Health History and Physical Examination Nursing

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By nclexnursing

Health history and physical examination nursing quiz for your nursing exam. The results of a thorough history and physical examination can reveal serious health problems that might be treated during a domestic medical checkup visit as well as more persistent diseases that require additional assessment or care.

Health History Nursing Quiz

During the day, while being admitted to the nursing unit from the emergency department, a patient tells the nurse that she is short of breath and has pain in her chest when she breathes. Her respiratory rate is 28, and she is coughing up yellow sputum. Her skin is hot and moist, and her temperature is 102.2° F (39° C). The laboratory results show white blood cell count elevation and the sputum result is pending. The patient says that coughing makes her head hurt, and she aches all over. Identify the subjective and objective assessment findings for this patient.

Subjective – Objective

Answer Key:
Subjective - Short of breath, pain in the chest upon breathing, coughing makes the head hurt, aches all over.
Objective - Respiratory rate of 28 breaths/minute, coughing up yellow sputum, skin hot and moist, temperature 102.2° F (39° C), increased WBC count.

Priority Decision: For the patient described in Question 1, the data will lead the night shift nurse to complete a focused nursing assessment of which body part(s)?

a. Abdomen

b. Arms and legs

c. Head and neck

d. Anterior and posterior chest

Answer Key:
d.The focused assessment is used to evaluate the status of previously identified problems and monitor for signs of new problems. In this case, the chest must be assessed related to the shortness of breath, chest pain with breathing, increased respiratory rate, yellow sputum, increased temperature, and elevated white blood cell count. If the patient's headache and achiness are not reduced after the cough and temperature have been treated, further nursing and medical assessments will be done.

Give an example of a sensitive way to ask a patient each of the following questions.

a. Is the patient on antihypertensive medication having a side effect of impotence?

b. Has the patient with a history of alcoholism had recent alcohol intake?

c. Who are the sexual contacts of a patient with gonorrhea?

Answer Key:
Examples: Many answers could be correct. It is helpful to preface the question with the reason it is being asked.
a. “Many patients taking drugs for hypertension have problems with sexual function. Have you experienced any problems?”
b. “Alcohol may interact dangerously with drugs you receive, or it may cause withdrawal problems in the hospital. Can you describe your recent alcohol intake?”
c. “It is important to contact and treat others who may have the same infection you do. Would you tell me with whom you have been sexually intimate in the last 6 weeks?”
d. “Today medications are so expensive that some people must choose between eating and taking their medications. Are you able to get and take all of the medications prescribed for you?”

Priority Decision: The nurse prepares to interview a patient for a nursing history but finds the patient in obvious pain. Which action by the nurse is the best at this time?

a. Delay the interview until the patient is free of pain.

b. Administer pain medication before initiating the interview.

c. Gather as much information as quickly as possible by using closed-ended questions that require brief answers.

d. Ask only those questions pertinent to the specific problem and complete the interview when the patient is more comfortable.

Answer Key:
d. Data are required regarding the immediate problem, but gathering additional information can be delayed. The patient should not receive pain medication before pertinent information related to allergies or the nature of the problem is obtained. Questions that require brief answers do not elicit adequate information for a health profile.

Priority Decision: While the nurse is obtaining a health history, the patient tells the nurse, “I am so tired, I can hardly function.” What is the nurse’s best action at this time?

a. Stop the interview and leave the patient alone to be able to rest.

b. Arrange another time with the patient to complete the interview.

c. Question the patient further about the characteristics of the symptoms.

d. Reassure the patient that the symptoms will improve when treatment has had time to be effective.

Answer Key:
c. When a patient describes a feeling, the nurse should ask about the factors surrounding the situation to clarify the etiology of the problem. An incorrect nursing diagnosis may be made if the statement is taken literally and its meaning is not explored with the patient. A sense of “being tired and unable to function” does not necessarily indicate a need for rest or sleep, and there is no way to know that treatment will relieve the problem.

Rewrite each of the following questions asked by the nurse so that it is an open-ended question designed to gather information about the patient’s functional health patterns.

a. Are you having any pain?

b. Do you have a good relationship with your spouse?

c. How long have you been ill?

d. Do you exercise regularly?

Answer Key:
There may be many correct answers. Examples include the following:
a. “Can you tell me how you are feeling?”
b. “Describe your relationship with your spouse.”
c. “Can you describe your experience with this illness?”
d. “What is your usual activity during the day?”

