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The nurse is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic.Which instruction would be appropriate for the parents before the interview begins?


A) "Please stay during the interview; you can answer for her if she does not know the answer."
B) "It would help to interview the three of you together."
C) "While I interview your daughter, will you please stay in the room and complete these family health history questionnaires?"
D) "While I interview your daughter, will you step out to the waiting room and complete these family health history questionnaires?"

E) C) and D)
F) B) and C)

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The mother of a 16-month-old toddler tells the nurse that her daughter has an earache.What would be an appropriate response?


A) "Maybe she is just teething."
B) "I will check her ear for an ear infection."
C) "Are you sure she is really having pain?"
D) "Describe what she is doing to indicate she is having pain."

E) B) and C)
F) A) and B)

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The nurse is performing a review of systems on a 76-year-old patient.Which of these statements is correct for this situation?


A) The questions asked are identical for all ages.
B) The interviewer will start incorporating different questions for patients 70 years of age and older.
C) Questions that are reflective of the normal effects of aging are added.
D) At this age, a review of systems is not necessary-the focus should be on current problems.

E) A) and C)
F) All of the above

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The nurse is assessing a new patient who has recently immigrated to Canada.Which question is appropriate to add to the health history?


A) "Why did you come to Canada?"
B) "When did you come to Canada, and from what country?"
C) "What made you leave your native country?"
D) "Are you planning to return to your home country?"

E) All of the above
F) B) and C)

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A female patient tells the nurse that she has had six pregnancies, with four live births at term and two spontaneous abortions.Her four children are still living.How would the nurse record this information?


A) P-6, B-4, (S) Ab-2
B) Grav 6, Term 4, (S) Ab-2, Living 4
C) Patient has had four living babies
D) Patient has been pregnant six times

E) B) and C)
F) A) and D)

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A patient tells the nurse that he is allergic to penicillin.What would be the nurse's best response to this information?


A) "Are you allergic to any other drugs?"
B) "How often have you received penicillin?"
C) "I'll write your allergy on your chart so you won't receive any penicillin."
D) "Describe what happens to you when you take penicillin."

E) A) and C)
F) All of the above

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In response to a question about stress, a 39-year-old woman tells the nurse that her husband and her mother both died in the past year.Which response by the nurse is most appropriate?


A) "This has been a difficult year for you."
B) "I don't know how anyone could handle that much stress in 1 year!"
C) "What did you do to cope with the loss of both your husband and your mother?"
D) "That is a lot of stress; now let's go on to the next section of your history."

E) A) and C)
F) B) and C)

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When the nurse is evaluating the reliability of a patient's responses, which of these statements would be correct? The patient:


A) Has a history of drug abuse and therefore is not reliable.
B) Provided consistent information and therefore is reliable.
C) Smiled throughout interview and therefore is assumed reliable.
D) Would not answer questions concerning stress and therefore is not reliable.

E) A) and B)
F) B) and C)

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Which of these statements represents subjective data the nurse obtained from the patient regarding the patient's skin?


A) Skin appears dry.
B) No lesions are obvious.
C) Patient denies any colour change.
D) Lesion is noted on the lateral aspect of the right arm.

E) All of the above
F) B) and D)

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During an assessment of a patient's family history, the nurse constructs a genogram.Which statement best describes a genogram?


A) List of diseases present in a person's near relatives
B) Graphic family tree that uses symbols to depict the gender, relationship, and age of immediate family members
C) Drawing that depicts the patient's family members up to five generations back
D) Description of the health of a person's children and grandchildren

E) B) and C)
F) All of the above

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A patient tells the nurse that she has had abdominal pain for the past week.What would be the nurse's best response?


A) "Can you point to where it hurts?"
B) "We'll talk more about that later in the interview."
C) "What have you had to eat in the past 24 hours?"
D) "Have you ever had any surgeries on your abdomen?"

E) All of the above
F) C) and D)

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The nurse is asking a patient for his reason for seeking care and asks about the signs and symptoms he is experiencing.Which of these is an example of a symptom?


A) Chest pain
B) Clammy skin
C) Serum potassium level at 4.2 mEq/L
D) Body temperature of 100° F

E) None of the above
F) B) and C)

Correct Answer

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During an assessment, the nurse uses the CAGE test.The patient answers "yes" to two of the questions.What could this be indicating?


A) The patient is an alcoholic.
B) The patient is annoyed at the questions.
C) The patient should be thoroughly examined for possible alcohol withdrawal symptoms.
D) The nurse should suspect alcohol abuse and continue with a more thorough substance abuse assessment.

E) None of the above
F) B) and C)

Correct Answer

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The nurse is taking a family history.Important diseases or problems about which the patient should be specifically asked include:


A) Emphysema
B) Head trauma
C) Mental illness
D) Fractured bones

E) None of the above
F) A) and B)

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