May 2003 END-OF-SEMESTER EXAMINA nONS

FRONTPAGE

COURSENO: BNS 300 DURAllON: 2 HOURS

DATE: MAY 2003

TITLE OFPAPER: HEALTH ASSESSMENTTHROUGHOUTTHE LIFESPAN

SUBJECT: NURSING

llTLE OF EXAMINAllON=

MORNING!AFTERNOON:

INSTRUCTIONS:

ANSWER ALL QUESTIONS: QUESTION 1 (50 Marks)

QUESTION 2 (20 Marks)
QUESTION 3 (30 Marks)

TOTAL MARKS: 100Marks

PAGES: 10
 QUESTION 1
INSTRUCTIONSTO STUDENTS

Answer aU questions.

Circle the letter next to the most correct answer

Touchshould beused during interview.

A. Only with clients from a western culture.

B. As a way of establishing contact with the client and comm1U1icatingempathy
C. Only with the clients of the same sex.
D. Only if the interviewer knows the client well.

2. Unconditionalpositiveregardtowardsa client \vithin a communicationcontextis an exampleof:

A.B.Empathy
Liking others
C.D.Empathizing with the client
A nonverbal listening technique

3. The practitionerreading a medical record seesthe following notation, client states"I have had a
cold for abouta weekand now I am having difficulty in breathing"This is example of:

Pastmedicalhistory.
Review of systems.
C.D.Functionalassessment
Reasonfor seekingcare.

4. During an initial meetingwith a new client, the practitionerinterviewsthe client aboutthe use of
alcohol.This is part of a:

A. Functionalassessment
B. Nutritional assessment
C. Health promotionassessment
D. Family healthassessment
5. You recentlyintervieweda client diagnosedashaving seizuredisorders,who revealsthathe plansto be
'an airline pilot'. The clientcontinuesto havethis careergoalevenafteryou havecounseledhim about
his illness,this mightleadyouto questiontile client's:

A. Thoughtprocess
B. Judgement
C. Attention span
D. Recentmemory
6. The balancebetweennutrientintakeand nutrientrequirementis describedas:

Under nutrition
B. Malnutrition
C. Nutritional status
D. Over nutrition

A. B.
7. Whenperformingindirect percussion,the stationaryfingersare struck:

A. At the ultra surface.

B. At the middlejoint
C. At the distal interphalangeal
joint.
D Where everthereis contactwith the skin.

8. The opthalmoscope
hasfive apertures,Whichaperturewould be usedto assessthe eyesof a client with
un-dilatedpupils'?

A. Grip aperturelight
B. Slit aperturelight.
C. Small aperturelight.
D. Large aperturelight.

9. Pulse pressureis:

A. The differencebetweenthe systolicand diastolicpressure

B. A reflectionof the viscosityof blood.
C. Anotherwayof expressingthe systolicpressure.
D. A measureof vasoconstriction

10. Nevusis a tenDfor:

A. A freckle.
B. .A birthmark.
C. An infectedhairfollicle.
D. A mole

11. Skin turgoris assessedby picking upa largefold of the skin on the anteriorchestunderthe clavicle.
This part of examinationis doneto detenninethe presenceof.
A. Edema.
B. Dehydration.
C. Vertigo.
D. Hydration.

12. Identify the blood vesselthat runs diagonallyacrossthe sternomastoid

muscle:

A. Temporaryartery.
B. Carotidartery.
C. Externaljugular vein.
D. Internaljugular vein.

13.During the palpationof the lymphaticnodeson the neck,palpablesuperficialcervicalnodesare

identified. The examinershould nextexamine:

A. The supraclavicularnodes.
B. The preauricularnodes.
C. The posteriorcervicalnodes.
D The posteriorauricular.
 4. The cornealreflex is mediatedby cranialnerves:

II&III
B.C.D.
II&VI
V &VII
VI &IV

15. While ~iewingthe ear with the otoscope,the examineinstructsthe client to hold the noseand swallo\\",
during this maneuver,the eardrumshould:

A. Flutter.
B. Retract.
C.D.Bulge.
Remainimmobile.

16.The mostcommonsite for nosebleedingis:

A.B. The turbinates.

The collumella.
C.D.Kiesselbach'splexus
The meatus.

7. Whereis the largestsalivarygland located?

A.B.C.D.
Within thecheeksin front of the ear.
Beneaththe mandibleat an angleof the jaw
Within the floor of the mouth.
At the baseof the tongue.