A patient has come to the health clinic and reports having diarrhea for 3 days. He says the stools occur five or six times per day and are very watery. Every time he eats or drinks something, he has an urgent diarrhea stool. He denies being out of the country but did attend a large family 23 reunion held at a campground in the mountains about a week ago. Identify the areas of symptom investigation using PQRST that still must be addressed to provide additional important information (select all that apply).

a. Timing

b. Quality

c. Severity

d. Palliative

e. Radiation

f. Precipitating factors

Answer Key:
c, d, e. Severity, palliative, and radiation are not addressed. The timing, quality, and precipitating factors are described

The following data are obtained from a patient during a nursing history. Organize these data according to Gordon’s functional health patterns. Patterns may be used more than once, and some data may apply to more than one pattern.

a. 78-yr-old woman b. Married, three grown children who all live out of town
c. Cares for invalid husband in home with help of daily homemaker d. Vision corrected with glasses; hearing normal
e. Height 5 ft, 8 in; weight 170 lb
f. Considers herself a stress eater; eats when stressed
g. 5-year history of adult-onset asthma; smokes two or three cigarettes a day
h. Coughing, wheezing, with stated shortness of breath
i. Moderate light-yellow sputum
j. Says she now has no energy to care for husband
k. Awakens three or four times per night and has to use a bronchodilator inhaler
l. Uses a laxative twice a week for bowel function; no urinary problems
m. Feels her health is good for her age
n. Allergic to codeine and aspirin
o. Has esophageal reflux and eats bland foods
p. Can usually handle the stress of caring for her husband but if she becomes overwhelmed, asthma worsens
q. Has been menopausal for 26 years; no sexual activity
r. Takes medications for asthma, hypertension, and hypothyroidism and uses diazepam (Valium) PRN for anxiety
s. Goes out to lunch with friends weekly
t. Says she misses going to church with her husband but watches religious services with him on TV

  1. Demographic data
  2. Important health information
  3. Health-perception/health-management pattern
  4. Nutrition-metabolic pattern
  5. Elimination pattern
  6. Activity-exercise pattern
  7. Sleep-rest pattern
  8. Cognitive-perceptual pattern
  9. Self-perception/self-concept pattern
  10. Role-relationship pattern
  11. Sexuality-reproductive pattern
  12. Coping–stress tolerance pattern
  13. Value-belief pattern
Answer Key:
a. 1; b. 10; c. 10; d. 8; e. 4; f. 4, 12; g. 2, 3; h. 6; i. 6; j. 6; k. 7; l. 5; m. 3, 9; n. 2; o. 4; p. 12; q. 11; r. 2; s. 10; t. 13

A patient has come to the health clinic and reports having diarrhea for 3 days. He says the stools occur five or six times per day and are very watery. Every time he eats or drinks something, he has an urgent diarrhea stool. He denies being out of the country but did attend a large family 23 reunion held at a campground in the mountains about a week ago. Identify the areas of symptom investigation using PQRST that still must be addressed to provide additional important information (select all that apply).

a. Timing

b. Quality

c. Severity

d. Palliative

e. Radiation

f. Precipitating factors

Answer Key:
c, d, e. Severity, palliative, and radiation are not addressed. The timing, quality, and precipitating factors are described

The following data are obtained from a patient during a nursing history. Organize these data according to Gordon’s functional health patterns. Patterns may be used more than once, and some data may apply to more than one pattern.

a. 78-yr-old woman
b. Married, three grown children who all live out of town
c. Cares for an invalid husband in a home with help of a daily homemaker. d. Vision corrected with glasses; hearing normal
e. Height 5 ft, 8 in; weight 170 lb
f. Considers herself a stress eater; eats when stressed
g. 5-year history of adult-onset asthma; smokes two or three cigarettes a day
h. Coughing, wheezing, with stated shortness of breath
i. Moderate light-yellow sputum
j. Says she now has no energy to care for her husband
k. Awakens three or four times per night and has to use a bronchodilator inhaler
l. Uses a laxative twice a week for bowel function; no urinary problems
m. Feels her health is good for her age
n. Allergic to codeine and aspirin
o. Has esophageal reflux and eats bland foods
p. Can usually handle the stress of caring for her husband but if she becomes overwhelmed, her asthma worsens
q. Has been menopausal for 26 years; no sexual activity
r. Takes medications for asthma, hypertension, and hypothyroidism and uses diazepam (Valium) PRN for anxiety
s. Goes out to lunch with friends weekly
t. Says she misses going to church with her husband but watches religious services with him on TV

  1. Demographic data
  2. Important health information
  3. Health-perception/health-management pattern
  4. Nutrition-metabolic pattern
  5. Elimination pattern
  6. Activity-exercise pattern
  7. Sleep-rest pattern
  8. Cognitive-perceptual pattern
  9. Self-perception/self-concept pattern
  10. Role-relationship pattern
  11. Sexuality-reproductive pattern
  12. Coping–stress tolerance pattern
  13. Value-belief pattern
Answer Key:
a. 1; b. 10; c. 10; d. 8; e. 4; f. 4, 12; g. 2, 3; h. 6; i. 6; j. 6; k. 7; l. 5; m. 3, 9; n. 2; o. 4; p. 12; q. 11; r. 2; s. 10; t. 13

What is an example of a pertinent negative finding during a physical examination?

a. Chest pain that does not radiate to the arm

b. Elevated blood pressure in a patient with hypertension

c. Pupils that are equal and react to light and accommodation

d. Clear and full lung sounds in a patient with chronic bronchitis

Answer Key:
d. Abnormal lung sounds are usually associated with chronic bronchitis, and their absence is a negative finding. Chest pain is a positive finding, and radiation is not expected for all chest pain. Elevated blood pressure in hypertension is a positive finding, and pupils that are equal and react to light and accommodation are normal findings.

