The nurse is teaching the student nurse the sequence for performing the assessment techniques during a physical examination. What is the appropriate order?

Inspection, percussion, palpation, auscultation

Inspection, palpation, percussion, auscultation

Palpation, percussion, inspection, auscultation

Inspection, auscultation, palpation, percussion

Answer and Explanation

The Correct Answer is B

A. Inspection, percussion, palpation, auscultation: This sequence starts with visual inspection, followed by percussion (tapping the body to assess underlying structures), palpation (using the hands to feel for abnormalities), and finally auscultation (listening with a stethoscope to assess sounds such as heart, lung, or bowel sounds). However, palpation is usually performed before percussion.

B. Inspection, palpation, percussion, auscultation: This is the correct sequence for performing a physical examination. It begins with visual inspection, followed by palpation to assess for

tenderness, masses, or other abnormalities, then percussion to evaluate the density of underlying structures, and finally auscultation to listen to internal sounds.

C. Palpation, percussion, inspection, auscultation: This sequence starts with palpation, followed by percussion, then inspection, and finally auscultation. However, inspection is typically performed before palpation in a physical examination.

D. Inspection, auscultation, palpation, percussion: This sequence starts with visual inspection, followed by auscultation, palpation, and percussion. While auscultation often follows inspection, palpation is usually performed before auscultation.

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Correct Answer is C

Explanation

A. The child exhibits plantar grasp reflex: The presence of the plantar grasp reflex at 10 months

is appropriate and not cause for concern. This reflex typically diminishes by around 9 months but can persist slightly longer in premature infants.

B. The child has doubled his birth weight: Doubling birth weight by around 6 months is a normal developmental milestone, and achieving this by 10 months is appropriate, indicating healthy growth.

C. No primary teeth have erupted yet: The absence of primary teeth by 10 months, especially in a preterm infant, may indicate a delay in dental development and should prompt further evaluation by a healthcare provider.

D. The child's head circumference is 49.53 cm: The head circumference of 49.53 cm falls within the typical range for a 10-month-old infant and is not inherently concerning.

A. Puberty might be delayed if scrotal changes have not occurred by the age of 11 years. B. Growth spurts in height occur toward the end of midpuberty. C. Changes in the voice signal the beginning of puberty. D. Gynecomastia commonly occurs during late puberty.

Correct Answer is A

Explanation

A. Puberty might be delayed if scrotal changes have not occurred by the age of 11 years: This statement is accurate because the lack of scrotal changes by the age of 11 years may indicate delayed puberty, prompting further evaluation by a healthcare provider.

B. Growth spurts in height occur toward the end of midpuberty: Growth spurts in height typically occur during midpuberty, rather than toward the end, as adolescents experience a rapid increase

in skeletal growth.

C. Changes in the voice signal the beginning of puberty: While changes in the voice, such as voice cracking and deepening, are indeed part of puberty, they usually occur later in puberty, not necessarily at the beginning.

D. Gynecomastia commonly occurs during late puberty: Gynecomastia, the development of breast tissue in males, typically occurs during mid-puberty and may persist into late puberty but is not exclusive to that period.

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The nurse is teaching the student nurse the sequence for performing the assessment techniques during a physical examination. What is the appropriate order?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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Correct Answer is A

Explanation

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