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NR 509 QUESTIONS WITH COMPLETE SOLUTIONS
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NR 509 QUESTIONS WITH COMPLETE SOLUTIONS
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NR 509 QUESTIONS WITH COMPLETESOLUTIONS
When performing a physical assessment, the first technique the nurse will always use
A. Palpation
B. Inspection
C. Percussion
D. Auscultation - Answer-B. Inspection
The nurse is preparing to perform a physical assessment. Which statement is true about
the physical assessment? The inspection phase:
A. Usually yields little information
B. Takes time and reveals a surprising amount of information
C. May be somewhat uncomfortable for the expert practitioner
D. Requires a quick glance at the patient's body systems before proceeding with
palpation - Answer-B. Takes time and reveals a surprising amount of information
The nurse is assessing a patient's skin during an office visit. What part of the hand and
technique should be used to best assess the patient's skin temperature?
A. Fingertips; they are more sensitive to small changes in temperature
B. Dorsal surface of the hand; the skin is thinner on this surface than on the palms
C. Ulnar portion of the hand, increased blood supply in this area enhances temperature
sensitivity
D. Palmar surface of the hand; this surface is the most sensitive to temperature
variations because of its increased nerve supply in this area. - Answer-B. Dorsal surface
of the hand; the skin is thinner on this surface than on the palms
Which of these techniques uses the sense of touch to assess texture, temperature,
moisture, and swelling when the nurse is assessing a patient?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation - Answer-A. Palpation
The nurse is preparing to assess a patient's abdomen by palpation. How should the
nurse proceed?
A. Palpation of reportedly tender areas are avoided because palpation in these areas
may cause pain
B. Palpating a tender area is quickly performed to avoid any discomfort that the patient
may experience
C. The assessment begins with deep palpation, while encouraging the patient to relax
and to take deep breaths.
,D. The assessment begins with light palpation to detect surface characteristics and to
accustom the patient to being touched. - Answer-D. The assessment begins with light
palpation to detect surface characteristics and to accustom the patient to being touched.
The nurse would use bimanual palpation technique in which situation?
A. Palpating the thorax of an infant
B. Palpating the kidneys and the uterus
C. Assessing pulsations and vibrations
D. Assessing the presence of tenderness and pain - Answer-B. Palpating the kidneys
and the uterus
The nurse is preparing to percuss the abdomen of a patient. The purpose of the
percussion is to assess the ___________ of the underlying tissue.
A. Turgor
B. Texture
C. Density
D. Consistency - Answer-C. Density
The nurse is reviewing percussion techniques with a newly graduated nurse. Which
technique, if used by the new nurse, indicates that more review is needed?
A. Percussing once over each area
B. Quickly lifting be striking finger after each stroke
C. Striking with the fingertip, not the finger pad
D. Using the wrist to make the strikes, not the arm - Answer-A. Percussing once over
each area
When percussing over the liver of a patient, the nurse notices a dull sound. The nurse
should:
A. Consider this a normal finding
B. Palpate this area for an underlying mass
C. Reposition the hands, and attempt to percuss in this area again
D. Consider this finding abnormal, and refer the patient for additional treatment -
Answer-A. Consider this a normal finding
The nurse is unable to identify any changes in sound when percussing over the
abdomen of an obese patient. What should the nurse do next?
A. Ask the patient to take deep breaths to relax the abdominal musculature
B. Consider this finding as normal and proceed with the abdominal assessment
C. Increase the amount of strength used when attempting to percuss over the abdomen
D. Decrease the amount of strength used when attempting to percuss over the
abdomen. - Answer-C. Increase the amount of strength used when attempting to
percuss over the abdomen
The nurse hears bilateral loud, long and low tones when percussing over the lungs of a
4 year old child. The nurse should
A. Palpate over the area for increased pain and tenderness
,B. Ask the child to take shallow breaths and percuss over the area again
C. Immediately refer the child because of an increased amount of air in the lungs
D. Consider this finding as normal for a child this age and proceed with the examination
- Answer-D. Consider this finding as normal for a child this age and proceed with the
examination
A patient has suddenly developed shortness of breath and appears to be insignificant
respiratory distress. After calling the position and placing the patient on oxygen, which
of these actions is the best for the nurse to take went further assisting this patient?
