D. Asking about sleeping after the seizure assesses the postictal phase (period after the seizure), not the presence of a pre-seizure aura.
Which finding would the nurse expect while testing the function of an intact cranial nerve XI (Spinal Accessory)?
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Demonstrates ability to hear normal conversation
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Moves the head and shoulders against resistance with equal strength
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Follows an object with eyes without nystagmus or strabismus
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Sticks tongue out midline without tremors or deviation
Explanation
Correct Answer: B. Moves the head and shoulders against resistance with equal strength
Cranial nerve XI (Spinal Accessory) innervates the sternocleidomastoid and trapezius muscles, which control head rotation and shoulder elevation. Testing involves asking the patient to turn their head and shrug their shoulders against resistance. Equal bilateral strength indicates an intact spinal accessory nerve.
Why Other Options are Incorrect:
A. Hearing normal conversation tests cranial nerve VIII (Vestibulocochlear), which handles hearing and balance. C. Following an object with eyes without nystagmus tests cranial nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens), which control eye movement. D. Sticking the tongue out midline without deviation tests cranial nerve XII (Hypoglossal), which controls tongue movement.
A patient states that his doctor told him that he has an "inguinal hernia." He asks the nurse to explain what a hernia is. What is the nurse's best response?
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Explain that a hernia is often the result of prenatal growth abnormalities.
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Tell him not to worry and that most men his age develop hernias.
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Refer him to his physician for additional consultation because the physician made the initial diagnosis.
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Explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles.
Explanation
Correct Answer: D. Explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles.
Patient education is a core nursing responsibility. An inguinal hernia occurs when a portion of the intestine or abdominal tissue pushes through a weak spot in the abdominal muscles in the inguinal canal area. Providing this clear, accurate explanation empowers the patient with understanding of his condition.
Why Other Options are Incorrect:
A. While some hernias can be congenital, stating it is often the result of prenatal growth abnormalities is not the best or most accurate general explanation. B. Dismissing the patient's concern by saying not to worry is inappropriate and does not provide the patient with needed education. C. Referring the patient back to the physician simply for an explanation is unnecessary and fails to fulfill the nurse's educational role.
During an assessment of an 80-year-old patient, the nurse notices the following: inability to identify vibrations at the ankle and to identify position of big toe, slower and more deliberate gait, and slightly impaired tactile sensation. How should the nurse interpret what these findings indicate?
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Cranial nerve dysfunction
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Demyelination of nerves due to a lesion
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Normal changes due to aging
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Lesion in the cerebral cortex
Explanation
Correct Answer: C. Normal changes due to aging
In older adults, age-related neurological changes include decreased vibratory sensation (especially in the lower extremities), reduced proprioception (position sense), slower and more cautious gait, and mild decline in tactile sensation. These changes result from normal degeneration of peripheral nerve fibers and are expected findings in an 80-year-old patient.
Why Other Options are Incorrect:
A. Cranial nerve dysfunction would present with deficits in head and neck functions such as facial movement, vision, hearing, or swallowing, not peripheral sensory changes in the lower extremities. B. Demyelination due to a lesion would typically present with more pronounced and asymmetric neurological deficits rather than the subtle, bilateral, age-consistent changes described. D. A cerebral cortex lesion would cause more significant neurological deficits such as weakness, aphasia, or cognitive changes, not the mild peripheral sensory changes described here.
What is the area of the nervous system responsible for mediating reflexes including pain and urination?
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Dermatomes
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Cerebral cortex
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Spinal cord
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Cerebellum
Explanation
Correct Answer: C. Spinal cord
The spinal cord serves as the primary mediator of reflex arcs, including pain reflexes and the micturition (urination) reflex. Reflex pathways travel through the spinal cord without requiring input from higher brain centers, allowing for rapid, automatic responses to stimuli.
Why Other Options are Incorrect:
A. Dermatomes are areas of skin innervated by specific spinal nerve roots; they are not responsible for mediating reflexes. B. The cerebral cortex is involved in conscious thought, voluntary movement, and higher cognitive functions, not basic reflex mediation. D. The cerebellum coordinates balance, posture, and fine motor movements but does not mediate pain or urination reflexes.
Which question is most appropriate when the nurse is obtaining a genitourinary history from an elderly man who lives independently at home?
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"Do you know how to perform a testicular self-examination?"
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"Have you noticed any change in your need to get up during the night to use the restroom?"
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"Do you need to get up at night to exercise?"
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"Do you experience nocturnal emissions, or 'wet dreams'?"
Explanation
Correct Answer: B. "Have you noticed any change in your need to get up during the night to use the restroom?"
Nocturia (waking at night to urinate) is a common genitourinary complaint in elderly men and may indicate benign prostatic hyperplasia (BPH), urinary tract infection, or other genitourinary conditions. This question is age-appropriate, clinically relevant, and directly assesses an important genitourinary symptom in this population.
Why Other Options are Incorrect:
A. While testicular self-examination is important, it is more relevant for younger men and is not the priority genitourinary question for an elderly patient. C. Getting up at night to exercise is not a genitourinary assessment question and is clinically irrelevant in this context. D. Nocturnal emissions are more relevant to younger males and are not an appropriate or sensitive question for an elderly man during a genitourinary history.
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