Chapter 19: Female Genitalia

Multiple Choice

1. Posteriorly, the labia minora meet as two ridges that fuse to form the: a. fourchette. b. vulva. c. clitoris. d. perineum.

ANS: A

The labia minora join posteriorly to form the fourchette.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

2. A cervical polyp usually appears as a: a. grainy area at the ectocervical junction. b. bright red, soft protrusion from the endocervical canal. c. transverse or stellate scar. d. hard granular surface at or near the os.

ANS: B

Cervical polyps are bright red, soft, and fragile. They usually protrude from the endocervical canal.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Skene glands b. Clitoris c. Perineum d. Bartholin glands

3. Which structure is located posteriorly on each side of the vaginal orifice?

ANS: D

Bartholin glands are found posteriorly on each side of the vaginal orifice.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. The Bartholin glands secrete mucus. b. The clitoris produces moisture. c. The Skene glands drain fluid. d. The urethral surfaces secrete water.

4. During sexual excitement, how is the vaginal introitus lubricated?

ANS: A

The Bartholin glands secrete mucus into the introitus for lubrication during sexual stimulation.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

5. The vaginal mucosa of a woman of childbearing years should appear: a. smooth and pink. b. moist and excoriated. c. dry and papular. d. transversely rugated.

ANS: D

Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

6. The adnexa of the uterus are composed of the: a. corpus and cervix. b. fallopian tubes and ovaries. c. uterosacral and broad ligaments. d. vagina and fundus.

ANS: B

The fallopian tubes and ovaries are collectively referred to as the adnexa of the uterus.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

7. A bluish color to the cervix during pregnancy is called (the): a. McDonald sign. b. Spinnbarkeit. c. Goodell sign. d. Chadwick sign.

ANS: D

The Chadwick sign is a bluish color to the cervix during pregnancy. The Goodell sign is an increase in vascularity and softening of the cervix. Spinnbarkeit refers to the quality of elastic mucus during mittelschmerz, and the McDonald sign is fundal flexing on the cervix.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

8. The pelvic joint that separates most appreciably during late pregnancy is the: a. sacroiliac. b. symphysis. c. sacrococcygeal. d. iliofemoral.

ANS: B

Of the four pelvic joints, the one that moves appreciably later in pregnancy is the symphysis pubis.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

9. Pregnancy-related cervical changes include: a. flattening and lengthening. b. thinning and reddening. c. hardening and pallor. d. softening and bluish coloring.

ANS: D

During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign).

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

10. Mrs. Robinson, a 49-year-old patient, presents to the office complaining of missing her menstrual period. She asks about menopause. You explain to her that the conventional definition of menopause is: a. the first day of the last menstrual period. b. 1 year with no menses. c. the last day of the last menstrual period. d. the cessation of ovulation.

ANS: B

Menopause is defined as 1 year without menses.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Increased abdominal fat distribution b. Decreased LDL levels c. Cold intolerance d. Decreased cholesterol levels

11. Which systemic feature is related to the effects of menopause?

ANS: A

Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Bowel habits b. Douching routines c. Menstrual flow d. Nutritional factors

12. Ms. A, age 32, states that she has a recent history of itchy vaginal discharge. Ms. A has never been pregnant. Her partner uses condoms and she uses spermicide for birth control. Which of the following data are most relevant to Ms. A s problem?

ANS: B

When obtaining history of present illness information for the woman with a vaginal discharge, you should inquire about her douching habits. Douching is not only medically unnecessary but it can also mask, or even worsen, conditions such as bacterial vaginosis or a yeast infection.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Endometriosis b. Low parity c. Multiple sex partners d. Obesity

13. Which risk factor is associated with cervical cancer?

ANS: C

Cervical cancer is associated with certain HPV strains. Multiple sex partners increase the risk of HPV infection.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

14. The risk of ovarian cancer is increased by: a. the use of oral contraceptives. b. cigarette smoking. c. age between 35 and 50 years. d. early age at first intercourse.

ANS: A

There is a relationship between the number of menstrual cycles and risk of ovarian cancer. Early menarche and menopause after 50 years of age increase the risk.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

15. The form of gynecologic cancer that is increased in obese women is: a. vaginal. b. cervical. c. ovarian. d. endometrial.

ANS: D

Obesity increases a woman s chance of developing endometrial cancer by twofold to fivefold.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

16. The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her daughter s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child s: a. drug ingestion. b. fluid intake. c. risk for sexual abuse. d. hormone responsiveness.