18. Identify the mostcommonsite for breastcancers.

A. Upper innerquadrant.
B. Upper outerquadrant.
C. Lower outerquadrant.
D. Lower iIU1erquadrant.

19.During a breastexamination,a massis palpable.Identify the descriptionthatis mostconsistentwith

cancerratherthanbenignbreastdisease:

A.B.Round.flfID, and well demarcated.

Irregular, poorlydefinedandfixed.
C.D.Rubbery,mobileandtender.
Lobular, clearmarginsandnegativeskin retraction

A 25 year old Ms. T. Who is 32 weekspregnantis involved in a roadtraffic accident,and is broughtto the
emergencydepartmentfor assessmentuponwhich appropriateinterventionstrategieswill bebased.
Pleasecircle the bestresponse.

20. The leadingcauseof blunt trnurnain a pregnantwomanis:

a) A fall
b) Domesticviolence
c) Sportsinjuxy
d) Motor vehicleaccident

A.
21. What proportionof blood volume can be lost by a pregnantwomanwithout showingsignsof shock?
a) One fIfth
b) One quarter
c) Onethird
d) One half

22. The growinguterus in a pregnanttrnumavictim can affect assessment

of:
a) Blood pressure
b) Body temperature
c) Electrocardiograms
d) Pulseoximetry

23. What effectdoeshemorrhaginghave on the uterinebloodflow'?

a) Blood is shuntedaway from the uterus
b) Blood flow to the uterusis maintained
c) Flow to all vital organsdecreasesby 10%
d) Uterineblood flow increasesto 700rnI/minutes

24. Direct traumato the placentaor uterusshouldpromptthe nurseto assessthe pregnantpatientfor:

a) Peritonitis
b) Gestationaldiabetes
c) Uterine prolapse
d) Disseminatedintravascularcoagulation

Assessmentof childrendiffer significantlywith thatof adults.The following questionsrelateto child

assessment.
Pleasecircle the bestresponse.

25. You observea child in the emergencydepartmentsitting in the tripod position,with handsforward and
down while archingthe back,the child is mostlikely experiencing:
a) Pain
b) Disturbances
c) Fearand anxiety
d) Respiratorydistress

26. Which of following is notpart of quick pediatricassessment?

a) Acrossthe roomassessment
b) Nutritional assessment
c) Physicalassessment
d) Pasthistory review

27. An early sign of shockin young childrenis:

a) An increasingpulserate
b) A decreasingpulserate
c) An increasedbloodpressure
d) A decreased bloodpressure

28. Feverin young childrenis most commonlycausedby:

a) Dehydration
b) Viral infection
c) Streptococcalinfection
d) High metabolicrate
29. You should suspect abuse if a child has:

a) Bruisesin variousstagesof healing

b) A petechialrashand fever
c) A history of vomiting and or diarrhea
d) Abdominal distention

30. The first technique you employ when conducting a client physical examination is:

a) Palpation
b) Inspection
c) Percussion
d) Auscultation

31. Whatis the main reasonwhy auscultationis donebeforepalpatingclient's abdomen'?

a) To preventdistortionof vascularsounds
b) To preventdistortionof bowel sounds
c) To detennineareasof tenderness
d) To allow the clientto relaxand becomfortable

32. To correctlypalpatethe client's skin for temperature,you will usethe:

a) Baseof your hands

b) Fingertipsof your hands
c) Dorsalsurfaceof your hands
d) Palmarsurfaceof your hands

33. To assessthe client's superficiallymph nodes,you would:

a) Deeply palpate the entire hand

b) Deeply palpate using a bimanual technique
c) Lightly palpate using a bimanual technique
d) Gently palpate using the pads of index and middle fingers

34. In assessingfor chronic tissue hyproxia you assessfor clubbing. How would you perfonn this
examination?

a) Inspectfor bulging of tissuesat the nail base

b) Palpatethechestwall for vibrationswhile the client says"99"
c) Comparethe anteraposterior diameterof the clients' chestwall with the lateral diameterof the
chest.
d) Observethe amountof time it takesfor normalcolor to returnto fingernailafterpressurehasbeen
appliedfor a few seconds

35. You are teachinga clientto inspectall skin surfacesand reportpigmentedskin lesionsthat:

a) Are symentricai
b) Have irregularborders
c) Are uniform in color
d) Are lessthan6mm in diameter