Match the following data with the assessment technique used to obtain the information.

a. Normal blood flow through arteries

b. Abnormal blood flow in the carotid artery

c. Tympany of the abdomen

d. Pitting edema

e. Cyanosis of the lips

f. Hyperactive peristalsis

g. Bruising of the lateral left thigh

h. Cool, clammy skin

  1. Inspection 2. Palpation 3. Percussion 4. Auscultation
Answer Key:
a. 2; b. 4; c. 3; d. 2; e. 1; f. 4; g. 1; h. 2

What is the correct sequence of examination techniques that should be used when assessing the patient’s abdomen?

a. Inspection, palpation, auscultation, percussion

b. Palpation, percussion, auscultation, inspection

c. Auscultation, inspection, percussion, palpation

d. Inspection, auscultation, percussion, palpation

Answer Key:
d. The usual sequence of physical assessment techniques is inspection, palpation, percussion, and auscultation. However, because palpation and percussion can alter bowel sounds, in abdominal assessment the sequence should be inspection, auscultation, percussion, and palpation.

When performing a physical examination, what approach is most important for the nurse to use?

a. A head-to-toe approach to avoid missing an important area

b. The same systematic, efficient sequence for all examinations

c. A sequence that is least revealing and embarrassing for the patient

d. An approach that allows time to collect the nursing history data while performing the examination

Answer Key:
b. A nurse should use the same efficient sequence in each examination to avoid forgetting a procedure, a step in the sequence, or a body part. However, a specific method is not required. Patient safety, comfort, and privacy are considerations but are not the priorities. The nursing history data should be collected in an interview to avoid prolonging the examination.

The nurse is performing a physical examination on a 90-yr-old male patient who has been bedridden for the past year. Which adaptations for performing the examination would be appropriate for the patient (select all that apply)?

a. Make sure that a family member is with him.

b. Handle the skin with care because of potential fragility.

c. Keep the patient warm and comfortable during the assessment.

d. Allow the patient to watch TV to distract him from any painful assessments.

e. Place the patient in a position of comfort and avoid unnecessary changes in position.

Answer Key:
b, c, e. Older adults may have decreased vision and hearing, so providing a quiet environment free from distractions will make the assessment easier than having the distraction of the TV.

In what patient situations would a comprehensive assessment be performed (select all that apply)?

a. Complaints of chest pain

b. On initial admission to the telemetry unit

c. On initial evaluation by the home health nurse

d. Found lying on the floor, unresponsive, with moist skin

e. On arrival in the surgery holding area of the operating room

Answer Key:
b, c. These are situations in which an initial and thorough baseline assessment must be completed. Options a and e would require focused assessments; option d would require an emergency assessment.

Which assessment tools can be used to assess the cardiac system (select all that apply)?

a. Watch

b. Stethoscope

c. Reflex hammer

d. Ophthalmoscope

e. Blood pressure cuff

Answer Key:
a, b, e. The watch is used to assess pulses, the stethoscope is used to hear pulses and heart sounds, and the blood pressure cuff is used to assess blood pressure. The ophthalmoscope is used to assess the retina, and the percussion hammer is used to assess reflexes.

What is the term used for assessment data that the patient tells you about?

a. Focused

b. Objective

c. Subjective

d. Comprehensive

Answer Key:
c. Subjective data or symptoms are obtained by interview during the nursing history. These data can be described only by the patient or caregiver. Objective data or signs are data that are obtained on physical examination. Comprehensive data are obtained from a detailed health history and physical examination of one or more body systems.

On the first encounter with the patient, the nurse will complete a general survey. Which features
are included (select all that apply)?

a. Mental state and behavior

b. Lung sounds and bowel tones

c. Body temperature and pulses

d. Speech and body movements

e. Body features and obvious physical signs

f. Abnormal heart murmur and limited mobility

Answer Key:
a, d, e. The general survey is considered a scanning procedure that includes mental state, behavior, speech, body movements, body features, obvious physical signs, and nutritional status. The physical examination includes auscultation and percussion of lung sounds and bowel sounds, palpation of body temperature and pulses, auscultation of pulses and heart sounds, and inspection of mobility. If there are obvious physical signs or abnormal sounds, a focused assessment will be done to assess the specific problems.

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