A. Count the patient's respirations
B. Bilaterally percuss the thorax, noting any differences in percussion tones
C. Call for a chest x-ray study and wait for the results before beginning an assessment
D. Inspect the thorax for any new masses and bleeding associated with respirations -
Answer-B. Bilaterally percuss the thorax, noting any differences in percussion tones
The nurse is teaching a class on basic assessment skills. Which of these statements is
true regarding the stethoscope and its use?
A. Slope of the earpieces should point posteriorly (toward to occiput)
B. Although the stethoscope does not magnify sound, it does block out extraneous room
noise
C. Fit and quality of the stethoscope are not as important as its ability to magnify sound
D. Ideal tubing length should be 22 inches to dampen the distortion of sound - Answer-
B. Although the stethoscope does not magnify sound, it does block out extraneous room
noise
The nurse is preparing to use a stethoscope for auscultation. Which statement is true
regarding the diaphragm of the stethoscope? The diaphragm:
A. Is used to listen for high-pitched sounds
B. Is used to listen for low-pitched sounds
C. Should be lightly held against the persons skin to block out low-pitched sounds
D. Should be lightly held again the person skin to listen for extra heart sounds and
murmurs - Answer-A. Is used to listen for high-pitched sounds
Before auscultating the abdomen for the presence of bowel sounds on a patient, the
nurse should:
A. Warm the endpiece of the stethoscope by placing it in warm water
B. Leave the gown on the patient to ensure that she or he does not get chilled during
the examination
C. Ensure that the bell side of the stethoscope is turned to the on position
D. Check the temperature of the room and offer blankets to the patient if she or he feels
cold. - Answer-D. Check the temperature of the room and offer blankets to the patient if
she or he feels cold.
The nurse will use which technique of assessment to determine the presence of
crepitus, swelling and pulsations?
A. Palpation
, B. Inspection
C. Percussion
D. Auscultation - Answer-A. Palpation
The nurse is preparing to use an otoscope for an examination. Which statement is true
regarding the otoscope? The otoscope:
A. Is often used to direct light onto the sinuses
B. Uses a short, broad speculum to help visualize the ear
C. Is used to examine the structures of the internal ear
D. Directs light into the ear canal and onto the tympanic membrane - Answer-D. Directs
light into the ear canal and onto the tympanic membrane
An examiner is using an ophthalmoscope to examine a patient's eyes. The patient has
astigmatism and is nearsighted. The use of which of these techniques would indicate
that the examination is being correctly performed?
A. Using the large full circle of light when assessing pupils that are not dilated
B. Rotating the lens selector dial to the black numbers to compensate for astigmatism
C. Using the grid on the lens aperture to visualize the external structures of the eye
D. Rotating the lens selector dial to bring the object into focus - Answer-D. Rotating the
lens selector dial to bring the object into focus
The nurse is unable to palpate the right radial pulse on a patient. The best action would
be to:
A. Auscultate over the area with a fetoscope
B. Use a goniometer to measure the pulsations
C. Use a Doppler device to check for pulsations over the area
D. Check for the presence of pulsations with a stethoscope - Answer-C. Use a Doppler
device to check for pulsations over the area
The nurse is preparing to perform a physical assessment. The correct action by the
nurse is reflected by which statement? The nurse:
A. Performs the examination from the left side of the bed
B. Examines the tender of painful areas first to help relieve the patient's anxiety
C. Follows the same examination sequence, regardless of the patients age or condition
D. Organizes the assessment to ensure that the patient does not change positions too
often - Answer-D. Organizes the assessment to ensure that the patient does not change
positions too often
A man is at the clinic for a physical examination. He states that he is very anxious about
the physical examination. What steps can the nurse take to make him more
comfortable?
A. Appear unhurried and confident when examining him
B. Stay in the room when he undresses in case he needs assistance
C. Ask him to change into an examination gown to take off his undergarments
D. Defer measuring vital signs until the end of the examination which allows him time to
become comfortable - Answer-A. Appear unhurried and confident when examining him
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