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A health care provider needs to assess a patient for a heart murmur. In what position should the nurse place the patient?
- A. Sims
- B. Prone
- C. Lithotomy
- D. Lateral recumbent
Correct Answer: D
Rationale: The lateral recumbent position aids in detecting heart murmurs.
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A nursing assessment is a process of collecting data to establish a database. The information contained in the database is a basis for:
- A. a complete physical examination.
- B. a medical assessment.
- C. an individualized plan of care.
- D. writing nursing orders.
Correct Answer: C
Rationale: The information contained in the database is the basis for an individualized plan of care.
A health care provider needs to assess a patient's rectal area. In what position should the nurse place the patient?
- A. Sims
- B. Prone
- C. Lithotomy
- D. Knee-chest
Correct Answer: D
Rationale: Knee-chest position provides maximum exposure of the rectal area.
When collecting data related to the present illness the nurse must obtain detailed and comprehensive data. What does this data help to establish?
- A. A patient problem
- B. A nursing care plan
- C. Appropriate interventions
- D. Nursing orders
Correct Answer: C
Rationale: The data collected related to the present illness must be detailed and comprehensive to allow planning of appropriate interventions.
When auscultating the chest a nurse hears crackles in both lower lobes. To further assess this finding the nurse should ask the patient to ____.
Correct Answer: cough
Rationale: It is a useful assessment to determine that the patient can clear the secretions by coughing.
The nurse is meeting a patient for the first time. What is the first thing the nurse will do to initiate a nurse-patient relationship?
- A. Appear interested.
- B. Introduce herself/himself.
- C. Provide support.
- D. Communicate trust.
Correct Answer: B
Rationale: The first step in a nurse-patient relationship is for the nurse to introduce herself/himself.