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NUR 1020C Florida State College At Jacksonville -NUR 1020C Final Review
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NUR 1020C Final ReviewA 2-week-old infant can fixate on an object but cannot follow a
light or bright toy. The nurse would: Correct Answer consider
this a normal finding.
A 3 month old has a heart rate of 135 BPM, is this normal or
abnormal? Correct Answer Normal
A 3 month old infant demonstrates the moro reflex, the nurse
notes this finding as: Correct Answer Normal
A 3 year old patient has palpable lymph nodes, the nurse
explains this finding as: Correct Answer Normal 3-6 yrs old
A 30-year-old woman tells the nurse that she has been very
unsteady and has had difficulty in maintaining her balance.
Which area of the brain would the nurse be concerned about
with these findings? Correct Answer Cerebellum
A 31-year-old patient tells the nurse that he has noticed a
progressive loss in his hearing. He says that it does seem to help
when people speak louder or if he turns up the volume. The
most likely cause of his hearing loss is: Correct Answer
otosclerosis.
A 35-year-old pregnant woman comes to the clinic for a
monthly appointment. During the assessment, the nurse notices
that she has a brown patch of hyperpigmentation on her face.
The nurse continues the skin assessment aware that another
finding may be: Correct Answer linea nigra.
,A 4-year-old boy is brought to the emergency department by his
mother. She says he points to his stomach and says, "It hurts so
bad." Which pain assessment tool would be the best choice
when assessing this child's pain? Correct Answer The Faces
Pain Scale—Revised (FPS-R)
A 65-year-old patient with a history of heart failure comes to the
clinic with complaints of "being awakened from sleep with
shortness of breath." Which action by the nurse is most
appropriate? Correct Answer Assess for other signs and
symptoms of paroxysmal nocturnal dyspnea.
A 70-year-old patient tells the nurse that he has noticed that he is
having trouble hearing, especially in large groups. He says he
"can't always tell where the sound is coming from" and the
words often sound "mixed up." What might the nurse suspect as
the cause for this change? Correct Answer Nerve degeneration
in the inner ear
A 70-year-old woman tells the nurse that every time she gets up
in the morning or after she's been sitting she gets "really dizzy"
and feels like she is going to fall over. The nurse's best response
would be: Correct Answer "You need to get up slowly when
you've been lying or sitting."
A 92-year-old patient has had a stroke. The right side of his face
is drooping. The nurse might also suspect which of these
assessment findings? Correct Answer Dysphagia
,A black patient is in the intensive care unit because of
impending shock after an accident. The nurse would expect to
find what characteristics in this patient's skin? Correct Answer
Ashen, gray, or dull
A cancer patient receives a flu shot, this is what type of
prevention Correct Answer Secondary prevention
A child's immunization may cause discomfort during
administration, but the benefits of protection from disease, both
for the individual and society, outweigh the temporary
discomforts. Which principle is involved in this situation?
Correct Answer Beneficence
A mother brings her 4-month-old child to the clinic with
concerns regarding a small pad in the middle of the upper lip
that has been there since 1 month of age. The infant has no
health prob-lems. On physical examination, the nurse notices a
0.5-cm, fleshy, elevated area in the middle of the upper lip.
There is no evidence of inflammation or drainage. What would
the nurse tell this mother? Correct Answer "This is a sucking
tubercle caused from the friction of breastfeeding or bot-tle-
feeding and is normal."
A mother brings her newborn in for an assessment and asks, "Is
there something wrong with my baby? His head seems so big."
The nurse recognizes that which statement is true regarding the
relative proportions of the head and trunk of the newborn?
Correct Answer Head circumference should be greater than
chest circumference at birth.
, A mother brings in her newborn infant for an assessment and
tells the nurse that she has noticed that whenever her newborn's
head is turned to the right side, she straightens out the arm and
leg on the same side and flexes the opposite arm and leg. After
finding this on examination, the nurse would tell her that this is:
Correct Answer normal and should disappear between 3 and 4
months of age.
A newborn infant is in the clinic for a well-baby check. The
nurse observes the infant for the possibility of fluid loss because
of which of these factors? Correct Answer The newborn's skin
is more permeable than that of the adult.
A nurse conducts health awareness training programs at a
community center. What kind of action is this? Correct Answer
Primary prevention.
A nurse goes to the doctor on behalf of the patient, this
demonstrates what? Correct Answer Advocacy
A nurse has assessed a patient's capillary refill, which was 5
seconds. What action by the nurse is most appropriate? Correct
Answer Assess the patient for signs of hypoxia.
A nurse is caring for a patient who is quadriplegic. According to
Maslow's hierarchy of needs, which patient needs should be
given priority over others? Select all that apply. Correct Answer
Food, water, and elimination are basic needs and should be
given priority over others. Reassurance helps to make the patient
emotionally secure. A visit by family members makes the
patient feel loved.
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