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Holistic Assessment Exam 1 Questions With Complete Solutions
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Holistic Assessment Exam 1 Questions With Complete Solutions
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Holistic Assessment Exam 1 Questions With CompleteSolutions
A 19 year old nursing student has a 4 day history of sore throat
and difficulty swallowing. The nurse observes tonsils covered
with yellow patches, and the tonsils are so large they fill the
entire oropharynx and appear to be touching. The nurse
documents:
a. Tonsils yellow and swollen
b. Enlarged tonsils 4+ with yellow exudate.
C. Strep infection to tonsils with 3+ swelling
D. 1+ edema of tonsils with pus. Correct Answer b. Enlarged
tonsils 4+ with yellow exudate.
A nurse asks an adolescent client to describe pain using a
number between 0 and 10 where 0 means no pain and 10 means
severe pain. What is the nurse trying elicit?
A. Tolerance to pain
B. Quality of pain
C. Temporal pattern of pain
D. Intensity of pain Correct Answer D. Intensity of pain
A nurse is inspecting a client's nails and notices that the angle of
the proximal nail fold and the nail plate is about 160 degrees.
The nurse understands that this finding indicates:
A. Clubbing
B. A normal finding
C. Edema of the nail bed
D. Poor perfusion Correct Answer B. A normal finding
, A skin lesion is noted over the maxilla of the client that looks as
pictured. Identify the skin lesion.
A. macule
B. pustule
C. bulla
D. nodule Correct Answer b. pustule
As the nurse performs a respiratory assessment, he notes a mole
on the client's back over the right scapula. What would be most
important for the nurse to ask the client?
a. "Do you sleep on your right side?"
b. "Does your bra strap rub this mole?"
c. "Has this mole changed recently?"
d. "Have you applied any creams to this mole?" Correct Answer
c. "Has this mole changed recently?"
Assessment of pain entails all of the following except:
A. Asking the patient about his or her experience with pain
B. Believing the patient's description of the pain he or she is
describing
C. Assuming that patients who are sleeping are not in pain
D. Communicating the pain assessment findings to the health
care team Correct Answer C. Assuming that patients who are
sleeping are not in pain
The "A" in the ABCDEF rule for assessing lesions stands for:
a. Accuracy
b. Appearance
c. Asymmetry
d. Attenuated Correct Answer c. Asymmetry
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