2024 NURSING 251 EXAM 3 WITH
CORRECT ANSWERS
During a head to toe assessment of a patient the nurse discovers a vascular
ulcer at the distal right great toe. This is most likely caused by which of the
following conditions? - CORRECT-ANSWERSArterial insufficiency
A patient is noted to be leaning forward with his arms supporting his body
weight as the nurse enters the exam room. For what disease process should
the nurse assess the patient for completely? - CORRECT-ANSWERSChronic
obstructive pulmonary disease (COPD)
Rhonchi adventitious sounds are heard when auscultating a patient's lungs.
Which one of the following actions should be done first by the nurse? -
CORRECT-ANSWERSHave the patient cough, then auscultate lungs again
What constitutes the manubriosternal (sternal) angle? - CORRECT-
ANSWERSThe articulation of the manubrium and the body of the sternum
What is the respiratory effort usually exhibited by a client with metabolic
acidosis (such as diabetic ketoacidosis) called? - CORRECT-
ANSWERSKussmaul breathing
The nurse is preparing to examine an adult client's eyes, using the Snellen
chart. What should the nurse do first? - CORRECT-ANSWERSPosition the
client 20 feet away from the chart
Shining a light into one eye and noting the pupillary response in the other
eye is testing for which of the following parameters? - CORRECT-
ANSWERSConsensual reaction
A criterion for testing the adequacy of a client's visual fields is which one of
the following? - CORRECT-ANSWERSThe correspondence to visual fields of
the examiner, if the examiner has normal visual fields
Which of the following represents the correct sequence of spatial
relationships for the client to do when testing for accommodation? -
CORRECT-ANSWERSFocus distant to near
, You assess a client's vision to be 20/50 in both eyes. What does this mean? -
CORRECT-ANSWERSYour client can read letters while standing 20 feet from
the chart that the average person could read at 50 feet
Testing for the air conduction of sound vs the bone conduction of sound
using a tuning fork is which one of the following tests? - CORRECT-
ANSWERSRinne test
An infection of the middle ear is called which of the following? - CORRECT-
ANSWERSOtitis media
No lateralization, sound heard in both ears, with Weber test - CORRECT-
ANSWERSnormal
AC = BC with Rinne test - CORRECT-ANSWERSabnormal
Tips of pinna slightly above canthus line of eyes - CORRECT-ANSWERSnormal
When performing an otoscopic exam on an adult patient of the right ear,
Where would the nurse document seeing the cone of light if it was in the
appropriate place? - CORRECT-ANSWERSIn the 5 O'clock position
A 16 year old female is referred to the school nurse for a vision test after the
teacher notes her squinting to see the front blackboard. The nurse uses
which one of the following tools to assess the patient's vision? - CORRECT-
ANSWERSSnellen eye chart
During an eye assessment, you gently palpate the eyeball through the
closed eyelid and note a firm, nonmobile eyeball. What does this finding
possibly indicate? - CORRECT-ANSWERSGlaucoma
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