ANS: C

Vaginal discharge in a child could be related to a chemical irritation from soap s, lotions, or powders or to urinary tract infections. Concerned parents and children should be assessed for the risk of sexual abuse.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Fowler b. Prone c. Lateral supine d. Lithotomy

17. The female patient should ideally be in which position for the pelvic examination?

ANS: D

Ideally, the woman should be in a lithotomy position for a pelvic examination.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

18. When you plan to obtain cytologic studies, speculum introduction may be facilitated by: a. lubrication with gel. b. lubrication with warm water. c. use of a plastic speculum. d. opening the blades completely.

ANS: B

It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water. Although gel lubrication would facilitate speculum introduction, the gel could interfere with cytologic studies. Use of a plastic speculum or opening the blades completely would not facilitate speculum introduction.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Allow the labia to spread, and insert the speculum slightly open. b. Insert one finger, and insert the opened speculum. c. Press the introitus downward, and insert the closed speculum obliquely. d. Spread the labia, and insert the closed speculum horizontally.

19. Which one of the following is a proper technique for the use of a speculum during a vaginal examination?

ANS: C

Use two fingers of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand, and insert the speculum past your fingers obliquely.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Chlamydial swab b. Gonococcal culture c. Pap smear d. Wet mount

20. When collecting specimens, which sample should be obtained first?

ANS: C

A Pap smear is obtained first and then other samples to test for gonorrhea, chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are obtained. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be obtained first.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

21. The presence of a fishy odor after adding potassium hydroxide to a wet mount slide containing vaginal mucus suggests: a. bacterial vaginosis. b. yeast infection. c. chlamydial infection. d. pregnancy.

ANS: A

A positive whiff test suggests bacterial vaginosis.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Cervix b. Bladder c. Uterus d. Ovaries

22. The assessment of which structure is not part of the bimanual examination?

ANS: B

The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

23. Mrs. Reilly brings her 6-year-old daughter in with complaints of a foul vaginal discharge noted in her underpants. The most common cause of a foul vaginal discharge in children is a(n): a. accident. b. foreign body. c. infection. d. ruptured hymen.

ANS: B

A foul vaginal discharge in the preschool-age girl is most likely indicative of the presence of a foreign body.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

24. A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vaginal vault, you should first: a. insert a pediatric vaginal speculum. b. place the child prone and in the fetal position. c. insert a cotton-tipped applicator and press down. d. pull the labia forward and slightly to the side.

ANS: D

Applying anterior labial traction allows the hymenal opening and the interior of the vagina to become visible, almost to the cervix. The presence of a foreign body will be visible with this maneuver.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

25. A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. On inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with: a. chronic masturbation. b. congenital defects. c. acute urinary tract infection. d. sexual abuse.

ANS: D

A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. The patient should assume the M or V position. b. Her legs should be farther apart. c. The head of the table should be elevated. d. The lithotomy position with obstetric stirrups should be used.

26. What accommodations should be used for the position of a hearing-impaired woman for a pelvic examination?

ANS: C

The woman with a hearing impairment will need to see the clinician and/or an interpreter during the examination; therefore, her head should be elevated.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

27. Asking the woman to close the introitus during a pelvic examination is a test for: a. endometriosis. b. rectocele. c. cervical polyps. d. sphincter tone.

ANS: D

The test for sphincter tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can b e inspected without squeezing.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

28. Itchy, painful, small red vesicles are typical of: a. condyloma acuminatum. b. condyloma latum. c. herpes simplex lesions. d. syphilitic chancre.

ANS: C

Herpetic lesions are painful, itchy red vesicles; condyloma acuminatum are warty lesions on the genitalia; condyloma latum are secondary syphilis lesions that appear as flat, round, or oval papules covered by a gray exudate; and a chancre is a painless ulcer.

DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis

MSC: Physiologic Integrity: Physiologic Adaptation

29. A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria and no vaginal discharge or odor. A pelvic examination is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action i s to: a. swab for gonococcal infection and then dip her urine. b. obtain a surgical consult immediately. c. remove the foreign body. d. dip her urine and then swab for Chlamydia.

ANS: B

The presenting symptoms of a tubal pregnancy are a surgical emergency. The only diagnostic test should be a pregnancy test.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

Multiple Choice

1. While examining an 18-year-old man, you note that his penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be: a. within normal limits. b. suggestive of a skin fungus. c. suggestive of psoriasis. d. caused by excessive progesterone.

ANS: A

Darker pigmentation on the penis and testicles, as compared with other body skin, is a normal finding and is not suggestive of a skin fungus, psoriasis, or excessive progesterone.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

2. In an uncircumcised male, retraction of the foreskin may reveal a cheesy white substance. This is usually: a. evidence of a fungal infection. b. a collection of sebaceous material. c. indicative of penile carcinoma. d. suggestive of diabetes.

