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NSG 6020 WEEK 10 Final Exam / NSG6020

WEEK 10 Final Exam(LATEST-2020):SOUTH

UNIVERSITY (ANSWERS VERIFIED 100%

CORRECT)

NSG 6020 FINAL EXAM

A 65-year-old patient remarks that she just can’t believe that her breasts sag

so much. She states it must be from lack of exercise. What explanation should

the nurse offer her?

After menopause, the glandular and fat tissue atrophies, causing breast size and

elasticity to diminish, resulting in breasts that sag.

The mother of a 10-year-old boy asks the nurse to discuss the recognition of

puberty. The nurse should reply by saying:

“Puberty usually begins about age fifteen.”

“The first sign of puberty is enlargement of the testes.”

“Penis size does not increase until about the age of sixteen.”

"The development of pubic hair precedes testicular or penis enlargement.”

A patient has bilateral pitting edema of the feet. While assessing the

peripheral vascular system, the nurse's primary focus should be:

The correct answer is: Venous function of the lower extremities

During an examination, the nurse notes severe nystagmus in both eyes of a

patient. Which of the following conclusions is correct?

1.This is a normal occurrence.

2.This may indicate disease of the cerebellum or brainstem.

3.This is a sign that the patient is nervous about the examination.

4.This indicates a visual problem and a referral to an ophthalmologist is indicated.

End-point nystagmus at an extreme lateral gaze occurs normally. Assess any

other nystagmus carefully. Severe nystagmus occurs with disease of the vestibular

system, cerebellum, or brainstem.

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When performing a musculoskeletal assessment, the nurse knows the correct

approach for the examination should be:

proximal to distal

A 43-year-old woman is at the clinic for a routine examination. She reports

that she has had a breast lump in her right breast for years. Recently, it has

begun to change in consistency and is becoming harder. She reports that 5

years ago her physician evaluated the lump and determined that it “was

nothing to worry about.” The examination validates the presence of a mass in

the right upper outer quadrant at 1 o’clock, approximately 5 cm from the

nipple. It is firm, mobile, nontender, with borders that are not well defined.

The nurse’s recommendation to her is:

“Because of the change in consistency of the lump, it should be further evaluated

by a physician.”

The nurse practitioner is examining a 3-month-old infant. While holding the

thumbs on the infant's inner–mid-thighs and the fingers outside on the hips,

touching the greater trochanter, the nurse practitioner adducts the legs until

the nurse practitioner's thumbs touch and then abducts the legs until the

infant's knees touch the table. The nurse practitioner does not note any

"clunking" sounds and is confident to record a:

Negative Ortolani's sign.

A patient's mother has noticed that her son, who has been to a new babysitter,

has some blisters and scabs on his face and buttocks. On examination, the

nurse notices moist, thin-roofed vesicles with a thin erythematous base and

suspects:

Impetigo

The nurse is testing superficial reflexes on an adult patient. When stroking up

the lateral side of the sole and across the ball of the foot, the nurse notices the

plantar flexion of the toes. How would the nurse document this finding?

1.Positive Babinski sign

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2.Plantar reflex abnormal

3.Plantar reflex present

4.Plantar reflex “2+” on a scale from “0 to 4+”

With the same instrument, draw a light stroke up the lateral side of the sole of the

foot and across the ball of the foot, like an upside-down “J.” The normal response

is plantar flexion of the toes and sometimes of the whole foot.

A woman is in the family planning clinic seeking birth control information.

She states that her breasts “change all month long” and that she is worried

that this is unusual. What is the nurse’s best response?

Tell her that, because of the changing hormones during the monthly menstrual

cycle, cyclic breast changes are common.

A patient states during the interview that she noticed a new breast lump in the

shower a few days ago. It was on her left breast near her axilla. The RN

should plan to:

palpate the unaffected breast first

A 16-yr-old girl is being seen at clinic for gastrointestinal complaints+weight

loss. Nurse determines that many of her complaints may be related to erratic

eating patterns, eating predominantly fast foods, + high caffeine intake. In this

situation, which is most appropriate when collecting current dietary intake

information?

•1. Schedule a time for direct observation of the adolescent during meals.

•2. Ask the patient for a 24-hour diet recall and assume this is reflective of a

typical day for her.

3. Have the patient complete a food diary for 3 days=2 weekdays + 1 weekend day

Food diaries require the individual to write down everything consumed for a

certaintime period. Because of the erratic eating patterns of this

individual,assessing dietary intake over a few days would produce more

accurateinformation regarding eating patterns. Direct observation is best used

withyoung children or older adults.

To assess the head control of a 4-month-old infant, the nurse lifts the infant up

in a prone position while supporting his chest. The nurse looks for what

normal response?

1.Raises head and arches back.

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