#1
Which vital sign is NOT typically measured during a medical assessment?
Body mass index
ExplanationBMI is a measurement, not a vital sign like temperature, heart rate, or blood pressure.
#2
Which of the following is NOT a characteristic assessed in the neurologic examination?
Cardiac rhythm
ExplanationNeurologic examination typically assesses mental status, cranial nerves, motor function, and sensory function, but not cardiac rhythm.
#3
What is the purpose of the Braden Scale in nursing assessment?
Evaluating skin integrity and risk for pressure ulcers
ExplanationThe Braden Scale is a tool used to assess a patient's risk for developing pressure ulcers based on sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
#4
Which of the following is NOT a component of the pain assessment?
Taste
ExplanationPain assessment typically includes location, intensity, quality, aggravating factors, alleviating factors, and timing, but not taste.
#5
Which of the following is NOT a component of the primary survey in emergency nursing?
Assessment of peripheral pulses
ExplanationThe primary survey in emergency nursing assesses Airway, Breathing, Circulation, Disability, and Exposure (ABCDE), but not peripheral pulses.
#6
What does the 'P' stand for in the SAMPLE history acronym used in medical assessment?
Past medical history
ExplanationThe SAMPLE history acronym stands for Signs/symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to the injury.
#7
Which of the following is NOT a primary assessment technique used in nursing?
Auscultation
ExplanationAuscultation is a secondary assessment technique; primary assessment includes inspection, palpation, and percussion.
#8
In a respiratory assessment, what does the term 'orthopnea' refer to?
Difficulty breathing while lying flat
ExplanationOrthopnea is a condition where a person experiences difficulty breathing while lying flat and may need to sit up or stand.
#9
Which of the following is NOT typically included in a cardiovascular assessment?
Pain assessment
ExplanationCardiovascular assessment typically involves assessing heart rate, blood pressure, and rhythm, but pain assessment is not specifically part of it.
#10
Which of the following is NOT a component of the ABCDE approach to trauma assessment?
Blood pressure
ExplanationThe ABCDE approach includes Airway, Breathing, Circulation, Disability, and Exposure, but blood pressure is not explicitly part of the initial assessment.
#11
During a physical assessment, what does the term 'crepitus' refer to?
A crackling or grating sensation
ExplanationCrepitus refers to a tactile sensation produced by the rubbing together of bone or irregularities in cartilage.
#12
Which of the following is a component of the Glasgow Coma Scale?
Eye opening
ExplanationThe Glasgow Coma Scale assesses eye opening, verbal response, and motor response to measure level of consciousness.
#13
In a skin assessment, which term refers to a localized collection of pus in the skin?
Furuncle
ExplanationA furuncle, commonly known as a boil, is a tender, dome-shaped bump caused by a localized infection.
#14
Which of the following is a tool commonly used for pain assessment in non-verbal patients?
FLACC Scale
ExplanationThe FLACC Scale assesses pain in non-verbal patients based on facial expression, leg movement, activity, cry, and consolability.
#15
Which of the following is NOT part of the standard assessment of a patient's level of consciousness?
Grip strength
ExplanationAssessment of consciousness typically involves evaluating orientation, response to stimuli, and Glasgow Coma Scale, but not grip strength.