ANS: B

In the uncircumcised male, smegma is formed by the secretion of sebaceous material by the glans and the desquamation of epithelial cells from the prepuce. It appears as a cheesy white substance on the glans and in the fornix of the foreskin. Smegma lubricates the cavity between the foreskin of the penis and the glans, allowing smooth movement between them during intercourse. It is not usually evidence of a fungal infection, penile carcinoma, or diabetes.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

3. Inspection of the scrotum should reveal: a. lightly pigmented skin. b. two testes per sac. c. smooth scrotal sacs. d. the left scrotal sac lower than the right.

ANS: D

The left cord is longer than the right; consequently, the left testis hangs somewhat lower. The skin of the scrotum is more darkly pigmented. The scrotum has one testis per sac. The scrotum has small epidermoid cysts that give it a lumpy appearance.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

4. Expected genitalia changes that occur as men age include that: a. the ejaculatory volume decreases with age. b. erections develop more quickly. c. the viability of sperm increases. d. the scrotum becomes more pendulous.

ANS: D

Ejaculatory volume increases with age, erections develop more slowly, sperm viability decreases, and the scrotum becomes more pendulous with age.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

5. Inspection of the male urethral orifice requires the examiner to: a. ask the patient to bear down. b. insert a small urethral speculum. c. press the glans between the thumb and forefinger. d. transilluminate the penile shaft.

ANS: C

Inspection of the urethral orifice is accomplished by pressing the glans between the e a i e h b a d f efi ge . Thi a e e e he li like ifice for further inspection.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

6. You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should: a. chart the finding as paraphimosis. b. inquire about previous penile infections. c. retract the foreskin firmly. d. transilluminate the glans.

ANS: B

This condition is phimosis and is usually congenital, or it may be related to recurrent infections or poorly controlled diabetes. You should not chart this finding as paraphimosis. Retracting the foreskin forcibly would lead to further adhesion formation and worsening phimosis. Transillumination is indicated for masses of the scrotum.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Umbilical b. Direct c. Indirect d. Femoral

7. Which type of hernia lies within the inguinal canal?

ANS: C

Hernias found within the inguinal canal are called indirect hernias.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Adhesions of the foreskin b. Continuous penile erection c. Lumps in the scrotal skin d. Venous dilation in the spermatic cord

8. Which condition is of minor consequence in an adult male?

ANS: C

Lumps in the scrotal skin are related to numerous sebaceous cysts and are within normal limits.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

9. Mr. L has an unusually thick scrotum, with edema and pitting. He has a history of cardiac problems. The appearance of his scrotum is most likely a(n): a. congenital defect that has worsened. b. indication of general fluid retention. c. normal consequence of aging. d. complication of the development of mumps.

ANS: B

General fluid retention can cause scrotal thickening and pitting edema, and is usually seen as a result of cardiac, renal, or hepatic disease. This swelling does not imply a condition of the genitalia, but rather a condition of these related systems.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

10. A characteristic related to syphilis or diabetic neuropathy is testicular: a. dropping, with asymmetry. b. enlargement. c. insensitivity to painful stimulation. d. recession into the abdomen.

ANS: C

Diabetic neuropathy or syphilis can cause a marked reduction of tactile perceptions. Asymmetry is a normal finding; enlargement and recession are not related to diabetes or syphilis.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

11. On palpation, a normal vas deferens should feel: a. beaded. b. smooth. c. ridged. d. spongy.

ANS: B

The vas deferens should feel smooth and discrete as it is palpated from the testicle to the inguinal ring. A beaded or lumpy vas deferens might indicate diabetes or the presence of old inflammatory changes.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

12. A e a e i fa c ill a ea : a. bifid. b. loose. c. ridged. d. smooth.

ANS: D

The premature male scrotum will appear underdeveloped, smooth, without rugae, and without testes; the full-term infant should have a loose, pendulous scrotum, with rugae and a midline raphe.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

13. An enlarged painless testicle in an adolescent or adult male may indicate: a. epididymitis. b. testicular torsion. c. a tumor. d. an undescended testicle.

ANS: C

A hard, enlarged, painless testicle can indicate a tumor in the adolescent or adult male. Epididymitis and torsion are painful; an undescended testicle is common in infants and is usually resolved by 12 months.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

14. You palpate a soft, slightly tender mass in the right scrotum of an adult male. You attempt to reduce the size of the mass, and there is no change in the mass size. Your next assessment maneuver is to: a. use two fingers to attempt to reduce the mass. b. palpate the left scrotum simultaneously. c. lift the right testicle and then compare pain level. d. transilluminate the mass.