6
36. You are assessingthe client for range of joint movement. You ask the client to move the arm away
from the body. What movement are you evaluating?

a) Flexion
b) Extension
c) Abduction
d) Addition
37. You ask the client to interpretthe saying" do not countyour chickensbeforethey are hatched,"the
clientsresponsereveals:

a) Judgement
b) Knowledge
c) Association
d) Abstract reasoning

38. You are conductingthe generalsurveyof an adult client Whatconstitutesthe generalsurvey'?

a) Appearanceand behavior
b) Measurementof vital signs
c) Observespecificbody systems
d) Conductinga detailedhealthhistory

39. You askthe client to smile,frown, and raiseand lower the eyebrows; theseactionstestcranialnerve
number:

a) VII-facial
b) V -trigeminal
c) III -occulomotor
d) XII-hypoglossal

40. To spread the breast tissue evenly over the chest wall during an examination, you ask the client to lie
supine with:
a) hands claspedjust above the umbilicus
b) both arnlS overhead with palms upward
c) the dominant arnl straight alongside the body
d) the ipsilateral arm overhead with a small pillow under the shoulder

41. In performing a breast assessmenton a female client, you teach the client that it is especially important
to palpate the upper outer quadrant of breast tissue becausethis area is:

a) the largestareaof the breast

b) more proneto calcifications
c) wheremostbreasttwnorsare located
d) wheremost lymph nodesarelocated

42. During a thoracicexamination,you placeyour thwnbsalongthe spinalprocesses at the tenthrib, with

the palms lightly contactingthe client's postero-lateralsurfaces.As the clienttakes deepbreaths,you
evaluatesymmetIy.Whatis this techniquecalled?

a) vocal fremitus
b) tactile fremitus
c) diaphrngmaticexcursion
d) lateralthoracicexcursion
~3. The client's respiratoryassessment
revealsbilateralhigh pitches,continuousmusicalsoundsheard
loudestuponexpiration.The nurseinterpretsthesesoundsas:

a) nomlal
b) crackles
c) rhonchi
d) wheezes

43. When inspecting the client's anterior thora.x, what are you observing?

a) presenceof fremitus
b) presenceof breathsounds
c) movementof the diaphragm
d) symmetryof the chestexcursion

44. When auscultating the adult client's thora.x, you would

a) instruct the client to take deep, rapid breaths

b) instruct the client to breathe in and out through the nose
c) use the bell of the stethoscopeheld lightly against the chest
d) use the diaphragm of the stethoscope held fmnly against the chest

45. You are auscultating the client's lung fields. What is the systematic pattern you use for comparison is?

a) sideto side
b) top to bottom
c) anteriorto posterior
d) interspaceto interspace

47. The client had surgery 24 hours ago. After listening for 30 secondsat a site below and to the right of the
umbilicus, you are unable to hear bowel sounds. The best assessmentof the situation is that:

a) The client has gastritis

b) You need to listen longer
c) The client has a partial bowel obstruction
d) You are not listening in the right place

48. While auscultating heart sounds, you document that S I is heard best at the apex. 11ris sound correlates
with closure of the:

a) aortic and mitral valves

b) mitral andtricuspidvalves
c) aortic andpulmonicvalves
d) tricuspidandpulmonicvalves

49. which of the following fonns an important part of the baseline data?

a) appearnnceand behavior
b) measurementof vital signs
c) observing specific body systems
d) conducting a detailed health history

8
 50. You are teaching a client how to perfonn a testicular self-examination. You should tell the client:

a) "contact your physician if you feel a painless pea-sized nodule"

b) "the testesare nom1a1lyround, moveable, and have a lumpy consistency"
c) "the best time to do a testicular self-examination is before you shower or bath"
d) perform a testicular self-examination every week to detect signs of testicular cancer."

(50 marks)

SECTION B

QUESTION 2

Selectand match the phrasesin column A with the terms! phrasesin column B.

Indicate your choice by writing the correct letter a.2ainstthe descriptionsin column A.
e.g.30. The liver is situated in the ...A. (right upper quadrant)

COLUMNA.

