health assessment practice questions nursing

Correct Answer: A

Rationale: The correct answer is A: At birth, the head is one fifth the total length. This is because newborns have relatively larger heads compared to their body size. This is known as cephalocaudal growth, where development starts from the head and progresses down the body. The head being one-fifth of the total length is a normal proportion in newborns. Choice B is incorrect because at birth, the chest circumference is usually greater than the head circumference. Choice C is incorrect as the head size reaches about 80% of its final size by age 2, not 3 years old. Choice D is incorrect because the closure of the anterior fontanelle at 2 months does not necessarily mean the head will appear proportionate to the body; it continues to grow in proportion to the body size.

Correct Answer: B

Rationale: The correct answer is B because the patient's symptoms (change in mole size, color changes, itching, burning, bleeding) are concerning for melanoma, a type of skin cancer. Given her history of blistering sunburns, early evaluation and referral are crucial for timely intervention. Option A is incorrect as it delays necessary evaluation. Option C is irrelevant as the symptoms suggest a serious condition, not environmental irritants. Option D is incorrect as compound nevi typically do not present with the described symptoms and are not common in this age group.

Correct Answer: A

Rationale: The correct answer is A: thyroid gland. Thyroxine is a hormone produced by the thyroid gland. An elevated thyroxine level indicates a potential thyroid gland dysfunction. The nurse would examine the thyroid gland to assess its size, texture, and any signs of abnormalities. Incorrect choices: B: Parotid gland - This gland is responsible for producing saliva, not thyroxine. C: Adrenal gland - Responsible for producing hormones like cortisol and adrenaline, not thyroxine. D: Thyroxine gland - There is no such thing as a "thyroxine gland." Thyroxine is a hormone produced by the thyroid gland.

Correct Answer: B

Rationale: The correct answer is B: Lyme disease. The presentation of a red circular rash with central clearing, known as erythema migrans, following a hiking trip in the summer is highly indicative of Lyme disease. The specific distribution of the rash across the midriff and behind the knees aligns with typical areas where the rash appears in Lyme disease cases. This rash is a hallmark sign of early Lyme disease caused by the bacterium Borrelia burgdorferi transmitted through the bite of an infected tick. Other answer choices are incorrect because rubeola presents with a different rash pattern, an allergy to mosquito bites would not typically present in this manner, and Rocky Mountain spotted fever typically presents with a different rash appearance and distribution.

Correct Answer: B

Rationale: Correct Answer: B Rationale: 1. Rubbing alcohol or 2% acetic acid eardrops help to maintain the pH balance in the ear canal, making it less conducive to bacterial growth. 2. These eardrops also help to dry out excess moisture, reducing the risk of otitis externa. 3. By using these eardrops after every swim, the student can prevent the recurrence of otitis externa. Summary of other choices: A: Using a cotton-tipped swab can push wax deeper into the ear canal, increasing the risk of infection. C: Irrigating the ears can introduce water into the ear canal, potentially worsening the condition. D: Mineral oil and hydrogen peroxide can be harsh on the delicate skin of the ear canal, causing irritation.