health assessment practice questions nursing

Questions 46

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health assessment practice questions nursing Questions

Question 1 of 5

When a light is directed across the iris of the eye from the temporal side, the examiner is assessing for:

Correct Answer: C

Rationale: The correct answer is C: the presence of shadows, which may indicate glaucoma. When a light is directed across the iris from the temporal side, it helps in evaluating the presence of shadows in the anterior chamber angle, which can suggest a narrow or closed angle glaucoma. This technique is known as transillumination test and is important in detecting potential glaucoma cases. A: Drainage from dacryocystitis is incorrect as it is typically assessed by pressing on the lacrimal sac area to observe for discharge. B: Conjunctivitis over the iris is incorrect as conjunctivitis is an inflammation of the conjunctiva, not the iris. D: A scattered light reflex indicative of cataracts is incorrect as cataracts cause clouding of the lens, not scattering of light across the iris.

Question 2 of 5

To assess colour vision in a male child, the nurse would:

Correct Answer: C

Rationale: The correct answer is C because testing for color vision once between the ages of 4 and 8 is appropriate to assess any potential color vision deficiencies. This age range is crucial as color vision development is mostly completed by the age of 8. Annual checks (A) are not necessary unless there are specific concerns. Asking the child to identify clothing color (B) may not be a reliable indicator of color vision deficiency. No information is provided for option D.

Question 3 of 5

When examining the nares of a 45-year-old patient who complains of rhinorrhea, itching of the nose and eyes, and sneezing, the nurse notes the following: pale, swollen turbinates and clear rhinorrhea. Which of the following is most likely the cause?

Correct Answer: C

Rationale: The correct answer is C: Allergic rhinitis. The patient's symptoms of rhinorrhea, itching, and sneezing, along with pale, swollen turbinates and clear rhinorrhea, are indicative of allergic rhinitis. Allergic rhinitis is characterized by an allergic response to allergens, leading to inflammation of the nasal passages and increased mucus production. Nasal polyps (choice A) typically present with nasal congestion and reduced sense of smell. Acute sinusitis (choice B) would likely present with purulent nasal discharge and facial pain/pressure. Nasal carcinoma (choice D) is unlikely in this case due to the patient's symptoms and age.

Question 4 of 5

While assessing the tonsils of a 30-year-old, the nurse notes that they look involuted and granular, and appear to have deep crypts. What is the correct follow-up to these findings?

Correct Answer: B

Rationale: The correct answer is B: Nothing, this is the appearance of normal tonsils. In a 30-year-old, tonsils commonly appear involuted, granular, and have deep crypts due to natural aging and exposure to infections. This is considered a normal variant and does not typically require further intervention. Referral to a specialist (Option A) is unnecessary as these findings are within the normal range. Continuing the assessment (Option C) may not yield significant abnormal findings related to the tonsils. Throat culture for strep (Option D) is not indicated unless there are specific symptoms or signs of infection.

Question 5 of 5

A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that:

Correct Answer: A

Rationale: The correct answer is A: she may have macular degeneration. Macular degeneration is characterized by loss of central vision while peripheral vision remains intact. In this case, the woman's difficulty with tasks that require central vision, such as reading and recognizing faces, points towards macular degeneration. The other choices are incorrect because: B: Her symptoms indicate a specific vision problem, not just age-related changes. C: Cataracts typically cause blurred vision, not loss of central vision. D: Glaucoma typically affects peripheral vision first before progressing to central vision loss.

Similar Questions

A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that:
A very concerned mother is at the clinic with her infant who has a large, soft lump on the side of his head. She tells the nurse that she noticed the lump about 8 hours after her baby's birth and that it seems to be getting bigger. One possible explanation for this is:
The nurse is performing middle ear assessment on a 15-year-old patient who has a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 o'clock and visible landmarks. The nurse should:
The nurse is assessing a patient with a history of intravenous drug abuse. While assessing his mouth, the nurse notices a dark red confluent macule on the hard palate. This could be an early sign of:
When a light is directed across the iris of the eye from the temporal side, the examiner is assessing for:

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