ANS: D

A soft mass is a hernia or hydrocele. If the mass can be reduced, it is probably a hernia; a nonreducible mass should be transilluminated to determine whether it contains fluid and is possibly caused by a hydrocele. Lifting the scrotum should be done when epididymitis is suspected.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

15. The most common cancer in young men ages 15 to 30 years is: a. testicular. b. penile. c. prostate. d. anal.

ANS: A

Because testicular tumors are the most common cancer occurring in young adults, self-examination is encouraged.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

16. The most emergent cause of testicular pain in a young male is: a. testicular torsion. b. epididymitis. c. tumor. d. hydrocele.

ANS: A

Testicular torsion is a surgical emergency. If surgery is performed within 12 hours after the onset of symptoms, the testis can be saved in about 90% of cases. Delayed treatment results in a much lower salvage rate.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

17. An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria or fever. Your priority action should be to: a. obtain urine and DNA probe urethral samples. b. lift the left scrotum to confirm epididymitis. c. establish absent cremasteric reflex. d. transilluminate the left and right scrotum.

ANS: C

The patient is displaying symptoms of testicular torsion. An absent cremasteric reflex is a supporting finding to differentiate torsion from epididymitis.

DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process diagnosis

MSC: Physiologic Integrity: Basic Care and Comfort

18. The most common type of hernia occurring in young males is: a. hiatal. b. incarcerated femoral. c. indirect inguinal. d. umbilical.

ANS: C

The most common type of hernia in children and young males is an indirect inguinal hernia.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

19. Difficulty replacing the retracted foreskin of the penis to its normal position is called: a. paraphimosis. b. Peyronie disease. c. phimosis. d. priapism.

ANS: A

Paraphimosis refers to the inability to replace the foreskin to its original position after it has been retracted behind the glans.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Condyloma acuminatum b. Molluscum contagiosum c. Herpetic lesions d. Lymphogranuloma venereum

20. Which genital virus infection is known to have a latent phase followed by the production of viral DNA capsids and particles?

ANS: A

Condyloma acuminatum (genital warts) are soft, reddish lesions commonly present on the prepuce, glans penis, and shaft. These lesions can undergo latency, followed by viral DNA capsids and particles, which are produced in the host cells.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

21. Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably: a. herpetic lesions. b. condylomata. c. molluscum contagiosum. d. chancres.

ANS: C

Smooth, dome-shaped lesions with an umbilicated center of a pearly gray color are indicative of molluscum contagiosum.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

22. A 12-year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not painful on palpation. The left inguinal canal is without masses. The mass transilluminates with a penlight. This collection of symptoms is consistent with: a. orchitis. b. a hydrocele. c. a rectocele. d. a scrotal hernia.

ANS: B

A hydrocele is a soft scrotal mass that occurs as a result of fluid accumulation and therefore transilluminates. Orchitis results in a swollen, tender testis. A rectocele does not result in scrotal swelling. A scrotal hernia would also be palpable along the inguinal canal.

DIF: Cognitive Level: Analyzing (Analysis)

MSC: Physiologic Integrity: Physiologic Adaptation

OBJ: Nursing process diagnosis a. Cystitis b. Epididymitis c. Orchitis d. Paraphimosis

23. Which condition is a complication of mumps in the adolescent or adult?

ANS: C

Orchitis is uncommon unless seen as a complication of mumps in the adolescent or adult.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

24. Parents of a 6-year-old boy should be asked if he has: a. erections. b. nocturnal emissions. c. rapid detumescence. d. scrotal swelling.

ANS: D

Scrotal swelling, especially with crying or with bowel movements, signals the presence of a hernia. The questions about erections and rapid detumescence are for the older male. The question about nocturnal emissions is asked of adolescents.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

25. The male with Peyronie disease will usually complain of: a. painful, inflamed testicles. b. deviation of the penis during erection. c. lack of sexual interest. d. painful lesions of the penis.

ANS: B

Peyronie disease is characterized by a fibrous band in the corpus cavernous. It results in unilateral deviation of the penis during erection.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

26. A cremasteric reflex should result in: a. testicular and scrotal rise on the stroked side. b. penile deviation to the left side. c. bilateral elevation of the scrotum. d. immediate erection of the penis.

ANS: A

On stroking the inner thigh with a blunt instrument or finger, the testicle and scrotum should rise on the stroked side.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

Chapter 21: Anus, Rectum, and Prostate

Multiple Choice

1. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. Which sign would indicate to the healthcare provider that she has a closed anal passageway?

a. Development of a scaphoid abdomen b. Vomiting after her first feeding c. Bleeding from the rectum d. Failure to pass meconium stool

ANS: D

Failure to pass meconium stool indicates that a newborn has an imperforate anus.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Median lobe b. Posterior c. Superior d. Anterior

2. In males, which surface of the prostate gland is accessible by digital examination?

ANS: B

The posterior surface of the prostate gland lies close to the anterior wall of the rectum and is palpable through digital rectal examination.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

3. The prostatic sulcus: a. divides the right and left lateral lobes. b. is the site of the seminal vesicle emergence. c. refers to the anterior aspect of the prostate. d. secretes clear viscous mucus.