6.
7.
8.5.
9.2.
4.
3.
1.
16.
11.
10.
13.
14.
12.
15. Pupiliaryreactionontheoppositeeye
The
Pressure
Test
Indicative
Position
Percussion
Position
Lymph
Comparison
Test
Palpation
Placing
Cranial ability
for node
nerve
handslateralization
position
for oftist followed
of note
to listening
of lobar
locatedinvolved
identify
behind air percussion
produced
sense and pneumonia
by atto over
over
the an quick
bone when
theangie
pulmonary object
neck over
the on
tricuspid conduction
release patient
theaortic with
gastric by
the of coastal liver
valvethe
feeling
valve
elbows
valve
is air smiling
mandible vertebral
sounds
bubble
sounds
sound
it out and
to the angle raising side eyebrows "'.'..'...""'.' ' ".,..".",.., '..' ""

20.
18.
17.
19. Lymph
Position
Lymph
Cranial nodes
nodes
nerve for listening involved
located
located to at in when mitral
the
the base
midline patient valve of the behind
sounds
shrugs skull the shoulders tip of the mandible...

COLUMNB

A. Spinalaccessories O. External rotation of the shoulders

B. Dullness P. Lower left sternal boarder
C. Consensualreaction Q. Apex
D. Webertest R. Kidney tenderness
E. Occipitalnodes S. Tympany
F. Submentalnodes T. Stereognosis

9
 G. Facialnerve U. Vesicular breath sounds
H. Right secondintercostalspace V. Rebound tenderness
I. Internalrotationof shoulders W. Left second intercostal space
J. Reboundtenderness X. Confrontation
K. Rombergtest Y. Tonsillar
L. Visual acuity Z. Bronchial breath sounds
M. Cmckles
N. Rinne test

(20 marks)

SECTIONC

QUESTION 3

ANSWER TRUE OR FALSE. Answerall questionse.g. 2 The pulse rate should be counted for CI
full minute.

Annular is a circular shapeskin lesion.

2. Crustis a thick dried out exudatesleft on skin whenvesicles!pustulesburst or dry up.
3. Turbinateis one of the threebonyprojectionsinto the nasalcavity.
4. Polypis a free projectionhangingdownfrom the middle of the soft palate.
5 The amountof air, following ma...omal expirationthatcan beexhaledis the vital capacity.
6 Normalbreathsoundheardover majorbronchiwith a moderatepitchand is equalin both
inspirationand expirationis the broncho-vesicular sound
7.. Spacebetweenthe ribs without consideringthe cartilageareais the intercostal-space.
8.. Precodiumis the areaof the chestwall overlayingthe heartand greatvessels.
9.. Mitral valve separates the right A V valveand the atrium
10. Ventricleis a reservoirfor holdingblood..Amplitude
11. is how loud or soft a soundis.
12. Whealis a red raisedlesionfrom a mosquitobite.
13 A maculais a round darlcerareaon the fundusseenon the retina.
14. Tail of Spenceis observedwhenthe clientis holdingthe armsin lateralposition.
15 Torsionis suddentwisting of spermaticcord requiringsurgicalintervention.
16. Plantaris the surfaceof the sole of the foot.
17. (ROM) rangeof motionis the extensionof the movementof the joint
18 Striaeare alsocalled linea albicans.Regular
19 apical beatcan beassessed within 30 seconds
20 .When auscultatingthe heart,you needto comparethe peripheralpulserate with the apicalrate
andnotediscrepancies
21 .You assessthe skin of a client,andnotice thathis extremitiesarecold and pale,with thin shiny
skin, decreased hair growthandthickenednails,You canconcludethatthe clientmaybe
having peripheralvasculardisease.
22 .When assessing a hypertensiveclient, it is importantto noterisk factorsfor alterationsin blood
pressure.
23.. .Fingertips are mostsensitivepartsof handto palpatearterypulsations.
24.. .Pulseis more accuratelyassessed with moderatepressure,too muchpressureoccludespulse
and
impedesblood flow.
25 Certainfamilial conditionsplacethe client at risk, family historyis importantto rule theseout.
26 It is importantto maintainclient's comfortduring assessment, discomfortmay influence
findings.

.True
27 It is a goodpracticeto washhandsevenbetweenexaminingdirty and not so dirty parts of the
sameclient.
28 Always verify your findings with the client beforejumping to conclusionsaboutwhatis wrong
with them.
29 Soundshear with a stethoscope on peripheralvesselsare calledmurmurs.
30. Asking the client to coughwhendoing abdominalinspectionenablesyou to detectherniation.

(30 marks)

GOOD LUCK