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
What are the positions for an adult male patient having a rectal and prostate exam? (Select all that apply)
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Prone position
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Semi-Fowlers
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Left, lateral decubitus
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Standing up and bending over the examining table
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Supine
Explanation
Correct Answer Is:
C. Left, lateral decubitus and D. Standing up and bending over the examining table
For a rectal and prostate examination in an adult male, the two accepted positions are the left lateral decubitus (Sims) position, where the patient lies on their left side with knees drawn up, and standing while bending over the examination table. Both positions allow adequate access to the rectum and prostate for digital examination.
Why the other options are incorrect:
A. The prone position places the patient face down and does not provide adequate access for rectal and prostate examination.
B. Semi-Fowlers position, with the head of the bed elevated 30-45 degrees, is not appropriate for rectal or prostate examination.
E. The supine position, lying flat on the back, does not provide the necessary access to the rectum and prostate for examination.
What position should a nurse assist in preparing a female patient for a pelvic exam?
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Left lateral decubitus position
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Knee-chest position
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Supine position
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Lithotomy position
Explanation
Correct Answer: D. Lithotomy position
The lithotomy position, where the patient lies on her back with hips and knees flexed and feet placed in stirrups, is the standard position for a pelvic examination. This position provides optimal access to the perineum and vaginal area for speculum insertion and bimanual examination.
Why Other Options are Incorrect:
A. The left lateral decubitus position is used for rectal examinations and certain cardiac assessments, not pelvic exams.
B. The knee-chest position is used for rectal examinations and certain spinal procedures, not pelvic exams.
C. The supine position alone does not provide adequate access to the perineum and vaginal area needed for a pelvic examination.
How should the nurse assess the functioning of the acoustic nerve (CN VIII)?
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Perform a whispered voice test
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Ask the patient to say "light, tight, dynamite" and note the lingual speech is clear and distinct
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Perform Snellen visual acuity test
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Ask the patient to say "sharp" or "dull," depending on the sensation felt when applying a sharp point or dull end to the patient's body
Explanation
Correct Answer: A. Perform a whispered voice test
Cranial nerve VIII (Vestibulocochlear/Acoustic nerve) is responsible for hearing and balance. The whispered voice test assesses hearing by having the examiner whisper words at a set distance and asking the patient to repeat them. This directly evaluates the auditory component of CN VIII function.
Why Other Options are Incorrect:
B. Asking the patient to say "light, tight, dynamite" tests the clarity of lingual speech, which assesses CN XII (Hypoglossal) function, not CN VIII.
C. The Snellen visual acuity test assesses visual sharpness and tests CN II (Optic nerve) function, not the acoustic nerve.
D. Asking the patient to identify sharp or dull sensations tests pain and touch sensation through sensory nerve pathways, not CN VIII function.
The nurse has palpated a lump in a female patient's right breast. The nurse documents this as a round, firm, singular, lump located at 2 o'clock, 2 cm from the nipple. It is nontender and fixed. No associated retraction of the skin or nipple, no erythema, and no axillary lymphadenopathy are observed. What information is missing from the documentation?
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Size of lump
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Consistency of the lump
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Whether the lump is solitary or multiple
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Shape of the lump
Explanation
Correct Answer: A. Size of lump
The documentation describes the shape (round), consistency (firm), location (2 o'clock, 2 cm from nipple), number (singular), tenderness (nontender), mobility (fixed), and associated findings. However, the actual size (dimensions in centimeters) of the lump is not included, which is a critical component of breast lump documentation for baseline comparison and monitoring.
Why Other Options are Incorrect:
B. Consistency is documented as "firm."
C. Whether the lump is solitary or multiple is documented as "singular."
D. Shape is documented as "round."
What finding best describes unusual movements in the head and face of some older adults?
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Scissoring
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Senile (essential) tremors
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Cremasteric Reflex
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Aphasia
Explanation
Correct Answer: B. Senile (essential) tremors
Senile or essential tremors are involuntary, rhythmic muscle movements that commonly affect the head, face, hands, and voice in older adults. These tremors are associated with aging and are the most common movement disorder seen in the elderly population.