ANS: A

The prostatic sulcus divides the two lateral lobes and is palpated as a shallow groove.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

4. The rectal past medical history of all patients should include inquiry about: a. bowel habits. b. dietary habits. c. hemorrhoid surgery. d. laxative use.

ANS: C

Past medical history should include inquiry about hemorrhoids, spinal cord injury, benign prostatic hypertrophy (BPH), prostate, colorectal, breast, ovarian, or endometrial cancers, and episiotomies of fourth-degree lacerations during delivery. Habits are part of the personal and social history; the use of laxatives is part of the history of the present illness.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

5. The effects of aging on the gastrointestinal system lead to more frequent experiences of: a. constipation. b. prolonged satiety. c. diarrhea. d. prostate glandular atrophy.

ANS: A

Older adults experience an elevated pressure threshold for the sensation of rectal distention and are therefore susceptible to constipation. They also experience early satiety, fecal incontinence, and prostate glandular hypertrophy.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

6. Factors associated with increased risk of prostate cancer include: a. African descent. b. cigarette smoking. c. a low-fat diet. d. alcoholism.

ANS: A

The incidence rate of prostate cancer is 50% higher for African American men compared with white American men. African American men also have a higher mortality rate.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

7. The caliber of the urinary stream is routine information in the history of: a. adolescents. b. infants. c. older adults. d. sexually active young men.

ANS: C

Routine questions about the caliber of the urinary stream and dribbling are directed toward older men because hypertrophy of the prostate gradually impedes urine flow.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

8. Equipment for examination of the anus, rectum, and prostate routinely includes gloves and: a. a hand mirror and gauze. b. a lubricant and penlight. c. slides and normal saline. d. swabs and culture medium.

ANS: B

Equipment for the examination includes a penlight, lubricating jelly, gloves, and fecal occult blood testing materials.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. High-fiber diet b. Diet low in animal fats and proteins c. Irish descent d. Inherited BRAC2 mutation

9. Which is a risk factor for colorectal cancer?

ANS: D

History of intestinal polyps is considered a risk factor for colorectal cancer, as are diets low in fiber and high in animal fats and an ethnic background of Ashkenazi Jewish descent.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

10. Nodules found in the peritoneum through the anterior rectal wall: a. are found with bidigital palpation. b. are called shelf lesions. c. are chronic fibrosis. d. are found by having the patient bear down.

ANS: B

Because the anterior rectal wall is in contact with the peritoneum, you may be able to detect the tenderness of peritoneal inflammation and the nodularity of peritoneal metastasis. The nodules called shelf lesions are palpable just above the prostate in males and in the cul-de-sac of females.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

11. Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience: a. bulging and wrinkling. b. constipation and pallor. c. diarrhea and redness. d. tenderness and inflammation.

ANS: D

Tenderness and inflammation to the perianal area may be related to an abscess, fistula, fissure, pilonidal cyst, or pruritus ani.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

12. Palpation of the anal ring is done by: a. bidigital palpation with the thumbs. b. inserting the smallest finger into the anus. c. pressing a gauze pad over the anus. d. rotation of the forefinger inside the anus.

ANS: D

The anal muscular ring is palpated by rotating the examination finger.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

13. The posterior surface of the prostate can be located by palpation of the: a. anal canal and perineum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum.

ANS: B

Palpation of the rectal anterior wall facilitates posterior prostate location.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

14. The cervix may be palpated through the: a. anterior rectal wall. b. internal umbilical wall. c. lateral urethral meatus. d. posterior uterine surface.

ANS: A

In women, the cervix can be palpated through the anterior rectal wall. It feels like a small, round mass.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

15. Yo r pa ien chief complain i repea ed, pencil-like stools. Further examination should include: a. a stool culture. b. parasite testing. c. a digital rectal examination (DRE). d. a prostate examination.

ANS: C

Persistent pencil-shaped stools are indicative of stenosis from scarring or pressure from a mass. DRE should be performed to assess for a mass.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

16. Very light tan or gray stools may indicate: a. upper gastrointestinal bleeding. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis.

ANS: B

Very light tan or gray stools suggest obstructive jaundice.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

17. Tarry black stools should make you suspect: a. internal hemorrhoids. b. rectal fistula. c. upper intestinal tract bleeding. d. prostatic cancer.

