A client tells a nurse that "this dark spot on my left shoulder has gotten bigger, changed from a reddish to a brownish color, and used to be flat but is now like a small bump." The nurse knows that these findings may suggest

Possible skin cancer

That there is nothing to be concerned about.

Normal Wound heating.

A secondary lesion

Answer and Explanation

The Correct Answer is A

A.   Changes in size, color, and shape of a mole or spot, especially with the development of a bump, could be indicative of skin cancer, particularly melanoma.
B.   That there is nothing to be concerned about. Given the changes in the spot's appearance, this is a concerning sign and requires further investigation, so this choice is not correct.
C.   Wounds typically heal without such significant color and shape changes, so this is unlikely to be a normal healing process.
D.   A secondary lesion is caused by trauma or infection, but the described changes are more concerning for a potential primary skin malignancy, such as melanoma.

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Correct Answer is D

Explanation

A. A score of 24 would indicate a fully alert and responsive patient. The Glasgow Coma Scale ranges from 3 (deep coma) to 15 (fully awake).
B. A score of 12 indicates a moderate level of consciousness, not a coma.
C. A score of 15 indicates that the patient is fully conscious and alert.
D. A score of 6 indicates a coma and represents a very low level of consciousness, with minimal responses to stimuli.

A. As the patient says a long "ee-ee ee" sound, the examiner hears a long "aaaaaa" sound. B. When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said C. As the patient says a long "ee-ee-ee sound, the examiner also hears a long "ee-ee-ee" sound. D. As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninetynine." E. Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice

Correct Answer is ["C","D"]

Explanation

A. As the patient says a long "ee-ee-ee" sound, the examiner hears a long "aaaaaa" sound. - This indicates a possible consolidation in the lungs, which is abnormal.
B. When the patient speaks in a normal voice, the examiner can hear a sound but cannot exactly distinguish what is being said. - This suggests abnormal voice transmission and could indicate lung consolidation or other issues.
C. As the patient says a long "ee-ee-ee" sound, the examiner also hears a long "ee-ee-ee" sound. - This is normal, indicating clear and symmetrical transmission of voice sounds.
D. As the patient repeatedly says "ninety-nine," the examiner clearly hears the words "ninety-nine." - This is also normal, as it indicates normal transmission of sound and no lung consolidation.
E. Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice. - This is normal for whispered voice sounds and is not a sign of abnormal lung findings.

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A client tells a nurse that "this dark spot on my left shoulder has gotten bigger, changed from a reddish to a brownish color, and used to be flat but is now like a small bump." The nurse knows that these findings may suggest

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is reviewing a patient's medical record and notes that he is in a coma. Using the Glasgow Coma Scale, which number indicates that the patient is in a coma?

Correct Answer is D

Explanation

The nurse is assessing voice sounds during a respiratory assessment. Which of these findings indicates a normal assessment? (Select All that Apply)

Correct Answer is ["C","D"]

Explanation

A charge nurse is observing a nurse auscultating a client's bowel sounds. Which of the following actions requires intervention by the charge nurse?

A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. Which area of the brain that is related to these findings would concern the nurse?

A nurse in a clinic is assessing a client. Which of the following findings should the nurse identify as a risk factor for osteoporosis?

A nurse is assessing a client's cranial nerves as part of a neurological examination. Which of the following actions should the nurse take to assess cranial nerve 11?

During an examination, the nurse notices severe nystagmus in both eyes of a patient. Which conclusion by the nurse is correct? Severe nystagmus in both eyes:

While assessing the client's gait during, which of the following would indicate a need for further evaluation?

A nurse is assessing a client's cardiovascular system. To palpate for unexpected pulsations in the pulmonic area, at which anatomical location should the nurse place her fingers?

A nurse is interviewing a male client who has a hearing impairment. What techniques would be most beneficial in communicating with this client?