Why Other Options are Incorrect:
A. Scissoring refers to a gait abnormality where the legs cross during walking, associated with spastic cerebral palsy or upper motor neuron lesions, not unusual head and face movements in older adults. C. The cremasteric reflex is a superficial reflex in males where stroking the inner thigh causes the testicle to elevate; it has no relation to head or face movements. D. Aphasia refers to a language disorder affecting the ability to speak or understand speech, not unusual physical movements of the head and face.
When performing a urinalysis for a patient, presence of red blood cells (RBCs) indicate which of the following?
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Dysuria
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Nocturia
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Hematuria
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Polyuria
Explanation
Correct Answer: C. Hematuria
Hematuria is defined as the presence of red blood cells in the urine. It can be visible to the naked eye (gross hematuria) or detected only under microscopy (microscopic hematuria) during urinalysis. It may indicate urinary tract infection, kidney stones, trauma, or malignancy.
Why Other Options are Incorrect:
A. Dysuria refers to painful or burning urination, not the presence of RBCs in urine.
B. Nocturia refers to waking at night to urinate and is not indicated by RBCs in a urinalysis.
D. Polyuria refers to producing abnormally large volumes of urine and is not associated with RBCs in urinalysis.
During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate?
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Whether the inversion is a recent change should be determined.
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Unilateral inversion of a nipple is always a serious sign.
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Nipple inversion is not significant unless accompanied by an underlying palpable mass.
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Normal nipple inversion is usually bilateral.
Explanation
Correct Answer: A. Whether the inversion is a recent change should be determined.
Nipple inversion can be congenital and present since puberty, which is generally benign. However, a newly inverted nipple is a significant clinical finding that may indicate an underlying malignancy pulling on the nipple-areolar complex. Determining whether the inversion is new or longstanding is the most important first step in assessment.
Why Other Options are Incorrect:
B. Unilateral nipple inversion is not always a serious sign; it can be a normal congenital variant present since puberty.
C. Nipple inversion is clinically significant on its own as a new finding, even without a palpable mass, as early breast cancers may not yet be palpable.
D. Congenital nipple inversion can be unilateral or bilateral; it is not exclusively bilateral.
What should the nurse plan to begin the interview with during an annual gynecologic examination?
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Sexual history because it will build rapport to discuss this first
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Urinary system history because there may be problems in this area as well
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Obstetric history because it is the most important information
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Menstrual history because it is generally nonthreatening
Explanation
Correct Answer: D. Menstrual history because it is generally nonthreatening
Beginning a gynecologic interview with menstrual history is appropriate because it is a routine, nonthreatening topic that helps establish rapport and comfort before moving to more sensitive subjects such as sexual history. Starting with less sensitive questions allows the patient to feel at ease and more willing to share information openly.
Why Other Options are Incorrect:
A. Starting with sexual history may make the patient uncomfortable and defensive before rapport has been established, making it a poor choice to begin the interview. B. While urinary history is relevant, it is not the standard starting point for an annual gynecologic examination interview. C. Obstetric history, while important, is not necessarily the most important information, and menstrual history is a more natural and comfortable starting point.
During the history of a 78-year-old patient, the spouse states that the patient occasionally has problems with short-term memory loss and confusion. What is the most appropriate action when assessing the sensory system?
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Before testing, assess the patient's mental status and ability to follow directions at this time.
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Do not perform this part of the examination because results would not be valid.
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Proceed with the explanations of each test, making sure the spouse understands.
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Perform the tests, knowing that mental status does not affect sensory ability.
Explanation
Correct Answer: A. Before testing, assess the patient's mental status and ability to follow directions at this time.
Sensory system testing requires the patient to accurately report what they feel, making it highly dependent on the patient's ability to understand and follow directions. Before proceeding, the nurse must first assess the patient's current mental status to determine whether the results of sensory testing will be reliable and valid at this time.
Why Other Options are Incorrect:
B. Skipping the sensory examination entirely is inappropriate. The nurse should first assess mental status and proceed if the patient is able to cooperate, rather than automatically omitting the assessment.
C. Explaining the tests to the spouse rather than the patient is not appropriate, as the patient is the one who must understand and respond during sensory testing. The focus should be on the patient's current ability to participate.
D. Mental status directly affects sensory testing reliability. A confused or disoriented patient cannot accurately report sensory stimuli, making this statement clinically incorrect.
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.
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