ANS: C

Upper intestinal tract bleeding results in tarry black stools.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

18. Prostate-specific antigen (PSA) screening is controversial because: a. there are many false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. no data have proved that it decreases mortality.

ANS: D

There are no data confirming that PSA screening decreases mortality from prostate cancer.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Perirectal redness b. Shrunken buttocks c. Rectal prolapse d. Dimpling in the pilonidal area

19. Which finding in an infant may indicate lower spinal deformities?

ANS: D

Sinuses, tufts of hair, and dimpling in the pilonidal area may indicate lower spinal deformities such as a pilonidal cyst.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Lack of an anal wink b. Rectal prolapse c. Anal fistula d. Small flaps of anal skin

20. A lower spinal cord lesion may be indicated by which finding?

ANS: A

Lightly touching the anal opening of an infant should produce a contraction referred to as an anal wink. A negative wink may indicate a lower spinal cord lesion.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

21. Pinworms and Candida may both cause: a. constipation. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion.

ANS: C

Pinworms and Candida both cause perirectal irritation and itching.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

22. Thrombosed hemorrhoids are: a. flabby skin sacs. b. red, inflamed, and painful. c. fluctuant soft papules. d. blue, shiny, painful masses.

ANS: D

Thrombosed hemorrhoids appear as blue shiny masses at the anus; they contain clotted blood and are edematous and painful.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

23. Palpation of a normal prostate in an older adult is likely to feel: a. cool. b. grainy. c. polypoid. d. rubbery.

ANS: D

Older men are more likely to experience prostate hypertrophy, which when palpated feels smooth, rubbery, and symmetric.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

24. Mr. Dunn is a 62-year-old man who has presented for a routine annual examination. On examination of the prostate you note a hard, irregular, painless nodule and obliteration of the median sulcus. These are signs of: a. benign prostatic hypertrophy. b. cancer of the prostate. c. long-standing prostatitis. d. swelling as a result of aging.

ANS: B

Obliteration of the median sulcus is consistent with organ enlargement; however, the associated findings of a hard, irregular, and painless nodule indicate a cancerous growth.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

25. The mother brings her 4-year-old to the clinic because the child complains of perianal itching. As part of your examination you complete a cellulose tape test. The cellulose tape test is used for the detection of: a. enterobiasis. b. carcinoma. c. amebiasis. d. steatorrhea.

ANS: A

Enterobiasis (pinworm infestation) is detected by the cellulose tape test. Pinworms are collected by applying tape to the perianal folds and then pressing the tape on a glass slide.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

Multiple Response

1. Mr. Sweeney is a 58-year-old man who has presented for a routine annual prostate examination. On examination, you note a normal prostate gland. Which of the following characteristics should describe the normal prostate? (Select all that apply.)

a. Rubbery consistency b. About 4 cm in diameter c. Fluctuant softness d. Gland protruding 1 cm into the rectum e. Firm, smooth, and slightly movable

ANS: B, D, E

The gland should feel like a pencil eraser, firm, smooth, and slightly movable and should be nontender. It has a diameter of 4 cm, with a 1-cm protrusion into the rectum.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

Chapter 22: Musculoskeletal System

Multiple Choice

1. The type of joint that has the widest range of motion in all planes is the: a. ball-and-socket. b. condyloid. c. gliding. d. saddle.

ANS: A

The ball-and-socket joint is the joint that has the widest range of motion (e.g., the hip joint). A condyloid joint may only move in two planes. A gliding joint is only able to glide. A saddle joint has no axial rotation.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

2. Spinal vertebrae are separated from each other by: a. bursae. b. tendons. c. disks. d. ligaments.

ANS: C

Except for sacral vertebrae, the spinal vertebrae are separated from one another by disks. Spinal movement is achieved by paraspinous muscles, tendons, and ligaments. Bursae are located in the knee, elbow, shoulder, and hip.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

3. The joint where the humerus, radius, and ulna articulate is the: a. wrist. b. elbow. c. shoulder. d. clavicle.

ANS: B

The elbow is the site where the humerus, radius, and ulna meet. The wrist is made up of the radius and the carpal bones of the hand. The shoulder is made up of the humerus and scapula. The clavicle connects to the scapula but not to the humerus.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

4. The articulation of the radius and carpal bones is the: a. wrist. b. elbow. c. shoulder. d. clavicle.

ANS: A

The joint comprising the radius and carpal bones is called the wrist.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

5. The tibia, fibula, and talus articulate to form the: a. ankle. b. knee. c. hip. d. pelvis.

ANS: A

The tibia, fibula, and talus (or heel) join to form the ankle.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

6. Long bones in children have growth plates known as: a. epiphyses. b. epicondyles. c. synovium. d. fossae.

ANS: A

Epiphyses are the growth plates found in long bones in children.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

7. The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are the result of: a. decreased mineral deposition. b. increased hormone secretion. c. uterine enlargement. d. gait changes.

ANS: B

Increased hormone secretion during pregnancy is responsible for the elasticity of pelvic ligaments and softening of the cartilage. These changes help accommodate the growing fetus.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

8. Skeletal changes in older adults are the result of: a. increased bone deposition. b. increased bone resorption. c. decreased bone deposition. d. decreased bone resorption.

ANS: B

With age, the skeletal system changes. One of the dramatic changes in skeletal equilibrium is that bone resorption dominates bone deposition.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

9. The family history for a patient with joint pain should include information about siblings with: a. trauma to the skeletal system. b. chronic atopic dermatitis. c. genetic disorders. d. obesity.

ANS: C

An important history to obtain for a patient with joint pain would be family history of genetic disorders, such as osteogenesis imperfecta, dwarfing syndrome, rickets, hypophosphatemia, and hypercalciuria.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

10. Risk factors for sports-related injuries include: a. competing in colder climates. b. previous fracture. c. history of recent weight loss. d. failure to warm up before activity.

ANS: D

Failure to warm up before exercise is one risk factor for sports-related injuries. Climate, previous fractures, and weight loss are not as strong risk factors for sports -related injuries.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

11. Light skin and thin body habitus are risk factors for: a. rheumatoid arthritis. b. osteoarthritis. c. congenital bony defects. d. osteoporosis.

ANS: D

People with light skin and a thin body frame are at greater risk for developing osteoporosis. Rheumatoid arthritis, osteoarthritis, and bony defects are not found to have a correlation with light skin and small frame.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

12. Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of: a. adolescents. b. infants. c. older adults. d. middle-age adults.

ANS: C

History taking of older adults should consist of symptoms of nocturnal muscle spasms. Pregnant women and older adults commonly experience nocturnal leg cramps resulting from imbalances of fluids, hormones, minerals, or electrolytes or dehydration. A particular concern with the older adults is that this may be a sign of intermittent claudication.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

13. The musculoskeletal examination should begin when: a. the patient enters the examination room. b. during the collection of subjective data. c. when height is measured. d. when joint mobility is assessed.

ANS: A

When the patient first walks in the room, the examiner should be observing his or her gait and posture as part of the musculoskeletal examination.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

14. Fa cic la i cc af e i j a m cle : a. venous return. b. motor neuron. c. strength. d. tendon.

ANS: B

Fasciculations can often be visualized as muscle twitching or dimpling under the skin, but they usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

15. The physical assessment technique most frequently used to assess joint symmetry is: a. inspection. b. palpation. c. percussion. d. the use of joint calipers.

ANS: A

The assessment technique most commonly used to assess joint symmetry is inspection.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

16. A goniometer is used to assess: a. bone maturity. b. joint proportions. c. range of motion. d. muscle strength.

ANS: C

The angle of a joint can be accurately measured by using a goniometer. A goniometer is used when the joint range of motion is beyond normal limits.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

17. When palpating joints, crepitus may occur when: a. irregular bony surfaces rub together. b. supporting muscles are excessively spastic. c. joints are excessively lax. d. there is excess fluid within the synovial membrane.

ANS: A

Crepitus is felt or heard when irregular bony surfaces rub together.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

18. The temporomandibular joint is palpated: a. under the mandible, anterior to the sternocleidomastoid muscle. b. above the mandible at midline. c. anterior to the tragus. d. at the mastoid process.

ANS: C

The temporomandibular joint is palpated just anterior to the tragus of the ear; the fingertips are placed inside the joint space as the patient opens and closes the mouth.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

19. The temporalis and masseter muscles are evaluated by: a. having the patient shrug his or her shoulders. b. having the patient clench his or her teeth. c. asking the patient to fully extend his or her neck. d. a i el e i g he a ie ja .

ANS: B

Having the patient to bite down and clench their teeth is the method for evaluating the strength of the temporalis and masseter muscles. Cranial nerve V is tested with this same maneuver.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

20. The strength of the trapezius muscle is evaluated by having the patient: a. clench his or her teeth during muscle palpation. b. h hi he head agai he e ami e ha d. c. straighten his or her leg with examiner opposition. d. uncross his or her legs with examiner resistance.

ANS: B

Having the patient apply opposite force with differing head motions, against the exami e hand, assesses the sternocleidomastoid and trapezius muscles.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

21. Expected normal findings during the inspection of spinal alignment include: a. asymmetric skin folds at the neck. b. slight right-sided scapular elevation. c. concave lumbar curve. d. the head positioned superiorly to the gluteal cleft.

ANS: D

S i al alig me i c ide ed i hi mal limi he he a ie head i i i ed directly over the gluteal cleft. The skin folds should be symmetric, the scapulae are at even heights, and both the cervical and lumbar curves are convex.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

22. A common finding in markedly obese patients and pregnant women is: a. kyphosis. b. lordosis. c. paraphimosis. d. scoliosis.

ANS: B

Bowing of the back, or lordosis, is more commonly found in pregnant women or obese patients because of an altered center of gravity. Kyphosis is more commonly seen in older adults. Paraphimosis is a penile condition. Scoliosis is more commonly seen in teenagers.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

23. A wheelchair-dependent older woman would most likely develop skin breakdown at: a. C7. b. the iliac crests. c. L4. d. the gibbus.

ANS: D

This older woman, most likely kyphotic from osteoporosis, would have the greatest friction point at the gibbus. The gibbus results from collapsed vertebrae, resulting in a sharp, pointy deformity of the back. C7 and L4 remain as concave curves, with less friction. The iliac crests would not protrude as far as the gibbus.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. Prominent lumbar hump b. Prominent cervical concave curve c. Lateral curvature of the spine d. Restricted ability to flex at the hips

24. When the patient flexes forward at the waist, which spinal observation would lead you to suspect scoliosis?

ANS: C

Scoliosis is suspected when there is a noticeable lateral curvature of the spine, or rib hump, as the patient bends forward at the waist.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

25. When a patient abducts an arm and the ipsilateral scapula becomes more prominent (winged), this usually means that: a. there has been an injury to the nerve of the anterior serratus muscle. b. one of the clavicles has been fractured. c. there is a unilateral trapezius muscle separation. d. one shoulder is dislocated.

ANS: A

If the long thoracic nerve is damaged or bruised, it can cause paralysis of the serratus anterior muscle and winging of the scapula, or shoulder blade. This is not a symptom of a fractured clavicle or trapezius muscle separation. A dislocated shoulder would result in a hollowing effect.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

26. When the shoulder contour is asymmetric and one shoulder has hollows in the rounding contour, you would suspect: a. kyphosis. b. fractured scapula. c. a dislocated shoulder. d. muscle wasting.

ANS: C

Asymmetric contours to the shoulder with a hollowing in the socket are symptoms of a shoulder dislocation. Kyphosis is a condition of the back; muscle wasting and a scapular fracture do not present with these symptoms.

DIF: Cognitive Level: Applying (Application)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

27. Ulnar deviation and swan neck deformities are characteristics of: a. rheumatoid arthritis. b. osteoarthritis. c. osteoporosis. d. congenital defects.

ANS: A

Deviation of the fingers toward the ulnar side and swan neck deformities are classic symptoms of rheumatoid arthritis. Osteoarthritis, congenital defects, and osteoporosis do not present with these symptoms.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

28. A finding that is indicative of osteoarthritis is (are): a. swan neck deformities. b. Bouchard nodes. c. ganglions. d. Heberden nodes.

ANS: D

Heberden nodes are bony overgrowths of the distal end of the fingers and are associated with osteoarthritis. When the overgrowths are concentrated in the proximal interphalangeal joint, they are known as Bouchard nodes and are associated with rheumatoid arthritis, as are swan neck deformities; ganglions are present in nerve conditions.

DIF: Cognitive Level: Remembering (Knowledge)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

29. Carpal tunnel syndrome would result in: a. a negative Tinel sign. b. a negative Phalen test. c. reduced abduction of the thumb. d. palm tingling.

ANS: C

Median nerve compression, as in carpal tunnel syndrome, results in a positive Tinel sign, positive Phalen test, reduced abduction of the thumb, and sparing of palm tingling.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation

Multiple Response

1. Cardinal signs for rheumatoid disorders include which of the following? (Select all that apply.)

a. Gradual onset b. Weakness that is usually localized and not severe c. Coarse crepitus on motion d. Joint tenderness e. Sleep disturbance

ANS: A, D, E

Hallmark signs of rheumatoid arthritis are gradual onset of stiffness for 1 hour after rising, sleep disturbance, joint tenderness, and medium to fine crepitus.

DIF: Cognitive Level: Analyzing (Analysis)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation a. eversion and inversion. b. proximal radius and ulna articulation. c. flexion and extension d. adduction and abduction.

2. The wrist moves in: (Select all that apply.)

ANS: C, D

The wrist movement is in two planes, flexion and extension or radial and ulnar rotation. Adduction and abduction are for shoulder and hip joints, and eversion and inversion are for ankle movement.

DIF: Cognitive Level: Understanding (Comprehension)

OBJ: Nursing process assessment MSC: Physiologic Integrity: Physiologic Adaptation